Health Wonk Review

Health Wonk Review

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Welcome to the Health Wonk Review.  2009 has been an exciting year for health care reform, and last Saturday’s passage of HR3962, the Affordable Health Care for America Act, has given us plenty to talk about.  For anyone who hasn’t kept up on the details of the House reform bill, I want to start things off with a four-part series from Tim Jost, who holds the Robert L Willett Family Professorship of Law at the Washington and Lee University School of Law.  His articles were published at Health Affairs Blog, and amount to an excellent primer, written in plain English, for people who want to understand HR3962, but don’t have time to read all 1990 pages.

First, we have an overview of the bill.  Then there’s an article devoted to the public option and insurance exchange.  Next, you can read about how the reforms will impact delivery systems.  And to round things out, there’s an article that details the last minute changes to the bill (like the Stupak amendment).  A big thanks to Professor Jost for making the reform bill so easy to understand.

Now that we all understand what the House of Representatives has been up to lately, I’d like to highlight a few other posts that I particularly enjoyed this week:

Dr. Glenn Laffel, writing at EHR Bloggers, has a very insightful article about how the public option “compromise” that would allow states to opt out is likely to only muddy the waters and create a fragmented “public option” available to people depending on where they live.

Dr. Roy Poses shares a fascinating account of alleged transplant fraud involving liver transplants, Japanese organized crime bosses, and the UCLA medical center.  Transplant lists are the norm for people awaiting new organs in the US, but apparently – for a price – one can jump to the front of the line.  Well worth reading.

Dr. Brad Flansbaum, writing at the Hospitalist Leader, gives us a gem of an article about how health care reform is portrayed in the media, what people – including lawmakers – really understand about the various reform proposals, and the impact of buzz words on popular perception.  I particularly liked his take on comparative effectiveness research, which some have said would put a “government bureaucrat between you and your doctor.”  Dr. Flansbaum’s response is that the “government bureaucrat” is “likely a health services researcher, and someone [he] would look to for guidance even for [his] own family’s health.”

Jaan Sidorov of the Disease Management Care Blog examines a published medical article that reviews the merits of “decrementally cost effective treatments.”  These are treatment options that involve a tradeoff between significant cost savings and a relatively smaller loss of effectiveness.  When it comes to medical treatment, we (especially here in the US) tend to focus on newer and better all the time.  But our medical innovations are often much more expensive than the treatment they are designed to replace.  And sometimes we can have treatment that is nearly as good, for a fraction of the cost.  Jaan says that our failure to bend the cost curve (terminology that Dr. Flansbaum specifically allows to be included in a worthwhile article) means that we’ll need to examine this closely in the not too distant future.

I decided to include two articles from Brad Wright, the voice behind Wright On Health Care.  They were both too good to pass up, and both good enough to land themselves in my editor’s choice section.   First, he gives us a visual breakdown of who the uninsured are, where they live, how healthy they are… demographics in general.  And he comes to the conclusion that the people voicing the strongest opposition to health care reform are part of the same demographic that makes up the largest uninsured sector of the population.  This isn’t a new idea, but the way Brad goes about detailing the evidence is highly compelling.

Brad also brings us his take on the Stupak amendment, which would prohibit health insurance from paying for abortions unless the mother’s life is in danger, or in cases of rape or incest.  He points out that the vast majority of abortions are currently not paid for by health insurance.  I agree with him that this amendment was designed as a wedge to divide people over a hot button issue, rather than as something of substance.

Rounding out the rest of the Health Wonk Review are a variety of good articles organized roughly by topic:

Anthony Wright gives us an article about the weak employer mandate in the health reform bill, which would only impact large companies, and would only penalize employers by a fraction of the actual cost of providing health insurance if they choose to ignore the mandate.  Anthony points out that throughout the entire health care reform debate, lawmakers have repeatedly said that people can keep their current health insurance if they like it.  More Americans get their health insurance from their employers than any other single source, but that percentage has been declining in recent years as the cost of health insurance continues to climb.  Anthony notes that if employers keep discontinuing health insurance benefits, people might not actually have a choice of keeping their current plan, regardless of whether they like it or not.

Health Access Blog’s Beth Capell brings us a sobering discussion about the ramifications of being an uninsured child.  While it’s relatively rare for a child to die, Beth looked at a study that found that half of the children who died following a hospitalization between 1988 and 2005 were uninsured.  This is far higher than the proportion of uninsured population in the general population, and speaks volumes about the perils of being uninsured.  Beth points out that the Children’s Health Insurance Program (SCHIP) was in effect for the second half of the study, and yet there are still seven million uninsured children in the US (nearly 170,000 of them are here in Colorado).

InsureBlog’s Hank Stern wrote about a recent blogger teleconference with Rep. Joe Wilson, for a glimpse at a right wing Representative’s take on all things health care.

Mad Kane has written a limerick for Fox News and a limerick for Joe Lieberman. I don’t think she’s particularly fond of either of them.

My Wealth Builder has an article about why the government isn’t fit to run our health care system.  I think most of us agree that the income tax system is way too complicated, and that some government programs could be run more efficiently.  But indeed there are plenty of people who believe that Medicare is a good example of a well-run health care system that could be a model for providing care for the rest of the population.

Chris Langston, writing at the John A Hartford Blog, has drafted a “Declaration of Innovation” (modeled on the Declaration of Independence) pertaining to health care.  He’s primarily focused on geriatric care and health care for an aging population, but his words are appropriate for health care in general.

Tinker Ready, of Boston Health News, writes about the relationship between medical academics/doctors and the medical industry (think: “consulting” fees for docs, vacations to exotic destinations sponsored by drug companies, speaking fees for medical professors, etc.).  Part of the health care reform bill includes long-overdue “sunshine provisions” intended to increase transparency when it comes to the relationship between doctors and industry.

Healthcare Technology News brings us an article about provisions in the House health care reform bill that would eliminated a lot of the complexity and frustrations that go along with our current (non-electronic) health care reimbursement system.  Real time determination of a patient’s financial responsibility for a service, either before the procedure is scheduled, or at the time of service, would be a huge improvement over our current system of waiting for the bills to arrive with only a sketchy idea of how much they will be.  In general, the adoption of an electronic and standardized health care administration system is a definite positive in the House bill.

David Kibbe, writing at the Health Care Blog, details the importance of a Continuity of Care Record for every patient, ideally in an electronic, easily accessible format.  Allowing doctors and nurses to see at a glance a patient’s health history, allergies, medications, and basic vitals would eliminated the need for redundant testing (a cost-saving plus), and would enhance decision making when it comes to current care.  David points out that while most of our health data is currently being entered into a computer somewhere, it tends to be in disparate systems that aren’t easily compiled into one continuous record for each patient.

Elyse at AntiClue has written an article about the various technologies available to help reduce the incidence of adverse drug effects.

Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon NH, puts a personal face on advance directives in an article that should encourage all of us to add an advance directive to our to-do lists.  As he says, “you don’t have to be dying for these discussions to matter.  You just have to be mortal.”

Workers’ Comp Insider’s Julie Ferguson brings us an article about the largest fine ever levied by OSHA – $87 million in penalties – directed at BP for a refinery explosion four years ago that killed 15 people and injured 170.  Incidentally, the second-largest fine they ever levied was also against BP, related to the same explosion.  BP is contesting the fine, saying that it is an example of big government intruding on private business.  Without knowing anything more about the situation than what I just read in Julie’s article, my bet would be that BP is probably more concerned about profits than they are about the health and safety of their workers.

Susan DeVore, CEO of the Premier Healthcare Alliance, writes about the collaborative efforts of 157 hospitals working together to improve patient outcomes and control costs through a program called QUEST (Quality, Efficiency, Safety, and Transparency).  The hospitals shared data and information with each other, and after a year the hospitals had 14% fewer deaths than expected, and had saved $577 million.  Systems like QUEST, implemented throughout the country, encouraging collaboration and transparency among all hospitals could result in even more impressive results.

But while hospital collaboration can produce better outcomes and save money, we don’t want to take a good thing too far, as hospital mergers are a factor in driving up health care costs.  Ken Terry, writing at BNET explains how costs have grown much faster than usual over the past decade, following a period of unprecedented hospital mergers that resulted in much less competition between hospitals in most metro areas.

Amer at Healthcare Hacks tells us about the FDA’s Emergency Use Authorization for Peramivir, a drug that can be used to treat H1N1 – without the normal extensive trials that drugs must go through in order to be approved.  He also throws in a reminder about hand washing, since prevention is always the best strategy.

While we’re on the topic of H1N1 treatment, Eric Turkewitz has an interesting article about drug wholesalers trying to peddle flu vaccine for eight times the normal price, while also refusing to say where the vaccine originated.

Thanks to everyone who submitted articles; it was a pleasure reading them.

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Posted on November 10th, 2009 by admin

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