Health Wonk Review: December 2007 edition

Welcome to the final edition of Health Wonk Review for 2007.  HWR is a biweekly compendium of the best of the health policy blogs, hosted in rotation by — you guessed it — health wonks who blog. 

Given the plethora of holidays with themes of light that fall around this time of year — Diwali, Eid al Fitr, Christmas, Kwanzaa and Hanukkah (well, some of them are on different calendars, so they sometimes fall around this time of year), I tried for a "lights" themed HWR, and some of you out there who submitted posts were happy to oblige.

Burning the candle at both ends department

Following up on a recent WSJ article, GoozNews’ Merrill Goozner highlights concerns about the end of the drug discovery pipeline: over a recent ten-year period, pharma R&D dollars more than doubled, yet new drug approvals decreased by more than half.

Similarly, at Managed Care Matters, Joe Paduda writes about A tale of two health plans.  One health plan has seen the light — and that light comes from its strong brand.  Yet all health plans must face the facts: slower growth due to a dearth of acquisition targets and fewer employers offering health plans.

Are Medicare’s administrative costs too high or too low?  Leave it to Michael Cannon at Cato@Liberty to argue the latter.  I can’t resist sharing his closing flame-related image:

To argue for single-payer on the basis of Medicare’s administrative costs is the equivalent of arguing that, because I can set fire to a pallet of $100 bills with a cigarette lighter and a can of gasoline, I should be entrusted with even more pallets of cash because my administrative costs are such a small share of the money involved.

And finally on this front, consider the discussion of medical practice variation (and attendant disconnect between cost and outcome), among other things, in a wide-ranging conversation presented as a looong podcast transcript from The Health Care Blog, nominally about Shannon Brownlee’s book, Overtreated.

Health care reform on the campaign trail

Huckabee’s star is rising in Iowa, but without much "there" there when it comes to his health care plan.  It’s health care reform "light" — more a statement of Huckabee’s health care principles.  So says Bob Laszewski at Health Care Policy and Marketplace Review. 

We’re getting closer to the opening bell, as it were, in New Hampshire, and Maggie Mahar — at Health Beat — wades into the universal health care debate and sparks a great deal of comment: she calls for a health care insurance mandate (as does Edwards) and wonders whether a tax-funded approach would work. 

Obama does not call for a mandate in his plan, and Richard Eskow also eschews a mandate.  Check out his interview of David Cutler, Obama’s health care advisor, at The Sentinel Effect.  See also Matthew Holt’s realpolitik assessment of Obama’s health care plan as head-fake over at Spot-On.

The mandate discussion continues at the Health Affairs Blog. Chris Fleming highlights a recent article in Health Affairs reviewing mandates abroad, together with two pieces citing that article: a newspaper editorial on mandates and Jonathan Cohn’s take on the article at TNR.  The editorial finds the article to be anti-mandate, Cohn finds it to be pro.

A final note on mandates, from the People’s Republic of Massachusetts:  Celia Wcislo, the SEIU 1199 rep on the MA Health Connector board (and thus a partisan in this debate, as I dare say we all are, one way or another), highlights some lessons for the nation drawn from the successes of the mandate to date at CommonHealth, our local NPR affiliate’s universal health care blog.

More burning issues

Zagreus Ammon, The Physician Executive, presents Mass Customization in Health Care. He posits that physician buy-in to a lot of quality initiatives is poor, since most initiatives come from industries outside of healthcare, especially manufacturing, and asks: Can the concept of mass customization reach the docs?

One initiative that is well-ensconced within health care, though still seen as an outside force by some, is HIT, or health information technology.  Have a listen at the Health Business Blog to a wide-ranging podcast interview with Dr. Robert Kolodner, National Coordinator for Health Information Technology 

Eric Turkewitz brings to our attention actor Dennis Quaid’s lawsuit against Baxter Healthcare over a labeling mixup for heparin administered to his infant twins in a left coast hospital at his NY Personal Injury Law Blog.  The hospital apologized; I guess Baxter didn’t. 

Moving from the younger to the older:  At Workers Comp Insider, using the case of a 73-year old Californian receptionist, Jon Coppelman examines the concept of "apportionment" in workers comp and the implications that it has for an aging work force.

Elders and their advocates and the House Ways & Means Committee (and Ms. Wcislo’s SEIU 1199 confreres) are all riveted by the pending $6.3b acquisition of Manor Care by The Carlyle Group.  See my HealthBlawg post on the surrounding discussions about quality, accountability and transparency.

Roy Poses is a real wet blanket this week — putting a damper on the holiday spirit by bringing up the sustainable growth rate and going so far as to call for "a better, transparent, rational, accountable alternative" to the RUC (no, not that RUC — it’s the Relative Value Scale Update Committee), the secret committee that recommends updates to the RBRVS.  (If this sort of thing gets you all heated up, see some past HealthBlawg posts on the SGR, too.)

More fruitcake, dear?

Shedding "light" on obesity policy, Daniel Goldberg presents On Fatness and Health at his Medical Humanities Blog.  Jason Shafrin observes that the acceptance of women in the workforce has been one of the great success stories in twentieth century America. But does the increasing female labor force participation have adverse effects on kids? The Healthcare Economist reviews a study as to whether having a working mother increases childhood obesity. 

Speaking of doughnut holes . . . Adam J. Fein of Drug Channels looks at generic utilization under Part D and wonders if drug makers are having second thoughts about the program.  As a result, more seniors are trying to get the biggest bang for their buck by accepting generic substitution as well as shopping around at pharmacies.  A neat example of how consumer involvement can lower health care costs.

Trade in your doughnut holes for prawn crackers, and follow David Williams to the East, as he brings us a podcast this week on MedTripInfo: Interview with Bumrungrad CEO Curt Schroeder.  Not everyone is heading East just yet. At The Health 2.0 Blog, Miriam Bookey of Xoova joins Joe Paduda (see above) in looking at members leaving UnitedHealth in droves (following that juggernaut’s acquisition of PacifiCare).  She suggests that docs should focus on their patients’ "customer" experience of their patients.  (Reminds me of all the hospitals that used to have "guest services" departments).  Richard Eskow, at The Sentinel Effect,  comes at this same issue from the other direction, suggesting that docs who don’t like the fact that their patients are wired and Googling need to see the light.

What’s it all about, Henry?

We wrap it all up for 2007 with a nod away from the commercialization of the holidays.  InsureBlog’s Hank Stern explains that charit

y begins at home, and notes that Hanukkah, the Jewish "Festival of Lights" is really a time of introspection, and "giving back."  That’s part of how it works in my house, too. 

I hope that the spirit of whatever holiday you’re celebrating is infused into the coming weeks, so you can survive HWR withdrawal.  HWR is on hiatus until January.

Shubh Deepavali, Eid Mubarak, Merry Christmas, Habari Gani, Hanukkah Sameach, and a Happy New Year.

— David Harlow