Taking Note

Advice to Hospitals in a Downturn: “Market the High-Margin Service”

One  might think that hospitals would be recession-proof.  After all, hospital care is a necessity.

But one would be wrong. When times are tough, people put off elective surgery, and even avoid going to the hospital in an emergency.  Although they may have insurance, often they can’t afford the co-pays that accompany hospital care. As for the uninsured, not long ago a study showed that uninsured patients suffering from gunshot wounds often leave the ER, voluntarily, without being admitted to the hospital.. (I’ll be writing about this study in a future post.)
 
What can hospitals do? Hospitalimpact.org, a new blog “dedicated for current and emerging hospital leaders, thinkers and enablers” offers some advice:

Peggy Noonan vs. the New England Journal of Medicine

Let’s put to rest, once and for all, the idea--or rather, the  notion (it’s not even an idea,  just a vague impression, based on hearsay)--that the health reform legislation now under discussion includes no plans for containing health care spending.  

The reform proposal now being debated in Washington would put a brake on health care inflation. As an eye-opening essay in the most recent (March 4) issue of the New England Journal of Medicine explains, Medicare would, at last, have the power it needs to lead the way,  not by cutting benefits, but by restructuring how it does business.

Meanwhile, pundits such as Peggy Noonan feel free to pronounce health care reform “a disaster” and “a colossal waste of time”without giving any indication that she has ever read the legislation. Presumably Noonan bases  the opinions that she expresses in her recent Wall Street Journal Op-ed on  what other pundits have said.

President Obama’s Speech—A Different Tone

This afternoon, President Obama spoke with the confidence and determination of a leader who knows that he is right—and that he has won.

He is no longer pleading for bi-partisan co-operation. His final proposal includes all Republican suggestions that reformers find useful. The president realizes that some will not agree with his plan. As he said at the end of the Summit, “That’s why we have elections.” Those who disagree can make their beliefs known at the polls.

In the meantime, President Obama is saying: “this is my proposal.”  He would not speak with such authority unless he was quite certain that the Democrats have the votes to pass this legislation.

Obama’s Letter to Congressional Leaders: We’re Almost There

Today, President Obama sent a letter to Congressional leaders, offering to incorporate more Republican ideas in health care legislation.

Don’t panic: Of the four ideas, two are excellent, one was almost certain to happen anyway, and one simply funds pilot projects in the states to explore alternatives to resolving medical malpractice disputes.   This provision does not call for capping malpractice awards—the president has made it clear that he opposes caps. 

Moreover, President Obama makes it very clear that he is not going to “strip down” his bill. He is insisting  on comprehensive reform.

More importantly, Nancy Pelosi appears very close to having the House votes to pass reform. The New America Foundation’s Joanne Kenen reports: 

The Messy Business of Transparency

President Obama’s latest plan for health reform brought a flurry of commentary in the last two days; including divergent views on whether his commitment to "transparency" is helping or hurting the process.

Yesterday, the Los Angeles Times blamed the current “healthcare backlash” on Obama’s insistence that the messy business of hashing out health reform be done in Congress, not behind closed doors in the Oval Office. In the L.A. Times’ view, there’s been too much transparency:

The President’s Proposal-Everything Depends On...

You might be wondering why I haven’t written about the President’s HealthCare bill. The reason is that I have very little to say. This, I realize, is unusual. But the truth is that the president’s proposal is very similar to the Senate bill—which is not a surprise.

Nevertheless, I am very glad to see the proposal. I was worried that the White House had put reform on the back burner.

Will it pass? As always, I’m trying to be optimistic. But I think that everything depends on whether the White House decides to twist arms.

The president will have to persuade House liberals that this is a good first step—and that we can worry about improving the plan over the next three years. I would still like to see a public option, and I hope that, in the end, the federal government will wind up overseeing the state-based exchanges. But the legislation doesn’t goes into effect until 2014; that gives us more than enough time to improve on it. The President also will need to keep an eye on Senate moderates. I would favor sending Joe Lieberman on a special mission to South Korea. A relative who is stationed there tells me that the demilitarized zone is particularly bleak this time of year.

Does Health Insurance Save Lives? Maybe That’s the Wrong Question

Do the uninsured die because they don’t have access to medical care—or because more than three-quarter of the uninsured are poor?  In part 1 of this post, I explained that we know that poverty is a killer. It destroys mind and body, slowly but surely. In the U.S. the poor die seven years earlier than the rich. And most of the uninsured are poor. 

I also explained that lack of access to medical care is not a major factor in determining who dies prematurely. Social circumstances, personal behaviors, and environment account for 60% of early deaths, and each is closely tied to socio-economic status.

Most Americans assume that good health care is the key to longevity. But in 2002 the Kaiser Family Foundation published a study that poses a radical question, “Does having health insurance improve your health?“ It might sound like a foolish query. One wants to say “Of course!”

Why Reformers Must Forge Ahead

While others seem ready to declare health care reform dead, Henry Aaron explains why reformers must stay the course in the most recent issue of the New England Journal of Medicine. They have everything to lose, and nothing to gain if they abdicate their responsibilities now. More importantly the nation will be left with a health care system that fails society while threatening our economy.
 
While others flail about, the Brookings Institution Senior Fellow makes his case in calm, lucid prose, reminding us that nothing has changed over the past month. The House and Senate have, in fact, managed to pass two very similar bills. If you explain the legislation to the public, the majority of Americans favor reform. All that remains to be done is to reconcile those bills—which in the end requires a simple majority.

Maryland’s Health Care Solution

While health care reformers argue about what it would take to “break the curve” of health care inflation, the state of Maryland has done it, at least when it comes to hospital spending.

In 1977, Maryland decided that, rather than leaving prices to the vagaries of a marketplace where insurers and hospitals negotiate behind closed doors, it would delegate the task of setting reimbursement rates for acute-care hospitals to an independent agency, the Maryland Health Services Cost Review Commission.

When setting rates, the Commission takes into account differences in labor markets and how much a hospital pays in wages; the amount of charity care the hospital does; and whether it treats a large number of severely ill patients. For example, the Commission sets the price of an overnight stay at St. Joseph Medical Center in suburban Towson  at $984,  while letting  Johns Hopkins, in Baltimore Maryland, charge  $1,555. For a basic chest X-ray, St. Joseph's asks  $81 and Hopkins' is allowd to  charge  $155. The differences reflect Hopkins's higher costs as a teaching hospital and the fact that it cares for generally sicker patients.

Autism and the MMR: Finally a Retraction

Are we finally ready to close the door on the much-disputed link between the MMR vaccine and autism?

On January 30, Britain’s General Medical Council ruled that Andrew Wakefield, a gastroenterologist, had acted “dishonestly and irresponsibly” in conducting his research that established a link between autism and the MMR vaccine. And yesterday, the British medical journal Lancet finally retracted the resulting 1998 study authored by Wakefield that helped drive MMR vaccination rates in the U.K. down to the point where in 2008, measles was officially declared “endemic” in the country.

The Lancet’s editor, Richard Horton, told The Guardian "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false," he said. "I feel I was deceived."