Now that health care reform is once again an active, visible issue in state governments and the presidential campaigns, the ideas are flying fast and furious. Predictably, some ideas are better than others.
Over at Health Care Policy and Marketplace Review, Bob Laszewski asks an important, practical but vexing question for universal coverage advocates: Can you really mandate people to buy health insurance?
In a great article called The Fallacy of Excellence my old boss and friend Ian Morrison explains what we intuitively know. people don’t understand that more care is not better care. This is going to lead to lots of political problems as we get to righting the Wennberg-illuminated wrongs.
On the other hand, Ian’s lifetime membership in the Paisley Fabian Society will probably be revoked when they find out he’s been watching the Republican candidates debate…..
Here’s one international comparison I’d missed when it originally. The US has fallen to last place amongst 24 developed nations in an index of preventable death–one presumably cooked up by a Marxist cell masquerading behind a front organization called the London School of Hygiene and Tropical Medicine and funded by that cabal of Trotskyites known as the Commonwealth Fund. We’ve fallen four places since last time and are now even behind the Brits & the Irish—who I’ve always thought encouraged preventable death.
What’s happened is that every other nation showed significantly better measures relatively quickly (over a 5 year period to the early 2000s) and the US didn’t improve much at all.Who came top? Yes, those darn French again.
And their President is shagging a super-model. It makes me long for the days of JFK and Marilyn Monroe.
For everyone who’s been going on about our (adopt Dr Evil voice) 2 Trillion Dollar health care industry, it’s now official. The 2006 data is out and we’re at 16% of GDP, $2.1 trillion and $7,000 and change per head. Growth, somewhere at the bottom of the trough, is around 6.5%. That’s nominal not real of course, but it’s still way over the economy’s growth rate, and that gap will grow if/when a recession hits.
The major change of course was the introduction in 2006 of Medicare Part D which mean that drug spending increased at over 8.5%. But then again, they’re telling us that Part D was less than originally projected. Although I bet you no one in CMS (or now out of it) will tell you what really was originally projected, and in fact which of the many revised projections the $41 Billion costs of Part D was really below!
And of course assuming that cost increases were stable in 2007, we’re actually already at 2.1 trillion + 6%, or 22.35 trillion!
This podcast I did with Michael O’Neil who is the founder of GetWellNetwork. Michael had an episode of cancer relatively early in his adult life and although he was the recipient of great medical care from one of our nation’s leading academic medical centers, he was also very upset about the quality of the in-room patient experience. The result is a new system of using the TV to improve patient care in hospitals. You can hear much more in the interview.
On a technical note: this interview was conducted in the middle of a significant California winter storm, so there will be occasional tricky patch. Thanks for your patience and thanks to Michael too for his.
Long time THCB friend Steve Beller tells me this:
We’ve created a Comparative Analysis of Presidential Health Care Plans, which analyzes much of the details of Susan Blumenthal’s and Kaisers’ work in order to identify top candidates based on voters’ wants and needs. We’ve taken a unique approach in which the complex details are distilled into categories of strategies that simplify comparisons between the candidates, and we’ve included comments on the key factors (with several quotes from Maggie Mahar’s blog and input from Barry Carol). It then groups the candidates on whether they propose universal healthcare, and it ranks them by the amount of attention they give to quality improvement and cost control. Then it matches the candidates to 18 types of consumers, which take into account their current insurance and health situation, their income level, and their support of good care for all.
Here’s the link.
Take a look and feel free of course to give your comments to Steve over on his blog or here.
Meanwhile as major bloggers are dropping like flies from the stress, (get soon well Om!), I feel good about the fact that I took the weekend off to go snow-boarding in some of the best powder the Sierras has seen in a while. And that’ll be all from me today!
I am writing this blog from Cedar Rapids, Iowa, grateful that the
temperature has warmed from brutally
cold to pleasantly sub-freezing.
Fortunately, the warm feelings left by the extraordinary victory of
Sen. Barack Obama, the candidate for whom I was knocking on doors and
making phone calls these last few days, has trumped the temperatures.
Talking to real voters in the suburbs and rural areas surrounding this
small city provides a nice change from the insular health care policy
world. For one thing, it reminds you that most people don’t care about
“policy,” per se, of any kind. Successful candidates connect first with
the heart and then the head. We instinctively believe that if we trust
a candidate’s values and broad beliefs, we will trust that candidate’s
detailed policy decisions.
Yet the sad reality is that a vast number of citizens won’t even make
that small emotional investment, and they don’t hesitate to proclaim
their apathy when you knock on the door or call. As much as you may
have heard about voters disenfranchised from the Iowa caucuses,
many more simply didn’t care enough to participate. That, alas, makes
Iowa quite representative of the nation as a whole. While Democratic
turnout at this year’s caucuses was double that of four years ago, that
merely turned a “tiny” slice of registered voters into a “small” one.
Susan Blumenthal, M.D. has updated her exhaustive (and exhausting) list of the Presidential candidates’ health care proposals You’ll find the Side-by-Side Comparisons on the The Huffington Post
I’m up over at Spot-on discussing why the opinion of 32 corn farmers in Iowa may not matter quite as much for health insurance as what’s going on in my fair state. The piece is called: A Californian Crystal Ball.
As ever come back here to comment.
Pretty much anyone interested in U.S. politics is focused today on
what 32 corn farmers in the middle of the country have to say about the
20-some people currently hoping to run the world by becoming President
of the United States.And while health care concerns have figured in many of the
conversations the U.S. political press has had – or overheard – with
Iowa Caucus voters, it’s been a wild holiday season for California’s
health care system. The impact on what type of health care reform
legislation will eventually come to national attention is probably just
as great.On Christmas Eve a California appeals court unanimously decided that
the way insurers have been practicing in the state for many years is illegal.
The case involving retroactive cancellation of policies was one that
the nice well-behaved non-profit California Blue Shield had fought in
the courts while its aggressive for-profit competitor, Wellpoint’s Blue
Cross unit, had settled.Blue Shield maintained it had the right to retroactively cancel
those insurance policies for which it says that policy-holders had lied
on their applications. At first the series of stories, which started coming out last year and ended up making an appearance in Michael Moore’s Sicko,
seemed cut and dried. People who’d received expensive care were having
their insurance canceled for pre-existing conditions that they’d either
clearly disclosed on their applications, or couldn’t possibly have been
expected to remember. Meanwhile the behavior of the health plans was
shown to be particularly cynical, with one, HealthNet, actually paying out bonuses to staff doing "recissions" based on how many expensive policy holders they kicked off their rolls.Continue reading this post o ver at Spot On.com
Frequent THCB contributor Maggie Mahar did a little detective work on the Office of Human Research Protection’s (OHRP) mysterious decision to suspend a trial designed to reduce medical errors by requiring that hospitals follow standardized safety and infection control procedures, a story that Atul Gawande wrote about over the weekend in an op-ed piece for the New York Times.
The logic behind the ruling – namely that patients should have been required to provide their express written consent before participating in a clinical trial, even one involving hospital staff and not some radical new experimental drug or treatment – struck Maggie as slightly, shall we say, strained. Particularly for an administration which boldly ran for office on a campaign platform of vanquishing bureaucratic incompetence and embracing scientific innovation. Maggie writes:
I read the letters that OHRP sent to Johns Hopkins and Michigan. They are dense with bureaucratic language, but make no sense whatsoever. So then I looked into OHRP and who runs it.Continue reading…
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