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U.S. health policy

Health System Reform: What Works and What Doesn’t

Posted by John McDonough October 17, 2012 11:05 PM

For folks who pay attention to fixing the U.S. medical care system, it's got to be a confusing time. So many developments trending is so many directions. How does one make sense of it, and what does it all mean? Let's dive in for a bit.

First, an important shift in how we pay for health care in the U.S. began this month as the federal government started financially penalizing hospitals with excessively high rates of hospital readmissions and hospital acquired infections for Medicare patients. New Jersey is a state with among the highest proportion of hospitals facing these penalties, and here's a story about how hospitals there are addressing the challenge.

This shift is important. We are moving beyond fee-for-service by which we pay providers for how much they do. We are also moving beyond "pay for performance" where we reward providers for doing process steps such as screenings and other tests. We are moving, slowly and surely, toward "paying for outcomes," a potentially game-changing stage if the current efforts aimed at readmissions and infections are seen as just the first steps.


Best Value in U.S. Health Insurance Is in Massachusetts

Posted by John McDonough October 10, 2012 10:08 PM

"Value" is a dicey word because we each value different things. This is especially true in relation to health insurance. Some people value insurance based on the price of premiums, and some people want to consider the required level of cost sharing in the form of copays, deductible, and coinsurance; some care mostly about choice of provider and others care more about the scope of services covered.

A new report from U.S. News and World Report takes a crack at answering this thorny question by closely evaluating near 6,000 health insurance plans across the U.S. that sell "non-group" coverage to individuals and families. Click here for the summary of the report and click here for access to the full report.

Bless USNWR, they also evaluated the value of plans state by state. We already know that Massachusetts has among the highest health insurance premiums in the nation. Surprise, surprise, though, U.S. News and World Reports concludes that Massachusetts health insurance plans "consistently offered broad coverage and protection against a potential flood of medical bills..."

Here are some more details, including their state by state map:


The Obama-Romney Debate – Big Winner is Massachusetts Health Reform

Posted by John McDonough October 3, 2012 11:10 PM

Some quick reactions on the health care debates in tonight's first presidential debate:

Tough for both when stats and debating points are flying everywhere fast and furious.

Massachusetts: The big winner from tonight's debate regarding health policy may be the Massachusetts health reform program.  Here's a point about health that both O and R agree on -- Massachusetts health reform is good and it working well. I'm sure that makes ObamaCare and RomneyCare opponents choke -- nice to have it agreed on by both candidates for president.

Romney added: "What we did in Massachusetts is a model for nation -- state by state. Whisking aside the 10th amendment is not the answer." The US Supreme Court weighed in on constitutional violations, and the ACA stands tall. RomneyCare works only because the federal government pays the lion's share of the tab.


Will the ACA Reduce Public Disability Coverage?

Posted by John McDonough September 24, 2012 10:24 PM

I've seen no comment or coverage about a most provocative commentary in this week's New England Journal of Medicine. The article, "Health Insurance-Motivated Disability Enrollment and the ACA," by Jae Kennedy and Elizabeth Blodgett, suggests that a positive and unintended impact of the Affordable Care Act (aka: ObamaCare) will be a slowdown in the number of Americans claiming public disability insurance coverage.

How come?

"Disabled workers often apply for public financial disability benefits in part to obtain public health insurance -- a uniquely American phenomenon that we call health insurance-motivated disability enrollment (HIMDE)."

What difference would the ACA make in relation to any of this?


The HIT-EHR Blues

Posted by John McDonough September 23, 2012 10:32 PM

The bigger the build-up, the harder the fall. So it appears in the world of health information technology (HIT) and electronic health records (EHR).

For about 10 years now, many health policy experts have predicted that health system salvation lay in the universal adoption of HIT/EHR systems that would enable hospitals, physicians, and other medical providers to avoid duplicative tests and use advanced quality information available at their fingertips. If there were such a thing as health system salvation, it was digital. And across the board, health system leaders, public officials, and others accepted the gospel. I was one of them -- more on that below.

2012 will be known, among other things, as the year the bloom fell off the rose.


McDonalds will post calorie info – thanks to the ACA

Posted by John McDonough September 13, 2012 09:54 PM

Today, the McDonalds restaurant chain announced that beginning on Monday it will post the calories in every item on their menus, including menu boards and drive-thru boards. And herein lies an interesting story.

A few years back when New York City and other localities began passing their own local laws to require posting of calories, McDonalds and other chains strongly opposed the requirement. My former boss in the U.S. Senate, Sen. Tom Harkin (D-IA), began introducing legislation in 2003 to create a national calorie-labeling requirement and faced a wall of opposition from the restaurant industry.

But in most cities and towns, the restaurant chains found themselves unable to beat back the requirements. And then they faced a problem because every locality defined the requirement in different ways, creating a caloric tower of Babel.

By the time the legislative process that led to passage of the Affordable Care Act (aka: ObamaCare) began, the industry knew they had already lost the war. Pretty soon, they saw federal health reform legislation as a way to rationalize the fast growing number of different calorie-labeling requirements.


Young Doctors in Love … With Primary Care!

Posted by John McDonough September 12, 2012 09:12 PM

I get asked what's best about teaching at the Harvard School of Public Health. Here's an example.

Last spring, three of my public health students, all medical students getting their masters in public health (MPH) degree before finishing their final year of medical school, sent me a draft of an article they had written. The article detailed their excitement at the prospect of specializing in primary care, not traditional primary care, but the new primary care now being developed in innovative medical homes and accountable care organizations across the U.S.

I was surprised and thought their proposed article was fantastic and important, a rationale for why primary care may just be the most exciting place to be in medicine in the near future. I gave them some ideas on how to improve it, and urged them to think big, say, the New England Journal of Medicine, one of the most prestigious medical journals in the world. And now...


Mitt Romney twists and bends on the ACA

Posted by John McDonough September 9, 2012 08:40 PM

I did yoga this morning as I try to do 2-3 times weekly. Bikram Yoga is my favored method -- 26 poses, always in the same order, 90 minutes in a room heated to 105 degrees, really. A lot of people diss it, but I'm hooked on the twisting, bending, stretching in every conceivable direction in the highly uncomfortable heat and humidity.

But my twisting was totally outdone a few hours later this morning when Mitt Romney appeared on Meet the Press and began talking about the Affordable Care Act:


A number to note: $342

Posted by John McDonough September 5, 2012 10:18 PM

As the national debate on Medicare bounces back and forth, there is one number that sticks with me and that I hear no one talking about.

It's $342.

What's that? It's the average annual cost by which Medicare premiums will rise over the next 10 years if Mitt Romney and Paul Ryan win and get to implement their plan to repeal the entire Affordable Care Act.

How can that be?


We didn't ask for health reform? No way.

Posted by John McDonough September 1, 2012 07:21 PM

One of the most gratifying elements of Cong. Paul Ryan's speech last Wednesday accepting the Republican Vice-Presidential nomination was the media's reaction to it. It's rare to see such a broad-based take down of a speech based upon clearly documented distortions. Despite the Romney campaign's assertion that "we're not going let our campaign be dictated by fact checkers," that will be the instinctive reaction to Ryan's pronouncements from now on.

There's one distortion, though, that got less attention and deserves more. It's Ryan's assertion that the Affordable Care Act/ObamaCare is "a new entitlement we didn't even ask for."

Really? Let's consider...


About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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