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WSJ Editorial on Liver Transplants Cherry-Picks the Numbers

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By MAGGIE MAHAR

Dr. Scott Gottlieb, a resident fellow at the conservative American Enterprise Institute, published an op-ed in the Wall Street Journal last week that returned to the much-exploited story of Nataline Sarkisyan, the 17-year-old Californian who died before receiving a liver transplant. Gottlieb used the story to make the argument that “the U.S. has the best health care in the world.”

Gottlieb is squaring off against John Edwards, who has been suggesting that if Nataline had lived in a European country she might have lived.  Edwards blames CIGNA, her for-profit insurer, for refusing to cover the procedure. Dr.  Gottlieb, who is a former FDA official, responds with a double-barreled argument: “Americans are more likely than Europeans to get an organ transplant, and more likely to survive it too.”  He sounds confident, and at first glance, his argument seems persuasive.

But a closer look reveals that Gottlieb makes his case by carefully culling the numbers that fit his argument, while omitting those that don’t. Unfortunately, too many people involved in the healthcare debate play fast and loose with the facts. Everyone interested in reform should be on the look-out for those who don’t cite solid evidence for their assertions. If they don’t give you their source, it may be because they don’t want you to look it up—and because they realize that they are cherry-picking the numbers.

Before engaging Gottlieb’s argument, I should acknowledge that, as I have said in an earlier post, I think Edwards has picked a bad case to make his argument for healthcare reform. I am not at all certain that the transplant would have helped this particular patient.  And while Edwards puts all of the blame on CIGNA, Nataline’s insurer, I am bothered by the fact that the hospital asked for a $75,000 down payment on the surgery and then refused to go forward without it. As one physician/blogger from the very same hospital where Nataline was treated asked: “Why didn’t the hospital simply perform the surgery and defer payment from the family or CIGNA [Nataline’s insurer] until later? If it was such a great idea, why didn’t they exhibit the outrage and strength of conviction to go ahead regardless of CIGNA’s assessment?”Continue reading…

POLICY: Can You Really Mandate People To Buy Health Insurance? by Robert Laszewski

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RobertlaszewskiThis evening THCB welcomes our newest contributor.  Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog. Can you really mandate people to buy health insurance? That’s not so much a policy question as a practical question and it is what Hillary Clinton seems to be saying
is the big difference between her health care reform plan  and the health reform plan of Barack Obama. That’s why a news story this week out of Massachusetts caught my eye.

It seems that the Mass Department of Revenue is in the process of drafting new regulations to up the penalty for people who do not buy health insurance. If they are approved, the maximum penalty for those who do not buy health insurance would jump from $219 per year to a maximum of $912 in 2008. The penalty is estimated to be half the per person cost of the lowest priced health plan available.

Penalties would vary by age and the time a person was without health insurance.
A 26 year-old would have a penalty of $672 per year and those over 26
would pay $912. So, a family of two adults over 26 would pay about
$1,800 in penalties if they didn’t buy health insurance (a reader has correctly pointed out children are not covered by the mandate).

Continue reading…

POLICY: Self-employed, and going it alone

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If you want to understand why an individual mandate in a community rated state won’t work without both significant reforms to the insurance systems and a whole new range of taxes and subsidies, read this experience of a healthy mid-20s writer in New Jersey who’s self-employed, and going it alone. Of course if she was living in California, she’d be able to buy a much cheaper policy–but then no sick person in California can get individual insurance.

Perhaps enough of this and it will dawn on people that we need a single pool funded by ability to pay….

On a side-note, any idiot can see that a single pool guaranteed universal system would help solo freelancers and small business people. And of course the NFIB leads the charge against it.

POLITICS: Just Saying No to crass politicization

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Yeah, I know it’s not likely that anyone will pay attention given the season, but I do feel that there are enough cases with which to bash insurers which are legitimate that John Edwards didn’t have to start politicizing one in which not only was the insurer’s argument pretty good, but about which a government-sponsored universal system would also have to make the same choices. So I’m up over at Spot-on about Just Saying No.

To separate himself from the Democratic front-runners former Sen. John Edwards has spent the last few days laying into insurance company, Cigna, for its failure to immediately approve a liver transplant for California teenager, Nataline Sarkisyan. That action, says Edwards, in concession speech after concession speech, is emblematic not just of the health care system’s break-down but of a failure of the current American political system.

Edwards like most Democrats wants a single payer health system and his plan is the closest of the three front-runners to providing one. But his advocacy of Natalie Sarkisyan’s case raise a question no one else seems to be asking.

Here’s the rest

POLICY: Ian Morrison–to be thrown out by the Paisley Fabianists club

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In a great article called The Fallacy of Excellence my old boss and friend Ian Morrison explains what we intuitively know. people don’t understand that more care is not better care. This is going to lead to lots of political problems as we get to righting the Wennberg-illuminated wrongs.

On the other hand, Ian’s lifetime membership in the Paisley Fabian Society will probably be revoked when they find out he’s been watching the Republican candidates debate…..

POLICY: It’s official–2 Trillion Dollars

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For everyone who’s been going on about our (adopt Dr Evil voice) 2 Trillion Dollar health care industry, it’s now official. The 2006 data is out and we’re at 16% of GDP, $2.1 trillion and $7,000 and change per head. Growth, somewhere at the bottom of the trough, is around 6.5%. That’s nominal not real of course, but it’s still way over the economy’s growth rate, and that gap will grow if/when a recession hits.

The major change of course was the introduction in 2006 of Medicare Part D which mean that drug spending increased at over 8.5%. But then again, they’re telling us that Part D was less than originally projected. Although I bet you no one in CMS (or now out of it) will tell you what really was originally projected, and in fact which of the many revised projections the $41 Billion costs of Part D was really below!

And of course assuming that cost increases were stable in 2007, we’re actually already at 2.1 trillion + 6%, or 22.35 trillion!

POLITICS: More on the Presidential plan comparison

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Long time THCB friend Steve Beller tells me this:

We’ve created a Comparative Analysis of Presidential Health Care Plans, which analyzes much of the details of Susan Blumenthal’s and Kaisers’ work in order to identify top candidates based on voters’ wants and needs. We’ve taken a unique approach in which the complex details are distilled into categories of strategies that simplify comparisons between the candidates, and we’ve included comments on the key factors (with several quotes from Maggie Mahar’s blog and input from Barry Carol). It then groups the candidates on whether they propose universal healthcare, and it  ranks them by the amount of attention they give to quality improvement and cost control. Then it matches the candidates to 18 types of consumers, which take into account their current insurance and health situation, their income level, and their support of good care for all.

Here’s the link.

Take a look and feel free of course to give your comments to Steve over on his blog or here.

Meanwhile as major bloggers are dropping like flies from the stress, (get soon well Om!), I feel good about the fact that I took the weekend off to go snow-boarding in some of the best powder the Sierras has seen in a while. And that’ll be all from me today!

Health Care’s Cold Truth: An Iowa Perspective – Michael Millenson

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Obama_webI am writing this blog from Cedar Rapids, Iowa, grateful that the
temperature has warmed from brutally
cold to pleasantly sub-freezing.
Fortunately, the warm feelings left by the extraordinary victory of
Sen. Barack Obama, the candidate for whom I was knocking on doors and
making phone calls these last few days, has trumped the temperatures.

Talking to real voters in the suburbs and rural areas surrounding this
small city provides a nice change from  the insular health care policy
world. For one thing, it reminds you that most people don’t care about
“policy,” per se, of any kind. Successful candidates connect first with
the heart and then the head. We instinctively believe that if we trust
a candidate’s values and broad beliefs, we will trust that candidate’s
detailed policy decisions.

Yet the sad reality is that a vast number of citizens won’t even make
that small emotional investment, and they don’t hesitate to proclaim
their apathy when you knock on the door or call. As much as you may
have heard about voters disenfranchised from the Iowa caucuses,
many more simply didn’t care enough to participate. That, alas, makes
Iowa quite representative of the nation as a whole. While Democratic
turnout at this year’s caucuses was double that of four years ago, that
merely turned a “tiny” slice of registered voters into a “small” one.

Continue reading…

POLITICS: The Crystal Ball – Healthcare reform in California

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I’m up over at Spot-on discussing why the opinion of 32 corn farmers in Iowa may not matter quite as much for health insurance as what’s going on in my fair state. The piece is called: A Californian Crystal Ball.

As ever come back here to comment.

Pretty much anyone interested in U.S. politics is focused today on
what 32 corn farmers in the middle of the country have to say about the
20-some people currently hoping to run the world by becoming President
of the United States.

And while health care concerns have figured in many of the
conversations the U.S. political press has had – or overheard – with
Iowa Caucus voters, it’s been a wild holiday season for California’s
health care system. The impact on what type of health care reform
legislation will eventually come to national attention is probably just
as great.

On Christmas Eve a California appeals court unanimously decided that
the way insurers have been practicing in the state for many years is illegal.
The case involving retroactive cancellation of policies was one that
the nice well-behaved non-profit California Blue Shield had fought in
the courts while its aggressive for-profit competitor, Wellpoint’s Blue
Cross unit, had settled.

Blue Shield maintained it had the right to retroactively cancel
those insurance policies for which it says that policy-holders had lied
on their applications. At first the series of stories, which started coming out last year and ended up making an appearance in Michael Moore’s Sicko,
seemed cut and dried. People who’d received expensive care were having
their insurance canceled for pre-existing conditions that they’d either
clearly disclosed on their applications, or couldn’t possibly have been
expected to remember. Meanwhile the behavior of the health plans was
shown to be particularly cynical, with one, HealthNet, actually paying out bonuses to staff doing "recissions" based on how many expensive policy holders they kicked off their rolls.Continue reading this post o ver at Spot On.com