Tag: Policy

Critical of Critical

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.

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My Health Care Reform House Party

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 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.

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Conservatives Need to be Part of Health Care Reform

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:

  1. 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.
  2. Encouraging insurance exchanges not unlike those envisioned by Democrats but at the state level where Stuart sees these exchanges avoiding “endless Congressional micromanagement.”
  3. 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
  4. 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.

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Washington, Please Don’t Bail Out the Health Care Industry

A health care Marshall Plan — $50 Billion stimulus to get electronic health records (EHRs) in every doctor’s hands or $50,000 to each physician -– what an incredible marketing job.

Detroit, are you listening? Stop whining to Congress that you need a bailout. Tell them you want to be the new alternative energy Manhattan Project, get the money, and then keep building SUVs and flying around in corporate jets.

To Congress, Daschle, and Obama, please don’t do this. Our industry, health care, combines the worst of the Big Three automakers with the worst of the hubris, dishonesty, and failure of the public trust of Wall Street. Please do not bail us out.

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Jack says cover the uninsured & spend less!

It’s no secret what the Dartmouth group’s solution for the health care system has been — reduce practice variation, get surgery and physician resource use rates similar to the Mayo Clinics’ of the world, and take the huge savings that would be generated to cover the uninsured. In fact Wennberg, Skinner, Fisher & Weinstein, now joined by “gone native” journalist Shannon Brownlee, have a new White Paper out—their own open letter to Obama’s mob.

Along the way that requires demand-side reductions (achieved by shared decision making) and supply side changes.

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Shifting costs from public to private payers

The other day, the American Hospital Association, the Blue Cross /
Blue Shield Association, Premera Blue Cross and America’s Health
Insurance Plans (FYI – HPHC is a member and I’m on the Board of
AHIP) released a joint study on public and private payment rates. 

study was prepared by Milliman, Inc., one of the nation’s most well
known number-crunching health care consulting firms. Readers of
this blog will not be surprised to learn that the study shows that
Medicare and Medicaid pay a lot less for health care services than the
Blue Cross and private health plans pay.  But I must say, even I was
a little surprised by the size of the differential.

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Holland, pay-or-play and the WSJ Opinion page making sense?

Don’t worry, the WSJ Opinion only makes sense because they let Zeke Emmanuel and Ron Wyden write an op-ed. The article is called Why Tie Health Insurance to a Job? and it’s impossible to argue with the logic about why we ought to move away from employer-based insurance.

There is of course an argument amongst those of us who both want to move to a social insurance system and want to have universal insurance as to whether this should be done in the voucher-type model that Emmanuel & Vic Fuchs have proposed (which looks a little like how the Dutch now do it) or whether we need to go to a modified single/multiple payer system like the French/Japanese/Brits/Australians.

I gave a talk in Canada the other night suggesting that there was some potential for convergence, and I used the very recent Commonwealth Fund data looking at the experiences of the chronically ill in seven nations. What is very interesting to me is that in terms of access to primary care and in terms of disease management, the Canadians and Americans look roughly similar—and not too good. As for specialty care, well as we know the Canadians & Brits ration by time and the Americans ration by money (or socio-economic status).

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Confessions of A Physician EMR Champion, Part 2: Empowering Health IT for the Connected Medical Home

In a post here three weeks ago, I explained that I am engaging physician audiences in a conversation about participatory medicine, using a talk and presentation entitled "Confessions of a Physician EMR Champion.”

I “confess” my own misplaced hope in the EMR movement, and that I’m finally embracing the reality that most investments in health IT have not met expectations.

My broad message is that the key lesson of this failure has been that adoption of health IT without understanding the fundamental interactions between people, business process, and technology wastes both human and economic capital.

To be successful, the adoption of health IT by physicians, nurses, and staff must extend communication and health data exchange beyond their practices and bill payers to include the patient and family members, the patient’s team of health and wellness professionals, and ancillary service providers such as pharmacists and lab technicians in the community.

Health IT must be able to support coordination and continuity of care, as well as accountability for doing the right things for patients. I now realize most EMRs are not sufficient to this task, and I was wrong to think they would evolve in this direction.

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Now, Sleepless in San Francisco

Having returned from Seattle, the persistent itching from the sand-fly bites of Roatan has awakened me at 5 a.m. So I’m commenting on three pieces of news, which I’ve commented on before here and at Spot-On.

First, United HealthGroup has introduced two new things this week. One is is a consumer portal/WebMD competitor called myOptumHealth, which gave a sneak preview (and was a sponsor) at the Health 2.0 Conference in October.

At first blush I like the look of what they’ve pulled together, although the about us section doesn’t exactly tell you much about who owns Optum! But the really interesting product United launched this week was aimed right at me. It’s an option to repurchase your individual health insurance without being re-underwritten and rejected.

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Addressing an epidemic of overtreatment

Health care costs in the U.S. are approaching 17 percent of the GDP and may be as high as 20 percent in the next few years.

What is causing the US to have the highest cost and lowest value for the healthcare dollar?  Simple – it’s overtreatment.

takes many forms – from over ordering expensive diagnostic tests to the
prescribing of expensive and sometimes unneeded therapeutics.

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