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The problems with high-risk pools

Aug 1, 2008• 5

By Robert Laszewski

What do we do with people who are uninsurable because they have a pre-existing medical condition?

That is a particularly important question as both McCain and Obama propose reforming American health care by building on the private health insurance system.

One of the solutions being discussed–by McCain among others–is to use state-based risk pools. Under McCain’s plan heavily dependent on an individual platform, people who don’t have employer-based coverage and healthy enough to qualify for individual health insurance could get a private mainstream plan and people who do not qualify for a standard individual plan could buy into a state-run high risk pool for the uninsurable.

The affordability factor must accompany discussions on health care coverage

Jul 31, 2008• 42

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care, Inc., a nonprofit health plan that covers more than 1 million New
Englanders. Baker blogs regularly at Let’s Talk Health Care.

I was in a meeting the other day when someone said — mostly in exasperation — "Everyone’s for affordable health care for everyone, but no one cares very much about dealing with the cost of health care.”

I’m sure that truer words have been spoken, but I can’t think of any off the top of my head. It’s too bad. Somehow, we’ve divorced the coverage/affordability question from the cost question, and we pay for it – everyday.

In a recent article in the Journal of the American Medical Association (JAMA), bio-ethicist Zeke Emanuel from the National Institutes of Health, put it pretty well — “Without controlling health care cost, any attempt at universal coverage will be transient. Sustainable expansion of coverage to all Americans requires credible changes in the rate of health care inflation. In the strange calculus that is American politics, the more politically salient issue of costs may provide a better way to achieve the comprehensive reforms necessary to cover the uninsured that the hitherto futile direct moral appeal.”

Readers respond to the primary care crisis

Jul 31, 2008• 6

By Sarah Arnquist

Two recent posts by Matthew and Bob Wachter on the crisis in primary care sparked great debates in the comment sections.

Matthew’s inference that Medicare’s bankruptcy will be fast upon us if everyone with brain cancer received an experimental surgery like Sen. Ted Kennedy recently had evoked this response from Bev. M.D. Tedkennedy

Kennedy’s case is an excellent example of why evidence-based medicine
will never translate into a "cookbook" of completely standardized
practice. As a pathologist who has looked at this nasty tumor under the
microscope too many times, glioblastoma is almost uniformly fatal
within, at most, a few years. But each patient’s tumor, and each
patient’s age and medical background, and each patient’s will to fight,
is different. Also, many medical advances are made by doctors
courageous enough to defy standard opinion who achieve good results and
then over time develop a track record to make their treatment an
accepted and evidence-based one. Therefore, one cannot apply a uniform
and permanent EBM rubric of – gonna die anyway, don’t operate – to all
glioblastoma patients for MEDICAL reasons. However, one COULD apply it
for social/political/economic reasons, and therein lies the basic
conundrum before us.

Deeper in the comments, Peter wrote:

Bev, I agree to a point, but why should there be only two people
involved in the decision – the doctor, who gets paid when he/she
operates using someone else’s money, and the patient, using someone
else’s money, and therefore has nothing to loose. If we went with this
thinking then who stops all the Mickey Mantle decisions? Is every Terri
Schiavo worth keeping on life support waiting for God to perform a
miracle? Would a Medicaid patient get to go to Duke and obtain the same
try? I know this discussion goes around in circles forever but there
must be a better way if we are going to avoid bankrupting the "system."

The $2,500 question

Jul 30, 2008• 7

By Craig Stoltz

There’s some peculiar numerology going in the presidential candidates’ health reform plans. Stoltz
John McCain proposes that every American receive a $2,500 tax credit ($5,000 for families) to help them afford health insurance bought in the private market.Barack Obama says his health care plan will save the average American family $2,500 per year.I mean, what are the chances?I suspect both campaigns are shrewd enough to know that "a couple hundred bucks a month" [middle-class citizen’s translation of $2,500 per year] is likely to get a voter’s attention. The fact that both campaigns came up with an identical figure is eerie, however. It’s enough to make you wonder whether anti-trust laws should apply to political campaigns.

SEIU’s questionable election strategy

Jul 30, 2008• 2

By Paul Levy

Several months ago, I mentioned the large sum of money being spent by SEIU on political races throughout the country. Now, an editorial in the Wall Street Journal questions the legality of the manner the SEIU is collecting these funds from its members. (By the way, the sum I mentioned was $75 million. The WSJ raises this to $150 million.)

I am not qualified to make a judgment on the legal issues raised by the Journal’s editorial writer, but I want to raise a related political issue. SEIU concludes one of its publications with the following depiction of the future:

SEIU’s health care profile — and power — will only continue to grow. After we help elect a pro-worker president and stronger pro-worker majorities in Congress, we will take all our energy, idea, organizing strength, grassroots lobbying and political muscle and make it happen. Next year, 2009, we — all of us — will make history. We will achieve quality affordable health care for every man, woman, and child in America.

Health apps for the iPhone

Jul 30, 2008• 3

By THCB Staff

US News and World Report has a useful story listing five health widgets for the iPhone.

Absolute Fitness. For $14.95, users can keep a food and exercise diary, monitor nutrition and weight goals,
and track and graph health metrics, including cholesterol, calories, saturated fat, and sodium.
Quitter. Is a program to help smokers kick the habit.
ICE. This In Case of an Emergency card lets you enter emergency contacts, medical conditions and any allergies.
iScale. Is another food diary feature.
Kenkou. It means "health" in Japanese and lets users keep track personal health and wellness data. The authors notes it’s particularly useful for diabetics.

Wal-Mart launches telemedicine business

Jul 29, 2008• 6

By Jane Sarasohn-Kahn

Leave it to Wal-Mart to continue to grow its franchise in health through yet another Walmart_logo2
revenue center. This time it’s telemedicine.

The company will pilot telemedicine through retail clinics in Houston, and will be trademarked as Walk-In Telemedicine Health Care. Wal-Mart will be partnering with My Healthy Access and NuPhysicia, the private company that comes out of the long-successful telemedicine program at the University of Texas Medical Branch at Galveston. Telemedicine was been pioneered at U-T in Galveston over the past 10 years, and the program has global reach.

Instead of employing nurse practitioners, the medical model for this program will use paramedics working under the supervision of physicians via various scopes technologies — electronic stethoscopes and beyond. NuPhysicia describes this process as, "interactive physician visits."

Jane’s Hot Points: While the retail clinic business may be flat, as I wrote on July 25, this new model will enhance patient choices on the retail health front beginning in Houston. If this program pans out in terms of process and outcomes measures, you can be sure Wal-Mart will replicate it in other metropolitan markets. Telemedicine in retail health clinics could differentiate Wal-Mart’s offering from other emerging clinic brands such as Minute Clinic, RediClinic, Take Care, and the many other storefronts among the 900+ clinics currently operating across the U.S.

The result of the primary care crisis

Jul 29, 2008• 11

By Matthew Holt

Over at Spot-on I’m writing about the primary care crisis in partial response to the great stuff from Bob Wachter last week on THCB and also from Maggie Mahar and Brian Klepper. Hopefully, it’s a primer for the politico types over there about the primary care crisis and also what the likely results of it are. Hint, no pay equality, but more retail clinics and online visits.

Meanwhile, my piece at Spot-on two weeks back about the Two Ted Kennedy’s appears rather smarter than it probably was given the long piece in the NY Times today about exactly how risky his surgery was and exactly the level of agreement (i.e. not much) that existed among the wide medical team he convened. Evidence based medicine? Well let’s just say that the oft heard rumors of Medicare’s impending bankruptcy may be truer than I tend to believe if every patient wants that level of service.

At any rate, please take a look at the new piece and the older piece and as ever come back here to comment.

Ask any health care wonk and they’ll tell you that within the larger
health care crisis is a primary care crisis. There is more and more
demand for primary care physicians – the person you probably call your
"family doctor" – but America’s medical schools are producing fewer of
them.

Why? Well in a word, money.

It’s not actually medical school that’s the problem. It’s what happens next. A newly graduated physician, looking a big chunk of debt used to pay for medical school tuition gets to chose their residency and, as such, decides what type of doctor to become.In the U.S. we let medical students choose what to do. Not being dummies, most of them notice that diagnostic radiologists and orthopedic surgeons make three times what primary care doctors make, and choose their career path accordingly. Why the vast difference in compensation? Doing something to a patient – fixing a broken hip, reading an x-ray – has always been better rewarded more than talking to them about their high blood pressure or their son’s excema.

Read the rest.

Herd immunity — vaccinations protect us all

Jul 29, 2008• 6

By Sarah Arnquist

I’m currently in the masters in public health program at Johns Hopkins University and am taking my first course in epidemiology. I have my first midterm tomorrow and among the many concepts the professors want me to understand is herd immunity.

Herd immunity is the ability to resist an attack of a disease because the majority of the members are immune to it. Disease passes from person to person so when a large portion of the population is immune — most likely through immunizations — this protects those who aren’t immune by decreasing the likelihood a susceptible person will come in contact with the disease.

I hope that was review for the clinicians. But for me, though I had been reporting on health care for four years, this was a new concept. It helps put the importance of mass vaccinations into context. Immunizations don’t only protect those who receive them, but the entire population.

That’s why this seemingly growing movement by parents not to immunize their children is so worrisome. I want to know why public health experts have not taken a stronger, more public position about the importance of immunization.

From Description To Action: The Future of Health 2.0 Tools

Jul 28, 2008• 1

By Brian Klepper

Last week, The Health Care Blog ran two articles about new wiki sites
that will develop
and continuously update medical information. A wiki
is a “content collaborative” that allows anyone (or anyone authorized
by the site) to contribute or modify content; Wikipedia is the best
known example. H20logo

In Medicine Meets Wiki, Jane Sarasohn-Kahn brought our attention to MedPedia, a
collaboration between major academic institutions and governmental
agencies to clearly describe the entirety of current medical knowledge.
Then Bob Wachter described Google’s new Wikipedia competitor, Knol, and
suggested sites like this could threaten the stranglehold that
traditional medical journals have had on emerging information.