In Massachusetts Elite Providers Drive Health Care Spending; What Does This Say about the Dartmouth Research? . . . Maryland’s Solution. Part 1

Massachusetts Attorney General Martha Coakely has just released a report which reveals that the state’s health care costs are spiraling in large part because he state’s primo hospitals and physician groups --those  with brand name recognition-- -are demanding exorbitant reimbursements from insurers.   Providers who control the market in geographically isolated areas also are insisting on reimbursements that far exceed what other providers receive for the same services.. http://www.mass.gov/Cago/docs/healthcare/Investigation_HCCT&CD.pdf

These providers have market leverage. Patients want both marquee names and providers close to home in their insurers’ network. If these providers are not included, customers will switch to a different insurance plan.  Thus, insurance companies have no choice but to pay what the providers demand.

The investigators “found no evidence that the higher pay was a reward for better quality work or for treating sicker patients,” the Boston Globe reports.  http://www.boston.com/news/local/massachusetts/articles/2010/01/29/attorney_general_says_clout_drives_up_health_costs/?page=1  

“In fact, eight of the 10 best-paid hospitals in one insurer’s network were community hospitals, which tend to have less complicated cases than teaching hospitals and do not bear the extra cost of training future physicians.”

Sometimes hospitals claim that they charge more because they treat poorer patients who are sicker.  But the truth is that, often, poorer patients receive fewer services because they have limited access to care. In addition the public hospitals and “safety-net hospitals” that treat indigent patients frequently have fewer resources: shriveled budgets, fewer specialists, less equipment. As I reported in Money-Driven Medicine, often “safety-net” hospitals must ration care.

The new Massachusetts report confirms what many already know about spending on low-income patients: the investigation discovered that hospitals that treat large numbers of poor patients  . . . are paid 10 percent to 25 percent less than average by commercial insurers.

Meanwhile, Coakley’s report made me wonder: Maybe Massachusetts should consider Maryland’s solution?

“I Don’t Quit”

In his address to the nation, President Obama made it clear: Jobs are now his #1 priority.

This is what most Americans wanted to hear. They fear that he has spent too much time on health care, and has not paid enough attention to climbing unemployment. This does not mean that they oppose  health care reform legislation—it’s just  that there are tired of hearing about it.  And the need for jobs is more pressing.

It was a strong speech—particularly when the President acknowledged that  “The only way to move to full employment is to lay a new foundation for long-term economic growth, and finally address the problems that America's families have confronted for years.”  One jobs bill will not solve the problem.

President Obama  also opened the door to a college education for many students when he pledged: “let's  . . .give families a $10,000 tax credit for four years of college and increase Pell Grants. And let's tell another one million students that when they graduate, they will be required to pay only ten percent of their income on student loans, and all of their debt will be forgiven after twenty years – and forgiven after ten years if they choose a career in public service.”

These are good ideas. But what about health care?

Hours before the State of the Union address, some believed that the President  would save health- care reform for the very end of his speech. The pivotal question was this: would health care seem an after-thought  or a climax?

The State of the Union--And the Economy: Why We Need Health Care Reform Now

According to the headlines, 10 percent of Americans are unemployed. The truth is that closer to 17 percent of  the population cannot find full-time work; this number includes workers who have become discouraged and have given up looking for work as well as those who have settled for part-time jobs because they cannot find the full-time employment that they need.

The situation is not going to change anytime soon. As Princeton economist Paul Krugman recently warned: “We are facing mass unemployment — unemployment that will blight the lives of millions of Americans for years to come.”

Some of the Best of Recent Health Care Blogs: Health Wonk Review

Over at the Disease Management Care Blog, http://diseasemanagementcareblog.blogspot.com/2010/01/welcome-to-tree-of-blogs-avatar-movie.html Jaan Sidorov hosts the most recent edition of Health Wonk Review, a round-up of some of the best healthcare blogs of the past two weeks.  I find that the Review is a good way to find out about excellent blogs that I haven't heard about--while also keeping up with favorites.

Sidorov, who is a primary care general internist and former Medical Director at Geisinger Health Plan., highlights some posts which suggest that physicians are thinking about how to reform their own specialties.

Who Voted for Brown in Massachusetts—and Why? Voters Cannot Oppose Legislation If They Don’t Understand It

The media continues to report that the Massachusetts vote was a referendum on health care reform—and that this has the White House worried.

If so, the White House is wrong.

Take a look at polling conducted by Hart Research Associates for the AFL-CIO on the evening of the election, revealing who voted for Brown –and what those voters said.  Then consider separate polling done by the Washington Post together with the Kaiser Family Foundation and Harvard University.  Read both reports, and you’ll have a very hard time believing that Scott Brown’s election represents a mandate on healthcare legislation.

Finally, factor in the eye-opening Kaiser Family Foundation January tracking poll,  and what it reveals about what voters do and don’t understand about health reform legislation.  If most voters have only a hazy idea of what is in the legislation, you really can’t say that they voted against the Senate bill.

In the Wake of the Mass Massacre—Bipartisan Reform or the Senate Bill ?

Let’s begin by addressing  some of the myths:

First, the Massachusetts vote was not a “Massacre”: Brown won 51 percent of the vote.

Secondly, this was not a referendum which shows that the public opposes  health care reform. Among Massachusetts’ voters who said health care was their top issue, 53 percent voted for Democrat Martha Coakley reports JoAnne Kenen, over at the New America Foundation’s New Health Dialogue.

How Did Democrats Manage to Lose Ted Kennedy’s Seat to a Man Who Reminds Me of Sarah Palin?

When explaining why the voters of Massachusetts turned Ted Kennedy’s seat over to a Republican, some commentators are suggesting that voters were appalled by the corruption they saw in Washington as Democrats struggled to put together health reform legislation:

Over at The Health Care Blog, Brian Klepper and David Kibbe write:  “The distaste expressed yesterday probably has little to do with the specific provisions of the bills . . . . But along the way, voters have witnessed  . . .  lawmaking in its worst tradition. There was the White House's deal making with powerful corporate interests like the drug manufacturers even before the proceedings began. And the tremendous lobbying contributions by health care and non-health care special interests in exchange for access to the policy-shaping process. Or the outright bribery of specific Senators and Representatives in exchange for votes. Last week's White House deal with the unions that exempted them from the tax on ‘Cadillac’ health plans until 2018 must have seemed like a perfectly OK arrangement to the people in the center of all this activity, but to normal people who read the paper, it was emblematic of the current modus operandi: If you have power and support the party in power's muddled agenda, you get a special deal.”

Can We Really Have A Bipartisan Health Care Plan?

Just in case you were wondering what the public thinks about the recent upheaval over health care reform, a USA TODAY/Gallup Poll taken Wednesday finds some 55% of Americans say President Obama and congressional Democrats should suspend work on the health care bill that was this close to being passed and consider alternatives that would draw more Republican support.

What might these alternatives be? Besides attacking every major Democratic version of reform, the Republicans have been fairly quiet about their own grand vision for the future of health care. Still, there is a vision. At the end of July, the Republican Study Committee, led by Rep. Tom Price (R-GA) (an orthopedic surgeon) introduced the “Empowering Patients First Act” (H.R. 3400) as their contribution to the debate.

On Pelosi’s Statement –

Over at TPM, the headline characterizes Pelosi's statement as meaning that she is walking away: “Pelosi: There Aren't Enough Votes To Pass The Senate Bill.”

If Pelosi walks away, then reform is dead.

But as I read her statement, she’s saying several contradictory things at once. Cognitive dissonance. (And if I were Pelosi, that’s exactly how I would feel.) It’s as if we are looking into her mind: stream of consciousness.

But I hear hope in her words.

Over at TNR, Jon Chait is even more hopeful than I am: “This doesn't sound like walking away to me. It sounds like she or some of her members are holding out for an agreement to amend the bill through reconciliation. The good news is that this actually makes the negotiations easier in some ways. The negotiation with the Senate before required the assent Senators like Ben Nelson and Joe Lieberman. Now it only requires the assent of the 50th Senator, who's probably far more willing to back a tax on the rich, beef up low-income subsidies, and do other things the House demands.

“The complicating factor is that this reopens negotiations that were previously all but settled, and may cause the House to increase its demands. That would be foolish -- they should take something approximating the deal that's been on the table, pass it, and walk away.

“If the Democrats were all rational people this would have a 100% chance of happening. Since they're not, I'll call it 60%.”

I would add that the reconciliation process is limited to issues with a budgetary impact. It could happen. The Cadillac Tax would be gone (good riddance) and Nelson would lose the special deal for Nebraska (at this point probably even Nelson regrets cutting that deal.)

What Does This Mean?

From Talking Points Memo: January 21, 11:34 a.m.

House Speaker Nancy Pelosi just told reporters that she does not believe she has enough votes in the House to pass the Senate health care reform bill as-is -- at least not yet.

"I don't see the votes for it at this time," Pelosi said. "The members have been very clear in our caucus about the fact that they didn't like it before it had the Nebraska provision and some of the other provisions that are unpalatable to them."

"In every meeting that we have had, there would be nothing to give me any thought that that bill could pass right now the way that it is," she said. "There isn't a market right now for proceeding with the full bill unless some big changes are made."

While she didn't say the option was dead -- "Everything is on the table," she said -- she outlined two very different options for passing a bill.

"There's a recognition that there's a foundation in that bill that's important. So one way or another those areas of agreement that we have will have to be advanced, whether it's by passing the Senate bill with any changes that can be made, or just taking [pieces of it]," Pelosi said.

"We have to get a bill passed -- we know that. That's a predicate that we all subscribe to."

When will that happen? Who knows!

"We're in no rush," Pelosi said.

Reporting by Brian Beutler