Repeal, replace, renew, revise, revisit – what the bloggers say

Anyone else feeling a bit of deja vu?
The blog world certainly is, with many of the entries for this edition of Health Wonk Review focusing on the ongoing battle over health reform, aka the Patient Protection and Affordable Care Act. (I’m always puzzled by pundits referring to PPACA as ‘ObamaCare’; the President signed a bill that was sent him by the Senate; BaucusCare would be much more accurate)
Before we dive into the reform pool (water’s awfully chilly this time of year here in New Hampshire), let’s take a quick look at the work comp world, which is being hammered by costs associated with obesity – proof that every business is affected by our growing BMIs. The always-erudite Jon Coppelman briefs us on two compelling studies that will give all work comp actuaries pause at WorkersCompInsider.
We’ll switch from waist to waste with Maggie Mahar’s great post which asks (my words, not her’s) ‘why in hell are we still doing so many spinal fusions for patients with degenerating discs?’ and then posits a possible (!) answer to her own question – money. (factoid – the number of fusions at US hospitals doubled between 2002 and 2008 – when costs hit $34 billion).
There’s a great read on David Harlow’s blog re the legal arguments around reform – quoting David, “The challenge to the individual mandate in federal health reform is grounded in the notion that the Commerce Clause of the US Constitution bars federal regulation of something so local as health insurance. Challenges to state health reform are grounded in the notion that Federal law (ERISA) pre-empts the field, making state regulation of something regulated by the federales (under authority of the Commerce Clause, by the way) impossible”.
Jeff Goldsmith’s contribution comes by way of the Health Affairs Blog, where he suggests a solution to the Medicare physician reimbursement mess debacle conundrum disaster. Jeff suggests “writing off the SGR “debt” to the federal budget as “uncollectable” and demanding both sacrifice and reform from the physician community in exchange.” While I am most certainly reluctant to challenge someone as insightful and knowledgeable as Goldsmith, my inner cynic tells me ‘no way’.
The economists’ (and psuedo-economists’) section
The argument/debate over whether reform costs or saves is a big part of the issue – perhaps as big as the legal one involving the Commerce Clause. We’ll begin with Austin Frakt’s take-a-step-back-and-think-about-this post; Austin reminds us that with – or without – reform, we’re still screwed. (my word, not his)
Jason Shafrin – hat tip to the economist with the most contributions to HWR! – offers his thoughts on legal issues that may hinder adoption and growth of the current rage – the Accountable Care Organization.
RIch Elmore isn’t an economist – but he knows his numbers. His post leads with this blast of ice water to the face – “The US, ranked just higher than Slovenia in performance among world health systems, has consistently higher prices than any other country surveyed by the International Federation of Health Plans.”
Avik Roy thinks more employers will drop health coverage due to PPACA, despite evidence to the contrary from Massachusetts, and that this will add cost to the system, cost that CBO doesn’t adequately address. I’d note that the CBO estimate also gives very little weight to the iPAC, a potentially very strong cost control mechanism.
My contribution discusses the conflicting claims by Ms Pelosi and Mr Boehner – Ms P says PPACA will save over a trillion while Boehner says it will cost $700 billion. You’ll be surprised to learn neither number is credible.
The experts’ section
Roy Poses gets my vote for most persistent, insightful, and thought-provoking observer of medical research, business, and ethics. His entry this fortnight discusses the fall of an apparently large and prestigious health care charity, which funded research projects at the most well-regarded academic centers – a charity that was involved with Bernie Madoff and some of his confederates.
We’re pleased to have a submission from the John Hartford Foundation, where Amy Berman dissects the definition of ‘good medicine’ – patient-focused, clinically sound, or some combination?
Louise’s contribution from Colorado is insightful as always – her state legislature is considering a bill that would repeal the Health Care Affordability Act, one authored by a physician who doesn’t seem to proffer answers to the problem – growing numbers of uninsured Coloradans – the Act attempts to solve.
Glenn Laffel’s back with an intriguing dissection of the microeconomics of flu shots – and why classical theory makes zero sense. Should be required reading for the ‘market solves everything’ crowd.
The creepiest entry I’ve ever read comes from David Williams, who’s dug out the news that two sisters’ life sentences in Mississippi were suspended on the condition that one donate a kidney to the other.