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.
Above the Fold
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!
Interview with IPC The Hospitalist Company’s Adam Singer
I don't delve into the world of hospitals, physicians and health care operations as much as I should. So when I was asked to interview Adam Singer, the CEO of IPC The Hospitalist Company, the biggest company (and a publicly traded one at that) managing a group of hospitalists–the internists who run patient care in more and more big and small facilities, I thought I should!
What I didn't realize is that not only does Adam know lots about the present and future of hospitalists and how that role has emerged in recent years, he also has some pretty strong views on the relationship between hospitals and doctors (keep 'em separate), bundling (no, thanks) and also the supply of physicians (let in more international docs or we're in a big hole). So it's a wide ranging discussion and one I think you'll enjoy. Here it is.
The Health Industry’s Achilles Heel
“You never want a serious
crisis to go to waste.”
Timing matters. The health industry has demonstrated steadfast
resistance to reforms, but its recently diminished fortunes offer the Obama
Administration an unprecedented opportunity to achieve meaningful change. The
stakes are high, though. The Administration’s health team must not miscalculate
the industry’s goals, or waver from goals that are in the nation’s interest.
The two are very different.
Aligning the forces of reform will be the first challenge. The White House and Congressional Democrats appear to be
collaborating to develop a unified reform design. Even so,
the effort is hardly pure. Lawmakers have been receptive to industry influence.
The non-partisan Center for Responsive Politics
reports that, in 2009, health care interests have already spent $128 million on
Congressional lobbying contributions, more than any other sector.
The tide now turned, most of that largess has gone to Democrats.
Canadians? Not as good as us!
Several of my friends in the blogosphere are getting very excited because eHealth Ontario has pissed away a few million dollars and the now fired CEO got more bonus than was seemly. So she gave Accenture and Price Waterhouse Coopers low 7 figure no-bid contracts and it’s now transpired that consultants billed food and random travel for expenses. MrH at HISTalk gives it two separate mentions in his section of the news and Inga piles in as well.
But I must remind you that as in all things Canadians pale in comparison to how we do it here.Continue reading…
Matthew went to Redmond, 2–Bert van Hoof, HealthVault & devices
Continuing my tour around Microsoft’s HealthVault team I met with Bert van Hoof. Bert is the devices guy who showed me lots of ways to get data into HealthVault. If you’re interested in how a power user links devices and data (and if you excuse my amateurish video work), you’ll like this one!
If you’re having trouble with this video in IE, you may need to download the latest FlashPlayer version. (Sorry, our video service Vimeo is having some problems that appear to need the latest version of FlashPlayer. You can do that here. Alternatively Firefox seems to work fin (but don’t let the folks at Microsoft know that I told you that!)
