Health Wonk Review: Special Edition on Health Care Reform

 

"The unfinished business is done."

Health care has never been so center stage and so enmeshed with policy and politics.  It took 100 years, starting with Teddy Roosevelt's 1912 presidential campaign. Seven presidents tried including two Republicans and five Democrats. 

Who won? Patients won't be denied coverage for pre-existing conditions (eventually) and are no longer subject to lifetime caps.  Physicians will benefit from the coverage expansion and increasing fees for Medicare primary care. Government trims the rate of growth of the deficit. Small business gets a tax break. Students can stay on their parent's plans until age 26. Seniors see the close of the Medicare prescription drug doughnut hole.  And hospitals receive payments for more of the care delivered. 

Not all of the "winners" improve access/health/costs:  Pharma doesn't have to negotiate for drug prices. Payers will still find reasons to deny care and are permitted medical loss ratios of 80-85%.  

The Debate

Did it go far enough? Could a public option have done more to hold down administrative costs and improve access and health?  Mad Kane skewers the "something is better than nothing" half-a-loaf theory with an hilarious limerick.

And in the aftermath of the bill's passage, Republicans warn of no cooperation for the rest of the year. You can just imagine Mad Kane's sharp witted riposte - - check it out in Addled Threats posted at Mad Kane's Political Madness.

Louise at the Colorado Health Insurance Insider reports that the Colorado and other Attorneys General are questioning the legality of the Health Insurance Mandate.  Basically, they’re saying that the federal government doesn’t have a constitutional right to compel citizens to take part in any specific market – including health insurance.

Health care reform unconstitutional?  Get over it. David Harlow's Health Care Law Blog spells it out. 

David Williams at Health Business Blog makes the case that  health reform would not have made it through Congress without unwitting help from Republicans.  "My biggest chuckles have been with Republicans complaining about Democrats using unfair processes and not accepting the will of the people."

Bob Vineyard lays out the questionable economics of the tax penalties for non-insurance in We Have Ways posted at InsureBlog

Austin Frakt at The Incidental Economist asserts that individual mandate penalties are adequate.  Some claim that health reform's penalties for failing to purchase insurance are lower than those in Massachusetts and therefore invite gaming of the system. Those claims are false.

Jared Rhoads at the The Lucidicus Project ("All Talk, No Debate") argues that there was never a principled debate around healthcare reform. Too much bickering. Ya think?  Also, at The Lucidicus Project:  21 brief thoughts and observations, Thomas Sowell-style, on health reform.

Jaan Sidorov at Disease Management Care Blog does a back of the computer monitor calculation and divides the $940 billion price tag of health reform by the number of lives that were reportedly being lost for lack of health insurance.

Minna Jung at Health Reform Galaxy Blog reminds us that the job of educating people about what did just happen in the health reform debate, and what will happen, is not over, not by a long shot.   

Anthony Wright at Health Access Blog spotlights a study showing that health services provides states with their best bang for their buck in terms of job creation and/or retention. Health care does much better from a "jobs per billion" metric than tax hikes or cuts.

Joe Paduda at Managed Care Matters endeavors to anger people on both sides of the political spectrum with this two-parter:  Unsustainable, irrational, unaffordable health reform and Flip flopping on the mandate - Gingrich's hypocrisy.

John Goodman's Health Policy blog contends that health reform won't reign in government spending, as the legislation will require just about every non-elderly person in America to buy health insurance, the cost of which is going to rise at twice the rate of growth of their incomes.

Tinker Ready at Boston Health News reports on the Brown and Romney dance around Mass Reform.

Jeff Goldsmith at Health Affairs Blog reviews the performance of the Obama administration during the recent health reform debate through the lens of David Blumenthal and James Morone's book Heart of Power.

The real work begins

Anthony Wright at The New Republic's "The Treatment" blog writes the real work now begins.  The work of health reform doesn't just continue, but explodes at the state level. In California, bills are already moving on issues from rate regulation to a public health insurance option.

As a great example of the impact on the states, Mike King at Georgians for a Health Future describes the work in front of Georgia in response to the health reform legislation. 

David Harlow at Health Care Law Blog interviewed Don Berwick about 18 months ago. As Don heads into the post of CMS Administrator, it is a timely window into the thoughts of the person who will be responsible for implementing a great deal of the health reform law.  Neil Versel at FierceHealthIT thinks Don Berwick will embrace IT as long as it improves quality. Ken Terry at BNET Healthcare believes that Don Berwick's big vision will make him a political target.

Dr. Sheldon Horowitz at the Health Reform Galaxy Blog reports on a Rx for primary care. Improving Performance in Practice (IPIP) is devoted to helping doctors in primary-care practices improve the quality of care they provide and encourages them to work with support staff to ensure their time is well utilized.

Vince Kuraitis at e-CareManagement blog recaps pilots, demonstrations and innovations in the health reform bill.  Just what are these demos and pilots in the PPACA all about? Vince was boggled by the sheer number and complexity, and shares his findings.

Fred Lee presents Crowded Hospitals And Mortality posted at Healthcare Hacks. In certain cases, patients admitted to crowded hospitals stand a 5.6% higher risk of dying.

Ethics and Economics

The law of unintended consequences strikes again: Erik Turkewitz at the New York Personal Injury Law Blog contends that the health reform bill will be a big benefit to personal injury victims.

Jon Coppelman at Workers Comp Insider explores the dynamic tension with employers and payers:  "it would be nice to think that the pending expansion of healthcare benefits to nearly all Americans might make this cost-shifting problem go away. Alas, the game of 'pin the tail on the payer' has only just begun."  He also presents Dueling Shrinks: Uncompensable Depression.


Jason Shafrin at the Healthcare Economist describes some recent work evaluating proposed changes to Medicare's hospital wage index..

Roy Poses at Health Care Renewal presents a sobering report on The Settlement and Conviction Round-Up: Friday Frequent Flier Edition. 

For your reference

Silicon Valley Blogger provides an overview of Health Care Reform Bill: How It Affects You posted at The Digerati Life.

Shannon Wills presents 100 Great Twitter Streams to Stay on Top of Health News posted at Radiography Schools. An outstanding list of sources in 140 characters or less.

Raymond Fernandez20 presents 25 Little Known Ways Everyday Technologies Are Affecting Your Health posted at Online BSN.

Clay at the Health Crazies compiles resources on how each state’s health stats stack up. 

Joel Ohman at Healthcare Insurance Providers graphically presents the health reform time line.  You'll want to keep this close by for easy reference.  It's reproduced below.


Infographic by HealthInsuranceProviders.com


Next Health Wonk Review will be hosted by David Harlow at Health Care Law Blog.