Killer viruses, computers that see all, and the undead public option. (Or, as Jon Stewart said last night –“It’s alive!“) Welcome to the haunted edition of the Health Wonk Review — the floating digest of posts from the health policy blogosphere. This week, we put the death back into death panels.
The health care system is an out-of-control beast, promising to heal us while sucking more and more out of our pockets. The shadowy Blob of the drug, device and insurance industries threatens to absorb a larger share of the GNP each year. (So do hospitals and some docs, but they have always worn their halos and angel costumes.) One time, a mob of angry Medicare recipients chased down a Congressman like a scene from Night of the Living Dead. But, the situation has become even more frightening. Until recently, people didn’t come to town meetings with guns to yell at at their reps and senators like crazed Jack Nicholson at the end of The Shining. There were no pictures of either Clinton with a Hitler mustache. And, who knows what other secrets lie behind closed White House doors beside deals with drug makers.
In honor of Halloween, BHN offers a costume theme. Add your own. Or go to the end and add a comment with your nominee for the scariest ever doctor, nurse, lawmaker, lobbyist or other healthcare player — real or imagined. I vote for the twin gynecologists, both played by Jeremy Irons, in the movie “Dead Ringers.” They made their own medical instruments.
Cancer Screening: Two-Face from Batman
Here at Boston Health News, we thought it was huge that The American Cancer Society finally admitted that cancer screening has been oversold. The push for screening is seen as model of a successful health campaign. So successful that people don’t want to believe that, in many cases, the value of early detection is a myth.
Dr. Anthony Horan’s article on the Health Care Blog Putting Profit before Patient ” contends that the current method of using PSA blood tests to screen for prostate cancer often causes more harm than good.
Then, there are some screening tests that work — like the pap smears and colonoscopies. But, most people don’t get colonscopies when they need them, says National Committee for Quality Assurance (NCQA) president Margaret E. O’Kane. She blogs on the agency’s “The State of Health Care Quality 2009″ report. The report includes good news -almost all of the 30 million Americans living with asthma are getting care. But, there are problems too. Only 42.5 percent of people are receiving colon cancer screening at the appropriate age. O’Kane recommends that Congress create insurance exchanges, tie payment systems to performance and standardize measures for public reporting.
H1N1: Virus shedding monster
Despite new movement on health reform, the arrival of H1N1 and the shortage of vaccines is generating a lot of news. On the Disease Management Care Blog, Jaan Sidorov “points out that it may not be the fault of the Obama Administration’s but it is certainly responsible for the H1N1 vaccine shortages. This may have implications on how the Government will handle the rest of the nation’s health and could give another opening to opponents of health care reform.”
The Public option: Devil or Superhero
Here we get silly.
Healthcare Technology News reports on a bit of harmonization in “Guerilla Music at the AHIP Conference.”
“On Friday October 23, America’s Health Insurance Plans (AHIP) met in the aftermath of a tumultuous month in which the health insurance companies’ lobbying operation released a study it commissioned which, according to the White House is “an attempt to confuse the debate around health reform…Just when the insurance industry must feel that it couldn’t get any worse, attendees at the AHIP conference were subjected to this guerilla music by “Public Option Annie.”
Health policy poet Madeleine Begun Kane offers this limerick urging the president to play a stronger role in bringing about the public option. (Too bad Obama vacationed in Martha’s Vineyard and not Nantucket.)
Public option’s at stake — tock, tick, tock.
Please step up to the plate, Dear Barack.
Though the sidelines were cool
For a while, you’re a fool
If you fail to ensure it’s a lock.”
Participatory medicine: Pirates
Jane Sarasohn-Kahn at Health Populi reports on The Center for Connected Health and “the launch of the new Journal of Participatory Medicine. We can’t bend the cost curve without engaging people in their own health care.”
The Health Blawg’s David Harlow also attended the Connected Health Symposium offering this: “Given the crushing cost of hospital-based health care services, the current and growing primary care physician shortage, and the expectation of high-quality health care services accessible to all, the Center for Connected Health is letting us all know that the road to the future is the information superhighway, paved with intelligent payment reforms — but that the nodes in the network will always be human beings.
Medicare: Uncle Fester
The AMA argues that Medicare doesn’t pay doctors enough. The AMA threatens that, unless Congress passes a bill called “The Medicare Physicians Fairness Act ” physicians will be forced to stop seeing Medicare patients, who are already worried about the stability of the program.”
Really, don’t they say that every time Congress tries to limit increases in Medicare Part B? Joe Paduda at Managed Care Matters give a quick history of the program to control Medicare Part B costs that this bill would override and worries “Where are we going to come up with a quarter trillion dollars?”
Quality of Care: Angel v. Dr. Sawbones
Mike King at Healthy Debate writes about how malpractice insurers recent years reduced the premiums they charge physicians. Some “at least scaled back annual premium increases that were common before reform. But there is no evidence to show that has led to a corresponding reduction in physician charges to patients.”
HIT : Frankenstien (Lots of pieces. Can we put them together and make them work?)
David Williams at the Health Business blog says telemedicine has the potential to dramatically increase the level of competition among health care providers, resulting in reduced costs.
The e-CareManagement blog suggests Senator Chuck Grassley probe more deeply into electronic medical records and patient safety.: “You’re on Track about EMR Problems, But Here Are Some More Questions to Ask”
Health 2.0 and the Big Bang, from 10/13 ehrbloggers.com : A review of the recent Health 2.0 conference in San Francisco “warns that conference organizers risk being seen as “all things to all people” if they don’t define what they want the term, “Health 2.0″ to stand for…and such a move, while financially lucrative in the short term (for the organizers), risks diluting any potential impact they wish to have on national policy…a mistake similar to the one made in the early 1990s by leaders (including myself) of the TQM movement.”
The Healthcare IT Guy— aka Shahid N. Shah – gets a little acronymy on us. But ,we are self described wonks so here it is: “All healthcare organizations need to be aware of a problem that’s probably bigger than the Year 2000 (Y2k) migration – the ICD10 and HIPAA 5010 migration. A huge fiscal burden has been placed on payers and providers as they look to redesign business processes and systems to handle hundreds of thousands of new codes at an estimated cost of more than $14 billion
Insurance: Dr. Jekyll and Mr. Hyde
Roy Poses at HC Renewal wonders why we see nothing in health services research and medical literature about a potential solution to high health costs –“a repeal of a law around since 1945 that insulated health insurance from government anti-trust regulation, appear in the media. As far as I can tell, the possibly causal role of this law, and whether it needed repeal never has been discussed in the above literature, a striking illustration of the anechoic effect (i.e., certain topics in health care rarely are discussed because doing so may offend powerful interests).
The Health Access Blog analyzes objections to “employer responsibility” section of Senate Finance Committee. A section of the bill would require employers who don’t offer coverage to potentially pay $1,000s per employee. The fee applies to those who work at least 30 hours a week who receive subsidies to purchase coverage in a health insurance exchange. The fear — all the low-wage workers will get their hours cut to 29 a week. More here.
The Health Affairs Blog reports on as paper entitled: Are Higher-Value Care Models Replicable? A Boeing Company pilot “shows that enhancing care via a ‘medical home’ designed explicitly for patients with severe chronic disease can improve quality of care and reduce per capita spending in well-led physician organizations without a long history of national clinical distinction.”
From Worker Comp Insider: Attorneys General in three states have put FedEx on alert for “widespread, long-term, and unlawful employment practices.” Jon Coppelman of Workers Comp Insider “looks at these new challenges to the company’s practice of classifying its drivers as independent contractors rather than employees, which leaves the drivers out in the cold when it comes to the safety net of workers comp coverage for work-related injuries – not to mention the protections of other basic labor laws.”
Obama Healthcare 2009 suggests that “Unions are supportive of the House health care reform bill , even though as a practical matter the bills discriminate against union workers.”
Food : The Headless Horseman
Of Carrot Cake and Oreos : The New America Foundation’s Joanne Kenen spent an afternoon with Dr. David Kessler, “talking about carrot cake, Oreos , policy, parenting and why the American diet is the biggest public health care challenge of our times. ”
Financing — Banker from Monopoly or Hobo
Drug Channels.net offers an analysis of the CBO review of Baucus bill and its implications for Pharmacy Benefit Managers (PBMs) and pharmacies: “Retail pharmacies would benefit from increased prescription volume but will likely see gross margins drop as the uninsured get the advantage of third-party bargaining power,” says Adam J. Fein, Ph.D.
Free-market supporter and health policy grad student John J. Leppard says Obama’s approach is flawed and should be dumped. On his Healthcare Manumission blog, he asks: “With all the talk about reforming health care going on, I’m a little surprised that no one is actually talking about health care reform.”
Uninsured: Circus performer, no net
College students who want to take a break from school to cope with a serious illness get more bad news when they file their claims. Many insurers won’t cover dependents over 18 unless they are in school full time.
Henry Stern of InsureBlog comments on Michelle’s Law, which aims to change that. “A college student has to choose between life-saving treatment and losing her insurance to pay for it. InsureBlog reports on a new law forbidding carriers from dropping students in this frightening position.”
Finally to bring to all back home to the land of Lizzie Borden and the Salem witch trials, the Health Reform Galaxy Blog tells us: The secrets of Massachusetts’ success (including bigger carrots and smaller sticks)
Thanks to my East Cambridge neighbors for allowing me to showcase their annual haunted house.