Aug
11

What the town hall protesters should be yelling about

I’ve been taking flak this week from several sources about inserting my ‘political’ views into this blog.
Guilty.
I’m also wondering why I didn’t hear similar complaints a few weeks ago when I was pillorying the Democrats [here here and here] for failing to include anything remotely resembling real cost containment in either the House or Senate Finance bills. Which is exactly what the “Town Hall Protesters” should be yelling about.
The problem with the Dems’ health reform efforts to date have nothing to do with death panels, rationing, government control of health care or any other right wing myth. We can’t afford to expand coverage unless we control costs. Covering another 35-45 million folks without controlling cost will devastate the budget, force large tax increases, and take funds away from infrastructure, energy, education, defense, and other critical needs.
That’s where the Dems are vulnerable – another entitlement expansion we can’t afford. Yet for some reason the protesters aren’t screaming at the top of their lungs about cost.
Are they not concerned about cost? Do they think a big new entitlement program is less of a problem than funding abortions or so-called death panels? Is the fate of Trig Palin more of an issue than the potential for vastly increased deficits? Are protesters OK with massive cost increases, as long as there aren’t death panels or comparative effectiveness research?
Of course not.
If they stopped for even a moment and thought about the Democrats’ proposed reform initiatives, the trillion dollar cost would become the front-and-center issue. Why haven’t they?
Perhaps it is because the opponents of health care reform don’t want anyone to start thinking about cost – after all, controlling cost means lower revenues and profits for hospitals, doctors, medical device companies, insurers, pharma, and other stakeholders. Sure, some will come out just fine, but the majority are terrified that meaningful, real cost controls will take big bites out of their top lines. But they can’t say this in public, even if they’re chewing their nails to the elbow in boardrooms.
So instead they are funding these fake ‘grassroots’ movements using made-up and patently false claims to scare the bejesus out of regular folks who will then (hopefully) kill any hope of health reform, thereby preserving the industry stakeholders’ business models.
I don’t have the resources to find out who the funders are behind Americans for Prosperity, Patients United Now (PUN – get it?) and many of the other groups. But there is ample evidence that one of the primary anti-reform groups is headed by Rick Scott, former CEO of hospital company HCA. The founder of Conservatives for Patients’ Rights, Scott has hired the same PR group responsible for the Swift Boat campaign to gin up resistance to reform.
Scott is a sleazeball. While he headed up HCA, the company was fined $1.7 billion for Medicare and Medicaid fraud; the company grew by buying up as many hospitals as possible in a market then shut down selected facilities while jacking up prices at the remaining hospitals. Great for his investors, not great for patients, employers, or taxpayers in HCA-dominated markets.
He’s also an investor in a Florida walk-in clinic operation, Solantic.
I’m sure there are other Rick Scotts out there, using their ill-gotten gains to encourage ignorant folks to rally against health care reform. I just wish I had the time to track them all down.


Aug
10

Palin on health care reform – she’s not the worst

Former Alaska Gov Sarah Palin (R) has added her own voice to those decrying the current health care reform proposals – and in so doing has added yet more evidence that she is not credible.
According to the unimpeachable Fox News, “Who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course,” the former vice Republican presidential candidate wrote on her Facebook page, which has nearly 700,000 supporters.
“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil,” Palin wrote.”
(Fox’ pundits went on to agree with Palin; here‘s one “death panel” quote from one of the ‘experts’ at Fox.) Fortunately, the good folks at ABC did their homework, identifying the source of the ‘death panel’ BS – our old friend Betsy McGaughey.
Just hours after her initial wacko proclamation, Palin appeared to temper her bizarre assertions by asking health reform opponents to calm down and be civil, saying “we must stick to a discussion of the issues and not get sidetracked by tactics that can be accused of leading to intimidation or harassment.”
Unfortunately the former Governor’s call for civility hasn’t had much of an impact – at least not in Memphis. Here’s one rather telling excerpt from the article:
“Roger Fakes, 70, said he sat quitely [sic] during most of the meeting, but Cohen’s insistence that citizens would be able to keep their private health care drove him to his feet.
He argued that changes to private insurance would force citizens into the government plan.
“There are some of us old gray-haired folks that don’t want the government involved in any of our business,” he said.”
Alas, he’s about as well informed as our erstwhile Vice President, Ms. Palin…It appears Mr Fakes isn’t aware that the insurance he so ardently defends is a ‘government program’.
This is one example of the apparent ignorance of at least some of the ‘protesters’ about what is being proposed, what alternatives exist, and the current state of the health care system. You don’t know whether to be furious with these folks for their blind support for right wing causes or pity them for the ease with which they are manipulated.
As I and others have noted, there are significant concerns with the current health reform initiatives, yet none of the real concerns are in evidence at these corporate-funded outrage parties. Lets start with cost – our system just costs too much, and that’s what is making it unaffordable. Why aren’t protesters screaming about cost? Because the people funding their outrage are the very companies that base their business’ success on that system.
Aided by their fellow travelers; here’s anexample of the ‘grass roots’ nature of the anti-reform campaign. The tour bus that has been cruising around North Carolina with an “Americans for Prosperity” logo has been funded by none other than Koch Industries, one of the most notorious polluters in the nation. AFP has also challenged global warming, an intelligent energy policy (one that is backed by oilman T Boone Pickens, no less), and tobacco legislation.
Thank goodness the ACLU will fight to its last nickel to defend these slimeballs’ right to publicize their propaganda.


Aug
10

PPO firm Viant acquired by MultiPlan

PPO company Viant (owner of Beech Street and PPONext) will be acquired by larger PPO company MultiPlan.
The announcement came last week; here’s the lead from the internal memo to employees:
“After much thought and deliberation by our Board of Directors and our Executive Team, we have decided to pursue a new chapter in Viant’s long history. Therefore, it is with pleasure that we announce that Viant and MultiPlan have reached an agreement where MultiPlan will acquire 100% of Viant sometime over the next several months.
This decision was not reached lightly. Viant has demonstrated tremendous resiliency over the years, overcoming market and competitive challenges while still growing the business at attractive rates. However, the current U.S. economy and the political momentum around health care reform are very real and represent significant risks. As a result of these challenging and uncertain times, we have considered the most favorable strategic options available to our company that enable us to strengthen our position in the managed care industry and continue to grow. Clearly, economies of scale permit larger companies greater opportunity for growth and cost savings when facing uncertain times.”
The two companies have significant overlap in their PPO networks; both claim five thousand plus hospitals and six hundred thousand plus other providers. It is highly likely the successor organization will pick the best discount deals from either network, giving customers (potentially) larger savings on some bills.
Unsurprisingly, there will be staff reductions; here’s how Viant bosses Dan Thomas and Tom Bartlett put it: “Predictably, as the two companies integrate, downsizing will occur over time where redundant resources and costs are most apparent. We are confident that as this process evolves, the new company will endeavor to retain the most talented and professional employees from both organizations in order to emerge with visibly greater expertise and productivity.
There is no doubt Viant’s team is viewed very favorably by MultiPlan and it is committed to ensuring we achieve this objective.”
So, what does this mean?
Large, broad-based, national PPOs have been faltering of late, as their ability to extract discounts from providers, especially hospitals, has diminished. Over the last few years we’ve seen the PPO market consolidate, with Beech bought by Concentra, First Health take over CCN, Coventry acquiring Concentra and First Health, and Aetna’s purchase of PPOM.
Expect this to continue, but it’s a losing game. PPOs are a cost containment solution that has fallen out of favor. While there will always be a place for them (think out of area coverage, work comp, companies with widely spread workers) they will continue to lose share to more tightly managed networks, vertically integrated systems, and Blues plans.


Aug
7

Health reform – just the facts

(Some) Opponents of health reform have abandoned all pretext of honesty, and instead have embarked on a campaign of fear, intimidation, and outright lies in an effort to halt Congressional action.
That’s not to say advocates of reform haven’t stretched the truth from time to time, but to date opponents’ behavior is by far the more egregious. If you sense a tone of anger here, you’re perceptive. These people are scum.
Exhibit One – The Death-ers
Last week, Betsy McCaughey said on Fred Thompson’s show that the House health care bill contained a provision requiring counseling sessions for seniors on how “to do what’s in society’s best interest … and cut your life short.” House Minority Leader John Boehner (R OH) also said the same provision “may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.”
In reality, the provision in question simply requires Medicare pay for voluntary counseling sessions to help seniors plan for end-of-life medical care, including designating a health care proxy, hospice options, and advice on deciding on life-sustaining treatment.
Boehner and McCaughey’s characterization is fear mongering at its worst. And puts them in league with blowhard Rush Limbaugh, who recently claimed Correspondent Helen Thomas would be “soon to be put out to pasture at Statist Farm…first time she gets sick it will be judged not worth it…”
It’s also patently stupid – why would the Democrats seek to kill off a demographic that favors them?
Exhibit Two – The disrupters
God forbid opponents of reform actually let Congressfolk hear their constituents’ opinions on this critical issue. No, they want to shout their Representatives and Senators down, intimidate them, and threaten those who disagree with physical violence.
News flash to the disrupters who are so blindly willing to be manipulated by the health insurance and medical device industries – this is a democracy, and the majority rules. You aren’t the majority, you lost, get over it. Now you know how the other side felt for the last eight years, yet they didn’t find it necessary to engage in brown-shirt tactics to vent their spleen.
Exhibit Three – Congress’ plan to Canadian-ize our health system
False false false. Canada has a single payer system – which is not under serious consideration here in the US. There is no single payer option in any bill under review, and single payer has been specifically rejected by the President, Secretary Sibelius, the Senate Finance Committee, and most of the House. Committed liberals aren’t happy with this, either.
Exhibit Four – The Canadian system almost killed me
Shona Holmes contends that she had to cross the border to get a brain tumor removed because the Canadian system would have forced her to wait over a year, and she would have died.
Highly unlikely. According to FactCheck; “CBC News (the Canadian Broadcasting Centre) aired a story July 31 quoting a top neurosurgeon in Canada saying that the claim that she would have died is “an exaggeration.” Holmes was diagnosed with Rathke’s cleft cyst, a rare, benign cyst that forms near the pituitary gland. It’s not known to be fatal. [emphasis added] Another neurosurgeon told CBC News that he’d never heard of someone dying from the condition.”
Yet the anti-reform forces persist in publicizing this nonsense.
When you confront these liars about the inaccuracy of these statements, they respond with allegations about the Democrats’ secret agenda to move everyone to single payer, ration care with waiting lines, and cover illegal immigrants (again, why would a politician provide services to folks who can’t vote?).
Ohhhh, here’s why…
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Aug
7

Health plans and health reform – not so simple…

The stock prices of health insurers wax and wane with the likelihood of health reform becoming reality – although in inverse. The announcement last month that the outlook for most of the major health insurers had been downgraded to (or remained) negative might be seen as an indication that reform is likely, or perhaps it is more a result of the conservative nature of rating agency Fitch.
Fitch’s analysis makes sense – if a public plan option is passed that includes the ability to force providers to accept Medicare or similar rates, then it will murder the private insurers. But that is just not going to happen. There is zero chance of any reform measure passing that includes a public plan reimbursing at Medicare – or any rates close to Medicare.
The ratings company’s assertion that reform that includes guaranteed issue without mandated universal coverage and/or pricing flexibility and/or underwriting is a bad idea has been convincingly demonstrated in Massachusetts.
That doesn’t mean the industry has substantial risk. But that risk is more resulting from the current economy than the potential problems from health reform. This was confirmed by Mark Farrah & Associates’ report that the top eight plans lost more than four hundred thousand commercial members in the most recent quarter. If anything, the employment picture is a lot more significant for health plans than the much less likely chance of public plans and other ‘maybe’ events. According to Farrah;
“WellPoint and UnitedHealth, the two largest plans in the United States, saw total enrollment declines of 490,000 and 465,000 respectively. The economy and maintaining strict pricing and underwriting discipline were cited as reasons for the declines.”
What Fitch is not adequately considering is the very real opportunity for health plans. The smart ones (a limited population to be sure) will see this as a big chance to gain millions of members. The even smarter ones will quickly move to slash their admin expenses by eliminating underwriting, refining marketing, and investing heavily in population health.
I’d note that Fitch now has awarded all plans the coveted ‘negative’ status; I believe this is misguided, as there are clearly several that are better positioned to take advantage of reform (if it happens). I’d include Aetna in that group; they actually gained 1.4 million members in Q1 2009.


Aug
6

Jaan’s Health Wonk Review is the go-to source

Jaan Sidorov is hosting this biweek’s edition of HWR; there are more than a few new bloggers featured, along with some old vets. But the great thing about Jaan’s edition is it covers the entire spectrum of reform – and a few other topics highly relevant to today’s debate.
And the guy can write…prose AND poetry.


Aug
6

The Administration’s drug deal – implications for work comp

Today’s NYTimes confirms that the deal struck by big PHRMA and the Administration over drug costs is set in stone; the White House confirmed that they will not go back to drug companies and ask for concessions beyond the $80 billion already promised. House Speaker Nancy Pelosi (D CA) has said Congress is not bound by the deal, but it appears that pharma is safe.
I’ll leave the sticky policy implications for a later post, but for now consider what this means for workers comp.
Recall that the current law of the land prevents negotiations by the Secretary of HHS with drug companies over price. This significantly limits the Feds’ ability to reduce costs, and is somewhat unique as most other of the G20 countries do negotiate directly with drug companies – either for prices directly or via a reference or index price scheme.
With yesterday’s ‘announcement’, the concern that work comp PBMs and payers (should have) had over the potential for a massive cost shift to comp appears allayed. There was significant concern that had the Feds forced the pharmaceutical industry to cut prices (via price negotiations, reference/index pricing, or a mandated Medicare rebate) manufacturers would raise prices charged to other payers – and the softest target out there in most states is the comp industry.
The big PBMs – CVS Caremark, Medco, Express – are all large enough to negotiate attractive deals on their own, and many of the payer-based PBMs would also be able to protect their pricing (or piggyback on deals cut by the big three). Not so for comp PBMs, which traditionally pay higher rates to pharmacies due to the higher handling and transaction costs associated with complying with state regulations and identifying and routing scripts.
What does this mean for you?
This doesn’t mean all is fine in the comp drug world, but it does mean the $2 billion plus industry has dodged a very large bullet.


Aug
5

Comparing health reform plans

The good people at the Kaiser Family Foundation have put together a terrific tool that enables side=by=side comparison of all the major health reform plans – or selected plans – across one or multiple areas.
For example, I looked at the Wyden-Bennett plan compared to the latest Senate Finance version and Rep Tom Price’s (R ) offering, specifically on cost containment, mandate, financing, benefit design.
Once again, W-B looks best – and cheapest too.
You’ll undoubtedly have your own set of criteria, and KFF is keeping this updated to reflect the latest variations and changes. Keep it tabbed if you want to stay on top of the real story.


Aug
5

This is getting ugly – and that’s good

phototrip-gt-black-griff-bi.jpg
Those vultures have nothing on (some of our) health care lobbyists and their funders.
After returning to ‘civilization’ from a couple weeks in the Tanzanian bush, it is interesting to see how much progress we’ve made in the health reform debate – or, as the Obama administration has taken to calling it, the ‘health insurance reform’ debate. As a measure of just how much progress has been made, some opponents have called out the big guns of misinformation and outright lies, employed at the ‘grass roots’ by people who, whether they know it or not, are working against their own best interests.
There have been many reports of town hall meetings disrupted by what appears to be carefully organized groups, using an approach scripted by a Washington lobbying firm headed by none other than former Texas Republican Rep. Dick Armey.
Armey’s clients include insurers and medical device companies, firms that are terrified of the potential that health reform may actually harm their business models. The disrupt and obstruct model was actually tested here in Connecticut in a town hall meeting held by Fairfield County’s Jim Himes (D). Read the memo at the link to see just how disgusting these people are.
What’s interesting is reform as currently described in the House bill would have the opposite effect – it would create a huge new constituency, a new market of folks previously without insurance who would suddenly have access to coverage – and the care that that coverage buys. Care that would include stents and drugs and MRIs and surgical implants and pain meds and therapy and tests and operations – creating revenue for Armey’s clients.
Now I don’t for a minute believe Armey’s clients are dumb. Therefore they must be concerned – very concerned – that reform will actually hurt them financially.
That’s really good news. The implication is clear – the health care industry fears that Congress will pass and the President will sign legislation that will actually control costs – reducing the overuse of drugs, technology, and treatments and impacting insurer admin expense. That certainly hasn’t been apparent from the House bill, or for that matter the bills that have gotten the most attention in the Senate.
I don’t know if they know something I don’t, or if they’re just running (very) scared, but I’m hoping their concerns are well-founded and we’ll see a serious health reform bill that does attack cost.
I’d suggest anyone who wants a dispassionate, objective, factual review of the debate make it a point to visit Politifact,


Jul
29

The Affordability Model is gaining traction

Health reform news reaches far and wide, even into the middle of the Serengeti, where I learned today that the NYTimes published a piece by David Leonhardt commenting on a variation of Bob Laszewski’s Affordability Model.
It’s more and more apparent that the train wreck scenario is coming to pass. And increasingly clear that some form of taxation is going to be required for health reform to happen.