a public option open to everyone (allow states to opt out of this if they dare), Medicare-negotiated drug benefits, no 12-year monopoly for new drugs, and a major squeeze on Medicare reimbursements for doctors -- and have CBO score the savings. I guarantee you, the number will be large.

A public option available to everyone -- not just people who lack insurance -- really would stop costs from rising so quickly. Letting Medicare negotiate lower drug prices would also save money, but probably not as much as Reich thinks. "A major squeeze on Medicare reimbursements for doctors" could have terrible consequences if the targets were primarily general practitioners, who are already getting hammered. The target needs to be specialists -- surgeons, neurologists etc. -- and not just on their fees per procedure (see below).

Reducing patent protections for new drugs is a terrible, terrible idea. Dollar, for dollar, pharmaceuticals are among the best medical investments going. Telling the biotech companies they'll

Continue reading "Warning sign: Reich says health bills too costly" »

Posted by Jay Hancock at 6:51 AM | Permalink | Comments (4)
Categories: Health Care
        

Excellent story by NYT's Robert Pear. Statements by more than a dozen members of congress weren't their own but were written wholly or partly by lobbyists for Genentech, the biopharm company owned by Roche. The statements were put in the Congressional Record, the official archive of the proceedings of Congress.

Pear queried Gententech for a response:

Asked about the Congressional statements, a lobbyist close to Genentech said: “This happens all the time. There was nothing nefarious about it.”

Well, he's half right. It probably does happen all the time. Why is it a scandal when a politician plagiarizes an author or another politician in a campaign speech but not when a multinational corporation programs more than a dozen Chatty Cathy lawmakers and pulls the string?

Posted by Jay Hancock at 5:03 PM | Permalink | Comments (3)
Categories: Health Care
        

Faithful reader Mr. Rational weighs in with a model health plan. This is how you might set it up if you were starting from scratch. But we're not. We have powerful interests wedded to the the inequities, inefficiencies, expenses and failures of the system we already have. Mr. R's scheme (he admits it's "quixotic"), if I have interpreted it right, is this:

1) Have people pay out-of-pocket for everyday medical encounters. That would encourage people to shop for good but inexpensive care. It would yield huge savings in bureaucratic costs. There would be no paperwork. 2) Have primary insurance to cover the odd appendectomy, broken-limb treatment and other "normal" emergencies that crop up throughout life. This would revert medical "insurance" to its true meaning -- a capitalized risk pool for non-ordinary expenses. 3) Have re-insurance from the government for catastrophic, bankruptcy-threatening expenses for say, cancer, car-crash recovery or heart surgery. 4) Devote a separate category of coverage for end-of-life treatment. Mr. R. puts it well:

If we are truly honest we can add a fourth category: Terminal care. Stop pretending that anyone gets out alive by refusing to flog and abuse our elderly and other terminal loved ones and still call it medicine. Most terminal care expenses are covered under Medicare (the elderly) but it still warrants its own category because of how it distorts every other cost statistic. It especially distorts when pointless treatments are used because the misguided emotionality and guilt of survivors mistakenly insist on them.

So we would cut bureaucratic costs in a huge way. We would deploy market forces for everyday care, making consumers spend their own money on medicine instead of somebody else's. We would have a safety net to keep people from going bankrupt. And we would have an honest discussion about why Medicare blows 30 percent or so of its dollars in the last six months of life.

Questions/possible objections: What about pharmaceuticals? Are they out of pocket? Wouldn't many people skip preventive care if they had to pay for it themselves, thus inflating aggregate health-care expense? Doesn't most medical spending come under categories 3) and 4), anyway -- so how will this save money? Thoughts?

Posted by Jay Hancock at 10:35 AM | Permalink | Comments (8)
Categories: Health Care
        

Nice to hear at least lip service from key Democrats over the lack of cost controls in the health-reform legislation advanced so far. Good NYT story from Sheryl Gay Stolberg on intra-Democratic tensions over the tradeoff between making sure legislation has cost-cutting teeth but not enough to hack off medical constituencies who so far have backed it. The Emanuel brothers find themselves on opposite sides. Budget czar Peter Orszag is trying to stifle himself. But his "absolutely" below, answering his own question about whether future cost control will be necessary, means "really, truly, totally yes and I completely mean it -- no matter what's in this bill."

“Let’s be honest,” Rahm Emanuel said in a recent interview. “The goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.”

He went on: “I’m sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.”

Mr. Orszag would not be interviewed. But in an e-mail message sent through a spokesman, he said the current legislation “lays the foundation” for cost-cutting over the long-term, adding: “Will more need to be done in the future? Absolutely.”

Posted by Jay Hancock at 8:37 AM | Permalink | Comments (6)
Categories: Health Care
        

Portfolio has a good roundup of business lobbies' reaction to the passage of the health-care bill. It's more of the same stuff: Employers will kick people of existing policies. It doesn't cut costs enough. The mandate will hurt small businesses. Etc.

“The current House legislation fails to bend the health care cost curve and breaks the promise that those who like their current coverage can keep it," Karen Ignagni, CEO of America’s Health Insurance Plans, says in a statement.

It's true that the bill doesn't do much about costs. But as somebody said (Andrew Sullivan? I can't remember) it's the Democrats' job to pass entitlements and it's the Republicans' job to control the costs. Still, not addressing costs is a huge flaw in this bill. Especially since today's Republicans seem to have forgotten all about fiscal conservatism. We can't be sure they'll do the job when they regain power.

Unlike the other biz lobbies, Big Pharma waffles. The bill seems to leave it pretty unscathed.

"This is a three-act play and a good critic doesn’t write a review after the opening scenes," Ken Johnson, senior vice president for Pharmaceutical Research and Manufacturers of America, says in a statement. "We are still hopeful that before the curtain comes down on health care reform, the Senate will seriously consider the impact any final legislation will have on U.S. jobs and innovation."

I'm not sure these are just the opening scenes. Seem like Act III, Scene 2 to me.

Posted by Jay Hancock at 9:00 AM | Permalink | Comments (2)
Categories: Health Care
        

I haven't been following this vote-by-vote, but I was surprised to see Kucinich vote "no" on health reform last night. Obviously he wanted single-payer, but I'm nevertheless taken aback to see him vote with the Republicans. Here's part of his statement on why he voted no.

Clearly, the insurance companies are the problem, not the solution. They are driving up the cost of health care. Because their massive bureaucracy avoids paying bills so effectively, they force hospitals and doctors to hire their own bureaucracy to fight the insurance companies to avoid getting stuck with an unfair share of the bills. The result is that since 1970, the number of physicians has increased by less than 200% while the number of administrators has increased by 3000%. It is no wonder that 31 cents of every health care dollar goes to administrative costs, not toward providing care. Even those with insurance are at risk. The single biggest cause of bankruptcies in the U.S. is health insurance policies that do not cover you when you get sick.

Posted by Jay Hancock at 10:13 AM | Permalink | Comments (11)
Categories: Health Care
        

Paul Krugman issues the clarion call:

For this is the moment of truth. The political environment is as favorable for [health care] reform as it's likely to get. The legislation on the table isn't perfect, but it's as good as anyone could reasonably have expected. History is about to be made – and everyone has to decide which side they're on.

And Frank Kratovil forgot to pick up:

WASHINGTON - If Democratic leaders manage to push a massive health care overhaul through the House of Representatives this weekend, they'll have to do it without one of Maryland's Democratic congressmen.

Freshman Rep. Frank Kratovil, facing one of the toughest re-election fights in the country next year, announced Friday that he opposes the measure. His stance could complicate efforts by Democratic leaders to secure approval of the legislation this weekend.

Posted by Jay Hancock at 12:37 PM | Permalink | Comments (7)
Categories: Health Care
        

Funny how Republicans whose jobs or health coverage are in jeopardy favor health-insurance reform in Washington. I've talked to one such family in recent months. Here's another instance. John Hewko, who was a Bush appointee and had to leave government when the administration changed, faces either being uncovered when his COBRA option runs out or enormous premiums from CareFirst BlueCross Blueshield -- as much as $3,000 a month for his family. CareFirst rejected him for standard coverage, he says, because of two pre-existing conditions -- stiffness in his shoulder and hip "for which I take an occasional Advil," and mild high blood pressure.

I am a Republican who did not vote for President Obama, but I support his health-care initiative because I have just experienced first-hand our system's dysfunctional wrath -- and it isn't pretty.

Like a good Republican, he attacks the Democrats for not including tort reform in their bill. Tort reform needs to be done, but it's really a sideshow to fixing the health insurance system. The billions that would be saved through fixing the malpractice system are substantial but not the main game, as I've written.

At the very most, tort reform would deliver a one-time, 7-percent reduction in medical costs, estimates Gerard Anderson, a professor at the Johns Hopkins Bloomberg School of Public Health. That's how much costs are going up each and every year. The lack of tort reform is not a reason not to pass health-care reform. Hewko doesn't come out and say so, but I bet he agrees.

Posted by Jay Hancock at 9:03 AM | Permalink | Comments (8)
Categories: Health Care
        

Rising Medicaid costs related to federal health-care reform aren't the only medical expenses Maryland taxpayers have to worry about. Maryland provides state retirees with health insurance, and according to new accounting rules it must start funding that liability. The unfunded cost is $14.5 billion, according to the Pew Charitable Trust.

That will require an additional annual appropriation of $600 million -- more than twice what the state is already paying for employee retiree health care, according to Cecilia Januszkiewicz, who was Maryland Secretary of Budget and Management under Gov. Bob Ehrlich. She wrote a piece for the Free State Foundation on the problem and pointed out that the extra money needed for retiree health care just about vacuums up all the money that slot machines will provide. She also notes that the current administration is not talking about this extra headache, which, if accounted for, would make projected budget-gaps even worse than they already seem:

Given the magnitude of the problem, state officials should be educating the public about this significant potential liability. Yet, finding anything regarding the work of either of the commissions on state Web sites is like looking for the keys to Fort Knox.

Posted by Jay Hancock at 8:51 AM | Permalink | Comments (6)
Categories: Health Care
        

Baucus gives an interview to the NYT and says he'll increase subsidies for low-income families. Times says the changes could add $28 billion to the cost over a decade, or $2.8 billion a year. That doesn't sound like enough to make much of a difference. But if the figure can move once, it can move again. In a bill that also requires people to have health coverage, increasing subsidies for people who can't afford it is the right thing to do. Boosting the assistance for lower-income folks by a material amount will raise the cost of a bill whose chief selling point had been its affordability.

Reality intrudes again. If you're going to cover everybody, it will cost a lot of money. Revenue has to be found to pay for this. It's worth doing. But do it with eyes open.

Mr. Baucus said the changes showed that he had heard the criticism of his bill from colleagues, who asserted that many people would be required to buy insurance who could not afford it — even with federal subsidies to help defray the cost of premiums.

“Affordability — that, I think, is the primary concern,” Mr. Baucus said. “We want to make sure that if Americans have to buy insurance, it’s affordable.”

Posted by Jay Hancock at 9:24 PM | Permalink | Comments (3)
Categories: Health Care
        

My colleague Eileen Ambrose and experts from the Johns Hopkins Bloomberg School of Public Health will be livechatting on health care reform at noon on Monday. Post advance questions and check out the chat here.

Posted by Jay Hancock at 4:59 PM | Permalink | Comments (0)
Categories: Health Care
        

The Baucus bill -- ie., the America's Healthy Future Act of 2009 -- is out. This is probably the closest of anything yet offered to what the final, passed legislation that Obama signs will look like. It certainly seems like it has the best chance of all the bills.

As expected it contains no 'public option' plan -- a new government 'Medicare' to compete with private insurers for the under-65 crowd. Instead there are provisions for nonprofit co-ops, whose look and effects are very uncertain. Of course no abortion funding. There is a "Personal Responsibility Requirement" mandating that everybody have coverage by 2013 or pay a fine, which could be up to $3,800 annually, depending on your income. You would have to report whether or not you have health coverage on your tax returns.

The bill would create an Innovation Center within the Centers for Medicare and Medicaid Services, based in Woodlawn, whose mission would be to improve patient care and control cost increases. Among its tasks: "Align nationally recognized, evidence-based guidelines of cancer care with Medicare payment initiatives."

It would improve reimbursement for primary-care docs -- a critical, underappreciated piece. And on malpractice tort reform -- there is nothing except "a Sense of the Senate that health care reform presents an opportunity to address issues related to medical malpractice and medical liability insurance." Here's a copy of the bill, thanks to the WSJ.

Posted by Jay Hancock at 10:52 AM | Permalink | Comments (1)
Categories: Health Care
        

Gus Sentementes writes about telemedicine -- having docs diagnose patients remotely via the Internet and video feeds. It's already happening in Baltimore and, as he notes, is about to go mainstream. About time. Along with education, health care has largely avoided the computer-aided productivity revolution that coursed through the American economy starting in the 1980s and 1990s.

We have computerized inventory controls and supply pipelines at Wal-Mart, but doctors still keep patient records and dispense prescriptions by hand. We have videoconferencing for roof-shingle salesmen and builders but not physicians and patients. We perform the same test thrice on the same patient for the same illness. Hospitals have joined the inventory-control and just-in-time delivery bandwagon. But even hospitals are way behind on getting patient records computerized. Largely because of privacy concerns, hospitals' sophisticated computer systems are great at tracking meds and supplies right up until they reach the customer (patient) -- and then they lose all track.

This has gone largely undiscussed in the debate over health-care reform. Productivity gains -- more results per procedure, per doc, per hospital day -- are one pain-free way to combat runaway health costs. The ultimate productivity gain of course would be clinical -- if we could wave a wand and cure cancer, for example. Barring that, we can still reduce the administrative overhead for the clinical arts we have already mastered. Telemedicine is part of that. Computerized records are a huge part of that. By themselves they won't stop the health-cost monster. But they're part of the solution.

Posted by Jay Hancock at 6:30 AM | Permalink | Comments (9)
Categories: Health Care
        

The invincible generation seem bulletproof from a medical standpoint, as today's Sun reports. But they're hardly invincible financially. We need comprehensive health coverage. The plan offered by Obama and other Democrats should be passed in some form. A health-insurance "mandate" requiring everybody to be covered has to be part of such a plan. But if everybody is required to have health insurance as they now have to have car insurance, the result will be this: The burden imposed by older Americans on younger Americans will immediately become heavier, and that's only the latest of what today's young adults and their successors will have to put up with.

Young people have been supporting old people forever, of course. Before the coming of social insurance in the 20th century, new generations were expected to support their aged parents and grandparents. The old people who started collecting Social Security benefits starting in the 1930s were free-riding on the backs of young generations who were financing the program. Young people have been paying for old-folks' health care via Medicare since the 1960s.

A health-insurance mandate would advance the process. Young people would be required to buy policies for thousands of dollars or pay a penalty of hundreds of dollars. But young people don't get sick much. Their money would be spent on the people who do -- folks in their 50s and early 60s. Add to that the Medicare premiums that every working young person pays to finance expensive care for seniors. Add to that the Social Security premiums they're also paying. Add in the enormous deficits that the nation is incurring to pay for Medicare and Social Security and wars -- debts that young people will inherit when they become older taxpayers. Add to that the fact that, when today's young adults get older and need care, the nation won't be able to afford the kind of health benefits available today, and maybe not the same Social Security benefits, either.

Add all that up and you could conclude that young folks are getting a pretty raw deal. But I don't hear any young people complaining. They're tuned out. The invincibles are also the insouciants.

Posted by Jay Hancock at 6:19 AM | Permalink | Comments (13)
Categories: Health Care
        

Last night Obama mentioned it that shall not be named by liberal Democrats: malpractice liability reform. Malpractice reform is not "a silver bullet," he said, "but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs." He wants to "move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine." Specifically, he referred to Bush administration proposals for "demonstration projects" in a few states to try to contain costs from bad medicine and expensive liability trials.

Presumably he was referring to proposals offered by the Institute of Medicine at the behest of Tommy Thompson, HHS secretary under Bush, to consider no-fault, nonjudicial compensation systems for patients harmed by medical mistakes.

But Mr. President, there already is a demonstration program on malpractice reform, and it has demonstrated some very impressive results. In New Zealand, court cases involving medical malpractrice are virtually nonexistent. Anybody who believes s/he has been injured by a doctor submits a claim to a no-fault insurance panel. The case is decided by medical experts, not a lay jury.

Cases are resolved in weeks or months, not years. There are no junk lawsuits. There are no huge awards to trial lawyers. Without judges, juries, court clerks, trial lawyers' staffs etc., administrative costs for malpractice awards in New Zealand are less than 10 percent, according to a piece three years ago in Health Affairs. In the U.S. they're over 50 percent. And malpractice insurance premiums for docs are less than $1,000 per year, even for obstetricians and neurosurgeons, said the Health Affairs article.

Critics note that patient safety in New Zealand is no better than in other countries. I would reverse this by saying it's no worse, either. Even without the threat of disastrous lawsuits overhanging their daily practice, New Zealand docs seem to be delivering the same standard of care as in other developed nations.

So there you have it. No need for any further demonstrations stateside. Obama is right that malpractice reform isn't a silver bullet. But that's not a reason not to move forward.

Posted by Jay Hancock at 10:21 AM | Permalink | Comments (18)
Categories: Health Care
        

As it often does, The Economist magazine boils things down to their essence. From last week's Lexington column:

We are all going to die. And the demand for interventions that might postpone that day far outstrips the supply. No politician would be caught dead admitting this, of course: most promise that all will receive whatever care is medically necessary. But what does that mean? Should doctors seek to save the largest number of lives, or the largest numbers of years of life? Even in America, resources are finite. No one doubts that $1,000 to save the life of a child is money well spent. But what about $1m to prolong a terminally ill patient's painful life by a week? Also, who should pay?

Love that last part.

Posted by Jay Hancock at 9:30 AM | Permalink | Comments (2)
Categories: Health Care
        

Kelly Brewington's story on the newest study on prostate-cancer tests illustrates some of the dilemmas surrounding health-care reform. The study she writes about points up the problems with the "preventing illness will save money" argument. It also demonstrates the problem with arguing that we're consigning people to "death panels" unless we spend as much as it takes to save every single last life, no matter how expensive it becomes. As Kelly reports:

Because many men are diagnosed with cancer that will not cause symptoms and will not kill them, the screening tests save few lives, the authors conclude.

To be more specific, some studies suggest to save one person's life from prostate cancer, the system has to test 1,000 men and treat about 50 of them through surgery, radiation or both. That's very expensive. Sure, we're saving a few lives. But we're also investing a ton of money that could be spent elsewhere in society, and getting relatively little in return.

Even the current protocols, which suggest men start getting tested for prostate-specific antigen after they turn 40, are controversial. It used to be 50. The study, Brewington writes, has "reignited a long-simmering debate in medical circles on the merits of the blood test." Why perform it, the argument goes, when it triggers so much unneeded treatment -- treatment that sometimes causes harm such as impotence or incontinence?

But if you're the one guy out of 1,000 whose life is saved (and somehow we can magically, retrospectively identify you), you're not buying that argument. "Don't sent me to the death panel!" you'll say. But why stop there? Men as young as 35 sometimes develop prostate cancer, and we don't routinely screen people their age. If we did it would add millions in costs to the system, make preventing a few prostate deaths even more expensive and inefficient and drive the cost of health insurance even higher.

So by decreeing age 40 as the cutoff for routine tests, we're rationing prostate-cancer detection now. Is that the right age? The job for society is to figure a way to deploy medical resources against prostate cancer and a thousand other diseases so that both the costs and the benefits are reasonable. But nobody, Democrat or Republican, wants to admit this.

Posted by Jay Hancock at 6:07 AM | Permalink | Comments (8)
Categories: Health Care
        

Today's column is on the big myths of health care reform -- the conservative myth and the liberal myth. The conservative myth is that malpractice lawsuit reform will do much to restrain soaring costs. The liberal myth is that preventive care will save money for the system as a whole. We need tort reform AND more investment in preventive care. But to pretend that either is the solution to out-of-control costs is disingenuous.

The Washington Post's Charles Krauthammer has joyfully discredited the liberal myth.

However, prevention is not, as so widely advertised, healing on the cheap. It is not the magic bullet for health-care costs.

You will hear some variation of that claim a hundred times in the coming health-care debate. Whenever you do, remember: It's nonsense -- empirically demonstrable and [Congressional Budget Office]-certified.

But the guy keeps yammering on about tort reform as the fix for health-care costs. What he doesn't mention is that tort reform, too, as a significant health-care solution, is also the subject of a negative CBO verdict. Such is the nature of the health-care debate. From my column:

The nonpartisan Congressional Budget Office, as usual the best source for this kind of analysis, says malpractice costs make up only 2 percent of health care spending. "The evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect," the CBO says.

Posted by Jay Hancock at 10:04 AM | Permalink | Comments (6)
Categories: Health Care
        

As Jamie Smith Hopkins reported last week, the Maryland economy continues to perform much better than that of the country as a whole. We seem to be adding a few jobs while other states are still shedding them. Dig below the surface and you see a familiar story: The health care sector continues to pull twice its weight.

This is why the changes being discussed in Washington are so crucial to the Maryland and Baltimore economies. If the country really does get a handle on medical cost control, local growth in the industry will stop or slow.

Below are tables showing the change in total Maryland jobs and the change in health-care and social-assistance jobs compared with the level three months previously. (I prefer the 3-month change because it smooths out ups and downs that can come with monthly figures that, even for the Maryland economy as a whole, are based on less-than optimal samples.)

The figures are seaonally adjusted. As you can see, the overall nonfarm economy added 8,500 jobs between April and July, while the health-care sector added 3,300. The figures below are for three month growth, in thousands. So "8.5" means 8,500 new jobs. The upshot: Health care accounted for nearly 40 percent of total job growth -- even though it makes up less than 20 percent of the economy. And you can see from the lower chart that there were hardly any three-month periods in the last 10 years when Maryland health-care employment didn't increase.

Posted by Jay Hancock at 6:00 AM | Permalink | Comments (0)
Categories: Health Care
        

Jim Surowiecki in the New Yorker notes two well-known psychological wrinkles that make people prone to resist change -- even if it's for their own good.

Most of us, for instance, are prey to the so-called “endowment effect”: the mere fact that you own something leads you to overvalue it. A simple demonstration of this was an experiment in which some students in a class were given coffee mugs emblazoned with their school’s logo and asked how much they would demand to sell them, while others in the class were asked how much they would pay to buy them. Instead of valuing the mugs similarly, the new owners of the mugs demanded more than twice as much as the buyers were willing to pay.

What this suggests about health care is that, if people have insurance, most will value it highly, no matter how flawed the current system.

Compounding the endowment effect is what economists dub the “status quo bias.” Myriad studies have shown that, even if you set ownership aside, most people are inclined to keep things as they are...

As noted in a previous post, the endowment effect in Medicare seems to be especially strong.

Posted by Jay Hancock at 10:35 AM | Permalink | Comments (0)
Categories: Health Care
        

Obama is increasingly hearing that he should cut health care reform into two parts. Let's get fiscal conservatives on board by dealing with out-of-control medical costs now, the advice goes. Worry about expanding coverage to the uninsured later. I think this is a losing tactic, as I'll explain below.

David Ignatius laid out the case in the Washington Post on Saturday.

If liberals really want to show they are serious, they should begin with our existing single-payer behemoths, Medicare and Medicaid... the White House should mandate that, within three years, these programs will shift from the current fee-for-service approach to a system that pays for value -- that is, for delivering low-cost, high-quality care.

Joe Lieberman picked up the theme on CNN yesterday.

I think great changes in our country often have come in steps. The civil rights movement occurred -- changes occurred in steps. Let’s focus now on how to reduce costs. That’s been a central theme of the president.

Problem: The idea of reducing costs -- and that idea alone -- is responsible for huge amounts of the resistance to the Democrats' plan at the town hall meetings and elsewhere. The outcry isn't just from those who object to government expansion and don't think we can afford extending coverage. It's from folks -- mainly seniors -- who have already been let into the government-paid health-care club and are worried that reform will limit the virtual carte blanche they now get under Medicare.

Ross Douthat wrote about this in the NYT last week.

If the Democratic Party’s attempt at health care reform perishes, senior citizens will have done it in, not talk-radio listeners and Glenn Beck acolytes. It’s the skepticism of over-65 Americans that’s dragging support for reform southward. And it’s their opposition to cost-cutting that makes finding the money to pay for it so difficult.

I've heard from these folks myself. The nutty "death panel" talk resonates with them. Many of them talk a good game about the dangers of big government. But at heart what they're worried about is that more health care for the uninsured or cost-control in any form will mean less health care for them. Plain and simple. That sort of "I want mine" sense of entitlement is, as conservatives know, one of the most powerful forces in politics.

Obama doesn't want half a loaf. He wants health cost control AND health coverage expansion. But I'm skeptical that tackling the first part by itself will be any easier politically than going for the whole thing.  

Posted by Jay Hancock at 6:00 AM | Permalink | Comments (6)
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Posted by Jay Hancock at 9:34 AM | Permalink | Comments (1)
Categories: Health Care
        

On Friday at 10 I’ll be live-chatting about health-care reform, Maryland health-insurance prices and whether it’s a good idea to launch a government-run, ‘public-option’ medical plan to compete with existing insurers. Feel free to leave questions in the comments section of this post.

Posted by Jay Hancock at 8:00 AM | Permalink | Comments (4)
Categories: Health Care
        

Ross Douthat, the New York Times' new conservative columnist, says:

In this future, somebody will need to stand for the principle that Medicare can’t pay every bill and bless every procedure. Somebody will need to defend the younger generation’s promise (and its pocketbooks). Somebody will need to say “no” to retirees.

That’s supposed to be the Republicans’ job. They should stick to doing it.

From the Friday Hancock column:

"We don't have unlimited resources to spend on health care," says Dr. Sean Tunis, head of the Center for Medical Technology Policy in Baltimore. "And we're already neglecting other important social needs because there's simply not enough money."

Republicans are supposed to get this. They're supposed to be the party that understands waste, limits, cost/benefit trade-offs and what happens when you let people (patients and doctors) spend somebody else's money (insurance companies' and taxpayers').

These days they sound like their own caricature of a Democrat, pretending that resources are endless, that everybody gets what they want and that measuring efficiency is the same as euthanasia.

Modern health care needs administration, priorities, choices and direction. It needs the best information on what works and what doesn't. Hysteria that blocks such information hurts patients, taxpayers and especially future taxpayers - our poor grandchildren who will get stuck with most of the bill.

Posted by Jay Hancock at 12:18 PM | Permalink | Comments (3)
Categories: Health Care
        

Pulled from comments. A bit of testimony to counter the Republican lies, fear-stoking and hysteria over health-care reform proposals.

I'm British and living in the UK but work with a USA based company and have an American wife. I'm sick of ill informed Americans latching on to a few bad experiences and skewed comments regarding healthcare in the UK.

A friend of mine died a couple of months ago but had been fighting cancer for several years. Her ongoing treatment by the NHS prolonged her life in the face of a terrible prognosis and her treatment would have bankrupted even an insured American with a good health plan. Healthcare in the USA is bloated and corrupt and the NHS in the UK is a nightmare of overspends and excess administration.

No system is perfect but far more of my friends and family have been ruined by the system in the USA than our 'socialised' system - whatever the hell that is supposed to mean. For the record, even routine treatment is very quickly referred to a specialist if required and the NHS is vastly improved and unrecognisable from the way it operated a few years ago.

Posted by Jay Hancock at 8:30 AM | Permalink | Comments (3)
Categories: Health Care
        

Impressive job by Rick Perlstein in the Washington Post of showing how the crazy "death panel" talk and other far-right ire are of a piece with paranoia we've been hearing since after World War II. The only difference was that the nuts who thought that Eisenhower was a traitor or that fluoridated water was a communist plot didn't have Fox News to give them a megaphone.

In the early 1950s, Republicans referred to the presidencies of Franklin Roosevelt and Harry Truman as "20 years of treason" and accused the men who led the fight against fascism of deliberately surrendering the free world to communism. Mainline Protestants published a new translation of the Bible in the 1950s that properly rendered the Greek as connoting a more ambiguous theological status for the Virgin Mary; right-wingers attributed that to, yes, the hand of Soviet agents. And Vice President Richard Nixon claimed that the new Republicans arriving in the White House "found in the files a blueprint for socializing America."

When John F. Kennedy entered the White House, his proposals to anchor America's nuclear defense in intercontinental ballistic missiles -- instead of long-range bombers -- and form closer ties with Eastern Bloc outliers such as Yugoslavia were taken as evidence that the young president was secretly disarming the United States. Thousands of delegates from 90 cities packed a National Indignation Convention in Dallas, a 1961 version of today's tea parties; a keynote speaker turned to the master of ceremonies after his introduction and remarked as the audience roared: "Tom Anderson here has turned moderate! All he wants to do is impeach [Supreme Court Chief Justice Earl] Warren. I'm for hanging him!"

Before the "black helicopters" of the 1990s, there were right-wingers claiming access to secret documents from the 1920s proving that the entire concept of a "civil rights movement" had been hatched in the Soviet Union; when the landmark 1964 Civil Rights Act was introduced, one frequently read in the South that it would "enslave" whites.

Posted by Jay Hancock at 6:10 AM | Permalink | Comments (5)
Categories: Health Care
        

"Town hall meetings" have always been a bit of a charade. Politicians rub sleeves with/pretend to listen to constituents and then go back to to Capitol Hill and vote the way lobbyists or the party leadership or -- sometimes! -- their consciences tell them. But now the tables have been turned. There may have been people in the audience at Towson University last night with genuine, reasoned concerns about health-care legislation, but it's hard to tell from the news coverage. "Obama Lies, Seniors Die"?? Ellen Sauerbrey, matriarch of Maryland Republicans, wearing a homemade "Euthanasia" button? The charade last night was in the audience, not at the lectern.

I thought we were talking about a plan to offer widespread medical coverage the way other developed nations do. These folks' health is threatened a lot more by their own bile and high blood pressure than anything going on in Washington.

UPDATE: Here is a sensible observation from RavensFan59. I suspect s/he is right. Pulled from comments:

" Canada, South America, or anywhere in Europe, you would be treated immediately either for free or for a nominal sum. The U.S. is the only industrialized nation on Earth where you have to pay out of pocket for health care."

The citizens of those nations pay for it in the form of higher taxes. Conservatives aren't the only ones lying about health reform. Obama and every Legislator who says that this reform won't cause significant tax increases down the road for all Americans in lying as well. At the end of the day someone has to pay.

Posted by Jay Hancock at 10:33 AM | Permalink | Comments (8)
Categories: Health Care
        

From Brad DeLong: (The topic is health care and health-care reform.)

The governor of California is incompetent at budgeting, but these words of his are well worth listening to:

This exercise is extremely effective for your lats[issimi dorsi] and your upper back. Stand with your feet on either side of an open door and grasp the doorknobs with both hands. Slowly sink away from the door so that your back jackknifes and your arms extend fully and lock. Now pull yourself back up to the starting position. Let your arms, not your legs, complete the motion. I will count out thirty repetitions. Beginners should do 10, intermediates 20, and advanced the full amount. LET'S DO IT! 1... 2... 3... 4, AND STRETCH YOUR BACK!... 5... 6... 7, DON'T USE YOUR LEGS!... 8... 9... 10... 11... 12... 13... 14... 15... 16, JUST USE YOUR ARMS!... 17... 18... 19... 20... 1... 2... 3, CONCENTRATE ON YOUR BACK!!... 4... 5... 6... 7, THREE MORE!... 8... 9, AND NOT LAST ONE!... 30... WE'RE DOING FIVE MORE!!... 31, 32... HA! HA!... 33, 34, 35. Next we have in our program a wonderful leg exercise, the lunges. This exercise develops the front part of your thighs...

Posted by Jay Hancock at 9:00 AM | Permalink | Comments (0)
Categories: Health Care
        

House negotiations that would advance health-care legislation today retained the "public plan" that would compete with private insurers and would also enable state health cooperatives as another option -- something Maryland policymakers would certainly be very interested in. They also softened the mandate for small biz.

From the Associated Press:

The deal calls for exempting more small businesses from a requirement to offer coverage, trimming subsidies to help people buy health insurance, and making any government-sponsored insurance plan negotiate payment rates with medical providers — instead of dictating them.

—Exempting businesses with payrolls of $500,000 or below from a requirement to provide insurance to employees or pay a penalty. The existing bill had set the level at $250,000.

—Payment rates to doctors and other medical providers would be negotiated with the secretary of Health and Human Services, instead of tied to Medicare rates as the bill now says. The Blue Dogs contend that change will lead to fairer payment rates.

—In addition to the public plan, states will have the option of setting up health care co-ops. Details on that were still being worked out.

Posted by Jay Hancock at 3:33 PM | Permalink | Comments (0)
Categories: Health Care
        

Brad DeLong says:

The Blue Dogs have been bought and paid for. They do not want a fiscally-responsible bill. They want to please their masters from the health insurance industry by trying their best to keep there from being a bill at all.

Paul Krugman says:

... even as they complain about the plan’s cost, the Blue Dogs are making demands that would greatly increase that cost.

There has been a lot of publicity about Blue Dog opposition to the public option, and rightly so: a plan without a public option to hold down insurance premiums would cost taxpayers more than a plan with such an option.

The Blue Dogs also oppose the surtax on high-income folks to finance health-coverage expansion. Krugman doesn't mention that. The Blue Dogs should make a deal: Accept the public option while getting Democratic colleagues/the White House to scrap the surtax and replace it with an alternative means of financing -- say, ending the deductibility of health-insurance costs.

Posted by Jay Hancock at 12:01 PM | Permalink | Comments (13)
Categories: Health Care
        

Friday's column, on Thursday:

Prediction: Obama's proposal will end up as some kind of law by the end of the year, but not by the August delivery date he seems to want.

It will be better than a summer rush job. But no, it won't eliminate wasteful care. It won't extend coverage to everybody. It will increase the budget deficit. That said, it has a fighting chance of improving on the status quo, which suggests just how bad the status quo is.

Posted by Jay Hancock at 1:58 PM | Permalink | Comments (2)
Categories: Health Care
        

Virginia Postrel and Megan McArdle furnish the proper response to the National Kidney Foundation's argument that allowing people to sell their kidneys would "cheapen the gift" of those who donate and might be "an affront" to donors. Actually, the only affront to donors is suggesting that they would be affronted if regulated, paid kidney markets were allowed to save thousands of lives.

Sez Virginia:

The argument that paying organ donors is 'an affront' to unpaid donors is disgusting. Are unpaid donors giving organs to save lives or just to make themselves feel morally superior?

Sez Megan:

Having volunteered for Habitat Humanity several times in college, I am personally offended by the existence of Toll Brothers. Also, I've worked in a soup kitchen, so I'm suing Friendly's for defamation. As for hotels, as the former employee of an organization that provides homeless shelters, I can only say: have you no shame, sirs? At long last, have you no shame?

Posted by Jay Hancock at 10:34 AM | Permalink | Comments (0)
Categories: Health Care
        

David M. Walker, former comptroller general and CEO of the Peter G. Peterson Foundation, in the NY Daily News: Rein In Insane Health Costs.

For example, we need some level of universal coverage. But what level of coverage is actually affordable and sustainable? Few are bluntly asking the question about where to draw the line.

We need comparative effectiveness research - comparing treatments, costs and outcomes to maximize efficiency. But beyond that, shouldn't we also improve standards across the board for medical practices by designing and implementing a set of national evidence-based practice standards that will enhance quality, reduce health care costs and dramatically bring down malpractice litigation risks?

Meanwhile, less popular - but more immediate - proposals to reduce health care costs and reform our existing outdated programs and policies need to happen without delay.

Posted by Jay Hancock at 12:20 PM | Permalink | Comments (4)
Categories: Health Care
        

From This Is Why You're Fat. HT Carla.

Posted by Jay Hancock at 10:15 AM | Permalink | Comments (2)
Categories: Health Care
        

Alec MacGillis asks the crucial question in today's Washington Post:

The bills being written would put new emphasis on evaluating treatments according to their "comparative effectiveness," or weighing the risks and benefits of different types of treatment for the same illness, but the bills stop short of incorporating cost-benefit analyses into the findings or of requiring that providers abide by conclusions.

Lawmakers are also considering ways to reform Medicare payments to emphasize the overall quality of care over the quantity of treatments. But lawmakers are not going as far as Massachusetts did; it is considering shifting entirely from a fee-for-service model to one where salaried physicians would be paid an overall annual price for covering a given person or family.

Posted by Jay Hancock at 10:04 AM | Permalink | Comments (5)
Categories: Health Care
        

The always-astute Megan McArdle offers the best explanation I've heard.

I find it hard to believe that none of the liberal commentators breathlessly celebrating Wal-Mart's "capitulation" on national health care have even entertained the most parsimonious explanation: that Wal-Mart is in favor of this because it raises the barriers to entry in the retail market, and hammers Wal-Mart's competition. Yet somehow, this appears nowhere in any of the analysis.

Posted by Jay Hancock at 8:33 AM | Permalink | Comments (1)
Categories: Health Care
        

Robert Reich has a nice summary of what's at stake in the D.C. fiscal debates:

Don't be confused by these alarms from the Social Security and Medicare trustees. Social Security is a tiny problem. Medicare is a terrible one, but the problem is not really Medicare; it's quickly rising health-care costs. Look more closely and the real problem isn't even health-care costs; it's a system that pushes up costs by rewarding inefficiency, causing unbelievable waste, pushing over-medication, providing inadequate prevention, over-using emergency rooms because many uninsured people can't afford regular doctor checkups, and spending billions on advertising and marketing seeking to enroll healthy people and avoid sick ones.

Posted by Jay Hancock at 11:13 AM | Permalink | Comments (6)
Categories: Health Care
        

Saturday's column was on the enormous sums society spends on medical care for seniors who are only months away from death. President Obama raised the subject in an interview with the New York Times over the weekend by mentioning his grandmother, who received a hip transplant last year after she had already been diagnosed with terminal cancer.

Here's reader Larry's idea: Let terminal patients decline additional care in return for payments by the government to their heirs.

If I had 3 months to live and had a choice of :

1. have a hip replacement
2. not have a hip replacement, but have the federal government offer a small percentage of the cost to my heirs

I would choose #2. It would save taxpayers money and give a last small token of love to my
heirs.

Great idea to save $$$$? Or terrible policy that puts a price on life and pressures old people to die? My take is that it would never work because it implicitly falsifies the notion that end-of-life care is necessary at all costs. That notion is at the heart of a very profitable industry.

Posted by Jay Hancock at 10:53 AM | Permalink | Comments (5)
Categories: Health Care
        

There appears to be no evidence of humans contracting swine flu from pigs. But the swine are getting it from us. From the NYT:

The news from Canada changes things. But it has a somewhat unexpected twist: a person appears to have spread the disease to the pigs, and not the other way around. A worker at the farm had traveled to Mexico, fallen ill there and unknowingly brought the disease back to Canada last month. The worker has recovered.

About 10 percent of the 2,200 pigs on the farm got sick. According to the Canadian Food Inspection Agency, all recovered without treatment in five days.

Posted by Jay Hancock at 1:24 PM | Permalink | Comments (0)
Categories: Health Care
        

Medifast, the Owings Mills-based diet food company, reported higher sales and higher profits yesterday. Let's see if they can sustain growth this time. The stock is still way below levels of a few years ago.

OWINGS MILLS, Md., April 29 /PRNewswire-FirstCall/ -- Medifast, Inc. (NYSE: MED - News) announced today first quarter financial results for the period ended March 31, 2009.

First Quarter highlights included:

First quarter revenues increased 34% compared to 2008 to $33.7 million;
Diluted EPS for the quarter increased 70% to $0.17 versus $0.10 year-over-year;
Direct sales segment, Take Shape for Life, increased sales 92% year-over-year for the quarter;
Medifast Weight Control Centers quarterly revenues increased 72%;
Improvement achieved in direct response revenue-to-spend ratio;
Operating margins improve to 11.9% versus 8.2% in the comparable quarter

Posted by Jay Hancock at 11:59 AM | Permalink | Comments (0)
Categories: Health Care
        

Should we pay for expensive medical procedures for people who are really old or terminally ill? In an interview with David Leonhardt, Obama talked about his grandmother, Madelyn Dunham, who had terminal cancer but got a hip replacement anway, presumably paid for by Medicare.

“I don’t know how much that hip replacement cost,” Mr. Obama said in the interview with David Leonhardt of The Times. “I would have paid out of pocket for that hip replacement, just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model is a very difficult question.”

He went on to say: “If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life, that would be pretty upsetting.”

Posted by Jay Hancock at 11:48 AM | Permalink | Comments (4)
Categories: Health Care