Categories

Tag: Policy

POLICY: Great new site–Health08.org, and more on health IT in the election

Health08.org – Health care election news, analysis and events from KFF.

And it’s the baby of someone THCBers know and love but we can’t identify in public because the individual concerned used to have opinions, and KFF isn’t allowed to have them, let alone act on them—unlike the plethora of right wing think tanks that have been writing legislation in this country for the past 27 years.

Meanwhile Susan Blumenthal is back with her second in depth comparison of the election “positions” of the candidates regarding health care—this time focusing on health care IT.

POLICY: Lies, half-truths and irrelevancies in defense of mean-spirited politics

My spies tell me that this WSJ article by Bush adviser Allan Hubbard is packed with more half-truths per inch than even stuff emanating from AHIP. But I’ve lost my WSJ access, as as I won’t pay money to Mr Murdoch on principle –after what he did to NSW Rugby League–I can’t get only get the the first part unless I subscribe. Can someone send me the rest of the text?

As it turns out, the whole thing is a defense of the upcoming Veto for SCHIP renewal.

Continue reading…

Don’t Blame The VA

I never wrote too much about Walter Reed at the time of the scandal. But this week’s resignation of the VA Secretary, reported by the AP as being connected to Walter Reed, is now being used by some on the right to re-attack the concept of universal health care. It’s bad enough that I have to range the web to combat this misinformation. It’s almost worse that it comes from a fellow columnist at my “lay people’s site, Spot-on. So I’m up over there saying, Don’t Blame The VA.

I like to combat the odd Republican in my columns in Spot-on, but it’s fairly unusual that the object of my humorous chiding is a fellow Spot-on-er. But this week Scott Olin Schmidt reworks the tired argument over Walter Reed Army Medical Center saying that since the hospital was revealed as a disaster some months back the government has no hope of competently running health care facilities, and by extension no hope of successfully running any type of health care organization including health insurance.

The evidence that Scott introduces – based on a somewhat misleading Associated Press story – is that Jim Nicholson Secretary of the Department of Veterans Affairs (VA) has resigned, apparently because of the Walter Reed scandal. Scott then makes the huge leap to say that if you don’t want to see the kind of problems Walter Reed represents, then you should be opposed to the very notion of universal health-care. And for good measure, he suggests that it is all Hillary Clinton’s fault as she "would apply the VA model for healthcare to everyone with one single-payer."

The problems at Walter Reed were indeed severe, but they were mostly concerned with the incredibly disorganized treatment of outpatients, and their being housed in shameful conditions, while the system essentially ignored them. No one is denying that these were terrible problems, or that whoever was in charge should have fixed them. But blaming this on the VA as a knee-jerk reaction reveals a teeny tiny error.

Walter Reed is not a VA-run hospital. More

Come back here to comment.  UPDATE: Other THCB posts on Walter Reed and the VA worth noting:             "In Defense of the VA" by Maggie Mahar

            "The VA and Health IT. A model that works" by Maggie Mahar

            "A National Disgrace" by John Irvine

            "Army pledges fixes at Walter Reed" by John Irvine             "Debating the Quality of VA care" by Eric Novack

            

INDUSTRY: Medical Bankruptcy Rate Disputedby Eric Novack

For those who remember the endless headlines of "50% of All
Bankruptcies Due to Medical Debt", and particularly for those who have
based many calls for national, single-payer health care, on that paper
by Single-payer zealot David Himmelstein, here is a must read.  Law
professor Todd Zywicki, testifying at the US House of Representatives
Judiciary Committee, this week. The link to the testimony is a downloadable word file… all 21 pages are worth reading.

POLICY: Debating SICKO’s Impact by John Irvine

Since opening a week ago, Michael Moore’s latest documentary has focused unprecedented attention on the U.S. healthcare system. The film has brought angry protests outside movie theaters. Standing ovations from audiences. And provoked angry debate in the nation’s editorial pages. It has also done fairly well at the box office, drawing far more viewers to theaters than many experts had predicted.  According to the Hollywood Reporter, the film finished second in per-theater gross last weekend, bringing in $11.3 million at 700 screens across the country — rather a respectable showing for a movie that specializes in disturbing subjects that Americans would generally rather not talk about. So far, Sicko has generated exactly the kind of controversy that the critics predicted it would.  Moore has  already had to deny that he is planning a trip to Iran next month to view the film at an Islamic film festival. (The story turned out to be a rumor spread by conservative opponents.  The filmmaker says he received an invitation from the Iranians but declined to accept.) This week he was on CNN, lambasting the network for its healthcare coverage and getting into a near shouting match on The Larry King Show with medical correspondent Dr. Sanjay Gupta over some of the stats used in the film.

Moore went on to accuse the network of colluding with the film’s
opponents, pointing out that one of Gupta’s researchers, Paul Keckley,
the former head of Vanderbilt’s Center for Evidence Based Medicine and
a current Deloitte consultant, has done a lot of work for big health
insurers and pharma companies
. (Something that could be said of a fair number of people working in the field, as THCB readers know all too well.) Could Keckley be censoring the network’s coverage?  Moore wondered out loud to himself and not-very-subtly. 

The theatrics aren’t a surprise to anyone who has followed Moore throughout his
career. Not surprisingly, the attack drew a rather hurt denial from Gupta on his
CNN blog
.

Meanwhile, Moore is living up to his reputation for drawing attention to himself. Earlier this week, the filmmaker published a leaked internal memo on his web site allegedly authored by
the Blue Cross communications department.  The document reviewed the film – acknowledging that the documentary is a slickly done piece of work. [Follow the link and scroll down to read the whole thing.] The review begins as follows:

"You would have to be dead to be unaffected by Moore’s movie, he is an effective
storyteller. In Sicko Moore presents a collage of injustices by selecting
stories, no matter how exceptional to the norm, that present the health
insurance industry as a set of organizations and people dedicated to denying
claims in the name of profit. Denial for treatments that are considered
"experimental" is a common story, along with denial for previous conditions, and
denial for application errors or omissions. Individual employees from Humana and
other insurers are interviewed who claim to have actively pursued claim denial
as an institutionalized goal in the name of profit. While Humana and Kaiser
Permanente are demonized, the BlueCross and BlueShield brands appear, separately
and together, visually and verbally, with such frequency that there should be no
doubt that whatever visceral reaction his movie stirs will spill over onto the
Blues brands in every market."

Will the public hold health care providers and insurers accountable for the lapses Moore documents in his film? That remains to be seen. For many Americans who haven’t been paying attention, the documentary is undoubtedly a wake up call. There seems little doubt that people will start to ask more questions when they walk into their doctor’s office or when they sit down to pick an insurer, which is certainly enough to make some people uncomfortable. There is also little doubt that the film has added to the already fiercely burning debate between supporters of a free market based system and a government run universal healthcare system.

PODCAST REVIEW: Here’s THCB contributor Dr. Eric Novack’s take on the film from his radio show last Sunday. Two thumbs up? Er, No. Here’s Part 1 and Part 2. Eric and I will get into this a little later on, we hope!RELATED: "Sicko and Healthcare Reform", Maggie Mahar’s piece on THCB drew thousands of readers  and led to excellent discussion.

POLICY/POLITICS: Susan Blumenthal review of the Presidential Candidates’ health care policy

Susan Blumenthal, M.D. has created a side-By-side Comparison of all the Presidential candidates’ health care proposals. What does it tell you? None of the Republicans have a real proposal–Rudy Guliani has made some big statements about turning the system over to consumers but no one else — including Romney — has dared say much. While Edwards has a convoluted plan (courtesy of Jonathan Gruber) and Obama has been standing far too close to David Cutler, Hillary Clinton has only announced half of hers.

Of course none of it matters too much. The journey between here and real health care reform is a long, long one. But good job by Susan and her team to put it all together.

INTERNATIONAL/QUALITY: Reggie will be having a fit

I’ve always been amused that the most cited example of the “focused factory” that Reggie Herzlinger perceives to be the answer to  medical cost and quality problems is the Shouldice Institute in Canada. That’s right the country where it takes ten months to get a doctors appointment if you’re pregnant, and where the state controls all health care—concepts Reggie’s not so keen on.

And of course the nearest thing to focused factories in the US are the specialty hospitals which—given our incentives—make most of their money increasing the amount of care given to a set populations (probably unnecessarily) and taking the most profitable cases away from the local community hospitals and away from their mission of care, or their fat endowments (Delete half the previous phrase based on your stance on the matter).

On the other hand if focused factories were established within a cost-constrained environment, presumably we’d get a clue as to whether they are more efficient and save money over all. Well maybe we’re going to find out.

Apparently London is going to be transformed into a city of 200 large multi-specialty group practices with what sounds like specialty hospitals to handle the acute care. This is going to be very interesting.

Meanwhile, in Southern California a doctor buys hospitals, kicks out managed care, jacks up prices and makes bank. Tthat’s real value add to the system

POLICY/QUALITY: Klepper on cabbages and Kings (or Congress)

Brian Klepper, who’s traitorously now pimping himself out on other blogs, extends the post I wrote the other day on the CBO at Pat Salber’s blog The Doctor Weighs In. It’s called Mr. Orszag’s Surprise and it’s a very good summary of the CBO document.

Also by Brian is his description of his heart surgery five years ago this week. Moral of the story—choose your parents better.

Finally, I have no idea what to believe about the Peak Oil movement, but Dan Berdnarz’s piece on the impact of the end of cheap energy on the world and global health is pretty terrifying.