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INDUSTRY: Health Care Mergers up

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Jonathan Cohn is very excited that health care mergers are up strongly in the third quarter. I suspect its a blip, as Wellpoint’s got no one left to buy, and who’d want Merck in its present state? But who knows what excites the Volvo driving frappuchino drinking liberal intellectual, these days. (Hint, conspiracy theories around Medicare Part D and health care as the "new defense" might be the answer).

Meanwhile I’ll have more on the PHR later, as I’ve had my knuckles rapped by someone who knows more than me about consumer surveys….

POLICY: Adverse Selection, a young liberal’s learning experience

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Sometimes I despair about the young liberals over at Ezra’s blog. Health care is so screwed up and they’re just discovering it. On the other hand they are discovering it and somehow figuring it out. Neil (the ethical werewolf) has written about Adverse Selection: A Big Problem with Private Insurane. Read the comments, ann you’ll notice a familiar name or two come up referring to the Wharton school of ecnonmic fantasy.

Still, good to find out that they are learning–I just wish they’d all been forced to read Enthoven, Fuchs, Evans et al so they don’t have to have it all explained again and again.

INTERNATIONAL: Monday morning world view

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If you thought America was strange consider the plight of my birthplace and its former Empire. For a start the Royal Family is so broke it’s having to send its first-born son out to work for a Hong Kong bank, no less. Meanwhile, at least one junior doctor (resident to you Yanks) thinks that doctors in the UK get paid too much. Finally a great soccer player, George Weah, (who starred for AC Milan in their hey day in the 1990s and played briefly for Chelsea and Manchester City) has decided to go back to his home country of Liberia and take over as President…

On a less light note, the earthquake in Pakistan and India is very, very serious, as are the mudslides in Guatemala. Here is a link to a page with several charities working in relief.

UPDATE: I got Liberia and Cameroon mixed up. Liberia was of course founded by free African-American slaves.

PHARMA/QUALITY/PHYSICIANS: Rational sense on opioid use for cancer sufferers, with reference to Kinsey and rationalism.

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A very important THCB reader — one that I have to be nice to if I want to feature in the will, and you might guess that I’m a couple of wickets down already — has forwarded me this BMJ article on opioid use for cancer patients.

Last night I saw the movie Kinsey, which told the story of how Kinsey’s research on human sexuality in the 1940s and 1950s created great advancement in human understanding, and helped remove the weight of hundreds of years of damaging religious bigotry — yup into the 1930s married couples were taught that any non-missionary position sex (including using the mouth or the fingers) was wrong and unnatural. There’s a harrowing scene were his father eventually tells him that he was fitted with a strap to prevent masturbation. I thought of this in the context of opioids, because apart from certain lunatics on the Christian right, rational people agree that the behaviors imposed by society on sexual "deviants" — homosexuality was a jailable offense as recently as the 1950s –were both morally wrong and harmful to individuals and society as a whole. We needed science (and I know there’s a lot of criticism of Kinsey, M&J and Hite’s methods, but they approached the issue from a scientific not a moralistic perspective) to show us the truth in a rational dispassionate way.

The war on pain doctors and patients is being fought by a similar band of lunatic puritans as attacked (and still attack) Kinsey.  Only these moralistic jihadists have the full force of the Justice Department behind them and are clearly bending every commonsense understanding of justice and ethics to imprison and destroy anyone who holds a different, more humane view.

Of course the main problem here is that the puritan jihadists have equated opioid use for pain as some kind of great moral failing. Well the scientific view is succinctly and excellently put by a leading British physician:

Concerns about morphine: Morphine has long been feared by the general public and the medical profession. Underlying this fear is the mistaken belief that the potential for misuse of opioids is linked with their use as analgesics. Unfortunately, concerns about addiction, respiratory depression, and excessive sedation cause healthcare professionals to avoid using opioids or to use them in suboptimal doses. Clinical experience has shown that these fears are largely unfounded and that addiction is not likely if morphine is used to manage pain responsive to opioids in doses titrated to the degree of pain. Withdrawal symptoms indicate physical dependence and should not be confused with psychological dependence (addiction).

It’s mainstream educated work like this that needs to be broadcast widely, and all physicians and other scientists need to continue to trumpet this loudly. Don’t forget that the puritan jihadists want to take us back to their equivalent of Sharia law, and the real fight among civilizations is not between Christians and Muslims, it’s between the rationalists and the zealots. And if you think I’m overstating it let me  use this quote from the Guardian of a smattering of leading anti-Kinsey campaigners (yup, they really exist)

The religious right still fear and despise Kinsey and all his works. Check out some of the (apparently coordinated) responses to the new movie. "Kinsey’s proper place is with Nazi doctor Josef Mengele," says Robert Knight of Concerned Women for America, inadvertently showing us what he thinks of the Holocaust. Robert Peters of Morality in Media: "That’s part of Kinsey’s legacy: Aids, abortion, the high divorce rate, pornography." Focus on the Family’s film critic (they have a film critic?), Tom Neven, calls the movie "rank propaganda for the sexual revolution and the homosexual agenda". And Judith Reisman, who has waged a decades-long war against Kinsey’s memory, refers to "a legacy of massive venereal disease, broken hearts and broken souls".

And is it a Jihad?  Well the lunatics certainly think so:

A recent newsletter of the abstinence-education group Why know? compared the publication of “The Kinsey Report,” in 1948, to the attacks of September 11th, and labeled Kinseyism “fifty years of cultural terrorism.”

BLOGS: World Mental Health Day

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Psychologist Deb Serani informs me that it’s World Mental Health Day.  Go to her blog to see more, and no snide remarks about which of our nation’s leaders this is aimed at!

POLICY/POLITICS: Linking Katrina, Medicare Part D and bird Flu

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Here’s my FierceHealthcare editorial today:

FierceHealthcare has been following two stories all year that both had big moments this week. One is the avian flu that’s been popping up in Asia and may end up being as deadly as the 1918 epidemic. The other is the new Medicare Part D roll-out. For Medicare Part D, the complex mix of plans being offered to seniors will test their ability to understand the options on hand — anyone who’s bought insurance in the individual market knows that’s not easy — and will also challenge the Federal government’s ability to run and police a complex program with many different private and public agencies taking part. Given the nation’s recent experience with a similar challenge on the Gulf Coast, we can be forgiven for looking at the Medicare roll-out as the next great test of government, and hope that it shows improvement. Especially if we have a real crisis in the near future if avian flu becomes the pandemic we all fear.

HOSPITALS: Sutter and Kaiser getting pissy, and fiddling while Rome burns

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Just to follow up on the recent "SEIU hates Sutter but loves Kaiser" piece, this morning I was up at CPMC as a patient, having a doctor looking at my bum knee in the medical office building next door. (And no, I didn’t cross a picket line as the doctor I was seeing was in a medical group that’s not owned by Sutter, at least I think it’s not and it wasn’t being picketed). The pickets were out in force with a SEIU RV parked outside.

Meanwhile, on the issue of giving free care to the uninsured (or not, as the case seems to be) Sutter is now pointing out that it thinks it gives lots of charity care because it "writes off" some $40m a year in discounts that it gives Medicaid and Medicare off its charges. After you pick yourself up from rolling on the floor laughing about that one, there is the slightly more serious issue that they raise which is that everyone else does it (or actually, doesn’t do it). "Everyone else", in this case, of course means Kaiser.

This is an old and perhaps even valid meme, in that Len Schaeffer brought it up years ago when he noted that Kaiser gives very little charity care at its hospitals, which he too converted into the concept that Blue Cross was paying for the "extra" charity care delivered at non-Kaiser hospitals, because of some mystic cross-subsidy from the care that Kaiser wasn’t giving.

So what’s the solution?  Well of course it’s to form a committee, provided that Blue Shield’s Foundation comes up with $75,000 to pay the committee. Yup that’ll solve the uninsurance problem overnight.

However, if I was in Sutter’s position, I might just be trying to get my head a little lower out of the firing range and not just using the "Officer, everyone else was speeding too" excuse.

THCB: Email problems

Some a-hole spammer is spoofing ATmatthewholtDOTnet as their outbound address, luckily so far without the correct first name. The result is that I’m getting hundreds of bounce-backs with "undeliverable" email (you know, the MAILER DAEMON ones), as all emails to matthewholtDOTnet by default go into my main account. Not that it’s their fault in the first place but my email and web-hosting service has been unable to figure out how to block them all and just let the correct email go through (i.e. the ones sent to my correct email address).

Worse, this morning some bright spark at my hosting company switched off my incoming email all together, including the proper address.  It’s back on now, but if you sent me an email between 1 am and 9.30 am PST, please send it again.

And any advice about dealing with this would be appreciated!

POLICY: Employer health insurance and stuttering efforts to delude the public

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In The New York Times Milt Freudenheim reports a little too gushingly about the attempt by a number of big companies to let the part-time employees that they don’t cover buy into their health insurance programs.

The companies are taking a small first step toward slowing the spiraling growth of the uninsured, who now number more than 45 million. They acknowledge that the program is far from an overall solution, but they are addressing a challenge that government officials have largely ignored, said Steven M. Coppock, a senior actuary at the Hewitt Associates benefits consulting firm, which is helping the association with the program.

Surprise, surprise there’s a benefits consulting firm selling yet another new idea here. I’ve started describing CDHPs as the bastard child resulting from a one night stand between benefits consultants with nothing new to sell and a libertarian think-tank that can’t do basic math. This pretty much comes into the same category.

There are some good things about this program, in that it allows the uninsured to buy into the benefits of a big group program, at the same rates that the company is paying for its "real" employees, and not having to worry about pre-existing conditions. Of course, this won’t do a whole lot to solve the uninsurance problem for two reasons. One, the vast majority of the uninsured don’t work for these big companies (or if they do they work for companies that pretend that they’re not big, like the franchised outlets of the fast food restaurants). Two, the problem of the majority of the uninsured is not just that they don’t have access to insurance, but that they can’t afford it. There are some people who are priced out of the individual market by medical underwriting who can buy a much better product in the group market, and for them this is a good option — but that’s a low number. In general you might get a better rate (in terms of premium per benefit rather than straight premium cost) from a group plan, but if you can’t afford an individual plan of any kind you probably couldn’t afford this either.

Unless I’m really missing something there are three blindingly obvious statements to be made about this effort.

1) Part of the way employers have got out of offering benefits is by asking employees to contribute for their dependents’ costs. The numbers of employees who are offered benefits (especially for dependents) but don’t take them up is high and increasing, (although that only accounts for about 1/4 of the uninsured–the rest just don’t get offered insurance by their employers). This program is really just an extension of that, and regular employees must be feeling that they are not so far away from being told that like the part-timers, they too must start paying for their care. That’s the trend that the NY Times should be writing about. While it’s not what they are writing about, plenty of others have noticed.  (Note that employees remain highly opposed to losing health benefits because they understand the grimness of the alternative).

2) As the Progressive Policy Institute and many others have suggested, if we are to allow people to buy into group programs, the logical way to do it is to open the FEBHP to everyone. Of course all buying groups like this will attract poorer risks who can’t get a better deal from the cream-skimmers in the individual market — but the FEBHP might just be big enough to let them all in and deal with it, and of course it has the heavy hand of the Feds behind it to spank any health plan that starts playing games.  Of course letting everyone into Medicare is a further logical extension….but let’s not get too far ahead of ourselves.

3) Given how ineffectual this is going to be, why is the NY Times covering it?

Coda: By the way I’m pretty unimpressed with the HR people at big companies. I talked to a group of VP plus level HR people last year, and I gave them a hard time about how they were allowing the health care system to run them around.  A number of them said, "but we do so much more than we did five years ago". I asked them which of their other suppliers had they allowed to hit them up with 15% annual increases for the past five years running, and not one of them had a word to say.

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