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Half-baked Alaska: Palin short on health care explanations in debate

Merrill Goozner has been writing about economics and health care for many years. The former
chief economics correspondent for the Chicago Tribune, Merrill writes the blog
Gooznews.com, where this post first appeared.

It must be disconcerting to health care economists to see one of their pet peeves about the inequities of the employer-based insurance system so poorly used by the Republicans, who would repeal it. I’m referring, of course, to the tax deductibility of health insurance premiums.

Gov. Sarah Palin repeated Sen. John McCain’s promise to give every American household a $5,000 check to buy health insurance. They would raise the money to fund the program by repealing the deductibility of employer-based coverage. I can’t recall if she gave one of her trademark winks when she said it, but she certainly gave an enthusiastic nod. Health care will become just like Alaska! The government will be sending you money every year so you can go out and buy your own insurance.

There is an argument that can be made in favor of repealing tax deductibility. Like the home mortgage deduction, the higher your tax bracket, the more valuable the tax deduction. So if your employer buys you a gold-plated health care plan that costs $15,000 and you’re in the highest tax bracket (around 30 percent), you get the equivalent of a $4,500 tax break from the government. But if your employer buys you a plan that only covers hospitalization and serious illnesses for $7,000 a year and you’re in the 10 percent income tax bracket, the tax deduction is only worth $700. Repealing all tax deductibility and distributing the revenue equally to buy individual insurance policies seems simpler and more equitable — both appealing traits.

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Hospitals going green

Hospitals generate 6,600 tons of waste per day, and about 80 percent of that is nonhazardous waste. There are lots of opportunities to get greener, and some hospitals really are making concerted efforts to do so.

While they might gain some positive PR from it, there is definitely a financial motivation to cutting energy costs and reducing waste.

Kaiser Permanente is promoting its new facility in Modesto, Calif. as one of the "greenest" hospitals in the country. The hospital saved $500,000 by using green building materials, according to a press release. It also has solar panels, asphalt parking that filters water, and supplies its cafeteria with locally grown produce.

The Green Guide published by National Geographic ranked the top 10 green U.S. hospitals in 2006, and indicated the trend was growing. Then this August, Hospitals & Health Networks Magazine’s cover story about green hospitals.

Practice Green Health has loads of good information and practical steps to make your hospital or health care facility more sustainable and efficient.

Obama’s Health Plan Under the Microscope and Through a Fair Lens

Each presidential candidate offers a blueprint for health care reform. Neither can expect to see his plan enacted whole—legislators will leave their fingerprints all over any proposal. And, if truth be told, neither plan is perfect. Each proposal is blinkered in its own way; each ignores just how difficult true reform will be. I very much doubt that national health insurance will become a reality in the next year.

That said, I believe that we can take steps toward reform in 2009 if we begin thinking clearly—and honestly—about exactly what it is that we want and what it will cost. To that end, I believe that in-depth analysis of each candidate’s proposal can help underline the core ideological differences between conservatives, libertarians and progressives, and highlight the economic realities that any reform plan will have to face.

Recently, opponents of each plan have offered their critiques in Health Affairs (here and here) and supporters have defended their favorites here and here. Inevitably, many readers found the critiques too partisan. At the same time, they complained that rebuttals from the home team “read more like a stump speech with details glossed over and facts overlooked.”

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Help for newly unemployed to decipher COBRA options

The downturn in the economy, means lots of newly unemployed individuals will be asking what happens with their health insurance.

There are a number of online resources to help them understand their options under COBRA. Here are a few:

eHealthInsurance launched a new initiative, www.COBRAlearning.com,
to education consumers about COBRA and alternatives health insurance
for the newly unemployed. Accompanying the launch, was a survey (paid
for by ehealthinsurance) that found many consumers don’t know what
COBRA is or what their options are after losing employment.

Besides having a cheezy name, bWell-Informed Health Plan Forecaster says it offers "vendor-neutral educational and personal underwriting tools" for those Americans who are in the position of having "the freedom, yet responsibility, to choose their own health care."

Here, also are government and nonprofit options. The Department of Labor explains COBRA coverage here. The American Cancer Society also has a page intended to explain COBRA coverage.

The invisible hand and capitalistic sustainability

I, along with everyone else, have been walking around hollow-eyed given the speed of the recent financial meltdown. One-hundred-year old firms disappearing in a weekend, markets roiling with every bit of news, experts clamoring about the greatest calamity ever in the recorded history of finance, and politicians actually working weekends to attempt to rescue the largest and most important financial system in the world.

This is serious business.

I have also been amazed at the Governments response to nationalize “key” companies – AIG, Fanny/Freddie, and probably a few others before it is all through. Several people have made the connection between the nationalization of financial companies with the potential nationalization of the health care systems. Actually the wealth-health connection is probably stronger than you think. Just as the current financial mess is related to the “toxic” subprime debt on the books of the eviscerated companies, hospitals are also being laden with “toxic” debt from consumers who are also leaving them holding the bag on their bad debt.

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Health Care and the Broader Economic Crisis

Over at HealthLeaders, Dr. Richard Reece and I have an article, Will Primary Care Be Re-Empowered By An Ailing Economy?, arguing that the turmoil in the larger US economy – and particularly the tightening of credit – is going to significantly enhance the pressures on purchasers and industry players, and grease the wheels of meaningful change throughout health care.

Consider, for example, the fact that most hospitals and health systems
have remained in the black only as a result of investment income. Many
lose money on operations. How will health systems remain afloat if the
returns on their investments are diminished?

Then there was the Wall Street Journal story
a couple weeks ago in which Vanessa Fuhrmans described significant
drops in office visits, filled prescriptions, elective surgeries as
consumers cope with the economic downturn. That was before the big
crashes that began a few weeks ago.

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Around the Web in 60 Seconds (Or Less)

A computer and one expert are as effective at spotting breast cancer as the two experts who usually used to read mammograms in the UK, according to a New England Journal of Medicine study. The BBC reports that these results may help the NHS expand mammagraphy to more women without placing greater demand on the existing workforce.

Wal-Mart is the first of eight Dossia members to offer its employees a personal health record.

California will become the first state to require restaurants to post calorie information on menus. Will consumers think twice before ordering that 2,000-calorie fettuccine alfredo?

A judge ordered Medtronic and Boston Scientific to pay Johnson & Johnson $1.2 billion in a lawsuit over patent infringement on a stent. It’s quite the time to have to deal with the 10-year-old lawsuit.

X2HN event calling for speakers

X2conference

What do high stakes poker, smart women and health care have to do with each other? The Third Annual Xscape conference coming up in February will combine all three in Las Vegas to promote and support women health care executives.

The conference is put on by the X2 healthcare network, and they’re looking for additional speakers.

Indu Subaiya, co-founder of the Health 2.0 Conference and Accelerator, will give the keynote address, bringing attendees up to speed on new health care players in technology and how Health 2.0 is empowering consumers.

KevinMD turns into raving socialist…

Well not quite, but in his op-ed at USA Today Kevin talks about why it’s a problem for the US not to have wide deployment of EMRs, and notes that it’s the wrong incentives that are to blame—docs have to pay but others reap the rewards. So in Kevin’s words:

One needs to look at the Department of Veterans Affairs for an optimal model. All of the VA’s primary care physicians, specialists and hospital-based doctors across the country use the same electronic record system. It has played a significant role in the reduction of medical errors, optimization of cost efficiency, and attainment of high scores in preventive care measures.

Kevin’s usually criticizing me for being the wooly lefty, but I could be pardoned for thinking that he’s suggesting that we junk the current US system in favor of rolling all docs and patients into the VA. I wouldn’t suggest that but far be it from me to tell Kev that he’s wrong!

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