Michael Millenson, the president of Health Quality Advisors LLC, is the author of an excellent book Demanding Medical Excellence: Doctors and Accountability in the Information Age. Earlier in his career, Millenson was a Pulitzer Prize-nominated reporter for the Chicago Tribune. Recently Millenson put his investigative skills to work to explore the two sides of Betsy McCaughey: “Good Betsy and Bad Betsy” for Matthew Holt’s The Health Care Blog (THCB) http://www.thehealthcareblog.com/the_health_care_blog/2009/09/betsy-mccaugheys-infected-advocacy.html Enjoy.
Author Archives: Maggie Mahar
If You Think Health Care Reform Makes You Nervous, Consider the Alternative
Health Wonk Review spotlights the best healthcare posts of the past two weeks. The most recent edition calls attention to Joe Paduda’s two-part post on Managed Care Matters. Part 1 is titled, “Your Life Without Healthcare Reform.” (See http://www.joepaduda.com/archives/001615.html
Paduda begins by observing that reports from consulting firms Segal and Aon reveal that health benefit costs will jump more than ten percent next year—and that this “shows exactly what we’re in for if reform efforts fail.
“And by 'reform'” Paduda adds, “I mean reform with strong cost controls.”
I would add that, for the past 10 years, the amount that private insurers have been spending on health care has been levitating by roughly 8% a year. If we continue on the current track, this means that in nine years, healthcare costs—and your premiums—will double.
“But when something can no longer continue, it won't,” says Paduda. “When enough Americans lose their coverage, when cost-shifting gets to the point where those left with insurance are paying thousands in premiums to cover those without, when local taxes to pay for teachers' and police benefits get so high that folks are losing their houses, when Medicare finally goes insolvent, when hospitals are collapsing due to the cost of indigent care, when big pharma and device companies are no longer making the gazillions they so richly deserve, then, and only then, will the screaming hordes at Town Hall meetings decide that any health care coverage is better than none.
“While the opponents of reform may well win this battle,” he concludes, “in the long run they will lose the war.”
I agree, and like Joe, I can only hope it doesn’t come to that. If it does, by then health care inflation will have driven a spike into the heart of the economy. If that sounds like an overstatement, keep in mind that White House budget director has told us that climbing health care costs represent “the single greatest threat to the U.S. economy.”
In part 2 of Paduda’s post, “Your Life Without Healthcare Reform,” he sketches what a future without reform holds. Here are just a few details (for links to his evidence, go to the post here: http://www.joepaduda.com/archives/001616.html
n 178,000 small business jobs will be lost by 2018 as a result of health care costs
n If employee contributions stay at their current level (about 30% of premiums), workers will be paying $9000 per year, or $750 per month, towards their health coverage – not including deductible, copays, coinsurance, and services not covered
n More Americans will have to rely on the kindness of others for their health care. Because 65 million of us will be without health insurance.
“Unlike the distortions, misrepresentations, and outright lies being spread by McCaughey, Limbaugh, Palin et al, this is the real deal,” Paduda writes. “So fight against reform if you wish, but don't complain later when you can't afford insurance, your employer can't afford insurance, your taxes are going up to pay for teachers' benefits, and our economy is sinking under the weight of health care costs.”
Kudos to Paduda, who understands what is at stake here.
To explore many other excellent health care posts included in the newest Health Wonk Review, check out the Lucidius Report http://lucidicus.org/editorials.php?nav=20090903a which is hosting Health Wonk Review this time around.
Why CBO Cannot Calculate the Savings That Will Come With Healthcare Reform –Part 1
The Congressional Budget Office (CBO) has warned that progressive proposals for reforming health care will add to the deficit that looms over our economy. But when you stop to think about it, just how likely is it that CBO can accurately predict the cost of health care reform—and the savings that it will generate– over a ten year period? Virtually any economic predictions that attempt to go out ten years are, at best, guesstimates. Few investors would attempt to project a single company’s earnings out over ten years: how can one “score” the effect of very complicated legislation on a $2.6 trillion industry?
"The CBO’s track record in predicting the effects of health legislation is abysmal,” observes Bruce Vladeck, the man who ran Medicare while serving as administrator of the Health Care Financing Administration from 1993 to 2997. “Over the last two decades, the CBO has routinely overestimated the costs of expanded government health care benefits,” Vladeck adds, “and underestimated the savings from program changes designed to reduce expenditures.”
Truth Squad: The Left Attacks Obama
If you take a look at the history of left-wing politics in America, you’ll find that left-wingers always seem to be spoiling for a fight—with each other.
This summer, many on the left have decided to attack the very president who so many championed not nine months ago. Let me be clear: I, too, could find fault with what the President has done, and hasn’t done, during his first eight months in office. In particular, I’m sorry to see a troop build-up in Afghanistan, and would be much happier if many more U.S. soldiers were coming home.
But military strategy is not my area of expertise. Health care is, and when it comes to reform, this president has accomplished more in eight months than any president in the past 44 years.
Yet, the left, like the right, continues to spread misinformation about President Obama’s efforts at healthcare reform. For example, today Allison Kilkenny co-host of Citizen Radio, the alternative political radio show published this piece on AlterNet alleging that the president has “betrayed the progressives who got him elected” :
Who Is Making the Biggest Profits From U.S. Healthcare? You Might Be Surprised . . .
Healthcare –and healthcare reform—is complicated, in part because so much of what we think we know about American medicine turns out to be untrue. For instance, one would assume that more expensive care would be better. But the Dartmouth research has taught us that isn’t the case. Most people also assume that for-profit insurers are making a fat profit; after all, look at how high insurance premiums are!
But as Rick Newman points out in the most recent issue of U.S. News & World Report , “blaming insurance firms for runaway healthcare costs is a weak argument, because the insurance industry isn't all that profitable to start with."
Let Health Care Reformers Listen to Ted Kennedy’s 1980 Speech—and Rally
I still recall Ted Kennedy’s speech at the 1980 Democratic convention. It remains the finest, most inspiring political oration that I have ever heard. This is in part because Kennedy was speaking from a position of defeat. He had just lost the Democratic nomination to Jimmy Carter. And yet this was a full-hearted, rousing speech delivered by a man who realized that in the battle ahead, the issues at stake were far, far more important than his own loss. Intuitively, he knew that the country had reached a turning point.
Many people are talking about that speech today. Instead of substituting my prose for Kennedy’s, I have decided to quote high points from that speech for the many readers who either didn’t hear it– or don’t remember it in all of its richness. This was a speech written long before slippery political strategists had learned to “frame” ideas as bumper-stickers. In its eloquence, it shows great respect for the English language, for ideas, and for its audience. And, I think, it reminds health care reformers that this is not a time to “yield.”
Does Medicare Under-Pay Hospitals?
Below, a guest-post by HealthBeat reader Pat S.
Medicare is the second largest health care payer in America, trailing only Medicaid. The program is very popular with its enrollees, with polls showing a higher level of satisfaction than with private insurance.
Medicare is less popular with hospitals.
Opponents of health care reform in general and of a strong public option in particular often cite hospital dissatisfaction with Medicare as a reason why the reform programs won’t work. They report that evidence suggests that overall Medicare pays hospitals less than what it costs them to provide care. Private insurers pay more, and by “cost-shifting,” hospitals use these payments to make up the losses on Medicare. Opponents worry that if a public option linked to or modeled on Medicare becomes the dominant payer for people under 65, hospitals will go broke without the “subsidy” from private insurers, and the health system will be destroyed. Data collected by hospital groups and the insurance industry suggests that this is unlikely to happen.
Finding the Waste in Our Health Care System – Low-Hanging Fruit
Too often, those who oppose health care reform say that while there may well be waste in our health care system, it’s hard to say where it is. One man’s waste is another man’s effective treatment. Many tests and surgeries may be controversial, but who is to say for sure what is unnecessary?
The truth is that we have stacks of medical evidence showing that many procedures and products are of little or no value to many patients who receive them. These treatments may be useful to patients who fit a particular medical profile: women between the ages of 50 and 70, for instance, or patients suffering from left main coronary artery disease. In these cases, health care reformers agree: patients should receive the treatment.
But typically a much larger group of patients are subjected to a procedure that provides no benefit. Thus, they are subjected to risk without gain. Keep in mind that one hundred thousand people die each year from complications of surgery—far more than die in car crashes. And some of those surgeries were unnecessary.
In a recent post on The Health Care Blog (THCB) (www.healthcareblog.com) Dr. George Lundberg, former editor-in-chief of the Journal of the American Medical Association, wrote about seven areas where we have enough comparative effectiveness research to know that a great many patients are being over-treated. Lundberg, who is now president and chair of The Lundberg Institute suggests that we could begin to rein in health care spending NOW –if doctors take “a good hard look” at the evidence (and “in the mirror”), and share medical evidence with patients about benefits and risks when discussing options for treatment. (For more on “Shared Decision-Making” see this Health Beat post)
Health Wonk Review—Top Health-Care Posts in the Blogosphere
Health Wonk Review, a round-up of some of the best posts in the Healthcare blogosphere over the last two weeks, is now up on Health Business Blog, hosted by David Williams here:.
http://www.healthbusinessblog.com/?p=2556
http://www.healthbusinessblog.com/
Just a few highlights:
The Robert Wood Johnson Foundation presents a users’ guide to health reform. Key assertion: if we improve efficiency in health care we can avoid cost/coverage tradeoffs
Managed Care Matters offers the top ten misconceptions about health reform. Reason #2: “A public plan would crush private insurers and we’d all end up covered by the public plan,:
Heath Care Renewal thinks hospital Group Purchasing Organizations (GPOs) are acting more like Group Kickback Organizations. As Williams points out, Roy Poses, the editor of Health Care Renewal has written about this problem “as far back as 2005, but now investigators are taking an interest” This is very good news.
To find links to these, and other top posts, go to
http://www.healthbusinessblog.com/?p=2556
http://www.healthbusinessblog.com/
Please Don’t Believe Everything You Read…
Below, a response to novelist Jane Smiley that I am publishing on the Huffington Post tomorrow. Earlier this week, Smiley posted on Huffington expressing her dismay that President Obama seems to be folding on health-care reform. I don’t blame her for coming to the conclusion: this is what the mainstream media has been telling her. My response begins:
An Open Letter to Jane Smiley: Please Don’t Believe Everything You Read
(The Media Is Not Always a Reliable Narrator )