Monthly Archives: October 2010

Intravenous Merlot?

I grew up on an island off the coast of southeast Georgia. It’s a resort area–nice hotels, fancy restaurants, first-rate golf courses, and miles of sandy beaches. But like I said, I grew up there, it wasn’t vacation for me. Right after high school, I started working summers as a phlebotomist at the local hospital. Each summer, I had to sit through a two-day-long orientation, and each summer, it bored me to tears. One summer, however, the hospital got a new CEO, and he came to speak to us at orientation (unlike the prior CEO who “spoke” to us via videotape). He said something that struck me.

“We live in an area where people come to stay on vacation and spend as much as $500 a night for their room. When they pay that much money, they have certain expectations about the level of service that they will receive. They expect their room to be clean. They expect the staff to be pleasant. They expect the best of everything. We are a hospital, not a resort. But many of the people who are admitted here will spend more for a night with us than they would for an oceanfront room. We should realize that, and exceed even their greatest expectations.”

It was an interesting point, but I found myself thinking about all of the reasons why the analogy didn’t hold up. The most prominent one in my mind was this: People choose where to go on vacation. They don’t choose to go to a hospital, they go because they’re sick. Well, that’s not entirely true anymore.

Apparently, competition is getting tougher, and hospitals are competing in ever stranger ways. Exhibit A, Parkview Ortho Hospital in Indiana, where patients are permitted to drink wine if their doctor says it’s okay and have a steak dinner before being discharged. The full story, which you can read here, makes it sound less like a cold and sterile linoleum lined environment with harsh fluorescent lighting and the incessant beeping of medical technology, and more like a place you might want to go to on purpose just to get away from it all for a few days. The hassles of insurance have already led to a growing movement of physicians deciding to establish concierge or boutique medicine practices. Might we be about to embark upon the age of the resort hospital? After all, if your options are get a knee replaced and deal with it or get a knee replaced and enjoy your choice of filet or lobster, which would you choose?


Posted by on October 28, 2010 in Uncategorized


Jobs Map

Go look at this.

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Posted by on October 27, 2010 in Uncategorized


The Party of Big Medicare

I never cared much for history when I was growing up. It was my worst subject by far in high school, and I had to force myself to do well in it during college. Somewhere along the way, though, that began to change. I wouldn’t say that I particularly love history, but I appreciate it. History holds valuable lessons (if we are willing to look for them) and it provides context for the present.

David Leonhardt–whose writing I especially enjoy–recently had a piece in the New York Times that examined the history of Republicans and Medicare. It’s a quick read, but for those of you strapped for time, here’s the gist: My how things have changed!

Back in the 1960s when Medicare was first proposed, the Republicans fought against it with all their might. The AMA even hired the young actor and aspiring politician, Ronald Reagan, to describe Medicare as a slippery slope to socialist America. Sound familiar? Well, it is……almost.

Yes, claims of socialized medicine have remained popular on the right when health reform winds up on the agenda, but the focus has shifted. Back then, Medicare was the devil. Lately, the Republicans seem hell bent on preserving and expanding Medicare. They added a costly drug benefit (Part D), which they did nothing to try and pay for. By contrast, with the latest reform, Democrats have targeted inefficiencies in Medicare to partially offset the cost of coverage expansions, while Republicans have sought to preserve the waste in Medicare. The bottom line is that Republicans are adamant about preserving–even growing–the very program they once despised as the harbinger of America’s downfall.

It makes me wonder: If health reform survives the next couple of elections and becomes fully implemented, how long will it take the very Republicans who voted against the legislation to switch sides and support the new status quo?

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Posted by on October 27, 2010 in Uncategorized


Tom Daschle On Reform

What do Tom Daschle and Sally Jesse Raphael have in common? They both wear eyeglasses with red frames. I find that striking, but not nearly as striking as Daschle’s comments about the threats facing the implementation of health reform–some of which I’ve mentioned before (lawsuits and funding problems), others I haven’t (waivers being granted to employers by HHS). You can read a partial transcript of his comments here, or just watch the video.

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Posted by on October 25, 2010 in Uncategorized


Where’s the Blog?

If you’re anything like me, you have habits. And, if you like me, I’m hoping one of your habits is reading my blog every day. Of course, the downside of that is that it requires me to keep writing new content, and that can get a little bit challenging sometimes. There are a lot of reasons why. For starters, sometimes there’s not much “news” to report. That’s why I started supplementing health reform updates with common sense interpretations of current research. However, even research is cyclical and sometimes lulls. On top of that, I’m working a lot on my dissertation, traveling the country quite a bit for job interviews, and, you know, living life. It’s enough to keep me pretty busy, and sadly, they don’t hand out PhDs for writing a blog, so I’ve had to prioritize. That may not change much for a while.

Now, the blog’s not going away, but it’s quite likely that the recent trend in declining frequency of posts will continue. What I want to avoid is having those of you who check the blog daily, become disappointed when new material doesn’t show up for a few days or a week, and stop reading altogether. I’m not committing to a particular schedule, so don’t expect to see a new post every Wednesday or anything like that. I’m just giving myself some room to breathe. Setting a boundary. Returning my writing from a place of “have to” to a place of “want to.” Just wanted to keep everyone in the loop.

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Posted by on October 22, 2010 in Blog Updates


I Love It When People Prove My Point For Me

No sooner did I pontificate about the political biases of the judiciary–and how that will play out in deciding the constitutionality of health reform–than another verdict (of sorts) was rendered. Specifically, the U.S. government made a motion for the lawsuit filed by the attorneys general of Florida and 19 other states to be dismissed, and Senior U.S. District Judge Rodger Vinson said “No.” His denial of the motion means that the states’ case can proceed. Not exactly earth-shattering news, but there is one thing worth noting. As I said before, the judge in the Michigan case who ruled in favor of health reform was appointed by President Clinton. This judge, who is permitting the case against reform to go forward, was appointed by President Reagan. Coincidence? Perhaps, but I wouldn’t bet on it.

You can read more on this story over at CNN. I, meanwhile, am headed to the state where CNN is headquartered to visit my family, so no more blog until at least Tuesday. Have a good weekend!

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Posted by on October 15, 2010 in Uncategorized


Shafrin Hosts Health Wonk Review

Jason Shafrin of the Health Economist blog hosts the latest Health Wonk Review. Lots of good stuff in there this time (including a post of mine)–and his tenuous connection to the rescue of the Chilean miners will make you groan out loud at your desk.

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Posted by on October 14, 2010 in Health Wonk Review


The First Verdict

I just wrote a piece about the challenges being mounted against the implementation of health reform by its opponents. One of those was that the issue could be decided in the courts. Well, last Thursday, the first judicial ruling came out. The case of Thomas More Law Center v. Barack Obama was decided by U.S. District Judge George Steeh, and he found that health reform–or more specifically, the individual mandate–was constitutional. (You can read his decision here.) As I explained before, if the individual mandate gets struck down by the courts, it effectively eviscerates health reform. Since courts tend to rely on precedent, this first “victory” is important, but it isn’t the final say by a long shot. A number of other District courts will rule, and this issue will most likely weave its way to the Supreme Court.

There are 9 justices there, and it will take 5 of them to decide that the individual mandate is unconstitutional. Judge Steeh’s ruling may or may not reflect how the Supreme Court will rule. The thing is, judges aren’t outside of politics. Sure, the members of the Supreme Court and District Courts are appointed for life, rather than elected. On the one hand, this means that they need not judge in such a way as to please the people. After all, justice is a stand-alone quality, right? Moral principles, for example, do not change based on popular opinion. The catch is to be found in that word “appointed.” The President has the job of appointing the District judges and nominating the Supreme Court justices (who are subject to Senate confirmation). It should be obvious that Presidents nominate and appoint judges who share their own political views (to the extent that such can be gleaned from past decisions and the like).

The judge who ruled in favor of health reform in Michigan was appointed by President Clinton. He sided in favor of the Democrats’ reform law. The Supreme Court looks different. Two were appointed by Ronald Reagan, one by George H.W. Bush, two by Bill Clinton, two by George W. Bush, and two by Barack Obama. If you’re doing the math, that’s five justices appointed by conservative presidents and four appointed by liberal presidents. That means essentially that one justice–just one non-elected official–could determine the fate of health reform in this country. Most would say that that person is Justice Anthony Kennedy, who is traditionally considered the swing-vote in 5-4 decisions. Does the result in Michigan really mean anything? Let’s hope Justice Kennedy thinks so.


Let’s Place Bets On Repeal

I have it on good authority that there are basically three outcomes that the health reform law may experience in the future (other than becoming a resounding–or mediocre–success). They are:

1. The Republicans get elected to a veto-proof majority and repeal the law in its entirety.
2. The Republicans get elected to a simple majority and are able to attack the law by reducing funding for a number of its provisions.
3. The lawsuits being brought against the law are successful and the individual mandate is found to be unconstitutional. Consequently, the entire thing unravels.

As to Option 1, I don’t see it happening. Is the GOP going to pick up seats in November? It would be historic if they did not. Will they pick up enough seats to override Obama’s veto and repeal health reform? I doubt it. Even if they did pick up the necessary seats, they might suddenly find out how hard it is to hold the votes together, especially considering that repeal isn’t going to be any easier politically than passage was. The obstacles here are huge. I’ll do a little forecasting, and say there’s about a 1% chance that this happens.

Option 2 is much more likely, because all that would be needed is a simple majority in both chambers. I put the likelihood of this one at about 30%, and that number would get greatly revised upward or downward after the election. After all, if the GOP can throw a wrench in the works without repealing reform, the end result will be pretty much the same, but with one major difference: Option 2 lets them say “Hey, Look! The Democrats’ health reform didn’t work!” They don’t have that luxury if they repeal the thing.

Lastly, Option 3. The courts are unpredictable. After all, this is the kind of case that would make its way up to the Supreme Court, and then you’re only talking about winning five votes in a best-of-nine series. (Sorry, the baseball postseason just started.) I’d give this one about a 20% chance of happening.

If you’re tracking with me and doing the math, that means I put the likelihood of health reform facing a serious challenge to implementation at 51%. Again, that’s without knowing how the elections will turn out. Still, the threat is quite real. Equally as real is the threat posed by the GOP’s proposed alternative to health reform as outlined in the Pledge for America. (As another aside, I can’t wait until another 16 years go by and we get the Promise to America to make the hat-trick with the Contract with America. But Washington never recycles ideas.) Others have had some good takes on the problems with what is being proposed. You can read them here, here, and here.


Out of Town

Lest any of you should see the lack of new posts and begin to worry that I have fallen in a hole, let me reassure you that I have simply gone out of town for a few days. Just exactly how much this will disrupt the blog, I don’t know. You should check back later in the week (say Thursday), but if nothing new shows up, then just come back on Monday. In the meantime, I hope everyone has a great week, and is enjoying the kind of fall weather we’re having here in North Carolina. We’ll talk again soon……..

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Posted by on October 4, 2010 in Blog Updates

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