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Tag: Policy/Politics

POLICY: The liberal media maliciously tells the truth about Rudy, again

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There’s more Giuliani bashing going on in the liberal media. First in the NY Times Frank Rich goes after him via the seedy route of the forthcoming tell-all lawsuit from Bernie Kerik’s ex-girlfriend. (It’s good stuff–I’d recommend a full read). Now the LA Times‘ Ricardo Alonso-Zaldivar points out the modest fact that cancer patients who would luxuriate in Rudy’s free market health care concept would not (and cannot in most of today’s American health care) guarantee that they would get access to health coverage or of course the care that Rudy is so happy about. In fact the American Cancer Society has been feeding Bob Herbert a steady series of terrible stories of cancer patients who got financially and medically shafted by the current system.

Of course Rudy was at the time of his cancer treatment enjoying socialized insurance, at least insurance socialized across the group known as NY City employees. Of course since 1970 he’s largely been a Federal or city employee, so apparently social insurance is OK for him, if not for the rest of us.

And all of this is a great pity. As David Brooks suggests, there have been times when Rudy was not merely playing to the most unthinking elements of the conservative primary voters. Maybe we’ll see that again if he wins the Republican nomination, but he’s giving the Democrats plenty of ammunition for the general election.

CODA Uwe has a great zinger about Giuliani’s use of the socialized medicine system he controlled to help out an old friend in a letter to the NY Times Saturday.

POLICY: Low prices ain’t cheap enough

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Mercer says that the number of small businesses offering health insurance to workers went down last year despite the greater and easier availability of high-deductible and HSA plans.

Fewer small employers offered health insurance this year, despite
the widespread availability of new, lower-cost high-deductible
insurance plans, a survey released today by benefit firm Mercer shows.
Advocates of the high-deductible plans touted them as one solution to
the growing number of uninsured, expecting the plans to appeal to small
employers, who would continue to offer health insurance as a result.
"That’s not happening," says Blaine Bos, a Mercer partner and one of
the study authors. "In fact, the reverse is happening."The
study of nearly 3,000 employers found that the percentage of employers
with 200 workers or fewer offering any kind of health insurance fell to
61% this year from 63% in 2006.That drop came even as the cost
of high-deductible plans with tax-free savings accounts averaged $5,970
per worker per year. That was $700 less than a comparable plan without
a savings account and far lower than the $7,120 for the average HMO,
the study says.

HSA/HRA type plans are growing in the market, but not as fast as employers are dropping coverage.

Continue reading…

POLICY: David Gratzer, source of Rudy misinformation

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My, my. We can’t exactly be surprised that Rudy Giuliani is on the one hand telling yet more porky pies and on the other hand not contributing to the debate in health care—other than shouting “socialized medicine” as loudly as he can.

It’s interesting to note that Giuliani who’s playing a moderate has surrounded himself with some of the most extreme wingnuts in health care, including Sally Pipes and David Gratzer. (Full disclosure, I think David is a very nice guy, but I think he massively misrepresents the facts in his book—as we discussed when I interviewed him. Also Rudy does have Mark McClellan on the list, who’s not an extremist.)

But I can’t understand how Giuliani can possibly believe that surrounding himself with people who think that Medicare is evil socialized medicine (after all it’s single payer for seniors) is going to help him. After all Rudy will need all the moderate votes he can get if he’s around come November 2008.

But according to the Giuliani campaign Gratzer is “an expert at a highly respected think tank”. And Gratzer has the chutzpah to say that Commonwealth is biased! As if Manhattan has no views, and no opinions.

And of course the tosh about cancer survival rates has long been revealed to be crap by John Cohn & Ezra Klein based on Gerald Anderson’s work—differences in survival rats are all based on early screening and doesn’t show up in overall death rates. In other words there’s have a different denominator.

It is amusing that the Brits are now saying that their prostate survival rate is 74% not what Commonwealth reported a while back. But as I’ve explained at nauseum it’s all about picking your disease. If you want to pick a bunch of others, we do much much worse. And of course we’re paying way, way more.

But the real point is not that Giuliani is misrepresenting the cancer rates.

Continue reading…

POLITICS: Liveblogging Hillary, by Amanda Goltz

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Hillary Clinton did a live webcast on Tuesday night. Given what’s happening in less than 36 hours I was way too busy to watch it. But luckily for me and for you Amanda Goltz who works for a certain large hospital system in Boston was there to blog it for us. Thanks Amanda! And despite this being her first post Amanda seems to have got the cynical style we like at THCB down very quickly!

8:00 PM:  Right on time, Senator Clinton welcomes us to her webcast, where she will answer questions she has received in the past two days since she announced her plan. She tells me I can submit a question if I like, but somehow I don’t think she’ll be taking the on-the-fly submissions. 

8:12 PM:  Nothing that deviates from what she said when announcing the plan on Monday. She is going after private insurers and pharma, who may not be angels, but are not the only blot on an otherwise perfect healthcare system. She also just said something about putting doctors back in charge of your healthcare, which doesn’t even sound that good, when you think about it. I know she meant “as opposed to payers,” but I don’t want my doctor in charge of my healthcare. *I* want to be in charge of my healthcare. Especially since in the next answer she essentially announces that fat smokers will be required to take better care of themselves. It could be just a cliché or campaign saying, but it would have flown better if she had put the patient (or, “ordinary Americans like you and me”) in the middle of her new plan, not the doctor. 

8:16 PM:  Now she’s talking about the EMR’s magical ability to reduce waste and administrative costs. I wonder how an EMR is going to save $70B a year in administrative costs if no doctor uses it. The latest numbers show that only 25% of physicians in the US use an EMR, even with a number of robust solutions that have been on the market for more than a decade

8:18 PM:  She has gumption, though. She just said "I will inherit two wars: the war in Iraq and the war in Afghanistan." No "if I am elected," no "if I am in office," no "when I am in office."  Oh! And she just said "as soon as I am elected President." Evidently the primary process has already happened and we missed it and Hillary is the nominee. (By the way, she is talking exclusively about the war now.  Evidently, healthcare is so depressingly messed up it is easier to talk about the morass that is Iraq.)

8:22 PM:  Now she is talking about bolstering the VA, which is all very well and good, but it highlights the total disconnect you must sustain when proposing progressive healthcare policies.  You can’t EVER talk about anything that has a whiff of national, public, single-payor care; but you can and should talk all you want about providing exactly that model to specific (very large) populations, like the armed forces and veterans. The VA is huge now and is going to grow a lot in the coming years as the troops return from Iraq and Afghanistan with TBI, mental health issues, and a whole host of other stuff we’re going to need cutting-edge medicine to deal with.

8:25 PM:  She just said the forbidden "universal" word. She was talking about access to mammograms, which is pretty mom-and-apple-pie, but still. I wonder if she struggles not to fall into 1994 speech patterns of talking about healthcare, even though this plan is quite different. Maybe it’s enough that she is preserving the insurance model. I know this has been discussed here as a shortcoming  but it is so obviously a political accommodation I can’t find it in my heart to be surprised. She is making no change to health insurance as a concept, and it will still be administered privately.  She is essentially insuring the 47 million uninsured by pulling them onto the federal employees’ plans, with a range of products.  It’s more or less just a fix to the uninsured issue, so that’s why her use of “universal” struck me as unnecessary strapping on a big bulls-eye and asking someone to take a shot, especially when this isn’t really universal healthcare at all – you still have to buy it.

8:30 PM: She ends by saying "this is a uniquely American solution to the healthcare problem" (so I guess she is implying that this is not that commie pinko European Canadian healthcare.)  Topics she did not cover: improving quality and preventing medical errors; eliminating unwarranted variation in healthcare practice; bolstering Medicare in the face of the baby boomer retirement wave; price or quality transparency, pay for performance, what happens to Medicaid in her plan.

POLICY: Guesses at important dates…

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In the comments to Brian Klepper’s piece yesterday, troublemaker commenter JD asks the following

Matt, I don’t know if you can do polls on this site, but I’d be interested to see what the readers here would guess as the date universal healthcare legislation passes. My own guess is that SCHIP expansion happens in 2009 (if not sooner), and effectively universal coverage is passed in 2011, effective in 2012. And my guess is that it is more like the Massachusetts model, actually, than Medicare-for-all. Idle wonkery, to be sure, but enjoyable idle wonkery.

I can’t easily put up a poll without pulling John off some real work, but you can all give your best guesses below. How about these three questions.

1) When will SCHIP pass?

2) When will comprehensive health care reform pass the Congress and get signed by the President?

3) When will we get to what reasonable people would agree was 100% universal coverage?

Have fun!

What Are They Thinking: ONCHIT and RTI – Brian Klepper

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I’m sure I don’t really get the deeper issues involved here, but sometimes its hard to not have your breath taken away by some people’s notion of a good idea. Maybe its because I’m not a true geek, but what I’m about to describe strikes me about the same way I feel as when I see a young adult with multiple facial piercings and hear her/him say "Aren’t these great!?"

Modern Healthcare has an interesting piece on a report that was developed by RTI, a contractor to HHS’ Office of the National Coordinator for Health Information Technology (ONCHIT). The report urges revising Electronic Medical Records (EMR) standards to make it easier for payers and the feds to access the records and spot  fraud.

Now I’m as big a transparency advocate as the next guy, and I routinely explain to doctors how claims or clinical encounter data can be used to accurately rate their pricing and performance relative to peers within specialty. I believe we should use performance ratings to reward the high performers and to incent the poor ones to do better.

But to really get to the system we need, doctors first have to implement and use EMRs. They’re key to making the health system as a whole work better. Fewer than a quarter of physicians currently use them at this point. While there are still some buggy whip advocates out there, a large and growing number of doctors get that. Young physicians take it for granted.

Still, there are a lot of hurdles to installing an EMR system. They’re expensive. They force you to change your practice’s work flows. Some of the designs aren’t all that friendly. They’re complicated. And who wants to learn a new system. Heck, I know I’d like what it can do for me, but I haven’t gotten up the nerve to tackle iMovie yet on my Mac, and that’s about a tenth as complicated as an EMR with embedded practice guidelines.

We KNOW EMRs are a good idea but there are lots of reasons for doctors to say NOT YET. This Administration, to its credit (he said, grudgingly) has gloried in their advocacy for these new
technologies, what they can do, and how they can help improve quality and cost. (Remember Newt’s
line, "Paper Kills?")

So WHY would the guys leading the charge on EMRs announce that one of the really great things to use EMRs for when doctors finally bring them online is to WATCH AND CONTROL THEM MORE EFFECTIVELY.

Dumb, dumb, dumb.

But I’m sure I don’t see the big picture here.

A Broker Afterthought: An Acknowledgment, An Apology and A Criticism – Brian Klepper

In the comment section of my post on broker compensation, KWeller properly points out that 1) some states regulate broker commissions more stringently than Florida does and 2) I do a disservice to brokers who practice without financial conflict. He is right, and I apologize to anyone whose practice is at odds with my description.

On the other hand, as several other commenters noted, the practices I described are well-known and widespread, and they occur because the brokerage profession does not self-regulate very effectively. (If it makes anybody feel better – it shouldn’t – neither do many other groups of health care professionals.)

So if you’re not one of the broker’s I was referring to, please excuse me then for pointing to the poor behavior of your colleagues. I wouldn’t have tarred you with the same brush if you had held your fellow brokers to a higher standard of practice.

Consultants to Hospitals: Prepare for Transparency – Brian Klepper

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We must view and treat the community as the "owner" to whom we are fully accountable. Aggregate financial performance data, aggregate productivity performance and aggregate quality and patient satisfaction data belong in the public realm. How else can consumers make a decision to…support us?

— Rich Umbdenstock, President and CEOAmerican Hospital AssociationInterview in Hospitals and Health Networks, 10/18/04

Most health care professionals sincerely believe in performance transparency, especially if it applies to someone else. Three years after the encouragement of Mr. Umbdenstock and similar pronouncements by colleagues throughout the industry, many physicians, health plan executives and hospitals executives remain extremely resistant to public reporting of pricing and performance.

Norton Healthcare in Louisville KY has developed one of the most progressive and forthright quality reporting efforts in the country. On their site, they provide their performance figures on a range of indices, indicating where they fall above or below national benchmarks. (You can just imagine how thrilled their staffs were with this decision to "bare all." ) The home page for their quality section lists six principals that drive their reporting.

   1. We do not decide what to make public based on how it makes us look.

   2. We give equal prominence to good and bad results.

   3. We do not choose which indicators to display.

   4. We are not the indicator owner.

   5. We display results even when we disagree with the indicator definition.

   6. We believe unused data never become valid. 

Norton sets a fine example for hospitals. But now, as demands for transparency become more compelling, the mega-consulting firms, always quick to lead the way and claim credit once a trend has been firmly established, are throwing their hats into the ring as well, hoping to provide guidance for tidy if exorbitant sums.

And so it is not surprising that the consulting firm Grant Thornton, in its spring newsletter Health Care Rx, has a thoughtful, pragmatic article urging hospitals to review and potentially change their pricing, document justifications when necessary, and generally take steps to ensure that they’re prepared as transparency efforts become irresistible. Its a good piece and, for hospital execs, well worth a few minutes time.

The Presidential Candidates On Health Care

Over at the Huffington Post, Dr. Susan Blumenthal and her team at the DC-based Center for the Study of the Presidency, have released their third in a series of articles comparing the Presidential candidates positions on various aspects of health care. This piece focuses on their views on the scientific and medical research that underlie progress in public health.

This has undoubtedly been yeoman’s work for this group of researchers, and as the election draws closer we’re indebted to them for making these positions so clear.

My guess is also that this article’s topic is particularly dear to Dr. Blumenthal, who is a former Assistant Surgeon General and recent recipient of the
US Public Health Service’s Distinguished Service Medal.

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