Monday, September 28, 2009

Democrats killing health reform...

There are so many people who are absolutely convinced that the republicans are killing healthcare reform. This usually makes me laugh a little, because, while they have certainly not been very helpful, the republican minority has very little real power currently, and are really bystanders in this whole affair. The REAL problem is the democrats. In particular the blue dogs who control a certain amount of power within both the house and senate, and are staunchly against the public option.

The real problem for Obama lies in what to do. He could choose to ram something through with reconciliation, although many on both sides would likely cry foul. If he succumbs and doesn’t pass a real, substantive healthcare reform bill, then he will alienate many of the more liberal democrats who strongly supported him. He ran on “Change”. The bills currently are not change. The WH hands off approach is not change.

The Baucus bill currently sits with 564 proposed amendments. It will likely not survive in any recognizable form. This article below describes what is happening. Schumer and Rockefeller are prroposing an amendment to include a public option, but Conrad and Baucus have already indicated that they will vote against it. Reid is calling on Obama to act as a referee for the senate sausage procedure, and the House leadership is stating that they will not even consider passing any legislature without a public option.

This is in the midst of RAPID escalations in healthcare spending, and significant growth in the ranks of uninsured thanks to a Wall Street induced recession.

Too bad, we could maybe actually fix something, but I really don’t think Congress is capable of doing the right thing here.

See more HERE

Healthcare Premiums

So, I've held off being really critical of the Baucus bill for a while, even though it is complete garbage. I am actually, quite certain that one of the insurance industry executives actually wrote it. Cause they win big. Yeah, they have to get rid of their history of recission, and of denying coverage for pre-existing conditions, BUT, with the mandate, and the exclusion of a public option, they stand poised to rake in hundreds of millions in additional revenue.

This article describes quite nicely the net effect of healthcare premiums next year. Even though the economy is rather static, although no longer contractile, healthcare premiums are expected to jump by 10% for workers, and 6% for employers.....

See article HERE

Does anyone really think that this might put more inflationary pressure on small businesses, and result in even more people losing work based coverage. It is truly bad enough that only 38% of small businesses currently offer health benefits.

The real sad part, described in the article, is how workers have seen their premiums triple in just the past 8 years. This is not sustainable long term. While they it may not be wall street brokers, trading default swaps, this represents a real threat to our long term economic vitality.

Friday, September 11, 2009

Budgetary concerns...

SO, I had a nice, long holiday weekend, and then had some work and family obligations over the past several days, and I apologize for my short absence.

Talking to a friend the other day, who works as a CFO for a large corporation, and showed me some interesting data from the Institute for Trend Research, a company he uses from time to time.

We were discussing the deficits, and the economic implications of ramped up deficit spending. These numbers are a little mind boggling.

Based on the current CBO estimates of future deficits, If there is a 1/2 of 1 % increase in real market interest rates (50 basis points), the governments debt service as a % of total budget outlays will grow to approximately:

13.0% in 2009
25.5% in 2012
34.1% in 2015

This excludes any effect from a change in Health care.

That's scary, like REALLY scary. 34.1% possibly in debt service obligations within 6 years??? WTF?? OH, and we haven't even touched on inflation yet. Which could become rampant if US debt obligations accelerate, which, in turn, could devalue the dollar.

This is multifactorial, and due to the deficit spending of the last administration, the Afghanistan/Iraq wars, and the recent stimulus package.


Friday, September 4, 2009

Obama's crisis

As usual, Bob Laszewski has it right again.

Obama is stuck between a rock and a very hard place. If reform fails, or becomes too compromised, the left may never forgive, not after his campaigning, and initial statements on the importance of health reform.


He talks about the two options available to the President. Neither are very appealing, and Bob is right, both have serious possibly political consequences, not only for the President, but perhaps for the entire Democratic Party.

I imagine the conversations in the Oval Office are quite heated indeed.

Now we see the death of reform

After speaking with more politicians than I care to really think about, I am convinced that congress cannot effectively pass good healthcare legislation. They simply do not have the ability to do so. Perhaps if two-term limits were in place, things would be different, but that is an entirely different discussion. Speaker Pelosi is now saying, as some of her colleagues have earlier in the House, that without a public option, a health bill WILL NOT pass the House.

Here's the problem. The Senate is faced with a much tougher problem, particularly from a certain group of Democrats who are, at this point, opposed to a public option. This is why the "Gang of Six" are still in session. What's funny is that many people are blaming Republicans, and to be sure, they have not played nicely in this debate, but it is the blue dog democrats who are going to run this bill into the ground.

What good is having a majority, if the majority won't follow you.


Medical Home Model

So this was interesting. We have all heard talk now for years about the medical home concept, and how this would help retain primary care physicians, increase patient satisfaction, and lower costs.

It would seem that now, someone has studied that.

The Group Health Home Cooperative performed a study comparing a medical home model with a control group.

“A medical home is like an old-style family doctor’s office, but with a whole team of professionals,” said Robert J. Reid, MD, an associate investigator at the Group Health Center for Health Studies and Group Health’s associate medical director for preventive care. “Together, they make the most of modern knowledge and technology– including e-mail and electronic medical records – to give patients excellent care and reach out to help them stay healthy.”



During the medical home pilot, each primary care doctor was responsible for fewer patients – a total of 1,800 patients, as opposed to 2,300. This reduction allowed physicians more time to coordinate care, have daily “team huddles” and allow for extended 30-minute office visits per patient.

The reduction in patient-to-physician ratio also created a need for extra staffing. The study found that the medical home was investing $16 more per patient per year, and that the home needed 72 percent more clinical pharmacists, 44 percent more physician assistants, 18 percent more medical assistants, 17 percent more registered nurses and 15 percent more primary doctors.

“Our evaluation showed these costs were recouped within the year,” Reid said. "The main reason was emergency room savings of $54 per patient in the course of the year.”

“These findings are important because they provide a 'proof-of-concept' that investments in a medical home can achieve relatively rapid returns across a range of key outcomes," he added.

Is the AARP suffering from Alzheimers?

They seem a bit confused.


So the AARP which was initially very supportive of Obama’s healthcare initiatives is now impersonating John Kerry.

First they were for it, now they are impartial?

Please. This is one of the reasons that we will not see substantial, and/or real health reform this year. I’m sorry, but congress is simply incapable of making the right decisions, and while the AARP is certainly not congress, their lobby carries a bit of weight on capitol hill, and the same pressures that are being applied to the AARP are also being applied to congress.

More at this LINK



Thursday, September 3, 2009

Minnesota payment system

Similar to a system like Prometheus that uses a "bundling" paradigm, Medica in Minnesota has developed such a package of "Paying for Value" with Fairview Hospital system.

More on NPR

I hope that more hospitals, and systems realize that this sort of reform can acutally have a lasting effect, and hopefully begin to slow, or curb HCE growth.