A couple of years back there was some bad publicity about a hospital in Illinois that had its debtors hauled off to jail. Perhaps they should instead have tried this solution from Burundi—Don’t let them out if they can’t pay!
Above the Fold
TECH: Do you believe in RHIOs?
Friend of THCB Matt Quinn does, if people can just trust each other—apparently they’ve got some trust going in Ohio. Well worth a read, althought the main purpose of a RHIO needs to be a central ASP providing applications for smaller practices; and that has some of the same problems of the back-up storage issue I’m writing about elsewhere on THCB today.
Anyway to figure out what’s going on in Ohio, read Matt’s letter to Hospitals & Health Networks.
POLICY/POLITICS/HEALTH PLANS: Communist alert! (Well not really…)
The Minnesota Blues plan is floating a proposal for universal care. It looks at first glance like a Mass type individual mandate. Not so long ago Ken Melani, now CEO of Highmark, the dominant Western Pennsylvania Blues plan, had a similar idea.
So it appears that little by little the non-profit Blues are coming around to the fact that they have to have some plan in place to survive the coming revolution. This assumes that their future is a choice between being state regulated utilities in a multi-payer universal care system, or being replaced by the government in a single payer system. And there’s little doubt which one they’d rather take.
Of course these Blues have been denied the option of going for-profit, as the various state legislatures are now wise to the scam that enabled an earlier generation of Blues executives to make themselves rich beyond recognition while providing damn little back to the states that had allowed them that tax-free status for decades (see the experience in Maryland, for instance).
Those that have gone over to the dark side are of course adopting all of the tactics you’d expect, while of course the non-profit guys claim that they have to do the same to remain competitive. If they could construct a universal care multi-payer model in which everyone has to play by the rules of the big local state regulated utility, they’d do fine.
And apparently there are enough senior people, in at least Minneapolis and Pittsburgh, who are beginning to think that that’s the choice they’ll end up with in a few years. So they’re starting to float the proposals now.
BLOGS: Health Wonk Review is up
HWR is served with pleasure and inspired gastronomie at InsureBlog
PHYSICIANS/PHARMA/TECH: A take on the news, sort of
Things we already knew:
Doctors are poor at judging their own abilities. It’s a bit like everyone says they’re a good driver, but that 75% of drivers are terrible.
Merck earnestly believes that it was as pure as the driven snow over Vioxx and never knew that it was dangerous until it took it off the market(who knew about Dodgeball, eh — let alone what Kaiser knew several months earlier).
Little girls don’t really cry tears of stone
Things that I don’t think we did know
Online PHR use is up to 7% by July. Which is about 6% higher than they said it was 2 years ago.
According to the survey, commissioned by UnitedHealth Group and conducted by Harris Interactive ® , only 7 percent of U.S. adults use online personal health records and 35 percent of people surveyed were not even aware this resource technology exists.
POLICY: Mahar squewers Cutler
Just when you thought you’d heard the last of it, Maggie Mahar, last seen over here abusing the health care system, pops up over at The American Prospect smacking down David Cutler’s study. Again well worth reading.
PHARMA: Probably another false start from the DEA
The black stone that resides in the chest of DEA administrator Karen Tandy in the place where the rest of us have a heart must have some gravel chipping off today. The DEA allegedly has revised its rules on prescribing pain-killers:
Yesterday, DEA Administrator Karen Tandy said the agency had been wrong in limiting the multiple prescriptions and had made the tough decision to reverse course. She said the DEA received more than 600 comments from doctors, patients and others about its policies on narcotic pain killers, many of them strongly opposed to the agency’s position on limiting refills.
But basically this is a tiny move—allowing multiple prescription refills for those in chronic pain, but only by doctors who the DEA considers not to be in violation of their unwritten laws. After all, 2 years ago—right in the middle of William Hurwitz’s trial when his defense was about to introduce them—they introduced some similar guidelines they’d worked on with pain specialists for two years. So what happened then? Well given the choice of allowing rational behavior, even according to guidelines they developed and allegedly agreed with, and putting a doctor treating the chronically ill in jail. Guess which one they took?
The agency briefly posted the guidelines on its Web site in 2004 but then pulled them down and disavowed them.
Siobhan Reynolds from PRN is rightly, rightly suspicious
But Siobhan Reynolds, who created the Pain Relief Network several years ago to help defend pain doctors who she said were being unfairly arrested and prosecuted, disagreed and said the new DEA policy has changed little. "Ms. Tandy states here, as she has on many occasions, that doctors need not fear criminal prosecution as long as they practice medicine in conformity with what these drug cops think is ‘appropriate,’ " Reynolds said. "If that isn’t a threat, it will certainly pass for one within the thoroughly intimidated medical community.”
The story is that chronic pain is massively under-treated in this country, and opiates are the most effective way of dealing with that pain. Yet as I pointed out over at Spot-on the mad Calvinists who run our criminal justice system care not a whit.
TECH: Molly Coye is also an optimist
Managed Care has a conversation with Molly Coye about the progress in automating and infomating the health care system. You’d think she’d be a pessimist after all these years. But she’s not really! Well worth a read.
POLICY: Becker-Posner miss the point
And in, I hope, the last comment on the Cutler piece, two venerable Univ of Chicago economists debate it on their blog, the Becker-Posner Blog
Posner ascribes the problem of the high cost of adding a year of life to an elderly person to the desire of people near the end of life to spend whatever it takes to stay alive. Other than that’s not how people at the end of their life usually feel, the problem with these rational analyses is that they don’t understand how health care works. Decisions about end of life care are not made by patients–they are made by doctors and health care organizations. Wennberg’s work clearly shows that. The enormous practice variation in end of life care is a factor of cultural variation amongst physicians not one of patient choice—the patient don’t know about it. And it applies whatever the insurance status of the individual because it’s ingrained in local medical cultures.Other countries have got their physicians somehow to accept that (for instance) heart surgery or kidney dialysis on a 95 year old with a life expectancy of 6 months is not good medical practice. Here we routinely do it (as in Posner’s father’s case).Stopping that absurdity is the solution to our health care crisis as that’s where the vast majority of the unnecessary spending is. But to do that we have to change medical culture, and rather more difficultly, health care system incomes!
POLICY/THE INDUSTRY: Klepper is still an optimist
Nice short video from Brian Klepper on P4P. I think he’s optimistic, in that he thinks employers and the government will impose P4P on
providers. On the other hand the leading proponent of P4P in the government just quit! Then again Brian’s talking about slamming on the brakes or driving over the cliff, so maybe he’s a pessimist.
