Health Wonk Review #21

Is there a happier day of the bi-week than HWR Day? Not for us health wonks. Here is this round of health policy blogging, complete with first-time hosting jitters.

R-E-S-P-E-C-T

Over at RDoctor.com, Aleksandr Kavokin interviews Kim McAllister, an ER/critical care nurse and host of Emergiblog, about the nursing profession and operating a web site devoted to that profession.

What Price, Scooters?

Bob Vineyard of InsureBlog wrestles with the inanities of administered pricing in Medicare. The most recent round of silliness? How much Medicare should pay for power wheelchairs and scooters. Seems that Medicare outlays for those geezer-pleasers jumped 28-fold in eight years. Medicare's bureaucracy just reduced the amount it pays for the things, having gotten the impression that maybe they were paying too much. Gosh, do you think?

What Price, Biologics?

Sure, we want inexpensive biotech drugs. But some (read: biotech innovators) claim that biogenerics are impossible. David Williams of Health Business Blog has "a better idea than biogenerics." Rather than allow biogenerics, Williams suggests slapping price controls on biotech drugs after an initial period of market exclusivity.

What Price, Medicare Private Plans?

In related news, the Century Foundation's Leif Wellington Haase discusses the consequences of having Medicare pay private health plans based on the average senior's expenses when plans have the ability to disproportionately enroll seniors with below-average expenses. It doesn't take a genius to figure out that taxpayers end up paying more.

Haase concludes that Medicare should just give seniors the cash and let markets sort it out. No wait -- that's my conclusion.

Haase concludes that overpayments to Part D and Medicare Advantage plans should temper the enthusiasm of those who think that markets forces are doing wonders for Medicare. (Hey, that's my conclusion too.) Haase also suggests that those overpayments "ought to be used for more benefits or for deficit reduction, not for drug company and insurer profits."

Sine Qua Non of Controlling Health Spending

Speaking of things skewed, Ezra Klein rightly reminds us that we ain't gonna make much of a dent in health expenditures until we restrain consumption among the 5 percent of patients who account for half of the spending. Klein deserves two cheers (hip! hip!) for noting that the rules surrounding health savings accounts (HSAs) are too restrictive to bring cost-consciousness to all such expenditures.

The host dangles that third cheer in front of Klein to see if he can be cajoled into acknowledging that, if widely adopted, HSAs could bring price sensitivity to more than 60 percent of medical expenditures by the non-elderly. Over at EconLog, Bryan Caplan offers another reason why Klein may be too pessimistic about the ability of HSAs to reduce above-the-deductible spending.

Save a Life, Buy an Organ

Every year, over 6,000 Americans die while waiting for an organ transplant because Congress prohibits payments to organ providers, thereby creating an artificial shortage. (Who says we don't ration health care?) The always educational Healthcare Economist notes that support for payments to organ providers is bubbling up in some interesting places. You'll never guess which country eliminated their waiting lists with a considerably more liberal organ procurement system than ours.

Is Health a Human Right?

The American Public Health Association made human rights the theme of its convention this year, and the Health Affairs blog is all over it. Parmeeth Atwal provides the background and interviews American Public Health Association president Georges Benjamin. Commenters include George Annas, Larry Gostin, and Sophie Gruskin.

Build Your Human Capital

Rita Schwab offers the following advice to those looking to excel in health care: attend some of the gazillion conferences put on by the industry every year. How to choose among them? Schwab has some ideas.

Cut to Cure? Or Ride It out?

Over at Workers' Comp Insider, Jon Coppelman blogs a new study showing that patients who do not undergo surgery for a herniated disc eventually do just as well as those who do undergo surgery. The tradeoff is that they have to live with the pain a while longer.

But if the injury occurred on the job, workers' comp provides an interesting twist: because comp pays as long as the injured worker is unable to work, that creates an incentive to forgo surgery and collect 2/3 of one's salary while not working. Coppelman thinks insurers and employers would do well to steer clear of those costs -- i.e., don't start discouraging surgery.

How to Stand up to Your Rheumatologist

Add India's to the list of health care sectors that aren't following best-practice guidelines. Or so says Dr. Qaedjohar Dhariwal, an orthopedist writing at orthINDIA. Dr. Qaed lists "ten things any decent rheumatologist should be implementing in his practice" and advises that if your doc doesn't make it past Thing Number One, "ditch him."

The Hardest-Working Man in Health-Care-Blog Business

Matthew Holt, writing at Spot-on, thinks about what the Democrats might do if they had a Republican-like desire to reward their base, and how they'd need to create the political coalition to force through universal health care. Holt writes that a politically viable plan would have to (1) cover all the uninsured, (2) maintain the incomes and autonomy of doctors and hospitals, and somehow at the same time (3) convince employers and taxpayers that they won't end up paying more. (Quoth Ned Flanders...)

As if that weren't heavy lifting enough, over at The Health Care Blog Holt interviews Lonny Reisman, CEO of Active Health Management, a company that manages care using claims and lab data from insurers.

I'm not Going to Pay a Lot for This Procedure

Shahid Shah (a.k.a. The Healthcare IT Guy) gives a forum to Chini Krishnan, founder and CEO of Vimo.com, which hopes "to be the Lending Tree of healthcare and offer comparison shopping for surgical procedures, insurance, doctors, health savings accounts, and hospitals." Krishnan expects that HSAs and other forms of consumer-directed health plans (CDHPs) will encourage the development of tools that help consumers make smarter decisions -- and argues that CDHPs would have failed pre-Al Gore (read: before we had the internet).

One Spoonful at a Time

The title of this brief blurb comes from a New York Times Magazine article praised by Jon Schnaars at the Anxiety, Addiction and Depression Treatments blog. Schnaars provides links to that article and others on the struggle faced by families who are fighting anorexia.

Choose Your Enemies Wisely

Fard Johnmar, of Envisioning 2.0, takes a look at the recent flap between the American Heart Association and Pfizer over the release of data relating to Pfizer's "good cholesterol" medication torcetrapib. Johnmar shows how this incident highlights the tension between numerous competing interests: medical societies vs. drug makers, medical societies vs. "outside" investors, medical societies vs. the SEC, small vs. large drug makers...

Duking It out in Denver

Speaking of industry bigwigs not getting along, Louise of the Colorado Health Insurance Insider laments the way that patients are getting jerked around in the spat between HCA and United HealthCare in Denver. Louise rightly questions whether those CEOs are really earning their seven- and eight-figure salaries -- but did she call the U.S. health care sector a free market?

Shameless Self-Promotion

Finally, your humble host would be remiss were he not to plug the Cato Institute's recent offerings on Indiana Gov. Mitch Daniels' new health plan, a Health Affairs review of the Cato book Healthy Competition, and the ethics of the Born-Alive Infant Protection Act.

Next!

Health Wonk Review #22 is scheduled for December 14 and is to be hosted by Rita Schwab of MSSPNexus Blog. Get your entries in by Wednesday, December 13, at 9am EST.