• All the cognitive biases

    Via Jay Van Bavel (Click to enlarge. Yeah, it’s still too small. You get the idea though.):
    cog-bias

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  • Walking back repeal

    That was fast.

    Mr. Trump, in an interview to be broadcast on CBS’s “60 Minutes,” said the guarantee of coverage for people with pre-existing conditions was “one of the strongest assets” of the law. He also said he would try to preserve the measure allowing young adults to remain on their parents’ insurance until age 26.

    “We’re going to do it simultaneously — it’ll be just fine,” he said.

    That’s from The New York Times. The Wall Street Journal has more:

    On health care, Mr. Trump said a big reason for his shift from his call for an all-out repeal was the meeting at the White House with Mr. Obama, who, he said, suggested areas of the Affordable Care Act, widely known as Obamacare, to preserve. “I told him I will look at his suggestions, and out of respect, I will do that,” Mr. Trump said in his Trump Tower office.

    “Either Obamacare will be amended, or repealed and replaced,” Mr. Trump said.

    So, possibly just amended then? That could mean anything. Nevertheless, given his track record, I would not take President-Elect Trump’s recent statements to the bank. Best to assume everything’s on the table, and he — with the help of Congress — could bring it all crashing down to the floor.

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  • AcademyHealth: Plan-provider integration in Medicare Advantage, a growing trend

    Health care provider organizations are increasingly offering Medicare Advantage (MA) plans. My new AcademyHealth post provides a description of growth in this phenomenon and quality of the plans.

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  • Today’s repeal and replace reading list

    It’s hard to keep up. Here are things I’ve read so far today. I’ll add more throughout the day, as warranted. (Provision of this list does not imply endorsement or non-endorsement of anything at the links.)

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  • Repeal and replace: The Democrats’ role

    Avik Roy articulates how Democrats might be drawn onto the repeal and replace wagon:

    [I]t is definitely possible for the GOP to repeal and replace Obamacare. The sequence would go something like this:

    1. Partially repeal Obamacare via reconciliation, with the subsidies expiring in 2019.
    2. Get Republicans to agree on a pathway to market-based universal coverage that reduces, instead of increasing, the federal role in health care.
    3. Use the two-year window to achieve market-based universal coverage by repealing the ACA’s premium-hiking regulations, replacing it with a system of means-tested tax credits.

    There are likely to be 60 votes for the Obamacare replacement under this scenario, because once Obamacare’s subsidies have been repealed, Republicans will have negotiating leverage with Democrats who would prefer a more statist approach.

    This is clever. To get around a filibuster, it puts a gun to the Senate Democrats’ heads, so to speak. “Do you want something or nothing?”

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  • Stuff for Health Care Systems (PHMD2350)

    What is this post about? Look here.

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  • Repeal and replace watch

    It’s way too early to tell with much certainty, but what could this mean?

    House Speaker Paul Ryan on Wednesday suggested Congress would seek to use a budget tool known as reconciliation to repeal the Affordable Care Act under the incoming Trump administration.

    But at a Capitol Hill press conference later in the day, Senate Majority Leader Mitch McConnell would not commit to using the process to repeal the law.

    Since Majority Leader McConnell has also indicated that repealing the ACA is “high on our agenda,” this could mean he intends to remove the filibuster as a means by which Senate Democrats could oppose repeal. (Budget reconciliation bills cannot be filibustered.)

    On the other hand “high on our agenda” leaves lots of wiggle room.

    More on the filibuster here.

    UPDATE: Ben Carson may be involved in crafting a replacement plan.

    Ben Carson says he’s still ironing out his role in the incoming administration of President-elect Donald Trump, but one thing’s certain: He’ll have a role in helping craft the replacement plan for Obamacare.

    “I think the replacement obviously must come first and it must be something that is very appealing and easy to understand. And then, only then, would you dismantle what’s in place,” the retired neurosurgeon said in an interview.

     Asked if he intends to be involved in designing that plan, Carson said, “Yes, of course.”

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  • Now that Trump has won, telling the story of research is more important than ever

    My first thought was that giving a midday talk at RTI today was, in hindsight, poorly scheduled. The day after the election — particularly this election — just isn’t the right time to talk about how to disseminate research. Who would care?

    But my second thought was much better. This is exactly the right time to talk about the importance of disseminating research.

    A Trump Administration, with a Republican Congress, is likely to be much less favorable to research and evidence, whether funding it or using it to inform policy, than a Clinton Administration would have been. This is not in and of itself wrong. There are other criteria that inform policy besides evidence. Values matter. Nevertheless, I agree with Bill that funding for research agencies like AHRQ, centers like CMMI, and institutes like PCORI is in jeopardy.

    What to do?

    What I told my audience was the same thing I would have told them any other day. We must keep telling the story of health care, if not all, research — why it matters, what it means, how we do it, where it leads to improvement, and how much more there is to do.

    There are so many ways to do this. We can write. We can make videos. We can tweet, post on Facebook, call our representatives, give talks in our communities, and on and on.

    I’m favorable to writing, so my talk focused on how to do that. I described my process of developing posts that translate research for a wider audience. I encouraged my audience to develop the skills to do the same, and I showed them how. (It’s up to them to put in the practice, of course. I cannot do that for them.)

    If we don’t redouble our efforts to communicate what we do as researchers, we will get what we deserve, which is less research support. That may be what we get anyway, but we have little to lose by trying to educate the public, our policymakers, and journalists why and how what we do matters.

    Telling the story of research has not become less relevant now that Trump has won. Now more than ever, it’s one of the most important things me and my colleagues at TIE and beyond can do.

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  • The next health reform

    It’s not hard to guess what it might include.

    Trump’s agenda is far less detailed than the 37-page Ryan document. Of 7 items on the Trump agenda, 5 also are part of the Ryan plan: (1) complete repeal of the ACA; (2) permitting interstate sale of health insurance; (3) allowing individuals to deduct the cost of health insurance premiums on their federal tax returns; (4) expanding use of health savings accounts; and (5) reforming Medicaid by implementing state spending block grants (or per beneficiary enrollment caps as an alternative under Ryan’s plan). Trump’s plan also promotes price transparency for physicians and hospitals, and would permit the importation and domestic sale of drugs with regulatory approval in other countries.

    Ryan’s plan includes more details on the proposals it shares with Trump’s approach, plus policy proposals not included in Trump’s plan. Most of Ryan’s proposals reflect recommendations that are also key elements of other Republican and conservative plans, such as: capping the tax deductibility of employer provided health insurance; nationwide limits on noneconomic damages in medical liability litigation; continuing the ACA’s guaranteed issue of health insurance though only for individuals who maintain “continuous coverage,” and reestablishing state high-risk pools for uninsured persons with preexisting conditions; not allowing expansion of Medicaid as permitted by the ACA in states that had not expanded Medicaid by January 1, 2016; raising the eligibility age for Medicare to 67 years; and moving Medicare toward a premium support financing structure to limit the federal government’s financial obligations.

    Many of Ryan’s proposals are ambiguous. Moreover, the plan has not been written in legislative language, preventing scoring by the Congressional Budget Office to determine the likely cost and the impact on health insurance coverage. Regarding the Trump proposals, an analysis by the Committee for a Responsible Federal Budget, a nonprofit, nonpartisan organization, concluded that it would increase the number of uninsured by 21 million by 2018, raising the number of uninsured Americans from nearly 30 million to about 50 million, and increase the federal budget debt over 10 years by between $330 and $550 billion.

    That’s from a recently published JAMA Internal Medicine Viewpoint by John McDonough and David Jones to which I’ve inserted links. Find more here.

    UPDATE: Per my tweets, here’s more on this topic.

    See also Tim Jost and Margot Sanger-Katz.

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  • Stuff for Health Care Systems (PHMD2350)

    What is this post about? Look here.

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