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Four Big Trends – Brian Klepper

Jan 16, 2008• 9

Brian Several events and trends emerged over the last year that will reverberate throughout the health care
marketplace in 2008 and going forward. While none of these dominated the trade press like some other issues – electronic and personal health records, RHIOs, the evolving labor shortage, pay-for-performance reimbursement – these manifestations of change are occurring in the marketplace as well as through policy, and are moving health care forward in fundamentally positive and far-reaching ways.

Health 2.0The most significant for the long term in terms of its capacity to change how health care works is the Health 2.0 movement, which Matthew Holt and Indu Sabaiya have played a central role in facilitating and explaining. In some ways, Health 2.0 is simply a continuation of what has come before: companies creating new value through information and connecting with customers over the Web. Health 2.0 takes this approach into every area of health care data, often driven by companies outside of or at the margins of health care, who have no financial stake in perpetuating inappropriateness and waste, and who see an opportunity to make money by rationalizing the system.

UPDATE: Medicare, SCHIP and Kids

Aug 3, 2007• 2

By MAGGIE MAHAR

Last night the Senate voted 68 to 31 to renew and expand the State Children’s Health Insurance Program SCHIP). A day earlier the House voted 225-204, largely along party lines, to approve a larger expansion of the SCHIP program. As Matthew notes below, the Senate, unlike the House, would not try to help fund SCHIP by eliminating Medicare’s overpayments to Medicare Advantage for-profit insurers. (See my post below)

Meanwhile, President Bush has said that he would veto either version of the legislation. But the Senate bill garnered enough votes for its version of the bill to overcome a veto. (18 Republicans joined 48 Democrats and 2 Independents in the vote.)

According to PBS, the House and Senate plan to meet after their August recess to reconcile the differences between the two bills before sending a final measure to President Bush.

Below, Matthew offers his best guess as to what will happen next. He suggests if the Senate/House compromise avoids taking a whack at the Medicare Advantage private sector insurers, the President might well sign it. Nevertheless, Matthew believes that Democrats won’t be able to resist the temptation to include the provision cutting over payments to insurers in order to provoke the veto and then campaign on the fact that Republicans hate children.

I’m cynical but frankly, Matthew is so cynical. I take this as an ethnic (i.e. British) trait. On the other hand, Iâm Irish, so I probably shouldn’t open a discussion about ethnic Achilles heels . . .

But I am idealistic enough to think that there are enough Democrats and Republicans who care about healthcare for uninsured children that they will eliminate the cuts to insurers in hopes of avoiding a veto.

It’s worth noting that on Tuesday, Sen. Orrin Hatch (R. Utah) and Sen. Edward Kennedy, (D-Mass), told the Washington Post that House-Senate negotiations will aim to keep the final bill within the scope of the Senate’s measure in order to try to avoid that Presidential Nix.In the end, if Congress doesn’t touch insurers’ profits, would President Bush say “no” to expanding SCHIP for kids? I don’t know.

What do you think?

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

HEALTH PLANS: SCHIP and Medicare Advantage

Aug 2, 2007• 51

You’ll be seeing more and more of Maggie Mahar here as she works blogging into her new role at The Century Foundation. But of course, she’s not the only one who’s made this connection. If you want to see more of your host’s caustic comments on Medicare Advantange, and lots of good comments around it, try here, here here, here or here. Here’s Maggie on this week’s dust up.

By MAGGIE MAHAR

A debate rages in Congress: Who needs the money more – UnitedHealth or the kids?

This week, a storm hit the House of Representatives when law-makers began to debate a proposal that would, in the words of a Wall Street Journal editorial, “steal nearly $50 billion from Medicare Advantage, the innovative attempt to bring private competition to senior health care” in order to beef up the State Children’s Health Insurance Program (SCHIP), a program that delivers health care to poor children.

Last night, the House voted 225-204 to pass the legislation.

SCHIP is scheduled to expire September 30; the House bill would renew the program while expanding it to include another 5.1 million children at a cost of an extra $50 billion over five years. The bill’s backers propose to fund the legislation by increasing the federal cigarette tax by 45 cents while simultaneously paring the premium that Medicare pays private insurers who provide Medicare to seniors. The goal of the bill, reformers say, is to ensure that all children in the United States have health insurance. The Wall Street Journal’s editors see things otherwise: “Democrats apparently want to starve any private option for Medicare,” the editorial concluded.

Rupert Murdoch hasn’t yet weighed in, so I decided to take a look at the proposal. Would the House bill really make it impossible for private sector insurers to continue to offer needed benefits to seniors?