The Supreme Court and the Mathless Health Care Reform Debate

Eugene Steuerle

Posted 4/10/12 on The Government We Deserve

Regardless of how the Supreme Court decides the constitutionality of the individual mandate, the health care debate is now reignited. If the mandate is sustained, the Accountable Care Act enacted under President Obama still has too many kinks to remain unaltered. If it’s thrown out, a return to the unsustainable system with growing numbers of uninsured is not a solution. Yet no fix is possible as long as elected officials dodge the basic arithmetic of health care.

As for the individual mandate, ignore the constitutional briefs for the moment. Ignore also how a mandate helps address problems that arise if insurance companies must offer coverage regardless of prior conditions and people otherwise are tempted to wait until they are sick to buy it. Instead, let’s see how a mandate fits it into the broader arithmetic of paying for health care.

Continue reading “The Supreme Court and the Mathless Health Care Reform Debate”

The GOP Budget, Fiscal Responsibility and Part D

Joe Paduda

Posted 4/06/12 on Managed Care Matters

Rep. Paul Ryan (R WI) and the House Republicans are touting their budget as fiscally responsible and prudent. What Mr Ryan conveniently forgets, or more likely avoids, is this:

Eight short years ago he – and his GOP buddies – passed the single largest entitlement program since Medicare – the Medicare Part D drug benefit – with no dedicated financing, no offsets and no revenue-generators – the entire future cost –which is now around sixteen trillion dollars [see page 148] – simply added to the federal budget deficit.

According to Bruce Bartlett writing in the Fiscal Times, “By 2030, Part D alone will cost taxpayers 1 percent of GDP.”

Continue reading “The GOP Budget, Fiscal Responsibility and Part D”

What Makes a Person Expensive in Healthcare? Not What Most People Think.

Posted 4/4/12 on the HCMS Blog

A question from the audience last month: “We spend the most in healthcare on a small portion of really sick people. You don’t expect them to shop for care during an emergency do you?”

I was giving a presentation about the important role that cost-conscious consumers can and should play in healthcare. The person asking the question, as everyone could tell, disagreed with the idea. While I doubt anything changed her mind, her loaded question illustrates some common misconceptions in healthcare: 1) high costs are driven by catastrophic medical events; and 2) treatments for these severe conditions leave little room for discretion and often require quick medical  decisions.

Continue reading “What Makes a Person Expensive in Healthcare? Not What Most People Think.”

Patient Engagement and Medical Homes – Core Drivers of a High-Performing Health System

Jane Sarasohn-Kahn

Posted 3/30/12 on Health Populi

It was Dr. Charles Safran who said, “Patients are the most under-utilized resource in the U.S. health system,” which he testified to Congress in 2004. Seven years later, patients are still under-utilized, not just in the U.S. but around the world.

Yet, “when patients have an active role in their own health care, the quality of their care, and of their care experience improves,” assert researchers from The Commonwealth Fund in their analysis of 2011 global health consumer survey data published in the April/June 2010 issue of the Journal of Ambulatory Care Management. This analysis is summarized inInternational Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey, published on The Commonwealth Fund’s website on March 29, 2012.

Continue reading “Patient Engagement and Medical Homes – Core Drivers of a High-Performing Health System”

Will the Quantified Self Movement Take Off in Health Care?

Kent Bottles

Posted 4/02/12 on Kent Bottles Private Views

“If you cannot measure it, you cannot improve it.” Lord Kelvin

“Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.” Nassim Nicholas Taleb

Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the “Quantified Self” blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. Most of us do not keep track of our moods, our blood pressure, how many drinks we have, or our sleep patterns every day. Most of us probably prefer the Taleb to the Lord Kelvin quotation when it comes to living our daily lives. And yet there are an increasing number of early adopters who are dedicated members of the quantified self movement.

“They are an eclectic mix of early adopters, fitness freaks, technology evangelists, personal-development junkies, hackers, and patients suffering from a wide variety of health problems. What they share is a belief that gathering and analysing data about their everyday activities can help them improve their lives.”

Continue reading “Will the Quantified Self Movement Take Off in Health Care?”

Health Care and the Supreme Court: Prepare Your News Dial

Bradley Flansbaum

Posted 3/25/12 on The Hospitalist Leader

To get a sense of why this case is different and will dominate the news cycle now until the decision in June, appreciate this fact: the time allotted for arguments—the period in which plaintiffs and defendants present their views to the justices—is six, instead of the usual one.  Moreover, the proceedings will transpire not just in one day, but three.  This is substantial.

There are several issues under debate, but the most significant, and the one you have likely heard about, is the individual mandate.  This is the requirement in the Affordable Care Act that all individuals without insurance must purchase it.  The alternative is paying a penalty (but not a tax)–and this is important.  Nevertheless I will revisit that below.  For most people, the mandate is not applicable, as folks with Medicare or Medicaid, or receiving insurance from their employer meet the necessary waiver requirements.

Continue reading “Health Care and the Supreme Court: Prepare Your News Dial”

The Legal Strategy To Defend Health Reform

Joe Paduda

Posted 3/15/11 on Managed Care Matter

There’s a seemingly intractable conflict facing the Obama Administration – how can they argue – simultaneously – that the mandate is crucial to the Affordable Care Act, while also arguing that the rest of the Act should and can survive if the Supreme Court rules the mandate is unconstitutional?

That’s the Hobson’s choice facing lawyers arguing for the Administration, and while the two positions seem irreconcilable, they may not be.

Merrill Goozner is convinced the two positions can comprise a reasonable and legally logical argument. He cites a recent article in the NEJM, to wit:

Continue reading “The Legal Strategy To Defend Health Reform”

Superconsumers and Value Mining: Health Care’s Uber-Trends Driving Care, Everywhere

Jane Sarasohn-Kahn

There’s a shift in power in health care moving away from providers and suppliers like pharma and medical device companies, toward patients and payers. This is the new health world according to Ernst & Young‘s latest Progressions report called, The third place: health care everywhere.

What’s underneath this tectonic shift is the need to bend that stubborn cost curve and address public health outcomes through behavior change. E&Y says look for new entrants, like retailers, IT companies, and telecomms, to be part of the solution beyond traditional health care stakeholders. These participants will be part of both delivery of care services and play an ever-important and -growing role in “value mining,” which E&Y defines as the use of data mining to determine the value of health interventions. THINK: comparative effectiveness through a lens of value-for-money and you get the picture.

Continue reading “Superconsumers and Value Mining: Health Care’s Uber-Trends Driving Care, Everywhere”

Defending the Affordable Care Act

Merrill Goozner

Posted 3/14/12 on Gooz News

What will they do? The Supreme Court (more or less) that gave us Bush v Gore in 2000 will later this month hear arguments by states challenging the Affordable Care Act, a.k.a. health care reform. The heart of the legal challenge raised by conservative state attorneys general is whether the individual mandate is constitutional. What happens if the Supremes say no? Does the entire law fall, or just the mandate?

The issue for lawyers is called “severability.” Did Congress when passing the law believe the mandate was necessary to the smooth functioning of the rest of the law? Clearly there are large swaths of the law for which the mandate is largely irrelevant: the physician payments sunshine act (disclosure of drug company payments to doctors); the creation of the Patient Centered Outcomes Research Institute to conduct comparative effectiveness research; the numerous payment pilot projects; and more.

Continue reading “Defending the Affordable Care Act”

Will the Pace of Innovative Change Overtake the Financial Imperative to Slash Spending?

Robert Laszewski

Posted 3/08/12 on Health Policy and Marketplace Review

I thought it was worth passing along the comments by Jim Tallon, president of New York’s United Hospital Fund, in a recent post.

Tallon reflected on an international meeting he attended with health care leaders from a number of industrial nations–“nations whose health care systems, indeed underlying philosophies, ranged from market orientation through hybrids to government authority:”

Continue reading “Will the Pace of Innovative Change Overtake the Financial Imperative to Slash Spending?”

Technology, Aetna, iTriage, and the Future of Medicine

Kent Bottles

Posted 3/06/12 on Kent Bottles Private Views

Somehow I got invited to an Aetna coming out party for their Care Pass Platform. The corporate event complete with chocolate covered strawberries, wine, and beef and chicken on a stick was an opportunity to meet some of my longest twitter colleagues: @MatthewBrowning@unitystoakes@stevenkreinmd @paulomachado @sjdmd @boltyboy @hjluks @PJMachado @shwen

Mark Bertolini, the CEO of Aetna, first appeared on my radar when he spoke at HIMSS on the challenges that health care insurance companies face: “The end of insurance companies, the way we’ve run the business, is here.” Finally, an insurance executive who gets it. I am reminded of another CEO who told me, “I am more scared about our business model than ever before.”

Continue reading “Technology, Aetna, iTriage, and the Future of Medicine”

Activating Consumers with Financial Control: Lessons from Health Savings Accounts

Wendy Lynch

Posted 3/6/12 on the Altarum Institute Health Policy Forum

Health Savings Accounts are growing up. No longer an oddity, millions of families have accounts funded by tens of thousands of employers (1). After almost a decade, the cumulative evidence about consumer-directed health plans is quite compelling. For those waiting and wondering if CDHPs “work,” three recent reports provide a convincing answer.

The Chief Medical Officer for Cigna health plans said this about one study: “Each year the evidence increasingly shows that properly designed consumer-driven health plans can lower health risks, reduce medical costs and drive engagement. The data once again shows that the combination of incentives, easy-to-engage health programs and consumer decision support tools can improve health while reducing costs.” (2)

Continue reading “Activating Consumers with Financial Control: Lessons from Health Savings Accounts”

Employer Incentives for Healthy Behaviors on the Rise

Nick Vailas

Posted 2/28/12 on Healthcare Transparency Now

Mercer in late 2011 reported that employer incentives for healthy behavior of employees have grown.

Tougher wellness program design, coupled with price transparency of care, lead the American household to greater accountability for their health.

It is obvious when issues of the heart effect people’s pocketbook, you get greater participation.  It’s called “skin in the game”.  By giving people firm incentives to take care of their health is an essential component in solving our healthcare cost problem.

Any solution to the healthcare cost problem devoid of personal responsibility or “skin in the game”, price transparency will fail.

It is essential that to get desired behavior, people need to have “skin in the game” or a firm incentive as well as the tools to be able to take responsibility.

Continue reading “Employer Incentives for Healthy Behaviors on the Rise”

Raise Medicare’s Age? That’s Cost-Shifting, Not Cost Savings

Merrill Goozner

Posted 2/27/12 on Gooz News

Mitt “Two Cadillacs” Romney in his Detroit speech on Friday said he’d like to raise the age on Medicare eligibility to 67 to save the taxpayers money. A Congressional Budget Office report released last month found raising the Medicare eligibility age to 67 from 65 would reduce Medicare spending by $148 billion over the next decade, but people in that age group would pay more for their health care.

Continue reading “Raise Medicare’s Age? That’s Cost-Shifting, Not Cost Savings”

Five Myths About Medicare

Robert Laszewski

Posted 2/26/12 on Health Policy and Marketplace Review

I recommend you read John Rother’s recent op-ed in the Washington Post, “Five Myths About Medicare.”

John argues that each of these statements is a myth:

  1. Medicare is inefficient and fails to control costs–the CBO has projected that per capita spending will grow only 1% more than inflation over the next decade.
  2. The well-off don’t pay enough for their Medicare benefits–working age premiums as well as Part B premiums already vary considerably by income.
  3. Medicare benefits are overly generous–in 2007 Medicare paid an average of only half of the $18,000 the average beneficiary spent.
  4. Cutting Medicare is the only way to save it–changing incentives to providers offers more promise.
  5. Medicare needs fundamental restructuring–“Even the most well-run and efficient program cannot nearly double its enrollment without a matching increase in money.”

And this conclusion:

“Containing health-care cost growth is critical for Medicare’s survival, but it’s impossible to do that for Medicare alone. Payment restraints and incentives that improve value must be applied to the entire health-care system to be effective.”

Read “Five Myths About Medicare in the Washington Post.”