Health Business Blog

Health care business consultant and policy expert David E. Williams share his views

John McCain and health care: conventional conservative views with a couple of interesting twists

Senator McCain, we will miss you

I mourn with the nation on the loss of Senator John McCain, an American patriot and public servant. Plenty of retrospectives are appearing on McCain just now; naturally I’ll focus mine on healthcare.

Back in 2008 I profiled the major candidates on healthcare policy, comparing Obama to McCain and calling out my favorite on each main area. In three posts, I examined the candidates’ positions on individual and employer mandates, expansion of public programspremium subsidies and tax law changes.

McCain never really made healthcare a centerpiece of his campaign, and I don’t think he was especially passionate about it. The policies he put forward were fairly mainstream GOP ideas of the day –modest in scope and likely to be modest in impact as well. He opposed an individual or employer mandate to purchase health insurance, and took no position on the expansion or cutback of government healthcare programs like Medicare and Medicaid. He was in favor of allowing veterans to use their VA benefits in the name of obtaining convenient, high quality care outside the VA system.

McCain proposed modest tax credits, and even some extra boost for people with pre-existing conditions. The math never added up on these and the impact would not have been great.

John McCain’s most radical proposal is one I generally agree with: eliminating the tax deductibility of employer-sponsored health insurance. McCain would have taxed these benefits as income, which they are. If implemented as proposed, this provision could have driven down the availability of employer sponsored health insurance without replacing it with anything; that would not have been a great outcome. More likely, a compromise version would have passed, essentially placing a cap on deductibility without scaring employers away from offering coverage.

This policy is not so dissimilar from the so-called Cadillac tax in the Affordable Care Act, which is hated by just about everyone. Nonetheless it’s good policy because it puts the brakes on insurance costs and encourages employees to value their benefits rather than take them for granted.

Looking back on these posts a decade later, it’s also interesting to see how pragmatic Obama’s proposals were. For example, Obama focused his attention on universal coverage for children, encouraging businesses to offer health insurance to their employees. He also called for creation of a public plan modeled on the Federal Employee Health Benefits Plan, to help individuals that couldn’t find good plans elsewhere.

Rest in peace, Senator McCain.

By healthcare business consultant David E. Williams, president of Health Business Group.

Off your walker? Foray’s founder Dr. Kavanagh takes a new approach to an old need (podcast)

What’s worse than needing help with gait, mobility and balance? Being told you need a walker. No wonder, when the typical walker basically screams “frail elderly,” and is difficult to use as well.

Neurologist Patricia Kavanagh was struggling to get her patients with Parkinson’s and other movement disorders to use a walker.  So she teamed up with a design and production team to found Foray and create the Spring, a modern device that is more functional and stylish.

In this podcast interview we discuss:

  • (0:13) Dr. Kavanagh’s clinical practice and the types of patients she treats
  • (1:19) Key challenges she faces working with patients with movement disorders
  • (3:24) Problems with current assistive devices like canes and walkers
  • (6:11)  Whether walkers are unique in their poor design
  • (7:26) The story behind the birth of Foray and the development of the Spring
  • (8:42) The target audience
  • (12:04) Price point for the new device
  • (12:50) The thinking behind the branding of Spring and Foray
  • (13:31) Potential line extensions
  • (15:20) Impact of burden of chronic disease on mobility and exercise tolerance

By healthcare business consultant David E. Williams, president of Health Business Group.

The state of healthcare interoperability. Podcast with eHealth Collaborative CEO Micky Tripathi

MAeHC CEO, Micky Tripathi

Massachusetts eHealth Collaborative CEO Micky Tripathi has been leading the charge on electronic health records and interoperability for more than 15 years, pre-dating HITECH, meaningful use and the Affordable Care Act. In this podcast, we caught up on the state of play, including :

  • (0:13) How e-health looks today compared with what was envisioned originally
  • (3:01) How interoperability has evolved
  • (11:23) What’s wrong with TEFCA and why he calls it a “regulatory” wet blanket
  • (25:12) The Argonaut Project

As usual, Micky is informative and unafraid to take a stand.


By healthcare business consultant David E. Williams, president of Health Business Group.

Optum buys the former Fallon Clinic. I’m quoted in the Worcester Telegram

Optum is a big, successful subsidiary of United HealthCare. In recent years it’s taken to buying up provider organizations including physician practices. Optum is pouring $250 million into the acquisition and expansion of Reliant  Medical Group in Worcester, outbidding traditional providers and injecting new competitive juice into the market.

Reliant –formerly Fallon Clinic– has 2600 employees and is almost 90 years old. Here’s what I told the  Worcester Telegram:

“A lot of these systems are under strain,” said David E. Williams, president of the Health Business Group, a Boston-based consulting firm. “I think what you’re seeing at the same time is there are some national organizations, health plans and companies like Optum that do have a lot of capital and that have diversified businesses that are looking for growth opportunities.”


By healthcare business consultant David E. Williams, president of Health Business Group.