THCB

Categories

Tag: Policy/Politics

What do Johnny Cash and employer-based health care have in common?

• 2

By Robert Laszewski

OK, maybe it’s a stretch but bear with me.

I heard a senior exec from a big health plan say the other day that it’s hard to believe we will ever see the end of health insurance distributed primarily through the workplace in favor of an individual-based health insurance system. In fact, much of the health insurance industry is lining up behind staying with the system we know best and the one who has been our customer all these years–the employer.

That is understandable. As someone who came up through the ranks looking at the employer as the customer and individual health insurance as a minor product subset I have the same reaction.

But I will tell you that this idea of moving away from third-party employer pay and to a system of individual responsibility — or moving from defined benefit health insurance to defined contribution health insurance — has been coming on us for some time now.

Continue reading…

The Health IT politics overview (more from Ix)

By Matthew Holt

Up next at Information Therapy was Claudia Williams from Markle introducing Kavita Patel, Ted Kennedy’s staffer from the Health (et al) Senate sub-committee, and Joel White, a former Republican staffer now running the Health IT Now coalition. There was far too much agreement between Kavita and Joel for my liking!

Essentially they both agreed that the Federal government should pay something for Health IT, and Joel said that actually HHS is piloting spending up to $56,000 per physician to buy medical records.

Joel seemed OK with this—and like Newt Gingrich—seems to be OK with socialist mandates as the way to provide IT (that is, the government paying). On the other hand, Kavita wasn’t sure that the Feds should pay for everything and maybe the states and even consumers should be paying something. So I for one now don’t understand where ideology has gone in health politics!

But they were both confident that bipartisan legislation will pass encouraging Health IT (such as ePrescribing) via Medicare and other programs in the next Congress (but not this one) but both were a little concerned about the incentives problem. As Claudia said, Health IT leads to better quality, but Health IT won’t be widespread without a change in incentives.

CODA: Meanwhile and somewhat off topic, at the end Joel, (who’s now a fellow at Galen with Grace Marie Turner to give you a hint), went off on a rant about what was wrong with comparative effectiveness research. He recited PhRMA’s lines pretty well, but ran away before the mass ranks of Kaiser attendees surrounded him and pecked him to death. If you want to see some of the controversy about who has what to say about comparative effectiveness, look at what Merrill Goozner said about it last year.

The Massachusetts Question

• 6

By Robert Laszewski

Two years ago lawmakers in Massachusetts made the state the first in the nation to mandate that residents purchase health insurance. The proposal quickly caught on, inspiring similar efforts on the state level and eventually becoming the blueprint for the national health reform efforts of Democratic presidential candidates Sen.  Barack Obama and New York Sen. Hillary Rodham Clinton.

More than a year into the experiment the first returns are in.  And reviews are mixed. Not surprisingly, the program is costing far more than backers had initially predicted. On the other hand, the ranks of the uninsured in the state have dropped sharply. (See Matthew’s podcast with Jon Kingsdale, executive director of the Massachusetts Connector, the agency created to administer the program, for more on the back story.) The Massachusetts experiment  is clearly not something to be dismissed — nor is it something to
defend for the sake of argument.

In brief, the Massachusetts health care reform law appears on its way to:

  • Covering two-thirds of those who did not have health insurance on the day it was enacted — about 400,000 people by the end of 2009.
  • Covering most of those who were uninsured in households with incomes below 300 percent of the federal poverty level–below which the plan pays all or most health insurance premiums.
  • Offering health insurance plans to middle-income people that are still largely unaffordable for those families making less than $110,000 a year –– people for whom the state has generally canceled the individual mandate that they must buy coverage.
  • Racking up costs well above what was first estimated. The plan looks to be coming in 38 percent higher than originally estimated for its first year and the Governor is now estimating second year costs 50 percent higher than the original estimate –– from $725 million to $1.1 billion for the 2008-2009 fiscal year.
  • Developing an annual cost trend for the program’s insurance programs, Commonwealth Care and Commonwealth Choice, in the 10 percent to 15 percent range.

So, lots more people, particularly lower-income residents, are covered but the program’s costs are unsustainable.

Continue reading…

Until the middle class truly cares, forget about health reform

• 9

By THCB Staff

Regular THCB contributor Michael Millenson published an op-ed piece in Sunday’s Washington Post, in which he says that until health insurance truly becomes an issue of the white middle-class, politically, nothing will happen.

Michael’s words:

"Here’s a cold truth: Despite much media hand-wringing on the subject, most of us give about as much thought to those who lack health coverage as we do to soybean subsidies.The major obstacle to change? Those of us with insurance simply don’t care very much about those without it. It’s only when health care costs spike sharply, the economy totters or private employers begin to cut back on benefits that the lack of universal health care comes into focus. Noticing the steadily growing ranks of the uninsured, the broad American public — ‘us’ — begins to worry that we’ll soon be joining the ranks of ‘them.’"

"The responses I’€™ve gotten by putting my personal email on the page have certainly been … educational," Michael told us. You won’t get his personal email here — you’ll have to visit the Post for that.

The Long Baby Boom

By Matthew Holt

Last Friday I had a great chat with healthcare futurist Jeff Goldsmith about his new book, the Long Baby Boom. We discussed the policy and cultural issues of retirement, Medicare, Social Security, immigration, end-of-life care and meaning in work.  With 76 million baby boomers heading towards age 65, these issues or of  great importance.

Here’s the interview.

Optimism about the baby boomers

• 1

By Jeff GoldsmithIjeff

Jeff Goldsmith is President of Health Futures, Inc, and a professor of public health sciences at the University of Virginia. His new book, "The Long Baby Boom: An Optimistic Vision for a Graying Generation," will be released shortly, and Johns Hopkins University Press granted THCB permission to print the introduction in full.

Fresh from liberating the world from the Axis powers, America’s Greatest Generation came home from World War II and brought forth a baby boom. Seventy-six million children emerged from this remarkable postwar celebration, almost four children per family. American society has not been the same since.

The baby boom increased the U.S. population 44 percent in just eighteen years! American society had to re-create itself to accommodate the new arrivals. Each social institution the baby boomers touched, from elementary schools to university to the family and the work world, they fundamentally reshaped, not only by the press of their sheer numbers but also by their unique, high-maintenance approach to the world. At each turn in their lives, baby boomers have torn up the script and started afresh.

Today, the advance guard of this generation’s legions is within four years of reaching a bristling societal Maginot Line: age 65. According to many pundits and forecasters, the aging baby boom threatens the U.S. economic future.

Continue reading…

Obama’s health plan may promise less but accomplish more

• 11

By Diana Dutton & Hal Holman

Hal Holman is a professor of Medicine at Stanford University, and Diana Dutton is a research fellow at the London School of Economics and a former director of health services research at Stanford. The married couple supports Obama.

Obama
Many people think Hillary Clinton has a better health plan than Barack Obama. She repeatedly tells voters her plan will cover everybody, while Obama’s will leave out 15 million people. Newly emerging data tell a different story.

Since 2006, Massachusetts has been running what amounts to a pilot test of Clinton’s universal mandate plan, requiring all uninsured residents to buy private insurance or be penalized. The state regulates participating insurers and subsidizes costs for lower-income people. Yet after two years, nearly half of the uninsured still aren’t covered, despite strenuous outreach. To boost enrollment, Massachusetts has stiffened fines – up to several thousand dollars. Nevertheless, many people remain uninsured, citing more pressing needs. Clinton insists her mandate wouldn’t force people to buy insurance they can’t afford, but that’s exactly what’s happening in Massachusetts.  The state has had to exempt 20 percent of the uninsured because they couldn’t afford even subsidized premiums.

Clinton’s plan would also likely fall far short of universal coverage. She hasn’t said how her mandate would be enforced, but has mentioned the possibility of garnishing wages. Without affordable insurance, a universal mandate means little.

Continue reading…

AHIP & Health 2.0 — caveat whatever the Latin is for movement

• 3

By Matthew Holt

Last month, the trade group America’s Health Insurance Plans sponsored a seminar on Health 2.0 with Lynne Dunbrack at IDC Health Industry Insights and Roy Schoenberg from American Well. Any resemblance in Lynn’s presentation to the talk I’ve been giving since mid-2007 is I’m sure completely coincidental. (To be less snide, it’s all pretty obvious stuff, and many others are doing it, too). Meanwhile, next month at the big AHIP meeting in San Francisco, another analyst from a Massachusetts research outfit (Carlton Doty of Forrester) will be presenting on this “new” trend.

Now, I’m not exactly blaming these guys for getting into a good thing. Both American Well and David Sobel (who’s appearing with Doty) have been featured at Health 2.0 Conferences already, and Indu and I certainly didn’t discover them, the term Health 2.0, or the Internet. And given the “praise” I’ve heaped on AHIP and its President on THCB over the years, I wasn’t exactly sitting by the phone waiting for their call. Certainly slightly more, ahem, compliant pundits can do a great job instead — even if flying a guy from Boston to talk in San Francisco, when I could walk three blocks may not be the best use of their members’ money.

While it’s good that AHIP is introducing its member health plans to the potential of the Health 2.0 world, let’s not forget that the motivations of the organization don’t exactly square with where many of us think health care, including Health 2.0, should be going — and nor that matter do the Association’s  President’s public pronouncements fit with  the long-term interests of those of its members who do have something to offer society (e.g not Mega Life/HealthMarkets). Meanwhile, over the years, the quality of AHIP’s research and the veracity of its public statements about the value its members deliver to society have been laughable. So let’s be a little careful about AHIP’s role in Health 2.0

OK, rant over. You can all go back to Friday dog blogging

Charley

American Cancer gets hip on uninsurance

By Matthew Holt

The American Cancer Society is focusing all its marketing budget this year on the issue of uninsurance and is trying to get the message out in new ways to new audiences. Here’s one using rap/poet MIKE-E.