It’s Health Wonk Review week! Oh, and the State of the Union was delivered, too. Even though the deadline for entries to this edition of the best of health policy blogging was 9 am the morning after, many bloggers were already debating the president’s foray into health reform.
The President’s plan. Robert Laszewski on the new Health Care Policy and Marketplace blog does a thoughtful job setting the President’s health reform proposal in context of the rash of reform plans. On the President’s plan, he writes: “The Bush plan (a regrettable label) is based on an old and generally discredited idea: the old health insurance “tax cap” proposed by Alain Enthoven circa 1979. But instead of merely a cap, the new plan will also give a standard tax deduction to everybody – employer or individual coverage – based on how much they are paying for health insurance. This cap might phase out quickly, but in the short run it seems a good idea.” And it may even work politically, says Laszewski.
Other bloggers beg to differ. Leif Wellington Haase of The Century Foundation group blog “Taking Note” pronounces the proposal “dead on arrival” and says it’s “bold enough to antagonize potential allies but not bold enough to make substantial changes.” Michael Cannon over on Cato at Liberty praises the “damn fine health care plan” for its proposal to limit the current tax break on employer-provided health insurance, a source of inefficiency that economists have been decrying for decades. However, Merrill Goozner of GoozNews says that limiting this tax break will provide a “powerful incentive” for wealthier (and healthier) Americans to abandon employer-based insurance.
More reform plans. States are in a reforming mood as well. Cannon looks at why an individual mandate (requirement for individuals to purchase health care coverage) won’t solve the free rider problem. The mandate is part of Gov. Arnold Schwarzenegger’s California plan.
On Insureblog, Bob Vineyard and Henry Stern explain their “less than enthusiastic support” of community rating—a feature of Sen. Ron Wyden’s Healthy Americans Act and other health reform plans. They argue the mechanism spurs adverse selection, increases insurance rates, and lowers availability of coverage.
Here on the Health Affairs Blog, guest contributor Jeff Goldsmith questions the feasibility of a new proposal by Dartmouth’s Elliott Fisher and colleagues to have hospitals and the surrounding community doctors work together to limit costs. Goldsmith also gets into Medicare’s Sustainable Growth Rate, which he says “has become the health policy equivalent of an inflamed hemorrhoid, requiring the annual application of anesthetic and emollients.”
Intermountain’s Brent James discusses a partnership project with Mayo Clinic and Dartmouth to collect data on the “true necessary” cost to deliver care for key conditions. His wide-ranging interview with Matthew Holt on The Health Care Blog tops 11,000 words and has many interesting nuggets on costs, practice variations, and quality. (And I thought Health Affairs Blog had some long posts!)
Merrill Goozner, in his role at the Center for Science in the Public Interest, organized a letter of protest concerning the conflict of interest in a planned National Institutes of Health practice guideline meeting on neonatal herpes where most of the featured speakers had ties to the pharmaceutical companies who make treatments for the disease. The meeting was cancelled, and Merrill blogged about it on GoozNews. Roy Poses, also a letter signee, writes about the thorny issue of guideline development on Health Care Renewal.
Insurers. BCBS of Massachusetts is now offering employers a plan design where smokers would pay a higher contribution toward their insurance premium, David Williams notes on his Health Business Blog. Where will this lead, he muses?
Fear of higher out-of-pocket costs are a significant reason why few employees choose consumer-driven health plans, according to new research by the Center for Studying Health System Change. Fard Johnmar on Envisioning 2.0 says insurers need to communicate better with consumers about these plans.
Home stretch. A few final posts on some diverse topics:
–On Point of Law the American Enterprise Institute’s Ted Frank is not convinced that the paper by Harvard’s David Studdert and colleagues in the new Jan/Feb Health Affairs adds to the debate surrounding the “Sorry Works” idea, whereby disclosure of medical injury to patients along with an apology will help to lower malpractice costs.
–And two posts in the category of advice to health care administrators: Rita Schwab of MSSPNexus Blog urges hospitals to run criminal background checks on doctors. The Healthcare IT Guy Shahid Shah warns administrators to not be taken in by health care IT developers looking to pad their resumes rather than offer sound advice.
And that’s all for this round. David Harlow of Health Blawg hosts the Feb 9 Health Wonk Review, with entries due 9 am Feb 8.