Worth noting that although I haven’t mentioned it for a while, asset tracking using WiFi appears to be making headway. Ekahau chalked up another client win last week while this is a big market for Pango, AeroScout, Cisco and others. The more interesting part is where they get to combine asset and people tracking.
Above the Fold
HEALTH PLANS/POLICY: And for those of you suffering from the voluntary pooling delusion…
PacAdvantage, nee CalHIPC, was the biggest small business purchasing pool in the nation. It was supposed to be a model for the Clinton-era Regional Health Alliances, but because that reform never happened, it was forced to soldier on and accept all the small businesses that wanted to join.
What happens to voluntary purchasing pools? Simple economics—they only get customers who can’t get a better deal in the underwritten insurance market and so they go into a death spiral where the people in them are too sick to be supported by the premiums they charge. Today PacAdvantage announced that it was closing down, throwing 110,000 people into the small group and individual market, where by definition, no insurer wants them (unless they’re like me—very lucky).
PacAdvantage is the type of organization that our friends in the “voluntary universal insurance” world (Cato, Galen et al) think is going to solve all of our problems, with no need for pesky mandates to buy insurance, or for community rating, or standardized benefits packages. I’m sad to say that I think Alain Enthoven has joined that philosophy, although I may be misinterpreting his views.
The answer is that there is no such thing as voluntary universal insurance, and there cannot be universal insurance without very different regulation of the insurance market. And the longer we let that go on, the closer comes the day of reckoning when there is no viable market for private insurance, and we go to single payer by default (or Brazil, take your pick).
Mark this one as a signal event, and if you don’t like that outcome, begin to figure out how to prevent that awful day.
CODA. I just found this CHCF piece from November 2005 which explains in more detail why voluntary pools are doomed–although it doesn’t quite call a spade a spade and suggest that mandatory coverage is the obvious answer.
POLICY: How dumb is this, part 34
Study Says Medicare, Health Insurance May Be Major Cause of Hospital Spending Growth. The Galen crowd are all over this study from an Asst Professor at MIT because it tells apparently a new tale which is that the spread of insurance, especially Medicare, has had the effect of increasing health care spending—rather than the BS foisted by the health care industry which explains that their costs have gone up because of the new medical technology that people want.
Brilliant and totally new, other than the minor fact that it is a concept called derived demand first coined by David Ricardo in the 1820s.
"It is not really true that the price of corn is high because the price of corn land is high. Actually the reverse is more nearly the truth; the price of corn land is high because the price of corn is high!"
Substitute the words health care for “corn” and medical technology for corn land and you have exactly the same thing. (If anyone’s got the brilliant poem about the corn and the hogs from the original text book, please add it to the comments)
So we added a huge amount of fuel to the fire by extending Medicare and private insurance, we left a mechanism where the providers made more money by doing more, and faced no restrictions on what they did, and we developed a medical and social culture where doing more was always regarded as better than doing less (or doing something was regarded as better than doing nothing). Exactly what did we think would happen, given those incentives? Providers would do more, get more medical technology and blame it all on patient demand for more technology. And we agreed to keep paying more. And that has never stopped in the last 75 years.
And of course the HSA crowd think that they have the solution. I’d be a damn site more impressed with this new discovery if Alain Enthoven hadn’t been ascribing the blame for increased health care expenditures to “cost unconscious” demand since the mid-1980s. He had a solution then and one that is much more comprehensive than the “let consumers spend their own money up to the deductible” mantra being quoted now. He just couldn’t get it past the health care industry…and there’s not much reason to think that the HSA backers will have much of a better experience. But at least Enthoven didn’t claim to have introduced the concept of derived demand.
HEALTH PLANS/POLICY/TECH: Millenson on health prediction
Michael Millenson writes on the new possibilities of predicting disease status and utilization using huge databases. As usual Michael is clever. Perhaps too clever!
PHARMA/POLITICS: Closing the loop on Plan B
So finally we got some resolution to the ridiculous Plan B situation which has helped drag the FDA even further into the mud —F.D.A. Gains Accord on Wider Sales of Next-Day Pill . It will go OTC but only for people over 18.
The drug agency has asked that the new Barr application restrict over-the-counter sales to women older than 18. Girls younger than 18 would have access to the pills only with prescriptions. Over-the-counter pills would be sold just in pharmacies and licensed clinics, the chairman of Barr, Bruce Downey, said.Mr. Downey said the acting Food and Drug Commissioner, Andrew C. von Eschenbach, had assured him in a call that the agency was committed to resolving the Plan B impasse. Barr had hoped to sell Plan B to women and girls of all ages, Mr. Downey said, “but I don’t have the ability to get all that I want.”
Of course this is bloody stupid, as women under-18 are those just as likely to be having unprotected sex and the consequences of them having unwanted pregnancies are much greater for them, and for the taxpayer and society, than for older women. And they are far less likely to want to have to deal with the shame and expense of going to a doctor to get a prescription. Plus the solution is unenforceable, because those under-18 will just get their friends to buy it, and they won’t even have the minor benefit of the pharmacist’s counseling.
But don’t worry about them, or the rest of us dealing with teenage pregnancies, Jesus (or at least his "representatives" on the loony right) will be happy. And they’re the ones who make scientific decisions these days.
HOSPITALS/TECH: Getting the machine that goes “ping” into the EMR
Tim Gee managed to get to one of my posts when I didn’t submit for the last HWR for which he was host, to my chagrin and I failed to return the favor. But he does have a really interesting piece on his blog about the integration of RFID, WiFi, Pumps and Monitors into hospital IT systems. This is crucial stuff, as most of the mess (i.e. process errors) in the hospital comes from poor management of this data, and the recording of this data probably accounts for 25% of nursing time, and is fraught with error too.
If we’re going to fix the process mess inside the hospital, the integration of digital clinical data into IT is essential. Tim gives us a progress report on how we’re doing (well with pumps, not so well on integration of the bio-med and IT staff), and if you care about health care progress you should read it.
POLICY/POLITICS: The Real Politic$-As-U$ual of Health Care
I am up at Spot-on putting Health Care Politic$-As-U$ual in context. As ever come back here to comment if you like.
BLOGS: Health Wonk Review
Welcome to Health Wonk Review. The bi-weekly round up of the great and the good in health policy wonkery around the web. Putting HWR together this week confirms that health wonks know alot about health care, but can’t follow simple instructions to save their lives. There’s a lesson in there for health care as a whole, and the lesson is that user interface design of software, insurance products, compliance regimens, or blog carnivals has to be mind-numbingly simple and foolproof.
So on with the show…
From Managed Care Matters, Joseph Paduda notes that some US employers are sending their employees to India for expensive procedures and that word is bubbling up into the mass media—more evidence that drastic times call for drastic measures. His take? The more pressure from alternative solutions like Indian surgeons, the better as it will force us to confront our mess of a health care system. Ain’t competition great?
At Ambulatory Computing Robert J Lamberts writes that Medicare has backed off due to pressure from device manufacturers. There were cuts due for reimbursement for high priced, high end devices, but caving to pressure from the lobbyists for the device manufacturers, the current administration has backed off from this plan. This entry is a rant by a primary care doctor who faces the threat of cutbacks on reimbursements for physician visits. "Politics as usual" threatens to undermine any attempt at real reform. His version is called Medicare Cuts Scaled Back
On the same topic at Health Care Renewal, Roy Poses says that some naively thought that CMS proposed cuts of its high reimbursement rates for high-tech procedures might make more money available for primary care, etc. Alas, the cuts were speedily rescinded. CMS bureaucrats could not withstand the onslaught of commentary from executives of big device manufacturers and hospitals, and surprisingly two famous left-wing senators.
At TMBN Dimitriy shares reports from two Silicon Valley conferences which hint how blogs and social media will transform health care, much like news, politics and entertainment. The AlwaysOn Stanford Summit offers an analogy with Hollywood (do not miss the War of the Worlds spoof video!). BlogHer offers a model of online community fused with a conference and an inspiration for TMBN. Finally, note how the health care blogger survey may help us find the right way to apply BlogHer ideas to health care.
What do the Grand Canyon, a Lotto ticket and the Union Jack have in common? Henry Stern from InsureBlog reports on how one nationalized health system gambles with folks’ lives.
Meanwhile Glowing appraisals of Cuba’s state-run health care system are plentiful in the health policy literature. But even if a few isolated metrics indicate something good (like a high doctor per capita figure), does it justify the whitewashing of medical apartheid? And how reliable are health data from a dictatorship, anyway? The Lucidicus Project touched on these questions.
Of course if you want to get beyond the rhetoric, perhaps you should look at some real data on the topic, as I did on this posting on Canadians grumpily waiting on waiting lists at THCB. Sadly for the anti-single payer crowd it’s just not as simple as they’d like it to be, even if most Americans can’t tell Cuba and Canada apart.
Talking about grumpy, also writing at THCB, surgeon Eric Novack is most pissed off with CMS for deciding just not to pay up for a few days….he should meet some of my clients!
Meanwhile a real full-time wonk, Michael Cannon at Cato@Liberty has not one but two interesting posts on P4P’s role in Medicare FFS (Hint: he doesn’t think it should have one). Michael also busts certain bloggers (err..me actually) for just reading the press release and not the whole report!
David Williams of The Health Business Blog writes about anesthesia-related adverse events which are four times as likely to occur when surgery starts at 4 pm compared to 9 am. Authors of the study call the results "expected." He’s not surprised either, but thinks it’s a scandal that quality varies so much based on time of day.
From MSSPNexus Blog, Rita Schwab writes that participating in the medical blogosphere has educated her about how strongly many clinicians feel about the Joint Commission on Accreditation of Healthcare Organizations. However, this post supports the premise that for all the angst and expense a survey generates, US hospital care is better than it would be without a "big brother" looking over our shoulders.
Vreni Gurd who writes the Wellness Blog says that drinking good quality water in adequate amounts is one of the foundational principles of good health. Therefore deciding where to source your water is important. Here are some ideas to help you make informed decisions.
Carol Krishner who’s still Driving in Traffic, tells us about a new senate bill (S 3719) introduced by Tom Harkin (D-IA) that would amend the Public Health Act and Rehabilitation Act of 1973 to establish a competitive grant program to support activities that would improve the health and wellness of individuals with disabilities.
At Drug Channels, Adam Fein has been busy..and he has a PhD too! He says that the Democrats are making Part D “reform” into a major theme of the 2006 elections, and wonders what effects direct negotiations between HHS and manufacturers would have on the pharmaceutical supply chain? Meanwhile the British fake Lipitor scandal continues to expand after an additional recall was announced. Adam wonders what can we learn from the European situation that can shed light on the misguided attempts to allow importation into the US? I think that we can all figure out his answers from his use of adjectives.
Finally people today are larger in stature and live longer than their ancestors. William Marcus Newberry, from Fixin Healthcare, tells us that most of this is the result of public health with sanitation, clean water, better nutrition and immunization, and antibiotics for life-threatening infections. Analysis reveals that conditions during pregnancy and the initial two years of life have a profound impact upon health status in middle and old age. The public would be well served if health policy was based upon these observations.
Meanwhile Fard Johnmar of Envision Solutions and Dmitriy Kruglyak of The Medical Blog Network have launched the first global survey of health care bloggers. It is open to all bloggers that spend at least 30% of their time blogging about health care-related subjects. The survey will run until September 29, 2006. Please go take it.
Next HWR is on August 24 at a to be disclosed location–check the HWR site for details or to volunteer. The one after that is at InsureBlog and the one beyond that at The Century Foundation.
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PHYSICIANS: The sky is falling
Mark McClellan says that Medicare payments to physicians are going down 5%. This of course is leading to political pressure, with the President of the AMA writing op-eds showing that the sky is indeed falling on the heads of seniors. And don’t let any of those pesky researchers at HSC tell you that cuts in Medicare reimbursement actually don’t lead to doctors dropping out of Medicare.
Oh well, perhaps the doctors will make their money back by investing in more specialty hospitals–after all, that moratorium is over. Let the self-referrals begin.
CODA: The AMA Pres uses this sentence "In 2006, Medicare is reimbursing physicians about the same as it was in 2001 — that’s in real terms, not adjusted for inflation." Someone needs to take him to a very basic economics class. "Real" means that it is adjusted for inflation. He means "nominal". And of course someone else needs to explain the P x V = I phenomenon.
BLOGS: Health Wonk Review is coming up this Thursday
Health Wonk Review is tomorrow, so please get yourself over to the form at Dimitriy’s place. Fill it in under the “Carnival” banner for Health Wonk Review
PLEASE include your link to your post linked to the relevant part of the "description" in the HTML. Just putting the link in the baox called link or title is NOT GOOD ENOUGH. That’s not a friendly request, it’s an order.
