Friend and colleague Maggie Mahar is back at it today, hosting this week’s edition of Health Wonk Review, the best of the blogosphere.  This ed is a quick read, with plenty of depth for folks looking for insights into cost savings, Medicare’s future, and the ills of Federal prosectors.

 

 

 

Health Affairs hosts this fortnight’s edition of Health Wonk Review, and does it with their usual  thorough style.  Host Chris Fleming’s put together the best o’ the blogs on health care costs and drivers thereof; presents an alternative view of the nursing “shortage” (hint:  there won’t be one); and digs into Louise’ discussion of the merits of charging smokers more for health insurance.

All the best of the blogging world, brought to you each bi-week by your buds at HWR!

the ho ho holiday edition of Health Wonk Review is ho-sted (I know, that’s reeeeeeeeaaalllly lame) by Julie Ferguson at WorkCompInsider.  If you want to see what a post SHOULD look like, click here!

Elections have consequences.  I don’t often quote Karl “Turd Blossom” Rove, but it certainly seems apropos now, three days after an historic election.  There are a plethora of interesting story lines surrounding the election and the hows, whys, and whos thereof.  We’ll keep our focus on those related to health policy, the impact on reform, and let the experts opine.

First out of the blocks is Bob Laszewski with his post listing some of the major health policy issues facing the President and Congress. Included among the challenges is addressing the fiscal cliff – I’m not as optimistic about our “leaders'” ability to get that fixed anytime soon.

Health Affairs’ contribution comes from Tim Jost, “Election 2012: A Win For Health Reform, But Much Work Remains” gets a bit more specific; “November 6 was a good night for health care reform, and for the millions of Americans who will benefit from it, but a great deal of work needs to be done before reform becomes a reality.  It is time for the administration to roll up its sleeves and get to work,” Tim says. He describes the areas where  important guidance and rules are promptly necessary to implement the Affordable Care Act, and he also points out continuing threats to the ACA such as challenges to the preventive services contraception mandate and premium tax credits on the federal exchanges, as well as the looming deficit reduction negotiations. We’ve less than 14 months till this thing fully kicks in, and time’s awasting.

The estimable Maggie Mahar explores the demographics of the vote in “The Nation is Divided, Not between Whites and Minorities, but between the Past and the Future. “ She sees this as a victory by the future population over the past. Maggie’s take is that “Women, minorities, and young people re-elected President Obama…This is not to say that, going forward white men will not also be in positions of power.”

Anthony Wright at Health Access blog is pretty darned excited about the result, and its implications for the nation’s largest (in population) state.  “A Great Night for California and for Health.” Anthony isn’t too giddy to remind us “this isn’t the end of the campaign, but the beginning of ACA implementation and the fiscal fight over Medicaid and Medicare.? 

Louise is one of our “battleground state” contributors and sends us via Colorado Health Insider a post responding to another’s recommendation that one can be “self-insured” if you’re careful enough.  Louise thinks not, saying “To be fair, I agree wholeheartedly with the tips he gives for “making health insurance a bad bet“.  Things like eating well, exercising, avoiding excess alcohol, not smoking, driving safely, managing stress, safe sex, not sharing needles, etc. are all great ideas.  They’re all things that our family does every day.  I’ve been told I’m a health nut, and I don’t shy away from the accusation.  I make green smoothies (kale and veggies and fruit all blended up – drink up!), exercise nearly every day and refuse to drive if I’ve had even a single glass of wine.  I fully plan on living to be a hundred.  But I would never ever go without health insurance for myself or my family.”

Fortunately, Obamacare (remember when that was a pejorative term?) includes wellness and prevention benefits; new contributor Chuck Smith at informthepatient.com has several posts lauding the benefits of pre-illness care.

John Goodman of the National Center for Policy Analysis contributes “Socialism Kills”, on the impact of “economic freedom” on population mortality. Actually, the research isn’t about socialism per se; rather John cites the libertarian Fraser and Cato Institutes as the source for underlying research on how “economic freedom” contributes to longevity.  I haven’t read the two studies, but I’m curious if those two august organizations factored in the impact of potentially confounding factors, such as the many wars in Africa, rapid rise in starvation in several countries, an deaths from disease.  Also wondering how the headline could possibly be true in the face of data indicating longevity in most European countries exceeds that in the good ol’ US.  In fact, as the only industrialized nation without universal health insurance, we rank behind every EU country in life expectancy – including Greece, Malta, Cyprus (my birthplace) – and even lower than Chile…

I take a different approach, looking at the implications of Obamacare for workers comp – and surprise some by opining that overall, it’s good news indeed.

There are a few folks out there looking at things other than reform and the election – thank goodness!

InsureBlog’s Bob Vineyard reports that more docs are beginning to shun insurance in favor of cash, and explains why.

Dr Roy Poses continues his tireless pursuit of profiteers, this time going after the cozy relationships existing in the medical-publishing industry.

In Marketers’ Systemic Influence over Ostensibly Scholarly, Peer-Reviewed Publications: the Medtronic Infuse BMP-2 Example, Roy informs us:

A US Senate committee report detailed yet another example of how marketers working for industry (in this case, for Medtronic, a biotech/ medical device company) sought to systematically but covertly influence the ostensibly scholarly medical literature and the public discussion to sell more of their product…Those who advocate the evidence-based medicine approach, as I do, must not be naive about the extent that the evidence-base has been deliberately corrupted.  We need stronger measures to protect the integrity of clinical science.

Hospital Quality Reporting in Italy is the subject of Jason Shafrin’s post, wherein he discusses P.Re.Val.E Italy’s hospital quality initiative. Pretty comprehensive approach…

A change in Medicare policy will have a significant impact on post acute care (and home services). Brad Flansbaum digs into the details of a recent settlement between CMS and the Center for Medicare Advocacy.

The American Academy of Family Physicians is pushing back on nurse practitioners’ role in primary care. David Williams explains why they aren’t doing the same to specialists. Evidently the family practice docs are OK if specialists act as generalists, but oh no, not those nurses (disclosure, my daughter is a nurse..)

We wrap up this edition with a state-based discussion of workers comp reform; Tom Lynch of Workers’ Comp Insider offers “A Modest Proposal for New York” for fixing what’s wrong with the state’s workers’ comp system.

Finally, apologies as this, the post-election edition of Health Wonk Review is out a bit later than usual this week as I was in Las Vegas for the National Workers Comp Conference.  Fortunately, my fellow bloggers were able to keep up their writing to keep you, dear reader, fully abreast of the issues and implications thereof.

The Wing of Zock’s Jennifer Salopek is this week’s host for Health Wonk Review; she’s pretty excited over the Nationals’ first playoff appearance in eighty – that’s right, 80 – years.

An excellent edition to be sure!

That’s the theme of Louise’s edition of Health Wonk Review – she has a terrific lineup and calls them like she sees them – with all the attention on health care after the recent conventions, the post provides an excellent review of the parties’ competing positions.
it is refreshing to read real journalism again!

Julie Ferguson’s taking no time off – her edition of health wonk review covers all that’s happening in what’s turning out to be a very, very busy summer in the health policy world.

The blogosphere’s view of the Supreme Court decision is nuanced, insightful, and often surprising. Following up on our late Thursday night report on initial reactions to the decision, this is a quick tour of “the best of” posts over the weekend.
We start off with views on the Supreme’s ruling that the Feds can’t cut off all Medicaid funding to states that don’t increase Medicaid coverage. Anthony Wright trenchantly observes:
“For the first three years, the federal government would pick up the cost of 100% of the newly eligible. In 2017-18, then the federal government picks up 95% of the tab, and then down to 90%, into the future. Even in the out years, the federal government is providing a 9:1 match.
In terms of investments in health care, or in terms of economic stimulus, there’s no place that can get you the bang-for-your-buck of a 9:1 match. Why would any Governor or Legislature reject this?
Over a dozen years ago, Congress created the SCHIP program, and allowed states to do a child health expansion voluntarily, with no tie to Medicaid funding. The SCHIP program provides a 2:1 match. And ultimately, 50 states took advantage of his benefit.”
Good take; I’d note the political winds have changed pretty dramatically over the last decade, and I would not be surprised to see some conservative govs stand on “principle” and refuse free money even if it gets their poorest citizens health care.
Bob Laszewski notes the 29 governors who’ve expressed outrage/concern/anger over the Feds attempt to require them to expand Medicaid coverage now are in the driver’s seat:
“Whether or not their state gets a Medicaid expansion is now entirely up to them. It’s put up or shut up time for conservative governors and state legislators who said the ACA was an onerous expansion of federal powers over their states.
If some states do reject the Medicaid expansion, consumers between 100% of poverty and 133% of poverty would become eligible for the private federally subsidized insurance in the exchanges since the subsidies start at 100% of poverty.”
Nathan Cortez at Health Reform Watch took the dissenting Justices to task; “What disappoints me about the joint dissent (by Alito, Kennedy, Scalia, and Thomas) is that it doesn’t seem to appreciate why health insurance is a unique problem of unique scale that requires unique solutions like mandates. How do you pretend that the uninsured are pre-commerce? How do you pretend a $2.5 trillion industry doesn’t exist?”
Neil Versel is still surprised about Chief Justice John Roberts’ support of ACA; he also notes that ACA is no panacea, and health care in the US is still, well, in need of improvement. Lots of improvement.
I’ve been reading a history of the New Deal; much of the legal footing for the dramatic expansion of governmental programs was based on the Constitutionally-established ability of the Federal government to tax. One book does not a scholar make, but the precedence is well-established and rock-solid.
I posted Friday about the impact of the decision on workers comp; overall, it is good news indeed – healthier claimants with more coverage = lower work comp costs, although access to primary (and some specialty) providers is going to be tight indeed for several years to come.
Finally, Jaan Sidorov has been tracking goings-on here whilst on vacation in Sweden; he thinks reform is here to stay, and we better get used to it.

Actually, it was.
Faithful readers will note the delay in this biweek’s publication of HWR, a delay that was not an oversight but intentional; like many of you I’ve been waiting breathlessly for news of the Supreme Court’s pending decision on PPACA.
Alas, the distinguished folk in the black robes aren’t cooperating, so I’ll have to proceed without them.
Much as the real world is. For truth be told, the real world is moving rather quickly towards reforming bits and pieces of what passes for a health care system. And herein begins our tale.
We lead with the estimable Maggie Mahar. Maggie believes if the Affordable Care Act’s individual mandate is ruled unconstitutional by the Supreme Court the government will have to take a carrot-and-stick approach to encouraging healthy Americans to buy individual insurance – and it will likely have to focus much more on carrots. The individual mandate isn’t likely to drive much in the way of behavior change as the penalty wasn’t much of a “stick”.
Maggie’s fellows take this a step further, Harold Pollack and Henry J. Aaron explain how a new GOP majority would assault the health reform law, but wouldn’t stop there; Medicaid and Medicare are on the chopping block too.
At HealthAccess.org, Anthony Wright discusses the “evolution” of the GOP; it’s worth pondering the reasons of the amazing switch of Republican leaders on the individual mandate, from originating the idea to disowning it entirely and saying it in unconstitutional. This transformation is first and formost about politics, of course. But it is more than that–it’s that the mandate forces government to take direct and serious action to force insurers to abide by rules that encourage coverage; “showing that governmental action could actually make progress on social issues.”
Horrors!
David Williams, one of the more insightful observers of all things health care related, doesn’t think the GOP is ready or willing to engage in a meaningful discussion of health reform – but it will need to get serious quick if it wants to be taken seriously
The Huffington Post’s Sanjay Sanghoee thinks losing ACA isn’t that big a deal, as it wasn’t going to accomplish much in the first place. If it does get overturned, Sanghoee wants President Obama to push the public option as a much more robust solution that is much more likely to work.
Methinks the New America Foundation’s Justin Jones and Sanjay would have an interesting discussion re the role of the free market; Justin notes that while the Anti-ACA crowd has long vilified the ACA as an unprecedented intrusion of government into the free market, the ACA is actually very market friendly and free-market advocates should consider whether it would really be the end of the world if it is upheld in its entirety.
But the discussion between Justin, Sanjay, and Bob Vineyard of InsureBlog would be even more interesting; Bob thinks we are being “primed for single payer“; Bob says single payer is a “system with a 100% failure rate.”
Love ya, Bob, but I guess it depends on how one defines “failure”; with 50 million uninsured and tens of millions more under-insured, we ain’t exactly a model of success in coverage, or outcomes, or cost!
My contribution this fortnight focuses on the impact of health reform on employment – Massachusetts has been a great laboratory, and the results are instructive.
Roy Poses – who’s been with HWR since its inception seven (!!) years ago draws parallels between Wall Street, the financial debacle, and the inherent issues with conflicts of interest at the highest levels of government and health care.
Roy is joined in his effort to increase understanding of potential conflicts of interest by Alison Hwong, an MD-PhD candidate at Harvard, and Lisa Lehmann, the Director of the Center for Bioethics at Brigham and Women’s Hospital; posting at Health Affairs, Alison and Lisa stress the importance of going beyond simple disclosure of physican-industry financial relationships to help patients understand the context and implications of these relationships.
Neil Versel wants the public to know that they do have a right to access and correct their own health information, though few know about this or do anything about it. Better to do that now than when it’s critical to your life – and perhaps too late.
Among the other hot topics on the minds of bloggers was obesity – childhood and otherwise.
Kat Haselkorn digs into NYC Mayor Mike Bloomberg’s move to shrink the size of sugary beverages – she’s not sure it will succeed, but applauds the politically-sensitive mandate nonetheless.
This isn’t just a NY thing; out West one of our favorite insurance brokers Louise discusses a similar move in Colorado where a new law bans trans fats in “competitive foods” in public schools.
We conclude with thought-provoking posts about things most of us don’t spend enough time thinking about, and Jessie Gruman’s contribution calls for all of us to consider the implications of moving from curative to comfort care whe “Shifting to Palliative Care”.
Julie Ferguson shines a light on an important public health issue: domestic violence in the workplace. Homicide is a leading cause of occupational death in U.S. women, and while work homicides in general are trending down, homicides of women at work are trending up.
Michael Gavin wants workers comp payers to pay attention to the quantity of opioids their claimants are taking, and do something if it gets excessive.
John Goodman opines that failing to make consumers price-sensitive at the point of purchase is one of the biggest problems with health care. No argument there, although it is no panacea – when you’re on the ER table with chest pain you’re not exactly ready to negotiate.
We do know the Supremes’ decision will come down next Monday or Tuesday, and we’ll likely have a special edition of HWR when it does…if Julie says we can.