Health Wonk Review – so, what do we do now?

If ever there was a time to be writing about health reform, this is it.
It’s an even better time to be reading about health reform. Is health reform dead, or is it just snoozing, waiting for a Prince Charming to lay on the smooch it needs to reawaken, full of promise and hope?

(hint, this guy doesn’t look much like Senator Brown…)
Before we get to the next chapter in the story, we’re going to hear from clinicians and politicians, policy gurus and providers, health administrators and educators, insurance brokers and Medicaid advocates, IT pros and pharmacists – in short just about everyone fits under the big wonk tent.
And where better to start than down in the trenches, where the real problems with our health care system are all too visible. Merrill Goozner kicks us off with an excellent summary of the new news on why hospital costs vary so much across the country – hint, NYC is pricey not because of high wages, but because CMS pays hospitals a ton to educate doctors and two tons for dispro. A great example of how unseen factors influence employers’ – and taxpayers’ – costs.
Drug prices are one source of consternation to many, with price control advocates complaining about big pharma’s unfettered ability to set prices, and free market fans countering that without that ability pharma couldn’t afford to develop new meds. A post that should get both thinking comes from David Williams, who describes how a pharma company is losing out, while patients are benefiting, without taking sides. A thought-provoking piece to be sure.
Julie Ferguson sends in an a synopsis of what could be a really fun development. Now that 14 states allow medical marijuana, when will it be part of a workers comp drug formulary?
For the real druggies among you, Adam Fein does a deep dive into the world of drug pricing and the future thereof.
Glenn Laffel asks why all the companies fighting over the Feds’ $19 billion allocated to electronic health records are offering guarantees that their version will meet HHS’ standards (hint – if they don’t, users stand to lose big bucks).
And finally, back to the Gooz, who’s penned a report on how the once-promising area of personalized, genomicly-specific cancer care is off to a very slow start.
Wrapping up the discussion of health care at the ground level, we welcome the Robert Wood Johnson Foundation to HWR. The RWJF blog team (what, they have a whole team? man I’m some kinda jealous!) posts on over-utilization of diagnostic imaging. Their post is a terrific synopsis of how several communities and provider organizations have reined in MRI spending by using clinical guidelines. Great stuff!
Jaan Sidorov wants the Obama administration to get crackin’ and name a head for CMS. He wants a fresh face and strong leadership for the folks who run about 40% of our health spending. Not a bad idea…
And when they do, the new boss should start working on long term care. Kyle Pinion reports that this is one area of health care that is in desperate need of fixing, specifically to address some of Medicaid’s deficiencies.
Sleeping Beauty could sure have used a little LTC – can you just imagine the poor gal’s bed sores?
At the state level, the purpling of Massachusetts sent shock waves thru the political landscape and got several contributors thinking hard about the ‘whys’ and ‘what nexts’. The general sense is now-Senator Brown is not looking to step into the Prince Charming role anytime soon (although he did vote for Mass’ health reform).
Tinker Ready’s piece asks if “Voters Reject[ed] the Massachusetts Health Reform Model?, and the sense is – they may have, but not because they didn’t want reform, they just didn’t want reform ‘lite’.
Who needs health insurance?!
All the way across to t’other side of the country, we find Anthony Wright walking us thru Rush Limbaugh’s recent encounter with what may be the most ‘socialized’ medical system in the country – Hawai’i. Limbaugh has a great solution to the health insurance problem – don’t buy any. He’s figured out how regular Americans can get by without coverage. The man’s a geenyus!
But wait, perhaps Rush isn’t so bright…I’m betting Jennifer Lyon wouldn’t think so, because she was also ‘self-insured’, at least until she passed away from breast cancer. When asked why she hadn’t seen a physician earlier. Lyon said, “I didn’t have insurance, which is a big part of it. And it really wasn’t changing much. But a year later, I felt another lump, and then I felt something under my armpit.” Read more here.
Oops, back to the drawing board, big (and I don’t mean tall) guy…
Well, at least Limbaugh doesn’t have to deal with insurance companies – lucky guy. Over at the Digerati Life, the Ms DL laments; well, no, that’s much too weak an adjective – we’ll go with detests – dealing with insurance company claim forms resulting from her family’s decision to go PPO instead of HMO.
Roy Poses MD has been a HWR’er since our denouement, and always gets the award for post no one else would have thought of. This ed. it’s about three California health centers with notable quality issues, that somehow still managed to pay execs big bucks in the form of incentive payments. Roy says “The rationale for these bonuses, given out at a time when the university system was under major financial constraints, was that they were incentives for exemplary performance and patient care.”
Peggy Salvatore weighs in on a study that says people trust their providers more than the government to protect the privacy of their health care data. (don’t these people read the news?!)
As we say in New England, Go figure…
So without reform, what happens…
Well, some believe reform is still possible, others don’t. We’ll start off with a point-counterpoint minus the hair pulling and hurling of invective – courtesy of Health Affairs. Henry Aaron wants the Senate bill enacted and ‘fixed’ in reconciliation. For those who have dismissed this out of hand, Aaron’s piece may well make you reconsider. The counterpoint comes from Joseph Antos; he wants incremental reform including the ability for insurers to sell policies across state lines…
Brad Wright agrees with Aaron, as he also thinks reform may not be dead yet, but it will require passage of the Senate bill by the House and making changes via reconciliation.
And long time HWR’er Hank Stern disagrees with Antos (when it comes to health insurance, Hank’s a very knowledgeable guy, so perhaps Antos should be calling Hank).
But wait, Mike Feehan, a colleague of Hank’s, agrees with Antos, noting that this might also address the issue of mandates and force more competition.
Joanne Kenen of The New America Foundation laments the lack of primary care, the lack of real funding for primary and preventive care, and the impact the demise of reform will have – more of the same. And costs will therefore increase to deliver care that should never have been necessary. Sigh.
David Harlow opines that all is not lost, and lays out his wish list for reform now that Senator Brown is, well, Senator Brown. David believes reform can happen without the bigwig pols getting involved.
Friend and colleague Maggie Mahar doesn’t want any initial reform effort to start with ending the insurance industry’s anti-trust exemption, calling the current interest in this move ‘pandering’.
Brady Augustine is a bit more – ticked off. In his contribution, he asks the insightful, yet idealistic question; “How can Congress expect providers to work together in interdisciplinary teams and accountable care organizations if it is unwilling to do the same?” Brady believes reform should have come from the middle. Me too.
Louise in Colorado (one of the best health insurance bloggers in the ‘sphere) has a very interesting suggestion on how to address pre-existing condition exclusions without an enforceable mandate. Go read it.
On the macro-est level, we welcome John Goodman, who believes reform is not about health reform but about collectivism, and more specifically how we shouldn’t let government take over health care. Goodman says “in matter of health, private decision-making is socially intolerable”. Ed note – I disagree, strongly with the premise and the conclusion.
The Incidental Economist thinks the real problem is political feasibility, and that’s where things went so horribly wrong.
Alas, we close this chapter (it’s bed time for your faithful author) leaving this story to the next HWR editor – Brady Augustine at medicaidfirstaid.com. He’s an old hand at this editor of HWR stuff, and has the honor of hosting the Fourth Anniversary Edition!
He’ll let you know if the smooching’s started