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POLICY: Try and reconcile these two basic statements

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The National Federation of Independent Business, which says it has 350,000 members with active lobbyists in 50 states, warned politicians and policy makers on Wednesday not to impose new health-benefit obligations on small employers. The group said in a statement of principles that “a health care system built on employer mandates or on pay-or-play taxes is unacceptable.”

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In its statement of principles the federation called for universal health care, with a government safety net to help the neediest obtain coverage. But it opposed proposals to place health care under an umbrella of Medicare-style “single payer” financing. Government safety nets should not be allowed to “crowd out private insurance and care,” the federation said.

Yup, it’s the math challenged folks at the NFIB staking out their territory–hating the current system, fraudulently demanding universal health care and opposed to any solution.

The incredible thing is that a single pool/social insurance system would be incredibly positive for small business—especially if based on progressive taxation. First, the number one impediment to people starting small businesses is job-lock due to fears over losing health insurance. Second, most small businesses don’t make that much money, so a social insurance scheme would only “hurt” the very few very wealthy small business people. Somehow that group manages to politically dominate the discourse at the NFIB—when they’re not shilling for the richest families in America, that is.

My real analysis of the NFIB was done over at Spot-on last year. It’s well worth a read as it spells out the math on why a universal health care system funded by progressive tax would be a godsend for most small businesses. But sadly they just can’t ideologically get their heads around it.

Health 2.0 Casting Call

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Media2_3We are excited to announce a new panel format at our Spring conference, “Connecting Consumers and Providers” in San Diego on March 3-4, 2008. In addition to spotlighting demos and reactions from industry experts, we will be capturing the user-experience of people living with health conditions as they use Health 2.0 technologies in their everyday lives.

Has the web changed your life? Does it help you deal with the isolation of a condition or improve your quality of life in some other way? We are looking for a few good consumers/patients to feature live on stage or in a video segment. Our roving video crew will be traveling the country to document interesting real-life stories showing how Health 2.0 impacts both people and the healthcare system.

Continue reading…

POLICY: Trading Places was right!

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Trading

Every so often I read an article that (I hope) confirms what we know is right. Remember “Trading
Places”? Dan Akroyd is stripped of his upper-class environment and fails. Eddy Murphy is plucked form the gutter and succeeds, and the experiment “proves” that it’s “nurture not nature.”

In this op-ed, All Brains Are the Same Color, psychology professor Richard Nisbett shows that IQ scores are remarkably influenced by the environment in which kids are brought up, and race has basically nothing to do with it. After he demonstrates that fairly conclusively, Nisbett gets to the punchline:

What do we know about the effects of environment?

That environment can markedly influence I.Q. is demonstrated by the so-called Flynn Effect. James Flynn, a philosopher and I.Q. researcher in New Zealand, has established that in the Western world as a whole, I.Q. increased markedly from 1947 to 2002. In the United States alone, it went up by 18 points. Our genes could not have changed enough over such a brief period to account for the shift; it must have been the result of powerful social factors. And if such factors could produce changes over time for the population as a whole, they could also produce big differences between subpopulations at any given time.

Continue reading…

HEALTH 2.0: Industry heavyweights meet in San Diego

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Dk130x72This meeting held by the Markle Foundation
near San Diego  over two days  last week may turn out to be
the most
important health information and technology policy meeting of the past
5 years.  So I’ll try to choose my words for this post very carefully.
If this increases the length somewhat, I apologize for that in advance.

Why was this meeting significant?  Simply put, the Health 2.0 community was involved. With Microsoft’s Peter Neupert, Google’s Missy Krasner, Adam Bosworth from Keas.com, Esther Dyson, Jamie Heywood from PatientsLIkeMe.com, Karen and Richard from Sophia’s Garden, and representatives from MinuteClinic, Wal-Mart, Intuit,  Dell, eClinicalWorks, and Intel
present and vocal, this meeting had a different, and to my mind more
open atmosphere than any other policy meeting I’ve attended.  It was
not dominated by entrenched large health care enterprises, such as the
academic hospitals, Kaiser, health plans,  the large IT vendors, and
the AMA.  In fact, those organizations were often on the defensive in
the conversation, because they are perceived by some as not making it
easy for consumers to get to the information they want and need.  In
fairness to these and other incumbent groups who were present, I
witnessed a new and a very welcome openness to discuss ways to get the
data into the hands of the consumer.

– Continue this post on the Health 2.0 Blog

JOB POST: Blue Cross and Blue Shield of Florida

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Become part of a progressive Medical Informatics team! We are redeveloping our analytic infrastructure and
are looking for high caliber individuals who think BIG, and think outside the box to enable our business to take care of our customers. Our team is building an integrated approach to analytics that thrives on technology, aligns with Actuarial methodologies, and informs the business through Six Sigma process design. Join our team and collaborate on creating new capabilities within an organization that is committed to the value of Informatics and how it informs our business and business partners.

We are determined to attain the next level of analytic sophistication in Medical Cost Analysis, Quality Outcomes Measurement, Process Measurement, and Provider Practice Pattern Evaluations to further enable our Medical Cost Management, Transparency, and Pay-for-Performance strategies. We are looking for your forward-thinking mindset and prefer advanced degrees (masters, PhD) in Statistics, Biostatistics, Epidemiology, Economics, Medical Informatics, Clinical Informatics, Actuarial Science, Healthcare Administration, Public Health, Business, and/or RN, MD, ASA, FSA Designations.

Please send your resume to jackie.biles@BCBSFL and include THCB Job Board in the subject of your email.

HEALTH PLANS: Bill McGuire–off the hook?

Bill McGuire Friday tried to put the options scandal behind him.

Don’t forget that he did (at least) two very questionable things before the scandal came to light. First he formally abandoned utilization review at United in 2001. That to me was a signal to employers and providers that health plans were giving up on trying to control the behavior of providers. So the way they were going to make money in the future was the old fashioned way—risk selection and adding a pass through chunk on top to what providers charged them—and sticking that to their end customer.

That failure of the managed care business to contain costs has directly led to more uninsured Americans. OK, so it wasn’t all their fault, but who’s picking up the slack? Yes, it’s the lower paid worker whose employer stopped providing insurance and the taxpayer who’s paying more for the people in government programs who previously would have had insurance at work. Had managed really worked to change health care, perhaps that wouldn’t have been the case.

But McGuire did fine despite that, of course. (And he’s paid much less tax personally than he would have done in the 1990s because of the way the Bush tax cuts were slanted to the super-rich). United instead did fine being an old fashioned risk-shifter.

Which leads to the second questionable thing. Buying Patrick looney Rooney’s company, Golden Rule—the insurer that made a living selling health insurance only to those who didn’t need it—for some $900 million. (And of course it was Rooney that pushed the MSA/HSA into the forefront of Republican policy).

Now in what looks like a desperate attempt to remain a free man, McGuire has given back a big chunk of the gains he got when he was backdating the options and pay a civil penalty to the SEC of $7m. Big to most of us, chicken-feed to him.

Of course the other people involved in option backdating in other companies are currently heading to court. The first two, from Brocade, have already been found guilty and are awaiting sentencing with a potential 20 years in the slammer. Other than United did well under McGuire and Brocade did badly, as a securities law neophyte I am struggling to tell the difference.

CODA: Funnily enough United’s current CEO has been making strange mea culpas about the company’s current customer service. Anyone who can figure that out should add their 2c in the comments. And United’s hometown paper the Minneapois Star Tribune had a long article Sunday detailing their "issues" with paying claims correctly over the years

POLITICS: Cohn on Obama; me on Cutler

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Jon Cohn’s TNR piece Mandate Overboard goes (in somewhat grueling detail) into a defense his estimate that a mandateless universal insurance plan will leave a substantial number uninsured. I’ll say it more simply.

Voluntary universal health insurance is a Harvard economist’s fantasy.

Obama’s campaign, meanwhile, is attacking Paul Krugman by showing that he said nice things about the Obama health plan before dissing it. But what Krugman’s been dissing is Obama coming out and attacking the mandates in Clinton and Edwards’ plan. Most of us thought that Obama was being late and careless when he introduced his plan (not to mention chose his adviser). Only when he started beating up Clinton on mandates did Krugman go after him.

Given that the majority of Democrats prefer single payer anyway I have no idea why Obama thinks this is good politics in the primaries (see the CODA). Although as I said in my Spot-on piece on Friday I think that he has no intention of introducing real health care reform in 2009 if he actually wins.

But then you get a Harvard economist saying this about mandates: “A better approach is to do everything possible to make it affordable and available. When it is, almost everyone will have it.”

I think by “it” he’s referring to health insurance and this is the same Harvard economist who thinks our current health care system provides “reasonable value”.

I am eagerly awaiting Cutler’s explanation of how he reconciles the “reasonable value” we are allegedly currently getting from the health care system with the presumably massive reduction in prices/costs of health care that’s going to be needed to make insurance “affordable”. I guess we’ll just be getting excellent value then!

CODA: By the way if you doubt that Democrats favor single payer then consider these two questions from the recent Gallup Poll:

"Do you think it’s the government’s responsibility to make sure that everyone in the United States has adequate health care, or don’t you think so?" 

84% of Democrats say yes. compared to 54% of independents and only 32% of Republicans

"Which of the following approaches for providing health care in the United States would you prefer: replacing the current health care system with a new government run health care system, or maintaining the current system based mostly on private health insurance.”

41%  say replace, 48% maintain.

This one isn’t broken down by party, but if you do the rough math it’s pretty damn clear that a sizable majority of Democrats prefer single payer, and apparently Stan Greenberg estimates that it’s the choice of 70% of primary voters. But as it doesn’t seem to impact their vote, I think that it’s not as important an issue as all that when compared to getting the Republicans out of the White House. Hence voting for war hero John Kerry and now the newly centrist Hillary Clinton and Barrack Obama.

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