Saturday, June 28, 2008

Run For the Hills, the Doctors Are Coming, the Doctors Are Coming!!!!

What is the one thing no human being should want to be next week?A Republican Senator at a Fourth of July Picnic.In the most amazing turn of events I have seen in 20 years of following health care policy in Washington, DC, the Democrats have the Republicans backed into an awful corner over the issue of the July 1st automatic 10.6% Medicare physician fee cut and corresponding private Medicare cuts

Wednesday, June 25, 2008

A Flawed Defense of Medicare Advantage

If private Medicare is to be continued proponents had better make better arguments than Scott Gottlieb made on Tuesday's Wall Street Journal op-ed page.Gottlieb is a former Bush Administration CMS official and is currently at the American Enterprise Institute.The context of his arguments is that this week Congress is debating making cuts to the private Medicare Advantage program in order to pay

Thursday, June 19, 2008

Coventry Health--Another Reminder That This Isn't an Easy Business

Here are some comments from a first quarter earnings call Coventry management would sure like to take back.Yesterday, Coventry reported that its Medicare private fee-for-service business will miss its second quarter medical cost ratio projections by more than 300 basis points and that it will miss its prior second quarter estimates for its commercial medial cost ratio by a whopping 200 basis

Wednesday, June 18, 2008

Coventry Health Care--What the Heck Is Going On?

When WellPoint, Humana, United, and others had earnings warnings this spring I pointed out their issues were largely unrelated and amounted to more rounding errors as the helpful five year deceleration in health care trend came to an end and the business just wasn't as easy.But today, Coventry hit us with a 300 - 340 basis point adjustment in their expected Medicare Advantage medical loss ratio

Tuesday, June 17, 2008

Transparency and Accountability: The Door Swings Both Ways--AMA Releases Its "National Health Insurer Report Card"

You have to wonder what they're thinking about over at AHP--the health insurance trade association that called for more transparency and accountability for the provider community a few days ago--now that the American Medical Association's (AMA) detailed report card on insurer claim processing performance is out.And, it's a fascinating read.How often do health plans pay at the contracted payment

Friday, June 13, 2008

Wall Street Relieved Democrats Unable to Cut Private Medicare Advantage Payments This Week--Why?

Congressional Democrats tried to take a big bite out of private Medicare this past week in an attempt to pay for an 18 month fix to the upcoming July 1st 10.6% reduction in Medicare physician payments.The effort, led by Senate Finance Chair Max Baucus (D-MT) got only 54 of the 60 votes he needed to end debate and move the issue to a floor vote. While getting that floor vote would almost have

"I Hear the Train a Comin"--What Does That Johnny Cash Refrain and the Employer-Based Health Care System Have in Common?

OK, maybe it's a stretch but bear with me.I heard a senior exec from a big health plan say the other day that it's hard to believe we will ever see the end of health insurance distributed primarily through the workplace in favor of an individual-based health insurance system. In fact, much of the health insurance industry is lining up behind staying with the system we know best and the one who

Thursday, June 12, 2008

Health Wonk Review is Up

This time Jane Hiebert-White does a great job of selecting some of the most thoughtful posts from the world of health blogs over at the Health Affairs Blog.Topics include federal health reform, health information technology, consumer and patient rights, the business of health care, research-based policymaking, and others.

Tuesday, June 10, 2008

Comparing John McCain's Health Care Plan to Barack Obama's Health Care Plan--What's the Big Idea Difference?

This election is different than any other on the issue of health care because both candidates are giving us serious blueprints to reorganize America's health care system and those blueprints are very very different.As voters, you have a huge and critically important choice on health care.There are dozens of details upon which they differ and for those I would point you to my comprehensive posts

A Detailed Analysis of Barack Obama's Health Care Reform Plan

March 8, 2010Any big health care bill will be full of compromises—political or otherwise. But the Democratic health care bill doesn’t even come close to deserving to be called “health care reform.” As the Democrats make their final push to pass their health care bill many of them, and most notably the President, are arguing that it should be passed because it is the “right thing to do

A Detailed Analysis of Senator John McCain's Health Care Reform Plan

A Detailed Review of Senator John McCain's Health Care Reform PlanMcCain’s thinking on health care couldn’t be more different from Democrat Barack Obama.McCain very rightly points to health care costs as the biggest health care issue, "We are approaching a 'perfect storm' of problems that if not addressed by the next president will cause our health care system to implode."Therefore, his focus is

Would Either Barack Obama's Health Plan or John McCain's Health Plan Contain Costs?

With the health care reform efforts in Massachusetts presenting us with an incomplete result for an unsustainable cost, just how the presidential candidates' health care plans will contain costs is an even more important issue.The short answer is neither offer any kind of silver bullet solution to controlling America's health care costs. Both Obama and McCain propose similar generally good cost

Tuesday, June 3, 2008

Comprehensive Health Care Reform and Massachusetts--Are We On Our Way To a Very Different Debate?

The Massachusetts health care reform law appears on its way to:Covering two-thirds of those who did not have health insurance on the day it was enacted--about 400,000 people by the end of 2009.Covering most of those who were uninsured in households with incomes below 300% of the federal poverty level--below which the plan pays all or most health insurance premiums.Offering health insurance plans