Tag: Policy

PODCAST: Overtreated–Shannon Brownlee explains all

Oct 18, 2007• 4

Overtreated is a marvelous new book by Shannon Brownlee. Shannon is a former US News & World Report health reporter, and now is a Fellow at the New America Foundation (that’s the centrist third way Clintonite Dem one). In the book she’s essentially trying to channel Jack Wennberg for the masses, and you all know how important that is.

I spoke to her about the book, changing the perception about what Americans think about the power of medicine, and how journalists haven’t got much chance of changing what they write about health. It was a great conversation.

POLICY: While Politicians Battle Over Expanding SCHIP, Children Are Dropped From the Program by Maggie Mahar

Oct 13, 2007• 10

At the moment, nearly everyone interested in the S-CHIP debate is focusing on October 18, the
day the US House of Representatives will try to override the President’s veto of an expanded State Children’s Health Insurance Program (SCHIP).

Unlike many of the critics, I favor the expanded program. Briefly, here are a few things to
keep in mind:

First, under the proposal, 70% to 80% of children in the program would be from
families earning less than twice the poverty level ($20,650 for a family
of four).

Granted families
of four earning up to $60,000 a year would qualify for the program
in most states. But given the fact that the average annual premium for
family coverage is now pushing $13,000, it is not at all unreasonable
to suggest that families earning $$60,000 before taxes cannot
afford private insurance.

In theory,
maybe these families could buy private insurance just for their children,
but it’s hard enough to buy individual coverage (when you don’t
belong to a group) –try finding individual insurance that covers
children only.

POLICY: Michelle Malkin is really dumb

Oct 12, 2007

Yes, that headline is a blatant attempt to get some of the opprobrium Malkin and her nutty commenters are venting on Jon Cohn and Erza Klein.

A little background. Jon, being the sensible moderate, wrote a good article on why the SCHIP veto helps Universal Health Care, and then pointed out that the smearing of the kid from Baltimore whom the Dems put up to support S-CHIP was a dumb idea with lots on the far right failing to do basic fact checking. In fact the family in question was exactly the type that S-CHIP needs to help

In the NY Times today Paul Krugman puts this all into a little more narrow perspective. Suggesting that sliming Graeme Frost–the 12 year old kid in question, is just standard operating procedure for the Rush Limbaugh-types on the right, who have a pretty direct line into the Republican machine.

POLICY: Up at spot on–The Garden Hose Health Care Brigade

Oct 5, 2007• 13

I wanted to call it “Hillary Clinton meets Ann Rand,” but my Spot-on Editor decided that she really liked the notion of privatizing the fire department. So I’m up over there dissing on the The Garden Hose Health Care Brigade.

As ever come back here to comment.

The Perpetual Health Care Crisis By Jeff Goldsmith

Oct 3, 2007• 20

I began teaching health policy almost thirty years ago with Odin Anderson at the University of Chicago
Graduate School of Business. Like me, Odin was a sociologist, and one
of his hobbies was tracking the sociology of our nation’s “healthcare
crisis”. He found that the health care “crisis” waxed and
waned (as measured by press mentions and journal articles), but never
disappeared. It had been going on for twenty years by then,
so I guess we’ve now been in “crisis” for fifty years. The
American health care “crisis” is not acute illness – rather it is
like a chronic disease which flares up periodically, accompanied by
fresh prophecies of impending doom and calls for someone on a white
horse to fix the problem.

From 1970 to 1993, health costs
roughly doubled as a percentage of GDP. All the way along, prophets
of doom forecast that the country would simply fall apart when
health costs exceeded 8%, then 10%, etc. . Our economy somehow
continued growing and innovating, and the health system got steadily
more capable at managing our illnesses the entire time. No-one
I know would trade our present, very expensive health system for the
cheaper one we had in 1965 or 1980.

Then, during the mid- 1990’s,
a remarkable thing happened. For the first time since people began
tracking the statistic, health costs remained dead flat as a % of GDP
for eight years in a row. It is remarkable how little attention
this flattening got from the “crisis” mongers. When we finally
get this year’s spending numbers from the CMS Actuary, my forecast
is thathHealth costs will have been flat as a percentage of GDP for
the past five years if you include 2007. Five years isn’t “momentary”,
as Brian Klepper characterized this latest pause.

POLICY/TALKS: TONIGHT IN HOLLYWOOD!! Holt v Browning Logan Clements–better leave the kids at home!

Sep 27, 2007• 8

John Graham at Pacific Research Institute is obviously looking for trouble. So he invited two people who really don’t get on — at least in their online comments on THCB — to come comment about Sicko and the Canada-bashers response. I’ve of course had my say about both Sicko and the Canada-bashers before.

So if you want to see me square up to Logan Clements (who is replacing Stuart Browning, who’s cried off sick) hopefully figuratively and not literally, come down to the Pacific Design Center in West Hollywood (Los Angeles) on Thursday September 27th. Stuart and Michael Moore (by proxy) will be showing why making anecdotal poorly researched movies actually changes health policy for better but mostly for worse, and I’ll be explaining why neither of them would recognize real research if they tripped over it in the street.

The info is here–Sicko and its malcontents

I think I’m supposed to be defending Moore, by the way. But perhaps John will step into that void. Local LA Pol Bill Rosendahl will be refereeing! Should be fun!

Meanwhile see how many ridiculous claims and outright irrelevant rubbish you can find in the trailer in the Sicko reply under construction. It’s up on Clements’ site.

That should get the juices flowing

POLICY/HEALTH PLANS: Why Health Plans need to change their business model

Sep 26, 2007• 8

A reporter called about the PNHP which is running single payer ads attacking Hillary, Barrack and John Edwards. Why are they doing it? Because they want to make sure those guys don’t give into the insurers. Realistically there will be a role for insurers in any reform scenario, so it has to be the right kind of role. And that means their role has to change, alot!

Why? Look at this quote

"[Senator Clinton’s proposal] would have negative implications for managed care companies, since it would limit their ability to manage risk in their most profitable book of business (individual and small group), likely causing margin compression."

– Morgan Stanley analyst Christine Arnold tellsAIS’s Health Plan Week

That is dead right and also dead necessary. The days of Golden Rule taking over United are not over by any means, but they need to end some time. The health plans have to start to be responsible citizens. That means telling Wall Street to go fish for now. Are you interested, Karen? The long term alternative is not pretty.

POLICY: Clinton and Edwards Open the Back Door

Sep 25, 2007• 24

Frequent THCB contributor and healthcare rockstar Maggie Mahar is back today with her reaction to the health care plans recently released by the Clinton and Edwards campaigns. What does Maggie think? Read on, but the title should give you a very good idea of the general drift of her logic about what’s really going on behind the scenes. If you want more of Maggie head over to her new blog at The Century Foundation for your fix. You’ll also be well advised to pick up a copy of “Money Driven Medicine: The Real Reason Healthcare costs so much” one of the most incisive and comprehensive books to be written on this topic in the past 20 years, in my (admittedly slightly biased) opinion, if you haven’t yet done so. Thanks Maggie! – John.

By MAGGIE MAHAR

In Thursday’s Wall Street Journal former Massachusetts governor Mitt Romney underlined what is most exciting about Hillary Clinton’s new health care plan. Okay, Romney didn’t use the word “exciting.” But he did recognize the vital differences between Clinton’s new plan and the one she proposed to the nation in the early 1990s:

First, under the proposal rolled out last week, if people like the employer-sponsored insurance they have, they can keep it. Fine—but this is not what caught Romney’s attention. It’s the alternatives: “people who don’t obtain insurance through their employer are invited to buy a government-run, Medicare-like plan or enroll in the Federal Employees Health Benefits Program (FEHBP). And so, more Americans will end up in government-run insurance. . . . It’s the gentle slope to a single payer, socialized medicine model,” Romney warned.. [my emphasis.]”

Quite simply, Clinton has opened the door to the single-payer model—if people want it. The beauty of her plan is that no one is forced into a government plan. Americans will wind up in a Medicare-like plan only if they choose it over a private insurer.

Clinton is not alone. Last spring John Edwards unfurled a proposal that would force private insurers to compete with a public plan that he calls “Medicare-Plus.” Today, in a web-cast sponsored by the Kaiser Family Foundation, he reiterated his goal “to give consumers a choice; they could gravitate in either direction.”

One journalist on the panel was blunt: “Is this a back-door to single payer?”

Edwards liked the question. “That’s partly right and partly wrong,” he said, with a big smile. “It’s not intended to take us to single-payer. It’s designed to let Americans decide whether or not they want single payer.”

“If I wanted to go [directly] to single payer, there are ways to do it,” he continued. “The benefit of single payer is lower administrative costs . . .. Over time, we will see in which direction this system gravitates. There are benefits in the private system. There are benefits in the public system. The question is: which will be more attractive in the real world?”

To make it a fair contest, public and private systems would need to be operating on a level playing field, and both Clinton and Edwards seem determined to do that. First, private insurers would not be allowed to “cherry pick,” as they do now in most states, either by refusing to insure individuals who are sick—or by charging them exorbitant rates.

(This is one difference between the Clinton and Edwards plans, on the one hand, and Mitt Romney’s Massachusetts plan, on the other. In the Commonwealth, while insurers cannot discriminate against those who are sick, they can charge older customers twice the premiums that they charge younger citizens of the state. As a result, some of Massachusetts’ elderly cannot afford to participate in the state’s plan. They’re not poor enough to qualify for state subsidies, but they’re not wealthy enough to pay sky-high premiums. To “solve” the problem Massachusetts is “exempting” some 60,000 individuals from the mandate that everyone in the state must have insurance. So much for universal coverage. )

Clinton and Edwards, by contrast, are mandating that every American must have insurance, while pledging that the government will offer subsidies that make that coverage affordable for everyone. Today, Edwards promised subsidies for everyone earning up to $100,000, while last week Clinton stated that premiums (minus subsidies) will not exceed a certain percentage of a family’s income (She has not specified the percentage, nor whether the number would be the same for a family earning $35,000 as for a household earning $95,000.) Employers also will help cover the cost either by “playing” (providing coverage to their employees) or “paying” (into a large fund that helps pay for the subsidies and government plans.)

Both candidates insist that private insurers must offer full, comprehensive coverage that will be, as Clinton puts it, “equal to what Congressmen receive under the Federal employees’ plan.”

At the same time, while Clinton isn’t putting an explicit cap on insurance company premiums, she does seems to be putting an implicit cap on how much they can charge by saying that premiums (minus subsidies) cannot exceed a certain percentage of family income. This suggests that insurers cannot raise premiums past a certain point unless the government is willing to boost subsidies—and it seems unlikely that Clinton is setting up a system where insurers can keep raising the bar for government subsidies. As for Edwards, he has declared that under his plan, an insurers’ profits and administrative costs cannot exceed 15% of total premiums.

Think about it: if insurers can’t cherry-pick young, healthy patients, if they are required to provide full, comprehensive coverage, and if their premiums cannot rise above the government’s willingness to expand subsidies . . . won’t some just drop out of the insurance business?

Meanwhile those that remain will have to compete with a public sector insurer that should be able to provide more coverage for less. “Medicare-plus,” after all, won’t need to generate profits for shareholders and will have lower administrative costs (both because it won’t need to advertise nearly as much, and because it won’t be paying its executives salaries that resemble telephone numbers). I don’t see how private insurers could win the competition.

Of course there is always a difference between with candidates propose and the legislation a president signs. If elected, would either of these candidates stick to their guns or would they compromise with private insurers?

On the other hand, I wonder, how could for-profit insurers force a compromise? What could they say: “We don’t want to compete with Medicare-plus on a level playing field.? It’s just not fair!? We’re really not more efficient than government.” But I’m sure they would find an argument.

Still, today, Edwards declared that he would not compromise on making coverage universal—which means that it must be affordable, which in turn, puts a brake on insurers’ earnings growth.. Moreover, he went on to say that if he doesn’t get the full support he needs from Congress, he will go directly to the American people: “If Congressmen are reticent, I will go to their districts. This is what happened with Iraq. Republicans are shifting their positions, [not because of what is happening in Washington,] but because of what is happening [in their districts].

Clinton has said that she wants to draw the lobbyists who represent the for-profit health care industry into the discussion, but Edwards rejects this notion. “”Her lesson is, give them a seat at the table,” Mr Edwards said recently. “I think if you give the drug companies, insurance companies and their lobbyists a seat at the table, they’ll eat all the food.” (Financial Times, Sept. 19)

POLICY: Edwards copies my idea, and a damn good one it is too!

Sep 18, 2007

For a very long time I’ve been saying that the quickest way to get effective health care reform would be to kick Congress out of the FEBHP and make them all buy their care in the individual market. Well in his reaction to Hillary’s plan announced yesterday, John Edwards has stolen my idea.

Mr. Edwards, in remarks earlier today in Chicago, added a new proposal
to his plan: He said that as president he would press legislation that
ends health care coverage for the president, members of Congress and
political appointees on July 20, 2009, until the Congress passes the
Edwards health care plan.

This is the most impressive thing Edwards has ever said. I wonder if we can extend this legislation to include certain Wharton professors and employees of certain right-wing think tanks?

As for Hillary. She promised to bash insurers, and like the rest of the Democrats she wants to ban underwriting. Well here’s her plan. I’m not sure that there’s much in place in her plan to regulate insurers…although she may prove me wrong. Meanwhile I’m inclined to agree with Michael Cannon. This is pretty similar to Romneycare, although Mitt doesn’t want to admit to what he did in Massachusetts anymore, and Hillary does have the other wrinkle of extending FEBHP to the uninsured, and offering tax credits/subsidies with an individual mandate.

But essentially she’s hoping that this can be pushed through in compromise a la Massachusetts. The sensible moderates will wonder why she wants to strengthen the anachronism of employer-based health insurance, without putting a risk adjusting body in place. The right will say she’s extending FEBHP to all via the back door (much as Edwards is trying to semi-explicitly do with Medicare), and that eventually the tax credits and subsidies will lead to a government take-over (whatever the hell that means). And the left will wonder why she’s leaving the insurance companies in place at all.

My sense is that unless we convince Congress how bad things are via some innovative technique like mine or Edwards’, not much will happen for a few more years. Any worthwhile health care reform plan is too complex and too easily smeared to pass Congress unless the wolf is not only at the door but eating the children in the living room.

BEST OF: JD Kleinke talks about PHRs, Omnimedix and the Dossia controversy

Sep 16, 2007• 4

JD Kleinke is always one of the more controversial and fun people in health care policy and health care IT. He doesn’t just write about stuff–he also gets really involved. From his early days at HCIA to his more recent roles at Healthgrades. And now of course he’s the head of Omnimedix — which was developing the technology for the employer based PHR Dossia, funded by WalMart, Intel et al. But apparently not funded enough.

I had a wide-ranging discussion with JD about his policy work, his career, what he thinks about health plans, and what went wrong with Dossia. The interview is of course well worth a listen.