Tag: Policy

Obama’s new ad is clever, but why aren’t they taking the open shot?

Oct 6, 2008• 10

By Matthew Holt

One of the few virtues of getting on a plane and leaving California is that you get to see Presidential political ads on actual TV. Obama has a new ad about health care which explicitly attacks “government run health care” on the left of an arrow and then attacks unregulated insurance companies on the right end. Geddit? Yup it’s 1996 Bill Clinton all over again. The man is a triangulator. Or an arrownator…

(Apologies for the poor quality but it’s the only version I can find online).

Obama’s plan is in the middle of the arrow of course. It’s a little bizarre that he attacks government-run health care — given that his plan involves both extending FEBHP and creating a separate version of Medicare/Medicaid that everyone can buy into. And of course Medicare is the most popular health insurance plan in the nation by a long way. I think the government still runs it.

But I guess that’s just politics. And of course nothing as major as what he’s talking about is going to happen once he gets elected anyway, (as I’ve been saying for more than a year).

But talking about politics, what I cannot get over is how the Obama team has not bothered to connect the McCain plan’s designs to push more people into the individual insurance market to specific actions of health insurers in California. There are still smart intelligent people running major health care lobbying organizations in DC (one of who I had dinner with last week in my professional life) who still have not heard about the retroactive policy cancellations in California despite the fact that all of the big insurers were doing it. And yet McCain’s plan is designed to explicitly put people into a situation where they’re at the mercy of those insurers!

This isn’t hard to explain. Why isn’t the Obama campaign featuring it? Especially as he’s now talking about health care. They are not taking the open shot (or as the English say, they’re missing an open goal!)

KevinMD turns into raving socialist…

Oct 1, 2008• 6

By Matthew Holt

Well not quite, but in his op-ed at USA Today Kevin talks about why it’s a problem for the US not to have wide deployment of EMRs, and notes that it’s the wrong incentives that are to blame—docs have to pay but others reap the rewards. So in Kevin’s words:

One needs to look at the Department of Veterans Affairs for an optimal model. All of the VA’s primary care physicians, specialists and hospital-based doctors across the country use the same electronic record system. It has played a significant role in the reduction of medical errors, optimization of cost efficiency, and attainment of high scores in preventive care measures.

Kevin’s usually criticizing me for being the wooly lefty, but I could be pardoned for thinking that he’s suggesting that we junk the current US system in favor of rolling all docs and patients into the VA. I wouldn’t suggest that but far be it from me to tell Kev that he’s wrong!

Busines ties and MRIs — it’s not rocket science

Oct 1, 2008• 2

By Sarah Arnquist

The Health and Human Secretary Inspector General’s office concluded last week that doctors are likely to order more MRIs if they have business ties with the imaging provider.

Shocking, isn’t it?

Modern Healthcare reports that inspector general’s report was a follow-up to a previous finding that MRI claims paid under Medicare’s physician fee schedule increased fourfold from 1995 to 2005.

“The complexity and limited transparency with which these services are provided warrants continued attention to ensure that services are reasonable, necessary and compliant with Medicare statutes and regulations,” the report states.

Some good news in health care, really

Sep 25, 2008• 5

By Jocelyn Guyer

Even as the economy has fallen into an abyss and I find myself with distressing frequency discussing with people whether Levi Johnston really loves Bristol Palin, it turns out that there is actually some good news out there about health coverage. Over the past year, 19 states have taken significant strides toward covering more children despite challenging fiscal times. At a National Health Policy Forum last week, three states explained their progress. And, no, the featured states weren’t the usual suspects like Massachusetts with its impressive, but so-complicated-that-you-need-an-MIT-degree-to-untangle-it system or Vermont with its population of 62 people and 4 dairy farms. They were Louisiana, Iowa, and Pennsylvania.

Here are the details of what they’ve done:

Study Shows Unpaid Medical Bills Put Families in Debt

Sep 25, 2008• 2

By Shuka Kalantari

While the federal government plans to bail out the financial sector with $700 billion of taxpayer dollars, a growing number of tax payers are grappling to get themselves out of debt from unpaid health care bills.

Yesterday’s New York Times discussed two studies released on Wednesday by the Kaiser Family Foundation and the Center for Studying Health System Change. The studies show that more and more American families have debt from health care.

"Premiums for employer-sponsored health insurance rose to $12,680 annually for family coverage this year – with employees on average paying $3,354 out of their paychecks to cover their share of the cost," said the Kaiser Family Foundation news release of the study.

Health reform prospects in the wake of Black Sunday

Sep 23, 2008• 20

By Jane Sarasohn-Kahn

"Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation," said John McCain to a reporter in an interview in Contingencies magazine. The article is titled: "Better Care at Lower Cost for Every American."

This isn’t a Photo-shopped, made-up comment. See page 30 of the publication, the last paragraph in the left hand-column which continues into the right side.

Contingencies is the magazine of the American Academy of Actuaries. These are those sober professionals who, according to their mission statement, "put a price tag on risk." They do that through evaluating the likelihood of future events, and, in their words, "designing creative ways to reduce the likelihood of undesirable events."

Health Affairs makes an apPaul(y)ing choice

Sep 22, 2008• 10

By Matthew Holt

Health Affairs ran a couple of partisan analyses last week. Joseph Antos, of AEI, Gail Wilensky, former Bush 41 HCFA administrator, and Hans Kuttner labeled the Obama plan as excessive tax and spend socialized gulag regulation.

In the other analysis, four liberal academic wonks — Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz — derided the McCain plan as the counter-productive ravings of a right wing nutjob. OK so they didn’t exactly say that, but you get the message. No surprises here.

The McCain plan is so far out of the mainstream that, when Bush proposed something very similar in 2006, he could not even get it introduced into a Republican-controlled Congress. Obama’s plan is a wishwashy centrist Democrat plan that doesn’t even pretend to get to real universal coverage and ignores the fact that the vast majority of Democrats prefer a straight single-payer plan (and so does he when scratched hard!).

So who does Health Affairs chooses to create a middling compromise between these two?

Free Lunch: David Cay Johnston off the leash

Sep 20, 2008• 5

By Matthew Holt Freelunch

A version of this review appeared at Spot-on last week, but as you know over there I get heavily edited by Chris Nolan who’s a real journalist and all that. The beauty of the zero cost of publishing online is that you can show lots of versions. This is what it looked before it got to her. Enjoy.

Despite being buried in Health 2.0 work, somehow I’ve been managing to read a few books lately. But none of them have been quite as staggering as Free Lunch, the latest from former NY Times investigative reporter David Cay Johnston.

Johnston’s best known for his exhaustive investigation into how corporations and very very rich individuals subvert the tax code so that they pay less, while the rest of us pay more. But in this book (probably because he’s no longer a NY Times Reporter and is off the leash of restraint that the Grey Lady seems to put on its reporters) he gets almost biblical in calling out the cheats, crooks and murderers.

And when I say murderers, Johnston is talking about John Snow, Bush’s former treasury secretary — yup the one who did such a great job regulating the sub-prime mortgage market that the potential for a credit and housing collapse in the latter part of this decade was avoided…oh, wait….

Controlling costs is the central problem in U.S. health care

Sep 18, 2008• 10

Sbeller_headshot_small By Stephen Beller

The central problem in the U.S. health care system isn’t cost or insurance, per se, it’s the challenge of increasing health care value to the patient/consumer.

That means we must improve the poor quality and inefficiency of care, so that we all receive only the care we need, delivered in a timely and effective manner, without waste and over-treatment, and with a focus on integrating “well-care” (prevention and self-management) with sick-care.

It also means dealing with the knowledge void, an ironic situation in which our health care community is drowning in oceans of information, yet no one knows the best ways to prevent health problems and treat them cost-effectively, especially when you take individual differences into account. To address this problem, we need better health information technologies, as well as a collaborated effort to develop, disseminate, and deliver cost-effective evidence-based care.

If consumers were to receive high value health care in this manner, costs would be lower since poor care costs more and delivering only the minimal necessary care typically results in better outcomes! More appropriate care, delivered competently and cost-effectively through cost-conscious, patient-centered “medical homes,” for example, is the only way to control costs long-term.

When is the same spending more spending?

Sep 16, 2008• 2

By Matthew Holt

When it’s routed through the government because their spending is done with mythically different dollars than private spending. Or at least it is in the bizzaro world of free-marketeer policy analysts. Let me explain…

A couple of weeks back a small consulting firm working for McCain sent me an article written by University of Minnesota economist Roger Feldman about the cost of Obama’s health plan. They were complaining that I hadn’t featured their analysis. So I read the report which suggested that the Obama plan would cause $450 billion in health spending. Bear in mind, Obama suggests that it’ll cost $65 billion, so this is quite some stretch.

I was going to write a long, learned article about this, but instead I’ll just show you the email back & forth.