Bob Laszewski hosts the current edition of Health Wonk Review at Health Care Policy and Marketplace Review -- check it out if you're ready for a dive into all things health care: health care reform, IT, payment, congressional jockeying, social media and related wonkery.
Welcome to Health Wonk Review, where everyone is above average. We enjoy above-average
health care costs per capita, above-average uninsured rates, and above-average
obsession with health care reform. That's what it's like today in
America. Our president has said, Change has come to America. In the
words of Robert Hayden's [American Journal]:
as much a problem in metaphysics as it
is a nation earthly entity an iota in our galaxy
an organism that changes even as i examine
it fact and fantasy never twice the same
so many variables
LikeSchrodinger's cat, America's
health care system seems to change in the changing light as we examine it; one
thing we can all agree on is that it needs some work.
We begin with some broad brush strokes on form and amount of spending:
One cost, no matter what the payment system, is labor. Lynn
Nicholas, President of the Massachusetts Hospital Association writes about some pending changes to labor laws that might make it easier for labor to unionize,
presenting the favored position of a non-union shop as one of worker, rather than employer, preference. See Keeping Communication Lines Open
in the Healthcare Labor Debate at CommonHealth, the Massachusetts health care reform blog of WBUR (a Boston NPR affiliate).
My dad used to say he wanted to listen to a radio station that broadcast only good news (not Good News, just good news). Merrill Goozner, of GoozNews, suggests this week that there ought to be a journal dedicated solely to publishing negative results -- as soon as they're known -- as he is all hopped up due to delayed publication and/or suppression of data on adverse effects of drugs. These issues in general, and a couple of current cases he discusses, have policy implications for the new leadership at the FDA.
At the other end of the spectrum, Health Access WeBlog's Beth
asks What are gold-plated benefits
anyway? An interesting question, now that the president has indicated that he is open to signing a bill including taxation of health benefits. (As an aside, Obama's approach -- White House Health Care Summit with stunning transparency, concluded with an invitation to Congress to send him a bill consistent with the policies he articulated throughout the campaign -- is both a refreshing change from the Clinton years and a strategy likely to insulate him from criticism on the exact contours of the plan when it reaches his desk.)
presents Less government, not more at The Lucidicus Project, discussing the recent report by Physicians
for a National Health Plan (the single payor proponents). I spoke with PNHP's David Himmelstein a little while back, and while he has a compelling argument for adopting a single-payor plan in this country (the savings would be impressive), I still believe that the more pragmatic approach is to make incremental changes in the system before us.
Taking our cue from Dr. Himmelstein, we begin a bit of a grand tour by visiting our neighbor to the north.
At BNET Healthcare, Ken Terry writes that Massachusetts Needs to Deal With Primary Care Crisis, saying that while proponents of the healthcare reform program in Massachusetts tout it as a model for the entire country, and detractors point to the program's rapidly rising costs, neither side is really focusing on the need for better access to primary care in the state. He also observes that retail clinics are expanding in Massachusetts, and community health centers are pulling in federal cash for expansion. One observation: retail clinics in Massachusetts are not currently expanding as they cannot find nurse pratitioners to hire. Also, on a national level, Minute Clinic recently shuttered 90 sites for the season. Even if they were growing, they are no substitute for primary care.
Here at HealthBlawg, I recently interviewed the CEO of Satori World Medical, a medical tourism company that offers a twist: through an HRA, it funds patients' future years' insurance premiums with a portion of the savings their employers or insurers enjoy as a result of their overseas medical procedures.
Closer to home, many doctors are now leery of online ratings sites, and have started using a service, Medical Justice, to get patients to agree not to post negative reviews as a condition of being taken on as patients. Dmitriy at Trusted.MD has been following this issue for a while and offers some insights.
Using the cost per doc put out by Wal-Mart, John
Moore does some calculations, and shows in his post The HITECH Challenge: Is $19B
Enough to Drive HIT Adoption at Chilmark Research that docs getting wired and getting HITECH incentive dollars will be engaged in a money-losing proposition -- they'd actually be better off financially not implementing EHRs and getting hit with the penalty a few years down the road.
Speaking of Wal-Mart, it bears mentioning that this day in history marks the anniversary of the Civil War Battle of Bentonville (No, not that Bentonville; the battle was in North Carolina.)
In addition to jump-starting HIT, current legislation is giving a boost to research funding. One pot of funds is time-limited; Glenn
Laffel looks at Beaker Ready projects ready for NIH funding at Pizaazz.
In The Color of Money: What Sort of School Doesn't Pay Its Faculty to Teach? Roy Poses at Health Care Renewal puts academic medicine on the spot, saying that some leaders have abandoned core missions in favor of collecting "taxes" from medical faculty, which makes faculty more dependent on commercial interests. Strong words indeed, and an issue that needs to be rolled out front and center together with other payment issues if there is to be a wholesale revamping of health care financing in this country.
Brady Augustine's Watchmen edition ofHealth Wonk Review, up at MedicaidFrontPage, ties the current fortnight's health wonkery to the characters of a limited-edition comic book series about to be released as a movie. The HealthBlawger's post on PHRs is linked to Ozymandias:
Ah, PHRs … they are kind of like Ozymandias in that he is one of the smartest persons on the planet and he thought he was a good guy but actually was a bad guy … who knows in the murky world that is Watchmen? Same with PHRs, they promise a lot but have delivered little to date … who knows in the murky world that is HIT? Only time will tell.
I don't know comic books (or graphic novels), but I do know Shelley's sonnet, Ozymandias, which is about a colossal statue of Ramesses II (and the transience of vainglorious humanity, like all good sonnets not written about love).... I saw a lot of colossal statues of Ramesses II on a trip through Egypt a long time ago, including my favorites at Abu Simbel, but I never would have made a connection between him and PHRs before today. I guess I'll have to ponder the meaning of all that, and maybe write a sonnet about it.
The next edition of Health Wonk Review will be right here at HealthBlawg. Read some sonnets, watch some movies, do whatever you need to do prepare yourself, and send in your finest posts (iambic pentameter not required, but ... surprise me). See you then if not before.
Jaan Sidorov hosts a post-inaugural Health Wonk Review. Trying to keep the party going, he's paired each wonk's post with a popular song. Somehow, he linked mine with a Madonna tune. No matter. Enjoy the posts. Enjoy the tunes.
Vince Kuraitis, channeling Joe Friday, brings us the latest edition of Health Wonk Review at his e-CareManagement Blog. Somehow, the HealthBlawger was corralled with "the usual suspects and hippies." But I know my rights . . . .
Uninsurance insurance. Yep, that's the latest arrow in the quiver of health care insurance giant UnitedHealthcare. As it loses covered lives thanks to layoffs of folks insured through employer-sponsored plans, UHC is looking to pick up a few bucks by selling insurance to folks who are currently insured but fear they might not be at some time in the future. By paying 20% of what their health insurance premiums would be, folks can lock in access to health insurance in the future having to worry about pesky details like pre-existing conditions and personal risk profiles that would pump up premiums in non-community-rated jurisdictions.
Here's the thing: between COBRA (which lets you buy continuation coverage post-employment at essentially the same rate -- yes it's expensive, but it's no more expensive than what UHC is offering to guarantee access to), and the right under HIPAA to buy insurance individually or through a new group plan even after a gap in coverage if you have sufficient "creditable coverage," with no pre-existing condition exclusions, most bases are already covered.
UnitedHealthcare's move looks to be a cynical combination of fearmongering and a bet against meaningful health care reform under an Obama administration.