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Tag: Policy/Politics

Managed Care Redux – by Brian Klepper

• 7

Like democracy, managed care is a great idea. It’s just that its rarely been tried.

Even so, my guess is that its about to re-emerge in a new, improved form, and possibly with some other name. If the signs around us now have any meaning, it will be different than our experience of a couple decades ago, and much truer to the original principles and possibilities that first caught our attention.

Last week the New York Times’ David Leonhardt ran another pop health economics piece, exploring several presidential candidates’ notion that the savings captured by providing better care could fund the uninsured. He explains better care as really being prevention – making sure that patients get services that stave off illness – and better management of the care process once they do get sick. And then, quoting a variety of health care experts, he takes issue with the notion that these approaches actually produce returns-on-investment. The problem, you see, is that while you may save money on the diabetic who avoids hospitalization to get his foot removed, you’re spending money taking care of all those diabetics who wouldn’t ever have had a costly problem.

Continue reading…

POLICY/POLITICS: In which I try to make sense of one Republican’s uncaring careless approach to health care policy

• 4

I’m up at Spot-on trying to make sense of Giuliani on health care.

George W. Bush decided that the way to save his presidency from irrelevancy was to threaten a veto of a bipartisan extension of the Childrens Health Insurance Program (SCHIP). SCHIP was a program developed in bipartisan fashion between a Republican Congress and a Democratic President back in the halcyon 1990s. It’s been a relatively ineffective program in that there are still 8 million American kids uninsured at any one time. But, as Spot-on Christopher Brauchli said, it’s clearly better for those kids than nothing. And nothing has been the alternative offered since 2000.

The threatened veto must be driving any Republican running for election in 2008 berserk. "Republicans hate children" is shaping up to be the 2008 equivalent of 1988 "Democrats love criminals." You’d think that on health care, as with the rest of his disastrous policies, the Republican Presidential candidates would be running away from Bush as fast as they can. Instead we’re seeing the Republican front-runner, Rudy Giuliani, announce that the Democrats want to join Michael Moore in offering Cuban health care to Americans. Read it all

POLITICS/POLICY: Hillary kicks idiot butt

• 7

I’m not exactly a huge Hillary Clinton fan, but this brief video of her responding to an idiot questioner calling universal medicine “socialized” is pretty funny! Almost more amusing is that there was a Republican in the audience of African-American journalists!

POLICY/HEALTH PLANS: SCHIP passes the Senate, but I think for now Medicare Advantage is safe…for now

• 5

A version of SCHIP that doesn’t touch Medicare passed the Senate last night. It has a veto proof majority. Of course it now has to be reconciled with the house bill that raises more taxes and cuts Medicare Advantage. So this will now go one of two ways. Either the bills will get reconciled along the lines of the Senate bill and probably get signed by Bush, or the emerging bill will have a hack at Medicare Advantage and get vetoed.

My guess is that it’ll be the latter. It’s just too tempting for the Democrats to provoke the veto and then campaign on the fact that Republicans hate children. (Some temporary extension for the current SCHIP will be worked out as it expires in the background).

Meanwhile despite all the rhetoric remember this:

The Congressional Budget Office says the Senate bill would cover 3.2 million uninsured children, including 2.7 million who are currently eligible but not enrolled. The House bill, it said, would cover 4.2 million children, including 3.8 million already eligible for benefits. In addition, both bills would provide money to prevent 800,000 children now on the program from losing coverage.

According to KFF there are 8 million uninsured children today. So we’re only talking about covering up to half of currently uninsured kids. Which makes all the rhetoric about socialized medicine a little overblown. Even though unlike some of the more timid moderate Democrats I’m happy to say that socializing the insurance side of health care —as in putting everyone in one pool — would be a very good idea.

Meanwhile, perhaps the recent pressure on managed care stocks is a little over done? (Far be it from THCB to recommend a buy on UNH, but it’s at $48 which is way below where it’s been for a while!)

UPDATE: AHIP isn’t taking any chances, Its headline in its propaganda this morning is (I shit you not) "House Votes to Push Millions of Seniors out of Medicare Advantage"  Click thru and you can see a video of my favorite lobbyist telling only a small number of lies in 44 seconds. Did you know that Medicare Advantage is a "safety net" for seniors? Neither did I….

POLICY/INTERNATIONAL: John Cohn puts the boot in….nicely

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I told John Cohn a while back that he was just too nice, and that he shouldn’t engage in the pointless argument with the free-marketeers about whether we treat cancer better or worse than the Europeans—especially as we do so much worse on many other measures. But John doesn’t listen to me—instead he takes the cancer argument and uses it to stamp all over the free-marketeers. At some point the referee should step in and stop this fight…

Meanwhile here’s the real problem. Next to John’s article on the CBS site is a video of Bush, and this is the text below it:

CBS News RAW: President Bush announced new proposals for the tax code intended to improve health care. His ideas counter Democratic proposals to nationalize the system.

Please could someone at CBS or anywhere else find me an example of a democrat wanting to “nationalize” the system. “Nationalize” means the government owning the production/service a la the Post Office or UK NHS. Not even Dennis Kucinich seems to be in favor of that. So what the hell are they talking about? I don’t know but neither do they. And, as they’re controlling a major news organization’s output, that is the problem.

POLICY: Great new site–Health08.org, and more on health IT in the election

Health08.org – Health care election news, analysis and events from KFF.

And it’s the baby of someone THCBers know and love but we can’t identify in public because the individual concerned used to have opinions, and KFF isn’t allowed to have them, let alone act on them—unlike the plethora of right wing think tanks that have been writing legislation in this country for the past 27 years.

Meanwhile Susan Blumenthal is back with her second in depth comparison of the election “positions” of the candidates regarding health care—this time focusing on health care IT.

POLICY: Carmona rips White House

• 3

Carmon
Richard H. Carmona, Surgeon General (and new Healthline Board Member BTW) rips the Bush Administration which made him Surgeon General. He says it’s happened for a while, but apparently according to Koop, Satcher and other Surgeon Generals, it’s worse under this Administration.

"The reality is that the ‘nation’s doctor’ has been marginalized and relegated to a position with no independent budget and with supervisors who are political appointees with partisan agendas. Anything that doesn’t fit into the political appointees’ ideological, theological or political agenda is ignored, marginalized or simply buried.”

C’mon. Given this White House’s record, is anyone surprised? Should Carmona have been? And of course, when it happened, why didn’t he speak out and quit? Still, it’s good to hear about it now at least.

POLICY/POLITICS: Giuliani sorta has a health care plan

Great. So the fake hero who made millions out of talking tough has a fake health care plan. About as rational as Bush’s and very similar.

Giuliani has blasted Hillary Rodham Clinton and the other two top Democratic contenders for pushing "socialized medicine." Clinton, whose failed 1993 health proposals were dubbed "HillaryCare," has said she wants to cover all 47 million people with no health insurance. Giuliani makes no mention of covering everyone. His health care proposals instead mirror those made by President George W. Bush last year, including Giuliani’s proposal to allow families to set up health savings accounts of $2,000 to $6,000 to cover medical expenses, before insurance kicks in.Bush urged expanding such accounts and proposed tax incentives to encourage people to buy their own health insurance, instead of relying on employers. But his proposals were controversial, in part because critics said they would undermine the employer-based health insurance system. Experts said the youngest, healthiest patients would go into the private marketplace, leaving behind those with serious — and expensive — health problems.

No doubt he’ll find a criminal co-conspirator to help run it. What is Bernie up to these days anyway?

But what’s more concerning is that the actual Republican politics will be to attack the Democrats as promoting government-run Stalinist health care. This may well keep the status quo in place even if Rudy is the Republican who loses the election—which seems likely at this point.

POLICY/POLITICS: Wyden gets a noted conservative to join him

• 2

Ron Wyden’s interesting universal health care proposal, which is essentially a variant of managed competition with an individual mandate that decouples employment from insurance is getting some support. And notably it has a major Republican, Bob Bennett from Utah, signing on. (Following is an email Wyden’s office sent out)

U.S. Senators Ron Wyden (D-OR) and Bob Bennett (R-UT) are scheduled to join some of the nation’s top CEOs at a news conference this Monday, May 7, to announce new business support for efforts to reform the nation’s ailing health care system. Wyden and Bennett are the chief Senate sponsors of the Healthy Americans Act (HAA), the first bipartisan, comprehensive health care reform bill in more than a decade to guarantee health coverage for all Americans.

CEOs and business leaders scheduled to attend the news conference with Wyden, Bennett and U.S. Reps. Brian Baird (D-WA) and Jo Ann Emerson (R-MO) include Steve Burd, CEO, Safeway Inc.; Art Collins, CEO, Medtronic, Inc.; H. Edward Hanway, CEO, CIGNA; Nancy McFadden, Senior Vice President, PG&E Corporation; Steve Sanger, CEO, General Mills; and Ronald A. Williams, CEO, Aetna Inc. Baird and Emerson announced earlier this week that they will introduce the Healthy Americans Act in the House.

Realistically this isn’t going to pass any time soon, and if it did Bush would veto it. But it does set the groundwork for a universal insurance system compromise sometime in the future and at least Aetna and Cigna think that they’ll be better off taking that compromise than the alternative!

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