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POLICY: The future of retirement

In this book review of a couple of finance books in the New York Times, Neil Genzlinger is close enough to being right to remind us why we need to figure out the underlying problems in the health care system.

But as far as radical new ideas, the visionary approach would have been the blunt one: forget retirement planning. Hakuna matata. In the future, whether you have $15 million socked away or $1,500, nothing will matter – not food, not shelter, not golf, not active-senior communities – except health care benefits. Medical science, which already offers rebuilt knees and transplanted livers and faces, will soon offer new everything, but at a staggering cost. The Health Care Cabal will issue a one-page retirement plan: “In exchange for all your assets, including your children (and all their future earnings in perpetuity), the H.C.C. agrees to replace your parts as needed, while supplies last.” And everyone will sign it, because here in the have-it-all era, death is simply unacceptable.

THCB: Last call for submissions

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Last call for submissions for the THCB health care reform
competition. Your mandate: solve the health care crisis in 250 words or less.
Be sure to, ahem … read the contest  rules, before submitting your master plan, as it’s clear several of our contestants didn’t.

The grand prize:
potential international superstardom and a guest spot on the Eric Novack show.

POLICY: Joe Paduda explains what’s wrong with Part D’s economics

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While we’ve been focused on what’s wrong with Part D’s implementation, Joe Paduda reminds us all about one of the other problems with Part D. It’s that by it’s nature a voluntary benefit is going to attract adverse selection. In other words, the only people signing up for it so far — and barring the dual eligibles who were involuntarily alloted into it there haven’t been too many, and DSS reports that there won’t be that many more — are the ones with big drug costs. So by definition eventually the plans will start losing money.

For now the PDPs are being covered against that risk, and the very generous taxpayer will make up the difference. But later on the taxpayer may not be so generous (as with Medicare Risk in the late 1990s) at which point the PDPs will start to exit.

This, by the way, is exactly the inverse of the problem with HSAs, where all the healthy people will leave the insurance pool, leaving those behind in a death spiral.

QUALITY/POLICY: Need an Organ? It Helps to Be Rich

Were you looking for this?ABC News reporter Joy Victory found a really juicy angle on the problems of being uninsured. Her article is called  Need an Organ? It Helps to Be Rich. As you might suspect getting on the waiting list for an organ if you’re uninsured is pretty tricky. Entry to the list is controlled by the big medical centers that do transplants. Although everyone is supposed to be viewed independently of means, its totally obvious that if the patient is uninsured the hospital concerned will lose a packet on the procedure. So like every other aspect of care access for the uninsured, their chances of getting access to that list are much lower than those with insurance. And of course it goes without saying that unless they are lucky enough to be in a job offering great insurance — a number which is getting lower every day — they are not going to be able to buy insurance at any affordable price.

But the fun contrast that the article brings up concerns the other end of the transplant pipeline. Nearly 23% of those who’s organs are donated for transplantation were uninsured, who in other circumstances wouldn’t be eligible to accept their own organs! So this is a case where the haves are literally living off the have-nots.

You’d think that the advocates of universal insurance could run with this one a little?

POLITICS/POLICY/PHARMA: Compare and contrast GWB and LBJ on Medicare

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2_24_112205_teacher_sex2_smallJonathan Cohn takes a good look at the Medicare implementation now and then, in What Bush could learn from LBJ on Medicare. Not too surprisingly the current screw-up wasn’t evident in 1965, even though the Johnson Administration had only 11 months to implement an entire new program, as opposed to the Bush Administration’s 25 months to add a new one on.

It does have to be said that McClellan’s golden boy image is starting to look a little like his brother’s — he of the “I know nothing” attitude (If you don’t know what I’m talking about look under N here)

PHARMA: The gift that keeps giving, or PhRMA being dumb and dumber

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Somehow I’ve ended up on Peter Rost’s mailing list. Now he’s a guy who knows a thing or two about the wacky behavior of big pharma. Peter sent me a press release about that novel that PhRMA funded until the grown-ups figured out in horror what they’d done. Unfortunately, their ham-fisted attempt to cover up the fact that they’d funded a novel about terrorists poisoning the drug supply from Canadian pharmacies apparently won’t die. Much more on the background at Health Care Renewal.

But you’d think that PhRMA would shut up about this and hope everyone forgets. After all it was fun while it lasted but there are other pharma-related issues on the front page now! Think again.

The latest round is that the consultant that PhRMA used as an intermediary is now apparently trying to stop the sale of the book — that’s already been published — and make the authors take done the email trail that is pasted on their website. Given that it’s pretty clear that PhRMA paid for the initial payment to the authors (although the consultant has been accused of taking a cut on the way), it sounds a little unlikely that PhRMA isn’t also behind trying to get this email trail taken down, and the book off the shelves. Of course the author Spivak, while claiming to be in high dudgeon, is loving the publicity, and is hawking the film rights claiming Nicole Kidman wants to star in it!

PhRMA apparently only offered them $100K to shut up early in the process. Presumably with the publicity they were already getting the authors thought they’d make more by keeping going. Perhaps a bigger number might have given them pause. I guess like many of big Pharma’s other products they’re discovering that doing the recall costs more and more, the longer you’ve been covering up the bad results.

Remember guys, there is a high road, and in the long run you’re better off taking it!

POLICY: Busboys On The Street

I’m up at Spot-On talking about pay or play, and the San Francisco Busboys On The Street. Next week we’re taking the politico-nerds remedial education in another direction, but for now this finishes pay or play….

POLICY/POLITICS/TECH: Jon Cohn plays Gotcha on Part D

John Cohn finds the December GAO report that says that CMS wasn’t ready for Part D’s launch, and also McClelland’s response that the GAO was underestimating CMS. Make that “mis-underestimating”, I think. 

Here’s what the GAO Report says would be some likely problems with Part D’s introduction for the dual eligibles:

For dual-eligible beneficiaries who do not have Medicare drug coverage because they were either not identified and enrolled on January 1, 2006 or are newly qualified dual-eligible beneficiaries, CMS has developed a point-of-sale enrollment mechanism designed to enable pharmacies to assist these beneficiaries in obtaining immediate Part D coverage. The agency signed a contract with a designated PDP on November 22, 2005 to implement this mechanism. Because these arrangements were completed less than 6 weeks before the transition is to occur, limited time remains to educate all pharmacies about its availability and details of its operation.

For beneficiaries who were enrolled in a PDP but do not have their PDP information, CMS has facilitated a new information-technology process, known as the Eligibility Transaction, that will allow pharmacies to identify a beneficiary’s PDP and provide the beneficiary with the PDP’s contact information. As with the point-of-sale enrollment mechanism, it is unclear to what extent pharmacies are informed about the Eligibility Transaction and will use it. Despite CMS efforts to publicize this tool to industry organizations, a pharmacy industry association representative stated that it is unclear how many independent drug stores, which dispense the majority of the nation’s retail prescription drugs, plan to use the Eligibility Transaction.

Translation: a) Pharmacies are supposed to be able to immediately register dual-eligibles if they’re not already in a PDP but that was only developed in November and wouldn’t be ready. b) GAO was unsure how many pharmacies would use the eligibility transaction system.

GAO didn’t seem to predict what apparently is the major problem — the data on eligibility from the PDP’s that the transaction database is hitting against is wrong or it’s just not working.

We will find out more, but they had two years to get this right! And it seems to be getting worse!

BLOGS: Why are you not sheep?

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So it sit here every day slaving away just to give you a little information and entertainment, and I ask you for one eeny-teeny thing….to go and vote for brave patient and young punkette Kate Steadman’s Healthy Policy blog in the medical blog awards, and she only got a miserable 27 votes. Yet the winner, the Bio-Ethics Blog only got 178 and Hospital Impact which ran an aggressive campaign got 170. Now if you look at Hospital Impact’s Site Meter  you’ll see that they get just over a hundred visitors a day, similar to Kate’s. THCB (by virtue of age and infirmity) gets about 5 times that. Yet basically everyone who visited Tony’s Hospital Impact site did what he asked and went and voted for him, and basically no one who reads TCHB gave a monkey’s about my request!

People, I am not feeling the love!

CODA: A poll for blogs with such a low turnout is of course a ridiculous way to pick the best blog. It would be the equivalent in the real world as if we picked the President of the most powerful nation on earth by having a straw poll amongst a few extremists in a couple of tiny rural states that share almost no issues with the vast majority of urban and suburbanite Americans who live near one of the three coasts, or anyone else for that matter. And while you might expect the quality of the results to be pretty similar, the blog winners were actually pretty good. No comment on the Iowa/New Hampshire/South Carolina primaries.

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