Wednesday, September 17, 2008

Welcome to the Health Wonk Review, Political Convention Style

Ahhh, the ranting. The soaring rhetoric. The partisanship. What’s there not to like about the political season's spectacle of spin, framing and bombast? Thank goodness for the wonkers who can help us separate the inconvenient half-truths from the easy misstatements. Think of this issue of the Health Wonk Review as our own virtual ‘open mike’ free-for-all Convention, sans Roman columns, faux patriotism, naïve rock stars and country-music boogying elders. Wherever you are on the political spectrum, there is something here for you. Don your straw hat, the silly glasses and lapel pins and read on. Your Convention Chair, the Disease Management Care Blog is bringing the gavel down and announcing this compendium forum is now open......

David Williams of the Health Business Blog argues that Obama’s health care proposals, contrary to popular perceptions, would increase competition in the individual insurance market. That competition may be called ‘the government,’ but why not? He points out the private insurance industry has had something of a free ride with their high executive salaries, lofty share prices and inattention to their poor track record on quality and costs. He also notes how absent Medicare is from all the teleprompters, which may not be such a bad thing. David’s post is Part 3. After you read that, you’ll want to read Parts 1, 2 and 4.

John Joseph Leppard IV of the Healthcare Manumission Blog rises in opposition to that motion. He argues Obama is recycling worn out liberal nostrums while McCain is meritoriously attempting to get at the underlying problem by making consumers spend their own hard earned cash for competitive policies across State lines. Hang in there to the bottom of this well-rounded posting and you’ll be asstutely aware of the history and arguments that buttress his thinking.

Not so fast, says Joe Paduda of Managed Care Matters. After recalling the well-known phenomenon of CAT scanners having patients go in one end while dollars come out the other, he contends that an underlying flaw in free-market thinking is the nasty track record of health care increasing demand and with it, costs. Go ahead and buy cheap cross State border insurance you Bush supporters you: you’ll still get irradiated, your physicians’ judgment will be negated and your outcomes will be … variated.

Senior wonkician statesman Matthew Holt of the Health Care Blog once again field dresses his favorite health policy expert spokesperson and his favorite health policy advocacy group by showing how they are muddling the distinctions between revenue, mission, premium income, expenses, profit, shareholder value and surplus. He asks if maybe, given huge amounts of money at stake, that’s the point?

And speaking of money, think all economists would vote for unfettered healthcare markets? Think again. Jason Shafrin at Healthcare Economist points out that another word for ‘decentralized’ is ‘fragmented.’ Other words for fragmented include turnover, cherry picking, inefficient payment systems, competing incentives, excessive variation and monopolistic consolidation. There are links at the bottom that lead to more speechifying about the models that have overcome these problems as well as some policy options that are worth your consideration.

As is her style, Maggie Mahar of the HealthBeat Blog brings the house to its feet with a ‘Part I’ examination of the important difference between having access to care and having access to insurance. Case in point? Go to Boston and toss an 'Obama for President' button in any direction and chances are you’ll hit a specialist physician. Good luck in finding a primary care physician, however. They’re out there, but hiding from new patients because they’re overworked, underpaid, stymied by a hostile training environment, unlikely to hire enough nurses and fed-up by their unattractive life style. The result includes hospital readmissions, emergency room overuse, excessive variation, shortages and queues. And that’s just Part 1. The DMCB is looking forward to Part 2 when the Health Beat Blog shines the light on the notion of a Medical Home (will anyone be at home in this home?). The DMCB is also looking forward to an explanation about why primary care shortages and patient queues aren’t the natural outgrowth of de facto price controls.

Can't wait to hear Maggie's view on the Medical Home? No problem, our next speaker is Arnold Milstein, who uses the Health Affairs bully blogpit to distinguish between medical homes and medical home runs. The DMCB thinks this makes for interesting not only because it has had its own doubts, but because it views homes as 'process,' while runs are the 'outcomes.' As we've learned in other clinical domains, one doesn't necessarily lead to the other. Is the same true here?

Neil Versel of the Healthcare IT Blog takes the dais and shows us just how impolitic it is it is when politicians laughingly speak the honest truth. Rep. Pete Stark (D-CA) introduced legislation with some commonsense reforms, including an open source EHR, the promotion of de-identified data use, and clarification of HIPAA. Likelihood of passage? Zero. And those of us who have watched Congress deal with other parts of healthcare reform? We say welcome to the club.

But it’s a sad day when doctors fail to speak the truth. Say it’s not so, but Henry Stern of InsureBlog alerts us to a report that some British physicians may not be letting their patients know about the option of getting potentially life-saving treatment abroad. Egads. Maybe they should put their mis-speaking skills to use by coming across the pond, getting U.S. citizenship and running for Congress.

When it comes to politics, timing is everything. Well, the same is true when it comes to generic drug pricing in the Medicare program. Dr. Fein of Drug Channels shows us how quarter-to-quarter delays in pricing and reimbursement can simultaneously harness the for-profit motive and increase the use of generic drugs. Too good to be true? Not if the Department of Health and Human Services Office of the Inspector General gets its way.

New America’s California branch members Leif Wellington Haase and Micah Weinberg take to the lecturn and dissect California’s messy budget impasse and its impact on MediCal and the individual insurance market. If you believe the Golden State is still a window into the future and support State sponsored reforms, however, be of good cheer. According to this report, a budget will eventually be passed in the short term and Californians are more than ever supportive of meaningful reform and seem to be willing to pay for it over the long term.

And speaking of California (and the rest of states), Anthony Wright of the Health Access Weblog examines the pros and cons of State reforms aimed at the individual insurance market. He points out the ‘lipstick’ of guaranteed issue, risk pooling, consumer protections, basic benefit structures and tight regulation may not be enough, but he wonders if it isn’t worth a try. Take a read and see if you agree.

Never mind kissing babies, Roy Poses over at Health Care Renewal calls both the American College of Cardiology and Johnson and Johnson awardees quoted in the Wall Street Journal to task for wanting to keep the bathwater and the babies AND the CME/research funding. Let's face facts, says he. Lingering K-street style conflicts of interest, both known and unknown, are influence-peddling physicians in obvious and subtle ways. He makes a good argument over the groupthink notion that transparency is enough. A case in point is when apologists for the status quo themselves aren’t being fully transparent. The DMCB suggests readers Google their own names before going public with a high profile opinion in the area of pharma support for CME.

Louise of the Colorado Insurance Insider is angry at Pharma. Biased research. Underhanded marketing. Ghost writing. Predatory pricing. And now this: our receptors are possibly being nudged in unforeseen ways by microscopic but potentially significant amounts of myriad drugs coming out of our faucets. She asks if the improper disposal of pharmaceuticals is the result of laziness and an unhealthy profit motive. Blister packs may help, but more importantly, Louise asks where the leadership of the health insurance industry is on this issue? When the DMCB takes his drugs, he’s going to wash them down with bottled water. And then recycle the plastic, naturally. And try not to feel guilty the next time he goes to the bathroom.

Are you a practicing physician and a blogger? Do you like that spotlight of a cheering audience’s attention? Sam Solomon at the Canadian Medicine Blog reminds you that it may pay for you to be scrupulously circumspect when it comes to writing about your patients, especially if there are allegations of negligence. You may think you can mask your identity or protect your patients’ privacy. Think again, because if this determined trial lawyer can find out who you are, chances are others can also. Right after they check out that regrettably unprofessional profile on a social networking site.

Maybe instead of blogging, physicians (and other health policy experts) may want to make better use of their time by not only getting familiar with P4P, DM, PCMH, CDHPs and EHRs but with MPs that are being championed by IHI. Click here to find out if this particular initiative will warrant its own set of initials, thanks to Joanne Kenen of the New Health Dialogue Blog, also of the New America Foundation.

There are the new initiatives of course, but then there are the old ones that work. David Harlow of the HealthBlawg reminds us that the CEO Leah Binder of the Leapfrog Group is still reminding us that we have to start somewhere. That somewhere may be outcomes-based, like hospital acquired infections and multiple other remediable complications that can be addressed with a turnkey NQF-based methodology, maximum transparency and purchaser activism. Now that will warm any crowd.

And then there’s always a speaker that cuts through all the chatter with inconvenient truths. Merrill Goozner of Gooznews reports on the countervailing perspectives of a debate sponsored by the New America Foundation. In the end, we Americans will never yield on our death-is-optional pursuit of happiness, even if means taking a pill of dubious benefit or being tethered to a ventilator with cost effectiveness ratios well north of $100K per QALY.


H G Stern said...

Oh my gosh - Outstanding job, Jaan!

Thank you so much for hosting, and for including our post.

John J. Leppard IV said...

Fantastic job! You misspelled my name, but KUDOS on one of the best HWR's I've read in a while.

Jaan Sidorov said...

The DMCB regrets the misspelling of the name and has repaired it.

Anonymous said...

This is a really great analytic round-up of the health care choices presented in this election. Over at Your Candidates - Your Health we've got both presidential candidates (and a number of congressional candidates) on the record about the specifics of their health policy positions for any of your readers who may want it "from the horse's mouth," as they say.

Thanks for the great resources!