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POLICY: Self-employed, and going it alone

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If you want to understand why an individual mandate in a community rated state won’t work without both significant reforms to the insurance systems and a whole new range of taxes and subsidies, read this experience of a healthy mid-20s writer in New Jersey who’s self-employed, and going it alone. Of course if she was living in California, she’d be able to buy a much cheaper policy–but then no sick person in California can get individual insurance.

Perhaps enough of this and it will dawn on people that we need a single pool funded by ability to pay….

On a side-note, any idiot can see that a single pool guaranteed universal system would help solo freelancers and small business people. And of course the NFIB leads the charge against it.

POLITICS: Just Saying No to crass politicization

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Yeah, I know it’s not likely that anyone will pay attention given the season, but I do feel that there are enough cases with which to bash insurers which are legitimate that John Edwards didn’t have to start politicizing one in which not only was the insurer’s argument pretty good, but about which a government-sponsored universal system would also have to make the same choices. So I’m up over at Spot-on about Just Saying No.

To separate himself from the Democratic front-runners former Sen. John Edwards has spent the last few days laying into insurance company, Cigna, for its failure to immediately approve a liver transplant for California teenager, Nataline Sarkisyan. That action, says Edwards, in concession speech after concession speech, is emblematic not just of the health care system’s break-down but of a failure of the current American political system.

Edwards like most Democrats wants a single payer health system and his plan is the closest of the three front-runners to providing one. But his advocacy of Natalie Sarkisyan’s case raise a question no one else seems to be asking.

Here’s the rest

POLICY: Ian Morrison–to be thrown out by the Paisley Fabianists club

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In a great article called The Fallacy of Excellence my old boss and friend Ian Morrison explains what we intuitively know. people don’t understand that more care is not better care. This is going to lead to lots of political problems as we get to righting the Wennberg-illuminated wrongs.

On the other hand, Ian’s lifetime membership in the Paisley Fabian Society will probably be revoked when they find out he’s been watching the Republican candidates debate…..

INTERNATIONAL: Those damn froggies beat us again

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Here’s one international comparison I’d missed when it originally. The US has fallen to last place amongst 24 developed nations in an index of preventable death–one presumably cooked up by a Marxist cell masquerading behind a front organization called the London School of Hygiene and Tropical Medicine and funded by that cabal of Trotskyites known as the Commonwealth Fund. We’ve fallen four places since last time and are now even behind the Brits & the Irish—who I’ve always thought encouraged preventable death.

What’s happened is that every other nation showed significantly better measures relatively quickly (over a 5 year period to the early 2000s) and the US didn’t improve much at all.Who came top? Yes, those darn French again.

And their President is shagging a super-model. It makes me long for the days of JFK and Marilyn Monroe.

POLICY: It’s official–2 Trillion Dollars

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For everyone who’s been going on about our (adopt Dr Evil voice) 2 Trillion Dollar health care industry, it’s now official. The 2006 data is out and we’re at 16% of GDP, $2.1 trillion and $7,000 and change per head. Growth, somewhere at the bottom of the trough, is around 6.5%. That’s nominal not real of course, but it’s still way over the economy’s growth rate, and that gap will grow if/when a recession hits.

The major change of course was the introduction in 2006 of Medicare Part D which mean that drug spending increased at over 8.5%. But then again, they’re telling us that Part D was less than originally projected. Although I bet you no one in CMS (or now out of it) will tell you what really was originally projected, and in fact which of the many revised projections the $41 Billion costs of Part D was really below!

And of course assuming that cost increases were stable in 2007, we’re actually already at 2.1 trillion + 6%, or 22.35 trillion!

PODCAST: Interview with Michael O’Neil GetWellNetwork

This podcast I did with Michael O’Neil who is the founder of GetWellNetwork. Michael had an episode of cancer relatively early in his adult life and although he was the recipient of great medical care from one of our nation’s leading academic medical centers, he was also very upset about the quality of the in-room patient experience. The result is a new system of using the TV to improve patient care in hospitals. You can hear much more in the interview.

On a technical note: this interview was conducted in the middle of a significant California winter storm, so there will be occasional tricky patch. Thanks for your patience and thanks to Michael too for his.

POLITICS: More on the Presidential plan comparison

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Long time THCB friend Steve Beller tells me this:

We’ve created a Comparative Analysis of Presidential Health Care Plans, which analyzes much of the details of Susan Blumenthal’s and Kaisers’ work in order to identify top candidates based on voters’ wants and needs. We’ve taken a unique approach in which the complex details are distilled into categories of strategies that simplify comparisons between the candidates, and we’ve included comments on the key factors (with several quotes from Maggie Mahar’s blog and input from Barry Carol). It then groups the candidates on whether they propose universal healthcare, and it  ranks them by the amount of attention they give to quality improvement and cost control. Then it matches the candidates to 18 types of consumers, which take into account their current insurance and health situation, their income level, and their support of good care for all.

Here’s the link.

Take a look and feel free of course to give your comments to Steve over on his blog or here.

Meanwhile as major bloggers are dropping like flies from the stress, (get soon well Om!), I feel good about the fact that I took the weekend off to go snow-boarding in some of the best powder the Sierras has seen in a while. And that’ll be all from me today!

Health Care’s Cold Truth: An Iowa Perspective – Michael Millenson

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Obama_webI am writing this blog from Cedar Rapids, Iowa, grateful that the
temperature has warmed from brutally
cold to pleasantly sub-freezing.
Fortunately, the warm feelings left by the extraordinary victory of
Sen. Barack Obama, the candidate for whom I was knocking on doors and
making phone calls these last few days, has trumped the temperatures.

Talking to real voters in the suburbs and rural areas surrounding this
small city provides a nice change from  the insular health care policy
world. For one thing, it reminds you that most people don’t care about
“policy,” per se, of any kind. Successful candidates connect first with
the heart and then the head. We instinctively believe that if we trust
a candidate’s values and broad beliefs, we will trust that candidate’s
detailed policy decisions.

Yet the sad reality is that a vast number of citizens won’t even make
that small emotional investment, and they don’t hesitate to proclaim
their apathy when you knock on the door or call. As much as you may
have heard about voters disenfranchised from the Iowa caucuses,
many more simply didn’t care enough to participate. That, alas, makes
Iowa quite representative of the nation as a whole. While Democratic
turnout at this year’s caucuses was double that of four years ago, that
merely turned a “tiny” slice of registered voters into a “small” one.

Continue reading…

On Medical Miracles – Brian Klepper

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Now and then, amid the stories of financial conflict, medical errors
and political intrigue that so often undermine health care, comes a
story of the miraculous, where patients in impossible conditions not
only survive, but thrive, due to the skill and resources of many
dedicated clinicians, due to luck and due to who knows what
extraordinary circumstances that are still beyond our understanding.

The New York Times has a story like this today.

On December 7th, Alcides Moreno and his brother Edgar, window washers,
fell 47 stories down the side of the Upper East Side apartment building
they were working on. His brother was killed instantly, but Alcides
survived, consuming 24 units of blood and 19 units of plasma. In a
coma, he went through 9 orthopedic operations, and then amazingly – I’m
not making this up – awoke on Christmas Day.

More
incredible still, Mr. Moreno is now on a path to full recovery, at
least from the looks of it, walking and talking as he did before his
fall. This has prompted Dr. Philip Barie, the chief of the Division of
Critical Surgery at the hospital where Mr. Moreno is being treated to
comment, “If you believe in miracles, this would be one.”

A David Bowie movie, anyone? Check out this story.

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