Health Wonk Review: Counting Our Blessings Edition

Next Thursday is Thanksgiving. A holiday that, despite its very name, has become all about gorging ourselves on turkey, dressing, mashed potatoes and pie(s). A day consumed with televised parades featuring giant inflatable cartoon characters and televised sporting events featuring giant muscled athletes running into one another at full speed. But it is meant to be a day to pause and reflect. To evaluate the past year and count our blessings. To give thanks for all that we have. In that spirit, this edition of the Health Wonk Review takes a look at the best of the health policy blogosphere from the last two weeks. While not all the entries are good news, I think you’ll find that there’s a lot here to be thankful for. And, of course, I’m thankful for such a talented group of bloggers with which I get to interact. And, for good measure, I’ve interspersed this post with some of my favorite paintings by the classic American artist, Norman Rockwell, whose work evokes the holiday spirit for me.

We lead off this edition with a post from the Health Affairs Blog entitled “To Understand Climbing Death Rates Among Whites, Look To Women Of Childbearing Age,” that examines one of the biggest stories in health services research this year. Laudan Aron, Lisa Dubay, Elaine Waxman, and Steven Martin of the Urban Institute look at a recent study by Anne Case and Angus Deaton, describing rising mortality among whites, that received national attention. Aron and coauthors focus on one important missing point in the Case-Deaton study: the particularly notable mortality rate increase among women. They write: “By not looking at men and women separately, Case and Deaton failed to see that rising mortality is especially pronounced among women…Our own analysis of the same data used by Case and Deaton shows that the average increase in age-specific mortality rates for whites age 45-54 was more than three times higher for women than men….By lumping women and men together, the study also missed the important point that the increases in mortality are affecting women of reproductive and childrearing ages, a finding that has huge implications for children, families, and communities.” Thus, a fitting picture would be a young couple breaking a turkey’s wishbone. Perhaps she’s wishing for a decrease in mortality for her and her peers?

Next in a post entitled “Dreaming On – The Illusions of the Leaders of Large Health Organizations, as Illustrated by Medtronic’s Founder,” we have Roy Poses of Health Care Renewal writing about the recidivism of large healthcare organizations, which have repeatedly been subject to legal actions and settlements for allegations, sometimes proven, of various bad behavior. According to Poses, “These behaviors seem to recur partly because they are so remunerative for the organizations involved and their top managers, and because while the organizations may sometimes be subject to monetary penalties, the managers almost always have complete impunity.” He offers up the case of Medtronic’s founder and the corporation’s troubled legal history as an example. What picture best encapsulates just about any post from Roy Poses? Why, Rockwell’s “Freedom of Speech” of course.

We health wonkers have pretty positive regard for our fellow wonkers. Case in point: Julie Ferguson cites an article by Joe Paduda in her post “Misunderstanding the Business of Workers Comp” at Workers Comp Insider. While it’s no mud wrestle, there’s some controversy afloat that you may want to check out. Since the post seemed to call for a little playful confrontation, what better than a pilgrim fleeing the arrows of the Native Americans?

Next up, David Williams of the Health Business Blog asks the pressing question: “What do obese, middle-aged and older mute Americans with Type II diabetes do for fun?” His answer, in a post entitled “Invokana Makes Diabetes Fun Again!” is that they pull Invokana frisbees down from the sky and change their lives. It’s a different kind of post, for a very different kind of pharmaceutical commercial. Check it out. If we’re talking diabetes, I think that warrants this painting of an older, overweight chef, smoking a cigarette and enjoying a cup of coffee at the end of his shift on Thanksgiving.










Speaking of pharmaceuticals, Peggy Salvatore contributes “Federal Health IT Strategic Plan: Where Are The Incentives?” at the Health System Ed Blog. She tells us that the Federal Health IT Strategic Plan shows the pathway to pay-for-performance through population health, requiring a fully functional national health IT infrastructure. This leads us to the push for outcomes-based payments, coming upon the health system rather quickly, and the various players are lining up to figure out how to get paid under this new system. You know what else people line up for? Thanksgiving dinner. Just above on the right is Rockwell’s classic “Freedom from Want.”

Another post about paying for value rather than volume comes from Jason Shafrin at the Healthcare Economist. Jason writes a post entitled “Does Tying Payment To Quality Improve Quality?” in which he examines efforts by CMS to tie 90% of reimbursement to measures of quality and explores whether or not it will work to improve quality. You’ll have to read his blog to find out. And–I’m really stretching the metaphors here–speaking of quality, why not a picture of a son spending quality time with his mother peeling potatoes in preparation for the big feast?

Speaking of CMS, Brad Flansbaum writes “CMS Just Paid for Advance Care Planning, But You’ll Still Make More Giving Injections” at The Hospital Leader about the agency’s decision to reimburse conversations between doctors and their patients about advance care planning. Somewhere Sarah Palin is freaking out that the death panels have arrived. However, Flansbaum questions whether the reimbursement will be enough to change a medical culture that has not prioritized these important discussions, and is still driven largely by fee-for-service volume-based payments despite the best efforts of the ACA. Perhaps a reminder that we should learn to be more satisfied and less greedy is in order. After all, no one likes a gluttonous pilgrim.

And that brings us to the ACA, which a lot of folks wrote about. First up is Joe Paduda of Managed Care Matters with a post entitled “ACA – What Can We Expect In The Healthplan Market In 2016.” He says markets are evolving, healthplans are failing, and hospitals are complaining. About what we’d expect in this brave new world! What are really failing are the co-ops.

Writing at the Colorado Health Insurance Insider, Louise teaches us all a “Lesson From CO-OP Failures: Low Premiums Aren’t Sustainable Unless We Reduce Healthcare Costs.” According to her, “while it’s popular to condemn rate increases as carriers profiting on the backs of sick people, profit margins in the health insurance industry have been hovering around 3% since 2008. However, the pharmaceutical industry’s profit margin is closer to 20%, and in 2013, Pfizer’s profit margin was 42%. Clearly, we have a spending problem, but as long as the actual regulations are aimed at insurers rather than the entire health care industry, we’re going to be fighting an uphill battle. Incidentally, the Trans-Pacific Partnership free-trade deal would only strengthen U.S. pharmaceutical companies protection from cheaper generic drug competition.”

As critics continue to hype the steepest health insurance rate increases, and co-ops fail, this might make a lot of people wonder “Is Obamacare Collapsing?” but health insurance industry whistleblower Wendell Potter reassures us that the Affordable Care Act is far from a disaster for the millions who are gaining coverage in a post at the blog.

And even more importantly, a lot of people don’t realize how blessed they are. At InsureBlog, Hank Stern writes “Leaving Money On The Table – An Update” underscoring that more than 2 million people eligible for federal subsidies to help them purchase insurance aren’t getting a penny of that money, because they failed to purchase a qualified health plan through the Marketplace. So, on that note, let us all take a moment to pause and give thanks for the many blessings which he have received, and continue our efforts to make sure that we do what we can to bless others less fortunate in our midst. Happy Thanksgiving all!


Posted by on November 18, 2015 in Uncategorized


Fall Has Begun and Louise Norris Hosts Health Wonk Review To Honor The Occasion

I say the same thing every time, because it’s true: This is good stuff. You should go read it. Here’s the link.

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Posted by on September 24, 2015 in Uncategorized


Peggy Salvatore Hosts Health Wonk Review

Head on over to the Health Systems Ed Blog and give it a read. Here’s the link!

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Posted by on August 19, 2015 in Uncategorized


Medicaid Managed Care in Iowa

The state of Iowa is about to conduct a bold experiment by putting everyone in Medicaid and the Children’s Health Insurance Program (known here as HAWK-I) into private managed care plans. There was a recent story on the subject by Iowa Public Radio’s Clay Masters, which ran on NPR’s All Things Considered and was also featured in the Kaiser Health News. In full disclosure, yours truly was interviewed for the piece, and was rewarded with a small quote towards the end of the story. I share it here with you not only for the obvious purpose of shameless academic self-promotion, but also because it is a very important story that offers a foretaste of what may be soon to come in your own state, as more and more states consider ways to relieve the pressure that Medicaid puts on their budget.

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Posted by on August 18, 2015 in Uncategorized


Hank Stern’s Health Wonk Review

We’re officially into summer, and Hank Stern hosts the latest edition of the Health Wonk Review, with a theme of Hot Summer Nights, Cool Summer Drinks. I encourage you to beat the heat by reading his wonderful piece, which summarizes some of the best health policy blogging of the past two weeks.

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Posted by on July 17, 2015 in Uncategorized


A Further Reflection on Give 1 For Dad

You may recall that about 3 weeks ago, I wrote a piece on this blog in honor of my Dad and in support of a novel and important charity to fund prostate cancer research at Duke University called Give 1 For Dad. If you missed that piece, I urge you to read it here.

The charity was founded by Sam Poley, whose father, Neil, had metastatic prostate cancer. I’ve actually never met Sam or his father. I know Sam’s wife, Stephanie, from my time at the University of North Carolina. I learned of the Give 1 For Dad charity through Facebook. I visited the website, watched the video Sam posted, and found myself moved by the cause and the concept. So I did the least I could do in support: I gave a donation and I wrote my blog post urging anyone who read it to do the same. I made an appeal echoing Sam’s own–to consider what our Dads mean to us and to give accordingly.

At last count, the charity had raised just $19,000. On the one hand, that’s fantastic–it’s nearly halfway to the amount that needs to be raised for the project to begin enrolling and treating patients with cancer. On the other hand, it’s disappointing that much more hasn’t been raised already. This week, when you go out for a dinner and drop $50 or $100 without a thought, you should think again. Could you, perhaps, sacrifice on that one meal? You needn’t go without. Just scale back. Make a conscious decision to say that, rather than a fancy meal out, we’ll stay in, or order off the value menu. Take the difference and give it to the cause of Give 1 For Dad.

You may think, “Oh, I intend to give, I’ll do it next week, or the week after, or at the end of the month when I get paid.” Friends, I urge you to do it today. Time matters. People are sick now who might benefit. People will get sick tomorrow and the next day. Sadly, for some, it is now too late. Neil Poley–Sam’s father–passed away on July 4th. Yet it is not too late for those others–known to us or unknown–whom we might help through a modicum of charitable sacrifice. Indeed, to honor Mr. Poley’s memory, the family has asked for donations to Give 1 For Dad. This blog post is, once more, echoing that call in hopes of disseminating it to a wider audience. Martin Luther King, Jr. reminded us that “It may well be that we will have to repent…for the appalling silence and indifference of the good people…” I’m not asking you to give until it hurts. I’m merely asking you to give something in the hopes that it might ameliorate the hurts of others.

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Posted by on July 7, 2015 in Uncategorized


A Review of PortionMate

For reasons unknown to me, my email address ended up on a list that landed in the hands of the makers of “a meal and snack measuring tool” called “PortionMate.” I was contacted with an email that seemed more or less targeted at individuals who run healthcare facilities–or perhaps for dieticians and other providers to use with their patients. However, as I do not run such a facility and my students do not count as patients, it seemed I was not their target demographic. Nevertheless, the content on their website seemed interesting, so I emailed them back. I told them about this blog, and said that if they’d send me a set of the measuring rings–more on that in a moment–I’d be willing to write up a review on my blog. Now, it’s not exactly the type of health policy and health services research content that you typically find here, but if people would eat better, and lose weight, it would go farther in improving health outcomes than most anything we have achieved through policy of late.

They agreed, and within a week or two, I got a kit delivered to my door. I should also disclose that, other than the free kit, I was not compensated in any way for writing this review. Consider it a public service.

The basic idea behind PortionMate is that we have no idea what appropriate serving sizes should look like. Sure, we can read the side of the package, but as comedian Brian Regan jokes about ice cream, some guy probably put “1/2 cup” on the container as a joke, but now it’s already packed on all the trucks and it’s going out like that. In other words, we don’t adhere very closely to the serving sizes on the nutrition labels. To make it easier for us, you’ll often hear guidelines like “Eat a serving meat the size of the palm of your hand.” The problem with that, of course, is that we all have differently sized hands. PortionMate basically takes this concept and standardizes it, using a series of 6 differently colored and differently sized rings (see below).IMG_2538











As laid out clearly in the accompanying booklet, the green ring is roughly 1 cup, and is for fruits and vegetables. The yellow ring is 3/4 cup, and is for cereal and fruit. The orange ring is 1/2 cup, and is for fruits, vegetables, cereal, and beans. The blue ring is 1/3 cup, and is for cooked grains and starchy vegetables. The red ring is about 3 ounces, and is used for measuring protein (i.e., meats). Finally, the purple ring is about 1 ounce, and is used for measuring nuts, seeds, dried fruits, and cheese. IMG_2539As you can see from my little experiment, however, it is very important to use the correct ring for the correct food type. Sadly, while the chocolate chip cookie fits easily within the red ring, I don’t think this is a correct use of the product, and none of the rings are allocated for use with sweets (if you exclude fruit). That, as far as I’m concerned, is a flaw in the product.

My other main issue with this product is that I don’t see how it adds much value. For example, I’ve used the MyFitnessPal app to keep a food diary, and it pulls in all of the actual nutritional information from everything I eat. All I have to do is make sure to measure the serving size. So, for example, it is easier for me to pour cereal into a measuring cup and then dump it into the bowl–and likewise for the milk–than it is for me to use the yellow ring. On top of that, not all cereal serving sizes are 3/4 cup. Some are 1 cup. So I’d have to remember when to use the yellow ring and when to use the green ring. But the biggest problem is that there’s no bottom in the ring. Of course, if there were, it would be a measuring cup.

That said, I think that it could be a useful tool for gauging portion size of things like steaks, that aren’t as easily measured. Sure, you can go off the weight, but fitting it inside the ring is easier. The same might be true for other foods that I can’t think of right now off the top of my head. The bottom line? There is nothing “wrong” with this measuring tool. Indeed, it might even work well for you. I think the point might be to train you what proper serving sizes of various foods look like. And, in that respect, if used consistently, I think it would work very well. I, however, will continue to use measuring cups, and iPhone apps.


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Posted by on June 29, 2015 in Uncategorized


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