Politics

What are the lawmakers, and other state and federal officials, up to when it comes to health reform laws?

Gruber Responds To Economix Critique Of Health Reform

Massachusetts health reform in general and its advocates in particular were the target of a pretty harsh critique yesterday in The New York Times’ blog, Economix.

The post, by University of Chicago Economics Professor Casey Mulligan, argued, among other things, that the U.S labor market is “in for a shock” when health reform takes full effect despite how “smoothly” things may have appeared when Massachusetts carried out its own health reforms starting in 2006. Mulligan writes:

Beginning next year, millions of Americans will be eligible for generous subsidies in the form of cash assistance to pay for their health insurance premiums and out-of-pocket health expenses pursuant to the Affordable Care Act. The subsidies will sharply reduce the financial reward to working because they will be phased out with household income.

Jonathan Gruber of MIT

Mulligan then goes on to trash MIT economics professor Jon Gruber, a key adviser on both state and national health reform, for his defense of the Bay State’s reform efforts:

When it comes to quantifying the new federal law’s penalty on employment, Professor Gruber and Health and Human Services are incorrect to take comfort in the Massachusetts experience since 2006. As I explained last week, the federal law’s employer penalty is more than tenfold the Massachusetts penalty. In other words, if the Massachusetts penalties pushed down workers’ wages by 16 cents an hour, the federal penalties would push them down $1.67.

Professor Gruber is also incorrect that the federal law is introducing less generous subsidies than the Massachusetts law did. Federal subsidies will be available for people laid off from their jobs, but the new Commonwealth Care subsidies in Massachusetts are not, because Commonwealth Care excludes people eligible for the Medical Security Program (a longstanding program providing health benefits to Massachusetts people receiving cash unemployment benefits).

I asked Gruber to respond to Mulligan’s critique. Here, unedited, is what he sent over via email:

Problems with Mulligan argument:

1) He cites as supporting evidence a 1994 article that referred to a completely different policy

2) He ignores the fact that the disincentives to income increase in MA are massively larger than in the federal program. Continue reading →

FILED UNDER: Insurance, Money, Politics, cost, health reform, jon gruber, labor

March 1, 2013 | 11:21 AM | Carey Goldberg

Debunking The Bad Math Of Workplace ‘Get Well Quick’ Schemes

(Wikimedia Commons)

“Workplace wellness” is a big and burgeoning movement. But is it a bubble?

If you work in a company of any size, chances are you know the “wellness” drill. Your employer is getting killed by health care costs, and tries to bring them down by motivating workers to get healthier. The wellness program offers you incentives — as much as several hundred dollars a year — to fill out a questionnaire on your health risks, get medical tests, lose weight, quit smoking, lower your cholesterol.

What could be bad, right? You win, your company wins. The idea is so appealing that it’s enshrined in the national health overhaul best known as Obamacare, and in the latest groundbreaking health reform moves in Massachusetts. And it has fast become the norm: Most companies that offer health insurance benefits now also offer some sort of wellness plan as well.

Author Al Lewis (Courtesy)

So when Al Lewis takes on the $6-billion wellness industry in his recent book, “Why Nobody Believes The Numbers,” he’d better be packing some good ammo. And he is: Fifth-grade math. Well, sometimes fourth-grade.

Lewis — an expert in “care management” across populations and measuring efforts to improve it — argues that yes, wellness is a bubble, because much of the movement carries a fatal flaw: Its potential economic benefits have been outrageously oversold.

Many wellness program vendors promise companies that they can quickly and cheaply cut their workers’ health costs — and back their claims with numbers that could not survive the most elementary scrutiny, he says. (Lewis titles Chapter 3, “Case Studies That Flunk Every Plausibility Test Known To Mankind.”)

‘The entire economic justification for wellness is made up.’

One example of many, his helpful analogy from the housing world: “If you insulate your house, you should save money overall, but you won’t save money on insulation.”

The health care equivalent is that you need to spend money to save money overall. If you get your workers to go to the doctor more and take more of the drugs they need, you may save money by avoiding hospital stays and ER visits. But — contrary to what some wellness experts claim — you’re not going to see your spending on drugs and doctors go down, too, Lewis says. That would be like saving money on insulation.

“What are these people thinking?” he asks. (On his Website here, he bestows “Intelligent Design Awards” to some of the more egregious overpromisers for “setting back the evolution of the wellness field.”) In essence, he argues, virtually all the data on the wellness Return on Investment — “The entire economic justification for wellness, is made up.” Continue reading →

FILED UNDER: Insurance, Medicine/Science, Politics, wellness

February 27, 2013 | 6:52 AM | Martha Bebinger

Should Massachusetts Tax Candy And Soda?

Are candy and soda food?

Yes, in Massachusetts, candy and soda are considered food and are exempt from the state’s 6.25 percent sales tax. But Gov. Deval Patrick wants to change that. He’s asking the Legislature to start taxing every bag of M&M’s and bottle of Pepsi you buy.

“Half of the people in the commonwealth are overweight or obese,” says Massachusetts Public Health Commissioner Dr. Lauren Smith. “A third of our kids are overweight or obese. Those are pretty daunting statistics, so the idea of adjusting the price of things that we know are associated with [obesity] makes sense.”

Public Health Commissioner Lauren Smith says taxing soda will discourage consumption. (Martha Bebinger/WBUR)

Smith says taxing candy and soda would raise about $53 million a year for general state spending. A coalition known as Healthy People, Healthy Economy is working with Rep. Kay Khan, of Newton, on a bill that would put candy and soda tax revenue into the state’s prevention and wellness trust fund.

But will adding roughly a dime to the cost of a soda make kids reach for something healthier instead?

“A small tax will have a small impact, a larger tax will have a larger impact. I mean, there’s just no way around that,” says Lisa Powell, a public health professor at the University of Illinois at Chicago.

Powell says applying the sales tax to soda would cut consumption by 7 to 8 percent, based on what’s happened in 35 other states. She says that’s a small but significant decrease that might be undermined if the state taxes just soda, “because you’re going to have substitution from soda to fruit drinks that have a lot of sugar in them, energy drinks, sports drinks.”

Powell says her research shows that “black children are twice as likely to be heavy fruit drink consumers, and white youth are twice as likely than their black counterparts to be heavy soda consumers. So you’ll miss different groups … if you only tax certain types of drinks.”

“I don’t think the governor should be picking and choosing what people are drinking,” says David Arons, a lawyer from Sharon, who opposes any new taxes. Continue reading →

FILED UNDER: Personal Health, Politics, google-editors-pick, obesity, soda tax

February 25, 2013 | 3:32 PM | Rachel Zimmerman

Another Health Care Leader Eyes Mass. Governor’s Seat

The election of 2014 is shaping up to be the year of the health-care-leader-as-politician, with another health expert today announcing his intention to run for Governor of Massachusetts.

WBUR’s Martha Bebinger reports that Evan Falchuk, of Newton, an executive with the online referral and consultation site Best Doctors, is jumping into the race. In his bid for governor, Martha reports that Falchuk is also starting the United Independent Party aimed at “voters [who] feel shut out of politics.”

“This is a movement,” Falchuk says. “And what we’re about is, taking the values of being socially progressive and fiscally moderate, and putting those two things together, which the two parties today don’t do.”

Evan Falchuk, the latest health care leader to jump into the 2014 Mass. gubernatorial race.

Evan Falchuk, the lates health care leader to jump into the Mass. gubernatorial race.

Falchuk’s announcement follows news from pediatrician and former director of the Centers for Medicare and Medicaid Don Berwick that he is seriously considering a run for the state’s top post.

“A lot appeals to me about the governor’s office,” Berwick, a Democrat, longtime Harvard faculty member and health quality guru, told WBUR’s Sacha Pfeiffer last month. “For example, I had this chance to work in Washington running the Medicare agency and I saw how good government can be. That is, how much productive force there can be in government for really helping relieve suffering and improving the well-being of people. I also saw how bad government can get: paralyzed, riven by contention. I think a lot of opportunity lies at the state level now, and I think productive state government — respecting the state employees, really working with vision — can get a ton done that can’t be done at any other level. That’s exciting to me.”

Also in the running is Democrat Dr. Joseph Avellone, described by The Boston Globe as “a Harvard-educated surgeon and former Wellesley selectman” and “executive at Waltham’s Parexel International Corp., a biotechnology services company. Continue reading →

FILED UNDER: Politics, governor's race, health care leaders

February 25, 2013 | 10:37 AM | Rachel Zimmerman

Globe On Gender Bias In The OR: Subtle But Persistent

Don’t miss this important story by the Boston Globe’s Liz Kowalczyk on persistent gender bias (subtle and sometimes not so) in the operating room.

Following news of a high-profile gender discrimination lawsuit that earlier this month ended with a massive $7 million settlement against Beth Israel Deaconess Medical Center and its former chief of surgery, Kowalczyk reports that bias against female surgeons still exists but it tends to be more under-the-radar and potentially insidious. After interviewing 10 female surgeons, she offers some examples:

–A female surgeon pointedly asks why her patient is late being wheeled into the operating room, and is accused by nurses of being too aggressive.

–Surgeons meet weekly at 7 a.m. at one hospital, just when some of their female colleagues are home getting their children dressed and fed.

– And several female neurosurgeons and orthopedic surgeons said women in these overwhelmingly male specialties often feel they must work longer hours and operate on more patients than their male colleagues to prove they belong.

…Still, female surgeons can experience subtler obstacles, including pressure to behave a certain way and conflicting family responsibilities.

I’ll add two more Boston doctor anecdotes to this list. First, one longtime neurologist recently told me she happened to discover she was earning far less than her male counterparts. Second, a general surgeon I know, who, after taking off several years to care for a young child, returned to the job market. At one interview, she was asked what her husband did for work. When she replied that he’s a manager in the financial sector, the interviewer responded (and I paraphrase here), Oh, well, then you don’t need to work.

Kowalczyk reports that gender bias within the medical arena these days generally doesn’t include sexist comments or a Mad-Men-like milieu. Rather, it tends to involve fewer promotions and recognition, particularly if you’re on the Mommy track: Continue reading →

FILED UNDER: Medicine/Science, Money, Politics, gender bias, hospitals, practicing medicine

February 12, 2013 | 10:54 AM | Carey Goldberg

Really? SEAL Who Shot Bin Laden ‘Screwed’ Out Of Health Care?

(Esquire magazine)

Here’s a bit of a brouhaha that’s sure to fuel newsstand sales of Esquire magazine:

Under the irresistible headline “The Man Who Killed Osama Bin Laden…Is Screwed,” Esquire Magazine posts here its cover story for March. It begins:

For the first time, the Navy SEAL who killed Osama bin Laden tells his story — speaking not just about the raid and the three shots that changed history, but about the personal aftermath for himself and his family. And the startling failure of the United States government to help its most experienced and skilled warriors carry on with their lives.

But now confusion and controversy is swirling over whether, in fact, the man identified only as “the shooter” will in fact be quite so screwed. NPR’s ‘the two-way’ blog covers the back-and-forth here, including the latest at this writing:

Update at 8:12 p.m. ET. SEAL Is Eligible For Benefits
Stars and Stripes is reporting that all combat veterans of the wars in Iraq and Afghanistan are “automatically eligible for five years of free healthcare through the Department of Veterans Affairs.”
The newspaper also interviews Phil Bronstein, who wrote the Esquire piece. You can visit the Stars and Stripes website to see what he said.

Readers? Perhaps the point here is that we live in a country where it is even possible that a long-serving soldier could lack health care. Whatever your viewpoint, you may get a dark laugh out of this trenchant comment on NPR:

He can write “I killed Osama” on his resume. That is good for any mall cop position in America.

(Hat-tip to Ben Swasey)

FILED UNDER: Medicine/Science, Politics, health care access

January 14, 2013 | 4:37 PM |

Opinion: It’s Time To Raise Excise Tax On Alcohol

(joseph a/Flickr CC)

On Friday, Massachusetts State Rep. Kay Khan, a Newton Democrat and Chair of the Joint Committee on Children, Families, and Persons with Disabilities filed a bill that would raise the excise tax on alcohol. (The bill isn’t online yet, says a spokesperson, but here’s the language from last year’s bill, which is identically worded.)

Our guest bloggers, Maryanne Frangules, executive director of the Massachusetts Organization for Addiction Recovery, and John McGahan, president and CEO of the Gavin Foundation, Inc., argue here that the measure is badly needed to support addiction treatment and recovery services.

By Maryanne Frangules and John McGahan

Two years after voters repealed the sales tax on alcohol, which funded addiction treatment and prevention programs, the Massachusetts Health Council reported that alcohol abuse is more prevalent in Massachusetts than the U.S. on average, and emergency room visits (especially in eastern Massachusetts) for drug abuse surpassed that of other much larger metropolitan areas in 2011, including New York, Chicago and Detroit. In fact, Massachusetts ranked first — at a rate of four times the national average — for emergency room visits involving heroin.

These are not categories of achievement for which Massachusetts wants to lead the nation.

We have a drug and alcohol addiction epidemic in Massachusetts, and we need to get serious about prevention, treatment and recovery. The human and economic toll of alcohol and drug addiction are not sustainable for a healthy, civil society.

While the Legislature and Governor Patrick have supported funding for addiction services during the recession and its aftermath, we now face another fiscal year of lower revenues, reductions in spending for vital health programs and perhaps mid-year cuts to public health services, including addiction treatment.

It makes sense to invest in addiction prevention, treatment, and recovery services. Otherwise our families continue to pay for the mounting social and economic costs of emergency room visits, law enforcement, court, and incarceration. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Politics, addiction, alcohol, public health, taxes

January 8, 2013 | 4:44 PM | Carey Goldberg

Berwick Mulls Run For Mass. Governor, State House News Reports

Dr. Donald Berwick

Think incumbent Gov. Deval Patrick is intensely oriented toward health care? Could be you ain’t seen nothing yet. State House News Service reports that Dr. Don Berwick, a national leader on improving the health care system, and the Obama administration’s former chief of Medicare, is considering a run for governor to succeed Patrick. From State House News:

Dr. Donald Berwick, a Boston-based pediatrician and former Obama administration health care official, is giving serious consideration to running for governor as a Democrat in 2014, injecting himself into a conversation limited so far to two statewide officeholders.

Berwick, who served for a year and a half as administrator of the Centers for Medicare and Medicaid Services before resigning in the face of Republican opposition to his permanent confirmation, has been talking with family, friends, civic and business leaders about a possible run.

He met privately on Monday with Lt. Gov. Timothy Murray in his State House office to inform the Democrat of his plans, and has also spoken with state Democratic Party officials.

“That’s correct. I’m strongly considering it,” Berwick confirmed to the News Service on Tuesday.

Berwick joins Murray and Treasurer Steven Grossman among those giving serious thought to a run for governor in 2014 when Gov. Deval Patrick plans to leave office at the end of the second term.

Readers, should he run? Why or why not?

FILED UNDER: Politics, donald berwick

January 7, 2013 | 11:56 AM | Carey Goldberg

Approaching Gun Violence As A Public Health Problem

“Non-Violence sculpture by Carl Fredrik Reuterswärd (Wikimedia Commons)

I would certainly describe something that kills 30,000 Americans before their time every year as a public health problem, wouldn’t you?

So would three Harvard experts who argue in the Journal of the American Medical Association today that the best way to curb gun violence is to treat it as a public health challenge not unlike smoking or car accidents.

From the press release:

They offer more than a dozen recommendations, based on successful strategies used in other public health crises. For example, they suggest a new, substantial national tax on all firearms and ammunition, to more accurately reflect the true societal costs of gun ownership and to provide a stable revenue source to target gun violence prevention. Such a tax would function like the tobacco tax, which provides crucial funding for smoking prevention efforts.

Other “off-the-shelf” approaches to preventing gun violence can be borrowed from efforts used in the 1970s to prevent accidental poisonings, the authors say. In the case of potentially harmful drugs, child safety packaging was introduced. In the case of guns, a similar strategy would be the manufacture of “smart guns” with security codes or locking devices. Also, routine education and counseling by physicians and national networks for education and prevention helped significantly reduce childhood poisoning deaths; similar efforts could help curb gun-related deaths. Continue reading →

FILED UNDER: Medicine/Science, Politics, gun violence, safety

January 3, 2013 | 11:18 AM | Rachel Zimmerman

Health Care And The Fiscal Cliff Deal

Harvard professor and author John E. McDonough

I don’t know about you but I never want to hear about the “fiscal cliff” ever again.

But for true wonks who wish to close the loop on what actually emerged from that final, chaotic and infuriating flurry of legislative wrangling earlier this week, here’s John McDonough, this town’s go-to guy for level-headed health care analysis, offering details in The Boston Globe.

Aside from the major fix to doctors’ Medicare payments (the deal prevents a 30% drop in physician fees) McDonough notes some other items that you probably heard nothing about:

There are 29 Medicare and other health related sections in all. Here are some of the big ones:

–The big “pay-for” cuts $10.5B from Medicare hospital payments to recoup over-payments to hospitals.
–Payment adjustments for End Stage Renal Disease (ESRD) will save $4.9B.
–Rebasing payments for Disproportionate Share Hospitals (DSH) will save $4.2B.
–Rejiggering the coding intensity between Medicare Advantage and Medicare fee-for-service will save $2.5B.
–$1.8B will be saved from reduced payments for certain therapies provided on the same day.
–Eliminating the Medicare Improvement Fund will save $1.7B.
–Throw in a bunch of smaller items less than $1B in savings, and we end up with only a net $1.7B increase in spending over 10 years.