The Post-Election Edition of Health Wonk Review

This most recent edition of HWR, a compendium of some of the best health care posts of the past two weeks, came out ten days ago. I apologize that I’ve been tardy in commenting— but, not to worry, it’s an “evergreen.” The problems Health-Wonkers raise haven’t been solved in the past week, and the issues discussed remain just as “hot”– as they were.

Managed Care Matters” Joe Paduda does an outstanding job of hosting the round-up in a post titled: “Elections Have Consequences.”

He begins with “Health Policy and MarketPlace Review’s”  Bob Laszewski, who  notes in the wake of the election, we can be certain of one thing: Obamacare will be implemented. To be sure, there will be lawsuits challenging reform legislation, but Laszewski says, “I wouldn’t waste a lot of time worrying about those. Anyone in the market will do better spending their time getting ready for all of the change coming.” He’s far more worried about whether the government will be able to set up the Exchanges in time to meet the deadline—and how legislators are going to solve the “fiscal cliff” problem.

Writing on “Health Affairs” Timothy Jost agrees that “there is a great deal of work needs to be done before reform becomes a reality.”  He focuses on the many rules that the administration will need to issue to provide guidance to the states, to employers and to insurers:  “The exchanges must begin open enrollment on October 1, 2013,” he observes. “By that date, the exchanges must have certified qualified health plans.  But before health plans can be certified, they must have their rates and forms approved by the states.  And before that can happen, insurers must determine what plans they will offer and what premiums they will charge.  Yet insurers cannot establish their plans and set their rates until they know a lot more than they do now about the rules they are going to have to play by.” In other words, the administration had better “roll up its sleeves and get to work.”

Meanwhile, President Obama still must contend with ornery governors, and rebellious states. “In an ominous sign,” Jost notes, “Missouri passed a ballot initiative prohibiting state officials from cooperating with the federal exchange in its state,  and authorizing private lawsuits against any official who cooperates.”   (Thanks, Missouri–just what we need, lawsuits against officials trying to do their jobs..)  “Whether this is constitutional remains to be seen,” says Jost, who is a constitutional expert.

Over on “Health Access Blog,” Anthony Wright celebrates “A Great Night for California, and for Health Care”: The election “means security for 14,000 Californians who insurers denied for their health status, but got new coverage through the Pre-Existing Condition Insurance Program (PCIP), a part of “Obamacare.”  While some states drag their feet, California, which often sets trends for the nation, is ready for the future.

Writing on “Colorado Health Insurance Insider”  Louise underlines why we all need insurance. She lives in a “battleground state” where not everyone is enthusiastic about the individual mandate, and her post responds to a piece by Leo Babauta (a writer who and has over a hundred thousand followers on Twitter), in which he explains his rationale for not having insurance for himself, his wife, and their six kids. 

One can be “self-insured,” he argues, if you’re careful enough.
Louise thinks not, saying “To be fair, I agree wholeheartedly with the tips he gives. Things like eating well, exercising, avoiding excess alcohol, not smoking, driving safely, managing stress . . . I’m told I’m a health nut,” she continues, “and I don’t shy away from the accusation. I make green smoothies (kale and veggies and fruit all blended up), exercise nearly every day and refuse to drive if I’ve had even a single glass of wine. . . But I would never go without health insurance for myself or my family.”

Indeed. I’m reminded of JFK’s remark that having children is “giving hostages to fate.” No matter how careful you are, there is no guarantee against the accidents of fate.

Joe then turns to John Goodman of the National Center for Policy Analysis. He, too, is not a big fan of government mandates: Goodman’s  contribution to HWR is a post titled “Socialism Kills.” Paduda is bemused. He can’t help but “wonder how the headline could possibly be true in the face of data indicating that longevity in most European countries exceeds that in the U.S. In fact, as the only industrialized nation without universal health insurance, we rank behind every EU country in life expectancy—including Greece, Malta, Cyprus (my birthplace)—and even lower than Chile.”

By contrast, over at “inform the” Chuck Smith lauds the benefits of government-subsidized  “pre-illness care”—the preventive care and wellness visits that we will all enjoy under the comprehensive insurance that the Affordable Care Act guarantees.

On “Managed Care Matters, Paduda himself looks at the implications of Obamacare for worker’s comp, and “surprises some by opining that overall, it’s good news indeed. The most important single impact is this: When injured workers have coverage there is no need for WC to pay for non-occ conditions for injured claimants (whether the WC payer follows through on this is a separate issue.)

Finally Paduda provides links to some provocative posts that have nothing to do with the election and look as if they are well worth a read:

“InsureBlog’s” Bob Vineyard reports that more doctors are beginning to shun insurance in favor of cash, and explains why.

On “Health Care Renewal”l Dr. Roy Poses “continues his tireless pursuit of profiteers, this time going after the cozy relationships existing in the medical-publishing industry.” Here, he looks at a U.S. Senate committee report detailing how Medtornic, a biotech/medical device company sought to systematically but covertly influence the ostensibly scholarly medical literature with one goal: to sell more of their product.

“Health Care Economist’s” Jason Shifrin reports on how hospital quality is reported in Italy. He’s worried that the reporting will make hospitals avoid risky patients.

Over at “The Hospitalist Leader” Brad Flansbaum digs into the details of a change in Medicare policy that will have a significant impact on post-acute care (and home services). Under new rules, Medicare will cover “skilled nursing and therapy services necessary to maintain a person’s condition” even if his condition isn’t “improved.” As Flansbaum observes: “The line is blurry. Maintenance and improvement are different entities and battles will ensue when caregivers demand services for patients not benefiting from services. The debate is who interprets “not benefiting.”

Meanwhile, “Health Business Blog’s” David Williams reveals that The American Academy of Family Physicians is pushing back on nurse practitioners’ role in primary care—and explains why they aren’t doing the same to specialists.  “Evidently the family practice docs are OK if specialists act as generalists,” Paduda writes, but, oh no, not those nurses .” He adds a disclosure: “my daughter is a nurse.”)

Joe wraps up HWR with a nod to “Workers’ Comp Insider” where Tom Lynch offers “A Modest Proposal for New York” for fixing what’s wrong with the state’s worker comp system.

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