Tag Archives: Elizabeth Rosenthal

Health Policy Updates: April 15 2017

I am giving my highest recommendation to Elizabeth Rosenthal’s new book on health care costs, An American Sickness. It was her reporting at the NYTimes several years ago that first got me interested in understanding (and controlling) the high costs of medical care that we have in this country.

Equally highly recommended is her interview with Terry Gross on NPR’s Fresh Air.

“What you see often now is when generic drugs come out … the price doesn’t go down to 20 percent of the branded price, it maybe goes down to 90 percent of the branded price. So we’re not getting what we should get from a really competitive market where we, the consumers, are making those choices.”
Continue reading Health Policy Updates: April 15 2017

Health Policy Updates: February 14 2015

Recently, 3 Republican senators put forward the latest plan under the “alternative to Obamacare” banner. As any health care plan is ridiculously complex, it is good to have clear summary of the main points. I think I have found one, here:
My sense is that voters will end up liking parts of both Republican and Democratic ideas. They might ask a reasonable question: Why can’t we take the best from both sides?
Latest piece by Elizabeth Rosenthal in the NYT. Subject: the out-of-pocket costs that are increasingly becoming a part of insurance plans, especially those under the ACA. The theory behind these costs – charging more to the patient at the point of care – is that this “skin in the game” will force patients to become more savvy consumers, searching out lower prices and getting on that care that they NEED, and maybe not go into clinic every time they get the sniffles. Whether this is a good strategy to hold down costs long-term is under study; what is clear, is that these extra charges hurt!
It is true that the Affordable Care Act has erased some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills…But by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.”
And here is a good quantification (with nice visuals) of those same out-of-pocket costs for patients on ACA exchange plans. They don’t talk about monthly premiums here, and one of the goals to having patients pay so much out of pocket is that at least the monthly cost will be less…but, at least looking at OOP costs alone, the difference is clear:
So it’s not surprising that out-of-pocket payments, also called cost-sharing charges, are higher for lower-cost plans. It is surprising just how high those payments are, even for middle-tier exchange plans, and also how high they are compared with the average plans that workers get through their  companies.”
Why does Medicare reimburse more for hospital tests than office tests? And is it a good thing that this is driving docs out of private practice and into the large health systems, if it means higher prices to patients?
But the government didn’t cut what it paid cardiologists who worked for a hospital and provided the same test. It actually paid those doctors more, because the payment systems were completely separate. In general, Medicare assumes that hospital care is by definition more expensive to provide than office-based care.”
A Vox.com primer on All-payer Rate Setting, a government regulation idea that would set prices for specific medical procedures, rather than leaving them up to insurers and health systems to negotiate. The potential to hold down medical costs through efficiency gains is great, but is it too close to a Single Payer (“government health care”) for America to swallow?
A system with so many prices can be inefficient: each time a patient comes in for an appointment, a billing clerk has to look up what rate his or her insurance company ought to be charged. All those billing clerks’ salaries become part of the country’s $2.7 trillion health care system.”
Pharma spending on advertising to physicians has been in the news recently, after John Oliver did a segment about this on his show. You can find a link to that in this Vox.com article here:
hat tip to Josh Briscoe


Health Policy Updates: December 20 2014

A GREAT series of lectures by Atul Gawande. Highly recommended:
This piece is a pretty good overview of cost-effectiveness research, an endeavor that straddles clinical medicine and economic modeling with the goal of determining the bang-for-the-buck for different health interventions. In the USA we kind of have a head-in-the-sand approach to considering the cost of care, wanting to believe that we can provide everything to everyone, but cost-effectiveness research takes a more reality-based approach:
Some think that discussing cost effectiveness puts us on the slippery slope to rationing, or even “death panels.” After all, if we decide that the billion-dollar-for-a-day-of-life pill isn’t worth it, then what’s to stop us from deciding that spending a couple hundred thousand dollars to extend grandma’s life for a year isn’t worth it either?
From Elisabeth Rosenthal at the NY Times, investigating the high costs of TTEs this time:
While academic hospitals have led the call for more targeted use of echocardiograms, not all doctors comply, and “it’s a black hole what’s going on in offices,” said Dr. Rory B. Weiner, a professor at Harvard Medical School. There is not even a good estimate of how many of the procedures are performed in the United States, although it is clearly in the tens of millions annually.”
The federal “CHIP” (Children’s Health Insurance Program) is due to expire next year. That will put the Republican congress in the position of having either to extend the entitlement, or see the beneficiaries roll over into the ACA exchanges:
The Affordable Care Act significantly changed the insurance market in 2014. With state and federal exchanges, many of the families getting CHIP coverage can now get plans through the exchanges, with the federal government often picking up a sizable chunk of the tab. All of which raises the question of whether the CHIP program is now obsolete.”
Merry Christmas everyone!


Health Policy Updates: November 8 2014

The latest from Elizabeth Rosenthal at the NYT. Her “Paying Till it Hurts” series is becoming one of the go-to resources to learn about the high costs of medical care in the USA.
As insurers ratchet down payments to physicians and hospitals, these providers are pushing back with a host of new charges…Some of the charges come directly out of patients’ wallets at the time of treatment and catch patients off guard.”
This piece focuses on an “across-the-aisle” proposal to help address health care costs in the United states, co-written by policy wonks from each side of the political divide:
Conservatives and progressives agree that cost growth will continue to be a problem in the coming years. We agree that this makes it harder for American families to make ends meet…We propose a model in which states could opt to be responsible for health-care costs and quality, earning financial rewards for success. They would become the driving force for action to constrain costs.”
One of the big “red herrings” out there with regards to how to reduce health care costs is malpractice reform. While there might be some impact if this was done well, the overall size of the impact would be very small, much smaller than most people would expect:
While that’s not a small amount of money, it’s still not a huge financial component of overall health care. The study pegged the malpractice system’s costs at 2.4 percent of health care spending.”
Updates on reimbursement through Medicare – some good and some bad. The “doc fix” question may be raising its ugly head again soon:
Doctors will be paid for Medicare care coordination, wellness and behavioral health telehealth visits. But, under final rules issued by the CMS late Friday, physicians also could see all Medicare payments cut by roughly 21% in April if the Medicare sustainable growth rate formula cuts are allowed to take effect.”

Health Policy Updates: October 4, 2014

Obama has had to eat his words a bit on the promise that “if you like your doctor, you can keep your doctor.” But is that necessarily a bad thing? Are there GOOD reasons that patients shouldn’t be able to pick whomever they want?
Narrow networks, which place greater limits on patients’ choice of care providers, aren’t new, but they’re emerging as one of insurers’ major levers for keeping down costs under the Affordable Care Act.
How diagnosis coding and reimbursement affect how we treat patients, from Duke’s own Peter Ubel:
We knew long ago that fee-for-service payment incentivizes healthcare providers to over-diagnose and over-treat patients. And we learned, when Medicare introduced lump payment systems in the 1980s – paying hospitals a fixed fee based on patients’ diagnoses – that hospitals would choose among possible diagnoses to find ones that maximized their income.”
Hat tip to Nick Rohrhoff
The latest from Elizabeth Rosenthal in the Paying Till it Hurts series in the NYT, on the topic of price transparency.
The study offers a compelling case for price transparency combined with medical consumerism as one strategy that could help reel in the nation’s $2.8 trillion health care bill.”
Also thanks to Nick Rohrhoff
We know that infant mortality is high in the USA. But is that actually because we are actually too good – that we deliver more early-term premature babies relative to other countries that this brings our numbers down? Or is it some other factor?
So there are two main takeaways from this paper. The first is that although reporting differences can account for some of our worse infant mortality statistics, most of the differences we see are not due to that explanation. The second is that most of the rest of the disadvantage is due to differences in postneonatal mortality, that likely require fixes to the healthcare system.”
Is this man in the process of creating the future of medicine? Or is it just showmanship?
In theory it will work like this…Everything from her DNA to the proteins in her blood will get instantly analyzed via a proprietary and superfast network…within minutes computers will recommend which drugs to try. Once the patient is sent home, the same technology will travel with her, allowing doctors to continue to monitor her in real time, as hospital administrators evaluate the efficacy and costs of various procedures and medicines...”
Hat tip to Matt Chung