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Tag: John Irvine

Is Trumpcare Dead?
Was It Ever Really Alive?

Senators Mike Lee and Jerry Moran said yesterday that they would not vote for the Better Care Reconciliation Act, effectively killing the legislation.  As anybody who has been following this story would have predicted, President Trump reacted publicly on Twitter on Tuesday morning, vowing to let the ACA marketplace collapse and then rewrite the plan later.

Senate Majority leader Mitch McConnell attempted a quick punt this morning, calling for an immediate Senate vote on the House bill, a trick card that if it worked, would give Republicans two years to work things out.

Unfortunately for McConnell, it probably won’t.

The White House sees the failure as saying more about the political establishment in Washington than itself, which shouldn’t be all that surprising. Caught up in the drama of the Watergate-Russia emails-Trump family narrative, major media outlets like the Washington Post and the New York Times see a historic defeat rather than a temporary setback. That may or may not turn out to be true. Predictably, conservative commentators and the alt-right believe the defeat says more about the mainstream media and the Deep State than it does about the Trump Presidency. For their part, Democrats clearly think they have found their issue and can be expected to continue to exploit it using legislative Viet Cong tactics (attack on social media, melt into the jungle, lob snarky public Molotov cocktails) to punish Republicans and keep the story on the front page.

One thing is clear. Instead of repealing and replacing Obamacare, the GOP now has to rewrite and replace its own plan. Doing that would be difficult under the best of circumstances, but in the current climate in Washington it is difficult to see how it would be possible without a major shift in the political landscape.

All of this is bad news for hospitals and health plans and a frightening development for consumers, although not the really bad news some had feared. The President’s threat to let the insurance marketplace die and then “figure it out” sounds good as a rallying cry to the troops on social media, but is not the kind of thing that investors and CEOs like to hear.  Realistically though, at this point everybody knew that the uncertainty would likely continue through the year (best case) or a year or longer (worst case) as the gridlock in Washington plays out. As depressing and frustrating as it is that the uncertainty will continue, by this point the industry is used to it. Insiders will continue to look for ways to minimize risk and for business opportunities to capitalize on the uncertainty.

Trump’s plan to allow the insurance exchanges to collapse is the kind of confrontational talk Trump and his advisors relish. In theory, the idea could work. There are in fact signs that it already is, as major insurers leave the marketplace and consumers hesitate before committing to expensive insurance policies.  In reality, however, the collapsing exchanges will create a political crisis that is even worse than the current one for the administration, with news cycle after news cycle dominated by stories of terminally ill cancer patients and parents with children with horrible diseases and no insurance coverage. At this point, it will be difficult for the party doing the collapsing to point at the other side and say “It was them. They did it!”

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After the American Health Care Act

DANIEL STONE, MD

The late UCLA Professor Richard Brown, once commented that the Clinton healthcare initiative failed because the status quo was everyone’s second choice. Some of that logic applies to today’s failure to vote on the AHCA. Additionally, no one ever lost money betting against the rollback of an established entitlement program.

The Republicans opponents of the ACA have not yet faced the fact that the reason coverage is so expensive is because the care is so expensive. You can’t have cheap insurance for expensive services. So, something “better and cheaper” was a never more than a slogan. That slogan showed the AHCA to be the bait and switch that it was.

Health insurance has evolved to serve two purposes; to protect against health related financial catastrophe and to finance care. The ACA, with its high deductibles does a better job with the former than the latter. (Although opponents give short shrift to the mitigation provided by the provision of preventive services without charge.) It will be hard to satisfy the diverse collection of stakeholders with anything much different.

This is another illustration of the fact that anything approaching universal coverage is challenging for the developed world’s outlier on healthcare cost. Medicare has around 15% lower costs than commercial plans. The only practical way out of the cost vs access quandary is to harness the commercial insurance overhead/waste/profit and direct it toward coverage.

So, to paraphrase Keynes, in the long run, we’re in both single payer and dead. It’s just a question of whether we’re all dead first or just some of us.

JOHNATHAN HALVORSON

My immediate reaction is that now they are going to nibble at the ACA for 4 years. I’d actually have preferred the House passed this monster of a bill, which the Senate would have rejected, and then had to answer for it in 2018.

Energy and Commerce committee is not going to rewrite the AHCA now and is instead turning to CHIP reauthorization (where they may sneak in ACA cuts) and exchange stabilization.

MICHAEL MILLENSON

I think Jonathan Chait’s piece in NY Magazine addresses a lot of the substantive issues very well, particularly noting high up the opposition of a broad array of conservative experts.

Let me comment briefly on a small political point. Trump issued an ultimatum asking for a vote, just like you’d do if you last paid attention to how Congress works during 8th-grade civics class. But, clearly, when it became clear they would lose, Trump Congressional allies who are more sophisticated explained to the White House why you didn’t want to expose GOP House members to casting a potentially toxic vote in a sure-to-lose cause, and so the president “requested” that the vote not be held; i.e., put the onus on himself, not Ryan.

Translation: Trump is learning how politics really works and is adjusting to reality. That will likely help him in the future.Continue reading…

Nominate a Speaker For TEDMED

Neeti writes:

I am on the 2016 TEDMED speaker review committee/research scholar i.e. I am among the group of people who will be reviewing potential speakers for this year’s event.

If you know someone (does not have to be an MD or PhD) who is doing great work in medicine, public health and policy or education (any aspect of healthcare including basic science research) and would be interested in giving such a talk, please nominate them here. It is a short form which needs their bio and pitch for a talk, also a speaking sample in public domain (i.e. YouTube or Vimeo) if available but not a necessity.

A little background about their nomination process: “There is no deadline to nominate a speaker, and we accept nominations year-round.  Typically, we consider about 10,000 nominations for about ~50 spots on our stage, and are nearly done with the speaker selection process for this year.  However, if we receive your nomination after we have completed the selection process, we will keep it in our database for future years.”

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Something Completely Different

The Endless Page of Scroll Is Dead .. If you’re an observant reader you may have noticed that things are looking a little different around here. That’s because we’ve “upgraded” the site to a new version of WordPress (WordPress 4.2), a new theme, a responsive new layout and made a lots of other changes that will be appearing in your browser in the near future.

The big thing: from now on you’ll need to be a registered user to comment. The good news is that registering is insanely, mindbogglingly easy.* Click on the register link at the top of the page and give us a user name and a working e-mail.

You’ll be able to join in the online discussion on the site, submit blog posts to the editors for consideration, win cool stuff like tickets to live events in your area, get invites to exclusive THCB meet ups and networking events, send our editors press releases and announcements (if that’s your thing) and do other really fun and productive things that we haven’t thought of yet.

* On the other hand, this is the Internet and stuff breaks for mysterious reasons nobody really understands. If you have trouble registering, email us. We’ll set you up.

And needless to say: if nothing shows up, check your spam filter.

Killing Cancer

Vice Graphic

As you might expect from a blog, we’re big fans of HBO’s VICE, the cable giant’s slickly-produced answer to staid network news magazine shows like Sixty Minutes. Over it’s first two seasons, the show has established a small cult following with fast-paced, drop-you-down-in-the-center-of-the-action investigations of stories that are usually owned by the major television news organizations.

The recipe works and works surprisingly well as entertainment. It’s also pretty damn good journalism, much to the dismay of traditionalists.

VICE generally avoids slower-moving health care stories in favor of edgy, faster-paced, occasionally subversive pieces that send correspondents to far flung locations around the globe and put their lives in jeopardy as they go places the other guys generally won’t go.

The show’s first two seasons have seen correspondents sent to Afghanistan to report on teen suicide bombers, to Bangladesh to report on the illegal organ trade and to North Korea to a report on a basketball game attended by Dennis Rodman and North Korean Dictator Kim Jong Un.

Killing Cancer, Season Three’s season opening special report, an optimistic hour long episode that airs before the season premiere, is an encouraging exception to the no-healthcare rule that demonstrates that the show may be capable of much more than critics give it credit for.

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Numbers We’d Rather Be Talking About

You’ll be hearing a lot about the number six point five million over the next few days.

Six point five million — or whatever the exact number turns out to be at the end of the day — being the number of people that the administration say signed up for Obamacare through the exchanges when open enrollment ends March 31st.

How meaningful the official numbers are will be open to debate. The bloviation factor will be in full effect.  The critics will be downplaying the administration’s number, ACA supporters defending it. Data geeks-turned-media stars will explain what it all means.

Here’s a guide to some of the other numbers we should be talking about as we try to make sense of what’s really going on and what really happened during the Obamacare rollout.

FUDs: The number of people who are innocently living their lives thinking they have bought health insurance, but who, for one reason or another,  be it technical glitch, bureaucratic incompetence or technicality – are going to wake up one morning not long from now and discover that they do not have health insurance.

And who one day soon will discover that they do not have health insurance.  This is the group that causes people in Washington to lie awake at night; because they are going to complain – and complain loudly. While the talk from the administration to this point has been all tough, it seems logical to assume it will build an appeal mechanism that will allow FUDs back into the system. The early signs are that this is the case.

404s : The number of people / applications lost in the system,  either as a result of the Healthcare.gov fiasco or because their application is sitting forgotten on somebody’s desk somewhere or on a laptop. Anybody who tried to log into Healthcare.gov at the height of the meltdown or who has gone back and forth with their insurance company over a bill gets it.

It is safe to assume that this is another number that keeps planners up at night. Let’s just say it is safe to assume that there are a lot of 404s.

CANCELS: The number of people who had their insurance plans cancelled by insurers on the grounds that they did not meet the standards set by the Affordable Care Act. In a way, being a cancel can be considered a badge of honor in the gamification of the healthcare system that is Obamacare.

UNCANCELS: The number of people who had their plans cancelled by the health insurers only to have them declared “uncancelled” by the Obama administration or their state.  Nobody really knows how many uncancels there are. Don’t ask. Yes, it will take a really long time to sort out the uncancels from the cancels and the QHPs.

And you will probably want to shoot the person explaining it to you.  In the gamification of the healthcare system, level ups go to people who have been cancelled, uncancelled and bumped.

BUMPS: The number of people who have been “bumped” out of network and are being forced to change doctors.  What’s going on? In gamification terms, bumps make things more exciting. In real life, they suck.  Getting bumped off a flight is annoying, getting bumped in the health care system is potentially life-threatening.

LIVES SAVED: As we speak Nate Silver or a smart person who looks and sounds a lot like Nate Silver is sitting at a computer in a darkened room somewhere trying to come up with a reliable quantification of the number of lives the Affordable Care Act has saved and will save by shielding people from the barbaric US healthcare system.

How would you go about coming up with that number? Would you look at people turned away from emergency rooms? Would you look at the  number of preventable deaths under the old system?  Would you total the number of deaths from cancer, heart attack and stroke?  Compare mortality rates over the decade from 2004-2014 with those from 2014-2024?  It will be long time before we have the data we need to really understand how well we’ve done.

You can forget the nonsense we’ve been hearing about Obamacare costing the lives of thousands of Americans by taking their health coverage away from them.  There is a difference between losing your coverage temporarily because the system is in transition and losing  it and knowing that you’ll never be able to get it back. Ever.

Calculated over decades to come the number of lives saved is likely to total in the thousands, if not the millions. And that will be the true test of the Affordable Care Act as a historical accomplishment for Barak Obama and his administration.

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Dispatch from Washington

In its wisdom, the Supreme Court of the United States may decide to overturn the Obama administration’s health reform legislation.

The Supreme Court of the United States may decide not to.

Mitt Romney may unseat Barrack Obama and wrest the Presidency away from the Democrats. Or he may not.

In a way, these things may not actually matter.

There may be uncertainty on Wall Street and in the media about the fate of the Affordable Care Act (ACA) and the upcoming presidential election, but the mood in the crowd gathered at the 9th session of the World Health Care Congress last week in Washington was  curiously upbeat.

There was a sense that health care is making progress.

And that is a good thing.

Innovations like accountable care organizations (ACOs), scientific management principles like cost containment and quality improvement and the movement for better health information technology will make their presence felt, regardless of what happens in the courts and on Election Day.

Unlike TEDMED, which brought together official Washington, the tech industry, entertainment and medicine — at the Kennedy Center last week, the World Health Care Congress is a meeting pretty much limited to health care industry insiders at larger firms.

As is generally the case, the speakers list read like a who’s who of very important healthcare names. Kaiser Permanente CEO George Halvorson, Intermountain CEO Charles Sorensen, Aetna CEO Mark Bertolini, Economists Ezekiel Emanuel and Jonathan Gruber, former OMB Director Peter Orzag, TEDMED curator (Priceline.com) Jay Walker talked about the power of the Internet to fundamentally rewire the way people think. Verizon CEO and NantWorks Founder Patrick Soon-Shiong were on hand to talk up a new collaboration. Xerox CEO Ursula Barnes introed the tech giant’s push into healthcare. Journos like Health Affairs Editor Susan Dentzer and NBC correspondent Nancy Snyderman provided media star power.

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THCB @ HIMSS11

This years HIMSS drew the largest crowd in history (31,000). That should be a tip off that something is going on. That something is the national drive for health IT launched by the Obama administration with a whole boatload of ARRA stimulus money being paid out starting this year.

Health Information Exchange (HIE)

While the evolving meaningful use standards for Electronic medical records remained a logical focus for many vendors and the subject of a mindblowing number of panels, there is a sense that the conversation is moving to the world of health information exchanges (HIE). As always, there is spirited disagreement about exactly how the term of the hour should be defined (see the debate over just what exactly the term Health 2.0 means for an example of a good controversy). Is health information exchange a central database, kind of like the old Community Health Information Network. Is it a new peer to peer network, linking hospitals and health systems in a more useful and fundamentally practical way?  Or is it about a new economic model, based on the business models that go along with the free flow of clinical data. We heard the term Accountable Care Organization a lot! Or – more likely – a little bit of all of the above? See Mark Frisse’s excellent blog post on THCB for an in depth look.

Innovation

Sure, nobody has yet come up with the world changing, completely disruptive, industry transforming Facebook for doctors that some pundits had predicted, but there are signs we’re getting closer. Lots of people are trying and social network-ish features are everywhere, with vendors giving their systems the ability to communicate with the outside world. That includes some of the “traditional” EMR vendors like Allscripts that are now linking their users.Continue reading…

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