Eliot Spitzer has big health care reform plans. And why would he want to be left out of all the fun? Moreover, he has the big problem/opportunity of all that lovely WF&A in New York Medicaid
POLICY/POLITICS: Bush’s Health Plan
I’m up over at Spot-on discussing the basics of Bush’s Health Plan. Go read and return to comment.
I was awakened during my slumber through the State of the Union by a
mention from President George Bush of a health care proposal that I
almost agreed with.
No, I haven’t come around on health savings accounts, and association health plans.
Nor did I join the Republicans in their standing ovation for
malpractice reform. The Bush proposal that woke me up was the creating
a tax deduction for health insurance that would apply to everyone.
Potentially this really matters, and inside it is the germ of the right
idea. But I guarantee you that most Americans won’t have a clue where
this came from, and why it made it into the president’s speech.
Let me explain a little. Health insurance for the vast majority
of Americans (60%+) comes from their employers. 99.9% of Americans
think that this is a natural relationship that costs them nothing and
they, in general, have no idea what it costs their employer. This is
though a historical accident, with its roots in a wage freeze policy
during WWII when employers added benefits to attract workers because
they couldn’t raise pay rates. The idea became fixed after the Supreme
Court ruled that health benefits didn’t count as taxable income.
So, today, you’re better off getting insurance paid for by your
employer than taking the cash, getting taxed and buying the same
insurance yourself. Lately self-employed people have also been able to
deduct their health insurance costs so the only saps left paying for
health insurance with post-tax dollars are those who are not
self-employed, don’t get it from their insurers and actually buy it
themselves.
You may think that’s not very fair, and you’d be right. Which is why Bush’s proposal is interesting.Go on, Continue …
POLITICS: Obama seems to be coming at Clinton from the left
Although he’s regarded as a sell-out by Harpers, Obama seems to be taking the sensible tack that Hillary Rodham Clinton won’t survive the Democratic primaries based on her pro-Iraq war vote and her incrementalist health care strategy. Today he called for universal care by the end of the next Presidential term.
The AP report seems to think that makes him the same as Hillary and Dennis Kucinich. That’s just ignorance of the press. Clinton has been explicit about doing this incrementally and Kucinich has been explicit about wanting single payer. Obama is, my guess, too smart to lay out any specifics. But an incremental reduction over 10 years in the uninsured rate (as AHIP favors, for example) is not the same as universal insurance by 2010.
BLOGS: HWR up, feisty
And found at Health Affairs Blog.
POLICY/PHARMA/HEALTH PLANS: Michael Cannon doesn’t understand market incentives
Michael Cannon (sensible libertarian, Cato Institute) has noted that Those Who Sell Out Will Eventually Be Punished. What he means is that once the pharmaceutical industry did the “deal with the devil” in 2003 for the creation of Medicare part D, it was only so long before real price controls will be instituted by the government. That’s because at some point the seat of power will be inhabited by those working on behalf of constituencies who dislike having their faces ripped off, as opposed to those looting the Federal treasury on behalf of the rippers-off of faces. Now that a mealy mouthed effort at negotiation has been passed by the new Democratic Congress—one that will be quickly vetoed anyway—the first signs of this “punishment” are coming.
Of course he could have said this about 1965. In fact many members of the AMA & AHA said just that at the time and bitterly opposed Medicare. Then they enjoyed 15 years of incredible rising incomes with no efforts to stop them before DRGs et al in the 1980s. And even then their incomes continued to rise for another 15 years, and haven’t rally stopped. So punishment can take a long, long time in coming.
And that is just the point. Who was the MMA passed in aid of? It was passed for the senior management at the companies it benefited—people like Hank McKinnell, Bill McGuire, Larry Glasscock. And what did they see after it was passed? Their stock prices rise when the program cut in for them (04 for United and the managed care cos, 05 for Pfizer and the pharmas) which of course sent the value of their retirement packages go through the roof ($200 mill for McKinnell, $1.6Bn sh for McGuire, I believe). That’s a pretty good market incentive if you ask me! I’m surprised Michael’s one of those Keynsians worried about the long run. After all none of the people “selling out” gave two hoots about it; they believe in the power of market forces.
Of course, there will be a long run, and Michael is kind of right. But it’s not those doing the selling out who will be punished. It’s the successors of McKinnell, McGuire et al who will have some cleaning up to do.
QUALITY/INTERNATIONAL: More confusing international comparisons
I don’t know much about medical care, but I do remember that in Lynn Payer’s Medicine and Culture the most amusing factoid was that German doctors put people whose blood pressure was too low on medication to raise it. Does that mean that the study of blood pressure control reported on by the AP, which suggests that it’s lower here because of more aggressive prescribing than in 4 other countries, means anything in terms of reducing poor health outcomes? I doubt it. What about in increasing or reducing costs? I suspect you can guess my answer! Here’s the abstract.
This stuff always reminds me of the Philip Morris study of the costs of smoking in the Czech Republic. Hint: smoking lowers societal costs cause the smokers pay more taxes than anyone else then die off quick before they cost the taxpayers much!
THCB: Advert
Business of Healthcare Conference
Saturday Feb 3, 2007
Haas School of Business, UC Berkeley
Panels will include topics on Health Care IT, Health Care Policy, Payor/Provider, and more.
For further details, and to register please go to http://www.haashealthcareconference.org/
POLICY: The libertarian bickering conintues!
More bickering between Jon Cohn, me, and the sensible libertarians Arnold Kling & Clark Havinghurst over at Cato Unbound . It’s a follow up to the articles we all wrote, and now Kling replied to all three of us, we’ve all replied back, and he’s replied back too….all extremely good stuff!
POLICY/HOSPITALS: (Google) Mapping NYC Health Care Disparity: 1985-2007, by Mike Connery, The Opportunity Agenda
About 9 months ago research director of The Opportunity Agenda, Brian Smedley, guest-blogged on THCB about a New England Journal of Medicine study. his colleague Mike Connery wrote to me to tell me about this:
Yesterday, as part of our Health Equity program, we rolled out a new tool that I think you’ll find very interesting. The tool is a new website designed to visually illustrate the economic and racial disparities that exist in New York City’s health care system, and drive all New Yorker’s of conscience to take action by emailing their elected officials. It’s a Google Map mash-up that takes data on NYC hospital closures between 1985 and 2007, and overlays it on an interactive city-wide map that can display either the racial or economic demographics of the Five Boroughs during three periods: 1985, 1995, and 2005.
Using this tool, visitors can visually see how hospital closures disproportionately impact poor neighborhoods and communities of color. Text on the sidebar guides the user through each decade and demographic overlay, explaining the changing conditions of the city and the impact that closures have on underserved communities.But the site is more than just a visual resource, it is also a data-rich resource for researchers that contains a variety of reports and fact sheets (as well as data on the patient demographics, payer source, and quality scores for each hospital), a community forum for health care advocates and New Yorkers, and an activism tool that encourages New Yorkers to write to their elected officials in support of creating a health care system that works equally for all.
All data on the site is from the census bureau, the New York State Department of Health and the New York State Planning and Research Cooperative System. The data were analyzed by Darrel Gaskin of the Johns Hopkins School of Public Health. The Opportunity Agenda, in partnership with a coalition of NYC health care advocates, assembled this map in response to the activities of The Berger Commission (aka the hospital closures commission), whose recommendations are now sitting on Gov. Spitzer’s desk. You can find more info on the Berger Commission here.
When we talk about health care policy in America, very rarely do we mention the roles that class and race play in determining our access to and the quality of health care that we receive. Hope you find the tool interesting and useful.
PHARMA: Remember the AIDS medicine in Africa fuss?
Remember when big pharma got its PR arse handed to it for denying third world countries the right to make cheap generic AIDS medicines? There seems to be the same kind of controversy starting up with biologic products in cancer too. One to watch.
