Brian Klepper is hosting the New Year’s edition of Health Wonk Review, and has a lot of new contributors to start out 2009. There’s a wealth of information and insight on reform, costs, regulation and care management – all timely and pertinent. Head on over.

From the sprawling city of sun and sin (LA, not LV), comes today’s edition of Health Wonk Review. Kind of retro, which we Health 0.1 types can relate to!

This two week-post-election edition of the Cavalcade of Risk combines a bit of prognostication about the directional impact of the political winds, a lot about the economy and impact thereof, and a few posts that manage to be both topical and intriguing-ly random.
upfront disclaimer – somehow I managed to offer to host CoR in the middle of the annual workers comp conference – an incredibly poor decision on my part as this is a rather busy time for your author. That’s my excuse for the brevity of this edition. But, hey, it’s a quick read!
First, here’s Julie Ferguson’s contribution – warning, it addresses the burning question – what to do if you own a bar and the bartender’s nude?
We’ll begin with health-related submissions, and no better way to kick off the CoR (and over the ant hill) than with Bob Laszewski’s post on the failure of the free market in health insurance. Bob’s oservation is straight forward – since HillaryCare went up in flames, the free market had fifteen years to prove itself. It failed miserably. No excuses and no whining.
What’s next? Louise takes Bob’s logic another step with her contribution, wherein she makes the case for allowing individuals to ‘buy in’ to Medicare.
Maggie and Niko of Health Beat follow up with a discussion of the possibility of a dramatic restructuring of physician compensation – shifting more dollars to primary care and away from specialists.
Nancy Germond from D&B (corporate bloggers are coming!) contributes her views on the likely implications of a Blue Washington.
I have a somewhat different perspective; my take is there will indeed be health reform, although it will not be in a single massive bill.
Economist Jason Shafrin reveals one of the many obstacles to meaningful health reform – patient pressure as docs who actually use decision support systems find that patients feel, well, that this makes them less ‘physicianly’.
Khan contributes a post on an issue of concern to those of us with older progeny; Health Insurance Options for Students.
Long-time contributor and pharma expert David Williams is of the opinion that big pharma may be preparing to shoot itself in the foot. Alvaro Fernandez continues our brief sojourn into the world of pharma – his post details the new sleep therapy – and it isn’t a pill.
Henry Stern, LUTCF, CBC informs us about what happens when politicians go too far in expanding programs – and it isn’t anything good.
In the non-health-related world, LAL believes the next meltdown will be in auto debt, pointing out that the average car loan is about $25k..
A very well done review of the current liquidity crisis and how it impacts the financial environment is up at VoxEU. The
http://www.workerscompinsider.com/archives/000963.html
Onto the property and casualty insurance world…
Eric Turkewitz has done a masterful job researching a key liability issue, personal injury due to President Bush’s Dog Biting a White House Reporter (Can Bush Be Sued?).
Jon Coppelman somehow draws a link between frozen embryos and workers comp. Really.
Workers Compensation expert James Moore reports on some interesting developments in West Virginia’s Workers Comp program, and a state-run but commercially insured risk pool for problem industries.

Louise has put a lot of effort into this week’s edition of HWR, and it shows. Really shows.
Her thoughtful analysis of each post makes for a cohesive, coherent whole – definitely greater than the sum of the parts.

David Harlow at HealthBlawg has posted his techno-rich version of HWR. I’m jealous of his technical prowess, and want to know how he gets Dorothy’s shoes to click…

Editor’s note – this is perhaps the most serious, thought-provoking edition of HWR I’ve had the honor of hosting. There’s a lot of meat here, so don’t expect to multi-task your way through.
These are momentous times. Not only will we be electing a new President, a third of the Senate, and all of Congress in less than three weeks, we’re also facing the biggest economic crisis in modern times. The combination of these two events looks like it will result in a much broader and deeper role for the Federal government in private industry.
Who would have thought taxpayers would be subsidizing loans to automakers, buying up bank stocks, guaranteeing interbank lending, and bailing out huge insurance companies? (If that ‘who’ is you, I would have appreciated a heads’-up before by portfolio cratered…)
The unthinkable is now the inevitable. I can also sense a subtle but nonetheless significant shift in the health policy world, as politicians and pundits absorb the implications of Federal intervention in the capital markets and begin to consider other areas of market failure – such as health care.
The financial crisis and government’s attempt to solve it are driving the health policy discussion in two distinct directions – one argues that there will be no money for reform, thus any reform will be incremental, while the other argues that the financial meltdown is precisely the time to fix health care and access to care.
For anyone thinking that health care is not that big a deal, Bob Vineyard of InsureBlog‘s post $85,000,000,000,000 and Counting . . .is a big bucket of icy cold reality in the form of the looming $85 Trillion (yes, that’s with a “T”) unfunded Medicare liability.
Okay, now that we have your attention, here’s what the best and brightest are thinking.
Lets frame the conversation with a post from the always-thoughtful Maggie Mahar on the question ‘Is health care an “individual right” or a “moral responsibility” that a civilized society understands that its citizens deserve? Maggie prefers the “moral responsibility” frame; in her view we should look at healthcare collectively, individuals should not have to “demand” health care as a “right”.
Maggie isn’t the only blogging wonk thinking about the right v responsibility question. From a health care perspective, the second McCain-Obama debate was interesting for all of about five minutes. But in that short period of time, Tom Brokaw raised an issue that goes to the very heart of the debate: Is health care a right or a responsibility? It drew this post from Merrill Goozner at GoozNews.
Len Nichols of the New America Foundation also weighs in on the debate. Len gleaned a few nuggets from the brief discussion of health care at HEALTH POLITICS: Truthful–and Helpful–Moments in Presidential Debate
The two men who will have a lot to say about what actually happens are named Obama and McCain. Next up is Health Affairs Blog, where several posts wrestle with the differences between the presidential candidates’ health reform plans. Harvard economist David Cutler and Obama advisor calls the McCain plan “out of touch”, while AEI economist Tom Miller and unpaid McCain advisor defends McCain’s plan.
Over on the Huffington Post, MIchael Millenson doesn’t like the McCain reform plan one bit. In his view, McCain’s plan is radical and reckless.
Bill Scher at the Campaign for America’s Future is one wonk pushing hard for major change. He’s no fan of incrementalism (and gently takes me to task for my advocacy of same), calling for us to stop worrying abut short term budget issues and focus on bigger issues.
(Ed. note – yes, most posts appear to favor Obama/take McCain to task. I had to search on my own to find (instead of relying on folks to submit their posts) for those supporting McCain’s positions. After twenty minutes I gave up. If anyone has any solid, well researched posts send them on and I’ll issue an update to this post.)
My take? We can do a lot to help people get coverage, with no impact on the Federal budget or taxes. If the Feds force insurers to stop denying coverage for pre-existing conditions, outlaw medical underwriting, and require community rating and a basic benefits plan, a big part of the problem would be solved. Note several commenters disagree…
Bob Laszewski is having none of this. His post on the disconnect between political reality and wishful thinking is firmly in the ‘lets get real folks health reform is a non-starter’. As a long time industry vet, astute observer of the realities of Washington, and pragmatist of the highest order, Bob’s views merit careful consideration – especially if you disagree…
Those who actually work on the front lines – selling health insurance and servicing their customers, have a reality-based perspective that is vitally important. Louise at Colorado Health Insurance believes “In order for health care reform to work, it has to work for everyone. We need a solution that spreads the cost of health care evenly across the entire population (adjusted for income, just as taxes are) and doesn’t leave large groups (like people with pre-existing conditions) to fend for themselves with no good health insurance options available.”
Continuing our virtual trip out west, Anthony Wright takes issue with those who believe reform must be either state OR federal in his postAn unspoken, untrue consensus….
Andrew’s colleague Beth Capell takes it to those who claim mandated employer coverage is a Job Killer ; and she’s got some good research to back up her assertions that it isn’t.
Christopher Weaver discusses how the media is writing about health care in the election coverage. Weaver’s observes coverage from the national media is scarce and spotty, while local media does a much better job of translating policy into what it means for real folks.
That’s it for policy. But policy is not the only thing on the minds of HWR contributors. Roy Poses MD’s post digs into the accusations that Pfizer Suppressed and Manipulated Clinical Studies of Neurontin. Roy found a rather awkward quote from a Pfizer exec, to wit: “we are not interested in having this paper published at all because it is negative.”
Brain Blogger reports on the latest recommendations on residency hours, with Are Doctors Super Human?.
From the work comp side of the world, Tom Lynch Of Workers’ Comp Insider offers a tried-and-true primer on managing workers comp costs and getting injured employees back to work in Eight steps to controlling workers comp.
Jon Coppelman takes another peek under the covers of the AIG debacle – hint, it’s nothing to examine on a full stomach.
David Williams did an email interview with Mark Bard of Manhattan Research re: the Revolution Health/Waterfront Media merger; David asks some tough questions about how media companies are evolving their web strategies.
David Harlow (no relation to David Williams, at least none I’m aware of) knows a lot about certification of hospitals – a rather arcane but increasingly important issue. David reports on CMS’ decision to allow DNV to break the stranglehold on acute care hospital certication deeming held for decades by the organization formerly known as JCAHO. ( passing a JCAHO survey means that a hospital is “deemed” to be in compliance with Medicare Conditions of Participation (aka Medicare certified) and can forego a government survey; up till now JCAHO has been the only game in town.)
From an attorney to an economist, our next post from Jason Shafrin addresses the issue of medical licensing, specifically whether it improves or harms the quality of medical care
Daniel Goldberg’s contribution provides much-needed perspective on one main component of health reform – the claims for and potential benefits of ‘prevention’. It may not be all its cracked up to be.
Jaan Sidorov digs into CMS’ medical home initiative, providing some much needed insight into what could be a major change in the way Medicare handles some aspects of primary care. This is a BIG DEAL.
We conclude this edition with a post from north of the border. Sam Solomon presents Coalition urges doctors to reject Ontario pay deal, saying, “An argument over a new contract for Ontario physicians is spiraling towards a civil war inside the doctors’ union. Among the issues: disagreement about the extent to which the current economic climate — and government’s projected budgetary struggles — should affect negotiations.”
I’m shot, and you probably are as well. That’s OK, because you now have two weeks to rest up for the next edition of health wonk review.

to read health wonk review are here.
Jason’s given us a quick synopsis of the best of the wonks sorted by topic.

Colleague Jaan Sidorov is hosting today’s edition of Health Wonk Review. Jaan’s writing is terrific, as is the content – objective, too!

Friend and colleague Hank Stern’s latest edition of Health Wonk Review is up, fresh and ready for viewing.
Thanks Hank!

I’m honored to once again Hank Stern’s Cavalcade of Risk, a kinda sorta departure from the usual stuff I do with MCM. [One caveat – I tried to use the auto-poster app, and the weird spacing results resulted from that effort. After slogging thru it for many (well, a few at least) minutes, I gave up – apologies for the spacing]
Today we’ll begin with Silicon Valley Blogger’s reminder that with a few rare exceptions, the house always wins. In this case the ‘house’ is the stock market, and SVB reminds us to ditch emotion and focus on reality (good luck with that!) at
The Stock Teacher contributes a post on the risks – financial and emotional, inherent in investing in high-flying stocks (something few of us can relate to, I’m sure) at Ouch- CROX Just Taught Me A Lesson.
Jim asks a question we all should consider when buying or renewing insurance – what’s my appetite for risk? Jim’s is higher than some.
Joe Manausa‘s perspective on the Fannie and Freddie bail out bill is very local – HR 3221 is Good For Tallahassee.
Sticking with the real estate theme for a moment, one of my new favorite blogs is penned (typed sounds so déclassé’) by
Jason Voiovich. His contribution for this ed. of CoR is Reverse mortgage: Hero or villain?, an excellent and thorough review of the pros and cons for consumers and mortgage brokers.
FMF has a quick update on the state of medical tourism – net is there’s a lot more going on these days, including acceptance of medical tourism in some Blue Cross and Aetna plans; read More Insurance Firms Allow Medical Tourism
I was looking forward to reading Nancy Germond’s take on management in her post entitled . I was not disappointed. My only addition is that most of us (your author included) exhibit jerk-y behavior from time to time, so please don’t tar all with the same damning brush!
Raymond contributed multiple posts, including a thoughtful and well-researched piece on federal deposit insurance -something any IndyMac saver wished they’d read thoroughly a few months before that bank cratered. Click thru to
Is My FDIC Insured Checking Or Savings Account Safe If My Bank Fails? to see what would happen to you if your bank followed suit.
As host, I get to pick who’s here and who stays on the sidelines – a difficult task, but a necessary one if we are to retain your interest – and one principle is to avoid multiple posts from the same contributor. I also get to break my own rules, and Jim’s post on car rental insurance is well written and brief and educational – which covers the requirements in my book. Before you head out on that trip, read Credit Card Rental Car Insurance is Secondary Coverage!?
Our august founder and resident sage, Henry Stern shows his age (and lack of memory loss) Car 54, Where Are You (and how’s your insurance)?, an entertaining look at the possible use of vehicle gps tracking devices by insurance companies. Big brother, indeed – but at a lower premium…
It will come as no surprise that the leading cause of death among public safety employees was heart attacks and vehicular accidents. What did surprise me – a lot – was the death rate among volunteer firefighters. That’s the report from Workers’ Comp Insider, the go-to source for the latest in the WC world.
Jason Shafrin is one of the better health care economists. His contribution is a synopsis of Health Affairs’ article on the Chinese health care system – a fast and educational take which includes this nugget the top social concern in China is “high medical expenses.”
On to my little corner of the world – IN-surance (that’s how southerners pronounce it). Colleague Richard Eskow notes the recent demise of FL Gov. Charlie Crist’s effort to cover more Floridians was doomed to fail from the outset.
Louise from the great state of Colorado chimes in with an interesting take on mandated universal coverage, Colorado State University style. Seems grad students are forced to buy into the CSU plan unless they can prove they have the same-or-better coverage.
From the east coast, David Williams finds that some docs in Massachusetts want to try to force drug stores to not provide medical care, by “barring health care providers from selling tobacco products”. David notes this is a slippery slope; I’d add that it reminds me of the old artisan guild strategies, as well as some of the more distateful aspects of union featherbedding…
Lastly comes this contribution from your author, a dissection of the reasons folks go without health insurance.
And with that, we’re outta here!