Envisioning 2.0

Over the past few months people on both sides of the ideological divide have been debating whether comparative effectiveness – relying on clinical studies to determine whether a medical intervention is more effective than another – is appropriate and can help reduce rising health expenditures.

This week’s edition of the Health Wonk Review features an article by BNet’s Ken Terry in which he says both sides are being disingenuous.  Using the example of virtual colonoscopies he writes:

“[M]edical ‘advances’ of lesser value will continue to be advocated by those who profit from them. When, as a result of comparative effectiveness research, payers have to decide whether to cover a particular type of back operation that has not helped patients any more than conservative therapy, they will undoubtedly find themselves locked in a political fight with surgeons who stand to lose income if nobody can afford the procedure. So we should not expect too much from comparative effectiveness research, as it’s now conceived.”

Terry has a very interesting perspective on the comparative effectiveness question.  When a procedure or medication is less painful or provides a better quality of life should that be considered when deciding which one is worth paying for?  In addition, as I discussed a few weeks ago, will comparative effectiveness research be doomed from the outset if we continue to conduct studies that do not include people from varying racial and ethnic backgrounds?

Clearly, there are no simple answers to this debate.  However, we are clearly benefiting from having a broad conversation about the benefits, drawbacks and scope of comparative effectiveness research.

With the election of Barack Obama as the 44th President of the United States, many health bloggers have begun to focus attention what changes the new chief executive will bring to nation’s health system.  This topic was a major focus of the latest edition of the Health Wonk Review.  I was happy to see that Louise Norris, who compiled this edition, focused on the human face of the health reform debate. She cites a post which focuses on the fact that nurses are not often included in debate and discussion about health reform.

Most bloggers participating in this week’s health policy carnival are optimistic that health reform will receive serious attention by the incoming administration.  In addition, some feel that Obama will learn from the mistakes of the Clinton administration and make the reform process much more transparent and inclusive.

This is a very insightful edition of the Health Wonk Review. Click here to read it.

The latest edition of the Health Wonk Review is up at Workers Comp Insider.  Be sure to read the interesting posts about the return of Harry and Louise.  This time, they are for comprehensive health reform.

Yesterday, David Williams published a very interesting (and easy to read) edition of the Health Wonk Review.  One entry caught my eye.  The author of a post from the blog Amateur Economists suggests that all Americans have access to health care and that “in countries where universal care is in place, you do not get a ‘choice’ to go to the doctor you think is better than the other.”

JC, who wrote the post goes on to note that “Americans love the idea of ‘fairness,’ but when it comes to ourselves and our bodies and our health, we want the best even if it is what others cannot afford.”

I have heard this argument many times before.   However, as is my custom, I am not going to take a position on JC’s  statement.  But,  I will say this:  If we are going to have a debate about the benefits versus drawbacks of non-US health systems, we must take facts rather than rhetoric into account.

In a number of countries, including  France, many people purchase supplemental health insurance policies that provide services not covered by the public system.  In addition, physicians in Japan – partly because their salaries are capped by the government – feverishly compete for patients.

With this in mind, it is important to note that some countries are struggling to deal with a new breed of health consumer that is demanding – and sometimes receiving – services not covered by national health insurance plans.  A few months ago, I wrote about how this trend is playing out in the United Kingdom.

Those interested in learning more about how other countries operate their health systems can start with the resources listed below.

-National Public Radio: The network has been running an ongoing series focusing on how European countries run their health systems.  While the pieces tend to be very favorable, they do provide a glimpse of the challenges faced by each country and how they are attempting to manage them.

-Wall Street Journal:  This article focuses on the Dutch health system and why it receives generally high marks.

Over the past couple of weeks it seems that rising healthcare costs are getting lots of attention in mainstream media and in the blogosphere.  This week’s edition of the Health Wonk Review had an interesting post from InsureBlog’s H.G. Stern on this topic.  He talked about Ben Bernanke’s assessment of rising health costs.  He said Americans will be spending an increasing amount of their incomes paying for medical expenses.  To prevent this, he Bernanke believes that government will have to assume more of the cost burden.

Stern disagrees, saying that over time, Americans’ taxes will increase, which ensures that we will be footing the bill either way.

But, because I prefer to focus on solutions rather than problems, I was very intrigued by a post by Maggie Mahar over at the Health Care Blog focusing on a solution to our health cost woes.  I won’t give away the solution here, but it would involve asking Americans to pay a value added tax that would be specifically designed to fund health costs.  (For anyone who has traveled in Canada or Europe the VAT will be very familiar.)  It’s a very intriguing solution that Mahar thinks should have the support of both Democrats and Republicans.  However, she’s not holding her breath waiting for a bi-partisan solution to our healthcare problems – even though unity is the theme of the hour.  (I’m not either.)

Overall, there’s lots of interesting policy-related content to read in the latest edition of the Health Wonk Review.  You can view it by clicking here.

. . . at the Healthcare Economist.

at the Medical Humanities Blog.

Better late than never . . . The latest edition of the Health Wonk Review is up.  Click here to view it.

Note:  I was inspired to write this post because of an article I read in the current round of the Health Wonk Review.  Check out the latest excellent edition here.

A couple of weeks ago, Jane Sarasohn-Kahn published a great analysis of some of the latest data from EBRI and the Commonwealth Fund focusing on the state of consumer-driven health plans (CDHPs).  In sum, the data’s not good.

Before I get into a discussion of Sarasohn-Kahn’s analysis, it’s best to talk briefly about the war of words currently swirling around CDHPs. Last year, , Gred Scandlen published a report, “CDHPs – ‘Working As Intended,’” where he noted that many studies are flawed and obscure the true benefits of CDHPs.  He argues that:

-    Recent surveys find CDHPs have continued to grow rapidly
-    High-deductible plans encourage people to take their care seriously, e.g., they are much more likely to go to their doctors to manage chronic conditions
-   “CDHP members are [not] likely to forego care due to cost”

Now, with that in mind, let’s look at what EBRI and the Commonwealth Fund found.  Most importantly, their study indicates that the healthy and wealthy are most likely to use CDHPs. Sarasohn-Kahn notes that this is not what CDHPs were designed to do. In fact, they have been touted as a means of getting more people into insurance plans.  In addition, although more affluent individuals are using these plans, Sarasohn-Kahn notes that “members of CDHPs and HDHPs are more likely to delay going to a doctor, visit a specialist, or undergo medical tests than members of comprehensive plans.”

I’m not going to take a position on whether CDHPs are successful just yet.  However, juxtaposing Scandlen’s analysis with EBRI’s research raises some interesting questions.  Most importantly, which numbers are we to believe?  Unfortuantely, there’s no good answer for this question.

The latest edition of the Health Wonk Review is up at Workers Comp Insider.  Many thanks to Jon Coppelman for highlighting my post re: Merck’s Gardasil.  To clarify, while I’m not sure Merck and the government have been mum about HPV’s status as a STD because of abstinence-only proponents, I’m quite sure this is not an issue Merck is comfortable tackling.