January 24, 2012
3:40 pm
If you’ve ever watched the movie “The Sixth Sense,” you see what a talented director and writer can accomplish by withholding critical information from the audience. In that movie (and, no, I’m not going to spoil it if you haven’t seen it), M. Night Shyamalan holds back an essential fact about Bruce Willis’s main character until the very end of the film. When that fact is revealed, it changes the entire context of what we thought we knew about the story.
What works well, though, in the cinema isn’t necessarily a sound methodology when it comes to public policy matters that affect lives. Transparency is public matters is virtually always a good thing, but when the practice of transparency reveals facts without context, it can be counterproductive.
Dr. Thomas Stossel, a professor of medicine at Harvard Medical School, discussed this issue in a Wall Street Journal op-ed this week, “Who Paid For Your Doctor’s Bagel?” In his op-ed piece, he discusses the Physicians Payment Sunshine Act, a new law that will require medical innovation companies to disclose any transfer of value to physicians. The Centers for Medicare and Medicaid Services (CMS) has recently issued draft guidelines for implementation of the new law.
Again, in principle, this type of transparency is a good thing. But when the new law results in a list of consulting fees and other payments made by pharmaceutical and medical device companies to physicians, there will be a piece of the puzzle still missing. What is the purpose of that exchange beyond a minimalist bureaucratic definition such as “consulting fee?” What was the impact for patients and for the current and future practice of healthcare? Without this context, negative inferences can be made about any exchange of value.
As Stossel wrote in the Journal, “The media already exploit disclosures….to demean physicians compensated by royalties from useful inventions that they license to companies, or who were paid consulting fees for advice concerning the optimal use of products, or for educating other physicians about products.”
The fact is that collaborations between physicians and industry have led to some of the most important medical breakthroughs of the last several decades. Physicians help guide industry on how to make new innovations beneficial for patients. Companies train physicians on the optimal use of new drugs and devices. This sharing of knowledge is essential to the advancement of healthcare.
We’ll be discussing this issue in greater detail in the months ahead. HLC launched an initiative called the National Dialogue for Healthcare Innovation and, through this effort, multiple organization representing healthcare providers, health industry sectors, academia and patients have been developing a consensus set of principles to help guide future physician-industry collaborations. More to come.
December 15, 2011
9:46 am
If there ever seemed an issue, in today’s political environment, upon which Democrats and Republicans would never meet in the middle, it is Medicare reform. This is always particularly true in the months leading up to an election. It’s just too easy to portray any new idea to make the Medicare program more affordable or sustainable as a dangerous threat to vulnerable seniors.
That’s why it’s impossible to overstate the significance of Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) reaching across the aisle and joining together to offer a meaningful Medicare reform plan. This development has probably caused no small amount of heartburn in some political and campaign planning circles, but for taxpayers, future Medicare beneficiaries and the program itself, this is a very positive step.
We’re not going to try to comprehensively analyze the Wyden-Ryan plan right now in this space. Both lawmakers have, in fact, said that they won’t offer legislative language until after the 2012 elections. In broad strokes, though, the concept offers a sustainable path for Medicare’s future, offering beneficiaries a fixed federal contribution that can be used to acquire coverage from either conventional fee-for-service Medicare or a selection of competing private plans. As we’ve said at the Healthcare Leadership Council, in advocating this type of approach, competition will drive greater innovation, quality and value.
The news today, though, is not the details of the plan, but the fact that Ron Wyden and Paul Ryan have opened up a crack in the previously impenetrable wall between the two parties on this issue. If this gradually moves us to a place where we have more substantive discussions about how to maintain a viable Medicare program, and fewer 30-second “Mediscare” TV ads, then these two have made an incredibly valuable contribution.
August 12, 2011
10:49 am
The Republican presidential candidates who participated in last night’s Iowa debate put on quite an interesting, as well as entertaining, show. With political analysts pointing out that this weekend’s Ames straw poll could winnow the field, the gloves came off as the eight candidates fought to maintain a critical mass of voter support.
Anyone who turned on the debate, though, to learn the candidates’ visions for healthcare in the United States would have come away disappointed.
We learned, to no one’s surprise, that the GOP presidential contenders have a steadfast dislike for the Affordable Care Act that President Obama signed into law last year. Most of the candidates also believe that the individual health insurance mandate contained in the ACA is unconstitutional.
It was also clear that, as long as former Massachusetts Governor Mitt Romney is the frontrunner, he will be criticized for what rival Tim Pawlenty calls “Obamneycare.”
But future GOP debates need to do more than reaffirm what the White House aspirants are against. There are indeed widespread concerns about the current health reform law, including questions over affordability, healthcare quality and whether an unprecedented expansion of Medicaid is the best approach for reducing the uninsured population. Those who would take Mr. Obama’s place need to spell out for us how they would do things differently. The questions they need to answer include:
• Do you support eliminating pre-existing conditions as a barrier to health coverage? And, if so, how do you achieve that without an individual mandate to ensure that consumers don’t wait until they’re sick or injured to purchase health insurance?
• How do you slow down the growth in healthcare costs without undermine healthcare quality, access or innovation?
• How do you address the question of Medicare sustainability?
• What are your answers to the projected workforce shortages in healthcare? How do we ensure enough medical professionals to treat a growing patient population?
• With the CDC calling for a huge escalation in the number of Americans with diabetes, how do you propose to address the rise in chronic disease cases that are driving healthcare costs?
With these questions and many others, there’s an important health policy debate to be had among the Republican presidential contenders. It just hasn’t happened yet.
May 13, 2011
11:16 am
When it comes to health policy, all eyes seem to be cast toward New England these days. The high-profile issue this week is Mitt Romney’s defense of the health reform enacted during his Massachusetts governorship and his battle with the Wall Street Journal over its merits.
I think, however, a more interesting story is developing in Vermont.
Later this month, Vermont Governor Peter Shumlin is expected to sign legislation that would, in essence, create a single-payer healthcare system in the state. The framework of the proposed Green Mountain Care system is essentially this (it’s explained very well in a question-and-answer piece in The Washington Post): The state would roll up all of its payers – state and local employees, Medicaid and Medicare beneficiaries, individual and small group plans – into one system, with all of the dollars received for their coverage going into Green Mountain Care, which would become the sole health payment system in the state. Vermont will need Medicare and Medicaid waivers from the Obama Administration to make this work, as well as cooperation from the state’s largest insurer, Blue Cross Blue Shield of Vermont, which has already declared its support (and would likely be the hands-on administrator for the new system).
Sounds neat and simple, and it’s getting raves from those who have long supported a national single-payer system, but there are some critical questions left to be answered.
First, what does Vermont do with the large employers who are self-insurers and covered under federal ERISA regulations? One theory, expressed in the Washington Post articles, is that these employers will be taxed anyway to help pay for Green Mountain Care and, therefore, they’ll decide it’s cost-efficient to put their employees in a system they’re helping to finance.
Another question concerns the dual challenges of how to pay for a state-run single-payer system and how to contain healthcare costs to make it affordable. Part of Vermont’s answer is the creation of a Green Mountain Care Board, sort of a revved-up version of the controversial Independent Payment Advisory Board (IPAB) that would have rate-setting powers for doctors, hospitals, pharmaceutical products and medical devices.
This is where Vermont’s economic and healthcare future gets a little precarious. You see, there’s a major difference between enacting state policy and writing federal laws. If individuals and employers believe they’re being hurt by a new state law, it’s not all that difficult to pick up stakes and move to another jurisdiction.
Will employers be open to the higher taxes that will accompany a single-payer healthcare system? What will happen when the state has to ratchet down on physician reimbursements to keep Green Mountain Care affordable? Will New Hampshire be the beneficiary of Vermont’s sharp swing to the left in health system transformation?
Some groups will, no doubt, judge Green Mountain Care a success if it drives private insurers out of the marketplace and replaces them with state-run healthcare. Vermont citizens, though, may hold their judgment until they see if jobs and doctors start an exodus across the state line.
March 25, 2011
12:21 pm
The one year anniversary of the Affordable Care Act wasn’t the only significant healthcare news this week. Here are links to some interesting and important reports you may have missed.
A study published in Health Affairs documents the savings generated by a major employer, Johnson & Johnson, as a result of employee wellness programs.
A new blood test is in development that can diagnose the risk of diabetes a decade before symptoms begin to appear.
On the subject of diabetes, Novo Nordisk and race car driver Charlie Kimball have teamed to launch a campaign urging patients to speak to their physicians about improved insulin delivery methods.
Could video games have a healthcare value? Experts say they may help discover whether children have vision problems.
The Cleveland Clinic is taking advanced healthcare delivery concepts far beyond U.S. borders, bringing its expertise to Abu Dhabi.
Meet “Sammons Says,” Baylor’s new blog on cancer prevention, treatment & research.
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