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Just when people were getting ready to write-off the Baucus bipartisan approach to a health bill the debate has swung back to the middle on a number of critical issues.
Above the Fold
David Gratzer is Nice. Dennis Kucinich is not.
I had David Gratzer on THCB a while back. He was so nice, that it was really hard for me to get mad with him—even though his book was basically a pack of lies. He seriously suggested that the UK under Blair was NHS was going to covert into an American-type system, and he couldn’t answer why he allowed his wife to come here and be uninsured! (Of course my father the gynecologist always told me that all psychiatrists are nuts anyway)
Then last week the single payer crowd finally got to appear before a Congressional committee, and for some bizarre reason Gratzer was there too (I guess he provided balance). And the very nice David Gratzer finds that Dennis Kucinich is not quite so nice. Watch this…
Designing an Effective Insurance Exchange. Or Not.
If health care reform legislation is passed, it will almost certainly include provisions for Insurance exchanges. Theoretically, these could be key to controlling costs and expanding access to coverage. In practice (and in addition to assumptions about guaranteed issuance, community rating, and the elimination of medical underwriting) these goals will be achieved only if exchange design adheres to some basic principles:
The Story of Dr. Sidney R. Garfield
“It’s about time,” declares Jay Crosson, MD, a recently retired physician executive at Kaiser Permanente, in his foreword to The Story of Sidney R. Garfield – The Visionary Who Turned Sick Care into Health Care (Permanente Press, 2009). “For too long,” writes Crosson, “Sidney Garfield has stood in the giant shadow cast by his more celebrated partner and friend, Henry J. Kaiser… (whose) name and fame live on, mainly in association with the only nonprofit organization ever incorporated by the builder of more than 100 for-profit companies – Kaiser Permanente. But the physician whose extraordinary vision and daring innovations in health care delivery gave birth to that same organization remains largely unrecognized beyond the select circle of medical historians and the heritage-minded physicians and staff of Kaiser Permanente.”
Sidney R. Garfield (1905-1984) is indeed one of the great under-appreciated geniuses of 20th century American medicine.
Starting out from the humble beginnings of a 12-bed hospital in the middle of southern California’s Mojave Desert, where he tended to injured industrial workers on the California aqueduct through the early years of the Great Depression, he not only went on to create the nation’s largest private, nonprofit, vertically integrated health care organization (Kaiser Permanente); he virtually reinvented the economics and organizational structure of health care delivery by envisioning and demonstrating the manifold advantages of the prepaid, group practice model – a model that many today view as a necessary element of effective health care reform.Continue reading…
Op-Ed: How I’ve Missed the AMA….
By MATTHEW HOLT
Over at Dr Val’s Get Better Health site Evan Falchuk from Best Doctors is very grumpy about Steve Pearlstein’s column in the WaPo. Pearlstein rewrites Gawande’s rewrite of Shannon Brownlee’s Overtreated. Not much surprise here—everyone is doing it and despite my cynicism Gawande’s piece in The New Yorker has hit a nerve, not least because Obama told everyone to read it—showing that he’s way more influential than Orszag in the White House despite what we wonks all think. Orszag by the way has been hammering on about the Dartmouth stuff for years and even dragged me into his office at CBO back in 2007 to suggest THCB kept plugging away about practice variation. But obviously no one in the White House was heeding his back reading of THCB, until the boss came and told them all to read Gawande.
Op-Ed: It’s the Waste, Stupid.
A recent Wall Street Journal editorial strongly challenged the notion that there is enormous waste in American health care. In the article the editors acknowledge that dramatic variation in health care spending exists across the country–but point out that the precise reason for that variation remains uncertain. They also note that much of the data about regional variation comes from the Dartmouth Atlas–and that work, they point out, is limited in that it only examines Medicare data. And they cite work from Richard Cooper at the Wharton School that directly challenges some of the Dartmouth Atlas conclusions–essentially arguing that the Dartmouth observed regional variation is actually simply an artifact of Medicare. They conclude that “Dr. Cooper’s assault on the Dartmouth Atlas is controversial but compelling. He argues that the less-is-more theory is based on the flawed premise that when a region’s outcomes did not improve as spending increased, the difference is simply classified as ‘waste’ – even if it isn’t.”
What “reform” legislation will achieve
This from single payer advocate Don McCanne whose quote of the day is a rich source of nuggets. He gave a talk in Orange County (California’s equivalent of Kansas)
Health Care Council of Orange CountyJune 11, 2009Annual MeetingKeynote: “Health Care Reform – What Has to Be Done”By Don McCanne, M.D.Opening questions directed to the audience:How many here believe that it is probable – not certain, but probable – that Congress will pass health care reform and President Obama will sign it this year?(Most individuals raised a hand)How many believe that the legislation will provide insurance coverage to everyone or almost everyone?(Not one hand went up)How many believe that the legislation will be effective in slowing the rate of health care cost increases?(Not one hand went up)
Sounds about right to me.
On a side note, I had a great talk with Hal Luft yesterday which will be on THCB next week. Hal had an interesting perspective on whether we should aim for 100% coverage or slightly less. Basically if we get to 100% of citizens covered, then it’ll be easy to cut the funding to safety-net providers who are looking after the homeless, the mentally ill, the destitute and many undocumented aliens (and lots of documented ones too). If we aim for say 98%, then we could justify keeping the safety net providers in a separate system and the 10 million or so (2–3%) of undocumented aliens in the country would at least have somewhere to go for their care.
Can’t say it’s my preferred solution, but it’s an interesting point.
Health Care Cooperatives–An Old New Idea–So What’s a Blue Cross Plan?
As opposition to a Medicare-like public health plan option grows, there has been a lot of talk about the compromise idea of creating not-for-profit health insurance cooperatives
that would compete on a level playing field with existing private
insurers. The reasoning goes they would keep the existing insurers
"honest" by introducing a new element of competition.That's a great idea.And it was a great idea 60 years ago when the first Blue Cross plans were established.
Problems with IE? Try Firefox or earlier versions of I.E.
For those of you using certain versions of Internet Explorer, we’re having some significant problems in the last day or so on THCB getting things like the right hand margins to appear, getting videos to appear and play properly, etc. (Issue seems to be limited to I.E. 8.) For now, these appear to be resisting the easy fix, BUT the good news is that everything is working fine in FireFox. So to those of you having trouble, can we suggest you use FireFox for the moment to view THCB and we hope to have regular service resumed soon.
A Special Reform Edition of Health Wonk Review
by BRIAN KLEPPER
Over at Managed Care Matters, the always thoughtful and energetic Joe Paduda has, once again, done us all a service. Tasked with hosting this edition of Health Wonk Review, he has assembled a great range of pieces on the current reform process, which make for enlightening, entertaining and sober reading. This one is useful, provocative and very educational. Check it out!
