Friday, February 29, 2008

A Slowing Economy--What Impact Will It Have On The Health Care Sector?

Health care is considered a business that tends to be resistant to economic downturns. Brian Klepper returns with a post asking just what the impact of a slowing economy will have on the health care sector. He specifically points to changes in real wages and home prices.Health Care and The Gathering Stormby Brian KlepperHere are two very interesting and frightening charts that my good friend

Another Government Study Questions the Medicare Advantage Business

You can now add the Government Accountability Office (GAO) to MedPAC and the CBO as highly respected government agencies who have issued reports questioning the cost effectiveness of the private Medicare program.This time, the GAO said:Insurers will receive $86 billion this year for the private Medicare plan--Medicare Advantage.Last year the government paid the private plans $8.3 billion more

Thursday, February 28, 2008

Drug Patents and "Pay-For-Delay"--Drug Industry Payoffs That Need To End

I call your attention to a recent op-ed by a member of the Federal Trade Commission, Jon Leibowitz, in the Washington Post.Commissioner Leibowitz writes about the growing practice of "colluding with competitors to keep lower-cost generic alternatives to prescription drugs off the market."The Hatch-Waxman Act made it easier for generic drugs to enter the market once a name brand drug's patent has

Wednesday, February 27, 2008

Health Insurance Industry "Racing to Defuse a Growing Furor Over Retroactive Policy Cancellations"

That was the lead line in a Wall Street Journal story on the recent health insurance policy rescission controversy. The controversy is over a health insurance company's right to cancel a health insurance policy when the insured made a misstatement on the original application.Some insurers have held they can cancel a policy even when the misstatement was not material. For example, forgetting a

Tuesday, February 26, 2008

Give Cuomo and the Physicians What They Say They Want--Show the Patient Just What the Doc Is Accepting From Everyone Else

New York Attorney General Andrew Cuomo says that health plans are using the "Prevailing Healthcare Charges System" to "defraud" consumers and "manipulate" the system.He points to the example of an insurer refusing to pay a physician's $200 bill--the insurer said that $77 was more appropriate.In an earlier post, I pointed out that an examination of my own family's health insurance "explanation of

How Profitable is Medicare Advantage? The United/Humana Deal in Las Vegas Says a Lot

UnitedHealth and Humana have announced that Humana will acquire UnitedHealth's Las Vegas Medicare Advantage business for $185 million.The transaction was important for United in order to get Justice Department approval of UnitedHealth's acquisition of Sierra Health Systems.That $185 million gets Humana only another 25,000 seniors--at a price of $7,400 a customer.

Monday, February 25, 2008

The Argument for Specialty Hospitals

The growth of specialty hospitals has always concerned me. Too often these niche players looked to be siphoning off the most profitable parts of the business leaving the big hospital to charge payers more for their less profitable services--creating higher prices overall.David Whelan recently called my attention to an article he just did at Forbes making a strong argument in favor of

Friday, February 22, 2008

Hillary Clinton Criticizes Barack Obama's Health Care Plan Saying It Would Not Cover Everyone--Is She Right?

This is a repost of an original that addresses Hillary Clinton's claim, repeated in this week's Texas debate, that only her health plan accomplishes universal coverage because it has a individual mandate and Barak Obama's does not. Senator Clinton goes so far as to say she would garnish wages to enforce her mandate that everyone buy health insurance.Hillary Clinton has gone on the attack in

Thursday, February 21, 2008

A "Health Care Fed" and Obama

An idea that has been floating around for some time is that a "Health Care Fed" needs to be created as a means to control health care costs.I first heard of the concept in a conversation I had with former Surgeon General C. Everett Koop a few years ago. Later, the idea showed up as a centerpiece in the National Coalition's plan to reform the health care system.And in both cases, I have supported

Wednesday, February 20, 2008

Health Wonk Review Is UP

This week's review of the best health care blog posts is up over at Merrill Goozner's, "" The former foreign correspondent, economics writer, investigative reporter for the Chicago Tribune, as well as teacher and researcher, always has interesting things to say on his blog.

The Usual and Customary Controversy--Who's Cheating Whom?

New York AG Andrew Cuomo recently announced an investigation into how insurers pay for out-of-network services. He charged that consumers were being "defrauded" by insurers who were "manipulating reimbursement rates."Cuomo used the example of a charge for an office visit of $200 that the insurer cut back to $77--the insurer claimed the lower amount was reasonable and the maximum that should be

Tuesday, February 19, 2008

Bush Administration Now Willing to Increase SCHIP Spending by $19 Billion Only Weeks After Vetoing a Bipartisan Compromise

At a February 7th Senate Finance Committee hearing, HHS Secretary Leavitt testified about the 2009 Bush budget request.This time, the Bush Administration is asking for $19.3 billion more for SCHIP over the next five years.Just a few weeks ago, President Bush vetoed the $35 billion bipartisan SCHIP extension yet again. Bush and Leavitt maintained all of last year that the program should be

Lifetime Health Care Costs For the Obese and Smokers Lower Because They're Dead Sooner

This was the impressive conclusion of a study published by the Public Library of Science Medicine. The study was sponsored by the Dutch Ministry of Health Welfare and Sport.Obese people had the highest health care costs between the ages of 20 and 56. Obese folks and smokers were found to have a higher rate of heart disease than others.However, the authors found that the obese and those who smoke

Monday, February 18, 2008

Mom, Dad, the Kids and Medicare––Would an Obama Presidency Energize Young Adults to Demand Entitlement Reform?

Barack Obama has made this election-year different. Not since the 1960s have young voters been so energized. One college town after another has voted big for him.On entitlement issues like Social Security and Medicare, the political debate has always been dominated by what senior voters want. They have been the big and effective voter block that have managed to insulate these programs from any

Friday, February 15, 2008

Haley Barbour or Hillary Clinton?

Here's a test.Who just proposed the following, Hillary Clinton or Haley Barbour:A government authorized health insurance purchasing exchange program for the purpose of marketing health insuranceRun as a not-for-profit clearing house from which consumers could purchase health insuranceTarget the uninsuredAvailable to workers in small businessesDesigned to reduce the overhead costs of small group

Thursday, February 14, 2008

Employers Finally Figuring Out They Can Shift Retiree Costs to Medicare

Employers are finally showing signs that they have figured out they can take advantage of the generous Medicare payments to Medicare Advantage plans.With Medicare Advantage plans paid 13% more than for the same beneficiary under traditional Medicare, many seniors have figured out the benefits are better in the private plans. Private Fee-For-Service (PFFS) plans even get more than that.What is

Wednesday, February 13, 2008

No One Ever Did Understand "Customary and Reasonable"

New York Attorney General Andrew Cuomo is suing Ingenix over its operation of the longtime "customary and reasonable" database.In the days before provider networks, insurers relied on this survey of insurance company claim data to determine an appropriate payment level. It was a survey of what all participating insurers paid by service in a particular market thereby ensuring that any one payer

Tuesday, February 5, 2008

Bush Budget Dead On Arrival But It Underscores the Trouble With Entitlements and The Choices That Must Be Made

President Bush is calling for $560 billion in cuts from Medicare over the next decade.He would make these cuts by reducing the payments doctors and hospitals would have received.What is amazing about the Bush budget numbers is that the administration is only trying to cut Medicare's annual growth rate from 7% to 5%. At one level, that ought to be easy. After all we aren't talking about reductions