Tag: Policy

POLICY/INTERNATIONAL: The Dutch–Better than the US at football, drug-laws and health care organization

Sep 7, 2007• 4

The Netherlands is a small nation of only 16 million, and yet they have a record in International soccer that’s better than many three times their size. laws about drugs and prostitution that reduce crime, violence and embody toleration, and now they probably have the most advanced health care financing system in the world.

How so? It’s essentially Enthoven’s original managed competition idea in action (circa 1987). Even the Wall Street Journal thinks good things. The key is you need to ban underwriting, and implement risk adjustment (not that it’s easy but it is doable) between plans. Then you have to give the insurer and the insured incentives to realize that the way that population health is managed has ramifications for both the population’s health and its wealth. Then you get rational trade-offs made at a population level.

Can it happen here? I think so, unless you think that Americans cannot handle rational choice. Of course the people who claim to value choice in health care here can’t abide by the concept of the rational structure that the Dutch have put in place which allows choice to be made about the right things. So "choice" here in health care financing means, as the WSJ put it:

In the U.S., competition among insurers often means competition to find
the healthiest customers, especially in the individual market.

But of course if you don’t allow individuals to make the choice of what they spend collectively on a monthly basis to be the point of decision on how much is spent on health care (and put those intermediaries in the middle in the position of benefiting from lowering that amount in the "right" way), then the only other rational allocation is to have the government do it via the tax system.

CODA: I wrote extensively earlier this year on my comparison between the two and how different they both are from typical American notions of competition.

POLICY: What the lumenati are saying may surprise you

Sep 5, 2007• 14

Forbes has one of those “pics and words” articles about healthcare, with quotes from lots of smart and not-so-smart commenters. But I just thought it would be fun for you to read the quotes and then play the “who really said that” game. Here are some quotes I picked, not quite at random. After the jump, I reveal who said them with a little commentary

1) We want to get to 100% insurance coverage so the whole country is in the risk pool, which eliminates cherry picking.

2) The old managed competition idea from the Clinton years is still a pretty good one. The idea was to have some entity–employer, private or possibly a public sponsor–set up a menu of choices for people and give them a lot of information about each choice. Then give people a set of choices that range from basic coverage to highly generous, expensive coverage and let them decide how much money they want to spend. Subsidize lower-income people in some way, like refundable tax credits, to ensure people have money to buy good basic coverage, but then they’d have to add their own money if they wanted something more extravagant.

3) We have turned over $2.2 trillion of our money to those who manage our health care, without holding them accountable. Not surprisingly, these folks–hospitals, insurers, governments–used the money to benefit themselves

4) All of the incentives are pointed in the wrong direction.

5) The Medicare program needs to focus on being a more active purchaser. We need to consider an entire episode of care from start to finish to ensure a patient gets care in the most appropriate location … We don’t, at the moment, have a rational reimbursement structure for health care. You may pay more for a procedure at one location, and the quality of care may not be higher. Part of fixing that will take legislation.

6) Spend money on an information infrastructure. Then it would technically be quite possible to track what different hospitals actually spend on health care and what happens to these patients that get treated. Put that information on the web and let people see it to hold doctors and hospitals accountable for how they practice.

7) You need to have a private marketplace rather than have government control in the health care sector, and that means fixing the federal tax code.

You want to know who really said that? Read on:

POLICY: The DEA continue their sorry role

Aug 31, 2007• 1

In raiding like Gestapo officers and then shutting down all the medical marijuana dispensaries in San Mateo county Thursday, the DEA confirmed the sensible opinion that it’s ana gency filled with total scumbags. I guess we can blame the cowardly Democrats who did not vote to suspend DEA raids on medical marijuana dispensaries even when they had the chance to do so last month.

But what’s worse is that for the first time that I can recall local law enforcement in California joined in, with both the City of San Mateo PD and the San Mateo County Narcotics Task Force taking part. That’s just shameful behavior from those local cops, presumably incited by the DEA offering them a share of the take—as usually happens in these situations. Are they unaware of the local support for Proposition 215 and medical marijuana?

Clearly we need Federal resolution of this ridiculous waste of taxpayers money, and the consequent suffering of patients—but the local cops need to get a clue first. I sincerely hope that the citya nd county elected officials let them know about this.

POLICY: Guesses at important dates…

Aug 30, 2007• 7

In the comments to Brian Klepper’s piece yesterday, ~~troublemaker~~ commenter JD asks the following

Matt, I don’t know if you can do polls on this site, but I’d be interested to see what the readers here would guess as the date universal healthcare legislation passes. My own guess is that SCHIP expansion happens in 2009 (if not sooner), and effectively universal coverage is passed in 2011, effective in 2012. And my guess is that it is more like the Massachusetts model, actually, than Medicare-for-all. Idle wonkery, to be sure, but enjoyable idle wonkery.

I can’t easily put up a poll without pulling John off some real work, but you can all give your best guesses below. How about these three questions.

1) When will SCHIP pass?

2) When will comprehensive health care reform pass the Congress and get signed by the President?

3) When will we get to what reasonable people would agree was 100% universal coverage?

Have fun!

POLICY: Health Care Reform Now? Don’t Hold Your Breath

Aug 29, 2007• 3

While Brian goes into the details of what’s need for reform, it just so happens that a few weeks back I wrote an op-ed for the LA Times suggesting that the current “crisis” wasn’t bad enough. As (after soliciting the darn thing) they didn’t print it, I thought it was time to give it an airing and I’ve put up a version of it as my Spot-on piece for this week. It’s called Health Care Now? Don’t Hold Your Breath.

Judging by the number of articles about corporations, unions and politicians decrying America’s healthcare system, you could be excused for believing that we will have health care reform very soon. You’d be wrong. More

POLICY: Nanotechnology and the Regulation of New Technologies by Bart Mongoven

Aug 29, 2007

Bart Mongoven is a senior analyst with Austin based strategic intelligence consultancy Stratfor.com, where he tracks public policy. This piece first appeared in the Stratfor Public Policy Intelligence Report. If you find his analysis interesting, you may want to take a look at his earlier analysis of the issues facing California Gov. Arnold Schwarzenegger’s health reform plan. You also may want to consider signing up for their free email reports, which I find very useful and well-informed. — John

Researchers from the Woods Hole Oceanographic Institution and Massachusetts Institute of Technology on Aug. 16 released a study stating that the production of carbon nanotubes gives rise to the creation of a slew of dangerous chemicals known as polycyclic aromatic hydrocarbons, including some that are toxic.
Discussion of a new regulatory regime for nanotechnology has been ongoing among think tanks, advocacy groups and industry for years, and findings that suggest the sector could generate public health risks will add to the growing pressure on regulators or legislators to decide how to regulate it.

The debate over the regulation of nanotechnology has taken place on two levels. The first is over the public health risks nanotechnology poses and ways to determine and measure those risks. This is mainly the familiar risk-assessment process applied to the products of a technology that acts slightly differently than previous technologies do.
At the center of a second debate over public policies governing nanotechnology is an older, more contentious issue: the politicization of science and technology.

At issue is the point at which government is justified in stepping into the realm of science to stop or slow scientific research, regardless of whether harm has been done. This concern lay at the center of the early debate over biotechnology, and also played a role in the debate over federal funding of stem cells and bans on human cloning.

POLICY: Klepper, moonlighting again!

Aug 28, 2007• 1

Just when we thought we had him pinned down, Brian is moonlighting over at Bob L’s blog. His piece is called Solving the Access Problem Isn’t Enough If We Don’t Deal With Costs. Not absolutely true in my view. I think you need to do access first then deal with costs. He thinks you need to do them both together. But we’re both sensible enough to think that they’re both problems, and plenty of people—whether at Cato or at Harvard—disagree.

What Are They Thinking: ONCHIT and RTI – Brian Klepper

Aug 24, 2007• 16

I’m sure I don’t really get the deeper issues involved here, but sometimes its hard to not have your breath taken away by some people’s notion of a good idea. Maybe its because I’m not a true geek, but what I’m about to describe strikes me about the same way I feel as when I see a young adult with multiple facial piercings and hear her/him say "Aren’t these great!?"

Modern Healthcare has an interesting piece on a report that was developed by RTI, a contractor to HHS’ Office of the National Coordinator for Health Information Technology (ONCHIT). The report urges revising Electronic Medical Records (EMR) standards to make it easier for payers and the feds to access the records and spot fraud.

Now I’m as big a transparency advocate as the next guy, and I routinely explain to doctors how claims or clinical encounter data can be used to accurately rate their pricing and performance relative to peers within specialty. I believe we should use performance ratings to reward the high performers and to incent the poor ones to do better.

But to really get to the system we need, doctors first have to implement and use EMRs. They’re key to making the health system as a whole work better. Fewer than a quarter of physicians currently use them at this point. While there are still some buggy whip advocates out there, a large and growing number of doctors get that. Young physicians take it for granted.

Still, there are a lot of hurdles to installing an EMR system. They’re expensive. They force you to change your practice’s work flows. Some of the designs aren’t all that friendly. They’re complicated. And who wants to learn a new system. Heck, I know I’d like what it can do for me, but I haven’t gotten up the nerve to tackle iMovie yet on my Mac, and that’s about a tenth as complicated as an EMR with embedded practice guidelines.

We KNOW EMRs are a good idea but there are lots of reasons for doctors to say NOT YET. This Administration, to its credit (he said, grudgingly) has gloried in their advocacy for these new
technologies, what they can do, and how they can help improve quality and cost. (Remember Newt’s
line, "Paper Kills?")

So WHY would the guys leading the charge on EMRs announce that one of the really great things to use EMRs for when doctors finally bring them online is to WATCH AND CONTROL THEM MORE EFFECTIVELY.

Dumb, dumb, dumb.

But I’m sure I don’t see the big picture here.

Benign Neglect and the Nursing Shortage – Brian Klepper

Aug 21, 2007• 34

I sit on the Dean’s Advisory Councils of the Colleges of Health at two public universities in Florida. Both Colleges are led by extremely capable PhD nurses, and have a variety of programs that train students to be health professionals, including nurses.

A few months ago, I was startled when one of the Deans mentioned that
her Nursing program had 500 qualified applicants for 132 student slots.
In other words, at a time when the market wants her to gear up, she
turns away 3 qualified applicants for each one she accepts. As it turns
out, it’s a national problem. In 2006, Colleges of Nursing turned away 43,000 qualified applicants.

It’s not news that health care institutions face a critical nursing shortage. An April 2006 AHA report estimated that American hospitals currently need 118,000 RNs to fill vacancies. That number is expected to triple by 2020, to 340,000 vacancies.

Essential Reading: Laszewski on Rove and Medicare D – Brian Klepper

Aug 17, 2007• 8

All of us who have worked in policy during our careers know the old joke that there are two things you never want to see made: sausage and laws. Never was this more true than with Medicare D.

Earlier this week, Robert Laszewski at Health Care Policy and Marketplace Review wrote an eloquent and succinct piece called "Good Riddance to Karl Rove: How Part D Left An $8 Trillion Debt And Got Them Nothing," a genuinely damning indictment of the cynical use of power. Read Mr. Laszewski’s posts and you quickly get the fact that he is a keen, unbiased, open-minded, analytical observer of the Washington health care scene. His obvious knowledge about the circumstances and his stature lend terrific weight to his words. I’d urge every person who reads this blog to read Mr. Laszewski’s column, and to pass it around to your colleagues.