Health Wonk Review #4

Health Wonk Review #4Welcome to the fourth installment of the Health Wonk Review, a biweekly compendium of the best of the health policy blogs. Let’s jump right in and see what the wonkers have been up to while no one was looking.InsuranceA 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) don’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 “retrospective review department” that looks for any old excuse to cancel a policy that results in large claims. As Matthew writes, “this 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.”Speaking of single payer, Hank Stern of InsureBlog points out the evils of the UK’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 can’t afford everything and is trying to make the hard choices on a rational basis. What I’d like to know is how would the NHS or Canadian system perform with US-level spending, and whether it’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 we’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.ConsumerismHere’s a little secret for you from Hospital Impact. The big push for transparency in hospital pricing isn’t actually going to make much of a difference. Click here to read the four reasons why not. Hey, aren’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 Millenson’s account on The Health Care Blog of the “bare bottom” colonoscopy administered to a Mr. McClellan (haven’t I heard that name somewhere before?) who apparently didn’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, it’s easier to evaluate demeanor than technical skills and everyone likes to be treated as a human. I’d like to see more emphasis placed on quality evaluation –especially of specialists—so we can de-emphasize the touchy feely stuff.Government policyJared Rhoads of The Lucidicus Project raises a valid point that we don’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 it’s a good deal for them. But turns out they’re not buying the pitch. Joe Paduda of Managed Care Matters explains what’s going on.It’s the water stupid! Health Care Economist points out that clean water is the number one health care priority in El Salvador.EthicsRoy 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. I’d like to see more education –especially of physicians—about how marketing and other forms of commercial influence work. Posts like Roy’s raise awareness, and that’s a good thing.Beth at Health Care Musings examines the case for and against Ambulatory Surgery Centers and concludes the customer service advantages don’t necessarily outweigh the downsides. Although she’s a new blogger, Beth has already realized it’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.Marcus Newberry of Fixin’ Healthcare thinks forcing patients to lay out cash for services before seeking reimbursement from their insurer would be a wakeup call. No doubt about that!Kate Steadman of Healthy Policy wrote that defensive medicine was a myth. Kevin, MD and his readers didn’t agree with that.Practical advice 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 “competitive pay and benefits” really means, “We have dull jobs and don’t pay much worse than most anybody else.”Impractical adviceThis last post’s author, Trapier from Hayek, MD described it as “some rather ridiculous libertarian theorizing and… a few respectable points about individual liberty and freedom.” The first part is accurate; I leave it to you to judge the second.

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I hope you’ve enjoyed this edition of the Health Wonk Review. The next host is The Healthcare IT Guy. Visit the Health Wonk Review website if you want to learn more.