Regular readers will know that, last Sunday, I posted a column that pointed to HHS’ schizophrenic behavior when it comes to the release of Medicare physician data. First they fight the consumer advocacy group Checkbook.org’s lawsuit demanding the release of data in 4 states and DC. (The AMA’s Board Chair has admitted that they lobbied HHS to appeal the court’s finding that they should make the data public.) Then, a week ago last Friday, HHS announced a new program that would identify Chartered Value Exchanges (CVEs) in 14 communities – these are coalitions of employers, payers, providers and consumers – and then hand over the same physician data they’ve been fighting the courts to keep secret so these groups can combine them with data available from the private sector and create physician quality/cost report cards.
Hating employer-based insurance, Chelsea Clinton-style by Michael Millenson
Chelsea Clinton is complaining about her health insurance. As a self-employed consultant, I almost felt sympathetic, until I saw she works for an asset management firm, Avenue Capital Group, that manages just over $20 billion worldwide. They are able to accomplish this with just 350 employees spread out over (take a breath): New York, London, Beijing, Bangkok, Hong Kong, Jakarta, Luxembourg, Manila, Munich, New Delhi, Singapore, and Shanghai.
The company’s Web site says the core team has been together for many years, so I strongly suspect the pay and benefits are actually quite, quite nice. Chelsea told CNBC she is “not happy” with her health insurance, but she didn’t offer enough detail to determine why her health benefits are so markedly inferior to the ones her Mom enjoys as a senator and that she’d like all Americans to be able to access.
Avenue Capital is more colloquially described as a hedge fund specializing in the debt and equity of “distressed companies.” I thought only Republicans did that kind of work, but it turns out her boss is a big Democratic donor. Poor Chelsea — first Stanford, then Oxford, then McKinsey & Co., and now this, stuck with “job lock” in a career that pays an ambitious 27-year-old just a few hundred thousand dollars or so annually on her way to a dreary low-seven-figure compensation. Who knows what hardship her health plan forces her to endure?
Call me cynical, but for that kind of money, you don’t need to buy into your senator’s health plan — you can buy the whole senator!
Editors Note: It’s worth mentioning that although Michael is a general purpose cynic he’s also a declared supporter of Obama for President.
Sunday Morning Post, by Brian Klepper
Here’s a classical example of a federal regulatory agency holding fast to two opposing ideas at the same time. I wonder what it means?
Last week the Department of Health and Human Services posted an interesting notice announcing a new program that recognizes 14 (presumably) forward-thinking health care coalitions of providers, employers, insurers and consumers, which it refers to Chartered Value Exchanges, or CVEs. (Who comes up with these names?!) HHS promises that, by summer of 2008, it will provide "access
to information from Medicare that gauges the quality of care
physicians provide to patients." This "physician-group level
performance information…can be combined with similar private-sector
data to produce a comprehensive consumer guide on the quality of care
available" in each community. Cool! Sign me up!
Is Mandated Universal Coverage the Right Way to Achieve Health Reform? The Health Reform Debate We Haven’t Had Yet, by Jeff Goldsmith
I don’t know how many of you linked over to Lawrence Brown’s perspective piece “The Amazing,
Non-Collapsing US Health Care System” in the January 24th issue of the New England Journal of Medicine
(buried in Mathew’s “Whisper it quietly. . .” post), but it’s the most useful piece of political analysis of the health reform conundrum I’ve seen in a long time.
What Brown argues, convincingly, is that we really have three healthcare systems: public and private health FINANCING systems (which operate in the lucrative fantasy land of “reimbursement”) and a public CARE system (the safety net urban hospitals, community health centers, public health clinics, the VA, etc.) that serve the rural and urban poor and uninsured.
Other than a few isolated outposts like Kaiser, the third health system that Brown discusses is the only place in the United States where population health is actually practiced. And, most important, it is also is the mysterious resource that prevents the 47 million uninsured, including a very large number of our 12 million undocumented people, from dying in our streets, and causing a huge political crisis. It is invisible to much of the voting public, but thank God we have a safety net healthcare system.
This latter system has been a political stepchild of state and federal governments, and lurches from financial crisis to financial crisis, living off the land. But it has successfully propped up the other two, and, I think, helped prevent a revolution. Precisely because it has succeeded in reaching its target populations and helping them, albeit “too late” in the disease process, it has drained both political urgency (and funding) from making the first two “reimbursement” systems universal.
An Analysis of Senator John McCain’s Health Care Reform Plan By Robert Laszewski
Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.
John McCain’s campaign reinvigorated, I am reposting my earlier analysis of his health reform plan.
McCain very rightly points to health care costs as the biggest issue, "We are approaching a ‘perfect storm’ of problems that if not addressed by the next president will cause our health care system to implode."
Therefore, his focus is on the health care costs that make health insurance so expensive that individuals can’t afford it for themselves, employers can’t afford to provide it to their employees, and government can’t afford a wider safety net for the poor. He also reminds us that costs can’t be improved without dealing with quality in tandem. so expensive that many
What healthcare ideas did Edwards and Giuliani leave behind?
Craig Stoltz is a web consultant working in the health 2.0 space. He has previously served as health editor for the Washington Post and editorial director of Revolution Health. He blogs at Web 2.0 … Oh really?
Whenever candidates drop out of a race, the first question is, Who’s going to get the stuff?
News reports said that both Clinton’s and Obama’s people immediately starting picking John Edwards’ pockets–for delegates, supporters, fundraisers, gold teeth, etc.–while the former candidate’s body was
still warm.
Rudy Giuliani gave it all to McCain immediately. But it’s hard to imagine that there hadn’t been
negotiations over the former mayor’s little stash of blood and treasure before the announcement was made.
But what I want to know is a bit more focused, if wonky: What happens to Edwards’ and Giuliani’s healthcare ideas now that they’re gone?
First, let’s see if they had any.
POLICY: The Best-Kept Secret of Campaign ’08: A Bipartisan Solution to Health Reform by Wendy Everett
Wendy Everett is president of the New England Healthcare Institute. She thinks that the candidates for President from both parties agree on the important stuff for health care–dealing with chronic care prevention. I can’t say that I’m totally in agreement with her political analysis, but her ideas about chronic care and prevention for the basis of bipartisan action are interesting (and as Wendy used to be my boss at IFTF I thought that it would be polite of me to let her have shot on THCB!)
The presidential candidates are doing a disservice to the voters and to themselves when they emphasize their differences over how to fix the broken health care system. They can argue all they want about the likes of universal coverage, tax incentives and employer mandates, but that cacophony obscures the fact that the candidates, regardless off party, actually share a major position on health reform. Though little-noticed to date, there is a breakthrough bipartisan consensus that the key to health reform is to redirect the system to prevention and management of chronic illnesses.
This unanimity is huge. Chronic diseases – including conditions such as diabetes, asthma and hypertension – are a major threat to both our health and our economy. More than half of all Americans already suffer from one or more chronic ailments, and the rate is rising as the population ages.And the price tag is staggering. Some 80 percent of the more than $2 trillion in annual health expenditures already goes to taking care of patients with chronic diseases. A recent Milken Institute study found that in 2003, chronic care cost the country $277 billion for treatment and another $1 trillion in lost worker productivity. If nothing is done to halt the rise of chronic illness, the Milken Institute projects that treatment and lost economic output will rise to $4.2 trillion by 2023.
And yet much of this cost is completely avoidable.
Bill would make it illegal to feed the obese by Eric Novack
From USA Today:
Three legislators want to make it illegal for restaurants to serve obese customers in Mississippi.
House Bill No. 282, which was introduced this month, says:
Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management established under Section 41-101-1 or its successor. The State Department of Health shall prepare written materials that describe and explain the criteria for determining whether a person is obese, and shall provide those materials to all food establishments to which this section applies. A food establishment shall be entitled to rely on the criteria for obesity in those written materials when determining whether or not it is allowed to serve food to any person.
The proposal would allow health inspectors to yank the permit from any restaurant that "repeatedly" feeds extremely overweight customers.
While it has little support today…
And note that it has both Republican and Democrats as sponsors…
‘Health Care That’s Always There’. Really? by Eric Novack
We haven’t heard from our favorite orthopedic surgeon in a while but Eric Novack is back to change the world…or at least express his annoyance at some people in it! I suspect that we’ll be hearing lots of arguments like this in years to come!
The initiative that SEIU aims to get on the ballot this November to amend the Michigan Constitution:
Michigan Health Care Security Ballot Campaign – ‘Health Care That’s Always There’
The State Legislature shall pass laws to make sure that every Michigan resident has affordable and comprehensive health care coverage through a fair and cost-effective financing system. The Legislature is required to pass a plan that, through public or private measures, controls health care costs and provides for medically necessary preventive, primary, acute and chronic health care needs.
Will it pass? Should it pass? Who wins? Who loses?
QUALITY: Medicare Health Support–Done and more or less dusted
Recently the targets on Medicare Health Support were changed to make them more financially favorable to the DM companies running the projects. Everyone inside the DM industry has known that MHS has not been doing too well for some time now. But now according to Vince Kuratis’ blog, the preparations to pull the plug are well underway. Here’s Vince’s interpretation of CMS’ decidely low-key announcement of where MHS stands.
MHS is not meeting targets for financial savings. While it is theoretically possible that the MHS program could climb out of the hole financially during the remaining months of the program, we are doubtful that this will happen — so much so that we are scheduling the patient’s (MHS’) funeral even though technically we are not allowed to pronounce the patient dead yet. In the event that hell freezes over and the program revives, we will then schedule Phase II, but don’t hold your breath.
In a new twist on an old saying by Mark Twain: The rumors of MHS’ death have NOT been greatly exaggerated.
