Why Only Business Can Save America From Health Care

Brian Klepper

Posted 3/24/13 on Medscape Connect’s Care and Cost Blog

BK 711For a large and growing number of us with meager or no coverage, health care is the ultimate “gotcha.” Events conspire, we receive care and then are on the hook for a car- or house-sized bill. There are few alternatives except going without or going broke.

Steven Brill’s recent Time cover story clearly detailed the predatory health care pricing that has been ruinous for many rank-and-file Americans. In Brill’s report, a key mechanism, the hospital chargemaster, with pricing “devoid of any calculation related to cost,” facilitated US health care’s rise to become the nation’s largest and wealthiest industry. His recommendations, like Medicare for all with price controls, seem sensible and compelling.

But efforts to implement Brill’s ideas, on their own, would likely fail, just as many others have, because he does not fully acknowledge the deeper roots of health care’s power. He does not adequately follow the money, question how the industry came to operate a core social function in such a self-interested fashion or pursue why it has been so difficult to dislodge its abuses. For that, we need to turn our attention to a far more intractable and frightening problem: lobbying and the capture of regulation that dictates how American health care works.

Continue reading “Why Only Business Can Save America From Health Care”

Day Three – The Wrap Up

Merrill Goozner

Posted 3/29/12 on Gooz News

This is what conservative justices will do if they strike down or cripple the health-care law … A court that gave us Bush v. Gore and Citizens United will prove conclusively that it sees no limits on its power, no need to defer to those elected to make our laws. A Supreme Court that is supposed to give us justice will instead deliver ideology. now  – E.J. Dionne, The Washington Post

The insurance mandate was effectively reduced to a bumper sticker by the opponents in their constitutional challenge, and the entire law reduced to little more than an appendage to the mandate. . . The fate of the mandate should not determine the survival of the other elements of the law — like prohibiting insurers from denying coverage to people with pre-existing conditions or charging them higher fees — which can operate without the mandate. – New York Times editorial

Overturning the whole law would be an act of judicial restraint. – The Wall Street Journal editorial

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Health Reform: An Amicus Brief for the Court of Public Opinion

C. Eugene Steuerle

Posted 3/23/12 on the The Government We Deserve

The Supreme Court will consider the constitutionality of the Affordable Care Act at the end of the month. We the public should be appalled.

It’s not that each side can’t come up with some good constitutional arguments. It’s that the suit is totally unnecessary, caused largely by the unwillingness of the major political parties to work together on anything. Like a divorce between two parties more invested in their fight than in the effect on those around them, it belongs in a domestic relations court that would refer the parties to a mediator.

Continue reading “Health Reform: An Amicus Brief for the Court of Public Opinion”

The Right Rx for Better Health Care: Rise Up to Challenge the Industry’s Lobbying Power

Brian Klepper and Shannon Brownlee

Published 3/29/12 in the New York Daily News

Obamacare had its days in the Supreme Court this week, and the justices’ decision could have sweeping consequences for the individual mandate provision in the Patient Protection and Affordable Care Act, and maybe even for the fate of the law itself.

Yet whatever the court decides, we will still be stuck with a problem that this contentious law was not likely to solve on its own: an out of control health care industry that threatens the stability of the U.S. economy and the federal government’s ability to deal with our long-term debt.

Continue reading “The Right Rx for Better Health Care: Rise Up to Challenge the Industry’s Lobbying Power”

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:

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Dismantling the Affordable Care Act: The Obama Supreme Court Argument + 51 Republican Senators

Robert Laszewski

Posted 2/9/12 on Health Care Policy and Marketplace Review

I have no idea which way the Supreme Court will rule this year on the Affordable Care Act. Let me go out on a limb and predict a 5-4 vote on the question of whether the individual mandate is Constitutional. Just don’t ask me which way the vote goes.

I found the recent Obama administration brief submitted to the Court on the mandate question somewhat ironic. Not surprisingly, the Obama Justice Department argued that a finding by the Court that the individual mandate is unconstitutional should not jeopardize the vast majority of the new health law.

Continue reading “Dismantling the Affordable Care Act: The Obama Supreme Court Argument + 51 Republican Senators”

Uwe on Premium Support and Vouchers

Matthew Holt

Posted 12/24/11 on The Health Care Blog

There’s a great post by Uwe Reinhardt on the NY Time Economix blog explaining the theoretical difference between premium support and voucher systems (and you thought they were the same thing!).

Unfortunately it skirts the real problem that those of us playing along at home know too well. Either a well constructed premium support (Ryan done right), or a well constructed voucher/managed competition (Enthoven) system, a mixed public/private system (Germany, Starr, Reinhardt) or even a decent Medicare for all /Single payer system (PNHP, McCanne) needs to be designed holistically to have a chance of working–especially to ensure that all people are in plans that treat them all equally.

Note that this very week HHS devolved the choice over plan benefits to the states–meaning that the very notion of Enthoven-like standard plan benefits required in a voucher system gets tossed out the window and even in the exchange plans will likely be able to alter their benefits to risk select. The sad facts of the matter are – speaking as a lefty who supports the concept of managed competition a la the Enthoven or Dutch model – that the 2009-10 debate shows that no holisitic system can emerge through our political process.

And worse, no cost containment device will be left alone by a future Congress, as this weeks extension of the now more than a decade old SGR cuts demonstrates.

So my non-cheery Christmas message is that the health care system will continue to promote over spending on the wrong types of people, and rational transformation of our 1950s designed insurance coverage and payment system will remain elusive for decades to come. What we get IF we keep the ACA will be the best we can hope for.

Meanwhile, back over at NY Times it’s great to see Uwe Reinhardt reacting to his commenters (even those not paying Princeton tuition fees!).  Kudos from a health care blogger who doesn’t engage with his commenters enough.

Matthew Holt is the Founder of The Health Care Blog and the Health 2.0 conferences.