JAMA Network Controlling Health Care Costs in Massachusetts With a Global Spending Target

The new legislation builds on the far-reaching health insurance reforms that Massachusetts enacted in 2006, including the mandate on state residents to carry a minimum level of insurance or to pay a tax penalty.⁶ The reforms became the model for key aspects of the US Patient Protection and Affordable Care Act of 2010.¹ The many features of the 2012 state act include provisions to improve transparency and accountability for health care providers with regard to cost, financial performance, quality, and competition within markets and to improve the clarity for consumers of information about the out-of-pocket costs of care. The provisions also include reforms to medical malpractice laws that would allow a physician, hospital, or others who provide health care to admit to a mistake or error, without the acknowledgment being used in court as an admission of liability.⁵ Attention, however, is likely to focus on the global spending target and its potential value as a cost-containment tool. From 2004 to 2009, health care spending in Massachusetts increased by 5.8% per year, regularly exceeding economic growth.⁷
The act creates a Health Policy Commission to implement the new law and a Center for Health Information and Analysis to collect and analyze data on health care costs and quality. The commission is charged with establishing by April 15 of every year “a health care cost growth benchmark for the average growth in total health care expenditures . . . for the next calendar year.” Total health care expenditures are defined as “all health care expenditures in the commonwealth from public and private sources,” including “all categories of medical expenses and all non-claims related payments to providers . . . all patient cost-sharing amounts, such as, deductibles and copayments,” and “the net cost of private health insurance.” The “growth rate of potential gross state product” is defined as the “long-run average growth rate of the commonwealth's economy, excluding fluctuations due to the business cycle.”

JAMA Network | JAMA: The Journal of the American Medical Association | Controlling Health Care Costs in Massachusetts With a Global Spending Target Controlling Health Care Costs in Massachusetts

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An Effort To Cut Through Romney-Ryan Doublespeak And Explain What They Really Want To Do | The New Republic

 

Ryan and Mitt Romney have called for the most profound, radical changes in the program’s history. But rather than clarifying the differences between their position on Medicare and President Obama’s, they’ve done their best to obscure them. They’ve accused Obama of “raiding” Medicare when Ryan’s own budget calls for reducing the program’s funding by the same amount of money. They have insisted they won’t do anything to affect current retirees, even though they have pledged to repeal the Affordable Care Act, which bolsters Medicare’s drug coverage and makes preventative care available without out-of-pocket expenses.

Romney and Ryan have also been less specific than you might have heard. That’s particularly true for Romney, whose “proposal” consists of a fact sheet, plus a few speeches, statements, and op-eds. This allows them to escape responsibility for the inevitable trade-offs that their vision, like every effort to reform Medicare, would require. And it gives them a political advantage over President Obama, who must defend reforms of Medicare in the Affordable Care Act and his latest budget—right down to the last legislative clause and dollar figure.

Yes, I keep reading that Romney and Ryan have been “brave” and “serious” about Medicare, while Obama has ducked hard choices. I would say it's the other way around.

An Effort To Cut Through Romney-Ryan Doublespeak And Explain What They Really Want To Do | The New Republic

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Why Can’t We End Poverty in America? - NYTimes.com

Why Can’t We End Poverty in America? - NYTimes.com

Interesting piece on the failure to eradicate poverty and its growing pervasiveness and persistence.

One of the things that always strikes me in analyses like these, and indeed, in comments like Mitt Romney’s, “I want everyone to have a house like this,” referring to a mansion owned by the Papa John’s Pizza founder, is the fact that not everyone can be rich. In response to Romney, I want to say, “Really? How much money do you propose we pay school teachers in order for that to work out?”

In the case of your piece, and many others, is the call for a better educated or more skilled workforce. This, unfortunately, reminds me of Judge Smails’ comment in Caddy Shack, “The world needs ditch diggers, too!” There will be huge swaths of the population that will continue to work in food service, cosmetology, retail sales, and so on. Until we have a minimum wage structure that supports lifting so many of these people into the middle class, poverty will persist.

I do not know the answers, and I applaud you for positing some very constructive ones, but I am afraid that until we acknowledge that we do have classes of workers, and that we would all be better off if the lower classes were supported more by better social services, better minimum wages, access to health care and so on, we will not be able to ask the right policy questions.

Cheers,

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’Informed Decision’ May Irk Surgeons as It Cuts Costs - HealthLeaders Media

’Informed Decision’ May Irk Surgeons as It Cuts Costs - HealthLeaders Media

But consider just a few recent headlines to see the paving of the large runway that may enable this plane to take off.

• A New York Times story last week revealed some 1,200 patients underwent unnecessary invasive cardiology procedures in one South Central Florida hospital, and many other facilities in the large HCA chain are under federal investigation.

• A Grand Rapids surgeon's study in September's Journal of Clinical Oncologysays far too many patients undergo unnecessary surgery to remove tumors in patients with advanced colon cancer when chemotherapy and a drug have a better success rate.

• A report in the New England Journal of Medicine found many women with breast cancer are unnecessarily undergoing a second surgery to remove more tissue for wider margins.

National blindspot

Some surgeons themselves think this is an idea whose time has come.

"We have a major national blindspot, and that blindspot is unnecessary medical care, and there's a ton of it that goes on," says Martin Makary, MD, a gastroenterology surgeon and researcher at Johns Hopkins School of Medicine.

Makary is the author of an upcoming and extremely controversial book, Unaccountable, about dangerous practices that persist in a culture that is allowed to hide its mistakes. He tells me that preliminary results of his research project reveal that when asked, surgeons think the amount of unnecessary surgery that hospital culture chooses to ignore is huge, "in the ballpark of 10% to 20%."

These are the big drivers of cost, Makary says. " [They are] big ticket items, like coronary artery bypass graft surgeries, colectomies, hysterectomies, and back surgeries. They not only have the biggest price tags, but they also have the highest complication profiles of anything we do in healthcare."

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They have our backs. We should have theirs | The Incidental Economist

They have our backs. We should have theirs | The Incidental Economist

I earn much more money. Some might conclude that I am the superior contributor to American society, simply because I hold a more lucrative job. After all, my tax dollars support a social safety-net that tow truck driver’s family might use: the Earned Income Tax Credit, Medicaid, CHIP, and more. Yet this truck driver and that IDOT guy operate a safety-net for me, too, which I used when I encountered trouble along the road.

Much important work is done by people with sore backs and calloused hands who don’t get paid that much, but who pick our fruit, diaper our kids, prepare our meals, drive our kids to school, and more. My brother-in-law was recently hospitalized with a minor infection. In the next bed over, two nurse’s aides gently cleaned a very-sick uninsured man. I’ll probably need that help someday, too.

Each of us is both a maker and a taker in life. I shouldn’t apologize for my good paycheck. I shouldn’t object, either, if I’m asked to pay a little more so that these tow truck drivers and nurse’s aides have access to decent medical care. They have my back. I should have theirs, too.

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The Republican ticket’s big Medicare myth

The Republican ticket’s big Medicare myth

Obama’s Medicare reform plan isn’t that hard to find. It’s largely in Title III of The Patient Protection and Affordable Care Act. The basic strategy has three components: First, figure out what “quality” in health care is. Second, figure out how to pay for quality rather than paying for volume. Third, make it easier for Medicare to quickly update itself to reflect both advances in knowledge about what quality is and how to pay for it.

And so, in Title III, you’ll find dozens of different efforts to achieve these goals. The most famous of them is Section 3403, which establishes the Independent Payment Advisory Board (IPAB). But there’s also Section 3021, which creates the Center for Medicare and Medicaid Innovation, and Section 3025, which cuts hospital reimbursements if too many of their patients are readmitted, and Section 3001, which establishes value-based purchasing for hospital services, and Section 3015, which collects data on quality, and Section 3502, which advances the medical home model.

Some of the efforts are outside Title III. The Patient-Centered Outcomes Research Institute is actually in Title VI of the law. And then there are the subsequent reforms the administration has proposed to save more money. Those can be found on pages 33-37 of the president’s 2013 budget proposal. They include expanding IPAB’s mandate such that it can change Medicare’s benefit package and setting a growth cap on Medicare of GDP+0.5 percentage points — which is, by the way, the same growth cap that Rep. Paul Ryan imposes in the latest iteration of his budget.

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Health - The American Dream or just a Dream? - Doctors for America

Health - The American Dream or just a Dream? - Doctors for America

The greater the income inequality, the worse those countries do on the health and social problems index.

Can you guess which country did the worst?

Sadly, our very own.

If you don’t have time to read the book, I encourage you to take a look at Richard Wilkinson’s recent TED talk which provides a glimpse of the remarkable evidence.

As physicians we have dedicated our lives to improving the health of our patients using evidence-based medicine to make decisions about medications and treatments for patients… Can we also use this evidence to write a prescription to make our society more equal and therefore healthier for all of us?

I highly recommend the TED talk linked to above!

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'Socialized' or not, we can learn from the VA - RAND

'Socialized' or Not, We Can Learn from the VA | RAND

In a recent post on the New York Times' Economix blog, Princeton economics professor Uwe E. Reinhardt addresses the common characterization of the British health care system as "socialized medicine." The label is most often used pejoratively in the United States to suggest that if anything resembling Great Britain's National Health System (NHS) were adopted in the U.S., it would invariably deliver low-quality health care and produce poor health outcomes.

Ironically, Reinhardt notes, the U.S. already has a close cousin to the NHS within our borders. It's the national network of VA Hospitals, clinics and skilled nursing facilities operated by our Veterans Healthcare Administration, part of the Department of Veterans Affairs. By almost every measure, the VA is recognized as delivering consistently high-quality care to its patients.

Among the evidence Reinhardt cites is an "eye-opening" (his words) 2004 RAND study from in the Annals of Internal Medicine that examined the quality of VA care, comparing the medical records of VA patients with a national sample and evaluating how effectively health care is delivered to each group (see a summary of that study).

RAND's study, led by Dr. Steven Asch, found that the VA system delivered higher-quality care than the national sample of private hospitals on all measures except acute care (on which the two samples performed comparably). In nearly every other respect, VA patients received consistently better care across the board, including screening, diagnosis, treatment, and access to follow-up.

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Papa John's: 'Obamacare' will raise pizza prices - POLITICO.com

Papa John's: 'Obamacare' will raise pizza prices - POLITICO.com

If you thought Obamacare was going to be expensive, Papa John's is here to show exactly how little an effect on businesses it will be to buy health insurance for employees -  less than 15 cents a pizza! As Pete Townshend once said, "I call that a bargain, the best I ever had!"

Pizza chain Papa John's told shareholders that President Obama's health care law will cost consumers more on their pizza.

On a conference call last week, CEO and founder John Schnatter (a Mitt Romney supporter and fundraiser) said the health care law's changes — set to go into effect in 2014 — will result in higher costs for the company — which they vowed to pass onto consumers.

"Our best estimate is that the Obamacare will cost 11 to 14 cents per pizza, or 15 to 20 cents per order from a corporate basis," Schnatter said.

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Truman and the fight for health care - Hawley, PA - The News Eagle

Truman and the fight for health care - Hawley, PA - The News Eagle

In fact, Medicare enacted only a part of what President Truman had advocated two decades earlier. In the 1940s, Truman was shocked and saddened by the poor state of the nation’s health care, which effectively excluded millions of middle-class Americans from access to the world’s most advanced medical technologies.

“That’s all wrong in my book,” Truman stated, “I’m trying to fix it so people in the middle-income bracket can live as long as the very rich and the very poor.”

Poor health was particularly a problem among young people. Nearly 8.5 million young men and women had been found physically or mentally unfit for military service during World War II – nearly half of those examined for their induction physicals. Truman saw this situation as “a crime.”

Noting that his predecessor, President Franklin D. Roosevelt, had advocated a national health initiative in his “Economic Bill of Rights,” Truman sent Congress a message on Nov. 19, 1945, proposing compulsory health insurance through payroll deductions and other revenue.

Truman supported complex legislation in a bill advanced by Democrats in the U.S. House and Senate. However, the president felt their effort had little chance for success in Congress. He proposed less complicated legislation that called for:

- Prepayment of medical expenses through compulsory insurance premiums and general revenues.

- Protection against lost wages due to illness or disability.

- Expansion of public health, prenatal care and child health services.

- Federal aid for medical schools and research institutions.

- Funding for local hospitals, clinics and medical institutions.

Truman proposed that the U.S. surgeon general set fees and administer the program. Doctors could choose whether or not to participate. He believed his plan would provide insurance for hospital and doctor costs for all working Americans and their families.

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