Relevant and even prescient commentary on news, politics and the economy.

Man Bites Dog

Newt Gingrich tells the truth.

“the individual mandate was originally developed by the Heritage Foundation and others, as a way to block Hillarycare.”

Firebaggers argue that the PPACA is conservative, because it is similar to a Heritage Foundation proposal. They neglect to note that the proposal was made in bad faith. The point was to complicate the debate by making it Clintoncare vs Obamacare vs no reform. That way the result was no reform, even though most US adults wanted some reform.

This is not speculation. The Heritage/Romney/Obama approach was also the Chafee proposal. [John] Chafee (R-R.I.) proposed something like the PPACA in 1993. Senate minority leader R. Dole cosponsored the bill. In 1994 Dole voted against a bill whcih he had cosponsored proving that his advocacy of an individual mandate was made in bad faith and aiming only at complicating the debate.

Similarly when Ted Kennedy was advocating single payer/Medicare for all, Nixon proposed a reform similar to that proposed by the Clintons.

Yes Obama, all Democratic Senators, two independent Senators, and a majority in the House voted for a plan similar to one proposed by The Heritage Foundation. Everyone who works at The Heritage Foundation (except maybe a janitor who hates the jerks after whom he cleans up) recognized this as a huge defeat. Jane Hamsher hasn’t wised up.

A little OWS, a little 99%, a little history

So today I read at the Yahoo Finance (it’s my home page because I can look at the stock numbers on the left and read the headline on the right for a guaranteed laugh) that  John Mauldin thinks the OWS would be better off if they occupiedCongress:
Mauldin believes America still has time to figure out a path out of what he says is the big problem worldwide: “We’ve over committed public monies and we don’t have them.” While some what sympathetic to the protestors’ frustrations, Mauldin says their anger is misdirected.
“My message to the ‘Occupy Wall Street’ guys: if they really want to If  they really want to go after the source of the problem, they should go occupy Congress,”
Instead of focusing on Wall Street,Washington and the protests should be focusing on reducing regulation and making it easier for new businesses to start, Mauldin says. To that end, he offers a new slogan I somehow doubt will showup at any Occupy Wall Street protest anytime soon: “Up with Entrepreneurs”
As I understand it, OWS is about economic equality. President Roosevelt referred to it as the economic royalty. I just don’t see how one can stop, look and listen to OWS and think “go tell congress to further deregulation”. John Boy can’t be this much of an idiot, can he?
My sweetheart gets home from the dentist. $4000 dollars worth of bridge work is down the drain because a tooth of the bridge went bad. 

For those who don’t know, we are the “Entrepreneurs” John Boy is referring to, thus we are paying for our health insurance, no dental. But, she was offered a payment plan. Has a nice dental name at 14.5% interest! This bit of private market solution to paying for health care is brought to you by GE Financial. Yes, the GE of Jeffrey Immelt, Obama’s job creating adviser. Hey Obama? Did you read my state of the union?  Obviously not or Jeffrey baby would not be your man.
Did you hear that JP Morgan was all blowed up? Yes, I’m not lying. People got pissed at Wall Street and blew up JP:
“During this period anarchists and socialists held protests on Wall Street out of a similar sense of frustration and rage at the banking system. The movement culminated in what was known as the greatest act of terrorism on American soil: the 1920 bombing outside J.P. Morgan and Company
Thirty eight people were killed when the horse and wagon bomb went off at noon on Sept 16, 1920. The perpetrators, thought to be anarchists, were never caught, but their exploits and the aftermath were captured by photographers.”
Check out the pictures here. 
Why do we not hear about this history considering the present times? I know, stupid question. To ask it is to give purpose to OWS. Though one sector of this nation seems to remember a portions of this history or we would not be hearing the pejoratives being slung a the 99%’ers. You know Anarchists, socialists, communists out to destroy the American Way (A catchy phrase brought to you by the National Association of Manufacturers via General Food’s CEO, the US Chamber of Commerce and AT & T’s monopoly is good all via Madison Ave, Time Magazine 9/28/1936) .
Which brings me to my original question since the shit hit the fan: HOW MANY TIMES DO WE HAVE TO DO THIS? HOW MANY FREAKIN’ TIMES DO WE HAVE TO LEARN THE LESSON?
Obviously from the above 3 subtopics, quite a few more times as we seem to have not learned the definition of Rat Race yet: A rat race is a term used for an endless, self-defeating or pointless pursuit…
I think I know what is wrong with US today. When I typed in Deja Vu at youtube,  amazingly this tune did not even come up in the suggestion list. 

No, I had to actually know that CSNY wrote what I consider the true musical capture of the concept of deja vu…the song that is most appropriate for the application of the concept today. I say this because they intentionally wrote the song so that it does not repeat any one section (heard years ago in an interview).

Get it?
(I haven’t forgotten the tax tables. It’s a coming.)

Guest post: Massachussetts leads the way!

Guest post by Michael Halasy Practicing Emergency Medicine PA, Health Policy Analyst, and Health Services Researcher

Massachussetts leads the way

We have talked about bundled payments here, and getting rid of the antiquated and inefficient fee for service model. It looks like Massachussetts is on board suggests The Washington Post.

Blue Cross is not alone. At Partners HealthCare, the famous Boston-based medical system that dominates health care here, Massachusetts General Hospital has been conducting a Medicare experiment in which nurses are assigned to coordinate care for about 2,500 older patients with multiple ailments. The experiment, which began five years ago, so far has reduced hospital re-admissions by one-fifth and cut medical spending by 7 percent.

They will be the first to implement integrated care organizations (really, a version of ACO’s) and a new bundled payment mechanism.

With 98% of the population insured, Massachussetts saw their costs soaring, at about 15% above the national average. The markets have already begun to respond, and some, like Partners, are already ahead of the curve.

At Partners HealthCare, the famous Boston-based medical system that dominates health care here, Massachusetts General Hospital has been conducting a Medicare experiment in which nurses are assigned to coordinate care for about 2,500 older patients with multiple ailments. The experiment, which began five years ago, so far has reduced hospital re-admissions by one-fifth and cut medical spending by 7 percent.

Massachussetts was bracing for this for some time. Last year, the insurance commissioner took on the health insurance companies for raising rates too rapidly. He rejected many of them outright. This was an important political maneuver, that really set the stage for the current willingness and cooperation of the insurers, providers, and hospitals.

As he says:
“We are preparing ourselves to grapple with a certain amount of constructive disruption in the industry,” Patrick said in a lengthy interview. “It’s a journey.”
Clayton Christensen would argue that it is JUST that disruption which is so sorely needed.

HEALTH CARE thoughts: Integration Speeds Forward

by Tom aka Rusty Rustbelt

HEALTH CARE thoughts: Integration Speeds Forward

Among those who ponder the operational aspects of health care reform, there is strong sentiment for more use of Integrated Delivery Systems (IDS) in delivering health care.

This is hardly a new concept, but it may well be the concept of the future.

My focus is largely on physician integration although there are other aspects, but the docs are the really big issue, as they drive admissions and order testing.

The first big IDS wave occurred in the early to mid-90s, as physicians and hospitals tried various medical service organization (MSO) models; essentially the hospital owned the physician practices. Many of these deals were disasters, some worked, some evolved into something that worked.

The idea is that if a central entity (an insurer, a hospital, or a hospital network) owns and coordinates services there will better care coordination and cost savings.

The successful integrations so far have largely focused on family practice, internal medicine and ob-gyn (the OBs assistance with malpractice premiums and 24/7 coverage issues).

An interesting change is surfacing, the acceptance of specialists and surgeons into IDS models. Historically there has been a great deal of friction between these docs and the hospitals.

Why the change? Fear of dire economic consequences of staying in a traditional group practice model. Preliminary numbers from the 6/30/2010 residency class is that for the first time, a majority may opt for IDS employment rather than group practice. There are also reports that young docs are more concerned with life balance issues than previous generations.

So, any problems?

Hospitals are notoriously bad at managing physician practices, physician contracts must be structured carefully, physician productivity sometimes drops off with a steady paycheck, and the process of merging practices and/or converting ownership is a great deal of complex work at no small cost. Also, making this work in rural areas is tough.

Biggest question, will IDS on a large scale really cut costs? Or just reshuffle the deck chairs?

Tom aka Rusty Rustbelt

HEALTH CARE: Bureaucrats Gone Insane

Tom aka Rusty Rustbelt


President Obama wants health care provider to invest in electronic medical records networked in electronic health records systems.

President Obama put funds in the the stimulus bill to subsidize providers’ large capital outlays.

President Obama wanted “meaningful” EHR utilization, and only providers meeting the “meaningful use” definition will receive subsidies.

Today the feds published the final “meaningful use” rules – all 864 pages.

Tomorrow I write a piece for a national audience telling most of them to forget the program, and wait-and-see what develops next.

This does not portend well for the rest of the health care program.

Tom aka Rusty Rustbelt

Baucus’s Side Deal Comes Unstuck

by Bruce Webb

The Amendments Are In — All 543 of Them

The Friday 5 p.m. deadline has passed for filing amendments to the health care legislation in the Senate Finance Committee, and aides to Senator Max Baucus have finished tallying them: 543 in all, from both Democrats and Republicans.

Senator John D. Rockefeller IV of West Virginia will propose the creation of a government-run insurance plan. So will Senator Charles E. Schumer of New York, but with careful rules to make sure that the public plan competes with private insurers on a level playing field.

Senator Ron Wyden of Oregon will propose a requirement that employers offer at least two different choices of health insurance, or provide vouchers that would let their workers shop for alternatives in a new, government-regulated insurance marketplace. Mr. Wyden has another amendment that would expand eligibility for subsidies to help people buy insurance, by raising the income cutoff to 400 percent of poverty from 300 percent of poverty, which for a family of four would be $88,200, instead of $66,150.

Senator Maria Cantwell of Washington will propose increasing the income cutoff for Medicaid to 200 percent of poverty, or $44,100 for a family of four. And Ms. Cantwell also has an amendment that would revamp Medicare payments to doctors, hospitals and other providers to reward high-quality, lower-cost care.

Senator Robert Menendez of New Jersey will push to lower a cap on the amount moderate-income families will have to pay in health insurance premiums to 10 percent of income, down from 13 percent. Senator Debbie Stabenow wants to push the cap even lower, to 6.5 percent of income.

It looks like Baucus’s hopes of cutting a deal with Republicans and just bypassing the concerns of liberals on Finance just ran up on a rock.

As the poet might have said: “The best laid schemes o’ mice an’ Max aft gang agley”

Open Health Care thread