Health Wonk Review #4
Welcome to the fourth installment of the Health Wonk Review, a biweekly compendium of the best of the health policy blogs. Letâ€™s jump right in and see what the wonkers have been up to while no one was looking.
A risk management consultant once explained to me how to make money in insurance: 1) avoid insuring people who are bad risks, 2) exclude from coverage anything that is likely to happen, 3) donâ€™t renew customers if they make a claim, and 4) offload your risks onto another party. Blue Cross of California may have been listening to the same guy, because according to Matthew Holt at The Health Care Blog, the company has been accused of having a â€œretrospective review departmentâ€ that looks for any old excuse to cancel a policy that results in large claims. As Matthew writes, â€œthis kind of story pours lots of flame on the single payer fire. The odds that there will be no insurance industry in 10 years time just got shorter.â€
Speaking of single payer, Hank Stern of InsureBlog points out the evils of the UKâ€™s National Health Service from the perspective of an MS patient. Fair enough. But I give them a little more credit. Unlike the US, the UK has decided it canâ€™t afford everything and is trying to make the hard choices on a rational basis. What Iâ€™d like to know is how would the NHS or Canadian system perform with US-level spending, and whether itâ€™s possible for a single payer system to garner support for what we in the States would consider full funding?
Kate Steadman uses her Healthy Policy blog to weigh in with support for basic health plans and a universal mandate in California. Sounds a lot like what weâ€™re about to put in place here in Massachusetts. An open question is whether mandated coverage will expand access or just drive up provider revenues.
Over!My!Med!Body! wants us to know that health care in this country is a big ripoff. If we lived in Switzerland, the next biggest per capita spender on health care, we could enjoy better health and have an extra $900 per person per year for vacation. Sounds tempting.
Hereâ€™s a little secret for you from Hospital Impact. The big push for transparency in hospital pricing isnâ€™t actually going to make much of a difference. Click here to read the four reasons why not. Hey, arenâ€™t health plans in a better position to tangle with hospitals on pricing anyway?
Think you got a bum deal at the hospital? Wait till you read Michael Millensonâ€™s account on The Health Care Blog of the â€œbare bottomâ€ colonoscopy administered to a Mr. McClellan (havenâ€™t I heard that name somewhere before?) who apparently didnâ€™t read the Hospital Impact post.
It comes as no surprise to Hippocrates that patients care more about the way their doctor acts toward them than about medical competence. After all, itâ€™s easier to evaluate demeanor than technical skills and everyone likes to be treated as a human. Iâ€™d like to see more emphasis placed on quality evaluation â€“especially of specialistsâ€”so we can de-emphasize the touchy feely stuff.
Jared Rhoads of The Lucidicus Project raises a valid point that we donâ€™t hear often enough: Does it really make sense for the federal government to play a driving role in the health care IT world? But this Econ major (me) was a little confused when the author presented a critique of the infant industries argument (traditionally used to support protectionism in developing countries) to bolster his point. Did I miss something?
The Salesman in Chief has been out shilling for the Medicare Drug Benefit, telling senior citizens itâ€™s a good deal for them. But turns out theyâ€™re not buying the pitch. Joe Paduda of Managed Care Matters explains whatâ€™s going on.
Roy Poses of Health Care Renewal has identified and catalogued a new species of conflict of interest. With all the attention given to conflicts caused by pharmaceutical and device company gift practices, few have focused on the equal or greater conflicts that arise from board membership. My view is that conflicts are inevitable. Companies need board members that are relevant to them; people who are involved in their world. Pharma and device companies need to market their wares. Iâ€™d like to see more education â€“especially of physiciansâ€”about how marketing and other forms of commercial influence work. Posts like Royâ€™s raise awareness, and thatâ€™s a good thing.
Beth at Health Care Musings examines the case for and against Ambulatory Surgery Centers and concludes the customer service advantages donâ€™t necessarily outweigh the downsides. Although sheâ€™s a new blogger, Beth has already realized itâ€™s ok to disagree with Professor Herzlinger.
Practice of medicine
I gave unlicensed midwives and home birthing a good kick yesterday on the Health business blog. Tell me if you think I was too harsh.
Rita Schwab of MSSPNexus Blog wants us to write better job ads. In a tight labor market, that is sound advice. As she says, the usual â€œcompetitive pay and benefitsâ€ really means, â€œWe have dull jobs and donâ€™t pay much worse than most anybody else.â€
This last postâ€™s author, Trapier from Hayek, MD described it as â€œsome rather ridiculous libertarian theorizing andâ€¦ a few respectable points about individual liberty and freedom.â€ The first part is accurate; I leave it to you to judge the second.