Health Wonk Review: Block That Metaphor!

I'm not a superstitious man, but April 15th is fraught with doom, linked as it is to death and taxes … among other themes, as we will explore in this edition of Health Wonk Review.  For that reason, and due to the happy accident that this edition is the fifth that I have hosted (Joe Paduda thought it was the umpteenth; I know, I know, we lawyers have a way with words … but there have only been 1, 2, 3, 4 others), I'm opening this post under the protective auspices of a khamsa, a five-fingered good luck talisman, or amulet, designed to ward off the evil eye.

Will Rogers once said: "The income tax has made liars out of more Americans than golf."  Honesty is, they say, the best policy. 

On the flipside, though, last week Roy Poses questioned the de-linking of ethics from pecuniary rewards in the for-profit health care corporate world in his post at Health Care Renewal titled What, Me Worry? – Leaders Prosper Despite Their Organizations' Ethics and Performance.

Will the as-yet-unread-by-many health reform law have an effect on the issues that Roy raises?  Whether it does or does not, many of the health wonks whose posts are featured here today have focused on various implications of the new law, which we fondly call PPACA.

Brad Wright, at Wright on Health, tells us that Big Business Bemoans Health Reform; Like Roy, he seems to take a dim view of large for-profit entities. In this case, the issue is with big companies' whining over PPACA's elimination of a Bush-era employer tax break related to pharmacy benefits that amounted to double dipping. This post fits in with today's announced categories of lying and taxes and is a near miss for the metaphor category.  Why "metaphor?" you may ask … Well, Brad quotes Uwe Reinhardt's swing at explaining the issue through the use of an analogy — not a metaphor or even a simile but, hey, it's close.  And what does April 15th have to do with metaphors?  Well, on this date in 1912, the world's largest metaphor hit an iceberg in the North Atlantic.

Joe Paduda doesn't quite invoke metaphor, but he does cite hyperbole and, well, statements that could be seen as lying — or at least as flip-flopping — in his post, Why all the sound and fury about the individual mandate? at Managed Care Matters, which recounts the Clinton-era GOP support for the individual mandate that has been more recently reversed by the Republicans.

Titanic doesn't even begin to capture the immenseness of the galaxy … so instead we'll leave that task to Minna Jung at RWJF's User's Guide to the Health Reform Galaxy and her current post: Health Reformers' Lexicon: Uncompensated Care.

It's Bessie Smith's — Empress of the Blues — birthday, and Jaan Sidorov is singing the blues in his post, The Decline of Small Physician-Owed Practices Explained … And a Prediction that Private Practice Will Hang In There, at Disease Management Care Blog.  Having included in his post an image of the Monet painting that gave the Impressionist school of art its name (Impression, Sunrise), Jaan earns double points — today also marks the birthday of Impressionist novelist Henry James.

Another blogger with the blues is Brad Flansbaum, who seems to like ACOs in concept, but in his post, ACO = Answers Clearly Overdue at The Hospitalist Leader, highlights the need for workable tools for risk assessment, quality adjustment, and bundled payment calculations to use in their implementation.

Louise, at Colorado Health Insurance Insider, considers The Impact of Refor

m on Student Health Insurance Policies, the effect of the general prohibition of lifetime maximums and unreasonable annual limits.

Jared Rhoads of The Ludicius Project says: Marche funebre — the PPACA represents the beginning of the end for the insurance industry.  He even quotes John Galt, seemingly equating the Administration's actions in getting the bill enacted with "destroying man's capacity to live."

Vince Kuraitis and David Kibbe, in a HITECH Act series at Vince's e-CareManagement blog, ask Is HITECH Working? 7 Observations Mom Could Understand.  They honor Jackie Robinson's breaking of the color barrier in major league baseball on this day in 1947 by using a baseball analogy to orient us to where we are on the HITECH rollout: "It’s the top of the third inning in the HITECH game."

Chris Fleming offers CMS And Health Reform: A Health Affairs Blog Roundtable, from the Health Affairs blog, with a stellar crew of participants, including some former CMS Administrators.

Some health wonks have been sniffing around my home turf of Massachusetts for some clues about what health reform implemented on the national stage will look like, given some striking similarities between the Massachusetts and Federal schemas. 

Bob Vineyard, at InsureBlog, does not think that the Health Insurance Exchange model rolled out in Massachusetts and described in PPACA is really the way to build a robust market for small group and non-group insurance.

The Tea Partiers might not have put it in those terms exactly, but they were out in force yesterday on the Boston Common, not far from the site of that long-ago Boston Tea Party.  Check out Tinker Ready's photos: Boston Tea Partiers on health care, at Boston Health News.

The recent excitement about Massachusetts' regulation of health insurance premium increases, and the state court's unwillingness to intervene on behalf of insurers until they exhaust their administrative appeals, has reached as far as California: Fight Over Premium Hikes Just Beginning writes Dan Diamond, at California Healthline.

The Incidental Economist, Austin Frakt, complains that Massachusetts has blown it, big time, by not being able to report reliable statistics, saying Not Enough Known About Massachusetts' Uninsurance Rate from the great experiment underway here.

On this day in 2002, the FDA approved botox for use in frown lines.  Glenn Laffel at EHR Bloggers has been frowning a bit because of the frustrating way in which clinical decision support systems have been developed and installed. A Research Agenda for Cinical Decision Support.

Ray Kroc opened the first McDonald's, in Des Plains, IA, on this day in 1954.  We don't often associate fast food with high-quality health care services, but both are known to suffer from quality control issues when the line is not humming along.  The burger left under the heat lamp for too long, like the health care procedures performed nights and weekends, are often sub-optimal.  Patti Hamilton's recent study on the subject is described in Nurses Key to Understanding the "Off-Peak Effect" at INQRI, the blog of the Interdisciplinary Nursing Quality Research Initiative.

Periodically, we hear from design firms seeking to reinvent the health care facility experience.  This time around, it's all about Applying Airline and Hotel Concepts to Hospital Design at David Williams' Health Business Blog, in honor of Leonardo Da Vinci, another one of today's birthday boys, and the consummate artist, inventor and designer.  (He was also an early penmanship role model for physicians and may have inspired early CPOE systems with his horribly illegible handwriting.)

WWLD?  As an inventor, what would Leonardo do if asked to opine on the validity of Patenting Genes? Jason Shafrin's post at Healthcare Economist takes a dim view of the whole idea.

A more positive attitude is shared by Joanne Kenen, who writes this week about medical apologies at The New Health Dialogue.  

At Workers Comp Insider, Julie Ferguson highlights a remarkable advance in rehabilitative technology: Dean Kamen's new prosthetic, the DEKA Arm, aka "the Luke Arm." 

The ink is barely dry on PPACA, and some legislators are already talking about working towards repeal.  Here's hoping that the khamsa at the top of this post can help keep the peace in Congress, among the health wonks and in the nation at large.  (Well, it's got about as good a chance as anything else.) 

Tune in again in a fortnight for the next edition of Health Wonk Review at Jason Shafrin's Healthcare Economist.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting