Hank Stern did an excellent job hosting the Health Wonk Review this week – be sure to head over to InsureBlog and check it out. His “life’s a beach” theme and pictures will have you longing for a hammock strung between some palm trees, but if that’s not available, the next best thing is some… Read more about Great stuff from some great health wonks
Jason Shafrin, aka The Healthcare Economist, hosted the Health Wonk Review today, and it’s an excellent edition. Some of my favorite articles in this HWR are from Harold Pollack, Tim Jost, and Joe Paduda. Writing at HealthInsurance.org, Harold takes a look at the recent Annals of Internal Medicine study that dug into the data to see how… Read more about Study analysis and data summaries from some of the best health wonks around
In Colorado, the snow is melting and the flowers are blooming. The health wonks around the blog world have given us an excellent collection of articles this week, many with suggestions of ways the ACA could be improved. Our favorite part of hosting the HWR is reading all of the different perspectives that the writers… Read more about Ways the ACA Could Be Improved Edition of the Health Wonk Review
Brad Wright hosted the most recent Health Wonk Review at his excellent blog, Wright on Health, and it’s a must-read. Or in some cases, a must-watch. Check out healthpolicy.tv, a resource submitted to the HWR by Jared Rhoads. Plenty of good stuff on there, with viewpoints from a variety of political perspectives. And also don’t… Read more about Health Wonk Review at Wright on Health
Brad Wright hosted the latest Health Wonk Review over at Wright on Health, and it’s full of great stuff. First, congratulations to Brad on the recent expansion of his blog team! His site has always been stellar, and now it’s growing from two writers to four, with expanded topics and coverage of healthcare issues. And… Read more about The ACA getting the job done, and a great Health Wonk Review
Jason Shafrin hosted the latest Health Wonk Review at The Healthcare Economist, and it’s an excellent edition. It’s mostly all about the ACA, and there are lots of different viewpoints to consider. One of my favorite posts in the HWR is from Health Affairs, written by Rick Curtis and John Graves. Rick and John make… Read more about Good News From the Health Wonks for ACA Enrollment in 2014
Hank Stern did an excellent job hosting the Health Wonk Review today. Head over to check it out – you’ll learn all sorts of things about health care policy and reform, and you’ll also learn why this Thanksgiving/Chanukah overlap is truly a once in a lifetime event. My favorite posts in this edition come from… Read more about Rational Thoughts on the Exchange Rollout, and Other Health Wonkery
Brad Wright did an outstanding job with the Health Wonk Review this week, hosted at his always excellent blog, Wright on Health. There are plenty of posts about the latest in ACA implementation, including several differing viewpoints on the recent news about policy cancellations. I particularly liked Joe Paduda’s article about Medicaid expansion – it’s an… Read more about News From The Health Wonks – Lots Going On In Health Care Reform Land
Joe Paduda did an outstanding job with the most recent Health Wonk Review, hosted at Managed Care Matters. This edition is all about the government shutdown and Obamacare, and there’s a little something for everyone. My favorite article in this HWR comes from David Williams, explaining why Conservative lawmakers ostensibly hate Obamacare – along with… Read more about The Government May Be Shut Down, But the Health Wonk Review Is Open For Business
David Williams: What would happen if health insurance companies tracked our health-related habits the way Progressive tracks driving patterns for insureds to opt to let them do so? This is similar to the concerns that many people had (and still have) about the results of genetic testing being available to employers and insurers… what can be done with that data? Of course, the key is that Progressive only puts the tracking device in cars if their insureds give them the go-ahead. If my car insurance company offered that, I’d be happy to let them put one in my car. And I think I’d also be willing to let my health insurance carrier track various data about me from a health standpoint.
The ACA has built-in limitations on using medical data to set rates or make eligibility determinations, but I can see real-time health tracking data being used for all sorts of purposes a decade from now. Heading out to the porch for an after dinner cigarette? You could get a text from your insurance company advising you to take a nicotine-free walk instead (or by then, maybe texting will be old-school and our phones will just be able to send messages straight into our thoughts). Who knows, but David makes a good point: the technology for […]
Welcome to the Midsummer Health Wonk Review! It’s always a pleasure to host, and this edition actually isn’t a Shakespeare theme, but it is jam-packed with excellent articles from some of the best writers in the healthcare blog world. The HWR had a break before this edition and will have a hiatus after this one too. We’re starting things off with a few articles that help to shed light on some aspects of health care reform that should be straight-forward but sometimes get a bit convoluted with political rhetoric. Then we’ve got several posts about corruption in healthcare and healthcare policy, and lots of posts that provide contrasting and well-reasoned viewpoints on healthcare reform and healthcare in general. We’ll keep things cool with some winter and spring pictures we took around us here in Northern Colorado. Enjoy!
In an excellent piece debunking popular “wisdom” regarding immigrants and healthcare, Joe Paduda of Managed Care Matters explains that when it comes to the Medicare Trust Fund, immigrants put in a lot more than they take out: In 2009, immigrants paid in 14.7% of trust fund contributions but only accounted for 7.9% of its spending, with a net surplus of almost $14 billion. US-born people accounted for a deficit of almost $31 billion in the Medicare Trust Fund that same year. This appears to be a long-term trend: From 2002 to 2009, immigrants contributed $115.2 billion more to the Medicare Trust Fund than they received in Medicare benefits. Joe goes on to explain the details and warn those who rally behind strict immigration reform that they may want to rethink their position. Our Medicare Trust Fund would be in a lot worse shape without the immigrant population.
And if you’re curious about the implementation track for the ACA (and understandably confused by the constant talk of repeal, delay, replace, etc. that we keep hearing from some politicians) Linda Bergthold has what I consider to be a straight-forward and factual review of the situation. To sum it up, she’s predicting that the employer mandate will go into effect in 2015, as currently scheduled (following a one-year delay, but not a repeal), and that the individual mandate will be implemented in 2014, as planned. And while some states that delayed the creation of an exchange marketplace will likely have a tougher time getting everything up and running by 2014, the exchanges will be operational next year. I imagine there will be some bumps in the road as the ACA is fully implemented over the next few years. But we can work on ironing those out as we go – there’s no need to start from scratch.
Although the exchanges are likely to be successful in the long run, it won’t be without significant effort on the part of the people running them. At Health Affairs Blog, Barbara Markham Smith and Jack Meyer explain their recommendations for strategies that can help the exchanges be successful both out of the gates and for the long haul. They discuss pricing (don’t make it too high!) as well as communication/advertising programs that need to be unified, clear, concise and nation-wide in order to generate awareness and interest in as many people as possible. (Unfortunately, there’s a significant portion of the country’s leadership who seem to want the exchanges to fail – even to the detriment of the American people – and are content to spread mis-information about the entire law. This is a considerable hurdle that the exchanges will have to overcome.) Barbara and Jack recommend a temporary respite from the tax reconciliation that will be done to determine whether a person or family that received a subsidy is required to pay back a portion of it due to increased income compared with the prior year. And they also call for fostering increased competition and CO-OP creation in the states have not yet done so. All in all, pretty solid ideas for success in the exchanges and policy-makers would be wise to take heed.
I think of Dr. Roy Poses as the healthcare blog world whistleblower – he can always be counted on to expose nefarious acts in the healthcare industry, and Health Care Renewal is a must-read blog. Here is his take on the recent Transparency International poll that found 43% of US respondents believe that the US healthcare system is corrupt, and that 64% believe that the government is run by big money and special interests. Roy notes that unfortunately, most of the media coverage of the Transparency International poll has focused on world-wide data and/or specifics from far-away lands. Instead of focusing on our own serious problems with corruption in healthcare, it seems that a lot of media outlets (keep in mind that media is sometimes beholden to special interests too…) prefer to present the problem as something that happens in other countries as opposed to something that we need to work on here in the US.
Continuing with the corruption theme, Eric Turkewitz of the NY Personal Injury Law Blog shares a multi-part series about Dr. Katz, who has been rebuked for lying on the stand in a personal injury trial that resulted in a mistrial because of the doctor’s actions. Central to the issue is the practice of independent medical exams (with the word “independent” being very loosely used in this case) conducted by doctors who are hired by insurance companies when they are defending personal injury cases. In the case that Eric is writing about, the doctor makes a 7 figure income from his medical-legal practice, but in one case that has been made public, he grossly over-stated the amount of time he spent with a patient (he claimed it was 10 – 20 minutes, but a secretly-made video recording of the visit showed that it was under two minutes). Eric has looked at additional data and found that the average length of Dr. Katz’s exams was around 4 minutes. Additional details on this story are here. Wow. The doctor was obviously concerned first and foremost with money, but the insurance companies who hired him were likely not doing due diligence to make sure that he was providing accurate data. They may have been more concerned with finding a doctor who would tell them what they wanted to hear rather than the actual details of the patients’ medical cases. Sad all around, but sadder still is the fact that it’s probably not all that unusual.
And for a little more on the cronyism/corruption topic (maybe those corruption figures Roy mentioned from the Transparency International poll were skewed a bit too low?), Hank Stern of InsureBlog writes about agencies and individuals who have been involved with the Obama Administration for some time, and are now finding themselves in lucrative financial and/or influential positions as the ACA gets implemented. In other words, business as usual in the government. Government appointments, grants, etc. are often awarded this way (ie, appearing to be rewards for donations and/or loyalty), in every administration, regardless of which party is in power. There’s ample room for opponents to cry foul, but it also has to be pointed out that presidents and secretaries and others in power have to be able to select people they trust for top leadership positions. And trust is earned over time. There’s a fine line between selecting the right candidate for the job, having that person be someone trusted by the top officials, and avoiding cronyism. I don’t know what the right answer is, but it’s easy to see how the appointments and grants and leadership roles being handed out with the ACA could be construed as rewards for political support and loyalty.
At Health Beat, Maggie Mahar writes a thoughtful and thorough review of Miriam Zoll’s Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies. After reading Maggie’s article, I’m eager to read the book itself (Maggie leaves a bit of a cliff hanger at the end…). Assisted reproductive technology is certainly a blessing to many families. But it can also be fraught with problems that stem from both overly-optimistic expectations on the part of patients (and society in general), over-promising on the part of providers, and a medical field that is largely unregulated and often not covered by health insurance policies.
At Health Business Blog, David Williams explains his skepticism about DealWell, a new Priceline-style website for healthcare services. I am very much in favor of increasing transparency in healthcare pricing and moving away from the proprietary pricing system we have now, where even the most dedicated patient “shoppers” can find it impossible to obtain real healthcare prices before having a procedure. And to that end, I love the idea of a website where people can bid on the care they need and providers can accept or decline the offer depending on their current workload and the payment offered. But David makes some excellent points about the downsides: not being integrated with health insurance is a big one, especially since nearly everyone will have to have health insurance starting in 2014 (even if a procedure is lower than your deductible, it makes sense to stay in network and have the amount you pay be credited towards your deductible, in case you need additional care later in the year). Although DealWell might be a good option for people looking for one-time services that aren’t covered by health insurance (such a LASIK or a dental implant, for example), it’s probably not going to be the next big thing in healthcare price transparency.
Over at Disease Management Care Blog, Jaan Sidorov takes a closer look at the glowing picture painted by CMS regarding ACO pilot programs, digs a little deeper, and gives us a slightly less rosy view of the results. And there’s even a T-Rex analogy, to keep things even more interesting. Jaan points out that the ACOs that didn’t meet the pilot program goals are likely feeling the sting of losing millions of dollars, since the initial investment costs are not cheap. Although 9 of the 32 pilot ACO providers have said that they want to leave the program, I wonder if results will be better as time goes by, mitigating the initial investment costs somewhat? Stay tuned.
Julie Ferguson of Workers’ Comp Insider writes about the July 6th 777 crash at SFO, detailing how the flight attendants did an excellent job of putting their emergency training into practice, saving lives in the process. Julie notes that while it’s easy to shrug off emergency plans simply because we rarely come face-to-face with an emergency, such preparedness can mean the difference between life and death. Does your business have a solid plan in place to deal with emergencies? Has everyone at the business been trained on it? How fast can your building be evacuated if necessary? All good things to think about.
Writing at Health Access Blog, Anthony Wright discusses the one-year delay of the employer mandate portion of the ACA that will require employers with more than 50 employees to provide health insurance to eligible full-time workers. Anthony makes some very important points: the delay doesn’t impact anyone’s eligibility for health insurance and/or subsidies. People who would have been offered health insurance from an employer with the employer mandate in place will still be able to get coverage through their state’s exchange – and if they make up to 400% of the federal poverty level, they’ll qualify for subsidies to help pay for it. In addition, the vast majority of large employers in the US already offer health insurance to their employees and have historically done so without a mandate requiring it. It’s unlikely that a large amount of those employers will suddenly drop their coverage in 2014. But Anthony goes on to note that if the delay were extended for additional years, it could begin to destabilize the financial foundation of the ACA and employers might begin to shift more workers onto exchange plans, relying on tax-funded subsidies to foot a portion of the bill.
The Healthcare Economist, aka Jason Shafrin, brings us a great summary of health insurance in China over the past half century. Until the end of the 1970s, there were three main health insurance systems in China that covered nearly everyone. But the wheels started to come off after that; by 1998 almost half of the urban population had no health insurance, and by 2003, 95% of the rural population in China was uninsured. In the last ten years, China has tackled health care reform in order to try to remedy the problem. While plenty of progress has been made, there is still a long way to go.
Jared Rhoads has written a review of The Autistic Brain by Temple Grandin. His review is a good read, and the book looks like it is as well. Professor Grandin teaches at Colorado State University – my alma mater – and consults for the livestock industry as well as being a bestselling author. She’s an inspiring and accomplished person even without taking into account her own autism. Her book combines her personal experiences with the latest that science has to offer us with regards to autism. If you’re interested in autism, Jared’s summary is that this book is a good place to start learning more. I’m adding it to my list of books to read, so thanks for the tip Jared!
John Goodman lays out some of the results of the ACA thus far (fair enough, but keep in mind that most of the law hasn’t been implemented yet). He details some positives and negatives, both expected and unintended, although his overall take is that the ACA is not a great solution. Strongly worded opinions about the ACA will likely meet with a round of applause from one side of the political spectrum, and boos from the other side. But regardless of your position, I would say that it’s tough to argue with John’s point about high deductible, consumer-driven health plans. I think he’s correct in saying that they’re probably going to be quite popular starting in 2014, when they will be among the least-expensive plans available. This is probably particularly true among people who won’t qualify for subsidies.
That’s it for this mid-summer edition of the Health Wonk Review. Many thanks to Julie and Joe for keeping such a great blog carnival going all these years! The HWR now has a summer hiatus. Don’t miss the next edition on August 15th, which will be hosted by David Williams at Health Business Blog.
Welcome to the Health Wonk Review! It’s an honor to host the HWR, and the posts in this edition are excellent, as always. We’ve got a wide range of topics today, but most of them are at least loosely associated with some aspect of health care reform, so here’s a brief visual summary for you.
Now that you know where we’re heading, here are the nitty gritty details. There’s something for everyone in this edition of the HWR, so keep reading!
Roy Poses, writing at Healthcare Renewal, explains how doctors are pushing back against corporate bosses who put profits above all else. His article describes two recent lawsuits filed by physician groups alleging that the hospital systems they worked for were sacrificing patient welfare in the name of profit. The details are sickening to read: One hospital group encouraged its docs to exaggerate the severity of patient conditions and needlessly admit patients from the ER to hospital beds in order to bill more for their treatment. Another hospital group that owns three hospitals and also partially owns an ambulance company was making patient transfers (using their own ambulance company despite slower response times) a top priority – to the extent that a doctor’s transfer rate was a factor in bonuses and performance reviews. An admin email stated that “the performance we are looking for are transfers.” Wow. Transfers just for the sake of racking up revenue – patient welfare had nothing to do with it, and was likely compromised when the slower ambulance company was used in cases where the transfer was actually warranted. These lawsuits are in their early stages and nothing has been settled in court yet, but they hint at some very serious problems brewing in for-profit (and even some non-profit) hospital systems.
Duncan Cross brings us an emotionally compelling article about Arijit Guha that is a must-read for anyone interested in the problem of under-insurance. Being under-insured might not be quite as bad as being uninsured, but while the uninsured know that they don’t have health insurance, people who are under-insured might not be aware of the specific short-comings of their coverage until they actually have a serious, ongoing medical condition. Arijit was a grad student at ASU, and he recently passed away from colon cancer. During his fight with cancer, he also had to battle his insurance carrier (Aetna) and raise money selling t-shirts in order to fund his treatment. He had a student health insurance policy, and those have long been notorious for having low coverage limits. Duncan has an insider view of some of the medical issues that Arijit had to face, and he, too, attended grad school for a while, working on campus at a job that afforded him faculty health insurance rather than student coverage. He notes that a major problem that wasn’t often addressed in articles about Guha is that the university was the organization responsible for choosing a health insurance plan for its students – Aetna just provided the coverage that the school requested.
Maggie Mahar‘s article at Health Beats will be appreciated by NPs and PAs. Her post A Doctor Confides: “My Primary Doc is a Nurse” is a great look at the increase in the number of PAs and NPs who are providing primary care, and the myriad issues that accompany this change. Maggie delves into topics like turf war and resistance on the part of MDs to accept NPs as quality primary care providers. She also addresses patient and provider satisfaction, patient safety, the cost of primary care, and the shortage of MDs who are choosing primary care versus the willingness of NPs to […]
We’re exited to be hosting the next edition of Health Wonk Review here at the Colorado Health Insurance Insider on Thursday.
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An excellent baseball-playoff themed edition of the Health Wonk Review is at Wing of Zock, hosted by Jennifer Salopek – be sure to head over and check it out. This article by Jason Shafrin should be of interest to anyone who has been paying attention to all the talk about ACOs lately. I have been generally impressed with what I’ve read regarding the potential cost savings and improved efficiency that ACOs will hopefully provide. However, although health care reform has focused quite a bit of energy on the creation of ACOs, it is far […]
Welcome to the Health Wonk Review Football edition because, well, it’s September and that means football season is here! And… we’ve got Peyton Manning!!!
Every time I read a post by Amy Berman on the John A. Hartford Foundation’s blog, I’m blown away[…]
[…] Overall, the rhetoric in the media hasn’t really changed much since the SCOTUS ruling. While it’s true that the PPACA’s legal battle is over, the political one is as fierce as ever, and will probably intensify over the next few months leading up to the election in November. Joe Paduda’s special edition HWR has opinions from both sides of the issue and plenty of good ideas about the future of healthcare reform in the US. Be sure to check it out.
[…] Under the ACA, most health insurance carriers, hospitals, medical offices, pharmaceutical companies, device makers, etc. will all remain privately operated, in the free market. It’s true that the ACA establishes some guidelines that the private entities – and individuals – must follow. Individual health insurance will be guaranteed issue by law, and everyone will be required to purchase health insurance (assuming that the individual mandate isn’t overturned by the Supreme Court), with subsidies helping many families cover the cost. But the products that will be purchased – health insurance and healthcare – will still be primarily in the private sector. I think Justin makes some very good points, especially at the end of his article when he talks about the future. The ACA is by no means perfect, and I believe it will need plenty of tweaks over the years, even if it’s upheld in its entirety by the court. But if it’s overturned and we wait several more years to implement a replacement, we might find that it ends up being a far less free-market-friendly approach.