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POLICY: The Times’ editorial leaves me baffled

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I for one remained baffled about what’s happening within the gizzards of the Grey Lady. On Sunday the NY Times published presented a long editorial about American health care and its high costs.

After the dog sore licking episodes of last year, (hinted at in the "does this matter?" section of this editorial when they dare to say "By some measures, Americans are getting good value.") this year the NY Times has had some sensible columns and has highlighted Wennberg’s work.

The editorial is a hodge podge of mostly correct analysis without any real "editorial" as to what to do. I’m baffled. Most of us would largely agree with their diagnosis but I’m confused as to what they’re suggesting here. The final paragraph bears repeating for being total woffle

By now it should be clear that there is no silver bullet to restrain soaring health care costs. A wide range of contributing factors needs to be tackled simultaneously, with no guarantee they will have a substantial impact any time soon. In many cases we do not have enough solid information to know how to cut costs without impairing quality. So we need to get cracking on a range of solutions.

I long for the halcyon days of 1992 when the NY Times more or less supported managed competition. There are plenty of things we could do (managed competition properly implemented is one, single payer is another, extending the VA to all Americans is a third). All of those policies would do something to contain costs. Now I’m a realist and I know we’re not going to do any of those–but this piece is supposed to be an editorial, fer chrissakes! Can’t they support something?

This editorial was clearly written by a committee that either didn’t understand the solutions or doesn’t agree about them.

PHARMA: Shocking revelations

Says here (“here” being a long mea culpa article by a psychiatrist and former agent of Wyeth in the NY Times) that some doctors get paid by drug companies to give talks to other doctors about drugs, and that not only do they use studies that make those drugs look better than others, but that if they start pointing out the flaws of their sponsors drugs in their talks, then the money dries up.

My word…

I guess repeating a point is OK. But it’s not as if John Abramson, Marcia Angell et al haven’t beaten this to death. Yup, we can’t trust doctors not to be both naive and greedy (as the NY Times correspondent points out).

But there are two counterpoints. First is the informal one from other doctors, such as the newsletter that the physician in question now puts out, debunking dodgy research. I think we’re going to see much more of this in the future.

The second unfortunately we’re going to have to wait for—that is purchasers getting serious about physicians’ use of certain drugs when it’s clearly not medically appropriate. And despite lots of clear evidence about that, we’re still waiting. Blaming the drug company for taking advantage is still pointing the finger in, mostly, the wrong direction.

Of course we’ve had this little argument on THCB many times before.

POLICY: The liberal media maliciously tells the truth about Rudy, again

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There’s more Giuliani bashing going on in the liberal media. First in the NY Times Frank Rich goes after him via the seedy route of the forthcoming tell-all lawsuit from Bernie Kerik’s ex-girlfriend. (It’s good stuff–I’d recommend a full read). Now the LA Times‘ Ricardo Alonso-Zaldivar points out the modest fact that cancer patients who would luxuriate in Rudy’s free market health care concept would not (and cannot in most of today’s American health care) guarantee that they would get access to health coverage or of course the care that Rudy is so happy about. In fact the American Cancer Society has been feeding Bob Herbert a steady series of terrible stories of cancer patients who got financially and medically shafted by the current system.

Of course Rudy was at the time of his cancer treatment enjoying socialized insurance, at least insurance socialized across the group known as NY City employees. Of course since 1970 he’s largely been a Federal or city employee, so apparently social insurance is OK for him, if not for the rest of us.

And all of this is a great pity. As David Brooks suggests, there have been times when Rudy was not merely playing to the most unthinking elements of the conservative primary voters. Maybe we’ll see that again if he wins the Republican nomination, but he’s giving the Democrats plenty of ammunition for the general election.

CODA Uwe has a great zinger about Giuliani’s use of the socialized medicine system he controlled to help out an old friend in a letter to the NY Times Saturday.

And the Health 2.0 Design Award Goes to … by Indu Subaiya

I’d
like to dedicate my Thanksgiving post to the people who are working on,
have worked on and most importantly, ought to be working on issues of
design and usability in healthcare.

I seem to be joined by Sohrab Vossoughi, Founder of Ziba Design who wrote a viewpoint article in this week’s Business Week, Designing the ‘Care’ into Healthcare.

What do I mean by design? To quote Joan Osburn, who runs Osburn Design,
a well-known architecture and design firm in San Francisco, with her
husband Steve, "design is not decoration." Design to me is a philosophy
and an intentionality behind creating things, be they physical
structures, gadgets, websites or services, that translate into an
optimal user-experience. Optimal, in turn, has elements of both
functionality and beauty i.e., (1) were you able to do what you needed
to do and, (2) did you enjoy doing it?

    > Continue reading this post on the Health 2.0 Blog

HEALTH 2.0: In mourning, meanwhile over at Health 2.0 Blog

Like every proud American I’m spending the day paralyzed by the effect of way too much excellent food and wine yesterday. And like every other Englishman (ex-pat or Blighty-based) I’m also mourning the national team’s appalling performance in losing at home to the mighty Croatia and hence missing out on going to the European Championships finals next summer.

So while THCB sleeps forlornly over the weekend, Health 2.0 Blog is up and humming with Indu Subaiya’s superb thanksgiving for excellent design in health care.

POLICY: Someone else beats up on Herzlinger

Here’s Maggie’s takedown of Herzlinger’s WSJ column, with a heavy dose of Uwe included. And as far as I can see the most important thing about any regulated individual insurance system is consistency of benefits across plans—which means the plans then have to concentrate on improving care rather  than gaming risk selection. And then there’s risk adjustment between them. (At least that’s the original Enthoven model).

I haven’t felt the need to torture myself enough to read the latest Herzlinger book—given that I suffered through the previous two, I awarded myself time off for good behavior. However, she appears to want to allow plans to offer personalized benefits “for consumer choice” and then somehow do back end-risk adjustment between them later. Funnily enough that’s roughly what Wellpoint’s California lobbyist said when I asked how they justified selling Tonik et al. At the least it sounds very complex (after all, risk-adjustment between plans with identical benefits is hard enough), and in reality it’s probably just more destruction of the risk pool.

So in other words the part of Switzerland that does work (the uniform benefits) is the part that Reggie wants to destroy. No doubt Maggie will be looking forward to lots of incoherent comments and accusations of plagiarism and poor research skills on her blog.

The Massachusetts Plan: What did they know, and when did they know it? by Eric Novack

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Dateline, Boston…

According to an article in the Sunday,November 18th, 2007, Boston Globe, “(Massachusetts) the state could face a funding gap as large as $147 million by the end of the fiscal year, according to a state projection.”

2009 looks worse: … “Since insurers who participate in the subsidized program are expected to ask for significantly higher payments from the state”.But, government regulators are keeping up appearances: "It’s too early to make any departure from the health reform plan," said Leslie Kirwan, secretary of administration and finance and chairwoman of theCommonwealth Health Insurance Connector.”

“"It’s a good problem to have – people are getting insured and hopefully getting care," state Senator Richard T. Moore told the newspaper.

Continue reading…

When the Patient is a pain the doctor blames Google, by Matthew Holt

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This article in Time written by an New York-based orthopedic surgeon is called When the Patient Is a Googler. But the problem is not Google, or online health information searching. Most doctors like a better informed patient. The problem is that this patient didn’t respect the doctor and that the doctor in turn didn’t respect the patient.

Trot over to Tara Parker-Pope’s Well blog on the NY Times to see a lot of comments about the surgeon’s attitude. (And no cracks from those of you who know a few orthopedic surgeons!)

Matthew Holt

POLICY: Low prices ain’t cheap enough

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Mercer says that the number of small businesses offering health insurance to workers went down last year despite the greater and easier availability of high-deductible and HSA plans.

Fewer small employers offered health insurance this year, despite
the widespread availability of new, lower-cost high-deductible
insurance plans, a survey released today by benefit firm Mercer shows.
Advocates of the high-deductible plans touted them as one solution to
the growing number of uninsured, expecting the plans to appeal to small
employers, who would continue to offer health insurance as a result.
"That’s not happening," says Blaine Bos, a Mercer partner and one of
the study authors. "In fact, the reverse is happening."The
study of nearly 3,000 employers found that the percentage of employers
with 200 workers or fewer offering any kind of health insurance fell to
61% this year from 63% in 2006.That drop came even as the cost
of high-deductible plans with tax-free savings accounts averaged $5,970
per worker per year. That was $700 less than a comparable plan without
a savings account and far lower than the $7,120 for the average HMO,
the study says.

HSA/HRA type plans are growing in the market, but not as fast as employers are dropping coverage.

Continue reading…

POLICY: The NY Times Remembers the War on Drugs, but has learned none of its lessons

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No one bothers to care much about the war on (some) drugs these days. Sure it’s an $80 billion a year boondoggle for law enforcement and criminals, paid for by the taxpayer at an untold cost in lost civil liberties. But that pales in comparison to the $200 billion a year boondoggle otherwise known as the War in Iraq—a trough in which there are even more snouts. And of course one which has created even more problems than the war on drugs, which may even have a larger effect and last as long. But out of nowhere, the NY Times Editorial page has remembered.

Sadly remembering and understanding are two very different things.

Mexican criminals make money off the criminilization of personal behavior in the US. That money, in the form of cash and guns, flows south. And there’s a terrible inevitability about it, as the Times says, Yet so long as there is demand, the narcotics will always find a route, through Mexico or some other way.

So what, after 90 years of failed prohibition, is the NY Times’ radical answer? Send more money to the Mexicans from the US taxpayer so that the police there can buy more guns.

Did Judy Miller get moved to the editorial department? The NY Times editorial is drinking the kool-aid straight from the futile but endless fundable idiocies of the drug warriors at the DEA. Can it not do better?

 

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