Tag: Policy

POLITICS: Ghost in the Attack Machine

Feb 22, 2008• 20

I’m up at Spot-on discussing the return of one of the more improbable and unlovable charcters in the last health reform debate, and her recurrence as a Ghost in the Attack Machine. As ever come back here to comment…

It’s almost full-on election season so I’m getting email from the Republican National Committee suggesting that there are problems with both the Sen. Hillary Clinton and Barrack Obama plans for health reform. Funny that – given my politics – but it gets better.

The RNC thoughtfully sent along a copy of a Wall Street Journal op-ed featuring an appearance by that blast from the health reform past, Betsy McCaughey who these days hangs her hat at the ultra-right wing Hudson Institute. In the 1990’s she was a brief star of the new right after writing, in early 1994, a magazine article in the then-quasi-liberal magazine The New Republic. Called No Exit, it contained a damning account of the Clinton Health Plan and got a fair amount of attention at the time. No Exit was a fair load of old tosh (you really keen health policy archaeologists can unearth the Clinton White House’s full rebuttal to see what I mean).

Read the rest

POLICY: The financial castrophe of uninsurance will get worse

Feb 20, 2008• 4

Just another reminder about the perversity of our insurance system. Steve Lopez in the LA Times writes a about a 57 year undergoing chemo whose COBRA benefits are running out . Whether or not chemotherapy is always the right option in these cases (and you’ll get plenty of arguments about that here on THCB), there is no excuse for a system where financial catastrophe will be visited on families by the random luck of getting sick.

But of course this problem is growing rapidly. Health Affairs confirms today with an Urban Institute study what’s well known—health insurance coverage has been declining while the economy has been expanding. This is the complete opposite of the 1990s, where the numbers covered by employer-provided health insurance increased as the economy improved.

So of course in the coming (or present?) recession the horror stories like that of the teacher and those Jon Cohn wrote about in Sick are just going to multiply.

A Blueprint for Healthcare Reform by Maggie Mahar

Feb 18, 2008• 8

On this blog, we have often debated these questions: “Why is U.S. healthcare so expensive? Why is it that states like Massachusetts and California just can’t seem to find a way to provide high quality, affordable medical care for all of their citizens?”

In the past, I have suggested that the answer can be found in the work done by Dr. Jack Wennberg and his colleagues at the Dartmouth Medical School. The story that I have posted below provides the narrative behind that assertion, tracing how, over a period of thirty years, Wennberg and his team uncovered the incredible, incontrovertible waste in our health care system.

Wennberg’s work reveals that roughly one out of three of our health care dollars is squandered on unnecessary tests, ineffective, unproven, sometimes unwanted procedures and over-priced bleeding-edge drugs and devices that are no better than the less expensive products that they have replaced.

Only a Luddite would fail to appreciate the wonders of 21st century medical technology. And Wennberg is no Luddite. He is quick to acknowledge that the most expensive, aggressive care that U.S. doctors and hospitals provide is often the most effective care.

But not always. This is what is less obvious. It would seem that by spending so much more than other countries, we would be buying the best care on earth. But the evidence shows that, often, we are not. And therein lies the conflict at the heart of our money-driven health-care system: while more health care equals more profits, it does not necessarily lead to better health.

Peeling The Healthcare Onion, By George Van Antwerp

Feb 15, 2008• 8

George Van Antwerp is a Vice President at Silverlink Communications where he focuses on developing healthcare communication solutions across the industry with a focus on the pharmacy space. He and I have been conversing back and forth by email for a couple of years (since before he joined Silverlink who are—FD—sponsors of THCB & Health 2.0). He blogs regularly on both topics at Patient Centric Healthcare and today is his first post on THCB

I think an onion is the right analogy for healthcare for three reasons: (1) it can make you cry; (2) every time you pull off a layer you learn more; and (3) what you see from the outside is a lot different than what you see from the inside.

POLICY: Two awful stories

Feb 15, 2008• 10

Just before you get too lost in the wonkiness of health policy, just remember the financial implications of being sick in the wrong circumstancesin this country. Here’s a woman with a sick kid who is going to have her husband take a pay cut so that she can qualify for S-CHIP.

And here’s a benefit tonight in Richmond Virginia, for Kellie Brown, a student who needed an emergency appendectomy and has dropped out of college to pay of the $10,000 she owes. I kicked in a few bucks; if you’re feeling nice you might too.

Think of the economic insanity of these two things–someone dropping out of college, and someone moving to a lower pay grade because of health care costs!And no, this shit does not happen anywhere else in the civilized world.

Let’s All Ask Secretary Leavitt To Explain HHS’ Schizophrenia On Medicare Physician Data – Brian Klepper

Feb 13, 2008• 3

Regular readers will know that, last Sunday, I posted a column that pointed to HHS’ schizophrenic behavior when it comes to the release of Medicare physician data. First they fight the consumer advocacy group Checkbook.org’s lawsuit demanding the release of data in 4 states and DC. (The AMA’s Board Chair has admitted that they lobbied HHS to appeal the court’s finding that they should make the data public.) Then, a week ago last Friday, HHS announced a new program that would identify Chartered Value Exchanges (CVEs) in 14 communities – these are coalitions of employers, payers, providers and consumers – and then hand over the same physician data they’ve been fighting the courts to keep secret so these groups can combine them with data available from the private sector and create physician quality/cost report cards.

POLICY: Has the dog’s sore not completely healed?

Feb 11, 2008• 2

The NY Times has been getting much better in its reporting on health care policy. After all David Leonhardt had Shannon Brownlee’s book as economics book of the year! And they’ve been getting Jack Wennberg in frequently.

But every now and again something crops up that worries me about it’s desire to go straight adn reminds me of that dog with the licking problem. Today it’s the idea that concerns about health care costs are global, which I guess is true, and that the rest of the world–where employers often don’t pay for health care–is becoming more like the US where employers do. The short piece is called Going Global With Concerns on Health Costs and the casual reader might think that systems are converging around the idea that employers should pay for health care because governments can’t afford to.

Leaving aside the basic point that the route by which money is raised to pay for health care is not very relevant compared to how it’s spent and the system by which people get coverage, the article makes two tiny confusions.

First, as it says, it’s supplemental health care costs that employers are paying for in most countries–and in many countries like the UK they’ve done that for decades. Here employers pay for everything. that’s a massive difference.

Second, the increase in percentage paid by employers is only big enough to grow really fast in 4 countries. Those are India, China, Venezuela and Russia. Not exactly health care systems that compare to the US. Our health care system is bigger than those economies!

Sunday Morning Post, by Brian Klepper

Feb 10, 2008• 1

Here’s a classical example of a federal regulatory agency holding fast to two opposing ideas at the same time. I wonder what it means?

Last week the Department of Health and Human Services posted an interesting notice announcing a new program that recognizes 14 (presumably) forward-thinking health care coalitions of providers, employers, insurers and consumers, which it refers to Chartered Value Exchanges, or CVEs. (Who comes up with these names?!) HHS promises that, by summer of 2008, it will provide "access
to information from Medicare that gauges the quality of care
physicians provide to patients." This "physician-group level
performance information…can be combined with similar private-sector
data to produce a comprehensive consumer guide on the quality of care
available" in each community. Cool! Sign me up!

INTERNATIONAL: Rational talk about Canadian Health Care

Feb 7, 2008• 14

I’m very happy to relate that one of the best pieces ever by me on THCB, Oh Canada, (written when THCB was just finding its feet in 2003) is still as relevant as ever. There are still inordinate amounts of crap talked about the Canadian system by defenders of the current US status quo (not that the far right loonies who dredge this stuff will say that’s what they’re doing). This is dspite the fact that no major US Presidential candidate, with the possible exception of Harry Truman, has ever proposed introducing such a system here.

But over on liberal blog Campaign For America’s Future (the guys who are backing Jacob Hacker’s work and by the way taking credit for the Edwards, Clinton and some of Obama plan) Sara Robinson—a self described “health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border”—has written a very balanced piece called Mythbusting Canadian Health Care.

I can see the Canadian ex-pat trio of Pipes, Gratzer & Graham going into apoplectic fits even as I type!

Is Mandated Universal Coverage the Right Way to Achieve Health Reform? The Health Reform Debate We Haven’t Had Yet, by Jeff Goldsmith

Feb 5, 2008• 17

Goldsmith_2 I don’t know how many of you linked over to Lawrence Brown’s perspective piece “The Amazing,
Non-Collapsing US Health Care System” in the January 24th issue of the New England Journal of Medicine
(buried in Mathew’s “Whisper it quietly. . .” post), but it’s the most useful piece of political analysis of the health reform conundrum I’ve seen in a long time.

What Brown argues, convincingly, is that we really have three healthcare systems: public and private health FINANCING systems (which operate in the lucrative fantasy land of “reimbursement”) and a public CARE system (the safety net urban hospitals, community health centers, public health clinics, the VA, etc.) that serve the rural and urban poor and uninsured.

Other than a few isolated outposts like Kaiser, the third health system that Brown discusses is the only place in the United States where population health is actually practiced. And, most important, it is also is the mysterious resource that prevents the 47 million uninsured, including a very large number of our 12 million undocumented people, from dying in our streets, and causing a huge political crisis. It is invisible to much of the voting public, but thank God we have a safety net healthcare system.

This latter system has been a political stepchild of state and federal governments, and lurches from financial crisis to financial crisis, living off the land. But it has successfully propped up the other two, and, I think, helped prevent a revolution. Precisely because it has succeeded in reaching its target populations and helping them, albeit “too late” in the disease process, it has drained both political urgency (and funding) from making the first two “reimbursement” systems universal.