The presidential election looks like it is going to be a battle of personalities or issues. Bob Laszewski notes that the lipstick issue is a winning one for the GOP while the Democrats want to keep the election focused on ‘real’ issues – such as health care and the economy.
For now, it looks like the electorate is living in la la land – more concerned about appearances than reality.

I’ve been rather vocal in my advocacy for a private insurance-based universal health care program. My thinking has been that once insurers stop employing all that expensive brain power to select risks and cancel policies, they’ll be able to actually work on ‘managing care’.
That’s the idea, anyway.
Unfortunately, my single payer advocate friends have had lots of ammunition to shoot holes in my argument, ammunition provided by the same health plans I’ve been pushing as solutions to the health care crisis.
And every time there’s another report of stock price manipulation, retroactive termination of coverage, or refusal to cover appropriate care, my argument weakens.
Today’s hit comes not in the form of another scandal or more evidence of incompetence, but rather from Health Affairs. The points made by the authors can be summarized thusly:
– non-single payer programs incur much higher costs due to the work inherent in eligibility determination and vetting.
– additional expenses incurred for advertising, marketing, PR, and overhead (that would include consultants like me) would be unnecessary
– the elimination of medical underwriting would simplify matters and prevent cost-shifting (true, but so would guaranteed issue and community rating and mandated universal coverage)
– provider administrative hassles would be greatly reduced – instead of dozens of arrangements, contracts, and provider manuals there would be one main one.
I’d add a biggie. WIth relatively minor exceptions, today’s for-profit health insurers are doing a lousy job ‘managing’ care. Strike that – they aren’t doing much at all. What they are doing is managing reimbursement. The only large national payer that is doing much in this area is Aetna, and they have quite a ways to go.
Here’s hoping the mainline health plans start providing me with compelling arguments in favor of their continued existence.
And please, no citation-free ideological rants against ‘socialized medicine‘. Single payer is NOT socialized medicine, and screaming about the ‘failure of socialized medicine’ is getting tiresome.

Free marketeers have been lauding Gov. Sarah Palin’s efforts to eliminate Alaska’s restrictions on new health care technology and facilities, calling it a push for “less regulation of health care providers and more competition”.
This blind faith in the marketplace to somehow solve the American health care crisis demonstrates not only a superficial understanding of health care, but an ignorance that would increase costs and reduce quality.
One excellent example of how wrong these ideologues are comes from KFF. The good folk at Kaiser report that:
“Physicians in 2007 ordered 68.7 million CT scans, more than three times the number ordered in 1995 [emphasis added], according to IMV Medical Information Division. In addition, a 2007 study by McKinsey Global Institute found that the number of CT scan machines in the U.S. had increased to 24,000 since the first apparatus was purchased in the U.S. in 1973, which is nearly three times the number of machines available in most other industrialized countries.
…the declining cost of the devices has encouraged more private practice physicians and independent imaging centers to install their own machines, the Times reports. According to the Times, manufacturers of the scanning machines, such as Siemens, “tout the ease of making money with the devices.” A Siemens marketing brochure notes that two scans daily generate enough revenue to cover the cost of the machine and its operation over a five-year period, while 10 scans daily can generate more than $400,000 in annual profits.”
And let us not forget the increased health risk from excessive radiation doses…
The CT scan issue is merely the latest in a long line of well-documented, rigorously-researched studies that clearly and unequivocally prove supply drives health care costs. The more health care facilities, beds, technology, the more physicians and care givers there are, the higher the cost and the worse the outcomes..
The authors of the Dartmouth Atlas have done an outstanding job in this area. Here is just a sampling of their findings:

• the U.S. could lower health care costs substantially if the highest intensity hospitals adopted the practices of the nation’s best performing hospitals.
• where medical decisions are most discretionary…admission rates are strongly correlated with the local supply of hospital beds
• higher spending and greater use of supply-sensitive care is not associated with better care
• more care does not necessarily mean better care. In fact, more hospitalizations and more procedures among similar populations resulted in higher mortality than for populations that received more conservative care.
• and the killer – any expansion of capacity will result in subtle shifts of clinical judgment toward greater intensity of care

Yet some persist in ignoring facts in favor of ideology. A piece in that bastion of intellectual rigor, the American Spectator, claims “Sarah Palin means it when she says she’s in politics to “challenge the status quo and to serve the common good.” Moreover, her push for greater competition also demonstrates that she understands the potential of the free market to cure much of what ails American health care.”
Actually, Palin’s statements don’t do that at all. Her actions show her to be ignorant of cause-and-effect, blind to the facts, and willing to sacrifice the good of Alaskans on the altar of the free market.
thanks to FierceHealthcare for the heads-up.

Igor at ThinkProgress brought up a stunningly obvious point –
Why is John McCain so adamantly opposed to Government health care?
For most of his life he’s been covered by ‘government health care‘. It’s kept him hale and hearty, taken care of his four melanoma episodes and other illnesses and injuries, allowed him to keep up with a woman 18 years his junior, and he certainly hasn’t lacked for energy and enthusiasm on the campaign trail.
McCain thinks this isn’t good enough for the rest of us; “My health care plan will make it easier for more Americans to find and keep good health care insurance. His plan [Obama’s] will force small businesses to cut jobs, reduce wages, and force families into a government run health care system where a bureaucrat stands between you and your doctor.”
(As opposed to, say, today’s private health plans, where a bureaucrat stands between you and your doctor.)
Actually, McCain has misspoken; Obama’s plan specifically calls for and encourages the use of private health plans, with the government plan as a backup (much as it is today for the poor, elderly, and disabled). That wasn’t McCain’s only ‘misstatement’.
Obama’s plan specifically exempts small businesses, does not force adults into health plans, and provides financial help to small businesses offering health insurance in the form of a refundable tax credit of up to half the cost of premiums. And, Obama allows anyone with insurance today to keep it.
What does this mean for you?
Bottom line, Obama’s plan would cover 18 million more Americans, while a million Americans would lose coverage under McCain’s plan.
On second thought, maybe McCain does need another check-up…

I’ve been considering why Republican politicians and pundits favor de-linking employment and health insurance. Portability is certainly a good reason; some workers can’t leave their jobs for fear they will lose coverage, or won’t be able to get new coverage due to a pre-existing condition. That interferes with the free flow of labor, and may well inhibit economic growth and prosperity.
The high cost of US health care is certainly worth mentioning, and especially the impact of that high cost on competitiveness. American manufacturers and service companies are at a big disadvantage simply because they have to pay a lot towards health care (via premiums and taxes, driven by the world’s most expensive health care).
Linking employment to insurance also means when people lose their jobs, they lose their coverage (except for those who can afford to pay the whole premium for the maximum 18 months allowed under COBRA). This last got me wondering – is there a correlation between unemployment and the President’s political party?
Turns out there is, and it isn’t what many suspect. In fact, unemployment under Republican presidents is significantly higher than when a Democrat is in the White House.
A study by Elliot Parker of the University of Nevada, Reno, found that unemployment at the end of presidential terms was significantly higher for Republicans (6.0%) than for Democrats (5.2%). And, the Unemployment Rate actually went up under Republicans (+0.3%), while it decreased under Democrats (-0.4%) Parker used the period from 1949 to present for his analysis, noting that the period prior to that date was heavily influenced by the Depression and two world wars. (but if you include the period from 1929 on, the numbers are actually worse for Republican administrations)
The reason for the differential seems pretty obvious – when economies perform better, jobs are added. As Christopher Hill at Boom2Bust writes;
“Real GDP Growth Rate (annual average) under Republican administrations now [for the preiod 1949 to 2005] stood at 2.9% and Democratic administrations at 4.2%. Real GDP Growth Rate Per Capita was 1.7% for the Republicans and 2.9% for the Democrats. These results prompted Dr. Parker to conclude that “the economy has grown significantly faster under Democratic administrations, and more than twice as fast in per-capita terms.”[emphasis added]
Parker also considered whether there was a lag effect – policies can take time to make their impact felt, time that may influence results. As Mr. Hill put it; “The professor found that even with up to four years of lagged effects, there was no evidence that the economy performed better under Republicans.”
It’s not just unemployment and economic growth. Parker’s research found that by many measures, Democratic administrations delivered better economic results than their Republican counterparts – Dow Jones Index, weekly wage indices, corporate profits…
This is one of those great validations of the internet – start looking for something and you’ll be surprised what you learn. Is it possible Republicans want to delink employment and insurance due to their poor record on the economy? I don’t think so.
And as their record indicates, they certainly wouldn’t publicize it.
Thanks to Joe Lyles for getting me thinking about this.

Gov Sarah Palin has claimed she is a reformer, maverick, independent pit bill, not afraid to take on special interests when it is in the interest of her constituents to do so.
She’s also not afraid to ignore the advice of experts when it runs counter to her ideological position.
Case in point – the Certificate of Need program in Alaska. CoN programs are in place to prevent the building of duplicative/redundant health care facilities. The theory (supported by most research) is that the more facilities there are, the more costs will increase, with no appreciable increase in health care quality. Therefore, limiting the number of MRI machines and ambulatory surgical centers reduces costs.
As I noted earlier this week, Palin has been trying to kill Alaska’s CoN program, claiming it will introduce more competition into the health care market, competition that will drive down costs and increase quality.
But that doesn’t happen. The more facilities there are, the more costs increase – and quality decreases.
When Palin convened an expert panel to review Alaska’s CoN program, they (surprise) advocated keeping it in place. The Governor didn’t like that answer. Palin ignored the advice of the experts and proposed legislation to kill the program.
Palin’s approach to health care is, to be kind, simplistic. According to the Washington Post, “It didn’t matter what you asked her about health care,” said Tony Knowles, the Democratic governor who lost to Palin in 2006. “Getting rid of certificates of need was her only answer.”
Why?
Here’s more from the WaPo piece.
“Palin was part practical politician, accepting more than $34,000 from medical groups that were trying to spur competition, [emphasis added] according to an analysis by the nonpartisan Campaign Money Watch. She also worked closely with Paul Fuhs, an Anchorage lobbyist who was helping imaging firms battle hospitals over control of a lucrative trade. And while supporters and opponents credited her with reaching out to all sides, they also said she was a fierce idealist, taking a philosophical position and not giving ground.”
What’s the net?
Another politician making decisions based on ideology and special interests, not on facts, data, and logic – decisions that will increase costs and reduce health care quality.

The folks over at Think Progress have compiled a brief summation of Alaska Gov Sarah Palin’s record on health care. There’s not much there, given her short tenure as governor.
What’s the net?
Alaska is a state with healthy people, very expensive health care, comparatively poor care for children and little in the way of a safety net for those kids. To date the governor’s answer has been to eliminate the CoN program and build a government bureaucracy to promote more transparency
Perhaps her most significant initiative is Palin’s effort to overturn the state’s Certificate of Need program – the details are here.
Palin has also called for passage of a bill authorizing a new state agency to promote transparency in health care. “The bill would establish an Alaska health care information office to give consumers factual information on quality, cost and other important matters to help them make better-informed decisions about health care in the state.”
Interesting that a staunch conservative would seek to increase the size of government to address a problem that private insurers are already working on.
The governor did sign a bill that slightly increased the amount of income an Alaskan could earn (from 150% of the poverty level to 175%) and still qualify for the SCHIP program. Still, Alaska’s criteria are among the lowest in the country; in comparison most states allow income well above 200% of the poverty level.
Of course, Palin’s health care record has to be viewed in context – which in this case is Alaska-specific. The most recent data from the Commonwealth Fund indicates health care quality in the state is ranked near the bottom, while access is also poor (36th), in general Alaskans lead healthy lives.
From a cost perspective, Alaska consistently ranks as one of the most expensive states for health care in the nation. For kids, the state was ranked in the bottom quartile by the Commonwealth Foundation.