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Tag: Policy

PHARMA/POLICY/POLITICS: November comes after September

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Interesting article in the WaPo about the impact of the donut hole in Part D on the Senior vote. I think it will matter, it will hurt the Republicans and the signs seems to be point that way in one House race in Florida. Of course whether it will matter enough to push the House over to the Democrats is another matter. But the most interesting stat in the article is buried on the second page.

Perhaps playing in Klein’s benefit: More seniors are finding themselves
in the doughnut hole as the election approaches. The Institute for
America’s Future, a group calling for the closure of the gap,
calculated that, on average, seniors who enrolled in the benefit at the
beginning of the year would have fallen into the doughnut hole on Sept.
22.

So this problem will get worse all the way up to election day, and the greed fest known as the Medicare Modernization Act (of which to be fair the greed of big Pharma was only one small part) may play a factor. And if it does, the obvious change that the Democrats would now put in the bill would be negotiated pricing.

That was not what Pharma wants, but of course it’s a maybe and the CEOs of big Pharma who pushed the bill through are leaving their posts and leaving the potential consequences to their successors. My guess is that those successors will wise up and figure out how to cut a more reasonable deal so that they are not so squarely in the gun sights when the nation has a real debate about health care costs in a few more years.

 

TECH/INDUSTRY/POLICY: Out with the trash

Just some quick Friday cleaning up of stuff I never got to but you should look at.

As you may have gathered I was crazy busy yesterday and am playing ubber catch-up on about 5 fronts today. Hopefully will have a little more insight for you on Monday. Have a good weekend!

POLICY: How dumb is the NY Times?

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Like a dog licking an open sore, the  NY Times again returns to the "we spend so much on health care because it’s worth it" meme in a ridiculous article called The Choice: A Longer Life or More Stuff. (This post was about a different NY Times author’s stupid article on the same subject last month). They then print a bunch of reader responses, sadly few of which point out the fact that compared to countries who spend less money we’re not getting "longer life" (although the first one does).

But none of them point out the simple truth. We spend that much because the system has been politically rigged so that it’s virtually impossible not to. There is no causal connection between the vague desire for increased life expectancy on behalf of the public, and the increase in health care system spending. But there is a huge causal connection between the desire for greater health care system revenue on behalf of the system stakeholders and the increase in health care spending– because we have a funding system set up on their behalf. Has the NY Times not heard of, say, Medicare Part D? Have they not heard of 30 years of Wennberg’s Dartmouth works which proves that high cost care has bugger-all to do with improved outcomes? This is like saying we need 5,000 nuclear warheads or a brand new attack fighter 15 years after the end of the cold war, or that the drug war is effective. It’s patently not because we need those things, but it’s because there are strong interests that have gotten them funded!

Why can the NY Times, which does occasionally notice the rape and pillage of the ecoonomy by the health care system (though not as well as the WSJ does), not leave this open sore alone? Perhaps Judy Miller has been reassigned to the health beat and is ghost writing all their stuff, being fed lines by the health care equivalent of the Iraqi National Congress. What other explanation makes sense?

 

 

QUALITY/POLICY: Futurist’s forecast from Clem Bezold

Clem Bezold from Institute for Alternative Futures (kind of the alternative IFTF) gave an overview of the conference and an optimistic 2016 forecast for the availability of broadband to the home, better knowledge and personalized tools that will work on that information. Then he gets a little more controversial, including personal values, need for universal coverage, end of life care in context, etc — all as part of care in 2016

His main talk is about accelerating Disparity Reducing Advances project—wants to accelerate the technologies and process that reduce the social disparities in health care. They are not looking at the bigger picture of employment, education, etc, (consciously) and its impact on health, but they think that they can make a difference in the health care provision and tech part. They’re trying to pick their targets. And the first one is:

—Prevent obesity in poor populations. That leads to different levels of action in diff government and social programs. but we need to change the social environment, including getting the right foods into the right neighborhoods, as well as doing the health care screening and pre-diabetes initiatives. So there are a whole variety of factors you;d get to for any diseases, and information therapy is a big part.

Some things they’re trying—working with cell phones (LG has launched a diabetes phone this month which has a built in test strip reader. Also looking at biomonitoring activity, all connected to cell phones infrastructure. But needs to be connected to services. There are proposals to say that spectrum should not be auctioned off, but instead should be free (internet telephony over free wiMax?). That will be all added to patient and care giver “navigation”.

His forecast for monitoring. By 2008 standards for biomonitoring; by 2012 reimbursement has changed so it gets pay for; by 2016 common in us for monitoring the chronically ill and elderly. My feelings that this is about right, but it’ll require a whole hell of a lot of changes in the system…and of course there are huge infrastructure issues for the lower income providers (tech access, language, etc) which Clem spelled out clearly (and far too quickly to note down easily!)

Clem is an “aspirational” futurist who’s trying to change the future as much as explain it. At IFTF we were “analytical” futurists, and we derided the aspirational guys as the “personal helicopters by the year 2000” school of futurist — but his talk was really interesting, and frankly alot of analytical futurism is by definition wrong. So hopefully Clem provoked some big goals that we should all be going after.

I asked him about the norms of advertising for food and obesity—he thinks policy things can be done. And also about the system change required for home monitoring? How can the system change? He thinks that health care will be redesigned the hard way, otherwise it’s a perfect storm. It’ll get worse before it gets better. How do you get the patients and care-givers in the right place within the system. We will re-torque our use of health care providers to make that change.

Josh Seidman put up the Ghandi mantra “First they ignore you, then they laugh at you, then they fight you, then you win.” I think Ix is still being ignored, but soon it’ll be heading to the “fighting” part—and that is when it’ll get brutal.

Meanwhile in a moment of Ghandi zen, here’s a photo of a balloon over the canyons this morning

Photo_092706_001

POLICY: The Uncertain Future of Public Retiree Health Coverage

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Brian Klepper has been warning about this for a while. Public agencies have much better benefits for their employees than their private equivalents. And they don’t account for those future costs. There is a FASB106 moment coming up—it was FASB106 that inspired private corporations to push managed care in the 1990s by forcing them to put their future health care liabilities on their balance sheets. Same thing is about to happen to government agencies, hence the new CHCF focus on The Uncertain Future of Public Retiree Health Coverage.

“These accounting changes will illuminate the significant and growing impact of retiree coverage on many public agency budgets,” said Marian Mulkey, M.P.P., M.P.H., senior program officer at the California HealthCare Foundation. “Difficult decisions about spending priorities will follow.”“By confronting this issue head-on and weighing options, elected officials, administrators, unions, and other decision-makers can begin to identify remedies to this complex problem,” said Dr. Smith.

In other words the brown stuff is about to fly through the air to hit the whirly thing. 

POLICY/HOSPITALS: UNC relents from going after the house

• 3

Jerry Ansley has had a pretty tough time, catching encephalitis, going to the hospital alot, and losing his life savings because whatever level of health insurance he had wasn’t enough. The good news is that after lots of pressure Univ of North Carolina Medical Center has relented on its legal claim to go after his house—all he had left. Nice, eh.

This is the kind of horror story that we’re going to see lots and lots more of in the coming years—especially next year when Jonathan Cohn is going to become a big media star after his sifting through the appalling underbelly of the insurance market, or the lack of it, appears in print.

INDUSTRY/TECH/POLICY/HOPSPITALS: ID Theft Infects Medical Records

In an LA Times article called ID Theft Infects Medical Records Joseph Menn tells several terrifying stories of people who have had their identities stolen by other people who have used them to get medical care. Not only does this give those people the nightmare of having to try to deal with bills and insurance hassles (as if they weren’t bad enough already) for medical care that was done to someone else, but it also means that false information arrives on their medical records. One victim went ot the hospital for a heart attack and was nearly treated for diabetes she didn’t have. That could of course be fatal, if a healthy person was given insulin, for example.

Lots to think about for health care organizations and the rest of us in this article so read it all!

HOSPITALS/POLICY: Another hospital CEO calls for single payer

I put this up because you guys love this type of thing as an open thread. Albany Medical Center chief calls for hospital reform and single-payer system.  Albany Med Center is a monopoly non-profit provider, so it’ll do fine under single payer, but maybe not quite as well as it does now—but it’ll save a bundle not cahsing up its uninsured and charity care.

Oh, and by the way, just in case you were surprised the Senate Finance Committee has found that non-profit hospitals don’t really deliver any more charity care than for-profit ones, and as the list of Boston Hospital CEO salaries makes clear, their senior executives aren’t exactly beggaring themselves working there. Which confirms my conclusion that there’s little difference between them and that we should get rid of the distinction one way or another—and make them look like old fashioned public utilities. (Maggie Mahar is slightly more charitable about the non-profits, but not much)

 

POLITICS: McLellan–a man too soon?

The NY Times calls McLellan’s resignation the Departure of a Pragmatist. The basic problem was that his “reign” at FDA will be remembered for the pained look on his face when he was forced to defend the ban on reimportation on 60 Minutes, and the horlicks that was the introduction of Part D. He never looked too happy defending the stupid industry-based bills that the Congress sent him.

What he really wanted to do of course was turn Medicare into a real influential purchaser. There’s going to be a huge political fight about that, but it will happen eventually. And that’s a role for which he’ll be much better suited. Perhaps he’ll come back then?

POLICY/BLOGS: Comments, and debate right here on THCB

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It’s Friday, it’s still the late summer, and people are drifting back to work…few comments on any of the posts. But wait!

On one tiny post here on THCB, debate and comment fever has broken out with over 65 back and forth comments. If you’ve missed it, go look at the debate, largely inspired by Jack Lohman, who’s book on the corrupting influence of money on politics is the basis for quite some ranting—from a Republican who favors single payer no less!

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