• Reflex: spiked

    We have decided to terminate our morning Reflex posts. The readership demand (as measured by comments) and blogospheric popularity (as measured by links) do not seem to justify the work required to produce them. If news items warrant comment, we’ll provide it in one-off posts.

    Sorry to those who loved Reflex. The economics of the blogosphere have spoken. We must listen, at least incidentally.

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  • Reflex: December 21, 2011

    Kicking the decision about what benefits must be included in individual and small-employer plans to states will continue the nation’s patchwork of uneven coverage, report Gardiner Harris, Reed Abelson, and Robert Pear. “People in Utah and Wyoming, for example, are likely to have more limited access to expensive services now mandated in states like Massachusetts and Maryland — at least until 2016, when a senior administration official said the federal government plans to establish a national standard of essential benefits.” Austin’s comment: I’m getting a lot of questions as to whether this was a good or bad move by the Obama Administration. One thing is clear, it was a politically wise move. Dodging another huge fight over health reform may aid the viability of the new law in the long run.

    Yes, Congress didn’t pass a deal to extend the Payroll Tax deal, but that also means they didn’t pass a temporary doc fix, writes Julian Pecquet. “Patient advocates immediately started blasting Congress on Tuesday after House Republicans nixed a temporary fix to Medicare payments to physicians. The House voted 229-193 to reject the Senate’s two-month “doc fix” and instead call for a conference meeting with the Senate. Senate Majority Leader Harry Reid (D-Nev.) says the Senate is done for the year. If neither chamber changes its mind, physicians will see a 27.4 percent cut in Medicare payments starting Jan. 1.” Aaron’s Comment: There’s no “if” there. The Senate has gone home for the holidays, and the House has voted. There will be no doc fix before the new year. This doesn’t mean that one own’t be passed retroactively, but it’s got to be frightening for the AMA and others. If Congress is willing to play chicken with all of America, I don’t know why they wouldn’t with physician reimbursement.

     

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  • Reflex: December 20, 2011

    House will not have direct vote on Senate deal, writes Tom Cohen and Alvin Silverleib. The two month extension of the payroll tax cut, Unemployment Insurance and the doc fix that passed the Senate 89-10 on Saturday appears dead in the House and there will not be a direct vote on the Senate measure; Senate Democrats say they will not negotiate a full year extension of the payroll tax cut (that everyone wants) until the House passes the 2 month version. Don’s comment: This is not as dumb and dysfunctional as the debt ceiling debacle in August, but there is still time.

    Ezekiel Emanuel rejects premium support. “Premium support is classic cost shifting, rather than cost cutting. [...] To address the root of the cost problem, we must change how we pay doctors and hospitals. We must move away from fee-for-service payments to bundled payments that include all the costs of caring for a patient, thereby encouraging providers to keep patients healthy and avoid unnecessary services.” Austin’s comment: Premium support is a broader concept than Emanuel suggests. It need not shift costs to Medicare beneficiaries. However, Emanuel’s conclusion is reasonable. The type of cost cutting we need will not be found in premium support alone. My recent series covered all these points and more.

    The administration’s first crack at essential benefits guidance is drawing no backlash, says Jason Millman. “The Obama administration’s first crack at defining minimum health benefits did exactly what consumer groups hoped it wouldn’t do: It gave states a choice of “benchmark” plans rather than spelling out the details. But the administration seems to have pulled it off — because there was no backlash to be found from groups that championed the law.” Aaron’s Comment: (1) It provoked no backlash because it punted the call to the states. (2) It’s sad that “success” is now being defined as not angering anyone. (3) That just doesn’t seem worthy

     

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  • Reflex: December 19, 2011

    Julian Pecquet expects continued attacks on and challenges to the ACA. “Its first life-or-death experience lies in the hands of the Supreme Court, which could potentially strike down the Affordable Care Act as early as June. Even if the high court upholds the law, it could remove its individual mandate [...] Every Republican presidential candidate has vowed to repeal the law, through executive orders and by signing repeal legislation. Republicans are expected to keep control of the House, and with Democrats defending 23 seats in the Senate, the GOP has a shot at gaining the 60-member majority needed to get anything through.” Austin’s comment: The outcome of the 2012 election is the most important factor in the future of health reform and structural changes to Medicare.

    Crisis line tries to save suicidal veterans, writes Christina Ginn. There is an epidemic of suicide among veterans in the U.S., but there are resources to help. Don’s comment: Even as the Iraq war ended yesterday, this piece points out that our nation will be dealing with the aftermath of this war as well as the one in Afghanistan for many years. 1-800-273-8255 is a crisis line that any vet can call to receive help, or you can send a text to 838255 or go to http://www.veteranscrisisline.net/

    And now there’s concern over deadlines for the federal government’s health-care exchange, writes Julie Appleby. “With many states unwilling or unable to get insurance exchanges operational by the health-care law’s deadline of Jan. 1, 2014, pressure is growing on the federal government to do the job for them. But health-care experts are starting to ask whether the fallback federal exchange called for in the 2010 law will be operational by the deadline in states that will not have their exchanges ready.” Aaron’s Comment: I’ve written many times of the gamble some states are playing by not getting their exchanges ready; if they don’t the feds will take control. It’s hard to understate the importance of the federal government not falling behind if they want the ACA to succeed.

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  • Reflex: December 16, 2011

    There’s more backlash for Wyden than for Ryan on controversial Medicare plan, writes Brian Beutler. “First, the political consequences of the Wyden-Ryan alliance are worse for Democrats than for Republicans. As noted above, it gives Romney or Gingrich some cover when the Obama campaign attacks them for wanting to end Medicare (“one of the most liberal members of your party supports my plan,” goes the imagined retort). And more broadly, it complicates the Democratic party’s heretofore unanimous opposition to all plans that involve partial or total privatization of the program.” Aaron’s Comment: The fact that many Republicans are embracing it and almost no Democrats are says something about which way the plan moves the ball.

    Advocates push for a public option in MA, writes Andy Metzger: “Five years after redrawing the lines in the national health care debate, Beacon Hill is looking at new reforms, closely studying payment system plans to lower costs and examining a government controlled single-payer model. “We will end up with a government option at some point. We will end up with a single-payer at some point, and wouldn’t it be wonderful if that point was now, and the place was Massachusetts?” said Sen. Dan Wolf (D-Harwich) at a Thursday afternoon legislative hearing.” Aaron’s Comment: Stranger things have happened. Vermont may go single payer, after all.
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  • Reflex: December 15, 2011

    Gingrich proposes more Medicare Advantage, reports Sarah Kliff. “What Gingrich proposes sounds a lot like what we have in Medicare right now: A public, traditional Medicare plan coupled with private alternatives, Medicare Advantage, that seniors can voluntarily enroll in.” Austin’s comment: It has become popular among leading GOP contenders to propose reforms to Medicare that are indistinguishable from current Medicare. Gingrich follows Romney who is not following Rep. Ryan. Kevin Drum reminds us what’s wrong with Medicare Advantage.

    Speaking of Rep. Ryan, he’s distancing himself from his own Medicare plan too, reports Sam Baker. “Rep. Paul Ryan (R-Wis.) is moving away from his controversial plan to end traditional Medicare, putting forward a new proposal with Sen. Ron Wyden (D-Ore.) that would keep the federally funded program in place. The plan, which Ryan and Wyden plan to unveil Thursday morning, would give Medicare beneficiaries a choice between today’s Medicare and private health plans.” Austin’s comment: I will write more about the Wyden-Ryan plan after I have a chance to review the details. An op-ed by the two legislators appears at the Wall St. Journal.

    Mandy Locke finishes her series on the WakeMed v. UNC Health Care competition for Rex Hospital. This installment focuses on the question of what is public and what is private and should the state-owned health system compete with private institutions? Don’s comment:The back story of WakeMed offering to buy Rex Hospital was the $3 Billion budget shortfall that the N.C. General Assembly had to address last session. WakeMed’s offer to buy Rex for $750 Million would close a big chunk of it, and cause the state (via UNC) to divest of an asset they felt the state shouldn’t own in any event. Of course, the $750 Million would be a one-time state budget help, but the asset would be gone forever. The status quo holds for the time being, but the N.C. legislature is looking more closely at what UNC health care should be allowed to do by way of competing against private health care systems.

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  • Reflex: December 14, 2011

    The TIE team lost the morning. The final straw was that Austin’s computer got taken over by a SAS install. Reflex will resume tomorrow.

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  • Reflex: December 13, 2011

    Mandy Locke has the third (of four) piece in a series on hospital-system competition. The latest installment focuses on the relationship between the CEOs of UNC Health Care and WakeMed. Don’s comment: Interesting series, but that phrase Duke University health system has barely appeared in it. Dean Roper (CEO of UNC Health System) is quoted in the piece as hoping that UNC and WakeMed one day can merge. It seems to me the bottom line is this: there will be two big players in the RTP area of N.C.: UNC and Duke. The only question is whether there will be a third (WakeMed) or whether they will be gobbled by UNC (or Duke). The other non-Wake Med hospitals (Rex and Duke Raleigh) are already owned by UNC and Duke respectively. Yesterday’s related Reflex.

    The House Republican bill to hold down payroll taxes and extend unemployment benefits will make it easier for doctors to own hospitals, writes Robert Pear. “The bill would repeal and relax several provisions of the 2010 health care lawthat clamped down on doctor-owned hospitals. The bill would allow such hospitals to open if they were under construction at the end of last year, and it would allow them to expand if they were already in existence. Congressional aides say dozens of hospitals and their physician owners could benefit.” Aaron’s Comment: I have no doubt. But it may not benefit the rest of us so much. When physicians own the stuff they use in health care, they tend to use it more.

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  • Reflex: December 12, 2011

    Mandy Locke with the second of a four-part series on the remaking of Wake County’s (N.C.) health care landscape. The series focuses on the competition between hospital systems to lure providers to affiliate with them, and what that is doing to remake the landscape of the local health care market. Don’s comment: Interesting series so far (here is part 1 on the blurring of the public/private line; and preview on reporting approach). The piece today on the negotiation between physician practices and hospitals and why both sides sought a merger is good, though I think the degree to which health reform is said to drive such deals is overstated; it was happening long before 2010 and will continue no matter what. The WSJ also has a big story this morning by Anna Wilde Matthews on aggregation in the health care industry. What does competition look like in health care delivery is an important question?

    Susan Wood, former FDA assistant commissioner, wonders what happened to Obama’s pledge of scientific integrity. “I was excited to have been invited to watch President Obama sign a memorandum on scientific integrity. The directive signaled that decisions about public health would no longer be blocked for reasons beyond scientific and medical evidence. Agencies such as the Food and Drug Administration would no longer have their decisions overturned by leadership that disregarded the science. That promise was betrayed this past week when Health and Human Services Secretary Kathleen Sebelius overruled the FDA commissioner [on Plan B.]” Austin’s comment: If you haven’t read Aaron’s post on this, I recommend and agree with it.

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  • Reflex: December 9, 2011

    Plan B decision draws strong and mixed reaction, reports Anne E. Kornblut and N.C. Aizenman. “President Obama on Thursday defended his administration’s decision to block unrestricted sales of the morning-after pill as a “common-sense” parenting choice, even as women’s rights advocates condemned it as a cynical move that could provoke a damaging political backlash for the president next year.” Aaron’s Comment: My thoughts on this decision yesterday.

    Federal judge halts changes to N.C. Medicaid, writes Lynn Bonner. The state Division of Medical Assistance had proposed to limit personal care services delivered via home health to elderly and disabled persons. Don’s commentThe proposed policy would limit home health services to persons with limitations in 3 Activities of Daily living (eating, dressing, toileting, bathing, etc) instead of the existing policy of 2. Several groups sued and the judge blocked the change. The policy was a small part of an overall $50 Million cost saving plan; 2,000-3,000 persons are affected by the ruling. This was a previous decision and is separate from the issue mentioned yesterday in reflex.

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