Health Wonk Review Is Up

David Harlow, author of David Harlow’s Health Care Law Blog hosts the newest edition of HWR.  Harlow offers a meaty summary of some of the most provocative healthcare posts that have appeared in recent weeks.  

–On Healthcare Collaboration, Dr. Kenneth Cohn suggests that if you want to herd cats, you probably have to let the cats figure out how to herd themselves: “Most physicians enjoy bottom-up processes more than top-down edicts.  They prefer being inspired to being supervised.  The only way that I know to develop a common culture is to allow physicians to play a role in shaping it. I agree. You can’t bribe them. You can’t bully them. They have to want to do it because they realize that if they work as a team, they and their patients will be better off.

Over at Managed Care Matters Joe Paduda reports that recent analysis indicates that some states’ active efforts to hinder enrollment are working,, and are partly responsible for the shortfall in Exchange enrollment
He also points out that  CMS may require health insurers selling via the federal exchanges to make sure at least 30 percent of “essential health providers” are in-network in 2015.  This in response to some complaints about networks that are allegedly too narrow.
Paduda’s note: “Which is kind of ridiculous; smaller networks are better at controlling costs and that’s a BIG part of the success criteria for health reform.”  I agree. Moreover, if you Google “Consumer Reports,” and “NCQA” and “HMO’s” you will find that the best HMOs deliver higher quality care than open-ended plans.

–Writing on Colorado Health Insurance Insider, Louise Norris explains that folks purchasing health insurance on the exchanges need to be sure they understand drug formularies. An important point.

–As the demand for high tech and mobile surges, Julie Ferguson of Workers’ Comp Insider reminds us that more and more cell tower workers are being killed. The intense pressure to meet unrelenting deadlines is undermining workers’ safety.

Brad Wright, at Wright on Health, wonders if we can make health care prices transparent so that patients can “comparison-shop.”  Wright  worries (rightly, I think, pun intended,) that even with better information, consumers aren’t likely to change their behavior much, because health care economics does not operate according to traditional market principles. When you’re sick, you’re not bargain-hunting. Most people assume (wrongly) that health care that is more expensive must be better.

Folks from the Brookings Institution have a piece up on the Health Affairs Blog, titled “Paying For a Permanent, or Semi-Permanent, Medicare Physician Payment Fix. They emphasize  that a plan that includes “off-sets for physician payment reform that support improvements in care as well as lower costs . . . could assure beneficiaries and other health care providers that these savings are not just payment cuts that must be absorbed, but steps to help reduce spending through reforms that improve care.”

This is just a small sample of some of the best recent posts. You’ll find more here.


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A New Edition of Health Wonk Review—Does Barack Obama Remind You of Richard Nixon? . . . Will Most States Expand Medicaid? Do All Non-Profit Hospitals Deserve a Tax Exemption? Why Didn’t Anyone From J&J Go to Jail?

Brad Wright has hosted the most recent edition of Health Wonk Review, a round-up of some of the best recent healthcare posts in the blogosphere. It’s an excellent read.

Wright begins with a post by John Goodman, published at the NCPOA Health Policy Blog, and titled “The Selling of Obamacare.” There, Goodman acknowledges, “As for the president himself, he is a complete enigma to me. I’ve never felt that I understood him.’  Goodman goes on to prove his point by comparing Barack Obama to Richard Nixon.

According to Goodman, when “the President suggested that most people will be completely unaffected by the new health law . . . he was lying.” After all millions who buy their own insurance in the individual market place are now getting cancellation notices. The President “looked directly into the TV camera and said something that was blatantly untrue . . . over and over and over and over again. You have to go all the way back to Richard Nixon to find something comparable.”

That’s one way of looking at things,” Wright observes, “but it’s certainly not the only way. Over at the Colorado Health Insurance Insider,/ Louise Norris counters with these words:

“Much has been said recently about how the ACA is causing a tidal wave of policy cancellations, and resulting in people losing coverage that they would prefer to keep.  The frustrating part about this – as has generally been the case with every big uproar about the ACA – is that we’re not really getting a complete picture of what’s going on, and it’s hard to see the reality through all the hype and hysteria.

I agree.

Here is the larger picture: in fact, most Americans will not be affected by Obamacare. The vast majority are insured by their employers. Medicare, Medicaid or the military. Of the 311 million people who now live in the U.S., just 15 million purchase their own insurance. They represent 5% of the population. And only some of the 5% who buy their own coverage are getting those cancellation letters,

We are talking about less than 3% of the population –far from “most people.” 

The folks I worry about most are those who should qualify for Medicaid under the Affordable Care Act, but live in states that have refused to expand the program. (Often they are not eligible for Medicaid simply because they don’t have children, no matter how poor they are.)

Wright offers hope by spotlighting Joe Paduda’s post on Managed Care Matters. There, he asks: “What’s happening with Medicaid Coverage?”

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Health Wonk Review – Rich and Varied Offerings

Joe Paduda has hosted the newest edition of Health Wonk Review, a bi-weekly roundup of some of the best healthcare posts in the blogosphere. You will find it at Joe’s blog,  Managed Care Matters.:

Here are just a few highlights:

  • Over at HealthBusinessBlog David E Williams  responds to a relative’s question : Why are Obamacare’s opponents so vehement?The bottom line, says David, is that “some opponents have whipped themselves into a lather over their revulsion to all things Obama and are living in an echo chamber where these views seem rational. It would be better for everyone if they went back to the Birther madness.”

    I agree. This is not about healthcare, and it is not about money. The Congressional Budget Office has told us that the ACA will not add to the deficit..  As David points out many of the ideas in the Affordable Care Act were originally Republican ideas. It is not a radical plan for health care reform; it is a moderate plan. And Obama himself is a moderate. Why then do they hate him with such a passion? I’ll leave it to you to answer that question.

  • In a post titledWe’re all in this together” Louise Norris confides that under the Affordable Care Act, her family’s insurance premiums will rise sharply. (They had a high deductible plan with low premiums. The ACA outlaws such high deductibles because in too many cases, insurers sell them to low-income and lower-middle income families who then cannot afford to use them. So they put off getting healthcare until they are very, very sick.)Meanwhile, Louise and her husband earn too much to qualify for premiums. But they’re not angry. “We support [reform]” she explains, “because something like this isn’t supposed to be all about us. In the case of healthcare reform, our higher premiums will help ensure that our friends and neighbors and fellow citizens have access to affordable health insurance.”  Joe writes: “Thanks for the reminder, Louise!” I agree wholeheartedly. (btw Louise is a health insurance broker.)




Health Wonk Review: Health Insurance in China over the Past 50 Years; A Review of The Autistic Brain; Stay Calm, Obamacare is On Track

The newest edition of HealthWonk Review, a round-up of some of the very best recent healthcare posts, is now online.
Colorado Health Insurance Insider’s Louise Norris hosts this mid-summer edition of the review. She offers summaries of intriguing posts, along with evenhanded, insightful commentary. Both will help you decide which posts you want to read.
Many of her reviews whetted my interest. But here I want to call attention to just two entries covering topics that we don’t often read about on Healthcare blogs, as well a reassuring sane post summing up what Washington insiders say about the state of Obamacare. It will be a bumpy ride, but it’s heading into the station.

A History of China’s Health Care System

Norris reports that on :“The Healthcare Economist,  Jason Shafrin, brings us a great summary of health insurance in China over the past half century. Until the end of the 1970s, there were three main health insurance systems in China that covered nearly everyone.
“But the wheels started to come off after that; by 1998 almost half of the urban population had no health insurance, and by 2003, 95% of the rural population in China was uninsured. “
Shafrin explains that a shift to “fee for service” health care seems to have exacerbated the problem: “Some have claimed that the stark increases in health-care are due to provider profit-seeking behavior in China’s fee-for-service system. . .
“This price structure that was originally intended to cross-subsidize the delivery of basic interventions creates perverse incentives for providers to supply sophisticated care wherever possible, by shifting demand from low-margin basic services to high-margin high-tech diagnostic services and drugs.”
Does this sound familiar?
The good news is that China, like the U.S., has set out to reform its enormous health care system.For details, see Shafrin’s post. .
As Norris observes: “While plenty of progress has been made there is still a long way to go.”
She could have been talking about either country.
Norris also spotlights Jared Rhoads’ review of The Autistic Brain by Temple Grandin. “If you’re interested in autism,” Norris writes, “Jared’s summary [suggests] that this book is a good place to start learning more. I’m adding it to my list of books to read, so thanks for the tip Jared!”
Here’s just a snippet from Rhoads’ review: “Gradin and coauthor Richard Panek trace some of the clinical history of the condition, explain what can and cannot be gained from techniques like neuroimaging, and share what they believe are some good child-rearing strategies for parents with autistic children. . . .
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A New “Sardonic”Edition of Health Wonk Review

This edition, hosted by Brad Wright, of Wright on Health takes an original approach to the bi-weekly round-up of the best healthcare posts of the past two weeks: It’s excellent—I urge you to check it out. Just keep in mind that the descriptions of the posts are largely tongue-in-cheek.

 (I would provide more detail about the newest edition of HWR, but my lap-top rolled over and died two days ago. As a result, I  don’t have the time to give newest edition of HWR the attention it deserves.)

I hope you will.

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Health Wonk Review: Oncologists Tell the Truth about Cancer Drugs; Will There Be Enough Plans to Choose From in the Exchanges? What Does Oregon’s Research on Medicaid Tell Us? And More . . .

The newest edition of Health Wonk Review  is up on Managed Care Matters.

There, host Joe Paduda calls attention to an eye-opening post by The Health Business Group’s David E. Williams. 

Williams reports on what oncologists say about cancer drugs in “The Price of Drugs for Chronic Myeloid Leukemia (CML); A Reflection of the Unsustainable Prices of Cancer Drug.” The article, which was published in the journal, blood, includes candid comments from more than 100 experts  They tell us  that:.

  • Many costly treatments aren’t worth the money
  • New treatments with tiny orno benefits often cost a multiple of existing therapies
  • Despite their reputation for penny-pinching, health plans are often not aggressive in negotiating price
  • Patients are already suffering mightily from high costs –and it impacts quality of life and survival as well as financial health
  • Society as a whole cannot afford to pay the high prices charged for so many of the new therapies

 (I’m reminded of “A Very Open Letter from an Oncologist published on HealthBeat in 2009.)  It’s encouraging to see more oncologist stepping forward to telll the truth about cancer drugs..)

.As Williams observes these insights “come from people who know what they’re talking about and who have traditionally been sympathetic to drug makers and unperturbed about costs.”  

But now, the companies that make these drugs have taken greed too far.

 Paduda also highlights Health Affairs just-released research indicating that the decline in inflation could result in a reduction of $770 billion (yup, that’s “billion” with a B) in public program health care costs over ten years. “

But is the trend sustainable? John Holahan and Stacy McMorrow of the Urban Institute are “cautiously optimistic.” Paduda agrees: “there’s no question there are fundamental changes occurring that are affecting care delivery, pricing, and reimbursement.”

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