Interpreting the Draft Health Insurance Exchange Regulations

Roger Collier

First posted 7/31/11 on Health Care Reform Update

The Obama administration’s progress—with just a few stumbles—towards health care reform implementation took another major step this month. In a carefully chosen small business setting—a Washington DC hardware store—HHS Secretary Kathleen Sibelius released draft regulations for the health benefit exchanges called for by the Affordable Care Act.

The exchanges, required to be established for every state, are predicted to serve some 24 million consumers by 2019 (provided that the ACA is neither significantly changed nor found unconstitutional), with the majority receiving federal subsidies to help pay for coverage. So far, a dozen states have enacted bills to create exchanges, while in nine states such legislation has failed.

Continue reading “Interpreting the Draft Health Insurance Exchange Regulations”

Who Needs Men, Anyway?

Dov Michaeli

To Pat and Elizabeth and Laurie and Elaine and all the other women who so enriched my life

First posted 8/1/11 on The Doctor Weighs In

This is no joke. Studies on the human genome showed that the Y chromosome, the one that determines maleness, is accumulating mutations at a much more rapid rate than the other chromosomes, which makes it conceivable that in a few short millions of years it would lose its functions and become totally useless. Does this spell the end of the human race? Not to worry, we are told. We know now how to clone a woman’s egg without fertilization, in effect getting a high fidelity copy of the mother. What about the males? Well, we males apparently outlived our usefulness; get used to it. So sex, banish the thought, will become superfluous as well? Now wipe the smirk off your face and think for a moment. Males need females to reproduce; they can’t do it by themselves. But from an evolutionary point of view, in most species males contribute little to the offspring except genes. On the other hand, there are species in which females can reproduce asexually, and they are doing just fine, thank you. In fact, they can grow at double the rate of a population that reproduces sexually.

What is sex good for?

This question occupied evolutionists for many years. The most common explanation is surprising: sexual reproduction allows the species to survive parasites. How does it work?

Continue reading “Who Needs Men, Anyway?”

Why IPAB Is Essential

Jonathan Cohn

First posted 7/29/11 on Kaiser Health News

A little over two weeks ago, while most of you were paying attention to the debate about how to raise the debt ceiling, those of us who study health care policy were following hearings before the House Budget Committee. The purpose of the hearings was to scrutinize the Independent Payment Advisory Board, a commission that the Affordable Care Act created as part of its apparatus to control health care costs. And the hearings produced some genuinely interesting testimony on everything from the scope of the board’s authority to the limits of its legal power. If we were in the middle of a dialogue about how to improve the board’s structure and function, that testimony would be extremely useful.

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Off Based Optimism: Part I

Paul Levy

First posted 7/31/11 on Not Running A Hospital

I like to view myself as an optimist, but two recent reports demonstrate the danger of misplaced or premature optimism.  I fear that they are influenced by what the authors hope will be the case rather than what has proven to be the case.  I find this generally to be the situation in the health care arena, where public policy is often based on shallow interpretations of data and on people’s political wishes rather than rigorous analysis.

The first comes from Karen Davis at the Commonwealth Fund, in a blog post entitled, “Health Spending Continues to Moderate, Cost of Reform Overestimated.”  We should know from the title alone that the conclusions cannot be accurate:  It is just too soon to reach them.  It would be like drawing a picture of climate change from one year of data about temperatures.

Here’s an excerpt:

A recent report from the Centers for Medicare and Medicaid Services (CMS) shows that national health spending grew at a historically low rate of 3.9 percent in 2010, almost paralleling the 3.8 percent increase in our gross domestic product (GDP) last year. This is . . . good news for the federal government as the slowdown indicates that the cost of health reform has been overestimated.

Continue reading “Off Based Optimism: Part I”

Off-Based Optimism: Part 2

Paul Levy

First posted 7/31/11 on Not Running a Hospital

In the post above, I present a review of a recent blog post from the head of the Commonwealth Fund that, to me, represents an all-too-common analysis of health care issues, one driven by desire rather than clear-headed thinking.  I promised a second example, and here it is, using a recent article in the New England Journal of Medicine.  It was again brought to my attention by this teaser from the Commonwealth Fund:

New Study: Innovative System for Paying Health Care Providers Slows Spending, Improves Patient Care

Continue reading “Off-Based Optimism: Part 2”

Modernizing Rural Health Care

David Harlow

First posted 7/27/11 on Health Blawg

The UnitedHealth Center for Health Reform and Modernization released a white paper today on Modernizing Rural Health Care.  To quote from the UHG presser,

  • [The paper] projects an increase of around 5 million newly insured rural residents by 2019 – even as the number of physicians in rural America lags
  • Quality of care is rated lower in rural areas in 7 out of every 10 health care markets; both physicians and consumers in rural areas more likely to rate quality of care lower than those in urban and suburban markets
  • Innovations in care delivery – particularly telemedicine and telehealth – can absorb future strain on rural health care systems

The paper inventories the current state of health care for the 50 million Americans living in a rural setting — and it’s not pretty.  The question, of course, is why does rural health compare unfavorably to urban health metrics, and what can be done to improve matters?

Continue reading “Modernizing Rural Health Care”

The Difference Between Health Care Costs and Investments

Kenny Lin

First posted 7/27/11 on Common Sense Family Doctor 

Now that the NFL lockout has ended, even sports fans can follow without distraction the ongoing spectacle of federal gridlock leading the government ever closer to defaulting on its more than $14 trillion in loans. With the abundance of fiery, uncompromising rhetoric and arcane terminology such as grand bargains, caps and balances, you may be forgiven for feeling, as I do, we are watching a rerun of the health reform non-debate in late 2009 and early 2010. Indeed, decisions over the next several days have almost as much potential to affect the quality of health care in the U.S., as funds for graduate medical education (and training of family doctors) are on the chopping block in proposals from both parties. While I hope that the advocacy efforts of primary care organizations and their supporters are enough to #SaveGME, the outcome is far from certain.

Continue reading “The Difference Between Health Care Costs and Investments”

The Long Term Effects of Our National Malaise

Dov Michaeli

First posted 7/28 on The Doctor Weighs In

Most of us are in a funk right now. We are involved with two wars which most of us don’t really believe in, we are slogging through the worst economic wreckage since the Great Depression, there is a pervasive sense that America is rapidly losing its optimism, its enthusiasm, its can-do attitude. It wouldn’t be a big stretch to conclude that we are losing our hope. On the individual level hopelessness is a hallmark of depression. Can our society suffer from the equivalent of depression? And what would the consequences be?

Research on environmental and cultural impact on societal behavior is hard to do. The main difficulty is to tease out causal connections from the incredibly rich fabric that affects society. For example, did religious institutions shape societal behavior, or did the latter provide fertile ground for the rise of religion? Or was it a two-way relationship, one affecting the other? All one can do is make observations, and observational studies are rarely conclusive.

Continue reading “The Long Term Effects of Our National Malaise”

5 Myths About Smoking and Mental Illness

Pat Salber

First posted 7/27/11 on The Doctor Weighs In

Judith Prochaska has written a very interesting commentary about smoking and mental illness that appeared in the July 21, 2011 issue of the New England Journal of Medicine (NEJM).   The point of the article is that we in the health professions have failed to aggressively address smoking in people with mental illness.  She posits that it is because of five prevailing myths about smoking and mental illness.  She provides evidence to dispel those myths in every instance.

Myth #1:   Tobacco is a useful self-medication for people with mental illness

It shouldn’t be a surprise to learn that our friends in Big Tobacco have played a role in promulgating this myth by funding research and presentations supporting this hypothesis.  In fact, the industry has a long and rich historyof manipulating research to reach its goal of selling more and more cigarettes to more and more people.  One of industry’s main strategies was to create confusion to counter the increasing body of evidence about tobacco’s adverse health impact.  Just read this quote from a 1969 Brown and Williamson document:

“Doubt is our product since it is the best means of competing with the ‘body of fact’ that exists in the mind of the general public….”

Continue reading “5 Myths About Smoking and Mental Illness”

Reaping What We Have Sown: The Debt Standoff

Robert Laszewski

First posted 7/27/11 on Health Policy and Marketplace Review

On this blog a month ago, I said the politicians were starting to scare me with the apparent eagerness of some to actually take the government to default to make a political point.

For weeks we have heard political leaders on both sides tell us there would be no default.

But the two sides have so backed themselves into opposite corners that they have left no opportunity to meet in the middle. Democrats say they have to have a tax increase, or failing that no cuts to entitlements. Republicans say absolutely no tax increases and they need to see entitlement cuts.

This only gets fixed if somebody capitulates. The consequences for any side doing that might be the loss of their own base going forward.

There isn’t any middle ground here because there is no middle ground left in Washington, DC. The last few elections have seen the replacement of “moderates” by evermore far right or far left senators and representatives. This process has only been exacerbated by the gerrymandering of Congressional districts to ensure they were safe for either side but at the same time leading to their coming under the control of party activists pushing their representatives either far left or far right. It also hasn’t helped that each side is so certain of their cause and only has to dial their favorite channel to be assured of that. Continue reading “Reaping What We Have Sown: The Debt Standoff”

More Clinicians Understand That Patients Want To Communicate Online

Jane Sarasohn-Kahn

First posted 6/26/11 on Health Populi

As people take on more DIY approaches in their daily lives for travel planning, photo management, and investing, they’re looking for health care touchpoints to do the same — especially, their physicians. In 2011, more doctors are responding to this patient-driven demand, based on data published in the InformationWeek digital health care issue July 25, 2011, titled The Pain of Change.

Most patients would be willing to change physician practices if their doctors don’t offer online access to tools, based on a recent survey from Intuit which Health Populi covered in March 2011 here.

Continue reading “More Clinicians Understand That Patients Want To Communicate Online”

The CLASS Act and Britain’s New Long Term Care Insurance Proposal

Howard Gleckman

First posted 7/20/11 on Kaiser Health News

Since the 1990s, nearly every developed country on the planet has reformed the way it finances long-term care for the frail elderly and adults with disabilities. Among the handful of exceptions: The U.S. and the United Kingdom.

In 2010, Congress took a small step in the direction of reform when it passed the Community Living Assistance Services and Supports Act, a voluntary public insurance program that would provide a modest daily benefit for life. But even before the first policy is ever issued, a bipartisan group of senators has targeted it for repeal as part of a broad-based deficit reduction plan that has already won the support of President Obama.

Continue reading “The CLASS Act and Britain’s New Long Term Care Insurance Proposal”

How Patients Disclose Medical Diagnoses Online

Jane Sarasohn-Kahn

First posted 7/22/11 on Health Populi

Once upon a time, being diagnosed with the “C” word, cancer, was information that kept people quiet and within the family. Today, social media platforms like Facebook, Twitter and blogs have increasingly become routine settings for discussions regarding the most personal of concerns” — like health care, according to an analysis titled, Seeking Social Solace: How Patients Use Social Media to Disclose Medical Diagnoses Online from Russell Herder, a Minneapolis-based marketing & PR agency.

Letting Go of Employer-Based Health Insurance

Jeff Goldsmith

First posted 7/22/11 on the Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

Other than the egg-laying exercise surrounding the ACO regulations, 2011 was a quiet year among Washington health policy experts until June 6 when McKinsey released the results ofa survey of employer plans under the Affordable Care Act. The McKinsey study found that roughly 30 percent of employers were considering dropping their employee insurance coverage and encouraging their employees to receive federally subsidized health insurance through the Exchanges created in the Affordable Care Act. This compared to low- to mid-single digit estimated drop rates based upon economic modeling by the Urban InstituteLewin and, importantly, the Congressional Budget Office (CBO).

Continue reading “Letting Go of Employer-Based Health Insurance”

Re The Express Scripts-Medco Merger — Calling Antitrust

Merrill Goozner

First posted 7/21/11 on Gooz News

If this merger doesn’t draw fire from the antitrust division of the U.S. Justice Department and the Federal Trade Commission, then those agencies aren’t paying attention. Express Scripts and Medco combined accounted for 1.7 billion prescriptions in 2010, worth about $110 billion in revenue. That’s about a third of the total prescription drug market.

The companies claim this merger will give them increased clout to negotiate better deals with drug companies. In theory, yes. But as we’ve seen many times in the past, prescription drug benefit managers spend more time squeezing pharmacies with their slim retail margins than they do calling questionable drug industry practices into question. They too often act as pass-through agents for drug company price increases, the same kind of cozy relationship that dominates every other nook of the health care field. They’ve played a somewhat constructive role in the high generic substitution rate in recent years, but as Matt Herper at Forbes points out this morning on the Forbes website, that behavior is now pretty much baked into drug plan and health plan behavior. That leaves PBMs without a function (except to add another layer of cost) unless they rigorously go after the drug companies on price and unnecessary use.

The only guarantee that PBMs will do that job is by the government insisting there be rigorous competition in the industry for drug and health plan business.

Merrill Goozner is an independent health care journalist, blogging at Gooz News.