Health Wonk Review – Campaign 2012 Edition

Welcome to the Health Wonk Review.  We’re honored to be hosting, and were thoroughly impressed by the quality of the articles that were submitted for this edition.  A good number of them addressed the politics of healthcare reform and/or the Republican primary race.  So I thought it would be fitting to organize this edition of the Health Wonk Review as an election.  All of the candidates are well qualified and knowledgeable about healthcare, from many different angles.  And they all write quite convincingly.  Some take polar opposite positions, while others lean more toward the center.  I’ll summarize each candidate’s platform, and you can get all the details by clicking on the names.  Once you’re finished, cast your vote for your favorite in the comments.  Be warned, however – you will have a hard time choosing!

Ladies and gentlemen, here are your candidates for Wonkiest Health Wonk 2012:

Anthony Wright‘s camp is taking issue with Rep. Dave Camp’s position that the ACA is the reason for the decrease in the percentage of employers who offer health insurance benefits and the increase in premiums (both trends that were well established long before the ACA was crafted, and as Anthony points out, most of the provisions of the ACA haven’t been implemented yet).  Rep. Camp quoted Wright on his website, and mis-used the words to support his position that the ACA is to blame for the current problems.  Anthony is – quite understandably – unimpressed.

Joe Paduda‘s platform is all about taking aim at Mitt Romney’s enjoyment of firing people – and insurance companies.  Although it sounds nice (and very “free-market-y”) to say that if you don’t like your health insurance company you can just fire them, that isn’t usually the case.  Joe explains how most people have limited options (if any at all) when it comes to their health insurance, particularly if they have any health conditions.  Firing ones health insurance carrier isn’t really a possibility for most of the population.  Joe’s common sense approach should win over a lot of voters.

Gary Schwitzer‘s campaign is focused on calling out half-truths and shoddy journalism.  He cites an example of an ABC News segment that purports to be a journalistic look at a new “lifesaving” technology.  But it might just be blatant self-promotion on the part of the doctor being interviewed.  And even worse, it might convince countless viewers that they need the same high-tech test (along with several others that are mentioned in the story), despite the far less flashy stories about the comparative effectiveness data that indicate that the tests in question aren’t really useful for low-risk individuals.  And that leads to over-utilization of healthcare.  Which leads to increased healthcare spending.  Which leads to higher health insurance premiums.  Which leads to more people being uninsured.  It’s not a good cycle.  Kudos to Gary for digging in on this story.

Maggie Mahar‘s campaign is all about healthcare spending.  This has been a hot topic for the last several years, and people have been able to make the numbers say pretty much anything they want (lies, damned lies, and statistics?).  Maggie – in her usual thorough style – delves a little deeper into the fact that healthcare spending rose much more slowly over the past couple years than usual.  At first glance, that’s cause for celebration.  But we may see a spike in healthcare spending after the recession ends and/or people regain lost health insurance coverage.  Whether that spike will put us back to pre-recession levels remains to be seen.

David Williams is running on the idea that the much-hyped nursing shortage might be exaggerated.  We’ve all heard that there is a shortage of nurses all across the country that is predicted to grow rapidly over the next couple of decades as our baby boomer population ages.  But David points out that the economy doesn’t work that way.  As demand grows, so does supply.  And he notes that it’s possible that the stories of nursing shortages might be started (or at least spread around) by people with a vested interest in turning out more nurses.  Hard to argue with that logic.

Jaan Sidorov‘s campaign is centered around the increase in physician-to-physician referrals over the past decade (which is not at all surprising as far as he’s concerned).  The study that Jaan references cites two possible reasons for the increase:  increasingly complex healthcare (thus the need for more physicians to weigh in on a patient’s care) and a need to offload some work onto other care providers.  Dr. Sidorov also notes a couple of additional explanations:  the shift from HMO to PPO-style care, and an increase in consumerism on the patient’s part.  He’s done his research and it makes sense… is it enough to get your vote?

Roy Poses is running on a platform of transparency and openness – it’s time to talk about the elephants in the room.  Roy writes about a recent survey of the chairs of medicine and surgery at US medical schools which asked various questions about problems at the schools that nobody was willing to discuss.  The survey found that the majority of the respondents felt that there were indeed “elephants in the room” at their medical schools (although most of them felt that they were not themselves responsible for the lack of discussion).  But interestingly enough, the article about the things that we cannot mention didn’t specifically address what those things are.  We cannot mention what we cannot mention.  I always like candidates who tell it like it is and are willing to openly discuss the elephant in the room.

Jon Coppelman is running his campaign on the effectiveness of government safety programs for the workplace.  He focuses on CAL/OSHA and whether or not it has been effective in terms of improving workplace safety.  The answers are a bit murky.  As with most government programs, paperwork and official compliance is only half the battle; you have to also have company management that is focused on workplace safety and making it a priority on a daily basis.  And government programs often start with lofty ideals and goals only to find that implementation is more of a challenge than expected.

Jason Shafrin‘s campaign takes a closer look at President Obama’s recent State of the Union address, and specifically examines the aspects of it that focused on healthcare.  His take is that healthcare wasn’t really a focus during this most recent address – especially when compared with the State of the Union address in 2010 – and the President didn’t mention anything new this year.  Jason notes that if a Republican wins the election this year, the State of the Union address next year will likely have far more talk about healthcare, since repealing or significantly changing the ACA seems to be a top priority for a lot of Republican politicians.

John Goodman is running on the notion that it makes a lot more sense to tackle healthcare costs with a market-driven supply side strategy rather than continuing to implement government run, demand-side controls.  He paints a rather dismal picture of how demand-side buyers of care (including government and private enterprises) have failed repeatedly to control costs, while some supply-side programs have done an excellent job of providing high quality care while also controlling costs.  Being from Colorado, I have to throw Grand Junction into this debate.  I think the three-decade long collaboration between Rocky Mountain Health Plans and the physicians in the Grand Junction area is a good example of supply and demand working together to create a good model that is definitely working well.  But as John notes, you can’t just copy what works in one place and expect it to work everywhere – it’s not that simple.

Sharon Long‘s camp is calling foul over Senator Santorum’s erroneous claims regarding health reform during the last Republican debate.  The specific focus is on Mass. health reform and how the state’s healthcare system has fared over the past six years (hint:  it’s nowhere near as bad as Senator Santorum would have people believe), and Sharon points out the progress the state has made as well as areas that still need work.  Although the details are state-specific, many of the general ideas can give us a rough road map for how the rest of the country might be faring a few years down the line, once the ACA is fully implemented.

Bob Vineyard‘s platform is focused on the health insurance exchanges that are slated to being operationg in 2014.  He’s not impressed, and the point he makes is a very good one.  Health insurance agents play a vital role in consumers’ understanding of the policies they purchase.  Agents also tend to be the ones to answer most of the clients’ initial questions when they’re comparing policies and a lot of insureds call their agent first when they have a question after the policy is in place.  Bob notes that the high risk health insurance pools created by the ACA were supposed to cover 4 million people in the first two years.  Nearly 1.5 years in, 30,000 people have signed up and many states (including Colorado) are rapidly running out of money for the program.  The exchanges are expected to be all online, guided by “navigators” who may not be as knowledgeable as licensed agents, and are supposed to be the conduit to health insurance for 200 million people.  It might not go as smoothly as lawmakers were hoping.

Jared Rhoads‘ campaign is centered on the individual mandate in the ACA (and specifically, the similar version that Mass. enacted several years ago).  He notes that not everyone fits into the “insured” or “free-loader” categories.  There’s a third category of people who self-insure and/or want to purchase high deductible, catastrophic-only health insurance (which might not be considered “good enough” under the ACA).  Jared’s point is that the individual mandate implies that the people in that third category are free-loaders who should be forced into purchasing health insurance, and he calls foul.  Given the divisive nature of the individual mandate, Jared is sure to win over plenty of voters.

Neil Versel‘s campaign is calling out the left and the right – Kathleen Sebelius and Newt Gingrich – on healthcare reform.  He points out that Gingrich has aligned himself with the far right idea of repealing the ACA and has been distancing himself from his work over the past decade that pushed for health IT reform and technology-enhanced improvements in our healthcare system.  Neil also notes that Sebelius and the Obama Administration have been focusing a bit too much on the health insurance aspects of the ACA and seem to have forgotten that health insurance is not the same thing as healthcare.  Simply having health insurance does not guarantee access to care, affordability of care, or that the care one will receive will be of the highest possible quality.  Neil’s position ought to win him quite a bit of favor from a lot of center-minded folks.

Brad Wright‘s platform is one that will appeal to a lot of people, regardless of their political affiliation.  He’s proposing that we do a better job of scrutinizing the community benefits provided by non-profit hospitals.  Non-profit hospitals are exempt from federal taxes, but that’s in exchange for providing benefits to their communities – things like uncompensated care and job creation.  However, there’s not a lot of accountability around the whole process, and the waters get a bit murky when we try to differentiate the business practices of the for-profit and non-profit hospitals.

Fiona Gathright is running a campaign on the merits of “just do it” instead of “just talk about it”.  When it comes to wellness benefits provided by employers, it appears that tangible incentives like gym memberships (or even just breaks in the workday that encourage movement and activity) are valued by employees and are also more beneficial than online resources to encourage employees to incorporate healthy habits into their lives.  We all know what we need to do to be healthy.  Fiona’s campaign slogan might be “less talk, more action.”

There you have it.  16 excellent candidates.  Lots of different viewpoints -all very well explained and defended.  Enjoy the reading, and don’t forget to cast your vote for your favorite candidate.

Jason Shafrin at Healthcare Economist has the next Health Wonk Review

-Louise