For those of you who had better things to do than spend last week reading wonkish blogs, I point you towards my article about Tom Daschle’s book. In particular I encourage you to look deep in the comments, for a particularly fun spat between me and a reader called Nate–the type of spat that used to be very common on TCHB but sadly has become a little rarer now we’re all grown up!. The original piece is here and the comments get juicy around Jan 3.
Above the Fold
Outlook for health stocks clouded by uncertainty about Obama’s health strategy
Although I wrote months ago that health executives weren’t very concerned about the elections, I think they have to be now.
Many health stocks are depressed and they will be until the
uncertainty about Obama’s proposed nationalizing of the health
insurance markets is resolved. We don’t know exactly what he’ll try to
get through Congress. And we don’t know whether the GOP will be able to
kill or modify Obama’s plans. Clinton had basically the same majorities
in the House and Senate that Obama will have, and he couldn’t get
Hillary care enacted.
The public mood, of course, is much different today. Insurers shoot
themselves in the foot every day, and consumers and politicians are
sick of them. They are much harder to defend today than they were in
‘93 and ‘94. So I think enough GOP senators will support Obama to get
something done.
But the markets aren’t sure, yet. Uncertainty is a market killer.
In addition, with higher co-pays and deductibles, the health
insurance and health care markets are acting much more like normal
markets despite all of the governmental distortions.
This is hurting demand for insurance, medical devices and medical
services. This is shown in the depressed prices of hospital company
stocks.
So, if you’re going to play the health ETFs, play the technicals as
much as the fundamentals, which are very cloudy at this point, imo.
A me-too strategy for me-too drugs
AstraZeneca appears set to follow Merck into the market for “bio-similars.” (See AstraZeneca may join generic rush.)
Congress and the media tend to portray biosimilars are analogous to
generic chemistry-based pharmaceuticals, and therefore believe that
they will lead to much lower prices as a result of the commoditization
of these products. If all goes according to plan, that should cut the
price of biologics by 50 to 95 percent as has been the case for generic
versions of traditional pharmaceuticals.
Pharma and biotech companies aren’t seeing it this way and neither
am I. Although they won’t say so, pharma companies are starting to
realize that biosimilars –which unlike traditional generics cannot be
subsituted by a pharmacist for a branded product– are really like
me-too products within a class of drugs. That’s exactly the model
that’s enabled multiple blockbusters within a given class in the
mainstream pharma business, and led to higher spending overall.
Biosimilars are unlikely to be a lot cheaper than the products they
copy, and they will have all the sales and marketing costs associated
with a branded product, plus some of the development costs. Don’t be
surprised if some biosimilars are actually priced higher than
the original products, based on some real or perceived improvement in
efficacy or safety. That’s what happened when me-too drugs like Lipitor
entered the statin market. (See Generic biologics — or Me Too Drugs 2.0? for more details.)
A new year’s resolution for greater hospital transparency
Just thinking, along the lines of a New Year’s resolution. What if all
of the hospitals in the Boston metropolitan area — academic medical
centers and community hospitals — decided as a group to eliminate
certain kinds of hospital-acquired infections and other kinds of
preventable harm? And what if they all committed to share their best
practices with one another and to engage in joint training and case
reviews in these arena? And what if they all agreed to publicly post
their progress on a single website for the world to see?
Can the physical examination save us from the dehumanization of medicine?
In last week’s NEJM, physician-author Abraham Verghese paints a disturbing picture
of a medical world in which technology has morphed from tool to object,
the patient relegated to a supporting role. To me, Abraham has nailed
the diagnosis but not the treatment.
I had the distinct pleasure of getting to know Abraham when we both served on the board of the ABIM (actually I came to know his work 15 years earlier, when I reviewed his bestselling book, My Own Country, for the NEJM). Abraham is a romantic and a traditionalist, and in last week’s New England Journal
piece he poignantly lays out a problem he has fretted about for years:
namely, that information technology is dehumanizing the practice of
medicine. Describing rounds with his ward team at Stanford, his new
academic home (he was recently recruited there from the UT-San
Antonio), he recalls:
When I stroked a patient’s
palm and caused a twitch of the mentalis muscle under the chin — the
palmomental reflex — it was as if I were performing magic. Still, the
demands of charting in the electronic medical record (EMR), moving
patients through the system, and respecting work-hour limits led
residents to spend an astonishing amount of time in front of the
monitor; the EMR was their portal to consultative teams, the pharmacy,
the laboratory, and radiology. It was meant to serve them, but at times
the opposite seemed true.
The Downfall of AIG
Those of you outside of Washington, DC likely missed the Washington Post’s three-part investigation of the events leading to the downfall of AIG.
It makes for good holiday reading. I highly recommend the series to you.
Knowing the culture at AIG from many years of activity with the company and its leadership, I can tell you the story certainly has the culture right.
While this is not a health care story per se, it is a story about risk taking and understanding, and never getting cocky about, risk. AIG
execs argued for years they really had no risk in their credit default
swap business. My experience is that when someone is willing to pay you
lots of money to lay a risk off on you–in this case a whopping $80
billion of exposure–there is risk.
Matthew’s end of 2008 start of 2009 message
Every year I put together a personal end of year letter about the charities, causes and issues I care about. It’s over on my otherwise almost defunct personal blog. Take a look if you like. Thanks!
Happy 2009!
Critical of Critical
Like legions of other wonks when I discovered that Tom Daschle was going to be Obama’s point guy on health care, I sent off for a copy of his book Critical. It’s a fast and easy read, but in its examination of the problem it doesn’t add much to superior books on what’s wrong with health care (much of the first section reads like an undergrad’s attempt to summarize Jonathan Cohn’s Sick) and there are some pretty weak logic flows and basic editing throughout (he refers to the book Uninsured in America on p155 as though it’s already been introduced before it actually gets introduced on p161). But ignoring all that, what does Daschle suggest we actually do?
First, he promotes himself as a scholar of failed attempts at health reform past, and of course a witness to the most recent attempt.
Are We Finally Entering the Golden Age of Healthcare Transparency?
By BOB WACHTER, MD
When will patients start reviewing quality data before choosing their doctors and hospitals? The answer has been “soon” for several years, but “soon” may finally be the right answer. If you doubt it, check out the Commonwealth Fund’s new site, “Why Not The Best?” The central premise of the healthcare transparency movement has been that
putting data on the Web (quality, safety, satisfaction, even cost) will change consumer behavior, the way such data does for autos and restaurants. The movement, which began in earnest with the launch of the HospitalCompare website by Medicare in 2003, lives by the following catechism:
- Let’s post some, even rudimentary, quality data on the Web
- Patients will look at the data, and demand improvement of their existing providers or choose better ones
- This consumerism will create “skin in the game” around performance data
- Hospitals and providers, now motivated to improve, will do what it takes to get better.
Is Massachusetts a model for national reform?
By 
I get asked this question a lot these days, which shouldn’t be that surprising. Harvard Pilgrim is headquartered in Massachusetts, and the Massachusetts health care reform plan is already a couple of years old. More importantly, it has added about 440,000 people to the insured ranks (185,000 through unsubsidized private plans and another 255,000 through subsidized, Medicaid-like coverage), has maintained high employer participation (over 70%) and doesn’t appear to be crowding out private coverage as public coverage expands.
But my answer to this question remains “it depends.” There were profound differences between Massachusetts and the rest of the country before health care reform took center stage here that make relying on our experience somewhat challenging for the nation as a whole. For example, Massachusetts already had guaranteed-issue requirements for individual health insurance coverage even before reform. Today, most states don’t. So in Massachusetts, individual coverage was available to anyone who wanted to buy it, but it was really, really expensive.
That’s because most of the people who buy individual coverage — absent a mandate to purchase — usually plan to use health care services once they purchase the insurance. Insurance works through risk pooling – a small number of people who get sick spend the premiums paid by a much larger group of people who don’t. If most of the people who buy the product plan to use it, there’s not enough healthy people to keep the overall price down.Continue reading…
