Health Wonk Review: A lot to chew on

It’s the golden era for health wonks. Affordable Care Act implementation is proceeding apace while opponents keep up their attempts to maim it, Steven Brill’s article on medical costs in Time has the masses up in arms about topics near and dear to our wonky hearts, my Health Business Blog turned eight, and the giant HIMSS meeting in New Orleans has just closed up.

So it’s fitting that I received so many high quality submissions for today’s Health Wonk Review.


On the Health Affairs Blog, former Surgeon General David Satcher eulogizes former Surgeon General C. Everett Koop, who passed away recently at age 96. He praises Koop for his courageous response to the AIDS epidemic and continuing the fight against tobacco use.

“Given the sexual, racial, and drug-related issues around the transmission of HIV…, he demonstrated unusual courage and fortitude in bringing these topics to the attention of the American people in the face of resistance within both Congress and the White House.  The major resistance to his report on HIV/AIDS stemmed from the need to explicitly discuss how it was transmitted heterosexually and homosexually.”

Steven Brill’s high-profile
Time article on medical costs garnered attention from two bloggers.

In Sight (while admitting a bias in favor of hospitals) contends that Brill’s focus on chargemasters, which represent hospitals’ rack rates for services, is a distraction. Few pay the chargemaster rate and hospitals are not nearly as profitable as Brill claims.

Meanwhile Health Access California notes that California addressed this issue back in 2006 with the Hospital Fair Pricing Act, and that the chargemaster does in fact affect people.

Affordable Care Act, aka ObamaCare partisans continue trying to sway us.

Insure Blog rags on ObamaCare, with a somewhat curious argument that insurers will price the bare bones policies in the exchange high to discourage adverse selection. A commenter makes a reasonable point that adverse selection is much more likely with the richer plans, not the bare bones ones, since high end plans are a better deal for the sick who use a lot of benefits.

Colorado Health Insurance Insider is skeptical about health insurance exchanges, in particular whether a government agency can provide the kinds of customer service that consumers have come to expect from commercial health plans, insurance agents and financial institutions.

Managed Care Matters addresses criticisms of ObamaCare re: cost control, expense of the program, socialism, injection of the government into doctor/patient relationships. Conclusion:

“It is a lot better than what we had before. Which, for those with short memories, was a completely out-of-control health system with declining numbers of insureds and rapidly rising costs.” interviews Medicare Payment Advisory Commission (MedPac) vice-chair Michael Chernew, who discusses most of the ObamaCare issues described above.

A couple of our bloggers favor giving providers more control of packaging and pricing.

Diners wouldn’t think of telling a restaurant manager how to package and price his menu offerings, and so  John Goodman’s Health Policy Blog suggests letting providers package and price their services rather than expecting third-party payers to dictate how it’s done. The post makes its point, but the restaurant analogy is a bit strained. There’s usually no third-party payer in the restaurant, people go voluntarily, and there are many choices.

On the other hand, it reminds me of a story from my first job out of college. A colleague who had been a starving student for years was enjoying the third-party payer opportunity posed by having our employer pick up the tab for dinner. When at a restaurant he would joyfully scan down the price column of the menu saying “@max, @max, @max” –mimicking the Lotus 1-2-3 function– to find the most expensive item, which he would invariably order and enjoy.

Wright on Health touts one of my favorite ideas: direct health care providers, and this post’s use of the term “menu” is more apt.

“These direct providers are able to combat many concerns through price transparency, easy access and lower costs as they establish what is basically a menu of cash only services. Further, these one-on-one scenarios improve decision-making between patient and physician and take out the need for insurance and proof of citizenship.”

Nearly 35,000 people (me included) were at the Healthcare Information Management Systems Society (HIMSS) conference in New Orleans last week, but I just got one submission.

Healthcare Talent Transformation encourages us to stay patient on cost savings from health IT adoption.

“Technology usually brings with it a falling cost curve. But the reality is, for now, we are still undergoing the transformation stage and the transition is rocky and costly.”

Since this section is surprisingly light I’ll go ahead and toss in my own post on HIMSS: What’s new at HIMMS? Airbnb. Although we may need to wait for IT to bring cost savings to health care, Airbnb has used consumer Internet tools to radically transform the lodging industry. I personally saved hundreds of dollars in New Orleans in one night.

We don’t get enough pharmaceutical related entries these days, so I’m happy to have these two.

Drug Channels chronicles the rapid growth of preferred pharmacy networks for Medicare Part D, and looks into why CMS says it is “concerned” about the trend.

Healthcare Economist investigates whether recent court rulings will hobble FDA’s ability to regulate the off-label promotion of pharmaceuticals.

When bad things happen, our bloggers are there to tell us about it.

Health Care Renewal is not pleased to see for-profit methadone clinics owned by Bain Capital, and says its practices appear to be enabling diversion of drugs to others, some of whom have overdosed.

“I submit that putting patient care into the hands of organizations whose leaders relentlessly seek profits ahead of all else is a bad idea.  True health care reform would ensure that health care is only directly provided by health care professionals and non-profit organizations which are directly responsible to their communities and the public.”

This one’s a little removed from health policy, but since I can’t imagine a Health Wonk Review without a post from Workers’ Comp Insider, I’m sharing this one commemorating the third anniversary of a mine explosion that killed 29 workers and reporting on the latest developments in the investigation.

Ending up with Big Data.

Disease Management Care Blog –in its typical trenchant style– takes a deep dive into the Big Data pool to provide a definition that’s relevant for health care and to offer up a few caveats.


The next edition of the Health Wonk Review will be hosted by Healthcare Economist on March 28.

March 14, 2013

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