Archive for the ‘health care’ Category

Health Wonk Review’s “Pink Edition”

Thursday, October 12th, 2017

InsureBlog’s Hank Stern has posted the latest edition, the “Pink Edition,” of Health Wonk Review.

Why the “Pink Edition?” Because October is National Breast Cancer Awareness Month, and Hank and his team, Love, Hope and Faith, are doing their best to raise money to help eradicate this terrible disease. They’re participating in a walk to do just that on October 21, and Hank would love some help from the HWR community. Something to think about.

So, after making a donation to Hank’s worthwhile cause, we hope you’ll grab a cup of whatever suits you best, put your feet up and once again revel in all things health wonkery.

This Cat Is Dead. Let It Stay That Way.

Friday, September 22nd, 2017

“Seriously. This is BANANAS” – Senator Chris Murphy, (D-CT), on Graham-Cassidy.

When I was in college I was part of a pretty successful folk group. We played all over, cut a few LPs. It was a great time. On college campuses we would sing a simple, little, nearly childish song that somehow actually became a bit of a hit. It was called The Cat Came Back.

Oh, the cat came back.
She didn’t want to stay.
She was sittin’ on the back porch
The very next day.

Well, there’s a new cat sittin’ on the porch, and it’s called Graham-Cassidy.

Every time we stick a fork in it and call it dead, a new zombie repeal and replace Obamacare horrendoma springs to life.

The selling point of this one, at least according to Senators Graham and Cassidy (and Vice President Pence yesterday morning on CBS), seems to be centered on the idea that passage of this bill will finally allow the states to plot their own health care futures.

That was also the position argued yesterday in a New York Times Op-Ed by Philip Klein, the Managing Editor of the Washington Examiner (Is this a coordinated effort?). In Graham Cassidy has One Great Idea Klein claims the different states have different healthcare needs and, consequently, should be able to address those needs through their own creativity rather than arbitrary requirements of  Washington.

A more flexible system would give states latitude to pursue healthcare programs that are a better fit for their populations’ ideological sensibilities. And there are practical reasons to think of healthcare as a state-based issue: Every one has its own demographics, health challenges and other unique characteristics.

“Ideological sensibilities?” Excuse me? Oh, well.

One thing that strikes me square in the jaw about the states rights argument is this: For the last 26 years, states have been able, with federal waiver approval, to craft their own Medicaid programs as long as the results are revenue neutral and comply with minimum requirements.

By way of explanation, Medicaid has been with us since 30 July 1965 when President Johnson signed it and Medicare into law. Medicaid has been a lifeline for the poor who, prior to the Affordable Care Act, were mostly uninsured for health care. The ER was their primary care physician. The Act had a number of goals, one of which was to lower the number of uninsured and underinsured Americans. Since these people were nearly all of the lower income variety, the Act provided federal funding for states to expand Medicaid. Thirty-one states plus the District of Columbia did that. And the numbers of uninsured dropped significantly in those states.

In 1991, the Social Security Act was amended to create federal waiver programs. States were given the authority, through what are known as Section 1115 waivers, to tailor their own Medicaid programs to their own population needs. As of September 2017, there are 33 states with 41 approved waivers and 18 states with 21 pending waivers. A subset of state waivers are aimed at healthcare delivery system reforms. They are known by the catchy title Delivery System Reform Incentive Payment waiversDSRIP waivers allow states to create innovative programs that reform how care is delivered and paid for. These are demonstration projects and come with federal funding. Lots of it. For example, one of Texas’s two DSRIP waivers, just concluded, provided $11.5 billion over five years. The Texas Health and Human Services Commission has applied for an extension and in May, 2017, submitted to the CMS its positive evaluation of the program’s results (Despite this deep drink at the federal trough, you might remember Texas’s very public, Alamo-like  rejection of federal money to expand Medicaid).

Personally, I think there are many reasons to bury the Graham-Cassidy cat so deep it never sees the sun again. Others have written and catalogued them (see America’s newest health care expert Jimmy Kimmel). But not much has been said to refute this ridiculous let-the-states-have-a-chance claim. The states already have, and have had for 26 years, autonomy to innovate and create programs, with the help of federal funding, that zero in on the needs of their particular populations within sensible federal limits. Graham-Cassidy would do away with those limits, significantly lower funding, force millions of our fellow citizens to become uninsured (again), drop the states down a deep well of chaos and put us all back in the wild west of health care.

Yesterday, in a highly unusual move, the Board of Directors of the National Association of Medicaid Directors (NAMD) issued a statement highly critical of Graham-Cassidy, saying it would place a massive burden on the states.

“Taken together, the per-capita caps and the envisioned block grants would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history.”

And last night, after learning of NAMD’s statement, Senator Chris Murphy (D-CT) tweeted, “You can’t get ALL 50 state Medicaid Directors to agree on anything else in health care. Seriously. This is BANANAS.”

America’s health care system is complicated (“Nobody knew healthcare could be so complicated!”) and full of inside baseball stuff. But it does allow states to chart their own destinies. So, here’s a question for Lindsay, Bill and Mike: What’s the real reason you’re trying so hard to resurrect this dead cat?

 

 

Reactions To “Pharma’s Nine Words”

Monday, May 15th, 2017

We received a lot of thoughtful feedback to last week’s post on drug company Direct To Consumer (DTC) television advertising. I thought I’d share a couple that are representative of the whole.

This from a doctor in Florida:

You have acutely illustrated the challenge that allopathic physicians now battle with every day. In short, big Pharma has found a way to circumnavigate the drug salesperson and physician and go directly to the end consumer
Every physician feels significant pressure to satisfy their patients even when the request for certain pharmaceuticals is unreasonable; if the patient walks out of your office empty-handed chances are they won’t come back, so at the very least most patients have some prescription in hand upon their exit.

And this from a C-Suite Chief of Marketing:

I must confess upfront that I was one of those “DTC advertisers” in the early 2000s, having worked with Eli Lilly, Boehringer Ingelheim and Pfizer to name a few former clients.

Over the years I’ve read conflicting studies on DTC’s effectiveness and impact.  This said, there is typically a relationship between the largest category spender and market share.

You may also be interested in a dated survey from the FDA on the subject.  While there are definitely some “pro’s” associated with these efforts, including but not limited to patient empowerment (more prepared for doctor’s appointment, asking thoughtful questions, generally being more involved in one’s health, and better conversations about one’s condition and possible treatments). But there are also some “con’s,” including but not limited to:  overpromises/over statements of a drug’s potential benefits (and a corresponding downplay of possible side effects); pressure on physician’s part to prescribe a patient-requested drug, among others.  (But let’s not forget that there were physicians who were also in pharma’s pockets long before DTC, prescribing certain drugs based on lucrative relationships with companies.  Certainly not all of them… but unfortunately there were – and likely still are – some “bad apples.”)

It will be interesting to see how this debate evolves as baby boomers age.  Let’s hope that the patient is the ultimate winner here!

We can all agree with that last bit about hoping the “patient is the ultimate winner.”

We welcome responsible, thoughtful comments from our readers.

 

 

Pharma’s Nine Words

Thursday, May 11th, 2017

Any idea what the nine most frequently spoken words on US television are? How about:

My doctor said…

Tell your doctor…

Ask your doctor…

These words come at the beginning, “My doctor said,” the middle, “Tell your doctor,” and the end, “Ask your doctor,” of Direct To Consumer (DTC) television advertising with which Big Pharma bombards Americans every day. This is especially true during the morning network shows between 7:00 and 9:00 AM, the evening news hours and the occasionally funny prime time sitcoms that follow. The ads also feature a swell story with great looking actors and sweet music that plays as someone doing a voiceover tells us all about the 25, or so, ways the drug being pushed can kill us.

DTC ads come in many forms, but in 2015  69% of them were television ads with about a third of those coming from Pfizer. These ads have been allowed since the mid-1980s, but gained momentum in 1997 when the FDA relaxed the rules regarding television. Since then, it’s been Katy bar the door.

According to Pharmacy and Therapeutics (P&T), a peer reviewed journal for managed care and hospital formulary management:

The average American television viewer watches as many as nine drug ads a day, totaling 16 hours per year, which far exceeds the amount of time the average individual spends with a primary care physician.5,23,27

Since beginning the recovery from the Great Recession, television DTC has seen staggering growth:

 

 

According to Kantar Media, 72% of the commercial breaks in the CBS Evening News now have at least one pharmaceutical ad in them. These ads have a specific demographic target: Baby Boomers. Until 2012, they were mainly aimed at conditions such as dry eyes, erectile dysfunction, smoking cessation, chronic pain, constipation, heartburn, allergies and cholesterol. But in the last five years, they’ve made a deep dive into cancer, rheumatoid arthritis, and other illnesses to seniors. And, a reflection of our time, Opioid Induced Constipation hit the field during the 2015 Super Bowl. I can still hear the collective national gasp from that one.

Kantar Media reports Pharma spent $6.4 billion on DTC in 2016, with television garnering more than two-thirds of the spend. Since 2012, television spending is up 62%. During that time, the number of drug companies annually spending more than $50 million and the number spending more than $100 million has doubled. For example, last year, makers of Viagra and Cialis spent a combined $306 million convincing older (and increasingly younger) men that without those magic little pills their once prodigious sexual prowess, rapidly approaching Wooly Mammoth-like extinction, will never rise again, literally (but watch out for that 4-hour thing).

And when a new drug hits the market, first year spending can be breathtaking. Consider Opdivo, which debuted in 2015. The drug treats a certain kind of end-stage lung cancer (non-small cell lung cancer), which has a US patient population of less than 200,000. Yet Bristol-Myers Squibb, Opdivo’s maker, spent $93 million marketing it in its first year.

All this money begs an obvious question: Does it work? Well, even Pharma’s not sure, saying ROI is only one measure of a brand’s marketing success. Who is sure? The American Medical Association, which, in 2015, saying it was a colossal waste of money, called for an “outright ban” on Direct To Consumer advertising. The AMA also said doctors felt pressured by vulnerable patients who were looking for relief from one thing or another and that older drugs often work just as well, or even better, than the newer high-priced brands. Of course, it is preposterous to think we’ll ever return to to good old days of the 1980s before DTC advertising became more than a gleam in a marketer’s eye. The drug lobby is nearly omnipotent and there is the  little matter of commercial free speech. Moreover, drug makers claim they are providing valuable information with which consumers can make informed choices. Yet, according to the World Health Organization, “DTC is used to drive choice, not to inform it.”

America is one of only two countries in the world that allow Direct To Consumer drug advertising, the other being New Zealand, a country with a population of less than 4 million. The medical community doesn’t like it there, either.

Pharma has long had a wish to bring DTC to the European Union. That’s not going to be happening, however, as last year 22 of the 27 members rejected the idea.

The P&T white paper, mentioned above is presents an excellent analysis of DTC advertising, and ProCon.org has a nifty for-and-against page regarding DTC advertising. They’re both worth a look.

Who Knew? Medical Marijuana Works (at least for chronic pain)

Thursday, March 2nd, 2017

Dean Hashimoto, MD, JD, is a highly-respected researcher and teacher, practicing at Massachusetts’s Partners Health Care (think Harvard and Massachusetts General Hospital) and teaching at Boston College Law School. Today, at WCRI’s Annual Conference, his topic was Medical Marijuana and Workers’ Compensation: Recent Scientific, Legal and Policy Developments.

He led off with the results of a January,2017, scientific report from the National Academies of Sciences, Engineering and Medicine (NAS). The NAS report is a comprehensive, in-depth review of existing evidence regarding the health effects and potentially therapeutic uses of Medical Marijuana (cannabis). The report arrived at nearly 100 research conclusions categorized by the weight of evidence (conclusive, substantial, moderate, limited, no or insufficient).

One of the report’s conclusions that had “conclusive and substantial support” was this: Medical Marijuana is proven to improve chronic pain in adults. There is “moderate” support for the conclusion that Medical Marijuana improves short-term sleep outcomes for both fibromyalgia and chronic pain.

Of course, there are downsides. The report also concludes (DUH!) that Medical Marijuana carries with it an increased risk of motor vehicle crashes. Also, however, there was conclusive, substantial support that taking Medical Marijuana can lead to the development of schizophrenia and other psychoses. Yikes!

The NAS report also investigated whether there was an association between cannabis and occupational injury. The conclusion? There was no conclusion, because the available studies do not permit one to be made with any degree of certainty.

The bottom line? Medical Marijuana presents a potentially therapeutic benefit in the treatment of chronic pain.

Well, that’s not really the bottom line. No, because the larger issue is this: Medical Marijuana is being used in a number of states. Today, along with Dr. Hashimoto, we also heard compelling stories from Paul Sighinolfi, of Maine’s Workers’ Compensation Board, and Paul Tauiello, of the Colorado Division of Workers’ Compensation, describing the successful medical use of cannabis which is generating momentum in both states toward the therapeutic use of cannabis. The trouble is the usage of Marijuana in any form is federally illegal in every state. Seems there is a collision coming, and it may not be pretty.

WCRI – Day One, Session One

Thursday, March 2nd, 2017

Here we are in Boston again for yet another year of swimming the Australian Crawl through the mother of all data dumps from the Workers’ Compensation Research Institute’s annual conference.

WCRI’s first year President, John Ruser, led off the day with a sneak peak at the Institute’s new website, which seems clean and easy to navigate.

Then the fun began. Former Oklahoma Senator Tom Coburn, who happens to be a medical doctor and a Republican, and former Representative Henry Waxman, a California Democrat, looked into their crystal balls to discuss the future, of lack of it, of the Affordable Care Act.

Not surprisingly, the two former legislators had differing opinions, and I’ll bet you can bet what they were.

Coburn opined that we no longer have three equal branches of government, because the congress has ceded its authority to the Executive branch. Waxman bemoaned the lack of bi-partisanship.

John Ruser asked each about “repeal and replace,” opening a ballroom size can of worms. If you’ve been watching Sunday morning television, you know how that went. Predictably, Waxman, the Democrat, and Coburn, the Republican, argued from opposite ends of the spectrum. Each of these intelligent and seemingly reasonable people sincerely believe their position is the right one.

One thing they did agree about was whether the federal government would do anything about workers’ compensation. The answer: No.  That discussion morphed into social security disability, with Senator Coburn saying 27 million people are now on the rolls. This is not true. According to the Social Security Administration, less than 16 million people now receive social security disability benefits.

Coburn and Waxman, two rational people, are not going to agree on what to do about the Affordable Care Act. Not even close, and that is a shame.

Colleague Joe Paduda has an excellent summary of this session here.

 

 

 

What Is The Meaning Of “Life?”

Wednesday, February 22nd, 2017

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. That to secure these rights, Governments are instituted among Men…” – The Declaration of Independence of the United States of America

“People with type 1 diabetes need to take insulin every day to stay alive.” – The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

““I must pay my mortgage.” If it’s a choice between the mortgage and the insulin, “It’s going to be the mortgage.” – 74-year-old Kathleen Washington. Some months, her insulin runs over $300 a month – more than she can afford.” – CBS This Morning, Anna Werner, 22 February 2017

As politicians and high-paid lobbyists dance around the Washington DC Tower of Babel debating the future of health care in America, here are three questions that, as far as I can tell, have yet to be asked:

  1. In the phrase, “Life, Liberty and the pursuit of Happiness,” what did the Founders mean by the word “Life?”
  2. Is good health care an “unalienable” right?
  3. Should Ms. Washington have to choose between paying her mortgage and buying her insulin?

Let’s begin by considering the phrase, “To secure these Rights, Governments are instituted.” Then, consider, “Pursuit of Happiness.” Those two phrases suggest that one of the prime responsibilities of Government is to insure nothing prohibits citizens from being able to seek Happiness. Everyone must have the opportunity to find Happiness for themselves, the key word being “opportunity.” Government doesn’t guarantee Happiness, just that we have the chance to land on it. It’s up to us, but Government must do all in its power to see that unreasonable impediments are not placed in our way.

But what about Life and Liberty? The Founders did not choose to put the word “pursuit” in front of Life and Liberty. What does that mean? If Life and Liberty are unalienable rights that Governments are instituted to secure, what must Governments do to accomplish the mission?

Consider Liberty. Government has created a national defense system to defend our country and, by extension, our Liberty. The Founders recognized taxation as the most equitable means of paying for this, and so every year each of us kicks in our share (although this might be debatable) to guarantee our unalienable right of Liberty.

Now, think about Life.  Some may say Life is what national defense is all about, but, as I have shown, Liberty is more closely aligned with national defense. If the Founders wanted to make Life and Liberty go together, they would have written, Life and Liberty, not Life comma Liberty.

Then what does “Life” mean? For the answer to that center of the bull’s eye question, I turn to those great English philosophers, the Bee Gees: Life means Stayin’ alive. What should Government be doing to secure this first of the three unalienable rights for us? If Type 1 diabetics require insulin every day to stay alive, to continue Life, should Government guarantee they are only able to pursue it, as in the “pursuit of insulin?” Or, to secure the unalienable right of Life, must Government provide the insulin, paid for by taxation of all citizens, as it provides a national defense system?

It is unfortunate that these most basic of questions are not front and center in our nation’s capital. But to truly “secure” our “unalienable Right” to “Life” requires the goring of too many oxen (or, an unlucky Matador), as Joe Paduda writes in his blog today.

Pity the Republicans. They’ve caught Obamacare, like that dog that caught the bus, a trite phrase, but, in this situation, apt. They need to do something, but whatever they do, a large swath of America is going to pour fire and brimstone on their heads. Damned if they do, damned if they don’t.

Too bad. It didn’t have to be like this.

 

 

Barack Obama, I Have A Bone To Pick With You

Monday, February 13th, 2017

Dear Mr. Former President,

I’m writing about the Patient Protection and Affordable Care Act, which you signed into law six years, ten months and twenty-one days ago. That’s 2,519 days. Nearly seven years. Didn’t take but about two hours to become ObamaCare.

The law has saved lives and money, a lot of both. It’s allowed nearly 20 million people to become insured, most of them poor. Those people were able to get that insurance because the law helped them pay for it. The Medicare Hospital Insurance Trust Fund, which in the year before the law’s passage was projected to run out of money right about NOW, is good for another 12 years as of today, according to Medicare’s actuaries as reported by the Kaiser Family Foundation.

No lifetime caps, no pre-existing condition denials, kids on the plan until age 26, free preventive care, donut hole gone, I could go on.

But you, sir, and your administration made a mess of what came after. Consider:

  • You did such a wonderful job of selling the ACA to the American public, that you got waxed in the 2010 mid-term elections. You lost the House big time, 63 seats, and also the super-majority in the Senate, six seats;
  • You had three and a half years to get Healthcare.gov ready, and what happened on 1 October 2013? A system crash that took months to fix. You were warned 18 times prior to scheduled launch that the project was mismanaged and in deep doo-doo, but your team did nothing;
  • You let a clever-as-a-fox, but dumb-as-a-doorpost former Governor of Alaska, of all places, get away with introducing Death Panels into the conversation, and to this day 29% of Americans still believe that lie;
  • You sat by and watched the House of Representatives vote 54 times to defund, delay or outright repeal the law you signed;
  • I could go on.

But it’s your failure to educate the American people and your failure to get down and fight for your signature legislation that bothers me the most. Maybe you should have demanded to get your cell phone back and taken to Twitter like the two-year-old who now sleeps in your used-to-be bedroom. Anything would have been better than the cerebral, thoughtful argument you brought to the battle. Right up there with the old knife to a gunfight thing.

And that is such a shame, because, sure, the law has flaws, but you could have fixed them if you’d been willing to approach the job like Lyndon Johnson, or even Harry Truman. But perhaps that kind of street fighting was beyond the Constitutional Lawyer, the Editor of the Harvard Law Review.

Obamacare had the potential, with a few tweaks here and there, to be a monumental achievement. Instead, it has had a tortured existence and may yet prove to be the only death panel victim.

But, wait. Hold on. Here’s a thought: It is looking more and more as if the Republicans, who now control all three branches of government (well, maybe not the Executive, after all) have become the dog that caught the bus. They do not appear to have a clue. For example, last Thursday the highly-respected Bob Laszewski wrote in his blog, “the repeal part is still on track to occur this spring, … likely in March.” But just the day before, the two-year-old with the Twitter account, who thrasonically said he’d repeal Obamacare on Day 1, told Bill O’Reilly we may not see any changes until sometime in 2018 (but they’ll be beautiful when they happen, really beautiful).

Here’s another thought: Maybe when the public actually begins to realize what it’s about to lose things will begin to change. Maybe when the 35% of Americans who still think Obamacare and the Affordable Care Act are different laws realize they are in danger of losing the Obamacare they hate as well as the Affordable Care Act they love, things will begin to change.

One can only “hope.”

Sincerely,

Tom

P.S. We miss you.

Health Wonk Review: The “words matter” edition

Thursday, January 12th, 2017

obamacare

 

Words matter. Right now, for good or bad, as the torch is being passed from one president to new one, one of the key platforms that PEOTUS ran on was eliminating Obamacare. But as the reality of that potential grows closer, social media is abuzz with debates. It would appear that some people didn’t fully understand what they signed up for. Going viral on Facebook, a poster celebrates the demise of Obamacare, patting himself on the back that he had the good sense to go with the Affordable Care Act instead. This person is not alone – witness the Twitter poster who berates Senator Murray: “Why don’t you shut up Murry. Stop Crying. You lost. We won. We are repleaing Obamacare, not the ACA.” We could post more examples, but you get the point. Polls have repeatedly demonstrated that words matter – the healthcare law is viewed much more favorably as the ACA than as Obamacare.  And a number of insureds don’t realize they are one and the same.  We may soon have the dubious privilege of learning how widespread this confusion is.

Wendell Potter also thinks words matter, and opines that poor communication was among the factors that got us to this point of repeal/replace. At healthinsurance.org blog, he says that “lazy, superficial reporting” – and poor communication from the Obama administration and Congressional Democrats – has kept most Americans in the dark about how repeal of Obamacare would affect them. Potter runs down a list of the health coverage problems Americans faced before ACA implementation … as a preview of the problems that the GOP will resurrect if they can repeal the law. Check out Back from the Future. (A sequel we’ll all hate.)

At Managed Care Matters, Joe Paduda tries to clear up some of the miscommunication with a Q&A aimed right at the insured. Joe has been engaged in a series of posts aptly titled ACA Deathwatch. In his most recent post, he tackles what ACA repeal will mean to the consumer in a basic Q&A format. He looks at post-repeal life under replacement plans, tackling issues like what will happen to your cost, will pre-existing conditions be covered, will plans be inclusive of all conditions, etc.

At Health Affairs Blog, Joe Antos and Jim Capretta look at the The Problems with “Repeal and Delay”, warning that the most likely end result of repeal and delay would be less secure insurance for many Americans and procrastination by political leaders. They lay out the possible legislative scenario that this would follow and document the problems:

“To build a functioning marketplace, and to provide a ready path for all Americans to get health insurance, it is necessary to put together a coherent series of policies across Medicaid, employer-sponsored insurance, and the non-group insurance market. A workable plan will necessarily touch on all of these areas, and will be lengthy and politically contentious. That may not be ideal from a political perspective, but the alternative is incoherence and half-measures that will lead to a system that many Americans will view as worse than the ACA status quo.”

At Colorado Health Insurance Insider, Jay Norris offers a street level view of the level of scrutiny that all things ACA have been under in his post Connect for Health Colorado and the OIG Audit Report. Apparently, the Office of Inspector General (OIG) released an audit report (the full report is here) regarding Connect for Health Colorado’s use of federal start-up funding. This funding was provided for state-run exchanges to get their operations up and running in 2013 and 2014. A poorly worded title on the front page of the report, combined with clumsy explanations in the report gave the media and anti-ACA folks a lot to complain about. Jay dissects the details, asking whether at least some of this falls under the much ado about nothing category.

Of course, not everyone is a fan of Obamacare or we wouldn’t be engaged in these political brouhahas in the first place. In a post entitled Flatline at InsureBlog, Patrick Paule “pulls back the curtain on the fiasco known as Open Enrollment v4.0. Disappointing!”

We do have at least a few entries that aren’t focused on the fate of the Affordable Care Act.

At Health Care Renewal Blog, Roy Poses looks at Dr. Tom Price and finds him wanting, in his post Follow the Money: Nominee for Secretary of Health and Human Services Traded Health Care Stocks and Owned Tobacco Stocks While in Congress. For the uninitiated, Roy is a longtime critic and caller-outer of conflicts of interest as they relate to physicians – something that he as a physician himself is fairly passionate about. He finds the current HHS nominee a little too cozy with big pharma, biotech, device companies and health insurers. But that’s just the least of what Dr. Roy finds objectionable … read up so you can be informed and ready for Tom Price’s cabinet hearing schnduled for January 18.

At Health Business Blog, David Williams says that concierge medicine is well-established in primary care, and now it’s coming to the specialties, too. Concierge pioneer Wayne Lipton explains how the “hybrid” model works and how primary care and specialty practices differ: Concierge Cardiology: podcast interview with Wayne Lipton.

At HealthBlawg, David Harlow ponders whether “Big Data” is too big to analyze productively – reasonable minds may differ. David draws some interesting analogies and concludes that computing power has indeed caught up with our data-generation runaway train. See: Of Borges and Big Data, Or: Is Big Data Too Big?

At Heatlh System Ed Blog, Peggy Salvatore finds bright spots for healthcare in the future, noting that no matter how the economy or politics turn, there are a few constants where people can have some control. Technological advances and wellness movements can help improve national health without increasing the cost of healthcare. See Healthcare’s Future: Population Health and Information Technology.

At The Healthcare Guys, Abhinav Shashank says that as eventful as last year was for the healthcare industry, expect a lot of surprises are in 2017, too. He cites the 21st Century Cures Act and MACRA as transformational legislation, and looks at potential trends and issues we are likely to see in the coming year. See: Healthcare 2017: What Does the New Year Have in Store?

At Healthcare Economist, Jason Shafrin brings us a great video short which reviews a recent publication in JAMA that details health care spending: Health Care Spending is Complicated.

Here at Workers Comp Insider, we forgo our own submission (OK, we’ve been goofing off in the new year) in favor of a post from our friends and colleagues at Work Comp Psych Net. We realize that workers comp is just a sliver of the overall healthcare budget, but we find it an important segment, dealing as it does with the health and safety of American workers. One thing that differs in the occupational arena is healthcare treatment is always working to an outcome, ideally a successful recovery and return to work after a work-related injury or illness. Mental health issues are often  impediments to a smooth recoveries because they are so often not factored in at all. Work Comp Psych Net sheds a light on progress in this area in the post Psychosocial Issues And How To Deal With Them.

Soapbox: As bloggers, we all enjoy speaking our mind.  As political discourse grows increasingly heated, we think it’s worth  this short PSA: Support the First Amendment and freedom of the press. Journalism isn’t free.  You can purchase great editorial cartoons like the one we use in this post at cagle.com. We’d also encourage supporting the Committee to Protect Journalists with donations. Journalists die for that freedom we enjoy.

Next issue: Jan. 25, 2017 – Joe Paduda – Managed Care Matters

The election’s impact on health care: ACA, workers comp, Medicare

Monday, November 14th, 2016

Joe Paduda posted a roundup of opinions on the results of last week’s election, with contributors sharing their thoughts on how the GOP’s sweep will affect health care, health reform, and the health care system: The election’s impact on health care – experts opine.

Before wading in to the fray, Joe reminds us that health care accounts for one-sixth of our GDP, and that it is an incredibly complex, deeply entrenched business.

Joe is a brave man with his crystal ball. Also on his blog, today he takes a look at Trump and workers’ comp. Last week, he offered his initial take on TrumpCare.

Over the weekend, we learn that Paul Ryan plans to phase out Medicare in 2017. Ryan says “What people don’t realize is because of Obamacare, medicare is going broke, medicare is going to have price controls because of Obamacare, medicaid is in fiscal straits.” His proposed “phase in” is contemplated as part of the plan to repeal Obamacare.

Josh Marshall notes:

First, Ryan claims that Obamacare has put Medicare under deeper financial stress. Precisely the opposite is true. And it’s so straightforward Ryan unquestionably knows this. The Affordable Care Act actually extended Medicare’s solvency by more than a decade. Ryan’s claim is flat out false.

Second, I’ve heard a few people say that it’s not 100% clear here that Ryan is calling for Medicare Phase Out. It is 100% clear. Ryan has a standard, openly enunciated position in favor of Medicare Phase Out. It’s on his website. It’s explained explicitly right there.

People voted for change, but it’s not clear that they contemplated a private Medicare system as part of that change.