HWR – the ‘fearless leader’ edition

Here in New England we’re about to welcome spring – that glorious time of year when the wind howls and the rain pours and mud covers all, best enjoyed while standing outside freezing your tukus watching one of your progeny splash up and down a lacrosse field.
What better time to sit in a warm car, editing the latest edition of HWR?

Reform
The always-informed Bob Laszewski has insights that somehow escape the rest of us. Bob’s latest pertains to House Dems Ground zero in health care reform (at least one of the ‘zeros’) is San Francisco, perhaps the largest political entity in this country to legislate universal coverage. Anthony Wright finds the most vocal opposition to Healthy San Francisco came not from insurers, or pharma, or physicians or neocons, but restaurants. From his desk, it looks like the restaurant’s opposition may be backfiring, as some patrons are happy to pay a surcharge to cover their server’s health benefits.
Our colleagues at Health Affairs’ blog provide an insightful glass-is-half-full view of the crash and burn of the California health reform initiative. Far from a disaster, the HA folks view the process as a model for other states, as well as a rich source of data on what works, what doesn’t, and why.
Tom Lynch has been pounding away at his keyboard, and the effort is certainly justified. The result is a four-part post on how and why American health care is nowhere near the best in the world. Part One, Two, Three and Four are a comprehensive yet concise summary of why claims that the US health system is ‘all that and a bag of chips’ are ludicrous.
Friend and colleague Hank Stern contributes an anecdote about a Canadian woman who had to come to the US to get surgery. I did a bit of additional research on this and the anecdote is true. Turns out that last year the province of Ontario approved 6132 requests for out of country treatment and denied 388 while paying $53.2 million for that treatment.
Louise sends her contribution from Colorado Health Insurance Insider, where a House Committee has rejected an effort to allow the State’s citizens to buy their health insurance from carriers not licensed in Colorado. Louise opines that it is probably a good thing the bill was canned, but the problem is not with Colorado, but rather that regulation of health insurers remains the province of the States. In an increasingly mobile world, this is rapidly becoming a bigger and bigger problem.
Reading Jason Shafrin’s ‘Healthcare Economist’ is always enlightening. This biweek Jason analyzes the pros and cons of a government-mandated health benefit plan. A quick read, and one we hope he expands upon in future posts.
My contribution this time around bridges the pharma and health reform headings. I propose a modest solution to the ever-growing problem of ever-increasing pharma costs by establishing a cap on national drug costs, allowing the market to figure out the best way to meet that cap, and if the market fails, requiring the Feds negotiate for price and allowing any and all payers access to that negotiated pricing.
Important but not-categorizable
Maggie Mahar, freshly returned from the World Health Care Congress Europe, has a terrific review of Uwe Reinhardt’s debunking of the “the sky is falling from the aging US population’s impact on health care costs”. Not so, Maggie says – the US population will age quite slowly over the next quarter century, with teh median age only going up by three years over that span. Aging isn’t going to drive up costs – technology is.
We welcome Canada’s National Review of Medicine to HWR. My perception of Canadians is somewhat more politic and restrained than we Yanks; Sam Solomon shows that’s not always the case as he skewers a UN agency’s criticism of Canada’s efforts to reduce the ill effects of illicit drugs. At first blush, the UN agency’s criticism looks ill-informed, naive, and dumb.
A Massachusetts health care system was all but on the rocks, and tried to sell itself to a bigger stronger system. David Harlow reports that, so far, this was not successful, and takes regulators to task for their ineffectual bumbling about in a market that desperately needs fewer high-acuity beds.
Right down the coast, John Colgan who sits in the Rhode Island Health Insurance Commissioner’s Office, has a lengthy post on why board members of not for profits should not be paid. John includes a list of institutions that don’t compensate their boards, and it is rather extensive.
Pharma and Technology
Merrill Goozner starts off the pharma chapter of HWR with a couple posts (as one of the veterans Gooz gets special privileges…). The first covers the FDA’s continued squirming around the use of EPO for cancer patients (remember those ads showing cancer ‘patients’ playing catch and gardening with the energy of a teen on Red Bull?) – turns out EPO may actually increase cancer’s progress in some patients…
Merrill’s second contribution will resonate with our friends Roy Poses and David Williams; he lays out the problems with the medical profession’s rather large blind spot on conflicts of interest.
Veteran blogger David Williams aims his digital pen at a bio-generics bill in Congress that he contends would do nothing to reduce costs, while protecting Botox from competition. David has a better idea.
HWR’s list of contributors continues to grow. Susan Jacobs takes JAMA and the NEJM to task for their close relationship with big pharma; between the two they raked in $45 million in payments from pharma for advertising and related services. That’s not necessarily a bad thing, but Susan notes the cash may be influencing editors…
Roy Poses has been a valued contributor to HWR from its inception two plus years ago. Roy has a knack for finding the little treasures out there that somehow elude the rest of us, and today’s post is no exception. You know those cardiac defibrillators that are implanted in patients’ chests? Turns out they communicate wirelessly for reprogramming and data extraction purposes. Also turns out they can be ‘hacked’, and Roy believes this could be done relatively easily. Roy’s question to Medtronic; “what, if anything, were you thinking?”
Electronic Health Records and related stuff
The world of Electronic Health Records (and variations thereof) is the domain of Vince Kuraitis and David Kibbe; they make a compelling case for the emergence of a ‘network model’ for an EHR vs a consolidated model (all info residing in one place). It is a long one, but stuffed full of good thinking.
Our new best friend, David Hamilton, joins us with a post on Aetna’s collaboration with Healthline Networks. The gist of the deal is Aetna members will (eventually) be able to use a web app to search for information related to specific health questions – and (here’s the cool part) the results will be matched against the patient’s own medical history, Aetna’s provider and procedure cost databases. We’re getting there…
In the spirit of public service, this edition concludes with a post from the Nursing Online site, which is more of a marketing venture than a blog. Nonetheless, they took the time to find 101 sources for scholarships for nurses.
The practice is ending (well, it was over hours ago) and so is this edition of HWR.
Thanks for reading, and see you in a couple of weeks when once again HWR hits the (electronic) streets.