Tag: Policy

Shocker–Karen Ignagni almost tells the truth

Jan 8, 2009• 21

The NY Times’ Robert Pear has an article on the politics of the Obama Administration introducing a public plan as part of FEHBP.

As you might expect a boat load of Republicans who were told in grade school that private is good and public is bad are concerned about this causing the demise of private health plans–even though that would clearly benefit the country. Of course Pete Stark is quite happy to say that it’s not that Medicare underpays (as Charlie Baker said here last week), but it’s that private plans over pay.

So why is that the case? Well you knew that I couldn’t resist the appearance of my favorite lobbyist. Here’s what Karen Ignagni says, and — this is the shocker– it’s half true.

Karen M. Ignagni, president of America’s Health
Insurance Plans, a trade group, said the consolidation of the hospital
industry in the last seven or eight years had increased the market
power of hospitals, thereby reducing the ability of insurers to
negotiate discounts.

Actually it’s been more
like twelve to fifteen years since big players started merging (IFTF’s
Ellen Morrison wrote a great report about that in 1994 called "The Six Americas").
By the late 1990s Sutter, for example, was facing down Blue Cross of
California on price and winning. And of course in Boston Partners was
getting bigger and bigger, and facing down Blue Cross and the other plans. (Leading occasional THCB contributor and Beth Israel Deaconess CEO Paul Levy to become a big whiner, according to Partners Chairman Jack Connors). So Karen is telling the truth.

Confusing ‘Standards’ With ‘Interoperability’–Lessons For The 111th Congress From HIPAA

Jan 7, 2009• 12

By RICK PETERS, MD

As we debate whether or not the Obama Administration and the 111th Congress should work towards directly funding EHRs, one of the key questions seems to be whether or not EHRs and interoperability standards are mature enough.

My colleague, John Halamka, Chair of the Healthcare Information Technology Standards Panel (HITSP), made an rational and impassioned plea last week that we have reached a state of interoperability that is at least good enough not to delay allocating Federal funds for investments in EHRs. Dr. Halamka had earlier in December advocated direct grants from the Federal government of $50,000 per U.S. clinician to states to fund the purchase of CCHIT compliant commercial EHR products.

In the ideal world, I agree with John’s position, but have spent perhaps too much time in the real EHR world and in health care standards to truly believe we are where we think we are. We have been here before and our best intentions were subverted.

The demise of Medicare Health Support

Jan 6, 2009• 4

By Matthew Holt

I guess we knew it, but here’s the confirmation in the analysis of the first 18 months from CMS.

The summary: DM companies in Medicare Health Support enrolled healthier than average populations; they had limited to no impact on improving their patients’ care, satisfaction or outcomes; and didn’t save any money.

I wonder how Disease Management is going to fare in the future. It’s clear that this "occasional remote intervention" model needs to change.

Viciously Vladeck

Jan 6, 2009

The new Health Affairs is out and with it a lovely piece of vintage Vladeck.

In a review of a new book on Medicare by old Brookings warhorse Henry Aaron and fast rising UT Longhorn star Jeanne Lambrew, Bruce Vladeck soon turns off the main topic (their book) and onto his favorite–the inevitability of the outcome when Medicare tries to do something about health care costs, and the inability of the political system to do much about it.

Policy analysts make fun of politicians who claim they can balance the budget by eliminating "waste, fraud, and abuse," but with a straight face they then propose to control health care costs by making the system more efficient. Efficiency has hardly anything to do with it. What health care costs are all about is market power and the distribution of monopoly rents. Every other industrialized nation understands that and does something about it. U.S. providers and insurers understand it, too, which is why the more sophisticated providers resist any efforts to aggregate power on the buyers’ side. But the mainstream of U.S. policy analysis just doesn’t seem capable of even framing the question, let alone solving it.

Of course despite me convening panels with Valdeck on them a couple of times, he probably doesn’t think THCB is mainstream policy analysis 🙂

But just last week I said:

As I’ve been saying for a long time, to rationally rationalize the
health care system, we need to make cardiologists in Miami behave like
cardiologists in Minnesota with a consequent impact on the incomes of
doctors, hospitals and stent & speedboat salesman in high cost
areas (Yes, Jeff, I do mean Louisiana, New York, Los Angeles and Boston
too). If the Federal Health Board has teeth, that’s what it’ll do, and
the AMA, AHA, AdvaMed, PhRMA et al know it. Which is why the PhRMA front organizations have been railing against cost-effectiveness for so long.

We know the question. Sadly we also probably know the answer. Vladceck’s short piece is great fun, nonetheless.

Let’s Reboot America’s HIT Conversation Part 1: Putting EHRs in Context

Jan 5, 2009• 7

By DAVID C. KIBBE & BRIAN KLEPPER

Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration’s investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I’d point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should–Matthew Holt

On Dec. 19, we published an Open Letter to the Obama Health Team,
cautioning the incoming Administration against limiting its Health
Information Technology (IT) investments to Electronic Health Records
(EHRs). Instead, we recommended that their health IT plan be rethought
to favor a large array of innovative applications that can be easily
adopted to result in more effective, less expensive care.

The
response to that post was vigorous. We received many comments and
inquiries from the health care vendor, professional and policy
communities – urging us to provide more clarity. One prominent
commentator called to ask whether we, in fact, supported the use of
EHRs. We both have been active EMR and health IT supporters for many
years. Dr. Kibbe was a developer of the Continuity of Care Record
(CCR), a de facto standard format for Electronic Medical Records
(EMRs), and has assisted hundreds of medical practices to adopt EHRs.
Dr. Klepper has been involved in EMR projects for the last 15 years,
and the onsite clinic firm he works with provides every clinician with
a range of health IT tools, including EMRs.

Not exactly health care, but follow the money…

Jan 5, 2009• 3

By Matthew Holt

Michael Lewis has returned from writing about Jim Clark, technology, baseball and football to his first
topic; finance. (Liars Poker is still the best book about Wall Street ever) His two part piece with hedge fund manager David Einhorn this weekend in the NY Times is one of the best things I’ve seen on the current financial crisis and what to do about it.

It’s called The End of the Financial World as We Know It and How to Repair a Broken Financial World. (I recommend reading them both straight through). And yes, Lewis wants more transparency and more regulation.

Paul Krugman estimated last month that the share of GDP going to the financial sector increased from 5% of GDP to 8% of GDP over the past 30 years or so. What did exactly we get for the extra 3% of the economy that was extracted by Wall Street? The answer is pretty evident. And of course lots of other sectors of society, generally inhabited by people earning significantly less money, have suffered pretty directly as a result.

Of course, there’s another sector of the economy that’s increased its share of the GDP by an even greater amount in roughly the same time period (from about 9% to about 17%). No prizes for guessing which one.

Anyone care to justify what value that sector has provided?

Reprise….Critical of Critical

Jan 5, 2009

By Matthew Holt

For those of you who had better things to do than spend last week reading wonkish blogs, I point you towards my article about Tom Daschle’s book. In particular I encourage you to look deep in the comments, for a particularly fun spat between me and a reader called Nate–the type of spat that used to be very common on TCHB but sadly has become a little rarer now we’re all grown up!. The original piece is here and the comments get juicy around Jan 3.

Critical of Critical

Dec 31, 2008• 49

By Matthew Holt

Like legions of other wonks when I discovered that Tom Daschle was going to be Obama’s point guy on health care, I sent off for a copy of his book Critical. It’s a fast and easy read, but in its examination of the problem it doesn’t add much to superior books on what’s wrong with health care (much of the first section reads like an undergrad’s attempt to summarize Jonathan Cohn’s Sick) and there are some pretty weak logic flows and basic editing throughout (he refers to the book Uninsured in America on p155 as though it’s already been introduced before it actually gets introduced on p161). But ignoring all that, what does Daschle suggest we actually do?

First, he promotes himself as a scholar of failed attempts at health reform past, and of course a witness to the most recent attempt.

My Health Care Reform House Party

Dec 29, 2008• 6

By Michael L. Millenson

The Obama-Biden Transition Team has encouraged individuals across the country to gather in small groups with friends and neighbors to discuss their ideas for health care reform. The team provided a background paper, discussion guide and a specific list of questions as a framework within which citizens could provide feedback to health reform czar-designate Tom Daschle. More than a thousand would-be hosts have officially registered on the change.gov website, and my wife and I were recently invited to one such gathering in a small village (yes, that’s the official designation) north of Chicago. My report below is not the official one.

‘Twas three nights before Christmas, and despite cold and stormWe’d gathered together to talk health care reform.Clutching Team Obama’s brief questionnaireWe went over each item with scrupulous care.Middle-class, middle-aged and in the MidwestWith our host’s college kids for reality test.O’er the country many thousands had signed up for the sameDespite fear “special interests” would come rig the game.But as we plain folk gathered by the living room fireWe closely read instructions, then vented our ire.

Conservatives Need to be Part of Health Care Reform

Dec 20, 2008• 3

By Robert Laszewski

Stuart Butler, Vice President of Domestic Policy at the conservative Heritage Foundation has an op-ed in Thursday’s Washington Times, “Four Steps Can Heal Health Care.”He makes some very valuable points and proposes four steps toward reforming the health care system most people—liberals and conservatives —could agree on:

Making sure every working family has access to an affordable private health plan
that could include state-based default plans with agreed upon minimum
benefits and premiums subsidized through reinsurance pools that spread
any adverse risk over the broad private market.
Encouraging insurance exchanges not unlike those envisioned by Democrats but at the state level where Stuart sees these exchanges avoiding “endless Congressional micromanagement.”
Reforming the existing federal tax preferences for health insurance by capping the value of these tax breaks as a means to encourage more efficient plans and raise revenue to help pay for premium subsidies
Redesigning the Medicaid and SCHIP programs
by giving states the ability to streamline these programs and free-up
funds to expand the help the low-income people get for health
insurance—including vouchers to purchase private coverage.