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HEALTH PLANS: Who said this….?

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In one of the many newsletters I diligently peruse so that you don’t have to be contaminated directly I read this. Astonishing, even considering the source.

I had a terrific opportunity to speak to 700 health insurance agents and brokers on Tuesday morning, here for the Capitol Conference of the National Association of Health Underwriters, most ably led by CEO Janet Trautwein. These people are entrepreneurs who are on the front lines of saving the private market for health insurance in this country, and they are my heroes.

So who is it who thinks that this country’s health care heroes are the insurance brokers and underwriters who are in fact just waste motion making money off our dysfunctional insurance system? Answers/guesses in the comments please…..

CODA: I was actually speaking at a PRI event last year and met an insurance broker who explained to me that he was giving wonderful service to his clients. I with a hint of cynicism asked him what he meant and he said that he was helping them navigate the health care system, finding them the right doctors and negotiating with hospitals for them. I pointed out that those were the functions of a health advocate not a traditional insurance broker. He agreed. Hmmm…I said so you want to move your business from commission based insurance sales to fee-based consumer advocacy, and he told me that he had even been discussing this with Sheila Kheul (the main proponent of single payer in California) as a potential role for brokers in a single payer world.  How many health advocates like you do you think we need in California, I said. About 2-3,00 he said. How many health insurance brokers and underwriters are there in California I asked. About 50,000 he said.

That leads to me thinking that this bunch isn’t going quietly into the night….but then again they’re "heroes"

POLICY: Has the dog’s sore not completely healed?

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The NY Times has been getting much better in its reporting on health care policy. After all David Leonhardt had Shannon Brownlee’s book as economics book of the  year! And they’ve been getting Jack Wennberg in frequently.

But every now and again something crops up that worries me about it’s desire to go straight adn reminds me of that dog with the licking problem. Today it’s the idea that concerns about health care costs are global, which I guess is true, and that the rest of the world–where employers often don’t pay for health care–is becoming more like the  US where employers do. The short piece is called Going Global With Concerns on Health Costs and the casual reader might think that systems are converging around the idea that employers should pay for health care because governments can’t afford to.

Leaving aside the basic point that the route by which money is raised to pay for health care is not very relevant compared to how it’s spent and the system by which people get coverage, the article makes two tiny confusions.

First, as it says, it’s supplemental health care costs that employers are paying for in most countries–and in many countries like the UK they’ve done that for decades. Here employers pay for everything. that’s a massive difference.

Second, the increase in percentage paid by employers is only big enough to grow really fast in 4 countries. Those are India, China, Venezuela and Russia. Not exactly health care systems that compare to the US. Our health care system is bigger than those economies!

Sunday Morning Post, by Brian Klepper

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Here’s a classical example of a federal regulatory agency holding fast to two opposing ideas at the same time. I wonder what it means?

Last week the Department of Health and Human Services posted an interesting notice announcing a new program that recognizes 14 (presumably) forward-thinking health care coalitions of providers, employers, insurers and consumers, which it refers to Chartered Value Exchanges, or CVEs. (Who comes up with these names?!)  HHS promises that, by summer of 2008, it will provide "access
to information from Medicare that gauges the quality of care
physicians provide to patients." This "physician-group level
performance information…can be combined with similar private-sector
data to produce a comprehensive consumer guide on the quality of care
available" in each community. Cool! Sign me up!

Continue reading…

PHARMA: Reprieve for Amgen looking doubtful

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In a story titled somewhat cryptically Medicare chief stands by anemia move (do they mean he’s trying to become anemic?) Reuters reports that CMS is not backing down from its decision to radically cut payments for anti-anemia drugs for chemotherapy patients. In English this means that Amgen’s Arenesp (& Epogen, though that’s not officially for cancer patients) and J&J’s Procit (which is Epogen re-marketed by J&J) are not going to recover their lost sales from last year.  Those sales began to be lost when studies revealed that the fairly rampant use of those drugs was overuse, and also that they were causing some severe side-effects.

Of course for reasons that we all know (e.g. they have little to do with clinical endpoints and more to do with financial ones), community oncologists have flipped out. I do like the response from Dr. Barry Straube, the chief medical officer at CMS. He said:

Our staff looked at over 800 evidenced-based articles published in the literature," he said. "I doubt seriously whether most clinicians read all 800."

Of course the real impact of this was not on patients per se, but on Amgen’s stock price, which has not had the best of years. The little rally late last year was on hopes that CMS would change its mind. I’m afraid that that gravy train looks like it’s over.

Amgn

PHARMA: Stunt doubles in pharma DTC?

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I’m sure (well I’m not sure but I’ll cheerfully and casually postulate) to keep you all amused on a Friday) that there are many possible overlooked problems with Lipitor and the statins. I’ve heard of severe muscle pain, even amnesia. But then again most cardiologists and the medical establishment recommend statins very widely and the general medical opinion is that they’re under-used.

I’m reading an interesting book The Last Well Person by Nortin Hadler whom I had the pleasure of meeting at the FIDMD meeting a few weeks back. Nortin is not exactly modest(!) but he’s very amusing and has firm firm opinions. In the book he systematically goes through the randomized clinical trial evidence of the value of much heart treatment including angioplasty, heart bypass, and statins. And his analysis from the West of Scotland trial (which admittedly was using Pravachol not Lipitor) is that statin use made only marginal absolute improvements in heart attacks and essentially no difference in overall mortality.

But is Congress investigating whether the medical establishment has been lead astray or is leading us astray? No.

Apparently the most important question is whether Robert Jarvik actually rowed his own boat in a Lipitor commercial….

INTERNATIONAL: Rational talk about Canadian Health Care

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I’m very happy to relate that one of the best pieces ever by me on THCB, Oh Canada, (written when THCB was just finding its feet in 2003) is still as relevant as ever. There are still inordinate amounts of crap talked about the Canadian system by defenders of the current US status quo (not that the far right loonies who dredge this stuff will say that’s what they’re doing). This is dspite the fact that no major US Presidential candidate, with the possible exception of Harry Truman, has ever proposed introducing such a system here.

But over on liberal blog Campaign For America’s Future (the guys who are backing  Jacob Hacker’s work and by the way taking credit for the Edwards, Clinton and some of Obama plan) Sara Robinson—a self described “health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border”—has written a very balanced piece called Mythbusting Canadian Health Care.

I can see the Canadian ex-pat trio of Pipes, Gratzer & Graham going into apoplectic fits even as I type!

HEALTH 2.0: Some simple 2.0 Definitions

The Pew Trusts’s e-patients blog (the one in honor of Tom Ferguson) has linked over to some very cool introductory videos to socal netowrking, blogs, wikis, & social bookmarking. About a minute each and great to explain these things to your grandma or CEO.

Here’s the post

BLOGS: Health Wonk Review up at the Health Business Blog

David Williams of the Health Business Blog fame has shaved his beard off. I had one of those terrible moments when I saw him a couple of weeks back of knowing I knew him but not being able to place the face–then I realized that was because he’s changed it! (He used to have much more hair on the bottom of his face than on the top!)

That’s all irrelevant. What’s not irrelevant is that today he’s hosting Health Wonk Review over at Health Business Blog.

The Ethics of CEO Blogging by Paul Levy

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Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. Paul recently became the focus of much media
attention when he decided to publish infection rates at his hospital,
despite the fact that under Massachusetts law he is not yet required to
do so.  For the past year and a half he has blogged about his
experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

Last week, the Harvard Medical School Division of Medical Ethics
held a session on the ethical issues surrounding blogging by a CEO,
particularly the CEO of a health care institution. Local examples were
this blog and the one published by Charlie Baker,
CEO of Harvard Pilgrim Health Care. Unfortunately, I could not attend,
but I received a note from one of the attendees who told me about some
issues that had been raised. I’ll report on that and add the comments I
would likely have made if I had been present.One of the
discussants identified four domains that he thought of as important in
thinking about the ethics of a CEO blog, and about which he posed some
questions: 1. Voice: Is the CEO blogger blogging as an
individual or as the voice of the organization? Charlie’s blog is
hosted in the HPHC website and linked to HPHC marketing materials.
Yours is on Blogger and not linked to the BIDMC site. But when the CEO
speaks, what he or she says can’t be separated from the organization. 

Continue reading…

HEALTH 2.0 San Diego Sold Out

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It’s official! Health 2.0 Connecting Consumers and Providers has sold out — exactly one month to the day before the conference. (March 3rd-4th/Westin San Diego.) If you absolutely, positively have to be there, we have opened a waiting list. A limited number of people may be offered passes in the event of cancellations or a change in availability. If your company wants a presence in the hall, a limited numbers of passes are still available for exhibitors and sponsors  email in**@********on.com for details.  What’s all the fuss about? Go take a look at the agenda. Stay tuned for updates. (TIP: If you’d like to receive notification of agenda changes, updates and other conference news sign up for our newsletter.)

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