I’m too lazy, stupid, busy to post anything here today, (although I’ll have something up at Spot-on later) but the commenters on the piece about CDHP’s that Brian Klepper wrote a few days back are kicking up a storm, and it’s interesting stuff. So please go read them instead.

This is a podcast that I’ve done with Michael Millenson who deigns to attack David Himmelstein’s hallowed article on medical bankruptcy.  We had a good time in this interview, even though I think Michael’s picked the wrong target, and he’s ever the purist.  The last couple of minutes had to be excised so that either of us might ever work in this town again….

Here it is: Michael Millenson interview

UPDATE. And here’s the Dranove Millenson article, and the reply from Himmelstein, and the retort to that reply.  And the name calling from Don McCanne.  They should have known that that Ignagni woman would be trouble!

THCB welcomes back old friend Brian Klepper from the Center for Practical Health Reform. He’s been asked to help various newspapers through the maze of consumer-driven health care, and here’s his take on the matter. You’ll note he gives it an easy ride, in that he doesn’t descend into the mire of risk pooling. Here’s Brian’s take:

In January’s State of the Union Address, President Bush called for expanding Health Savings Accounts (HSAs) as one sensible approach to curb rising healthcare costs. An HSA is a tax-favored healthcare-dedicated savings account that a patient controls. Combined with out-of-pocket requirements and a High Deductible (also called “Consumer Directed”) Health Plan (HDHP), these financing devices can provide comprehensive coverage. Federal 2006 HDHP family coverage guidelines call for deductibles of at least $2,100, with maximum out-of-pocket expenses of $10,500. To his credit, the President also proposed tax changes that would give individuals the same advantages employers already enjoy when they buy health insurance.                                                              The main logic and “sell” of these plans is that HSAs and HDHPs give patients more “skin in the game,” more awareness of healthcare costs, and more control over healthcare spending. The increased involvement in healthcare decision-making encourages healthier lifestyles and smarter healthcare purchasing decisions. In turn, the changes in patients’ buying behaviors will drive down healthcare costs.The reality may be somewhat different.First, there’s little question that HSAs and HDHPs will become major forces in the health insurance market the same way that managed care did in the 1990’s. They’re less costly for employers than conventional plans, so there’s every reason to believe that the market will grow quickly. A recent Kaiser Family Foundation study found that 20 percent of employers offering health insurance already make HDHPs available. Nearly every major health plan now offers an HDHP. And the health insurance industry association, AHIP, claims that HDHP enrollment tripled in the last 10 months, to 3 million lives.The deeper question is why. Are HDHPs becoming more popular because they urge patients to be more sensitive to cost? Or are they successful because, as the scale of healthcare cost has grown out-of-reach, skinnier benefits and higher out-of-pocket costs constitute a lower cost insurance alternative?Both. Employers clearly see HDHPs as a less expensive way to continue offering health coverage. It’s also apparent that, when care costs employees more, they’ll ask more questions.But studies also show that half of employers offering HDHPs do not help fund the HSAs. This may not be a problem for high-income or some middle-income workers. But if you’re low-income – one-quarter of workers make less than $18,800 per year and one-third of families make less than $35,000 – the increased out-of-pocket requirement can be onerous, especially if there’s a serious medical problem. Hospitals and many doctors are already experiencing rapidly increasing bad debt associated with these plans, because HDHPs without funded HSAs are, for many people, simply coverage that can’t be accessed. How about information that helps consumers become better purchasers? There are good Web sites that help patients learn more about their conditions and treatments. But so far, even though inexpensive evaluation tools exist, consumers still can’t get much information on the pricing and performance of hospitals, doctors and drugs. It’s hard to be an effective shopper if you don’t know what things cost or how the vendors stack up. Will consumerism significantly impact out-of-control health care costs? In truth, patients’ diagnostic and treatment choices represent a tiny portion of larger healthcare cost. The real money is associated with chronic disease and catastrophes. In those cases, healthcare professionals, not patients, guide the purchasing decisions. That’s exactly as it should be. But for consumerism to work, healthcare professionals must then be publicly accountable for their financial and clinical results.More to the point, unless consumers have access to robust information about pricing and performance, mechanisms like HSAs and HDHPs won’t really impact cost so much as finance it, merely guiding how the money flows. Even Regina Herzlinger, a renowned conservative Harvard-based healthcare economist, challenged Mr. Bush on this. “Health savings accounts are being touted as a way to control costs, and I very much doubt that claim.”The real roots of our healthcare crisis reside in the ways suppliers and clinicians are rewarded to deliver goods and services that are inappropriate, unnecessary and wasteful. Most healthcare experts agree that half or more of healthcare cost is due to these factors. Making healthcare affordable, stable and sustainable once again will require the infusion of skills and tools – compatible information technology platforms, clinical/administrative practice standards, pricing/performance transparency, payment that’s tied to outcomes – that other industries have long taken for granted. No matter how it’s pitched, consumerism just won’t get us there if these other components aren’t available to support the process.When it’s more mature, healthcare consumerism will likely include the mechanisms that help patients become better buyers and impact cost. Until then, HSAs and HDHPs are less expensive, slimmed down, short-term solutions that can work well if you’re healthy or financially secure. But they’ll do little to address our rapidly collapsing healthcare system. And as a national solution, they’re inadequate and oversold.

The opinion pages of the WSJ are known for being full of neo-cons and conservatives — people who think that they know what’s best for you and aren’t afraid of getting the US Government to use its power to enforce it here and abroad. The only libertarians with a megaphone I know are the love ’em or hate ’em John Tierney in the NYTimes, and the pop-culture joker John Stossel on PrimeTime 20/20 ABC.

But what’s this, on Feb 21 the WSJ had a signed op-ed column from staffer George Melloan called Musings About the War on Drugs. The column suggests what anyone who isn’t blind, deaf, dumb, biased or making a living from prohibition already knows — the war on drugs is a complete failure that is contributing to most of the worse elements of society. It continues only as a full employment act for some very unpleasant agencies of the US government (the heartless DEA prominent among them), even more unpleasant private corporations, and international criminals and terrorists — all of whom apparently have similar personal ethics.

Given that the WSJ is usually a mouthpiece for some of the worst hypocritical pontificators of the fascist social conservative right (Bill Bennet, anyone), is something going on that we should know about?  After all a much more rational media organization of the right, The Economist, has been pushing for an end to drug prohibition for years. I’m hoping that this isn’t just a flash in the pan…

So I just wrote about pooling and why it’s a necessity over at Spot-On, and I had a little to say about the revelations about employer subsidies buried in Part D over at TPMCafe.

Please go take a read and feel free to come back here to comment.