Category: Uncategorized

Why I'm voting against marijuana legalization in Massachusetts

published date
October 24th, 2016 by

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I’m not dead set against the eventual legalization of marijuana for recreational use. Still, I’m strongly opposed to Massachusetts ballot question 4: Legalization,  regulation and taxation of marijuana, and will be voting No.

Why? Because the arguments in favor of approval are not strong enough to make Massachusetts one of the first states to legalize. And some of the arguments against the ballot measure raise serious concerns. Instead I’d like to take five years or so to observe  how things go in early-legalization states like Colorado and Oregon and apply the lessons in Massachusetts.

I thought Massachusetts did the right thing by de-criminalizing marijuana. That kept police and the courts from wasting resources on possession of small amounts of marijuana and stopped lives from being ruined through unfair imprisonment and the stigma of  a criminal record.

Voters then went further and approved medical marijuana, which as I expected, became a precursor to the push for full legalization just a couple years later.

The innovative Citizens’ Initiative Review Project summarized the pros and cons of Question 4. The strongest pros were as follows (quoted verbatim):

  • Legalized and regulated marijuana is safer than black market marijuana because the legalized product will be tested and clearly labeled according to state regulations.

  • Question 4 will create a large number of regulatory, law enforcement, legal, and licensure jobs that are supported by taxes on the sale of marijuana.

  • Question 4 would give patients and health providers ready access to marijuana without committing a crime. Legalization could help people avoid opiates, addiction and worse problems. 

The first point is accurate, however there is an implicit assumption that legalization will eliminate the black market. Colorado’s experience indicates that the black market may continue to thrive alongside the regulated, legal market, and that the official market is the province of middle and upper class white people, while the poor and minorities are priced out. So that’s not such a strong argument.

On the second point, it’s weird that one of the strongest arguments for a libertarian-oriented law would be to create large numbers of government jobs. That’s a terrible rationale as far as I’m concerned.

On the third point, there is already ready access to medical marijuana for patients and health care providers, thanks to the legalization of medical marijuana. There are some hints that people may be substituting marijuana for opiates. That’s probably a good thing and we should follow it closely.

The strongest “con” arguments from the Review Project include the views I expressed above about the black market and large number of new government jobs. The cons include two additional, compelling points:

  • Although in development, at this time there is no definitive method of testing for impaired drivers.

  • There is conflicting evidence of an increase in teen use or motor vehicle accidents in states that have legalized recreational use.

Beyond the Review Project’s findings, there are other good arguments against legalization. Marijuana is addictive for some people, it affects the developing brain in negative ways, and “edibles” are too easy for kids to get ahold of and to consume before or during school.

Please join me in rejecting Question 4 in Massachusetts in this election. If you do, I promise to be open minded about reviewing my stance in a few years, once evidence is in from other states.

Image courtesy of Paul at FreeDigitalPhotos.net

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

 

Public option pops up again

published date
September 23rd, 2016 by
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Where do we go from here?

The so-called “public option” is back on the table. According to Politico there’s a “feud” between liberal and moderate Democrats about the wisdom of such an approach. That’s an overstatement, and really it doesn’t even matter if they are fighting about it or not.

Health insurers have a problem, which is that it’s hard for them to prove that they add value. Does all their utilization management, network development, formulary administration and price negotiation improve cost, quality and patient experience enough to justify the extra administrative costs and hassles they impose on the system? It’s an open question, and one that health plans have a hard time answering convincingly.

Since the Affordable Care Act (ACA) passed, health plans haven’t really had to address this fundamental question. With all the new regulations, marketplaces, and mandates, customers and plans have been busy getting themselves into compliance and learning and testing out the new system. No one has really asked the question about whether we need plans or not.

ACA health insurance marketplaces in some parts of the country are seeing less competition than is ideal as some health plans give up. Aetna gave the feds the middle finger by announcing plans to exit exchanges in retaliation for the government’s opposition to the company’s mega merger plans. The exchanges are fixable but opponents in Congress prefer to let them die if possible rather than fix them. However, this passive aggressive approach to the exchanges could ultimately backfire if it means the government sponsors a “public” competitor to give people choice.

For some, opposition to the ACA is ideological. They don’t like federal mandates, or expanding access to birth control, or they just don’t like Obama. But opposition to the public option is more about business considerations than ideology. Apple wouldn’t be worried if the government started making smartphones, but health insurers are worried about whether they can do a better job than Uncle Sam.

And let’s face it, a government option brings us a big step closer to a single payer system under which insurance companies would essentially be out of business.

Health plans don’t have to worry too much today about single payer or even a public option. Even Senate Democrats can’t agree, so it’s unlikely a public option will make it through Congress. But give it another 10 to 15 years and we’ll see.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

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

Health Wonk Review: Back to School Daze

published date
September 8th, 2016 by

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Ah Labor Day! A final blush of summer before jumping back to work and into the school year. Here’s a pretty serious set of posts as you settle back in to the fall routine.

The opioid epidemic

Managed Care Matters tells tales from the front lines of the opioid epidemic. Not pretty. Not pretty at all.

Health Affairs Blog shares insights on the development of a “safe space and medical monitoring to prevent overdose deaths” in Boston. This excellent post describes the observation and treatment facility (which is not a supervised injection facility) and lays out five policy lessons learned to date.

Insurance and the Affordable Care Act?

The Obamacare insurance exchanges are in somewhat rough shape, but as Wright on Health explains, there are some pretty straightforward fixes. Politics (as usual) is likely to get in the way.

If you were somehow under the illusion that Health Care Renewal was a fan of managed care mergers (and for-profit, managed care companies in general) this week’s post should erase any doubt. In fact, it’s a trip down memory lane from the early 1990s formation of Aetna and its merger with US Healthcare to today’s politically motivated withdrawal from the exchanges to retaliate for the government’s opposition to a new mega-merger.

Oh boy. Insurance is about spreading risk, but you have to be pretty darn to big to spread around the expense of a $1 million/month chronically ill patient. That’s what Wellmark is having to do, and InsureBlog says good for them, it’s insurance working the way insurance should.

Ready for the fourth Obamacare open enrollment period, coming up in November? Healthinsurance.org has a guide to what’s new.

Technology and population health

Is that the best we can do?  HealthBlawg does not think health systems deserve credit for leveraging Uber to get people to their appointments. Telemedicine is the way to go, instead.

Population Health Blog, on the other hand, applauds the potential of personalized, tech-enabled approach to diet.

Like HealthBlawg, The Hospital Leader wants to focus on social determinants of health to keep people out of the hospital.

Drugs are pricey

Healthcare Economist describes various value frameworks that can help life sciences companies evaluate and justify the value of innovative approaches.

I made a few new enemies at Health Business Blog with my contention that EpiPen prices may still be too low.

And Health System Ed rounds out the wonkery with a post on drug prices, EHRs, and the Affordable Candidate. Big topics all!

A hopeful finish

Workers Comp Insider shares a firefighter’s miracle: a face transplant after sustaining severe burns.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

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