This is damn interesting, about how modern technology is perverting an old world subsidy. Free International Calls! NOT Too Good to be True. I guess at some point this is what’s happening in pharma and may happen in surgery. Of course it’s much easier if no goods or people have to be moved.
Above the Fold
HEALTH PLANS/HOSPITALS: Maverick pulls hosptials out of HMOs
This medical maverick, (or that’s what the paper’s calling him) owns three hospitals in The OC (California) and has cancelled all his HMO contacts—going after Medicare patients and charging HMOs and PPOs full fare for those admitted via the ER (and being very difficult about transferring them out).
My two questions are:
1) What happens when the HMOs won’t pay the full charge for ER and post ER care—if they feel they have to, that has very interesting anti-trust implications. Why shouldn’t all hospitals cancel their HMO contracts and just charge the Medicare rate? (at least in areas like Orange County where Medicare pays more than the HMOs do)
2) He owned a medical group that got bought by Phycor which then went bust, so that his stock was worthless. So where did the money come from to buy his helicopter and the hospitals?
QUALITY/POLICY: The Scourge of Skid Row
This is very, very unpleasant. A staph infection outbreak in Los Angeles that’s got its own name— the Scourge of Skid Row. And it’s one reason why public health, including the real basics like housing, clean water and access to medical care affects everyone—not just those without it.
POLICY: Six Dirty Little Health Care Secrets
I’m up at Spot-on talking about Six Dirty Little Health Care Secrets. Comments back here if you like….
With no lurid sex scandal this week and apparently little public interest or Congressional caring about what’s going on overseas, ABC News and USA Today have turned to the health care system to fill some air time and column inches. As you may have heard, ABC’s even been wise enough to ask a couple of bloggers – yes, I’m one of them – to chime in on the debate.
They were asking for solutions to the health care crisis. But asking
for that’s pretty much a waste of time. Americans may hate their health
care system, but they apparently like their health care providers and
even think that their costs are OK. Or at least that’s what one survey
said. But suveys don’t tell the whole story – they serve as a kind of
cover for the real reasons it’s so hard to change the system we live
under. Continue …
PBMs: Cynics patrol
Late last month Jack Bruner joined PBM Caremark Rx as VP of Marketing. What was he doing before? He was head of Hewitt’s Global Health Care Practice. Who’s Hewitt? It’s one of the biggest benefit consultants in the world. What did it do last year? It tried to put together a coalition of coalition of employers (HR Policy Association) to go around the PBMs. It basically appears to be failing.
How hard did it try, and on whose side is it (and the other benefits consultants) really on? I’ll let you Wall Street Journal readers decide if you’re suspicious of a revolving door between the consultants and the PBMs.
POLICY/POLITICS: New York Times, dogs, pustilent sores, licking of.
After the previous three times, I don’t think I can bear it. This time David Leonhart has written a NYT article saying that the reason we spend more here is because of American culture. This may be the most moronic sentence of the whole series of articles:
We Americans tend to treat any rejection of a health claim as some conspiracy by insurance companies, the government, doctors and the pharmaceutical industry. In other countries, people have arrived at a better understanding that health care necessarily involves economic triage — that $10,000 spent on quixotic care is $10,000 that can’t be spent more usefully.
“We Americans” are somehow are magically controlling the spending, apparently over the objections of “insurance companies, the government, doctors and the pharmaceutical industry”
He’s supposed to be the economist. Does he have no idea who controls health policy and health care spending in this country? For chrissake, the government here more or less represents the “insurance companies, the government, doctors and the pharmaceutical industry” and their interest is in spending more, not less. “We Americans” did not get a seat at that table, unless you count patient groups that also have an interest in higher spending and are co-opted by industry. Any high school senior doing a basic political science class who read the cliff notes on Stigler’s theory of capture can tell you how that works. But apparently you get to miss that class, or Econ 101 if you want to write on health care for the NY Times.
POLICY: Healthcare Economist on P4P
And via HWR, young punk Jason Shafrin, at the Healthcare Economist has a just excellent article about why P4P isn’t enough and impicitly why we need budget and supply constraints to get health care costs under control. (Hint, it isn’t always possible to tell when the curve is flat or heading downhill).
BLOGS: Health Wonk Review
Health Wonk Review is up at Ezra Klein’s blog.
HEALTH PLANS: Blue Cross Settling Patients’ Lawsuits
Lisa Girion in the LA Times has had no small part in the story she reports today. Wellpoint’s Blue Cross unit is settling the patients’ lawsuits against its rather nasty habit of widespread retroactive cancellations. The settlement cannot have been that cheap, given that they had to pay all the bills, pony up cash and pay of their and the plaintiff’s lawyers. Still better than going before a jury, and better than having the state really throw the book at them. And they seem to be the only one that the plaintiff’s lawyers are getting anywhere with:
“All the other insurance carriers are in denial,” Shernoff said. “Blue Cross at least is not in denial anymore. They are in rehab now.”
On the other hand the statewide hospital lawsuit is still ongoing, and there are probably more fines to come from the Dept of Managed Health Care.
POLICY: Communism breaks out on ABC news (well apart from Stossel)
Even though I’m “starring” on their site I can’t say I’m a regular viewer (or actually ever watch) ABCNews — unless it’s being replayed on The Daily Show or Colbert Report. But I’ve been watching some of the videos, and reading the blog from their week long series on health care. And it appears that their health correspondent Dr Tim Johnson is a raving commie. Or at the least he’ll have his AMA card taken away any minute.
He thinks that the plight of the uninsured is terrible and that we need a national, government universal health care system—and that we’ll get pressure for it within a couple of years. He was asked in one video how to tell if a doctor delivered good care. He said that they needed to a) have information tech on their desk and be using an EMR, and b) it helped if they were part of a big integrated system that checked up on them—and specifically mentioned the VA and Kaiser! I can feel Eric Novack grimacing a state away!
Now all my devotees over here know that that’s perfectly sensible. But Johnson works for the Mouse! Now a more typical employee is John Stossel who dives off a cliff that surely even the Cato guys wouldn’t follow him over by suggesting that health insurance itself is a bad idea. Well we wouldn’t expect a coherent argument from Stossel but he’s lots of fun. (On a quick re-read that’s a little unfair—voluntary high-deductible plans are OK apparently) . But do you really think he turns down his Disney-provided insurance?
But given that GE’s MSNBC unit fired Phil Donahue for being too left wing, and chief Mouse guy himself Walt was a rabid anti-communist, I think Johnson will have to watch his back at those county medical society meetings and at work too!
CODA: Canada-basher David Gratzer is mentioned in Stossel’s report. I’ve read his book (and he’s at least selectively read the Commonwealth Fund studies, if apparently none of Bob Evans’ work). I’ll be interviewing him in a couple of days…should be fun. And to give David a hint, a certain recent speech by a consvervative politician might just come up.
