How will the Senate bill impact health insurance companies and their customers?Even better, how will it impact a not-for-profit health plan--one with a reputation for being a "good guy" that continually wins the country's top awards for member services and with historic profits of less than 1% of premium? And, one that is operating in Massachusetts--a market that has already been through much of
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The Senate Bill--Wall Street Likes It and the House Will Have To
In morning trading HMO stocks are once again hitting 52-week highs with each of the major publicly traded plans up 3% to 6% from their Friday gains.Hospitals and pharmaceutical companies are also doing pretty well.Liberals have been talking all weekend long about having to make the Senate bill better—and more like the House bill. That just won’t happen. Reid’s 60-vote majority is held together
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Coal in Your Christmas Stocking?
Is there anyone left, on either side of the political spectrum, who wants the Senate health care bill to pass?Republican Mississippi Governor Haley Barbour had this to say about the Senate bill last week, “This health care plan is like mackerel in the moonlight. Longer that it's out there, the more that it stinks.”And yesterday, MoveOn said this about the Senate Democratic health care bill in an
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Oh, Ease Up on Joe Already
The Democratic rhetoric coming from Capitol Hill today beating on Joe Lieberman is, in the least, disingenuous.The public option has not been tenable for months. It was not just Lieberman that has been against it in all forms--robust Medicare-like or the neutered variety in the House and Senate bills.All of the liberals claiming they weren't going to vote for a health bill without a public option
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The Medicare Buy-In Is Dead--The Liberals Are Now the Swing Votes in Health Care
The Medicare buy-in idea is dead. After Democratic Congressman Weiner's candid comment, “Never mind the camel’s nose, we’ve got his head and neck in the tent," no senator from the likes of Arkansas or Indiana is going to vote for this.Add to that yesterday's critical Washington Post editorial and the sharp response from the various doc and hospital lobbies and this was dead before Reid's request
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Selling Insurance Across State Lines--Now the Dems Are Pushing the Idea--Why It Won't Work
A favorite Republican health care soundbite calls for making the health insurance system more efficient by letting health plans sell across state lines.Now Democrats are jumping on that idea. The latest public option idea would have the Office of Personnel Management (OPM) contract with national not-for-profit health plans and introduce those plans into local insurance exchanges--that would be
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Liberal Demands Over Giving Up the Public Option Threaten Health Care Deals
I actually feel for Harry Reid this morning.He was on his way. He had mastered an incredibly fine balance in his health care bill.No it wasn’t real health care reform and it wasn’t going to bend any curves but the Dems long ago gave up on that looking for one big political “W” instead.The liberals were finally backing off on the public option there never were the votes for. But even the “neutered
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The Latest Version of the Public Option—The Democrats Could Have Saved Us Lot of Time If This is What They Call a “Public Option”
If the latest version of the public option is something that will give its proponents reason to argue they still have a way to "make the health insurance market much more competitive," then a motor scooter is a Ferrari.The details are still fuzzy but the word is that senators are working toward a compromise over the controversial public option that would create something that:Would be run by the
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2009 a Year of Surprises and Change for the EHR Technology Market
2009 a Year of Surprises and Change for the EHR Technology Marketby DAVID C. KIBBE and BRIAN KLEPPER"Oft expectation fails, and most oft thereWhere most it promises; and oft it hitsWhere hope is coldest, and despair most fits." All's Well That Ends Well (II, i, 145-147)2009 began with a bang for legacy Electronic Health Record (EHR) vendors, promising strong sales and windfall profits
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Good For Orszag--Budget Director Discusses Cost Containment in Dem Bills
I was encouraged by remarks White House Budget chief Peter Orszag made in Washington yesterday.There has been substantial debate in recent days about whether the pending House and Senate bills have the kind of robust cost containment we need to really "bend" any health care cost "curves."Readers of this blog know of my concern that these bills amount more to expensive entitlement expansions than
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There Are Four Health Insurance Renewal Cycles and Two Elections Between Now and 2014—Could be Sort of Like a “Death By a Thousand Cuts” for the Dems
The Congressional Budget Office (CBO) issued a report today saying that if the Reid bill becomes law the price of non group policies would be about 10 percent to 13 percent higher in 2016 than it would be under current law. The CBO projects that small group and large group premiums would be about the same in 2016 as they would have been anyway as the benefits of the bill would offset some of its
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The Senate Democratic Health Care Bill is a “Milestone” on the Road to Cost Containment—If It Is It's a Pretty Small One
The Obama administration is reportedly pleased with a recent Ron Brownstein article in the Atlantic.In it Brownstein praises the Reid Senate health care bill for the steps it takes toward containing costs. He quotes MIT economist Jonathan Gruber who says, “My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really
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Don't Rationalize Busting the Budget--Start Over
I detect a growing rationalization among supporters of the Democratic health care bills: The recent flare-up over when a woman should have a mammogram proves we are nowhere near ready to pass a health care reform bill that will actually control costs. So, why bother?You would be hard pressed to find any health policy expert who isn’t disappointed that cost containment has fallen off the health
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The Democratic Health Care Effort--A Political "Charge of the Light Brigade?"
The latest polls are an unmitigated disaster for Democrats even as they're on a fast track to get their health care legislation passed.This from Rasmussen this morning:“Just 38% of voters now favor the health care plan proposed by President Obama and congressional Democrats. That’s the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June.“The
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How Can Harry Reid Keep a Straight Face Telling Us His Health Bill Will Reduce the Deficit?
The accounting gimmickry in Harry Reid’s Senate health bill is astounding even by Capitol Hill standards.Reid says his bill will cost $850 billion and reduce the deficit by $130 billion—all over ten years.Based upon the outline Reid gave the CBO that could well be right. But let’s look at it further:Reid delays most of the spending in the bill to 2014—a year longer than in the House. More
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Why Isn't the Press Talking About Affordability--For "Ordinary Folks"?
I thought Trudy Lieberman hit the nail on the head in a post she did yesterday at the Columbia Journalism Review entitled, "Missing Persons--How Will Reform Affect Ordinary Folks." Here is a small part of it:The media have talked about affordability mostly in the context of whether the country can afford reform, not whether individuals can afford it. It’s easier for a reporter to write about
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The Outlook for a Health Care Bill in 2009
Readers of this blog know of my yearlong pessimism over our getting a trillion dollar health care bill in 2009.With the historic passage of the House bill, are we now on our way to a big health care bill in 2009—or even by early 2010?Clearly, Democrats desperately want to pass a bill. Given their compromise over abortion and the neutering of the public option in the House legislation—things most
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The End of the "Robust" Public Option and the Potential for "Robust" Cost Containment?
Two things happened this week that in tandem have the potential to lead to a compromise over a health care bill.First, there are unconfirmed reports that Senate Majority Leader Reid is leaning toward offering the neutered version of the public option like that in the House--not tied to Medicare rates, providers not required to participate, and provider reimbursement rates negotiated.The second
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The Best Health Care Idea All Year
Out of almost nowhere has come momentum for a proposal to create a bipartisan entitlement and tax commission to draft proposals to control the long-term costs of Social Security, Medicare, and Medicaid. The idea would require the Congress to quickly vote the recommendations up or down via a super majority vote.The idea isn't new--proposals for a such a commission have been around for a
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The House Health Bill--Loading More People Onto the Titanic
Our health care system is truly titanic, in more than one sense of the word.Not only is it huge, but it's also growing at unsustainable rates that undermine our health care security and fiscal stability - and threaten to sink the system under its own weight.When the health care debate began in earnest just after the November 2008 election, it was supposed to be about reform-moving the nation
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AMA Supports the House Democratic Health Care Bill--Take Another Look
The AMA came out in support of the House Democratic health care bill this afternoon—sort of. From their press release:“The American Medical Association (AMA) today announced support for concurrent passage of H.R. 3962 and H.R. 3961, U.S. House of Representatives health system reform bills."I would suggest the operative word is "concurrent."HR 3962 is the big House health care bill. HR 3961 is the
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The House Bill Should Be Defeated on Saturday
Here's the email I just sent my Congressman, freshman "Blue Dog" Frank Kratovil of Maryland:Please vote no this weekend on the House bill.This is not health care reform.This is at least a $1 trillion entitlement expansion paid for half with only modest provider cuts and $500 billion in taxes.Real cost containment would bend the curve and produce the savings needed to accomplish universal
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The Neutered Public Option—Where’s the Rage?
The public option contained in the House Democratic health care bill is hardly more than a neutered version of the “robust” public option one House Democrat after another said was a minimum requirement to keep their vote on health care reform. After threatening for months to fall on their swords if they didn’t get the “robust Medicare-like” version, there was nothing but enthusiastic support for
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Saving Health Care--Saving America
Saving Health Care--Saving AmericaBy BRIAN KLEPPER, DAVID C. KIBBE, ROBERT LASZEWSKI and ALAIN ENTHOVENSo far, Congress' response to the health care crisis has been alarmingly disappointing in three ways. First, by willingly accepting enormous sums from health care special interests, our representatives have obligated themselves to their benefactors' interests rather than to those of the American
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The Health Care Bills, the Fine Print, and a Troubling List of Budget Gimmicks
Julie Appleby has an important article today at Kaiser Health News.She has identified an important and before unreported issue in the Senate Finance health care bill.In order to keep the cost of the plan down, the Senate Finance bill literally locks in the erosion of insurance subsidies for middle class families.From her report:"The first year the legislation would take effect, people getting
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“The Public Option Is Back in Play”—That Depends Upon Your Definition of the Word “Is”
It appears that Harry Reid is going to include a robust Medicare-like public option in his Senate draft. Speaker Pelosi is also doing her best to put as robust a public option in her House version as she can get the votes for.One press report after another has proclaimed the return of the public option.I’d like to see some of these reporters to do a vote count.No doubt the hype over the public
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Doing the Right Thing--The Doc Fix Vote and the CMS Report
Predicting the outcome of yesterday's Senate vote on the $245 billion deficit adding doc fix was easy.Democratic Senate Majority Leader Reid was going to sail this thing through the Senate with almost all Democrats and even a bunch of Republicans onside.Senators are afraid of the docs—after all they have voted for years to waive any cuts. Democrats needed to get this $245 billion cost out of the
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The Senate Finance Insurance Reform Rules Have to Be Fixed in Spite of the Gang That Can’t Shoot Straight
Last week the health insurance trade association (AHIP) released a report it sponsored, and was authored by PricewaterhouseCoopers (PwC), that claimed the Senate Finance bill would be problematic for the insurance markets only leading to much higher costs.As I posted last week, my own analysis of the Finance bill gives me big concerns about what it would do to health insurance costs and the
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Apparently The "Games" Have Begun--Democrats Move to Fix Physician Fee Problem Off-Budget
Apparently, Democrats are getting ready to pay-off the physicians for their support of the health bills by quickly fixing the Medicare Sustainable Growth Rate (SGR) fee cut problem off-budget and ahead of the pending health care bills.This in today's Kaiser Health News on a Congress Daily Report:Physician lobbyists met with several key lawmakers and administration officials Wednesday to push for
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What’s Next? Follow the Money
With the passage of the Senate Finance bill the health care effort now moves to a critical stage with the Senate Majority Leader and the House Speaker now clearly in charge.The more important effort will be Reid’s. Pelosi’s final product will be more predictable (very liberal) but Reid’s will have to be more practical. Every inch Reid moves away from the more moderate Baucus bill will cause
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The Senate Finance “Cadillac” Health Insurance Excise Tax Collects Almost Five Times More Revenue in 2019 Than It Does in 2013
Critics of the Pricewaterhouse Coopers (PWC) report on the Senate Finance bill have been making the argument that the analysts are not giving credit for the changes in behavior the bill would create. In short, the notion that, for example, insurers would pass on billions in taxes on high cost health plans to customers is flawed because the Baucus bill would provide the incentive to lower the cost
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The Senate Finance Health Bill Has No Clothes
Readers of this blog know that I have lots of concerns for the Senate Finance health bill primarily because it does not so much represent health care reform as just an expensive entitlement expansion.Readers also know the insurance lobby--AHIP--is not one of my favorite organizations.But I will tell you the report by Pricewaterhouse Coopers (PwC) commissioned by the AHIP and released this morning
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The Democratic Health Care Bills Could Be A Disaster for the Insurance Pool
With Baucus gutting his fine for not having health insurance there would be no reason for people to buy it. In 2013, for example, there would be no fine for not having insurance. By 2014 the penalty would be $200 per adult and it would rise to $400 in 2015, $600 in 2016, and $750 by 2017. Coupled with the expectation middle class families would have to pay $6,000 to $10,000 a year for insurance
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Managed Care: Because I'm A Scorpion, And It's In My Nature - An Editorial On Health Reform
Carl McDonald is a Managing Director at Oppenheimer & Company. He is one of the most followed health insurance industry analysts who can regularly make stock prices rise and fall with his comments. Today, he and colleague James Naklicki offer an "editorial" on the current health care proposals pending in Congress. I will suggest that their analysis of the impact of potential "reform" on consumers
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Health Care and the Nobel Peace Prize
October 8th, 2009President Obama this morning: “I will accept this award as a call to action, a call to all nations to confront the common challenges of the 21st Century.”I was in a private meeting last week where I heard a longtime and influential Washington insider describe her view of the Obama health care effort. Her point was that the White House has approached the effort more from an ego
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What a Tax on "Cadillac" Health Insurance Plans Would Really Mean to Mainstream Americans
Milliman consulting actuary, Robert Dobson, is out with a must read paper for those that think the "Cadillac" health plan tax makes sense.The bottom line:"The idea of taxing so-called Cadillac plans may not sound unreasonable upon first glance. But an actuarial view quickly reveals that the high cost of these plans has as much to do with the characteristics of the covered population as it does
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Will We Get a Health Care Bill in 2009? We Are About to See the Convergence of Three Powerful Forces
It’s decision time. The Congress will or won’t pass a major health care bill during the next few weeks.Will we get health care reform in 2009?Almost certainly not. As I have been saying for months, if we get a bill it will be more a trillion dollar entitlement expansion funded by relatively minor provider cuts and about $500 billion in tax increases. That is not health care reform.Will we get
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Just Exactly What is "Health Care Security?"
The President has said many times this health care debate is about "health care security." But the fact is that, under the Democratic bills now being considered, many middle class families (those making between $50,000 and $100,000 a year) would not be able to afford to buy a health insurance policy even with the proposed federal government subsidies.Under the House Energy bill a family making
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Getting a Health Bill Done—Special Interest Politics Versus Public Support
It is becoming more and more clear to me that the White House health care strategy this fall is based upon a belief they have been very successful in neutralizing the health care special interests and have therefore prepared the way to a legislative victory.Each of the key stakeholders—doctors, hospitals, drug companies, device makers, and insurers are in a terrific place should any of the health
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Health Care Outlook Not Improving
The next big test for a health care bill in 2009 (notice that I did not call it health care reform) will come in Senate Finance.The final vote in that committee will tell us a lot about whether the Democrats have any chance for 60 votes in the full Senate. So far, it does not look good.I have the greatest respect for Senators Baucus and Grassley and their good faith efforts to find a bipartisan
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The Proposed Health Insurance Company Taxes To Pay for Health Care––You Really Need to Know What “Loadings Available” Means
The Congress has investigated about every conceivable way to tax people to pay for the health care proposals—a millionaire’s tax, bigger taxes on home mortgages and charitable contributions, and a couple of dozen more ideas.Now Congress looks to be the most interested in taxing insurance companies to pay for a big chunk of their health care proposals. The new taxes would come in two parts––a 35%
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What Voters Really Think About Evidence-Based Health Care
I want to call you attention to an important survey done by the California-based Campaign for Effective Care. They surveyed California voters on their understanding of evidence-based medicine.The bad news is that patients think their health care treatment is generally evidence-based even though that assumption is highly questionable. The good news is that patients want it to be evidence-based.At
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"Please Don't Call It Health Reform"
Readers of this blog already know of my disappointment in what the White House and many in Congress are calling "health care reform."So, I was happy to see Alain Enthoven's recent KHN op-ed.Here is a small portion of it:"Once again the President did not put forth serious proposals to reduce the growth rate in health expenditures in his speech last night. Obama likes to talk about the iconic
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Curb Your Enthusiasm! Health Care Will Still Be Very Hard to Do
I guess all of us in the health care debate are a bit bipolar. From lots of folks thinking health care reform was in critical condition a couple weeks ago we’ve now gone to lots of reports extolling a newfound optimism in the wake of the President’s impressive speech this week.Don’t interpret this post as my thinking health care reform is something we should be putting off—it’s already 20 years
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The Obama Administration––What Will They Do Next?
How’d you like to be a fly on the wall in those White House health care meetings this week?It looks to me like they have two choices—neither attractive to them:1. Full Speed Ahead, Damn the Torpedoes – This might also be called the Pelosi Option for the Speaker’s intransigence for compromise. Just keep driving the existing Democratic bills through. This has the advantage of keeping the liberal
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Will Republicans Be Spoilers Or Problem Solvers on Health Care Reform?
by BRIAN KLEPPER and DAVID C. KIBBEIn theory Congress' return next week from recess could offer a new beginning to the health care reform process, giving everyone a chance to take a deep breath and recalibrate the components of change.Nine months into the wrangling around a new Administration, the talk-show right has seemingly hijacked the discussion on health care, Democrats' signature issue,
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Making Health Care Reform "Deficit Neutral" Accomplishes Little--So Why Is That the President's Health Care Reform Budget Objective?
For me, one of the more amazing things about this health care debate is the way the press and many advocates of health care reform have accepted the notion that the fiscal objective should be to pass a health care bill that is "deficit neutral."With health care costs unsustainable, why is that an appropriate goal?Deficit neutral means that any impact of a health care bill on the federal budget
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Bob Bennett Wants to Turn "Control of Our Health Insurance System Over to the Government"–-Say What?
That’s what the Club for Growth is saying about Senator Bob Bennett’s health care proposals.Apparently, the Club for Growth has a reading comprehension problem. Or, are they just trying to twist the truth about the Utah Republican's health care efforts? The Wyden-Bennett Healthy Americans Act has to be the most pro-market health care reform proposal on the table.First, it does not have the
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The Health Reform Bills Would Be Great For the Business Of Health Care
Have you noticed how none of the big health care business special interests is running any negative health care reform ads? Why should they when each is poised to gain billions of dollars from it?As President Barack Obama has said many times, any health care bill that costs about $1 trillion would be paid for, roughly half and half, with savings in the health care system and new revenues (taxes).
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Health Care Reforms Deeper Problems
by BRIAN KLEPPER and DAVID C. KIBBENote: We were asked by Northeast Florida's regional newspaper, the Florida Times-Union, to write a piece for lay audiences distilling our thoughts on what's behind the reform curtain. This piece published this week and, while we doubt much of it will be news to this blog’s readers, we wanted to offer it up as a summary statement.Congress' health care reform
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There Will Not Be Health Care Reform in 2009 Without Republican Leadership
I will suggest that there is an opportunity for the Republicans to score a huge political and policy win. It can be done in a bipartisan way and it can be done in a way that does not sell out the core principles that either Republicans or Democrats believe in.It would require a new effort—a clean sheet—this time initiated by the Republicans.The Republicans have won August. No doubt about it. But
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Splitting the Bills? The Democratic Leadership and the White House Staff Really Need a Vacation
The latest word is that the Democratic leadership and the White House see a “60% chance” they will split their health care bill into two parts—one a budget bill that would be eligible for the 51-vote Senate rule and the other the operational non-budget portions that will need 60 votes. This is all intended to get around the Byrd Rule—which allows the use of reconciliation
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The Obama Admistration Would Do Well to Read the Senate Rules and the Polls
The latest reports are that the White House is getting ready to ditch any thoughts about a bipartisan health care bill and just ram the Democratic bills through the Senate with bare majorities. Readers of this blog know that I don’t think it is ever possible to ram anything so big as health care through with slim Congressional majorities and even less public support. I
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Co-Ops Are the Single Dumbest Idea I Have Heard in the Health Care Debate in Twenty Years
This is a repost from June 23--sort of like regifting...I am sure you have heard the story about the committee that was charged with designing a horse but, because of the bureaucratic ways of the committee process, instead ended up creating a camel.We will not see a Medicare-like public health plan as part of any health care reform bill in 2009. I know proponents don’t want to hear that but it is
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The Other National Universal Systems of Care Are Not Our Problem
You can't have an American health care debate without plenty of trashing of single payer systems elsewhere.I am not a single-payer advocate. I believe it is simplistic to think that if we just had one and eliminated the duplicate expenses multiple payers bring with them everything would be OK.I think a single-payer solution is simplistic because it misses the different histories that have gone on
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Are Democrats Getting Ready to Ditch the Public Option? But They Would Still Be Challenged by the Trillion Dollar Price Tag
It looks to me like the popular objections to a health care bill being expressed by voters this month are concentrated in two primary areas:A concern about “government control of the health care system”—mostly around the public plan option.The trillion-dollar cost of a health care bill at a time deficits are swelling and worries about who will really end up paying for it.As a result of the first
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You Call This a Health Care Debate?
Any of us who do health care policy full time might as well take the rest of the month off and let the demagogues bent on scarring the American people just get it all out. I swear it is getting worse by the hour. Then maybe we can get back to a rational debate.The British Health System's National Institute for Health and Clinical Excellence (NICE) and Dr. Ezekiel Emanuel have been particularly
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Why the Democrats Are On Their Way To Blowing Health Care –Again
There will be a pretty long list of answers to this question but I will give you what I consider to be the number one reason.The Democrats chose partisanship over bipartisanship.There has been a school of thought in this town, of which I have strongly agreed with on this blog, that the only way you can do something as big and complicated and close to people’s self interests as health care is to
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Insurance Companies Say They Can't Compete With a Public Option--But FedEx and UPS Do Pretty Well Against the Post Office--What's the Difference?
The Post Office doesn’t get to unilaterally fix the cost of all of the things it buys that go into its services--Medicare and Medicaid do.What critics of the public health plan option often fear is that, like Medicare, a public option health plan would be able to unilaterally set what it pays doctors, hospitals, drug companies, and other providers. Private health insurers often pay providers 20%
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This Health Care Reform Debate is Really Starting to Scare Me—What if We Were Having a Real One?
The recent stridency of this health care debate has led me to wonder what if the Democrats were proposing real health care reform?The Democratic health care bills are hardly more than expansions of the health insurance entitlement paid for by largely insignificant cuts to existing spending and lots of new taxes. Any provider cuts to Medicare are so small they will be easily cost shifted to the
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The Bigger the Lie
I come from a corporate background.A longtime ago a chief marketing officer introduced me to the term, “The Big Lie.” Apparently, this also applies to politics.As he put it, in not a complementary way, the bigger the lie that is told the easier it is to believe.Sarah Palin has been practicing Big Lie politics.She recently posted on her Facebook account:“The America I know and love is not one in
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Health Insurance Reform or Health Care Reform? The President Gets It Right!
Advocates of the health care bills now pending in Congress, led by the President, have been calling for health care reform. They argue that our health care system is unsustainable as it is. Not only do we need to create a system of universal coverage but also we need to do it in a way that is sustainable, affordable, and doesn’t continue to add to our deficits.They are right.But, for months I
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The Public Plan Option: Litmus Tests Are Never a Good Sign
Before now, I can think of only one “litmus test” in American politics—abortion.That is an issue that simply polarizes the nation—and our political system. On a good day, people on one side or the other just agree to disagree and move on.But I think we are seeing another litmus test issue emerge—the public health plan option.I have no doubt that there are not the votes to pass a public plan
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Never Give Up!
At the rate this crazy health care reform debate is going it could well come full circle and back to twelve Senators who still think they have a good idea--if everyone else would stop digging in on what they can't agree on.This from a Washington Post op-ed they co-authored this week:As 12 U.S. senators from both sides of the aisle who have widely varying philosophies, we offer a concrete
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Leave the Town Halls Alone!
Apparently, conservative activists are attempting to disrupt town hall meetings being held by Democratic members of Congress to discuss the health care bills.I can tell you from conversations I have had with members of Congress that these town hall meetings are VERY important to representatives and senators of both parties as a way to gauge the mood of their constituents. If activist groups
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Finally, A Reasonable Plan for Certification of EHR Technologies
by DAVID C. KIBBE and BRIAN KLEPPERA caution to readers: This post is about methods for certifying Electronic Health Record (EHR) technologies used by physicians, medical practices, and hospitals who hope to qualify for federal incentive payments under the so-called HITECH portion of the American Recovery and Reinvestment Act (ARRA). It may not be as critical as the larger health care reform
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Back to the Future! Pelosi Calls Insurers “Villains”
Like we didn't know it would get to this.This from Speaker Nancy Pelosi’s news conference yesterday:"The public option--that's where the insurance companies are making their attacks-––it's almost immoral what they are doing. Of course they've been immoral all along. They are villains in this, they have been part of the problem in a major way. They are doing everything in their power to stop a
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Health Care Reform Coming Out of Senate Finance?
We’ve been getting lots of news these past few days leading to optimism that a bipartisan health care bill will soon emerge from discussions between the “Coalition of the Willing.” That term refers to the three Republicans and three Democrats trying to find common ground in the Senate Finance Committee.First, let me be clear that I have the greatest respect for Senators Baucus and Grassley and
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A Health Insurance Premium Tax Would be a Chicken Tax
The Congress has looked at taxing about everyone and everything to pay for half the cost of a health care bill.They’ve considered sugary soft drinks, beer, “millionaires,” and “gold plated” health benefits to name a few. Every time they come up with one it gets shot down by the interests it would offend.First, as I have asked on this blog before, why do we need to use at least $500 billion in new
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What It Would Take to Really Make America's Health Care Costs Affordable and Sustainable
Most health care experts agree the reason our system is so unaffordable is because of all of the waste and unnecessary care—up to 30% of what we spend.I will suggest that it will take the genius of individual creativity to separate the 70% of this health care system that is the best in the world from the 30% that is waste.So far, the Congress has focused more on entitlement expansion then
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Health Care Reform Should Mean Health Care Reform--A Proposal for Real Change
CMS says that we will spend 17% of GDP on health care this year and we are on our way to having 22% of our GDP being spent for health care by 2018.The stated goal of the President and all of the Congressional health care reformers is to accomplish health care reform and have it be deficit neutral.Deficit neutral means we wouldn't reduce our costs one bit. We would have no assurances that we would
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Grandpa Harry and Grandma Louise
Word from all those town hall meetings members of Congress are having back home this week is that lots of seniors are showing up scared that all the talk of health care reform in Washington, DC might just hurt them.The seniors’ reasoning goes that Congress is getting ready to cut Medicare in order to pay for the uninsured grandkids' newfound access to a health insurance policy of their own.Watch
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Will Eliminating Medical Underwriting and Merging the Small Group and Individual Market Into a New Insurance Exchange Work? Lessons From Massachusetts
Creating a universal system of health insurance is everyone’s objective. But even if we pass an expensive health care bill in 2009 we won’t achieve it. We just don’t have enough money to cover everyone. Maybe, in the most expensive proposals, we would make it possible for 90% to be covered. In others, far less.The problem is that without an absolutely seamless system there will still be people
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Wyden-Bennett Touted as an Alternative
I have to say I was a bit surprised watching Meet the Press this morning to hear the pundits on both sides of the political spectrum discussing the Wyden-Bennett Healthy Americans Act as an alternative to the more partisan Democratic health care reform bills already on the table in the House and Senate HELP Committee.The Republican spin seemed to be that, "We've always been for Wyden-Bennett,
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Unions May Get a Pass on Health Care Benefits Tax
There is a major bipartisan effort going on in the Senate Finance Committee to reform the health care system.Reportedly, one of the elements of that effort may be a tax on "gold plated" health insurance benefits above a certain threshold--$17,000 for family coverage is one option being discussed. The new tax could raise close to $300 billion over ten years to help pay for a health care
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The Co-op Version of the Public Plan—It’s a Camel!
I am sure you have heard the story about the committee that was charged with designing a horse but, because of the bureaucratic ways of the committee process, instead ended up creating a camel.We will not see a Medicare-like public health plan as part of any health care reform bill in 2009. I know proponents don’t want to hear that but it is crystal clear to me there simply are not the Democratic
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Time to Take Another Look at the Wyden-Bennett Healthy Americans Act?
This from today's Kaiser Health News:"A bipartisan proposal from Sen. Ron Wyden, D-Ore., to replace the tax exclusion for employer-based health benefits with a standard deduction would do more to contain healthcare spending than Senate Finance Chairman Max Baucus' plan to cap the exclusion, according to a recent assessment by the Joint Committee on Taxation,' Congress Daily reports. 'The
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Senate Finance Scrambling to Find a Way to Pay for Health Care Reform While CBO Warns That the Congress Needs to Get Serious About Cost Containment
Toldjaso.As I have been posting, it has been my observation that the Democrats were headed for a health care bill that had a little cost containment window dressing, would take a little off the top in provider payments, and use lots of new taxes to pay for at least half of it. I also argued that would not be health care reform but just entitlement expansion.Apparently the CBO (God bless’em)
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The Dumbest Thing I have Ever Seen a Health Insurance Company Do––And Three of Them Took Their Turn Doing It in Front of the United States Congress
And, I’ve been in the business for 37 years.First, let me stipulate we really need a system of universal care where everyone gets to have insurance. But we don’t yet so certain rules are unavoidable until we do.Here are a few separate clips from today's Los Angeles Times article, "Health Insurers Refuse to Limit Rescission of Coverage:""Executives of three of the nation's largest health insurers
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Just Which $2 Trillion Were They Talking About?
Just two weeks after putting $2 trillion in health care cost reductions on the table, the response to President Obama's plan to cut the health care providers by a total of $618 billion over the next ten years ($305 billion in his original budget and another $313 billion this week) is startling--if not in the final analysis predictable.Given that, at present trends, we are on our way to spending
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It’s NOT the Prices Stupid!
Out here on Kent Island, the federal government says that I like to watch the Baltimore TV stations and therefore forbids my satellite provider to give me access to the local DC channels. (We’re about an hour from both Baltimore and DC.)There is reason number one never to put the government in charge of any more than absolutely necessary.While my new digital converter box had been working just
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Here's an Example of a Cooperative Not-For-Profit Health Plan--North Dakota Blue Cross
North Dakota Senator Kent Conrad has proposed establishing not-for-profit cooperative health plans as an alternative to the Medicare-like public health plan President Obama supports.I will suggest Senator Conrad take a look at this one:North Dakota Blue Cross Blue ShieldFrom their website:"More than 65 years ago, Blue Cross Blue Shield of North Dakota (BCBSND) began as two separate pre-paid
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Health Care Cooperatives--An Old New Idea--So What's a Blue Cross Plan?
As opposition to a Medicare-like public health plan option grows, there has been a lot of talk about the compromise idea of creating not-for-profit health insurance cooperatives that would compete on a level playing field with existing private insurers. The reasoning goes they would keep the existing insurers "honest" by introducing a new element of competition.That's a great idea.And it was a
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Raising Taxes to Pay for a Health Care Bill--Apparently the Congress Wouldn't Be Able to Find a John Deere in a Hay Stack
Why Do We Need to Raise Taxes to Pay For a Health Care Bill in a System That Has $10 Trillion in Waste?White House Budget Director Peter Orszag has promised in the next few days to detail just how the administration would like to see health care reform paid for.There are some people who question whether he will play it straight or play games with those numbers—will the list really be scoreable?He
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The Health Industry's Achilles Heel
by BRIAN KLEPPER and DAVID C. KIBBE"You never want a serious crisis to go to waste." - Rahm Emanuel, White House Chief of Staff.Timing matters. The health industry has demonstrated steadfast resistance to reforms, but its recently diminished fortunes offer the Obama Administration an unprecedented opportunity to achieve meaningful change. The stakes are high, though. The Administration's health
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The House Tri-Committee Bill—The Playing Field Just Moved Back to the Middle
Just when people were getting ready to write-off the Baucus bipartisan approach to a health bill the debate has swung back to the middle on a number of critical issues.For a longtime I have been telling you two things:The final health bill will be more moderate than liberal—for example, no Medicare-like public plan, only a soft individual mandate, but including insurance exchanges and
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Public Plan Option: Sustainable Growth Rate Formula On Steroids?
Everyone in the health care debate seems to agree that the biggest problem is costs and that the best way to control costs is to get at the waste in the system. To raise the money needed to cover everyone and to make the system sustainable, goes the argument, we need to convert the upwards of 30% in excess costs now in the system to savings. I think that’s right. Many of my friends in the health
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Beware of Tax Increases Disguised as Good Health Policy
Many believe we need to use the tax system as a way of reforming the health care system.The idea is to use tax policy to encourage more efficient benefit plans. It seems to me such proposals make a great deal of sense as part of a more comprehensive reform.However, I am worried that the Congress will simply raise taxes to pay for health care reform--perhaps as much as half the cost of a new
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$2 Trillion Sure Doesn't Buy You a Lot These Days
I know that we talk in terms of trillions and not billions in Washington these days but even by that new standard the way the Democrats are dissing the "$2 trillion stakeholders" is amazing.Not two days after the big stakeholder trade associations offered their "$2 trillion in health care savings," President Obama called on Congress to pass a health care reform bill that included the dreaded
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The Health Care Reform Meter--Do the Dems Have the Money to Pay for It?
If I knew anything about computer graphics I'd post this really neat picture of a meter--sort of like a your car's gas gauge.The full point would represent the cost of a health care bill--somewhere in the $1.2 trillion to $1.5 trillion range.Each time someone put up scoreable savings I'd post it toward achieving the ultimate objective.So, you will have to imagine my meter.Here's where I think we
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How to Use Comparative Research to Manage Health Care Costs
Recent proposals from the American Medical Association (AMA) to voluntarily use comparative research information ring hollow without their having any teeth to assure the information is in fact used.I thought Gail Wilensky had some thoughtful comments on the issue of using comparative research to control health care costs in today's Kaiser Health News.An excerpt from her interview with Christopher
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The Health Care Affordability Model—A Plan That Will Control Costs and Improve Quality
The Health Care Affordability ModelHealth plan networks made up of insurers and providers would be required to first begin to stabilize and then control their costs. Failure to do so would mean the loss of their federal tax qualification. Premiums for a non-qualified health plan would no longer be tax deductible for individuals or plan sponsors who used these unqualified plans.The Affordability
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Stakeholders Provide 28 Pages of Detail on How to Save $2 Trillion Dollars--And They Did it With a Straight Face!
America's Health Plans (AHP), the American Medical Association (AMA), the American Hospital Association (AHA), The Pharmaceutical Research and Manufacturers Association (PhRMA), the Advanced Medical Technology Association (AdvaMed), and the Service Employees International Union (SEIU) have detailed their plans to "do our part" toward achieving the administration's goal of saving $2 trillion in
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Kaiser Health News Debuts Today and Features an Important Insight Into a Likely Health Care Bill
Kaiser Health News (KHN) debuted today and is a critically important addition to America's debate over health care reform.As the media has downsized in recent years, we have lost many reporters who were health care specialists. KHN will provide news outlets across the country with an important specialized source of solid reporting from an organization that has come to be known as uniquely expert
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Money-Driven Medicine—N.Y. Premiere of Film, June 11
Many of you know Maggie Mahar who comments regularly on this blog and has one of her own.She is also the author of "Money Driven Medicine: The Real Reason Health Care Costs So Much."Now here is something to be impressed by, Maggie's book has been made into a movie! Here is a recent post from her blog, Health Beat, with an open invitation from Maggie to all you health care wonks out there to
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When We Really Do Health Care Reform They'll Know It In McAllen Texas
In recent posts I have expressed my concern that the Congress has all but given up on real health care reform and seems more interested in entitlement expansion.I worry that the Democrats have found the path to paying for a health care bill (note that I did not say health care reform).I will suggest that path includes a little cost containment window dressing so they can spin that they have a way
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UnitedHealth Knows How to Save $500 billion In the Medicare Program--So Why Do They Need the Extra Private Medicare Payments?
This from Erica Werner's AP story today:A major health insurer [United Health Group] says the government can save more than $500 billion in Medicare spending by sending patients to less expensive, more efficient doctors, reducing hospital visits by the elderly and cutting down on unnecessary care.So UnitedHealth knows how to save $500 billion in Medicare spending.Aside from the fact that all of
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An Open Letter to the New National Coordinator for Health IT: Part 4 -- Bringing Patients into the Conversation About "Meaningful Use" of Health IT
by DAVID C. KIBBE and BRIAN KLEPPERThe Obama health team at HHS and ONC are gradually establishing the rules that will determine how approximately $34 billion in ARRA/HITECH funds are spent on health IT over the next several years. But there is a "missing link" in these deliberations that, so far, has not been addressed by Congress or the Administration: how the patient's voice can be "
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The First "Harry and Louise" Ads!
To me a "Harry and Louise" ad is negative health care reform advertising meant to defend a special interest's self-interest in what we all pay for health care. Whether it actually has "Harry" or "Louise" in it is for me beside the point. To qualify it just has to be trying to scare people to protect a special interest.Yesterday, CQ's Drew Armstrong had a story with the headline, "Labor Unions'
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We Are On Our Way To Confusing Entitlement Expansion With Health Care Reform
I generally find Washington Post business columnist Steven Pearlstein levelheaded. But his column today has me shaking my head.Effectively, he is saying forget what it costs--health care reform needs to be done.His biggest problem is that he doesn't know the difference between entitlement expansion and health care reform.But the way things are looking neither does the U.S. Congress.From
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Progress on Finding the $2 Trillion--Insurer Association Says Physician and Hospital Payment Changes "Won't All Be Voluntary"
Just how will the health care stakeholders who promised President Obama $2 trillion in savings last week achieve the reduction?This from a May 18th Bloomberg story:Standardized billing and forms would cut administrative expenses, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a Washington-based trade group, in an interview today. Some likely measures, such as changing
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"Health Care Leaders Say Obama Overstated Their Promise to Control Costs"
That was the headline in yesterday's New York Times regarding Monday's promise by health care stakeholders to reduce spending by $2 trillion.A couple of snipets from the Times article:Hospitals and insurance companies said Thursday that President Obama had substantially overstated their promise earlier this week to reduce the growth of health spending.“There’s been a lot of misunderstanding that
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Paying For a Big Part of Health Care Reform With New Taxes Would Be a Terrible Mistake!
How would you like a chunk of your income taxes tied to the top line in this graph?The top line represents the health insurance cost trend rate over the past 20-years.The two bottom lines represent the increase in worker earnings and overall inflation during the same period.This chart comes from the Kaiser Family Foundation.I have repeatedly reported here that the Congress is having trouble
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Halfway to Paying for Health Care Reform? A Growing Consensus for Taxing Health Insurance Benefits Produces Lots of Money
But do we want to pay for most of it with tax increases?This is a reprint of an April 22nd post.Yesterday in Senate Finance it was clear that changes to the tax treatment of employer-provided health insurance are on the table.I thought it important to revisit my earlier summary of just what such a tax change does toward raising the needed money for reform. Since I posted this, the most commonly
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The $2 Trillion Offer to Reduce Health Care Costs—Now They've Done It!
First it was great to see the press coverage of the $2 trillion offer come back down to reality as the day wore on yesterday. From gushing over the “unprecedented” commitment to reform by these key stakeholder groups the news reports and editorials finally, by days end, reflected the fact that nothing is really promised or enforceable yet.Now we hear that these groups have to deliver specifics on
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"Trust But Verify"--Health Care Stakeholders to Pledge $2 Trillion in Reductions
This from the Wall Street Journal on Sunday:Major health-care providers are planning to pledge Monday to President Barack Obama that they will work to reduce cost increases in the nation's health-care system by $2 trillion over the next decade, officials said…Groups representing hospitals, health-insurance companies, doctors, drug makers, medical-device makers and labor are joining in Monday's
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An Open Letter to the Men and Women Over at the CBO--Hang In There!
Last November I did a post: To the Congressional Budget Office: Please Keep Playing it Straight!In it I said:I hope the CBO doesn't cave to political pressure and keeps doing its non-partisan down-the-middle job.If I hear the politicians whining and the special interests squealing about CBO's conclusions about how these cost containment "lite" proposals...don't save much money I know the CBO pros
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"An Open Letter to the New National Coordinator for Health IT: Part 3 -- Certification As The Elephant in Health IT's Living Room"
by DAVID C. KIBBE and BRIAN KLEPPERIn the first and second parts of this series we talked about how and why there is no universal definition for the term "EHR." Instead there is a legitimate, growing debate about the features and functions that "EHR technologies" should offer physicians seeking to qualify for HITECH incentive payments. We explored the layers of network technology, suggesting that
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A Side Deal on the Medicare Physician Fee Cuts? What Does That Say About the Chances for Health Care Reform?
John Reichard has dug deeper than anyone else into the Medicare physician payment problem in an important article in today's CQ HealthBeat.He reports that the Blue Dog Dems (about 50 House moderate and conservative deficit hawks) may be willing to give the docs a pass by not requiring offsets for a two-year patch for their upcoming fee cuts--including the 21% fee cut due on January 1st. They are
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CBO Proving to be an "Obstacle" to Health Care Reform--I Hope They Don't Cave!
Looks like it's "in season" for shooting the messenger up on Capitol Hill!Senate Finance Chair Max Baucus was heard to complain this week about that pesky Congressional Budget Office (CBO) saying that, "The slight challenge we have is getting numbers and estimates from CBO,“ he went on, "Otherwise, health care reform is in jeopardy. The learning curve for all of us is fairly steep."Well Senator,
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Will Arlen Specter Vote for Health Care Reform? Wrong Question.
The last couple of days have been filled with speculation about Arlen Specter’s party switch and the Democrat’s apparent success in getting to 60 seats in the Senate.Will the Specter switch, and filibuster-proof majorities at hand once Al Franken arrives, mean the Democrats can now ram through a partisan health care reform bill?The real question is just what will a health care reform bill cost
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Health Wonk Review--The Best Health Care Posts on the Web!
This week it's my turn to host Health Wonk Review, a regular review of some of the best health care posts on the web.Veteran Henry Stern starts things off this time with a timely discussion about just who should have the most say about your health care. If someone else (say, the government) is paying for your health care, how much say should your own doctor have? InsureBlog's Stern explores a
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An Open Letter (Part 2) to the New National Coordinator for Health IT: Opening the Aperture of Innovation
by DAVID C. KIBBE and BRIAN KLEPPEROne of the important decisions before Dr. Blumenthal and his colleagues at ONC and HHS is whether the national health information network will be one of closed appliances that bundle together proprietary hardware, software, and networking technology, or one of open data exchange and management platforms in which the component parts required to do medical
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A Public Health Plan That Looks Just Like a Big HMO---Why?
Respected health policy expert Len Nichols has published a paper, “A Modest Proposal for a Competing Public Health Plan.”There’s this 1970s TV commercial promoting Xerox document copiers. It opens with a sales rep for a competitor saying his machine is, “Just as good as a Xerox!”The Xerox commercial’s response is, “Then why not just buy a Xerox?”In the paper Nichols, and co-author John Bertko,
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Progress on Key Health Care Reform Issues?
I recently posted on what I see as a growing consensus for finding the money for health care reform—albeit only about half of it.I also see some consensus on what a health care reform structure could look like--or not look like.Proposals for a public health plan that would compete in the under-age-65 market look to me to be out--particularly one that would pay Medicare rates. I do expect the
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The Public Plan--Mutual Assured Destruction?
I typically don’t talk about my travels on this blog but something happened this week that bears reporting.Whether the federal government should or should not offer a public health plan alternative to compete with private insurers in the under-age-65 market is a hot topic in Washington and in the market.I recently posted on it in detail: The Public Plan Option for the Under-Age-65 Market—The
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"An Open Letter to the New National Coordinator for Health IT - Untying HITECH's Gordian Knot: Part 1"
An Open Letter to the New National Coordinator for Health IT - Untying HITECH's Gordian Knot: Part 1by DAVID C. KIBBE and BRIAN KLEPPERCongratulations to David Blumenthal on being named National Coordinator for Health Information Technology (ONCHIT). Dr. Blumenthal will be the person most responsible for the rules and distribution of the American Recovery and Reinvestment Act's (ARRA) nearly $20
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The Public Plan Option for the Under-Age-65 Market—The Biggest Health Care Controversy on the Hill
Since when was a two-tiered health insurance system a Democratic policy goal?Among Democrats in the Congress and at the White House there is a great deal of interest in creating a government-run health plan in the under-age-65 market. Such a plan would compete with the existing private health insurance market in a head-to-head showdown between private and public health insurance.Such a plan was
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Will We Finally Have Health Care Reform This Time?
Will we have a big health care reform bill passed by the Congress and signed by the President in the next year?Readers of this blog know my opinion--show me where the trillion dollars comes from and I will be optimistic.CQ's Drew Armstrong and Alex Wayne have a thorough and detailed feature article on that question in the April 5th CQ weekly, "A Second Onion."Here's a bit of the article and a
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"A Self-Fulfilling Prophesy: The Continuity of Care Record Gains Ground As A Standard"
A Self-Fulfilling Prophesy: The Continuity of Care Record Gains Ground As A Standardby Brian KlepperWe live in a time of such great progress in so many arenas that, too often and without a second thought, we take significant advances for granted. But, now and then, we should catalog the steps forward, and then look backward to appreciate how these steps were made possible. They sprung from grand
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Congress Taking a Second Look At Changing the Way Health Benefits Are Taxed--Good--But We Can't Tax Our Way to Health Care Reform
As you have heard me say many times, paying for health care reform is the real challenge. An Obama campaign-style health plan will likely cost at least $1.5 trillion over the next ten years.Until I see some constructive progress on how we pay for health care reform I cannot be optimistic the latest health care reform debate is going anywhere.Where we stand today is that the Congress and the
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"Sick Around America" on FRONTLINE
You may remember the FRONTLINE report, "Sick Around the World." It was the best job I have ever seen anyone do summarizing five different national health care systems--the U.K., Taiwan, Germany, Japan, and Switzerland--in just one hour.I recommended it when it originally ran and I recommend it today. You can still see it here.Now FRONTLINE has aired producer Jon Palfreman's effort to explain
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"EGMN: Notes from the Road"--A Refreshing and Interesting Look Inside the World of Docs
I just discovered a relatively new blog that might be of interest to you: "EGMN: Notes from the Road."It comes from the publishers of a number of the periodicals physicians read, including Internal Medicine News, Cardiology News, and Family Practice News. Their unique take on the world of health care and policy blogging is to post from medical meetings, press conferences, and policy gatherings
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"Take the $600 Billion in New Revenue from Obama's 'Cap and Trade' Climate Change Proposal and Use it To Pay for Health Care Reform"
Last week Senate Majority Leader Harry Reid was quoted as raising the possibility we could take the $600 billion in new revenue projected from a "cap-and-trade" plan to cut green house-gas emissions and use some or all of it to help pay the estimated $1.5 trillion cost for comprehensive health care reform.Energy and climate change issues aside that would be a bad idea--a really bad idea.The
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"Will CIGNA Remake The Health Plan Marketplace?"--CIGNA Embraces Onsite Clinics
Will CIGNA Remake The Health Plan Marketplace?by BRIAN KLEPPERAmerica’s health plans are floundering. If their job has been to provide the nation’s mainstream families with access to affordable care (let’s leave quality out of it for the moment), they have failed miserably, though they were very profitable along the way, at least until Q1 2008. In 2008, the Milliman Medical Index – an estimate of
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Anybody Know Where We Can Find a Quick Trillion Dollars?
"Irrational exuberance" over the chances for health care reform meet the budget realities.The House and Senate Budget committees have begun work on the federal budget.Last week’s CBO report estimated the Obama budget would:Produce a nearly $9.3 trillion deficit over the next decade.Generate annual budget deficits of nearly $1 trillion in each year from fiscal year 2010 to 2019.Increase budget
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Little Ado About Nothing—Part Deux
Last November, the insurance industry offered to do away with pre-existing conditions limitations. This week the health insurance trade associations have also offered to phase-out the practice of varying premiums based on health status in the individual market.From their letter to Congress this week:Specifically, by enacting an effective, enforceable requirement that all Americans assume
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The Newest Health Care Reform Arithmetic--Unbelievable!
"A coalition representing 30 health care organizations on Monday asked lawmakers in the House and Senate to suspend pay-as-you-go rules when drafting and passing health care overhaul legislation, saying much of the savings introduced by such a plan would be realized beyond the rules' 10-year budget window."That paragraph from last week's Kaiser Daily Health Policy Report caught my eye.I don't
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Physician Payment Reform--Time for Hard Choices
I recently authored a guest editorial in the February 15th edition of Family Practice News--"The Leading Independent Newspaper for Family Physicians."Many years ago, the Congress established the Sustainable Growth Rate Formula (SGR) to control physician spending in Medicare. The concept is simple, if Medicare physician costs grow at a pace beyond affordability, next year's payments get cut to
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The Intensifying Collapse of the Health Care System, Why It's Different This Time, and What We Need to Think About Along the Way
The Intensifying Collapse of the Health Care System, Why It's Different This Time, and What We Need to Think About Along the Wayby Brian Klepper and David C. KibbeMore than at any time in recent memory, powerful forces are buffeting the health care sector. We are in the midst of profound upheaval, driven by market and policy responses to the industry's long-term excesses. We can already see
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The Obama Health Care Budget Cost Cuts Pretty Small
In conversations with members of the press the last couple of days, it is apparent the scope of President Obama's proposed federal health care cuts is not well understood in context.Is the President really making hard choices to bring America's health care spending under control?You decide.Here are some facts from the Obama budget message spreadsheets (pages 117-127):In 2012, three years into the
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"Five Recommendations for ONC Head Who Understands Health IT Innovation"
The team of David Kibbe and Brian Klepper are at it again with some advice on who best understands the health IT challenge in America:Five Recommendations for ONC Head Who Understands Health IT Innovationby DAVID KIBBE and BRIAN KLEPPERNow that the legislative language of the HITECH Act -- the $20 billion health IT allocation within the economic stimulus package -- has been set, it's time to
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A Detailed Analysis of the Obama Health Care Reform Budget
Speaking about the imperative to bring America’s entitlement spending under control last December, Barack Obama said, "What we have done is kicked this can down the road. We are now at the end of the road and are not in a position to kick it any further. We have to signal seriousness in this by making sure some of the hard decisions are made under my watch, not someone else's.”Right-on!But in his
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A Commission on Entitlement Reform--A Good Idea
The Kaisernetwork reported the following today:On Sunday, White House Office of Management and Budget Director Peter Orszag during an appearance on ABC's "This Week" said that Obama might establish a commission on entitlement reform, or broader health care reform, to take some of the authority over the development of legislation from Congress. Under such a commission, the Obama administration and
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What is Needed to Unravel a Gordian Knot is a Bold Stroke—Access and Coordination
Today, Andy Wallace joins us with some concise advice on how to make our health care system work far better.He comes with a special perspective; a highly regarded physician specialist, a former medical center executive (former CEO of the Duke University Hospital), a former Dean of the medical school responsible for the Dartmouth Atlas and Vice President for Health Affairs at the Dartmouth Medical
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Medicare Advantage HMO Stocks Down Big This Week
Matthew Holt, publisher of the Health Care Blog, and I have been in a state of incredulity over Wall Street’s head in the sand view of the Medicare Advantage business for more than a year. See his post today, "I Don't Really Understand Wall Street, Part 98."Why was it that in the wake of a Democratic take-over of Congress in 2006 and Obama’s victory last November that HMO stocks heavily invested
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Mr. President, Aren’t You Just Kicking the Can Down the Road?
Pieces of the health care portion of the Obama budget are leaking out.Based upon published reports, the Obama “down payment on health care reform” will include:$634 billion to help pay for health care reform over the next ten years. $318 billion of that—about half—will come from tax increases that include reducing the mortgage and charity deduction for high income Americans.Charging wealthier
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"Obama Budget Would Creat $634 Billion Health Care Fund"
Here is what Ceci Connolly is reporting at the Washington Post:President intends to release a budget tomorrow that creates a 10-year, $634 billion "reserve fund" to partially pay for a vast expansion of the U.S. health system, an overhaul that many experts project will cost as much as $1 trillion over the next decade.Obama would pay for the expansion by trimming tax breaks for the wealthy and
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For the Obama Administration Health Care Reform Will Require Really Tough Cost Containment—Coming and Going
The President has made a powerful argument—America cannot get its economic house under control without comprehensive health care reform. The cost of existing entitlements—public and private—and any new ones are just too big a ball and chain on our short and long-term economic health.The President has also argued that there could be no better time to fix this mess than now—when it is so critical
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Raising the Price Before You Put It On Sale—The Obama Budget and His Health Plan
The Obama budget team has made it clear they are going into the next federal budget process playing it straight on many fronts that the prior administration had fudged on.The cost of the wars, the cost of adjusting the alternative minimum tax each year to keep the middle class from falling into it, the cost of disaster relief, and the cost of avoiding the otherwise automatic cuts to Medicare
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SavingPrimaryCare.org Doing Good Work
A comment to a recent post caught my attention.There is a new group of primary care practitioners doing some good work that deserves some attention.From their website:SavingPrimaryCare.org is an off-shoot of the Ideal Medical Practices Project that has been running since 2006. This grant funded project supports solo and small practices across the US as they struggled to provide
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“Leading Figures in the Nation’s Long-Running Health Care Debate…Appear To Be Inching Toward a Consensus”
Robert Pear, in the New York Times, is reporting that, “leading figures in the nation’s long-running health care debate…appear to be inching toward a consensus that could reshape the debate.”He goes on to write, “While not all industry groups are in complete agreement, there is enough of a consensus, according to people who have attended the meetings, that they have begun to tackle the next steps
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The Big Stakeholders and Health Care Reform--No More Happy Talk?
For a number of months I have been beating the drum that there is nowhere near the consensus for health care reform we need to get the big one done and that the key stakeholders are no more ready to give up valuable real estate to make it happen than they have been in years past.I got a call from Maggie Mahar earlier today to discuss an article in yesterday's Chicago Tribune, written by Julie
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Drug Industry Wins Comparative Research Fight in Stimulus Bill
If you are looking for something to do over the weekend I suggest reading the one thousand page final stimulus bill.You can access it here.This past Wednesday, I posted the following regarding the differing health care comparative effectiveness research provisions in the House and Senate versions of the stimulus bill:Comparative research--which drugs or medical devices work the best--makes a lot
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Health Care Reform--The Stimulus PreGame
"Drug Makers Fight Stimulus Provision""Lobbying War Ensues Over Digital Data"The first was a recent Wall Street Journal headline and the second headline comes from the Washington Post. Both refer to what were supposed to be two already agreed on health care reform ideas--comparative research about which treatments work best and the creation of a nationwide system of medical records. The lesson
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The "Cleanest and Strongest Lever" to Make Health Care Reform Work
I like the Congressional Budget Office (CBO). In a town where self-serving BS generally pollutes the health care reform discussion these guys regularly play it down the middle. Are they always right? I suppose not. But they play the game on the up and up and that makes them noteworthy.Their latest contribution came from Director Doug Elmendorf. In Congressional testimony he said that, "The
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The AMA Wins A Round Against Patient Information
The AMA Wins A Round Against Patient InformationBy BRIAN KLEPPEROn January 30th, a 3-judge DC appeals court overturned a lower court decision that would have forced public release of Medicare physician data. Writing for the majority in a split 2-1 judgment, Circuit Judge Karen LeCraft Henderson declared that, “The requested data does not serve any (freedom-of-information-related) public interest
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Ron Wyden for HHS Secretary
Let me be the first to suggest that the President name Senator Ron Wyden (D-OR) to be the next Secretary of HHS.The withdrawal by Tom Daschle has underscored just how important it will be for the President to name someone who can bring a number of key strengths to the job. The right candidate will have:A high degree of respect from members of Congress--both Democrats and Republicans.An
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Daschel Withdrawal Sets Back Health Care Reform
In many ways picking Tom Daschle to be HHS Secretary was the perfect choice. The former Senate majority leader knew Congress like the back of his hand, he wrote a book outlining not only what would be the Obama health plan but laid out the process to get there. He is an effective communicator on behalf of the administration on an issue that can easily become buried in controversial policy minutia
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The Daschle Appointment and "Limousine Liberals"
Republicans are fond of referring to liberals who lead a comfortable life while claiming they understand the plight of the poor as "limousine liberals."I have a friend who says that when you first come to Washington you see it as this ugly political swamp but after you are here awhile it begins to seem like this wonderful hot tub. He says that's when it's time to get out of town and go back
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To Break the Bank or Not to Break the Bank With Health Care Reform?--The Wrong Question
The new debate in Washington these days seems to be over whether we can or cannot afford to do health care reform given the financial crisis and the huge budget deficits.Some argue that with the rising unemployment rate, certain increases in the number of those uninsured to follow, and the need to inject money into the system, this is the right time.Others say that in the face of daunting
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"Consumer-Driven Health Care: Promise and Performance"
I am always struck by the difference between the salesmanship of health plans offering consumer-driven health products and the reality of the data.James Robinson and Paul Ginsburg have an article in the January 27th edition of Health Affairs with an objective review of the consumer-driven movement of recent years.Here is the central point of the article:The performance of consumer-driven health
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Five "Shovel-Ready" Health Care Reforms
Five "Shovel-Ready" Health Care ReformsBy Brian Klepper & David C. KibbeMicrosoft Health Vault's leader Peter Neupert has a wonderful blog post that makes two important points really well. One message is that health care reform is about the outcomes, not the technology. We should think expansively about which technologies to invest in, based on the results we want to get.The other message is the
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SCHIP Bill Not a Good Sign for Major Health Care Reform
The extension and expansion of the State Children's Health Insurance Program (SCHIP) has now passed the full House and the Senate Finance Committee and is on its way to the full Senate.After minor differences between the House and Senate are reconciled it will become law.However, the way it is being done does not give me a good feeling.In the Senate Finance Committee the Democrats were only able
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What It Will Take for President-Elect Obama to Accomplish Health Care Reform
President-elect Obama has listed entitlement reform as a major goal for his incoming administration.Just this week he said, “The big problem is Medicare, which is unsustainable. We can’t solve Medicare in isolation from the broader problems of the health care system.”I doubt anyone would disagree with the President-elect on that score.Fixing the entire U.S. health care system cannot be done in
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Cuomo Shows the Health Insurance Indusry Who's Boss!!
New York Attorney General Andrew Cuomo today announced a "victory" in his battle with the insurance industry over how out-of-network physician claims are paid. Cuomo had argued that the industry's use of its out-of-network "customary and reasonable" database "defrauded" consumers and he sued the database's manager, United Health's Ingenix, over the controversy.In a February 2008 post I said, "In
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Health Care Reform––Are the Adults Taking Over?
In past posts I have pointed to what I called the “irrational exuberance” over health care reform––that the excitement over the new administration and its ability to accomplish all the big things was getting out of hand.There was even talk that Democrats would use the Senate budget reconciliation process and bypass the 60-vote rule enabling them to use their big new majorities to ram their idea
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Sanjay Gupta Could Be a Great Pick for Surgeon General
I have been surprised at some of the political criticism President-elect Obama has taken for considering CNN correspondent Sanjay Gupta for Surgeon General.That some in the Public Health Service would be concerned career officers are being passed over is legitimate. And Gupta does not have managerial experience overseeing thousands of career health officers.But the most successful Surgeon General
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Let's Reboot America's HIT Conversation--Part 2: HIT Beyond EHRs
Let's Reboot America's HIT ConversationPart 2: HIT Beyond EHRsby DAVID C. KIBBE AND BRIAN KLEPPERYesterday we tried to put EHRs into perspective. They're important, and we can't effectively move health care forward without them. But they're one of many very important HIT functions, and EHRs and HIT alone won't fix health care. So developing a comprehensive but effective national HIT plan is a
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The Five Myths of Health Care Reform––Health Information Technology, Prevention, Outcomes Research, Pay-For-Performance, and Universal Coverage
The arguments that the widespread use of health information technology (HIT), improving health status, expanding outcomes research, implementing pay-for-performance systems, and covering everyone will make it possible for us to afford comprehensive health care reform are commonly cited by people on both sides of the political aisle.It's all a myth.Undoubtedly, these ideas will be at the core of
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"Let's Reboot America's HIT Conversation---Part 1: Putting EHRs in Context"
Last Month David Kibbe and Brian Klepper asked me to post an open letter to the Obama Health Team with their thoughts on how to spend the coming federal health IT money. That letter ended up as the centerpiece of a Boston Globe story with the lead line, "some specialists are warning against investing too heavily in existing electronic recordkeeping systems."Encouraged by the response to that
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