Tag: Policy

Interview with Alan Greene MD, author of “Raising Baby Green”

Dec 21, 2009• 1

One of the most remarkable talks I heard this year wasn’t about health care. It was about food. Of course, food is very, very closely related to health and health is at least tangentially related to health care.

So I invited Alan Greene of drgreene.com (who is a friend and has spoken at a couple of Health 2.0 Conferences) to tell me about the new book, Raising Baby Green. It really is a potential way to change how Americans (and everyone else) eat, and to use the most important years (the ones we can’t remember!) to do it.

Most importantly Alan is starting a viral campaign to get this information into the hands of expectant mothers. For anyone who knows an expectant mum or someone who might be one someday, this book is very important. And the message needs to get out and get mainstream quickly.

Here’s the interview in which Alan explains how to feed kids right, and we do a little plotting in how to get this into mainstream child-raising.

Senate Deal on Health Care Bill Done

Dec 19, 2009• 52

By Matthew Holt

As it's a work day for the Senate worth reporting here that Ben Nelson’s vote has been bought for more Medicaid spending for Nebraska and a complex formula for States to opt out of exchanges being able to fund abortions. So presuming there’s no problems in reconciliation we can expect the reform bill to be done relatively soon. Full details on what’s in the new bill on Think Progress’ The Wonk Room.

The netroots left has been complaining loudly over the last couple of days since Lieberman was bought off by dropping the public option and the Medicare buy-in. Howard Dean and Markos of Daily Kos both called for massive changes to the bill, or killing it and the debate between the “sensible left” and the “this is a sellout to insurers” has got a little silly. However, (unless Bernie Sanders pulls fast one) none of the more left wing Senators (Sherrod Brown et al) are going to vote against the bill, so what we see now is what we get.

The real issue will be when the voting public finds out that nothing happens for 3 years.

MedEncentive’s Five Year Report

Dec 15, 2009• 11

By Matthew Holt

As many involved in the worlds of Health 2.0 and Information Therapy know, some of the most interesting experiments in the world of patient-physician engagement have been happening in the somewhat unlikely environs of small town Oklahoma. There the City of Duncan has put its employees (and their providers) into a system that incents (but doesn’t mandate) physicians to practice according to accepted guidelines, and incents (but doesn’t mandate) patients to read information prescribed by their physicians about their treatments (and tests them about it). The system then asks each party to rate the other.

It sounds simple and frankly, compared to much in health care, it is. The system is supplied by MedEncentive, an Oklahoma City firm led by the charming and engaging Jeff Greene. While I remain fascinated by MedEncentive’s program (and FD MedEncentive has sponsored the Health 2.0 Conference in the past), it’s perhaps grown a little more slowly than Jeff and other fans might have liked—given the scope of the problem.

But the results have been impressive in reducing costs (mostly by reducing hospitalizations) and increasing patient involvement. Yesterday MedEncentive released a five year retrospective. The key finding?:

City of Duncan costs for the most recent year was 8.6% less than five years ago prior to implementing the Program, which is 34.9% less than the projected costs. The resultant four year savings equates to an 8:1 return on investment. (emphasis added)

Jeff abandoned a lucrative business in physician practice management to have a go at this intractable problem. Five years on he deserves plaudits for what he and his team have achieved, and hopefully we’ll see much more innovation like this mushrooming in the future.

Given the relatively lightweight nature of the intervention, I’m amazed that many much larger payers/employers haven’t given it a try. After all, whatever else they’re doing doesn’t seem to be exactly working too well!

Joe is kicking them when they’re down

Dec 14, 2009• 16

By Matthew Holt

From a deeply depressing survey of the unemployed in today’s NY Times:

Nearly half of respondents said they did not have health insurance, with the vast majority citing job loss as a reason, a notable finding given the tug of war in Congress over a health care overhaul. The poll offered a glimpse of the potential ripple effect of having no coverage. More than half characterized the cost of basic medical care as a hardship.

Meanwhile what is Joe Lieberman concerned about? Playing politics against liberals who, correctly, think he erred terribly in his support for Bush’s war and McCain’s candidacy.

And even if we pass legislation, when does the help arrive for these unemployed? 2013.

Convergence and the Death of the Public Option

Dec 10, 2009• 9

By TIM GREANEY

So maybe the two parties are coming together on health reform after all. Last night we learned that after days of “secret talks” among the “gang of ten” the Democrats have reached agreement to restructure their health care proposal. The changes are significant:

– ditch the already-watered-down public option plan;

– create a new insurance exchange “option” for individuals and small groups consisting of a nonprofit plan as negotiated by the Office of Personnel Management;

– expand Medicare eligibility to cover uninsured individuals aged 55-64.

What does the Democrats’ “public option ultralight” compromise have in common with Republicans’ alternative universe? Well, consider the latter’s proposal to open interstate competition for all health insurers–a move they promise will immediately lower health care costs. Besides being shameless attempts to offer simple solutions to complex problems, the two proposals are guilty of the same fundamental misunderstanding of health insurance. Simply put, they both ignore a critical economic truth of health insurance today: insurers require a provider network of hospitals and doctors or must have market leverage in order to negotiate for lower provider prices and for controls on excessive volume.

Making (sh)it up as they go along

Dec 9, 2009• 9

By Matthew Holt

So today’s news is that the gang of ten have come up with something. (If you haven’t been following along, the gang of ten are the five “liberal” Democrats and the five DINOs asked by Harry Reid to come up with something to break the deadlock and get some type of compromise that will pass the Senate). More details are here from Brian Beutler at TPM

So it might vanish like a Clinton-era trial balloon, or it might be a stayer, but the core of the new concept is to allow the 55–64 crowd to buy into Medicare, and to ask/allow/mandate a non-profit insurer(s) to provide a substitute public option. Exactly what the second point means is unclear to me. It may turn out to be some collapsing of Kent Conrad’s notion of the cooperative with an extension of the Federal Employees’ Plan (presumably minus the for-profit carriers) and somehow cramming that into the exchange. Of course providing something like the choice among private plans that Federal Employees now get was at the heart of Ron Wyden’s plan. We’ll see if it can last a couple of days scrutiny, or the wrath of the House Democrats.

The Medicare buy-in seems both sensible politics and half-decent policy.

Four grumpy lefties with Laura Flanders

Dec 4, 2009• 1

By Matthew Holt

Maggie Mahar, Jon Cohn, Jon Nichols and Olga Pierce hang out with Laura Flanders on the amusingly titled GRITtv and discuss how screwed up the politics of health care are in the Senate. Twenty minutes of amusing chat without a “moderate” or a Rpublican in sight. (Can’t get the video to embed here, so sneak over there).

Paul Starr agrees with me (or I steal from him–take your pick)

Dec 1, 2009• 3

By Matthew Holt

Paul Starr and I have been agreeing a lot lately. Not that Paul knows or cares what I think or say, but a while back we both expressed fear that private health plans will end up channeling bad risks into the public option. That time I beat him to the punch (but I happen to know his piece was on the way before I hit “publish” on mine).

This time he was out first. Last Saturday he reminded Democrats that the big deal is not what happens with the public option, but instead what matters is how aggressive and effective Federal regulation of insurance (via the exchanges) will be.

For these reforms to succeed, there needs to be effective regulatory authority to prevent insurers from engaging in abusive practices and subverting the new rules. The bill passed by the House would provide for that authority and lodges it in the federal government, though states could take over the exchanges if they met federal requirements. The Senate bill would leave most of the enforcement as well as the running of the exchanges to the states. Yet many states have a poor record of regulating health insurance, and some would resist passing legislation to conform with the new federal law.

Of course Paul was a major author/player of the Clinton plan in 1993–4, which had it been enacted would have been way more extensive and impactful than the current legislation—and in a good way. I fear that this time his influence will be equally lacking in terms of the end result. Which is a big pity.

The post-reform insurance market, or will Mega survive?

Nov 30, 2009• 7

By Matthew Holt

I had an interesting call from a member of the legal profession the other day, and it got me thinking about the post-reform prospects for my own particular collection of bete noirs—the insurers who prey on desperate people in the individual market. Yes, you can expect the subject of Mega Life & Health to appear later in this article.

Now some dummies are starting to complain about what, to this point, have been broadly accepted parts of the upcoming reform legislation. Robert Samuelson is a typical advantaged recipient of community-rated insurance yet complains about the same concept being extended outside his community-rated group made up of Washington Post employees. AARP suggests in response that he should be sending (his much younger WaPo colleague) Ezra Klein a check, as Ezra is in effect subsidizing Samuelson’s health insurance.

While the political cognoscenti is struggling with the public option and payment rates to rural hospitals (and other bribes needed for DINO Senators from Nebraska & Louisiana, and the NEDINO one from Connecticut), the real issue of health insurance regulation is getting scant attention. In particular three huge issues remain to be resolved:

Karen Ignagni tells the truth, unfortunately

Nov 29, 2009• 24

By Matthew Holt

There’s a big to-do about whether there are really any cost-saving measures in the House and Senate bill. Most people say that the answers are “no” and “sort of”. There’ll be much more discussion about that on THCB this week, and I suspect the answer will really come down to whether or not pilot programs which have the potential to reduce costs can be both successfully piloted, then extended by CMS and then protected from Blue Dogs, reps from academic medical centers, Republicans saving Medicare and basically everyone in Congress carrying the industry’s water. So “sort of” may well mean no.

But let’s not dwell on that. Instead let’s have some fun. Regular THCB readers will know that AHIP’s Karen Ignagni has told half-truth after half-truth after outright lie to protect the position of her members. All the while somehow holding together a coalition that really should have broken apart long ago (and may yet still do that). And she gets paid very well for that role.

But today in the WaPo she told the truth:

Karen Ignagni, president of America’s Health Insurance Plans, said the Senate bill includes only “pilot programs and timid steps” to reform the health-care delivery system, “given the scope of the cost challenge the nation faces.” Unless lawmakers institute changes across the entire system, Ignagni said in a statement Wednesday, “Health costs will continue to weigh down the economy and place a crushing burden on employers and families.”

Don McCanne (who runs the Quote of the Day service from the PNHP) puts the boot in:

There could not be a more explicit admission that the private insurance industry is not and never has been capable of controlling our very high health care costs. <snip> Karen Ignagni says that the lawmakers must institute the necessary changes across the entire system (because the insurers can’t). Let’s join her in demanding that Congress take the actions necessary, and then thank her for her efforts, as we dismiss her superfluous industry from any further obligations to manage our health care dollars.

And it’s basically true. Health plans have no ability to overall restrict health care costs. And worse, because they’ve been able to charge more to their customers than the increases they’ve received from their suppliers, they do better in a world in which costs go up.

Of course Ignagni knows that gravy train can’t roll on forever, so she’s trying to craft a future in which the health plans can continue to make money, yet not bankrupt their customers outright. Whether it’s good for the rest of us remains a very open question.

Meanwhile, in another example of catching someone saying something that they don’t really understand the meaning of, Uwe Reinhardt busts Sen. Kay Bailey Hutchinson (R-TX) as saying that not having insurance coverage is rationing and shouldn’t be allowed. Well she may know have thought she was saying that, but that’s what she was saying.