Tag: Policy/Politics

POLITICS: The Crystal Ball – Healthcare reform in California

Jan 3, 2008• 5

I’m up over at Spot-on discussing why the opinion of 32 corn farmers in Iowa may not matter quite as much for health insurance as what’s going on in my fair state. The piece is called: A Californian Crystal Ball.

As ever come back here to comment.

Pretty much anyone interested in U.S. politics is focused today on
what 32 corn farmers in the middle of the country have to say about the
20-some people currently hoping to run the world by becoming President
of the United States.

And while health care concerns have figured in many of the
conversations the U.S. political press has had – or overheard – with
Iowa Caucus voters, it’s been a wild holiday season for California’s
health care system. The impact on what type of health care reform
legislation will eventually come to national attention is probably just
as great.

On Christmas Eve a California appeals court unanimously decided that
the way insurers have been practicing in the state for many years is illegal.
The case involving retroactive cancellation of policies was one that
the nice well-behaved non-profit California Blue Shield had fought in
the courts while its aggressive for-profit competitor, Wellpoint’s Blue
Cross unit, had settled.

Blue Shield maintained it had the right to retroactively cancel
those insurance policies for which it says that policy-holders had lied
on their applications. At first the series of stories, which started coming out last year and ended up making an appearance in Michael Moore’s Sicko,
seemed cut and dried. People who’d received expensive care were having
their insurance canceled for pre-existing conditions that they’d either
clearly disclosed on their applications, or couldn’t possibly have been
expected to remember. Meanwhile the behavior of the health plans was
shown to be particularly cynical, with one, HealthNet, actually paying out bonuses to staff doing "recissions" based on how many expensive policy holders they kicked off their rolls.Continue reading this post o ver at Spot On.com

The Politics of Publicly-Funded Health Care – Brian Klepper

Jan 3, 2008• 1

Over at Health Care Policy and Marketplace Review, the always insightful Bob Laszewski walks us through the mechanics of the just-passed federal budget and its health care financing implications for SCHIP, physicians, hospitals, Medicare Advantage plans. This clear, common sense analysis is a must-read for anyone interested in how the budget process actually works.

The final bill had 12,000 earmarks,
testimony to continuing special interest domination over the public interest. Everyone facing
a cut got a reprieve, but all the same issues (and cuts) will be on the
table in the near future. Here’s one of Bob’s summary paragraphs.

Late in 2008, the docs will be facing
a 15% Medicare fee cut on January 1, 2009, SCHIP will be out of money a
few months later on March 1, 2008, the extra payments to Medicare
Advantage plans will present the same plump target, and we will know
who won the November elections.

So the cuts were held off. Nothing really changed. And once again,
our Congressional representatives on both sides of the aisle made
decisions that accrued much more to the interests of their contributors
than those they claim to represent.

California not really uber alles

Dec 26, 2007• 9

Late last week Brian Klepper stirred things up around here calling California’s health care bill Business As Usual. Over at Spot-on earlier this week I was a little more simplistic. I call the California approach The Last of the Old Solutions, largely because it keeps intact the employer-based health insurance system and doesnt include an effective individual mandate because that needs a real tax increase. (My original title of "California not really uber alles”was somehow vetoed over there—but here I’m in charge!)

As I say over there

If the goal is universal coverage, the pay-or-play system in which employers have to offer coverage sounds good – as well as familiar – but it doesn’t really get us there. Hawaii passed something similar in the 1970s and several other states have tried some variant and still no one’s really got close to universal coverage.

Please go there and read the rest and come back here to comment if you’re feeling bored at the end of the year!

POLICY: As Goes California, So Should Go the Nation, by Mary Kay Henry

Dec 19, 2007• 4

Now I can’t claim to be an optimist about the future of California’s health reform bill. But at least someone is. And that someone is SEIU Executive Vice President Mary Kay Henry. Here’s her take on the latest California news and why the SEIU is at least one union buying in.

ABx1 1: no, it’s not the holiday season’s hot new video game. It’s the bill name for historic legislation approved yesterday by the California State Assembly to make healthcare more secure and affordable for those who have insurance, and provide coverage to millions who don’t.

Months of intense negotiations drew on the collective creativity and wisdom of elected officials, consumer groups, healthcare professionals, and labor and business community leaders to generate the comprehensive plan. The measure has the potential to transform the healthcare reality for millions of Californians, and it will fundamentally change the healthcare debate nationally.

Policy- vs. Market-Based Reform: RHIOs as a Case Study – Brian Klepper

Dec 18, 2007• 2

Brian As Anonymouse insightfully commented, the Harvard team’s RHIO study in Health Affairs is very telling
about the barriers facing do-gooder health care projects. That said, I wanted to add two comments.

First, while RHIOs are unquestionably good public policy, what they might accomplish can be seen as counter to their interests of many organizations expected to support them. (The same can be said for EHRs, by the way)

Second, this is why health care reform will emerge not from within health care and not from policy, but from the marketplace, driven by non-health care interests.

Read the rest over at the Health 2.0 Blog

Bad Medicine: How The AMA Undermined Primary Care in America – Brian Klepper

Dec 13, 2007• 44

On Tuesday’s Wall Street Journal website, Dr. Benjamin Brewer describes
physicians’ reactions to the 10.1% cut in Medicare physician payments
that will take effect January 1. He argues that the onus will fall,
once again, disproportionately on primary care physicians, who are
already losing the struggle to keep their heads above water.

He is right, of course. There is no question that Medicare must rein in
cost. But the cuts are approximately the same across specialties and
therefore regressive. Insensitive to its distinct role, its lower
revenues and its high operational costs, they hit primary care harder
than they do specialties. Given its already battered status, the cuts’
impact on primary care could translate to real consequences this time.

POLITICS: Cohn on Obama; me on Cutler

Dec 10, 2007• 4

Jon Cohn’s TNR piece Mandate Overboard goes (in somewhat grueling detail) into a defense his estimate that a mandateless universal insurance plan will leave a substantial number uninsured. I’ll say it more simply.

Voluntary universal health insurance is a Harvard economist’s fantasy.

Obama’s campaign, meanwhile, is attacking Paul Krugman by showing that he said nice things about the Obama health plan before dissing it. But what Krugman’s been dissing is Obama coming out and attacking the mandates in Clinton and Edwards’ plan. Most of us thought that Obama was being late and careless when he introduced his plan (not to mention chose his adviser). Only when he started beating up Clinton on mandates did Krugman go after him.

Given that the majority of Democrats prefer single payer anyway I have no idea why Obama thinks this is good politics in the primaries (see the CODA). Although as I said in my Spot-on piece on Friday I think that he has no intention of introducing real health care reform in 2009 if he actually wins.

But then you get a Harvard economist saying this about mandates: “A better approach is to do everything possible to make it affordable and available. When it is, almost everyone will have it.”

I think by “it” he’s referring to health insurance and this is the same Harvard economist who thinks our current health care system provides “reasonable value”.

I am eagerly awaiting Cutler’s explanation of how he reconciles the “reasonable value” we are allegedly currently getting from the health care system with the presumably massive reduction in prices/costs of health care that’s going to be needed to make insurance “affordable”. I guess we’ll just be getting excellent value then!

CODA: By the way if you doubt that Democrats favor single payer then consider these two questions from the recent Gallup Poll:

"Do you think it’s the government’s responsibility to make sure that everyone in the United States has adequate health care, or don’t you think so?"

84% of Democrats say yes. compared to 54% of independents and only 32% of Republicans

"Which of the following approaches for providing health care in the United States would you prefer: replacing the current health care system with a new government run health care system, or maintaining the current system based mostly on private health insurance.”

41% say replace, 48% maintain.

This one isn’t broken down by party, but if you do the rough math it’s pretty damn clear that a sizable majority of Democrats prefer single payer, and apparently Stan Greenberg estimates that it’s the choice of 70% of primary voters. But as it doesn’t seem to impact their vote, I think that it’s not as important an issue as all that when compared to getting the Republicans out of the White House. Hence voting for war hero John Kerry and now the newly centrist Hillary Clinton and Barrack Obama.

POLITICS: President Obama’s Health care head fake

Dec 7, 2007• 6

So unlike Paul Krugman who’s just being critical of Obama’s lack of a mandate, over at Spot-on I think I see the political brilliance behind it–or am I just deluding myself? Come back here to comment of course:

It’s a perplexing time to be a liberal. A Martian arriving on earth,
having seen the Republicans pandering hard to their base in the
primaries would assume the Democratic base would be rallying behind the
candidate who held the correct positions in 2004, and be apologizing
for ignoring him last time.

SNIP

Getting to voluntary universal coverage by trying to lower encourage
lower costs and hoping everyone will join in will not work, and even
Obama’s main health care adviser admits it.
But this irrationality has got me thinking. Why is Obama trying to promote something he knows won’t work?

Read the rest at Spot-On

Meanwhile, there’s an almost companion piece also at Spot-on from Deborah Klosky. Interestingly, both pieces focus on misinterpretations of how our society
actually functions – Deb notes that assuming women will care for the old and
sick is as out-dated as assuming they’re able to stay home and care for their
children. Some are but many – most are not. She writes:

It’s the same problem as with caring for a child; our current
system relies on a mythical, anachronistic view – there’s a big happy family
living all together, with mom in the kitchen running the home front all
day.

Kind of like Obama – a little wishful thinking might go a long way. Read Deb’s piece also at Spot-on

POLITICS: Jonathan Cohn confesses on the Obama 15 million problem

Dec 4, 2007• 2

Apparently the 15m uninsured in Obama’s plan are all Jonathan Cohn’s fault. At least the picking up on that number by Hillary and Edwards in the debates, that is.

I’m still struggling with how Obama is correctly to the left of those guys on the only foreign policy that really matters but in a foolish place on health care. Anyone relying on David Cutler for advice on health care must be seriously internally conflicted over what the aim is! After all Cutler seems to be too.

More on that to come later this week; but my explanation is that Obama shares my belief that health reform is impossible in 2009—so why bother?

If Grady Fails By Brian Klepper

Nov 29, 2007• 6

In an extraordinary move earlier this week, the politically-appointed Fulton-DeKalb Hospital Authority, the governing body over Atlanta’s Grady Health System, unanimously and voluntary stepped aside, to be replaced by a new non-profit corporation. Projecting a $55 million deficit this year, the hospital had just three weeks of cash on hand. It needs $300 million immediately for sorely needed renovations, and must deal with $63 million in accumulated debt to its biggest creditors, Emory University Medical School and Morehouse School of Medicine. New oversight was the predicate for a hoped-for financial bailout from business, philanthropies and financial institutions.

Other Atlanta hospitals are undoubtedly concerned that Grady will fail, and will probably do everything possible to support a bailout. The last thing they want is for Grady’s patients to come to their facilities. Now would be a good time to rally business leaders and legislators, who nearly always go to fancier hospitals, which of course has been a big part of the problem.

Grady’s turmoil should be recognized as the first small shock of much larger seismic event, long in the making, a concrete sign of America’s relentlessly intensifying health care crisis. The wrath falls on our most vulnerable – those with health problems or with few financial resources – as well as on the institutions and professionals that care for them.