Reform
Health Care and the Broader Economic Crisis
10/02/08
I used to worry that the economic turmoil resulting from health care's relentless cost explosion would cascade into all other economic sectors. Now it appears that the credit crisis could push health care over the edge. The silver lining is that a sudden spike in the pressure on health care organizations could facilitate a transition to the meaningful reforms that are necessary to resolve the crisis.
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Chastened and More Sober, Harry & Louise Return
08/21/08
A clever new ad sponsored by powerful DC-insider groups features a reformed Harry and Louise, this time hoping that Congress will make the changes that they opposed during the Clinton years. But reform is unlikely unless the nation's most powerful power-brokers - non-health care business - galvanize and mobilize to drive it.
The State of Employer-Sponsored Health Coverage
04/28/08
New data make it clear that America's employer-based health coverage system is increasingly in shambles, providing adequate coverage to a rapidly diminishing percentage of the population. We can fix it or replace it but, for the good of the nation, we need to do one or the other. To let it languish causes enormous unnecessary suffering and cost.
An Open Response To HHS Secretary Michael Leavitt
04/22/08
Under the Bush Administration, HHS officials keep telling us how they support health care pricing and performance transparency. But in withholding Medicare physician data from public scrutiny - they have followed the AMA's advice that doctors have a right to privacy - they demonstrate that their interest in transparency is selective.
On Corporate Health Care: An Exchange with Maggie Mahar
03/28/08
In a response to my article on the emergence of corporately-run worksite clinics, Maggie Mahar argues against for-profit health care, and I clarify my position.
Families USA Health Action 2008: An Alternative Plan
01/29/08
Families USA is an impressive organization that has built a formidable platform over the year through its base, consumers. But to achieve the reforms it advocates for, it must leverage that platform with the one group that has enough strength and motive to bring meaningful reforms to fruition: large employers.
Families USA Health Action 2008: Don Berwick MD on Everything
01/28/08
Through patience, an ability to articulate need and solutions, and diplomacy, Dr. Berwick has facilitated tremendous quality advances in hospitals across the country. And that lends him enormous authority to urge the process on. At the Families USA meeting, he described his vision.
Families USA Health Action 2008: Tom Daschle on Reform
01/27/08
Former Senate Majority Leader Tom Daschle delivered a satisfyingly comprehensive and thoughtful reform proposal that made it clear he's aware of the deep challenges involved in actually getting change accomplished.
Families USA Health Action 2008: Nancy Pelosi's Address
01/24/08
Nancy Pelosi made a major health care reform speech at the Families USA Health Action 2008 Conference. If this is the most complete vision the Democrats have, then we're in trouble.
At Families USA Health Action 2008
01/23/08
The health care consumer advocacy organization Families USA invited several bloggers, including me, to attend their Health Action 2008 Conference in late January 2008. It was the chance to observe the health policy goings-on from the perspective of a very well-supported and well-intentioned group with great connections. I wrote several pieces there, though I doubt they appreciated my perspective.
Four Big Trends
01/15/08
Four relatively little-noticed trends will have profound, positive impacts on health care. Health 2.0 is using the Web to bring patients much better knowledge and data about all aspects of health care. The lawsuit by the advocacy group Consumer Checkbook to get HHS to make Medicare physician data public has the potential to make physician performance profiling easy. Come October, 2008, Medicare and most commercial health plans will stop paying hospitals for avoidable errors like "never-events." And though its slow, we're making steady progress toward the establishment of a national health care "comparative effectiveness" agency.
On Practical Reforms
01/08/08
We know a great deal about what works and what doesn't in health care, and what structural reforms are critical to re-establish stability and sustainability to our health system. But most policy-based reforms are ideological instead.
Business As Usual: California's Health Reform Proposal
12/20/07
Like the other reform efforts we're seeing, California's is characterized by politics, back room dealmaking, and who will win the biggest purse. That's not a probable recipe for real change.
Policy- vs. Market-Based Reforms: RHIOs As A Case Study
12/20/07
RHIOs as Health Information Exchanges (HIEs) offered great promise in theory, but have been blocked by interest groups concerned that the exchange of data would hurt their competitiveness. But that role is now taking on much greater power through Health 2.0 ventures, which will make data available independent of the wishes of those who wish to keep information secret.
Bad Medicine: How The AMA Undermined Primary Care In America
12/13/07
Unknown to most of us, over the last several years a proprietary AMA subsidiary, the RVS Update Committee, has been the sole advisor to CMS on physician reimbursement. Dominated by representatives of medical specialty societies, their consistent advice has resulted in much higher reimbursements for specialists at the expense of primary care and, more importantly, the American people. Their actions are directly attributable to the explosion of health care costs in America and to the crisis.
If Grady Fails
11/28/07
The first cracks in American health care's stability can seen most clearly in our safety net health systems, like Atlanta's Grady Hospital, where years of neglect, underfunding and demand have demoralized and overwhelmed that system's capacity.
A Broad Vision of Health 2.0
10/12/07
By creating product, service and knowledge exchanges, then knowledge- and data-driven decision support for everyone involved with health care, the Health 2.0 movement holds the promise to fundamentally and positively change how health care works.
Reform's Tougher Problem
08/29/07
Most reformers frame the problem in terms of universal coverage. But the much more difficult issue is cost and how to control waste in a policy landscape controlled by powerful special interests.
Don't Invite Anyone From Health Care
07/27/07
In October 2006, the Northern Nevada Health Care Coalition decided to hold a health care conference. They made sure their community's health care leaders knew about it, but pointedly told them they weren't invited. And the attendees unanimously agreed to contribute their data into a common data repository, so that it could be mined to identify problems and opportunities. Now they're focused on addressing each problem and opportunity they've found.
Employers, as the purchasers, can drive real solutions when they decide to be decisive.
Employers, as the purchasers, can drive real solutions when they decide to be decisive.
Mr. Bush's Health Care Reform Proposall
07/24/07
The Wall Street Journal ran an article on Mr. Bush's health care reform proposal. In terms of ameliorating the crisis, its functionally meaningless.
The Distribution of the Uninsured and the Total Population By Income Level, 2004
Source: US Dept. of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, Tabulations of the Current Population Survey
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The Distribution of the Uninsured and the Total Population By Income Level, 2004
Source: US Dept. of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, Tabulations of the Current Population Survey
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To Fix Health Care, Fix America First
07/15/07
We can't fix health care because Congress and our legislatures are bought off by the health care industry, and there's no more powerful force that has influence over our lawmakers. If you don't believe it, look at the size of the 2006 lobbying contributions in the table below.
The Cognitive Dissonance of Conflicted Care
06/15/07
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Can Consumerism Save Health Care
02/27/06
As standalone coverage vehicles, there are lots of reasons to worry that HSAs and High Deductible Health Plans aren't good answers if you're low income or have a chronic disease.
