Some Health Care Reports
We’ve had three interesting health care papers produced at CAP over the past couple of days that I wanted to highlight. First, David Balto writes about the possibility of using anti-trust laws to eliminate barriers to generic drug competition:
Stopping these types of anticompetitive conduct could not be a greater priority for the Obama administration’s antitrust enforcers. With more than $60 billion in drugs scheduled to go “off patent” during the remainder of the President’s first term, stopping anticompetitive conduct in the pharmaceutical industry is crucial to controlling health care costs. If antitrust is a “consumer welfare prescription,” then our health care system is certainly in need of a prescription for an added dose of enforcement in pharmaceutical markets.
Next, David Cutler and Melinda Beeuwkes Buntin write about saving over $1 trillion by reforming health care.
And last, Ellen-Marie Whelan and Judy Feder on transforming the health payment system so that we pay providers to make people healthier rather than just paying them to do stuff.
21 Responses to “Some Health Care Reports”
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June 24th, 2009 at 5:36 pm
The way drug companies avoid generic competition is FDA approved “reformulations.”
How are anti-trust rules needed, when the government is the group granting the franchise? Don’t extend patent protection to begin with.
June 24th, 2009 at 6:02 pm
The Cutler and Buntin report is blather.
For nearly 20 years, scholars have argued that generous reimbursement policies for medical care have led to innovations that almost always increase health care costs.
That “generous reimbursement” has most safety net providers in financial stress. Look at the hospitals that didn’t reopen after a bad hurricane. New Orleans, Galveston, they’re all safety net hospitals. This is the group the Obama team wants to cut further.
Empowering people to make decisions. When the right information is present and employees’ financial interest are aligned with that of their company as a whole, empowering people to make changes sets in motion a process of continuous quality improvement. In health care, there is little ability for individual actors to make systemic changes.
Who wrote this drivel? Bribing people via pay for performance harms quality. People focus on optimizing their pay, not on producing quality services.
Systemic change requires more than empowering individuals. It requires leadership and profound knowledge. CAP knows little of either.
Bad theory means change will make matters worse. It’s a shame President Obama didn’t find the solutions embedded in his favorite article.
http://stateofthedivision.blogspot.com/2009/06/did-obama-read-piece.html
I don’t expect CAP to report on the Blue team’s planned bait & switch:
http://stateofthedivision.blogspot.com/2009/06/max-kents-cool-bait-switch-co-op.html
That said, the report is disappointing from a progressive standpoint.
June 24th, 2009 at 6:07 pm
The report by Melinda Beeuwkes Buntin and David M. Cutler continues a Big Lie that Cutler has engaged in before: there are not 47 million uninsured Americans. Note that Cutler’s assistant confirmed that my request for clarification had been received, and I never received a reply from him. He’s a liar.
June 24th, 2009 at 6:21 pm
According to notes in the census itself, 7.3 million people on Medicare improperly reported that they were “uninsured.”
Adding to this, the questionnaire actually asked have you been uninsured “at any time” in the last year. Obviously with people switching jobs and the government creating a system forcing them to attach health care to jobs there are quite a few people.
Digging deeper it appears 40% of the “uninsured” Americans make over $50,000 a year.
45.6 million is clearly a fabrication designed to draw an emotional response.
June 24th, 2009 at 6:42 pm
Sorry, a repost:
Can someone explain to a poor Canadian, ignorant of the niceties of the politics of the Senate, how it is possible for this body, elected to express the will of its constituents, can ignore the fact that 72% of the American public is in favour of a public medical plan?
June 24th, 2009 at 6:55 pm
5 – once elected, reps actually work for the corpocracy.
The big question is “Why are some dems already talking about a need to “compromise” and find a “bipartisan” (read: mclame’s do-nothing approach) solution when people rejected modest/no reform in fall and now 3 out of 4 want universal coverage and public option.
Even bigger question – why was single payer totally removed from the dialog at all levels?
June 24th, 2009 at 7:13 pm
These are the same drug companies that chop off part of a drug molecule or take an active metabolite and market it as a new, better drug. Then the new expensive drugs become the first-line ones because they’re on TV all the time and doctors are inundated by drug reps peddling samples.
Often there are generics available. They’re just not used.
June 24th, 2009 at 7:15 pm
Look, 50k/year is not a lot of money if you don’t have health insurance.
June 24th, 2009 at 7:21 pm
Obviously with people switching jobs and the government creating a system forcing them to attach health care to jobs there are quite a few people.
And obviously, switching jobs and insurance isn’t an issue, given that breaks in coverage don’t trigger pre-existing condition rules.
Oh.
June 24th, 2009 at 7:38 pm
“Can someone explain to a poor Canadian, ignorant of the niceties of the politics of the Senate, how it is possible for this body, elected to express the will of its constituents, can ignore the fact that 72% of the American public is in favour of a public medical plan?”
Much like the Canadian Senate, the US Senate is not “elected to express the rules of its constituents”. Unlike the Canadian Senate, US Senators are elected, but in districts of unequal population, for lengthy terms, and not all at once. It doesn’t express the will of the people in any meaningful sense. Any Democratic majority depends heavily on the support of “local notables” from rural states who are a throwback to the days when the Democrats were actually the more conservative of the two parties.
The difference with the US and Canada is that the Canadian Senate will almost always give way before the more or less democratically elected lower house. In the US, the less democratic upper house is arguably the more powerful, and has actually gotten less democratic over the years with abandonment of the idea that a majority can pass legislation. I think this difference indicates that US elites, unlike Canadian elites, have gotten more hostile towards democracy in recent years.
June 24th, 2009 at 7:42 pm
For a second you thought that thing was a cappuccino cup as in there’s practically nothing a delicious cup of coffee and a couple shots of whiskey can’t fix.
June 24th, 2009 at 7:56 pm
Only 40% of the Senate is required to stop legislation. Because of the ridiculous population distribution of states, a faction can get to that 40% level with states that represent much less than 40% of the population. Because it is legal in the US to bribe senators with large sums of money, even senators whose constituency supports reform are likely to oppose it. There are still other Senators, such as Evan Bayh, who personally profit directly from positions on boards of Health care industry companies, or ownership of their stock. Because our major media is comprised of a mixture of the slow-witted, the lazy and self-interested wealthy individuals, all of whom would rather have a Senator as a pretend friend rather than do their job well, the public remains poorly informed about the way that the Senate is screwing them over.
June 24th, 2009 at 8:01 pm
While bribing them to perform unnecessary procedures makes everything turn into sunshine and lollipops!
June 24th, 2009 at 8:08 pm
What Njorl said.
If we had proportional representation in the Senate, things would be much better. Instead, Wyoming and California each get the same number of Senators. The filibuster is the mechanism Njorl alludes to in his first sentence.
Other undemocratic or otherwise highly problematic elements in the structure of US governance: The electoral college which allows, even if electors were bound to follow the popular vote, a president to win with fewer votes than the opposing candidate; and Supreme Court nominations with no term limits.
The last is not to be underestimated. If we had a less corporatist Supreme Court, we might have reasonable limits on bribery of politicians and the ability of rich special interests to swing elections.
June 24th, 2009 at 9:03 pm
So, upon close examination of the kerning, the estimate of 47 million for those without health insurance might actually be overstated by 15-20%, and many of these uninsured earn a middle-class income. Hence the involuntarily uninsured might number only 20 million, give or take a few million. I can feel my sense of urgency slipping away already.
All I have to do now is pretend that health insurance and/or a middle-class income are an adequate safeguard against being bankrupted by medical bills, and I can fall back into utter apathy.
Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.
Medical Bankruptcy in the United States, 2007:
Results of a National Study (pdf)
June 24th, 2009 at 10:11 pm
1. The point I made is that UHC advocates – in this case Cutler – keep lying about a rather large number. If they’re willing to lie about that, what else are they lying about?
2. Perhaps instead of taking the time to type out “anonymous”, how about letting us know how you are? Visit neuticles.com first if necessary.
3. Since the Endgame post is missing today, I’ll link this off-topic criticism of Insty here.
June 24th, 2009 at 10:33 pm
There was a sad fuck named LoneWacko,
Who lived on cold soup and tobacco.
He saw a Hispanic,
Went into a panic,
And ass-raped himself with a taco.
June 24th, 2009 at 11:21 pm
Where’s the Endgame? Maybe Matt’s gone AWOL hiking on the Appalachian Trail.
June 25th, 2009 at 2:17 am
And this has something to do with 45.6 million being misleading?
Yea, Oh.
10, at the most.
June 25th, 2009 at 3:29 am
Shorter Nathan: die already, scum.
June 25th, 2009 at 9:19 am
Turning health care into a Skinnerian pellet box will harm quality.
It’s not lollipops and sunshine, it requires leadership and profound knowledge. America’s hallowed halls of government and corporate board rooms haven’t a clue.
An American taught the world about quality. Government and business leaders ignore his teachings.
http://deming.org/
Solutions are embedded in the New Yorker article President Obama loves so much. Why does he ignore them?
http://stateofthedivision.blogspot.com/2009/06/did-obama-read-piece.html