Streaming Health Wonk Review

Trying something new in this fortnight’s edition of Health Wonk Review – instead of grouping contributions by topic, we’ll take them as they come – just like we encounter them on the web – and at the end, I’ll try to summarize and find common themes and make sense out of the chaos.
note the use of the word “try”…
Our revered colleague Hank Stern is pushing hard for full insurance coverage of men’s facial grooming products. Hank, you kill me!
David Williams takes issue with Mitt Romney’s call to increase the Medicare eligibility age, asking why we can’t start raising it now, and faster than Romney suggests. Good policy isn’t good politics, and to me this looks more like another Romney effort to address a perceived problem without angering a voting block… (I do agree with David’s note that a better faster way to reduce the long term deficit would be repeal of Medicare Part D…)
From new mandates we jump to the latest from Health IT, with dedicated reporter Neil Versel bringing us the news from the HIMSS 2012 conference. Neil walked the aisles, listed to talks, and chatted up insiders, all so we don’t have to suffer the sore feet and info overload. Think “meaningful use” and ICD-10…
Just in time, our colleagues at Health Affairs contributed their observations on the proposed rules for Meaningful Use of EHR , diving deeper into the issue with another post from an EHR stakeholder, noting the list of quality measures is likely to be significantly trimmed in the final rule.
Louise Norris – a retail health insurance broker in Colorado – combines a deep understanding of the implications of health policy on a national scale with her hands-on, daily working knowledge of how health insurance markets actually work, and that rare combination makes her observation “if all continues as currently planned but with the individual mandate eliminated, I would expect premiums – in the long run – to be significantly higher than they would be with the individual mandate in place…” one we would be well-advised to carefully consider…
Changing gears, At Workers’ Comp Insider, Julie Ferguson has been following the ingoing criminal probe and charges related to the 2010 Upper Big Branch Mine disaster. Many insiders believe that criminal charges will climb higher up the criminal ladder. How high? Stay tuned. (Ed. note – the Big Branch mine safety boss just got a three year prison term…)
HWR veteran Jason Shafrin PhD provides a critical review of a paper exploring factors affecting patients’ access to care. The always-insightful Shafrin’s summary is tight.
A different take on access comes from Anthony Wright who reports county-based Low-Income Health Programs (LIHPs) in California have already increased access to coverage for a quarter-million folks under the poverty level thanks to an early expansion of the Affordable Care Act.
Transparency in health care decisions is great – as long as consumers understand what the “price” buys, and the relative value and effectiveness and issues of different treatment options. That’s the point Joe Colucci makes while noting we’re a loooooong way from having access to enough usable information.
Another view comes from Greg Scandlen, who wants Medicare to incorporate spending accounts so individuals can set aside funds to cover their deductibles and copays. As a side note, Scandlen claims that his recent 19% premium increase is due to “ObamaCare”, a meme that has been debunked here and here – see page 19. In fact, PPACA’s impact on health insurance premiums accounts for about 1.5% of trend on average, and at most less than 5% when direct and indirect impacts are counted. In return, there’s coverage for dependents to 26 (adds <0.2%), elimination of lifetime dollar limits, coverage of pre-existing conditions, and free preventive care. There's rarely a point in time where it is suddenly and clearly obvious that no more medical care should be provided to a deathly ill patient, rather, it is a long and gradual decline, and suddenly we find ourselves with a very old, very infirm person with multiple problems all seemingly insoluble requiring Herculean efforts incurring massive cost. That’s Brad Flansbaum’s conclusion in his post on the timing of death.
Gary Schwitzer’s Health News Watchdog is fast becoming the go-to site for intelligent analysis of the mass media’s handling of health topics. Gary takes on the media’s handling of new research on colon cancer screening, noting “One study [in the New England Journal of Medicine focused] on colonoscopy, one on a form of blood stool testing, plus an editorial that addressed both. Some benefits for each approach were found in each study. Some stories only reported on the colonoscopy study, ignoring the blood stool test study. Others ignored the editorial – which provided easy access to an independent perspective.” Gary’s point? The blood stool study shows significant promise, and not discussing it in context diminishes the reader’s ability to understand that.
Perhaps the most diligent watchdog in the industry is Roy Poses, MD. Roy’s tireless efforts to uncover self-dealing and unethical behavior in the health care industry is notable not only for its thoroughness but, sadly, for the wealth of material. Roy takes on lazy reporters’ patent inability to see through conflicts of interest in health care research, and the logical fallacies that make a mockery of their “reporting.”
A new contributor is Wing of Zock (no, that’s not a typo), and from Michael Weitekamp MD comes a solid post leading with HL Mencken’s oft-used quote “For every complex problem, there is a solution that is simple, neat, and wrong.” Dr Weitekamp notes “The free market cannot fix this. We spent $2.6 trillion on health care in 2010 and the vested interest in the status quo is formidable.” Weitekamp goes on to note a government mandate won’t address duplication of low value services either. A very good overview; here’s hoping he continues with a series on solutions.
Good to hear from Maggie Mahar, who sends us her piece on obesity – I learned that it’s not the weight that kills, it’s the lack of activity. Obesity – in and of itself – isn’t near as damaging as inert behavior.
At Corporate Wellness Insights, Fiona Gathright has a different lament – many health care providers aren’t exactly pictures of health themselves, noting ” health care workers (nurses, aides, hospital administrators, etc) have some of the highest rates of obesity, hypertension, and diabetes in the country!”
Jared Rhoads discusses an effort to better understand public survey non-respondents views on health care reform, and laments the inadequacy of the “don’t know” answer.
A big component of some health plans’ efforts to improve patient care is the “medical home”. Jaan Sidorov MD isn’t sure medical homes are “all that”, and some research supporting medical homes is rather limited in scope.
A different perspective comes from Kerry Willis MD, who has a practitioner’s view of the issues with the health care system.
Finally, Avik Roy takes big pharma to task for working to delay approval of drugs, thereby forcing biotech firms to partner with big pharma companies if they’re going to survive long enough to get their molecules to market.
So, what does this all mean?
Technology adoption isn’t a panacea, and mixed and changed messages from CMS are causing mega-heartburn in the tech and health systems sectors. Most payers are pushing hard to prepare for reform, understanding that the world is changing with or without an individual mandate.
Big money has big influence and as long as it does, we’re likely not going to see significant reform – there’s just too many billions at stake.
And big media doesn’t help, with their superficial and under-researched take on news, studies, and assessments thereof.