Health Wonk Review, Yogi Berra edition…

This week, we have the privilege of hosting Health Wonk Review, a regular compendium of the best blog posts on health policy. While the beginning of April signals the end of spring training and the call of “Play Ball,” this year this is true of health reform as well.

Next week, the Obama Administration’s road show on health reform ends here in California, and the health reform debate back in Washington, DC, moves from a broad framework to working through the thorny policy and financing issues, starting with the crucial question of whether they include money in the budget for health reform. The goal is action in the summer, for passage in September-October, right during the playoffs.

For those of us in California, it’s like baseball great Yogi Berra said, “it’s like deja vu all over again.” As the statewide health care consumer advocacy coalition, we’ve been involved in many efforts for comprehensive health reform at the state level, most recently in a high-profile effort that stalled last year (which was the subject of three recent web articles of interest in Health Affairs). Many that we work with in California and nationally have longer histories in health reform; our scars are merely fresher.

In the spirit of the baseball season, it seems that health wonks can learn a lot from Yankee great Yogi Berra, who will soon attend the opening of a new Yankee Stadium in my hometown of the Bronx. He was savvy enough to understand the blogosphere before it was even invented, when he said: “It was hard to have a conversation with anyone. There were too many people talking.” So onto the posts, some of which were suggested and nominated, and others that we found and liked:

Let’s start with health care costs, where much of the conversation on health reform is focused. As Yogi said, “a nickel ain’t worth a dime anymore.”

Matthew Holt of The Health Care Blog asks “So what’s the real usual, customary and reasonable price of care?” As Yogi says, “I wish I had an answer to that because I’m tired of answering that question.” Holt’s answer: “They’re what providers have made up over the years.” So his take on the Ingenix scandal is that the whole pricing structure of health care system is screwed up.

I can’t disagree, given that I’ve seen too many uninsured or underinsured patients who are sent to collections and court for hospital and doctor bills that are multiple times what insurers pay, that have no relationship to the actual cost of providing care.

These bills not only have financial impacts, but deter people from getting the care they need. Ill and Uninsured in Illinois tells a personal story in the post Lutheran General: Pay first, and we’ll put a Band-Aid on it. “This personal story illustrates why access to emergency-room treatment does not constitute access to health care in any meaningful sense.”

Another big issue is government’s role in the insurance market, as a regulator, a negotiator, and a competitor.

There’s one view by Jared Rhoads at The Lucidicus Project, who even opposes government as an information provider, because as he describes it, “the government should not be funding comparative effectiveness research because it should not be involved in healthcare at all.

Another skeptic about new rules for the marketplace is Bob Vineyard at InsureBlog, who asks in Good News, Bad News if the insurance industry’s “offer” to give up medical underwriting really a good thing, wondering if it could means higher rates.

Frankly, I would much rather if insurers competed on cost and quality rather than on their ability to avoid risk–a.k.a sick people. My colleague Jason Rosenbaum at the Health Care for America Now campaign is also skeptical of “the insurance industry’s disengenuous concession,” but from a totally different position. This is something the industry should have started with, and they are still screaming against a public health coverage option for consumers. As Yogi said, perhaps about the distance the insurers have come, “it’s not too far, it just seems like it is.”

Maggie Mahar at HealthBeat also thinks there’s a lot more distance for the insurers to go, with regard to new rules for the road, and a public option to keep them honest.

Jaan Sidorov of the Disease Management Care Blog posts about the debate about a public health coverage option, and fears that a public option would use its significant market power to dictate rates, undermining the private insurer competition.

The wunderkind Ezra Klein at The American Prospect, in a “primer” on the public health coverage option, hopes that any potential compromise does not take away the main benefit–the public health insurance option’s ability to negotiate for the best possible rate.

Jeffrey Seguritan at nuts for healthcare has a detailed post on the back-and-forth in the blogosphere around health reform and the public health coverage option. He ultimately argues that the lessons from the Massachusetts univeral coverage experiment is that expanding access cannot be sustainable with a cost containment strategy, and while a public health plan would be potentially a dangerous competitor, its main appeal would be its market power to implement broad changes in provider payment paradigms.

I wonder what all the fuss is about. After all, more than a third of the population is in a public health coverage program already, including Medicare and Medicaid. Here in California, we have lots of public health plans, run by counties. The concept was part of the reform agreed to be our Republican Governor Arnold Schwarzenegger, and part of the Healthy San Francisco reform as well. This isn’t some new concept, and people tend to like their coverage. As Yogi said, “nobody goes there anymore, it’s too crowded.”

But let’s all take a step back. At The New Republic’s The Treatment, (where I post regularly as well) the host and ace reporter Jonathan Cohn wonders whether all the fuss about public insurance plans, individual mandates, and such is premature. “None of these things will mean bubkes if we don’t come up with the money to pay for reform,” he writes–and offers some options for solving that problem. Some of those are controversial–for example, removing some of the tax deductions for employer-based coverage–but forgive him, he’s a Red Sox fan. He’s seen the improbable happen twice in this decade.

Other posts of note cover the range of health policy, and feature some original reporting. As Yogi said, “You can observe a lot by watching.”:

* Joe Paduda reports over on his blog Managed Care Matters, on the interesting turnaround, after years of providers not liking being rated by insurers, that now providers are rating health plans,

* Jason Shafrin provides a comparison of pharmacists and primary care providers as immunizers, posted at Healthcare Economist. In a paper evaluating whether pharmacists can be effective vaccinators, he finds that pharmacists proved more consistent in following safety protocols, had lower unit costs, and were more efficient than vaccinators in traditional settings.

* Yogi once explained, “you’ve got to be careful if you don’t know where you’re going cause you might not get there.” Some of those lessons for improving health outcomes at a hospital–leadership matters, the need to set clear goals–are described in the post “GOOD NEWS: How the Baylor Health Care System Disseminates Quality Improvement (Part III)” posted by Joanne Kenen and Tom Emswiler at New America Blogs.

* David Williams of the Health Business Blog wonders if how newspapers report about deaths–from detailing whether seatbelts were worn in car crashes, to describing other circumstances of potentially preventable deaths–could be a form of public education, in the post “Death reporting: Time to wade into medical matters in cases like Jade Goody’s?” The dead (and their survivors) might object, as everybody looks better in life: as Yogi said, “Steve McQueen looks good in this movie. He must have made it before he died.”
* Julie Ferguson at Workers’ Comp Insider posts on the high price of fresh tomatoes: more on agricultural slavery in Florida. She posts about modern day slavery and human trafficking, especially within the immigrant workforce in the agricultural industry, particularly in Florida. It’s an issue in California as well, where the agricultural workers do not have healthy conditions, and largely don’t get health coverage or care.

UPDATED: Here’s some worthy lost-in-the-E-mail-deluge nominations:

* Also from a public health perspective, Boston Health Notes’ Tinker Ready reports that health disparities are not just black and white. We in the hyper-diverse California agree.


* Speaking of universities, Roy Poses at Health Care Renewal writes about “the political incorrectness of discussing conflicts of interest in medical adademia.” He reports on how Tufts administrators withdrew from a panel discussion to avoid appearing with an aide to Senator Grassley–perhaps because of their discomfort with the Senator’s views on conflicts of interest in academia.
So there’s a lot of work to do. There always will be, since as Yogi said, “if the world were perfect it wouldn’t be.” But the status quo is decidedly not perfect, and it’s deteriorating, and so the task of health reform is even more urgent.

Attempting health reform might qualify as a national pastime, given that our country has been trying in multiple effort since the Cubs last won the World Series when Teddy Roosevelt was president. In previous efforts, “we made too many wrong mistakes.” Can we learn from them?

What plan should we advocate? As Yogi said, “when you come to a fork in the road, take it.” As consumer advocates, Health Access California has advocated for a range of solutions, from single-payer to pay-or-play. But as with any directions, we want to make sure we are going roughly in the right direction. It will always be a balancing act, pushing the dire urgency of reform while also advocating the right reforms–and even figuring out what those are.
Health Wonk Review continues two weeks from now at Pizzazz. Until them, let’s end with Yogi Berra’s best advice, on the value of persistance: “It’s not over till it’s over.”

Play ball!

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Health Access California promotes quality, affordable health care for all Californians.

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