Insight, analysis & opinion from Joe Paduda

Apr
17

When will reform come?

As part of a very good (defined as substantive, open-minded, and comprehensive) discussion on health care reform options going on at TPMCafe, Jonathan Cohn notes:
“a lot of these people don’t understand how precarious their current situation is – because they don’t realize how easily they could lose coverage or the extent to which their insurance might not cover their bills.(emphasis is mine) (Indeed, that’s the whole point of my book.) But for now, anyway, that’s what they think. And if you start telling them you’re going to change their health insurance – even for an alternative as well-liked as Medicare – a lot of them will get skittish.”
That’s true. But at some point, enough of “those people” who lose coverage or go broke paying bills will decide to do something about it. And that “something” doesn’t have to be national; I’m of the opinion that there will be real reform in more than one state years before we do something nationally.
But which ones, and why them?

Continue reading When will reform come?


Apr
16

Connecticut’s still-born single payer plan

An effort in Connecticut to implement a single payer, universal coverage program is just about dead, after the state’s Office of Fiscal Analysis determined it would cost as much as the entire state budget.
Politicians were shocked by the estimated total cost, which ranged from $12 billion to $18 billion.
I’m shocked that they were shocked.

Continue reading Connecticut’s still-born single payer plan


Apr
13

Fee for service drives up surgery rates

Jason Shafrin reports on the link between physician compensation mechanisms and surgery rates.
Here’s the “money quote” –
“When specialists are paid through a fee-for-system (FFS) methodology rather than a capitation or salaried basis, surgery rates increase 155%. There is suggestive evidence that surgery rates fall when primary care physicians are paid on a fee-for-service basis compared to capitation or salaried payments.”
Not addressed is the key question – is the rate of surgery appropriate under either compensation mechanism?


Apr
12

Hooray for United Healthcare

I’m having a tough time getting mad at United Healthcare. The huge managed care company is under fire for penalizing docs who use any lab other than UHC’s preferred partner, LabCorp. The AMA, regulators, individual physicians, and a few consumer groups are all screaming about UHC’s heavy-handed, dictatorial infringement on their right to practice medicine.
They’ve got it all wrong.

Continue reading Hooray for United Healthcare


Apr
11

Personalizing the US health care mess

What gets lost in the healthcare debate is the impact of our dysfunctional system on individuals and families. Jon Cohn of The New Republic and elsewhere has gone a long way to personalizing the health care mess in his new book, “Sick”.
Jon’s also leading a debate on the topic at TPM. Several health care types including your author are arguing to and fro, while others are keeping us honest.


Apr
10

those damn vendors

Insurance companies, employers, and TPAs rely on vendors to process bills, build and operate networks, manage prescriptions and PT, support litigation, and provide expert advice on problematic medical issues. In many instances the vendors are selected thru a competitive bidding process, wherein the lowest bidder gets the deal, or at the least has a much better chance of landing the business than their more costly competitors.
But in others, the selection process goes on seemingly without end.

Continue reading those damn vendors


Apr
9

Part D’s ugly beginnings

If watching the legislative process in DC is akin to watching sausage made, the passage of the Medicare Drug bill might be akin to the composting process. Roy Poses at Health Care Renewal reflects on “60 minutes'” recent piece on the making of Part D; Roy’s deep experience with big pharma adds a good bit of perspective.
Health care reform is coming; read Roy’s piece for a heads’ up on what the legislative process may look like.


Joe Paduda is the principal of Health Strategy Associates

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