Categories

Tag: Policy/Politics

HEALTH PLANS/POLICY: Ignagni–arguing out of both sides of her mouth, with UPDATE

My favorite lobbyist has a letter in the NY Times.
In which she argues that beneficiaries save money compared to regular
Medicare, and (this is the fun part) if payments are reduced then this
will have to be reflected in more charges to the poor. I have a long reply to this in waiting, but I’ve been persuaded to give my shorter version a shot at the NY Times letter’s page. If they don’t want to print it, then I’ll be back here with the long and the short version later in the week.

UPDATE: Not that this will surprise anyone remembering Medicare Risk Plans putting their sign-ups on the second story of a walk-up (I know no one eve proved those stories in the 90s…) but the NY Times today has a story about sales abuses in the Private Medicare FFS market which sound very like long distance phone "slamming" of 15 years or so ago. Except of course the victims are a little more vulnerable. Even CMS (which is at least partially run by Republicans who approved of the MMA) seems a little distressed by what’s going on.

POLICY: Ezra Klein’s The Health of Nations

Now I’ve met Ezra I can stop calling him the young punk. He has written another excellent review of health care in universal coverage nations, including socialized medicine in the heart of America for our allegedly most treasured citizens.

It’s called The Health of Nations. Go read it.

It’s not entirely without flaws, almost all to do with the lack of good recent data that’s a problem with these comparisons and a need to conserve space. He skips over the UK’s private insurance system which enables the rich to trade up for elective surgery, and the recent increases in spending under Blair which have enable the Brits to buy spare capacity in private countries, (and ramped up GPs pay!). It would be nice to have Ezra do something similar on Japan and Holland (although Japan looks something like Germany plus a Canadian fee schedule, and Holland looks like an Enthoven-wet dream).

What’s also to some extent missing is the changes that have happened recently. Humphrey Taylor remarked to me on Sunday that Americans dont realize how much other systems are changing as ours essentially never does. The Brits have gone to 30% P4P in primary care; the Dutch to individually purchased insurance in a managed competition framework; the Danes and the New Zealanders have added rapid deployment of IT (100% EMR use in ambulatory care); whereas the Australians have added a private top up layer over their traditional socialized  medicine system; the Swiss have their individual mandate.

Of course all of these systems have their problems and all are changing; we’re stuck in 1991. And in fact the VA system, although it works very well it about to be hit with a wave of Iraq war vets who have real problems–and is unlikely to get the resources it needs to deal with them.

And although it goes without saying to those in the know, we should keep repeating that this is the only system that visits not only ill health on the unlucky but often financial disaster too.

BLOGS/POLICY: WorldHealthCareBlog

I’m in DC at the World Health Care Congress where I’m writing about speakers like George Halvorson from KP talking about health care reform (he’s right but wrong) and Tadataka Yamada from the Gates Foundation talking about health in the developing world. It’s all up on the WorldHealthCareBlog.org

POLICY: Criticizing Jonathan Cohn

OK, it’s official. All this congratulatory fawing over Jonathan Cohn and his book Sick is getting to me, and I have a real criticism about him. And it’s the topic of my column over at Spot-on today–Jonathan Cohn is Way Too Nice.

By the way, Jon is coming round for breakfast later—I’m going to interview him and see if he’s able to defend himself from that charge. Perhaps he’ll turn out to have a vicious streak that I don’t know about.

POLICY/POLITICS: Pat Salber on gun laws

In the wake of yesterday’s massacre in Virginia, here’s Pat Salber about the gun massacre on campus.

We need to empower and fund reputable organizations to perform the research on violence and violence prevention. (It has effectively disappeared from the Center from Disease Control’s research agenda in the last six years).  We need to put the health and safety of our kids ahead any other political agenda…can we possibly value  gun ownership more than the safety of our kids at school?

If our past actions are a predictor of the future, then this is what will probably happen.  Time will pass and the rawness of our emotions, so exposed right now in the aftermass of the Virginia Tech Massacre, will dampen. We will start to waffle on any enthusiasm to pursue rational gun control…we simply won’t care as much as the folks who profit from profligate sales of firearms.   And then we will be right back to where we have been for the last twenty or thirty years, waiting for one more (short-fused) time bomb to explode onto our campuses and into our national psyches.  

How many more school kids need to get shot to death? How much more campus blood and gore do we need to see?  How many more unbearable tragedies do American families need to endure before we finally stand up and demand a change in our national firearm policy?

POLICY/POLITICS: Universal Health Insurance and the NY Times–all hail Jon Cohn (with brief UPDATE)

In recent months, not content with letting Judy Miller transcribe enough Cheney press releases to sink us into a $1 trillion dollar/3,000 lives and counting quagmire in Iraq, whomever runs the New York Times’ health care coverage has essentially handed the keys to the liquor cabinet to a succession of idiots who wouldn’t know anything about health care if they were sober. It’s then printed a series of the most illogical, stupid and plain wrong articles about health care that’s so bad that I’ve run out of ways to describe how if the NY Times were a dog it could not leave its pustilent sore alone.

But Holy Cowdung Batman. Maybe there’s hope, as they’ve this weekend allowed Volvo-driving latte-quaffing liberal Jonathan Cohn—who actually knows something about the topic— to write a long article for the magazine. It’s called What’s the One Thing Big Business and the Left Have in Common? and the answer isn’t too surprising.

But now they’ve taken this timorous first step, what’s next for the NY Times— op-eds from Enthoven or Fuchs? Regular columns from Brian Klepper? Giving Ian Morrison or Robert Laszewski a chance to explain how health care really works? Cutting and pasting from THCB? I’m waiting!

UPDATE: I’ve added a permanent & free link to Jon’s piece so it’s not buried behind the NY Times firewall. He focuses on exactly the correct topic, which is "Do big business CEOs have the cojones to take on the health care industry," in other words to piss off all those drug and insurer CEOs they meet at their Wyoming hunting lodges. And of course can the ones who are losers in the current charade (Safeway, Costco, anyone with a union) persuade enough of their colleagues that they shouldn’t be competing over who can pay the lowest health care benefits–when WalMart seems to be winning that contest too. An excellent piece, so go over there, read it and ponder why the NY Times doesn’t print more like it as compared to the pustilent sore variety for which they seem to have such an appetite.

POLICY/POLITICS: Up at The Grauniad

My father would rolling in his grave if he wasn’t still alive. I, yup the guy who voted for Thatcher twice, have been given a column on the venerable web site of The Guardian–the paper of the wet liberal lefty chattering classes in the UK. I’m up explaining the Democratic Presidential candidate’s health plans or lack of them.

This past week saw the first debate among the Democratic candidates
for president about what has become the most important domestic issue
in American politics: the country’s failed healthcare system.
To serious students of policy, America’s healthcare is the most obvious
feature of its society and economy that needs correction. However, to
serious students of American
politics, reforms to the
healthcare system are the most difficult problems. Case in point: the
Democrats lost control of Congress in 1994 in large part because of
opposition to the Clinton healthcare plan.

The problem is that healthcare system reform will necessitate
controlling the system’s huge and growing costs – currently 17% of GDP
in the US against less than 10% in most of Europe. But those reforms
will need to cover the 45 million people who now lack insurance, as
well as reassure middle America that they will keep their coverage, and
not upset upper-income Americans and the senior lobby who are generally
happy with their doctors. And of course then there is the problem of
dealing with a powerful $2,000bn industry which has little interest in
seeing its bumper profits diverted.

POLITICS/INDUSTRY: Oooh, vicious but beautiful.

From my favorite Cal health care economist

Pisano is an HBS professor, and for HBS professors books are consulting platforms. A strong consulting platform must demonstrate knowledge of the sector (check), stroke the egos of industry leaders (check), profess a cataclysmic view of the sector if things go on the way they have been going (check), and then offer a simple-to-grasp solution.

I’m not sure they tend to bother with Jamie’s reason #1, though even though Herzlinger, Porter, & Christensen are straight onto #4.

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