Health Wonk Review: Mud Season Edition

March 16, 2014
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I moved around a lot when I was really young, but for the most part, I grew up in southeast Georgia–that’s the place that I’ll always identify as home. So, the last few years, first in Rhode Island, and now in Iowa, have taken some getting used to weather-wise. This year, winter has been especially brutal. But as I write this, I am sitting in my house with the windows open.

I moved around a lot when I was really young, but for the most part, I grew up in southeast Georgia–that’s the place that I’ll always identify as home. So, the last few years, first in Rhode Island, and now in Iowa, have taken some getting used to weather-wise. This year, winter has been especially brutal. But as I write this, I am sitting in my house with the windows open. Sure, it is supposed to snow tomorrow, but today it got up to 60 degrees. We have moved our clocks forward, leading to longer sunlit evenings, and I feel the promise of Spring approaching. For now, though, it’s mud season. All of the snow that has blanketed the ground since December has finally melted–quickly–leading to a sloppy mess. To be frank, the world of health policy is not that different. Things can change quickly, and they can certainly get messy. Thus, this mud season edition of the Health Wonk Review is presented with the understanding that while things might be a bit of a mess right now, there is hope on the horizon.

As the snow melts, we’re also nearing the end of open enrollment under the ACA. The latest numbers suggest that the Obama Administration is going to miss its target. I suppose the problem with setting goals is that you can fail to meet them. Louise at the Colorado Health Insurance Insider suggests that it might have been more efficient to spread open enrollment across the whole year. As long as that policy doesn’t extend to frozen precipitation, I’m intrigued.

Likewise, much ado–replete with mudslinging–has been made of Obamacare’s early going: Are enough people signing up? Are they the right types of people in the right proportions? Is it working? These are all excellent questions, but as Joe Paduda points out at Managed Care Matters, they aren’t the most important questions. Those, he contends, are what is happening to health plan prices and quality, and he is encouraged by what he sees at this early stage.

In that spirit, perhaps it will help if health care providers heed the advice of the Healthcare Talent Transformation blog’s Jonena Relth, who urges them to rediscover the adrenaline rush they first felt when they began treating patients. By encouraging use of portals and other patient-engaging technologies, she believes that our nation’s health care system can be the best in the world. On his Health Policy Blog, John Goodman also advocates for personalized medicine over protocols.

When it comes to Obamacare, there’s a lot to wade through, but our bloggers are on it. Hank Stern of InsureBlog examines the disturbing story of a vet caught up in an Obamacare tragedy and asks: What does a 1944 French existentialist play have to do with health care in modern America? Anthony Wright of the Health Access Blog takes a close look at President Obama’s appearance on Zach Galifianakis’ “Between Two Ferns” and in the process of fact-checking the video, dismantles the myth of the “young invincibles.” Also not afraid to fact-check is Linda Bergthold who, writing for healthinsurance.org, explains why rumors about the threat of Obamacare to your employer-sponsored health plan shouldn’t be keeping you up at night.

When the snow piles up, you need a shovel. When the disinformation around the ACA piles up, you need Maggie Mahar to help set the record straight. In “How a CBS Video About an Obamacare ‘Victim’ Misled Millions,” Maggie finds that neither the woman being interviewed, nor the reporters and producers involved in creating the piece seemed to understand some basic elements of the ACA thanks to the fog of disinformation that reform’s opponents have generated. It’s a terrific read–even if a bit unsettling.

Seemingly like the arrival of Spring, implementation of the ACA has also been delayed on more than one occasion. Delay of the employer mandate has gotten a lot of attention, but now there’s a push to delay the individual mandate too. At the Healthcare Lighthouse, Billy Wynne discusses how the House’s decision to pair the bipartisan doc fix policy with delay of the individual mandate is a death knell for permanent SGR repeal in the near term. Also on the subject of payment reform, the Health Affairs blog presents a post from Suzanne Delbanco, executive director of Catalyst for Payment Reform. Suzanne looks at the track record and potential of pay-for-performance and finds that the evidence on whether pay-for-performance models improve quality and affordability is mixed at best.

Mud season is typically referred to in New England (although trust me when I say it applies to the Midwest!), so it’s worth looking at the state that was doing Obamacare before Obama was President: Massachusetts. At the Health Business Blog, David Williams is running a series of interviews about health policy with all of the Massachusetts gubernatorial candidates. He shares with us his interview with well-known health quality advocate and gubernatorial candidate Don Berwick, who says as Governor, he’d pursue a single-payer system and work to implement the Triple Aim.

As we slog along, let’s not forget about other health care providers, like dentists and the hygienists that assist them. As the ACA is implemented, we’re hearing a lot about the use of midlevel providers to meet increases in demand, while helping to control costs. Well, the Healthcare Economist, Jason Shafrin, finds that this principle holds true in dental care as well. When hygienists’ scope of practice is limited, meaning dentists are left to do some less advanced tasks such as cleanings, the net result is approximately a 12% increase in many dental care costs.

The muck and mire is especially thick when you look at conflicts of interest in health care, as our good friend Roy Poses does regularly at the Health Care Renewal blog. This time around, he’s writing about a policy that actually condones keeping conflicts of interest a secret and the implications this may have had in a separate controversial case. Read both of his posts here and here. And, while we’re at it, Tom Lynch of Workers’ Comp Insider tells us all about a hospital that has been bribing politicians and providing doctors with kickbacks for referring patients for surgery.

Finally, for those of you still stuck inside for a few more weeks, I highly recommend checking out a new resource from Jared Rhoads. Healthpolicy.tv is a source for the most interesting health policy videos from around the web. Perhaps most importantly, it aims to elevate the debate by including views from all across the political spectrum. See? I told you that mud season foreshadowed better days ahead. Well, that’s it for this edition of the Health Wonk Review. Next up to host is Chris Fleming at the Health Affairs blog.