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HillaryCare 2.0 – Back to the Future

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By JIM PURCELL

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It was 1993, nearly a generation ago.  President Bill Clinton had delegated massively to the First Lady the task of putting meat on the bones of his ambitious healthcare announcement.  Ms. Clinton, in turn, undertook the task of drafting and then selling to Congress what was titled the “Health Security Act of 1993,” but what is remembered as “Hillarycare.”

No one doubts Ms. Clinton’s intelligence and determination.  That she was so completely derailed and the way it happened is nothing short of remarkable.  In many ways, we were then so ready for reform.  Many things were aligned, including a newly robust economy that lasted for over 7 years.

There are many reasons why Hillarycare failed back then, not the least of which were the AHIP sponsored television ads,  Harry and Louise, who became famous for their very effective skewering of what was loosely represented to be the effects of the Act.  The entire debacle became a cautionary tale about how healthcare IS different and is extremely resistant to change.

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Is Obamacare Working? Show us the Data

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By FRED and ALMA TROTTER

MU_stages_final
As President Obama’s healthcare reform unfolds in the last years of his administration, critics and supporters alike are looking for objective data. Meaningful Use is a funding program designed to create health IT systems that, when used in combination, are capable of reporting objective data about the healthcare system as a whole. But the program is floundering. The digital systems created by Meaningful Use are mostly incompatible, and it is unclear whether they will be able to provide the needed insights to evaluate Obamacare.

Recent data releases from HHS, however, have made it possible to objectively evaluate the overall performance of Meaningful Use itself. In turn we can better evaluate whether the Meaningful Use program is providing the needed structure to Obamacare. This article seeks to make the current state of the Meaningful Use program clear. Subsequent articles will consider what the newly released data implies about Meaningful Use specifically, and about Obamacare generally.

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Is Obamacare working? Where’s the data?

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By FRED and ALMA TROTTER

flying cadeuciiAs President Obama’s healthcare reform unfolds in the last years of his administration, critics and supporters alike are looking for objective data. Meaningful Use is a funding program designed to create health IT systems that, when used in combination, are capable of reporting objective data about the healthcare system as a whole. But the program is floundering. The digital systems created by Meaningful Use are mostly incompatible, and it is unclear whether they will be able to provide the needed insights to evaluate Obamacare.

Recent data releases from HHS, however, have made it possible to objectively evaluate the overall performance of Meaningful Use itself. In turn we can better evaluate whether the Meaningful Use program is providing the needed structure to Obamacare. This article seeks to make the current state of the Meaningful Use program clear. Subsequent articles will consider what the newly released data implies about Meaningful Use specifically, and about Obamacare generally.

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On Moving the Physician Movement Forward

By RICHARD L. REECE, MD

Richard ReeceThere are always two parties, the party of the Past, and the party of the Future. The Establishment and the Movement.

— Ralph Waldo Emerson (1903-1882), Notes on Life and Letters of New England

On July 20-26, 2015, a new physician organization, the United Physicians and Surgeons (UPSA), held a conference, dubbed the Summit at the Summit, in Keystone, Colorado.

The conference featured over 40 speakers. Speakers represented many physicians and physician organizations, both bearing workable innovative ideas. The conference was designed to restore physician autonomy, protect the patient-physician relationship, and reset relationships between overreaching government and corporate entities.

Conference attendees were enthusiastic about this physician Movement to restore the voice of medicine.

But inevitable questions arose: Where do physicians go from here? How do we sustain the movement? Where will funding come from? What form will the Movement take? How will physicians inform hundreds of thousands of fellow physicians and millions of their patients about grievances of physicians, their ideas for the future, and what can be done to improve quality and convenience and confidentially of care?

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King v. Burwell: Will the Supreme Court Save the Republican Party from Itself?

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By GARY L. KAPLAN

flying cadeuciiLast week, the Supreme Court heard arguments in the most recent and pernicious attack on the Affordable Care Act – aka Obamacare.  In the absence of a dysfunctional Congress, the case would be beneath the dignity of Court:  it addresses no complicated legal issues that might guide future decisions of lower courts.   Instead, the Supreme Court has been asked to decide whether a drafting error resulting in one unfortunate phrase in the much maligned 2000 page law –“Exchange established by the States” — means that more than 6.3 million citizens would not be eligible for federalsubsidies allowing them to afford commercial (i.e. – non-governmental) health insurance.

Ordinarily, Congress is expected to fix such drafting problems itself.  Each year Congress pass dozens of “Technical Corrections” bills to fix such errors in prior legislation.  These bills are akin to software patches that are regularly released by companies to fix unanticipated “bugs” previously release programs.  But this is no ordinary legislation.  Having spent six years vilifying for President Obama and has supporters for passing legislation that improves American lives it is far too late in the day for the Republican Congress to replace demagoguery with common sense.

So this issue is now in the lap of the Supreme Court, with its well-known partisan divide of four liberals, four arch-conservatives, and Justice Kennedy, who as the “swing vote” effectively decides many of the most divisive cases himself.  The Court can decide to gloss over this drafting error, as proposed by the Obama Administration, or apply its language to devastating effect.   Prior Supreme Court cases—i.e. “precedent” in the jargon of the law—can be found to support either position.   In the end, there have been few cases in which the Court has more judicial freedom – assuming precedent ever really binds the Court – to do whatever it wants in keeping with the Justices own political biases.Continue reading…

Healthcare’s Reform Pareto Trap

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By SAURABH JHA, MD

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It is reassuring that in a country which produced HL Mencken, Homer Simpson and Mark Twain, reports of death of satire have been grossly exaggerated.

Recently, the faculty at Harvard were up in arms because their new health plan involves copayments and deductibles. With ninety cents to the dollar covered, the plan is generous by national standards, and would be rated “platinum” in Obamacare’s exchanges. It’s not as if the professors were placed on Medicaid to show solidarity with the poor.

Increased out-of-pocket contribution is the trend post health care reform. That same reform which many Harvard professors supported and some designed. This is why their revolt, an Orwellian political satire, has spread schadenfreude amongst conservatives who are enjoying Gore Vidal’s favorite words in the English Language: “I told you so.”Continue reading…

A Detailed Analysis of the Republican Alternative to Obamacare

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By ROBERT LASZEWSKI 

GOP vs Democrat

House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

Republicans will now argue they have a better health insurance reform plan and that Obamacare should be repealed and replaced by it––particularly if the Supreme Court plunges the new health law into chaos by throwing the subsidies out in 37 states.

They will have an uphill battle. Not because these Republicans don’t have a lot of good ideas, but because they have put a list of big and complicated changes on the table. Lots of people may not like Obamacare but Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause.
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More Evidence Obamacare is Good For White People

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By MICHAEL MILLENSON

Dear White People Poster

The latest Gallup and Healthways poll doesn’t phrase it this way, but its findings that the Affordable Care Act “appears to be meeting its goal of reducing the percentage of Americans without health insurance” is more evidence Obamacare is good for white people.

In an interview with National Public Radio at the end of last year, President Obama was asked whether he and the Democrats had lost support among white voters. He denied it, comparing his share of the white vote favorably to that John Kerry in 2004 and pointing to the Affordable Care Act (ACA) as a program that benefited working-class white voters without many realizing it. I’d written much the same thing about Obamacare in a THCB blog post a couple of weeks before the 2012 presidential election. But as with other issues related to race, it’s a topic that the president has only reluctantly discussed, even when good policy is also good politics.

In response to NPR questions about race, Obama noted that some of the biggest beneficiaries of the ACA live in places like “Mitch McConnell’s state,” home to relatively few blacks or Hispanics. Coincidentally, a front page story in the print New York Times documented Kentucky’s experience with the law – which, the president wryly noted, Kentuckians do not call “Obamacare” – the same day the NPR interview aired.

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Grubernomics

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By SAURABH JHA, MD

Gruber OptimizedIn the giddy days after the passage of ACA, I was chatting to a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; ‘Healthcare post Obamacare’ or ‘Radiology in the new era.’ Talks warning us that we were exiting the Cretaceous period.

He spoke about variation in healthcare, six sigma, fee-for-value and ‘paying doctors to do the right thing.’

‘How?’ I asked.

‘I just told you, we need to pay doctors for value and outcomes.’ He smugly replied.

‘How?’ I asked again.

He did not answer. Instead he gave me the look that one gives an utter imbecile who doesn’t know the difference between a polygon and a triangle.Continue reading…

Halbig corpus interruptus

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By Matthew Holt

In more stunning proof that America’s 18th century style governing process just doesn’t work, a subset of a regional Federal court ruled against part of Obamacare. The Halbig ruling is certain to be overturned by the full DC court and then probably will stay that way after it makes it’s way through the Supremes–at least Jonathan Cohn thinks so.

But think about what the Halbig ruling is about. Its proponents say that when Congress (well, just the Senate actually as it was their version of the bill that passed) designed the ACA, they wanted states only to run exchanges and only people buying via states to get subsidies. But that they also wanted a Federal exchange for those states that couldn’t or (as it turned out) wouldn’t create their own. But apparently they meant that subsidies wouldn’t be available on the Federal exchange. That would just sail through Logic 101 at any high school. Well only if the teacher was asleep, as apparently most Senators were.

Now two judges interpret what was written down to imply that subsidies should only be available on state exchanges–even though logic, basic common sense and fairness would dictate that if we’re going to subsidize health insurance we should do it for everyone regardless of geography.

Don’t forget that in the House version of the bill there was only a Federal exchange. Continue reading…