"Hospitals Not-Profit Full"

Was Zach of 'Rage Against the Machine' implying what we're all thinking now?

How many non-profit hospitals/hospital systems truly deserve their non-profit status?

Should they be competing with the for-profit systems in the same way?

Traditional Medicare is More Efficien than Medicare Advantage Plans? So Says MedPAC Chair Hackbarth

Overall, it may be true.

But the good, cost-effective, high-value Medicare Advantage plans (which often are tightly managed by virtue of a risk-sharing structure) are getting a bum rap by being lumped in with the FFS Medicare Advantage plans.

Guess what?

The fee-for-service versions of these plans aren't managed as tightly, and have more cost! It doesn't take a rocket scientist to figure this out!

From a recent MedPAC report:

"...However, most of the enrollment growth was in private FFS plans—whose enrollment more than doubled last year. Yet, private FFS plans have no requirement to coordinate care or report quality measures, and their payments and inefficiency are even greater (117 percent and 108 percent of FFS) than the MA program as a whole."

Down with the Anti-Vaccinists!

I've said it before...

The anti-vaccinists are selfish bastards, that think nothing of leeching off of the rest of society. Belgium has taken a hard stand on this, and rightfully so, jailing Belgians that refuse polio vaccine.

Polio is a horrible disease. The World Health Organization's efforts at eradicating it started in 1988, and they've done a pretty damn good job: 99% reduction.

Both medical experts and bioethicists agree:

"...unlike other medical problems, in which rejecting treatment only affects the individual, refusing a vaccine for a transmissible disease like polio puts others at risk as well."

"Ethicists argue that people who refuse vaccinations are taking advantage of everyone else who has been vaccinated. Once the majority of a population is vaccinated, there are few susceptible people the disease can infect, thus lowering the odds of an outbreak.

People who refuse to be vaccinated are 'free riders,' Harris said. 'They can only afford to refuse the vaccine because they are surrounded by people who have fulfilled their obligations to the community.'"


So, listen up you fucking selfish dumbshit anti-vaccination cocksuckers! Just because you're rich enough to both "afford" and waste the luxury of health care in this country doesn't give you the right to potentially inflict harm on the rest of the population.

...and once and for all, despite the media bullshit, vaccines don't cause autism.

Bite me...self-indulgent assholes.

2008 Election: Health Care Op-Ed Summaries

From the Kaiser Daily Report comes a nice summary of recent health policy op-ed pieces related to the election.

Virtual Bundling to Penalize Health Care Wasters

Virtual bundling to reduce payments to wasteful hospitals and physicians is likely to be coming soon from CMS.

It's a payment penalty. It's going to spank those that are inefficient and wasteful, thus depleting our precious health care resources.

I like it.

Even more, I like the concept of redistributing some of these funds to reward those with more responsible resource utilization, but only if this is not the sole variable (e.g., outcomes must also be considered if we want to ultimately reward on value).

I'm not quite sure what the "virtual bundling" concept will look like in practice, however.

Employer-Sponsored Health Care--"The Slick Pickpocket"

From the WSJ Health Blog:

Uwe Reinhardt, a Princeton health economist, likens the employer-based health insurance to a garden party where a very slick pickpocket steals your wallet and then buys you roses and chocolates. “You’d be very grateful,” Reinhardt tells the Health Blog. Employers “are pickpockets who very skillfully take it out of your paycheck. Then they say, ‘Now genuflect.’ ”

We all know this, but it's good to be reminded. Employer-sponsored health care is inefficient and ultimately is offset by salary adjustments, not typically from the profits of the organization.

Health Wonk Review Hosted by Work Comp Insider

Health Wonk Review is a biweekly summary of the best in health policy blog posts and knowledge.

Top 10 Health Affairs Blog Posts

Health Affairs kicks ass.

Here are the top 10 posts from the Health Affairs blog.

Fuck It...Who Needs Oxygen?

One way to reduce costs is to stop paying for oxygen 13 months after discharge.

Fucking rocket scientists in the Bush administration....

(Especially, because we all know how expensive oxygen is!)

Medicare Cuts Reimbursement 15.4% on 1/1/09

Don't fix the formula, and here's what you get.

(P.S., It'll be handled through the veil of efforts to improve quality and efficiency, with measures that place the burden for this on primary care physicians, without requiring tighter management of specialty referrals and procedures.)

Cap the Greedy Bastards, and Use the Money to Fund Mental Health Parity

Yeah. I'm for this bill.

1. Limiting the number of physician-owned specialty hospitals and ambulatory surgical centers will definitely reduce the number of unnecessary procedures being done in these places.
2. Mental health has been screwed over for way too long, and the lack of mental health resources ends up shifting costs to the medical side...health care costs go up without mental health treatment.

Even thought they're cheaper, I'm not convinced that they are safer or provide better service.

(FYI...the limits would protect my dumb-ass colleagues that continue to invest in these despite the fact that there's an oversupply in most markets.)

International Health Charity Fills Need in US

Believe it.

Remote Area Medical typically serves those in desperate need of health care in developing countries.

It turns out that there's a huge need here at home.

Their recent weekend outreach in Knoxville, Tennessee treated almost 1,000 people in need, and had to turn away 400 due to the overwhelming response.

I'd hate to see how bad it needs to get before we do something meaningful in health care reform, instead of the watered-down versions in some places (Mass, Colorado).

FDA Wants More Power

Give the FDA more powers?

Nah...fuck it. I'm against big government.

By the way, I also like shit with my beef, maybe even served with a side of Creutzfeld-Jakob Disease. Prions...mmm.

Should Universal Coverage Even Be an Item on the National Agenda?

Some people don't think so. Check out the article in the NY Times here.

Oh Shit. Bad News for Health Care Finance. Worse News for Health Status and Homelessness

Two graphs, one depicting trends in earnings, and another showing trends in housing prices, just might hint at what's in store...

(Never mind the fact that these folks are on a runaway freight train to homelessness and piss poor health status.)

Skin Color is Often the Most Important Predictor of Survival

RWJF on Thursday released a report that looked at how education, income, race and ethnicity play a role in health. Findings include:

• Blacks are more likely than whites to die from many health conditions, such as diabetes, heart disease and cancer (Hille, Washington Examiner, 2/29);
• Residents who have not graduated from high school are more than four times as likely to have poor or fair health than college graduates;
• College graduates on average live five years longer than residents who do not graduate from high school;
• Higher-income residents on average live two years longer than middle-income individuals; and
• About one in three lower-income residents has a chronic disease, compared with about one in 10 higher-income residents.

Nader and Single-Payer

Yes, he's running again.

And he's very clear about differentiating himself from the other candidates via his support for single-payer heath care.

Google Health and Cleveland Clinic--Hell Yeah!

Google and Cleveland Clinic are teaming up to create a personal health record (PHR) quicker than anyone else could hope.

PHR's from our perspective are very important.  The fact they are patient-centric is huge.  The fact that they are portable and can be viewed outside of the walls of just one clinic is extremely valuable, and ultimately saves lives by reducing the likelihood for medical error.

(If you live in Cleveland and, by chance, are somehow rendered unconscious and taken to an ER in Lincoln, Nebraska, the fact that the physician can access your information completely dramatically increases the likelihood that you'll survive.)

We've had the technology to do this for a long time, but so many people haven't had the balls to move forward.  These companies have been fearful of the potential problems associated with HIPAA, and have either chosen to rack up legal fees in the process of creating a watered-down version of their initial idea, or have abandoned the idea completely.

Google has balls.  And although I didn't realize it, Cleveland Clinic seems to have balls too.

I like it.  

HIPAA hasn't been tested in this fashion.  When a law is created, it's also important to test the legislation based on real-world scenarios.

Do something remarkable, and worry about the impact later.  This is an idea that kicks ass, that is revolutionary, and that is in the best interest of all of us.

Privacy is important, but not to the degree that people get hurt.

More commentary on The Health Care Blog...

Single-Payer versus Universal Health Care--Graham vs Porter/Teisberg

Single-payer options have a lot of merit, from both an economic standpoint and from the standpoint of moving towards a healthier society.

Check out this fantastic single-payer animation (which apparently was done by a doc while still in school).

My only adaptation of a single-payer approach would be that any such approach much ensure adequate competition, as discussed in more detail by Michael Porter and Elizabeth Olmstead Teisberg in their book Redefining Health Care.

In their book, the authors do conclude that traditional single-payer approaches can't/won't solve our problems, but state that the reasons for this are based on the assumption that a single-payer solution will eliminate competition as it has in other countries.  My take is that single-payer health reform and competition are not mutually exclusive.  We have an opportunity to learn from the weaknesses in other single-payer systems, and have experience from the polar opposite to design a "single-payer 2.0" option.

However you feel about single-payer, the authors provide a very nice and very thorough description of why universal coverage is essential to solve our problems. 

Coverage without Access is Meaningless-Gov Crist Proposal Falls Short

Like I've said before, you can expand coverage to win points with your supporters and to get elected.

Medicaid provides coverage. But nobody wants to accept Medicaid...they can't survive if they do.

Nobody is talking about reimbursement rates and how mandated coverage will affect these rates.

Governor Crist's plans are no different.