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Health Wonk Review isn’t waiting for the Supremes…

Actually, it was.
Faithful readers will note the delay in this biweek’s publication of HWR, a delay that was not an oversight but intentional; like many of you I’ve been waiting breathlessly for news of the Supreme Court’s pending decision on PPACA.
Alas, the distinguished folk in the black robes aren’t cooperating, so I’ll have to proceed without them.
Much as the real world is. For truth be told, the real world is moving rather quickly towards reforming bits and pieces of what passes for a health care system. And herein begins our tale.
We lead with the estimable Maggie Mahar. Maggie believes if the Affordable Care Act’s individual mandate is ruled unconstitutional by the Supreme Court the government will have to take a carrot-and-stick approach to encouraging healthy Americans to buy individual insurance – and it will likely have to focus much more on carrots. The individual mandate isn’t likely to drive much in the way of behavior change as the penalty wasn’t much of a “stick”.
Maggie’s fellows take this a step further, Harold Pollack and Henry J. Aaron explain how a new GOP majority would assault the health reform law, but wouldn’t stop there; Medicaid and Medicare are on the chopping block too.
At, Anthony Wright discusses the “evolution” of the GOP; it’s worth pondering the reasons of the amazing switch of Republican leaders on the individual mandate, from originating the idea to disowning it entirely and saying it in unconstitutional. This transformation is first and formost about politics, of course. But it is more than that–it’s that the mandate forces government to take direct and serious action to force insurers to abide by rules that encourage coverage; “showing that governmental action could actually make progress on social issues.”
David Williams, one of the more insightful observers of all things health care related, doesn’t think the GOP is ready or willing to engage in a meaningful discussion of health reform – but it will need to get serious quick if it wants to be taken seriously
The Huffington Post’s Sanjay Sanghoee thinks losing ACA isn’t that big a deal, as it wasn’t going to accomplish much in the first place. If it does get overturned, Sanghoee wants President Obama to push the public option as a much more robust solution that is much more likely to work.
Methinks the New America Foundation’s Justin Jones and Sanjay would have an interesting discussion re the role of the free market; Justin notes that while the Anti-ACA crowd has long vilified the ACA as an unprecedented intrusion of government into the free market, the ACA is actually very market friendly and free-market advocates should consider whether it would really be the end of the world if it is upheld in its entirety.
But the discussion between Justin, Sanjay, and Bob Vineyard of InsureBlog would be even more interesting; Bob thinks we are being “primed for single payer“; Bob says single payer is a “system with a 100% failure rate.”
Love ya, Bob, but I guess it depends on how one defines “failure”; with 50 million uninsured and tens of millions more under-insured, we ain’t exactly a model of success in coverage, or outcomes, or cost!
My contribution this fortnight focuses on the impact of health reform on employment – Massachusetts has been a great laboratory, and the results are instructive.
Roy Poses – who’s been with HWR since its inception seven (!!) years ago draws parallels between Wall Street, the financial debacle, and the inherent issues with conflicts of interest at the highest levels of government and health care.
Roy is joined in his effort to increase understanding of potential conflicts of interest by Alison Hwong, an MD-PhD candidate at Harvard, and Lisa Lehmann, the Director of the Center for Bioethics at Brigham and Women’s Hospital; posting at Health Affairs, Alison and Lisa stress the importance of going beyond simple disclosure of physican-industry financial relationships to help patients understand the context and implications of these relationships.
Neil Versel wants the public to know that they do have a right to access and correct their own health information, though few know about this or do anything about it. Better to do that now than when it’s critical to your life – and perhaps too late.
Among the other hot topics on the minds of bloggers was obesity – childhood and otherwise.
Kat Haselkorn digs into NYC Mayor Mike Bloomberg’s move to shrink the size of sugary beverages – she’s not sure it will succeed, but applauds the politically-sensitive mandate nonetheless.
This isn’t just a NY thing; out West one of our favorite insurance brokers Louise discusses a similar move in Colorado where a new law bans trans fats in “competitive foods” in public schools.
We conclude with thought-provoking posts about things most of us don’t spend enough time thinking about, and Jessie Gruman’s contribution calls for all of us to consider the implications of moving from curative to comfort care whe “Shifting to Palliative Care”.
Julie Ferguson shines a light on an important public health issue: domestic violence in the workplace. Homicide is a leading cause of occupational death in U.S. women, and while work homicides in general are trending down, homicides of women at work are trending up.
Michael Gavin wants workers comp payers to pay attention to the quantity of opioids their claimants are taking, and do something if it gets excessive.
John Goodman opines that failing to make consumers price-sensitive at the point of purchase is one of the biggest problems with health care. No argument there, although it is no panacea – when you’re on the ER table with chest pain you’re not exactly ready to negotiate.
We do know the Supremes’ decision will come down next Monday or Tuesday, and we’ll likely have a special edition of HWR when it does…if Julie says we can.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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