Posted 6/29/12 on Medscape Connect’s Care and Cost Blog
Like most health law watchers, I was surprised by yesterday’s decision. I’m sure that on this issue, as with everything else, zealous responses will rationalize the result and split the country down the middle.
I expected the Court to be purely partisan, but apparently Chief Justice John Roberts acknowledged the gravity of his role and saw his way clear to support the law with some constraints. Here’s the comment from SCOTUS (Supreme Court of the United States) Blog:
Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial – and most controversial – feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.
Continue reading “The Game’s Not Over, and It May Not Even Be The Real Game”
First published 3/14/11 on Health Policy and Marketplace Review
The good news is that Democrats and Republicans are finally seriously engaged over the country’s fiscal crisis.
And, each side is presenting a starkly different course for the voters to choose from.
When it comes to the health care entitlements, Republicans want to cut the health care entitlement benefits and therefore ease the pressure on federal spending.
Obama wants to largely leave the programs in place and raise taxes–about $1 in tax increases for every dollar in cuts.
Neither touches Social Security. Obama wants to make cuts to the Pentagon’s budget—the Republicans don’t.
Continue reading “The Budget Fight: It Will Be A Long Hot Summer, And Fall, And Winter”
First published 4/10/11 on Health Policy and Marketplace Review
Last week, I posted that I was disappointed in Paul Ryan’s health care budget proposal because it lacked cost containment ideas other than the usual conservative reliance upon the market and defined contribution health care.
In my last post, Why ACOs Won’t Work, I argued that the latest health care silver bullet solution, Accountable Care Organizations (ACOs), are just a tool in a big tool box of care and cost management tools. But, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.
How do you make the American health care system efficient?
You change the game.
Continue reading “Changing the Game on Health Care Costs”
First published 4/7/11 on Health Policy and Marketplace Review
First, I think Accountable Care Organizations (ACOs) are a great idea. Just like I thought HMOs were a good idea in 1988 and I thought IPAs were a good idea in 1994.
The whole notion of making providers accountable for balancing cost, medical necessity, appropriateness of care, and quality just has to be the answer.
But here’s the problem with ACOs: They are a tool in a big tool box of care and cost management tools but, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.
Continue reading “Why ACO’s Won’t Work”
First published on 4/3/11 and 4/5/11 on Health Blawg
ACO regulations and related federal issuances hit the street last Thursday, after several months of waiting — from CMS, OIG, FTC, DOJ and IRS. They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt organizations.
I had the opportunity to discuss the regs the day after they were issued on a special edition of the Blog Talk Radio show, ACO Watch, hosted by Gregg Masters(@2healthguru). Gregg’s guests included Mark Browne (@consultdoc), Vince Kuraitis(@VinceKuraitis), Jaan Sidorov (@DisMgtCareBlog) and yours truly (@healthblawg). We are geographically diverse, and bring a variety of perspectives to the table. I invite you have a listen — we enjoyed the opportunity to discuss the rules, we all learned from each other, and we hope you enjoy the conversation as well. (It runs about 90 minutes.)
Continue reading “Accountable Care Organization (ACO) Regulations: First Look”
First published 3/31/11 on Kaiser Health News
Accountable care organizations take up only seven pages of the massive new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. A cottage industry of consultants has sprung up to help even ordinary hospitals become the first ACOs on the block.
First published 3/30/11 on Kaiser Health News
Conservatives think traditional health insurance provides too much financial protection from medical expenses. They also think that the Affordable Care Act will make this situation worse. That’s one reason they want to repeal it.
The problem, according to the conservatives, is that insurance dulls the average person’s consumer instincts. When medical care is cheap or free, people don’t bother to shop around for the best prices — and they don’t think twice before seeing the doctor. In other words, they end up with too much care at too high a price. Insurance and government programs spread that cost around, so that eventually all of us end up paying more in the form of higher premiums or taxes over which we have little individual control.
Continue reading “High Deductible Plans: When Spending Less on Health Care Isn’t Always Good News”
Originally published 2/7/11 on Organon
Andrew Koppelman at Balkinization calls Judge Vinson’s opinion a “bizarre collection of non sequiturs.” I’ve also noticed instances of the opposite: super-sequiturs—conclusions which logically follow from any premise whatsoever because they are necessarily true. Here’s one:
[T]he record seems to strongly indicate that Congress would not have passed the Act in its present form if it had not included the individual mandate.
(p. 66-67 of the opinion [pdf])(oomphasis added). I don’t know about the record, but the law of material equivalence strongly indicates that Vinson is right: if Congress had passed the ACAwithout the individual mandate, Congress would not have passed the ACA in its present form—with the individual mandate.
Continue reading “Logical Bare Necessities”
Originally published 1/31/11 on Kaiser Health News
When the House of Representatives roll was called Jan. 19, only three Democrats joined with House Republicans in voting to repeal the new health law. This development was notable in that it meant most of Democrats who voted against the overhaul the first time around, and were reelected to Congress in November, voted not to repeal it this time — evidence that they may be sensing that support for the health overhaul hardening. A quick examination of public opinions offers evidence as to why this idea might be taking hold.
Continue reading “It Will Be Democratic Senators Leading The Charge To Fix Or Improve The New Health Law”