Crowdsourcing, Price Formation, & Health IT

From the perspective of the average patient, going about his life unconcerned about health policy or economics, what is the most frustrating characteristic of U.S. health insurance? Surely, it is the madness of the billing cycle: Never knowing how much a medical service costs until long after you’ve received it, and sometimes only after a flurry of phone calls and paperwork that can take months to clear up.

My Participation in the Daily Blogs

Who will suffer most from Obamacare? Those most in need of medical care, as I and others discuss at John Goodman's Health Policy Blog.

Who's to blame for the forthcoming "doctor shortage"? Physician heal thyself, says I, also at John Goodman's Health Policy Blog.

There's an interesting discussion of the absurdity of medical billing over at The Health Care Blog, in which I point out that any claims adjudication will be burdened by bureaucratic frustration - which is why insurance should be used rarely, and only for unforeseen, catastrophically expensive illnesses or accidents.  Obamacare takes us in the wrong direction.

Federal Exchange Grants Fertilize Obamacare

Over at The Health Care Blog, Merrill Goozner cheers Republican governors who are taking federal money to develop Obamacare exchanges.

Mr. Goozner asserts that the shower of federal Obamacare grants enables states to act as "laboratories of democracy.  If only! Accepting federal grants to implement Obamacare is far from the idea of states being "laboratories of democracy". It's the kind of thinking that led George W. Bush to impose No Child Left Behind on states' schools.

Greg Scandlen Takes on the Bush Republicans

I immigrated to this country in 2005 to research and promote consumer-driven health care.  I had unrealistically high hopes for what the Republicans led by George W. Bush could achieve.

Obamacare Exchanges a Bad Bet for Wisconsin

Wisconsin has a Republican "trifecta": majorities in both legislative chambers and the governor.  There's no reason for them to throw away their advantage by collaborating on setting up an Obamacare health-insurance exchange.

Read my column in the Milwaukee Journal Sentinel.

Two Ways to Improve the Repeal Bill

Not that I’m trying to be a party-pooper, but there are two things that would have improved yesterday’s repeal bill (and, by implication, will improve it if and when the Senate deals with it), neither of which adds complexity to the elegant and brief bill passed by the people’s chamber.

Read the rest of the post at National Review Online.

Rhode Island's Medicaid Waiver Shows How States Can Save Their Budgets From Obamacare's Assault

Key points from this month's Health Policy Prescription:

• On the last day of the Bush Administration, Rhode Island won a federal waiver to reduce federal control and increase patient choice in the state’s Medicaid program.

• In 18 months following the waiver, Rhode Island’s Medicaid spending was almost one-third less than budgeted: $2.7 billion versus $3.8 billion.

• Rhode Island’s successful reforms include the ability to incentivize higher quality care, rebalancing long-term care, and giving beneficiaries more direct control of their health spending.

• Because Obamacare will impose a catastrophically expensive expansion of Medicaid dependency on states, governors and state legislators should invest significant effort in crafting and lobbying for waivers similar to Rhode Island’s.

Read the entire article here.

Repealing Obamacare Is Not "Symbolic", It's a Constitutional Duty

Even conservative talk-radio hosts and, this morning, the Wall Street Journal seem to have fallen for the line that the vote to repeal Obamacare, expected tomorrow in the House of Representatives, is “symbolic.” Apparently, because Sen. Harry Reid is unlikely to allow a vote in the Senate, and the president would veto repeal if it managed to beat the odds and get to his desk, the whole exercise is a waste of time.

How the tables have turned! Back when Nancy Pelosi was speaker, the legacy media bemoaned the fact (as of last October) that the House had passed 420 bills that the Senate had not taken up. Journalists would never have dared label these bills “symbolic.” Rather, the problem was a “gap in productivity” between an energetic and progressive people’s chamber and the Jurassic Senate, where archaic rules empowered a rump to block critical agenda items.

Read the entire entry at National Review Online.

200 Economists' Letter Encouraging Repeal of Obamacare

About 200 hundred economists (including me and about 199 who are smarter than me) signed a letter to Congressional leaders strongly endorsing the repeal of Obamacare.  It was organized by Douglas Holtz-Eakin of the American Action Forum.  The text is here.

On Medicare Paying Doctors for End-of-Life Counseling

The Wall Street Journal published my letter this morning on the Administration's (since rescinded) decision to pay doctors an extra fee for providing end-of-life counselling to Medicare beneficiaries.  I wrote it in response to a letter by a physician who advocated such reimbursements.  My letter disagreed:

Insurance Brokers Should Reverse Their Position on Obamacare

A recent story in Politico confirmed what was already known in health-policy circles: In order to meet Obamacare’s arbitrary Medical Loss Ratios (MLRs), health insurers are cutting commissions to brokers. (The MLR is the ratio of premiums to claims paid out to health providers.)

Fair enough, many might say: The point of establishing this arbitrary accounting target was to ensure more cash flow to providers than to middlemen. This outcome leads to an unhealthy schadenfreude for me, because I’ve always thought brokers should have advocated strongly for individually owned health insurance, instead of the current employer-based monopoly, but unfortunately, because most health insurers pay commissions as a percentage of premiums, brokers’ interests were not aligned with society’s interest in reforming the bloated and expensive employer-monopoly system.

Read the entire entry at National Review Online.

The End of the Individual Mandate is Not the End of Obamacare

Last month Virginia attorney general Ken Cuccinelli successfully argued that the so-called “individual mandate” in Obamacare was outside congressional competence. Advocates of individual choice in health care cheered a significant victory, but this is not the final judicial word on Obamacare.

Off the blog until next week

To Orlando for Cato Institute conference on state health reform - which I'll be tweeting, so be sure to follow johnrgraham on Twitter.

Health-Insurance Exchanges Bad for Michigan

My op-ed in the Detroit Free Press: States with freshly baked, single-party, Republican rule, need to be especially wary of being duped into enabling Obamacare.

Pawlentycare vs Obamacare: A Brief Examination

Over at The Atlantic, Nicole Russell has given us “A First Look at Pawlentycare.” There’s little doubt that Tim Pawlenty, former governor of Minnesota, is eager to trumpet his state’s achievements on health-care reform, and he definitely talks the talk of consumer-driven health care. I was very impressed by an op-ed he wrote in the San Diego Union-Tribune last November, wherein he called for “repealing Obamacare state by state”.

Read the entire article at National Review Online.