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Above the Fold

The Best Health Care Idea All Year

Nov 11, 2009• 23

By ROBERT LASZEWSKI

Out of almost nowhere has come momentum for a proposal to create a bipartisan entitlement and tax commission to draft proposals to control the long-term costs of Social Security, Medicare, and Medicaid. The idea would require the Congress to quickly vote the recommendations up or down via a super majority vote.

The idea isn’t new–proposals for a such a commission have been around for a longtime.

What is new is the bipartisan enthusiasm that is growing–particularly in the Senate. Coming out of the Budget Committee, and Chairman Kent Conrad and Ranking Republican Judd Gregg, the idea is picking up bipartisan steam with, among others, Republican Senate Minority Leader Mitch McConnell expressing general support for the idea.

A number of Senators have threatened to tie their votes to raise the deficit ceiling to establishing such a commission.

If the recent Democratic health care bills have made one thing crystal clear it is that the Congress is wholly incapable of dealing with cost containment under present circumstances.

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria,
Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

Medicare’s Biggest Change in 40 Years on the Horizon?

Nov 11, 2009• 2

By Vince Kuraitis

Earlier this week CMS issued a typically cryptic Announcement indicating that they were shelving the Medicare Medical Home Demonstration (MMHD) and instead would focus on the recently announced Multi-Payer Advanced Primary Care Initiative (MAPCI). My blog post from Tuesday provides details and asks the question “What does all this mean?”

Medicare’s Biggest Change in 40 Years?

CMS’ Announcement about the rise of MAPCI and the fall of MMHD struck me as highly significant…but all the pieces didn’t fit. I’ve spent a fair amount of time emailing and talking with colleagues this week…and the big picture is emerging…and it’s really BIG. My working hypothesis is that Medicare is on the verge of its biggest
change in 40 years:

Medicare was created as a centralized, monolithic payment model.
It’s been one size fits all, and that size is created in Washington DC.
There has been little tolerance of regional administrative variability,
and the ironic result has been high variability in regional costs and
quality.
Medicare seems poised to do a 180. It’s signaling movement toward
supporting state-based, multipayer initiatives — where Medicare is at
the table and influential, but not in control. It’s a recognition that
health care is local and that unique solutions will be needed in
different regional markets. The Obama administration is demonstrating
strong support for the Patient Centered Medical Home (PCMH) and
Accountable Care Organizations (ACOs) as important building blocks in
this transition.Continue reading…

Dave Durenberger on Lieberman

Nov 11, 2009• 2

By Matthew Holt

Former Minnesota Senator Dave Durenberger, a thinking centrist Republican (remember them?) puts out an occasional newsletter full of gems. This is today’s zinger:

The Senate has a better bill than the House, but it also has a 60-vote requirement which empowers the odd-ball “if not my way, the highway” members – like Joe Lieberman claiming that something like a public insurance plan violates his “conscience.” I guess I don’t understand Conservative Judaism.

Intermountain – Proof That U.S. Hospitals Can Improve

Nov 10, 2009• 23

By MAGGIE MAHAR

I urge everyone to read this story by David Leonhardt in this Sunday’s (November 8) New York Times. (Thanks to reader Lisa Lindel for spotting it. )

Leonhardt profiles Intermountain Healthcare, a network of hospitals and clinics in Utah and Idaho that President Obama and others have described as a model for health reform.

Leonhardt concludes:

“If you simply looked at Intermountain’s overall results — the good outcomes and low costs — you might be tempted to dismiss them as a product of the environment. Utah has the youngest population of any state, as well one of the lowest rates of alcohol and tobacco use. More than half of the state’s residents are Mormons. This homogeneity creates a noticeable sense of community, even a sense of mission, among many Intermountain doctors and nurses.Continue reading…

The Federated Health System of America

Nov 10, 2009• 4

By GLENN LAFFEL

After a spy plane confirmed the Soviet Union was building launch platforms for first-strike ballistic missiles in Cuba in October, 1962, President John F. Kennedy convened his Joint Chiefs of Staff and cabinet members to help him decide how to respond.

Kennedy managed the diverse input he received, including surreal, saber-rattling rants from Air Force General Curtis Lemay, and eventually resolved the crisis. It was the closest we ever came to nuclear war.

But the consensus-based, inclusive leadership style JFK used to resolve the Cuban Missile Crisis doesn’t seem to be working as well for President Obama as his Health Reform Express barrels towards an unknown final destination.

Take the latest cockamamie plans for the public option, for example. As the House and Senate struggle to cobble together some semblance of a bill, we hear that the end result is likely to contain a public option along with a rider that allows states to opt out of it if they so choose.This ridiculous compromise is the byproduct President Obama’s decision to let Congressional group-think generate a legislative package that (a)could pass Congress and (b)he could sign. In making this decision, Obama sacrificed his principles before the altar of political success.

Controlling Health Care Costs: How to “Bend the Curve”

Nov 10, 2009• 5

Stephen Shortell

By STEPHEN SHORTELL

As Congress nears passage of the first substantial health care reform in decades, there is an ominous challenge: No reform will be sustainable unless we slow the rapid growth of health care spending.

Health care costs are rising at a staggering pace. Expenditures have been increasing at 2.7% per year faster than the rest of the economy over the past 30 years. In 1980 the US spent about 8% of GDP on health care. We now spend over 17%. We need to rein in growth of health care spending to levels no higher than overall economic growth — or ideally “bend down” the growth curve to an even lower figure.

How do we “bend the curve”? What are the best ways to slow the growth of health care costs, thus making other reforms sustainable?There are three major areas in which reforms will help bring health care spending under control.Prevention: US health care is burdened by diseases that are preventable. If we can improve lifestyle issues – nutrition, exercise, obesity, tobacco use – we will lower the future incidence of diabetes, heart disease, cancer, and other costly maladies. Current health reform proposals that allocate $10 billion for a Prevention and Wellness Fund represent a major step in the right direction. Disease prevention likely provides the greatest return on investment regarding health care costs of anything we do.

Hospital and Physician Behavior: Hospitals have no incentives to prevent unnecessary hospitalization. Physicians, paid mostly by fee-for-service, have every incentive to order more tests and procedures. Neither is rewarded directly for making – or keeping – patients healthy. Key to controlling health care costs in the future will be to realign these incentives.

This will require performance measurement and public reporting for both cost and quality. Provided that predetermined quality criteria are met, hospitals and physicians who can provide better care for less money would share in the savings.

Spotlight on Health 2.0: The Patient Is In, from SF 2009

Nov 9, 2009• 1

Every week we bring you a new video from Health 2.0! This week we’re featuring The Patient is In, a session focusing on how Health 2.0 tools are making a difference for patients.

To see more videos from past Health 2.0 conferences, or to purchase the entire conference DVD sets from ’07 & ’08 click here. 2009 DVD sets will be available shortly, please check back for updates.

Where were you?

Nov 9, 2009• 4

By MICHAEL PAINTER

I distinctly remember the first time I heard the title, “National Coordinator for Health Information Technology”. It was 2004. That’s, of course, the year that RAND released its important national report card highlighting the overall mediocre state of health care quality. You know the one that told us “it’s a flip of a coin.” I was an RWJF Health Policy Fellow working on the Hill with then Majority Leader Bill Frist’s health policy staff.

There was a flurry of staff activity regarding the president’s pending executive order pushing adoption of the electronic health record and creating a new federal health information technology, dare I say, czar. . . . But what to call this new position? To be honest, when I initially heard folks say the words, “national coordinator for health information technology,” my first thought was, “Well, that’s a mouthful.” My second was “It sort of sounds like a character from that TV show, ‘The Love Boat’”. But I kept those smart remarks to myself and quite quickly got on board—and, to be honest, never looked back.Continue reading…

Are We Too Small to Succeed?

Nov 9, 2009

By DON LINDSTROM

The logic behind the government bailouts in the financial and automobile industries goes like this: some institutions are so large and interconnected that their failure could collapse the entire economy. They are considered to be too big to fail. The notion of too big to fail implies its opposite, that some individuals and businesses are too small to succeed. Of course, that includes most Americans.

Author, commentator, and former Republican strategist, Kevin Phillips, uses the near economic collapse to illustrate current reality regarding American values. He calls the government bailouts welfare for the financial sector. Conversely, he points out that whenever topics like universal health care or national pensions arise, they are invariably described as too expensive or socialistic. The same arguments were made about the bailouts, but they did not prevail. Thus, we can afford to bail out large corporate entities in self-made crises, but we cannot afford a basic level of health care for all Americans. This has been true for nearly a century. Prior to the Great Depression, government took a hands-off approach to economic bubbles, allowing the ‘invisible hand’ to work its magic. Since that time, government has taken a hands-on approach to economic crises. In the current case, everybody must pay for the greed of a few, some of whom continue to be rewarded for their behavior. The invisible hand seems to have become the visible finger.

In contrast, universal health care has been proposed and defeated repeatedly over the past century (in 1915, 1935, 1948, and 1994). With the exception of the old and the infirm (Medicare) and the young, the disabled, and the poor (Medicaid), we as a society have not defined health care as a public good like education or police and fire services. The Social Security Act of 1965 that created Medicare and Medicaid is attributed to the masterful legislative skills of LBJ.

Unlike comedian Jack Benny, our leaders don’t have to think much about the question, “Your money or your life?” With the exception of the SSA of 1965, financial security (money) has always trumped health security (life). In effect, the acute condition (economic crisis) gets action while the chronic condition (health insecurity) does not.

For those with health insurance who have not tested its boundaries, health care is not a crisis. It might be costly. It might be time consuming. It might be infuriating to navigate the insurance and health care labyrinth. But it’s not a crisis. It will probably take a catastrophe like the collapse of the safety net hospitals before universal health care becomes public policy.

Many Americans believe the fix is in, the system is rigged. A friend refers to members of Congress as “the whores in Congress” and suggests they should wear sponsor patches like those worn by NASCAR drivers. To be fair, we the people don’t seem to have a problem with outsourcing political campaigns to the private sector. That’s the game we allow to be played in Washington.

If health care were a product, this would be the current offering. Pay twice as much as other industrialized countries, waste 30% to 40% of that payment due to a highly inefficient system, get lower overall quality (33% less value in terms of outcomes), cover only 80% to 85% of the population, and put 15% to 20% of those with insurance at risk financially if they fully use the product. According to the Business Roundtable, this product puts American business at a competitive disadvantage globally.

One wonders if Yankee ingenuity has died or has simply been co-opted by a collection of balkanized special interests. If we Americans are unable to create a sensible health care system out the current mess, we really are too small to succeed.

Don Lindstrom is a business strategy consultant. His firm recently recommended a redesign of the Florida Medicaid program. He can be reached at do*@**************nc.com.