Posted 3/24/13 on Medscape Connect’s Care and Cost Blog
For 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”
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”
Posted 5/2/12 on Managed Care Matters
When it comes to health reform, perhaps the only thing Congressional Republicans agree on is they hate ObamaCare.
There’s no agreement on a basic framework much less consensus on an actual bill. Moreover, there are parts of ObamaCare that enjoy solid support amongst many Republicans, complicating the GOP’s efforts to develop an alternative without conceding political ground.
Their dilemma is certainly understandable; as anyone who followed the tortuous path of the PPACA (aka Obamacare), there was precious little consensus among the Democrats who passed the bill. While most had serious issues with various bits and pieces, they held their noses and voted “aye” when pressed.
Continue reading “GOP Alternatives to ObamaCare”
Posted 4/25/12 on the Huffington Post
While it’s comforting to just blame the GOP for the unhappiness with health reform threatening the president’s re-election, the truth is that Barack Obama repeatedly botched, bungled and bobbled the health reform message. There were three big mistakes:
The Passionless Play While Candidate Obama proclaimed a passionate moral commitment to fix American health care, President Obama delved into legislative details.
Continue reading “How Obama Botched and Bungled the Health Reform Message”
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”
Posted 3/24/12 on Gooz News
Opponents of health care reform, whose case will be heard next week by the Supreme Court, base their complaint against the Obama administration’s signature domestic achievement on the claim that its individual mandate to purchase health insurance is unconstitutional.
Challengers, including state attorneys general and governors in a majority of states, say it represents an unwarranted extension of the constitution’s commerce clause into the personal realm of individual choice. If people do not want to buy a particular product – in this case health insurance – the government has no right to make them.
Continue reading “The Mandate May Fall, But Not Reform”
Posted 2/22/12 on Not Running a Hospital
A New York Times editorial — “A Real ‘Doc Fix’” — provides a wonderful example of how a dogmatic adherence to a particular policy prescription causes one to develop constructs that are politically impractical. This editorial is about how to tackle Medicare costs. The proposed solution:
- Cut fees for specialists and then hold them flat;
- Have the Secretary of HHS identify overpriced and overused services and reduce the fees paid for them;
- “Protect primary care doctors” by holding their fees flat for a decade; and
- Establish a fee schedule that pays doctors more if they leave fee-for-service and form organizations that will coordinate care or take on the financial risk of managing a patient’s care for a year at a fixed fee.
There are germs of good ideas in here, but it doesn’t hold together. Let’s look at reality.
Continue reading “Change Will Not Come From DC”
Posted 2/7/12 on Gooz News
I had dinner over the weekend with a close friend who is a breast cancer survivor (her word) and a former avid participant in the annual marathons sponsored by the Susan B. Komen Foundation. Her status as a former activist was new. “Is this what we were racing for?” she said. She is skeptical by nature, and the brouhaha over Komen’s back-and-forth over funding Planned Parenthood last week didn’t make her angry. It merely flipped the switch that changes skepticism into cynicism. To paraphrase the old Phil Ochs song, she ain’t a marchin’ anymore.
Continue reading “Racing To Nowhere”
David C. Kibbe and Brian Klepper
Posted 2/2/12 on the Health Affairs Blog
©2012 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.
Americans increasingly distrust what they perceive as poorly run and conflicted government. Yet rarely can we see far enough inside the federal apparatus to examine what works and what doesn’t, or to inspect how good and bad decisions come to pass. Comparing the behaviors of two influential federal advisory bodies provides valuable lessons about how the mechanisms that drive government decisions can instill or diminish public trust.
Continue reading “Trusting Government: A Tale of Two Federal Advisory Groups”
Posted 12/28/11 on the Health Affairs Blog
©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.
In the recently released bulletin from HHS on the essential health benefits (EHB), the administration answered a major question on the minds of many critical healthcare stakeholders: Will the administration be specific in their guidance and create a definition of what constitutes “essential?” The answer, is no, they will leave the bulk of the decision-making to the states, thus increasing the likelihood of variation in benefits and access to elements of care.
Continue reading “Essential Health Benefits: Policy Considerations”
Posted 12/20/11 on Health Populi
2012 will be a dynamic year for health information technology (health IT) in the U.S., which I outline in my annual health IT forecast in iHealthBeat, the online publication on technology and health care published by the California HealthCare Foundation. The full forecast can be found here.
The key headlines for you Reader’s Digest abridged fans are that:
- The Health IT sector will continue to grow jobs in the ongoing Great Depression, particularly in key competencies in data security, analytics, integration, and EHR implementation.
- There will be more data breaches, and consumers will be justifiably concerned about data security. Government will more consistently implement sharper “teeth” in their punishment of health organizations who leak personal health information.
- Health IT suppliers will consolidate. The Microsoft-GE combination, announced in December 2011, is a sentinel event in this regard.
- Health IT start-ups will continue to emerge in 2012, some of which will have sound business models that will be acquired by larger firms to round out their offerings and address, in particular, consumer/patient-facing applications that support health engagement to enhance health outcomes.
- Connected health, in the form of telemedicine, mobile health, and remote health monitoring to the home will gain traction and business models as health payment moves toward accountable care, medical home, and paying for outcomes.
- IBM’s Watson is an example of high-powered data analytics, which will get more practical and targeted in 2012. A ripe area for this will be preventing re-hospitalizations, a focus of health reform and Medicare financing.
- People – patients and providers – live multi-channel, multi-platform lives every day. Thismodus vivendi is translating into health and health care. Patients want online connections with doctors for administration (e.g., Rx refills and appointments), clinical decision making, and communications (e.g., email with practices).
Continue reading “Health IT in 2012: a Dynamic Sector in the Context of a Fiscally-Challenged Health System”
Posted 12/08/11 on Common Sense Family Doctor
In February, I predicted that Don Berwick would not survive the partisan politics surrounding his recess appointment as administrator of CMS (Centers for Medicare and Medicaid Services), and regrettably, Dr. Berwick indeed stepped down from that position last week despite a number of notable accomplishments in his too-short tenure. Speaking yesterday at the annual national forum of the Institute for Healthcare Improvement, which he led for nearly two decades, Dr. Berwick struck back fiercely at politicians who have used the myth of “death panels” to oppose health reform efforts, and others who he called the “true rationers” of health care. In his own words:
Cynicism grips Washington. It grips Washington far too much, far too much for a place that could instead remind us continually of the grandeur of democracy. … Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels” – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas.
Continue reading “Striking Back at Care’s True Rationers”
Posted 11/30/11 on Health Populi
The U.S. public’s views on health reform — remain fairly negative, although the percent of people feeling favorably toward it increased from 34% to 37% between October and November. Still, that represents a low from the 50% who favored the law back in July 2010. It’s quite possible that American health citizens’ views on health reform are largely reflective of their more general feelings about the direction of the country and what’s going on in Washington right now, versus what’s specifically embodied in the health care law, according to the November 2011 Kaiser Health Tracking Poll from the Kaiser Family Foundation.
Continue reading “Half of Americans Don’t Realize There’s No-Cost Preventive Care in the Affordable Care Act”