Thursday, May 26, 2011

Ryan's Medicare Reform: More, Please

A few months ago, News Corporation launched a new publication, The Daily, which is designed specially for the iPad.  Regrettably, I don't have an iPad, but the editor ran my column anyway.  It's about Paul Ryan's and the House Republicans' Medicare reforms (and especially timely in the wake of Republican defeat in the Congressional special election in New York a couple of days ago).

Now, I can fantasize that everyone whom I see playing with his or her iPad is reading my column.  If you don't have an iPad, you can read it here.

Wednesday, May 25, 2011

Will Kathy Hochul Vote to Repeal Obamacare?

The surprise victory of the Democratic candidate in NY-26’s special election yesterday teaches a curious lesson: Seniors who rose up against Obamacare’s Medicare cuts at town-hall meetings in the summer of 2009 appear to have risen up against Paul Ryan’s Medicare plan in the spring of 2011.

Or maybe they didn’t. Read the entire post at National Review Online.

Earth to Republicans: You Are In Big Political Trouble Over the Ryan Medicare Plan

Update: The Wyden-Ryan Medicare Plan - Paul Ryan and Ron Wyden Blow the Medicare Reform Debate Wide Open! It should now be clear to Republicans they are in trouble over the Ryan Medicare plan.Yesterday, they lost a seat in a solid Republican New York House district. Their candidate had benefited from lots of money and House leadership attention. The big issue was the Ryan Medicare plan.All month,

Friday, May 20, 2011

If Air Travel Worked Like Health Care

This may be the best health-care video ever!  By Jonathan Rauch of National Journal.

Thursday, May 19, 2011

Comparative-Effectiveness Research: How Many Lives Will It Cost?

I write a lot over at John Goodman's Health Policy Blog.  For every original post, I also write about half a dozen comments on others' posts.  I don't usually share the latter here.

However, I was interested to see Dr. Goodman's take on a new paper published by the Center for Medicines in the Public Interest, an outfit which is often tagged as simply a mouthpiece for Big Pharma.  Here's what I wrote:
Yes, I certainly appreciated the last “dig” and I shake my head at the irony of PhRMA funding research designed to push back key elements of a law for which PhRMA lobbied and invested. I doubt that Obamacare would have passed without PhRMA’s support. If PhRMA had resisted Obamacare, the threat of Comparative-Effectiveness Research (CER) would not be nearly as great as it is today.

But that is water under the bridge. IMHO, Vernon & Goldberg have written a very good paper. Deriving a point estimate from one factor in a function that has many factors is obviously risky, but they have used scholarly sources appropriately. And they are obviously trying to have an impact on public policy so they communicated their findings in such a way as to generate as much “heat” as possible.

Isn’t that why we are in think tanks and not academic departments at universities? So that our research has impact in the real world and not just in articles in scholarly journals that few read?

If we are going to challenge people solely based on where they get their funding, without considering the work, then we must logically accept only research by amateur gentlemen who do if for free! I don’t think anyone fits that bill.

Even if we think the point estimate derived by Vernon & Goldberg is overconfident, it complements a principle that we champion: CER cannot be effectively achieved by a centralized bureaucracy. CER can only be effective when millions of patients, prescribers, scientists, and entrepreneurs are trying new medicines free of central control.

Wednesday, May 18, 2011

Governors Declining Health Benefit Exchanges

I was interviewed in a story for Health Care News about states whose governors are declining to implement Obamacare Health Benefits Exchanges.  Read it online here.

Massachusetts En Route to Single-Payer Health Care

Mitt Romney has thorwn himself in front of a buzzsaw with his continuing defense of his 2006 health reform in Massachusetts.  The other day, the Wall Street Journal editorial board sharply criticized Mr. Romney's approach.  In a letter by yours truly that the WSJ published today, I noted another problem with the Massachusetts reform: It amplified political incentives that have put the solvency of Bay State health plans at risk.  Read the letter here.

For non-subscribers, the text is copied below:
Your editorial's criticism of Mitt Romney's 2006 Massachusetts health law is correct in that taxes, costs and political interference in medical decisions have all gone up while access to medical care has deteriorated ("Obama's Running Mate," May 12). The Massachusetts law also jeopardizes the very solvency of private health plans in the Bay State.

Because it was politically intolerable to allow premiums to rise in line with the costs of RomneyCare, the state's insurance commissioner denied 235 of 276 rate increases in April 2010. For a short time, no new policies were offered and plans suffered significant losses. The next month, Blue Cross Blue Shield of Massachusetts, the state's largest carrier, announced a $55 million provision for anticipated losses in the second quarter alone. Of the 12 largest carriers, five were already operating at a loss. At this point, even if the state allows Blue Cross Blue Shield of Massachusetts to increase rates in line with medical costs, my analysis concludes that the carrier will become insolvent somewhere around 2017.

Gov. Romney did not give Massachusetts "universal" private health coverage. He put it on a glide-path to a single-payer, government-monopoly health system.

Tuesday, May 17, 2011

Who Is The Republican Health Care Candidate?

The Wall Street Journal and most NRO writers have pretty much written off both Mitt Romney and Newt Gingrich as acceptable Republican presidential candidates because of perceived weaknesses on health care. Health care has become the third rail of American politics — just not the way we used to understand it.

Until recently, a Republican could churn out crowd-pleasing sound bites about fixing health care but never put the pedal to the metal by investing political capital in a serious proposal for reform. Republicans understood that when the talk turned to health care, Democrats won the debate and Republicans lost. It was just a fact of life. Not anymore.

As Romney and Gingrich bind their wounds, I’m sure that they are more surprised than anybody at the hostile response their recent comments have drawn. After all, it is true that trace elements of the “individual mandate” can be found in conservative policy proposals from the days of yore. Our friends at the Heritage Foundation considered such a mandate in the 1990s, but have long since rejected it. And the quality and quantity of the Heritage Foundation’s current research on health policy, which unambiguously rejects every part of Obamacare in favor individual choice and fiscal responsibility, leaves no room for excuses that there are no conservative alternatives to mandates and tax hikes.

On the other hand, when I look at Gingrich’s campaign website’s section on health care, I see nothing inexcusable. He champions repealing Obamacare and lists ten reforms, all of which one can find in the publications of one conservative think tank or another. (I don’t find all ten convincing, but while I don’t think it’s Congress’ job to pass a law on medical-malpractice liability, for example, it wouldn’t be the end of the Tenth Amendment either.)

So, how did one unfortunate interview on a Sunday TV show do so much damage to the launch of his campaign? I think it’s a matter of trust. Repealing Obamacare is not something Republicans can waffle on in the slightest. And attacking the congressional caucus that voted for Medicare reform is very close to attacking their vote for repeal.

We cannot afford a “national conversation” on repealing Obamacare. Every day that it persists is another day that doctors, hospitals, pharmaceutical firms, health insurers, medical-device manufacturers, and all the other concerns in the health sector invest more time and energy “implementing” its harmful provisions. Every day that goes by is another day in which those interests dig themselves deeper into the new status quo, making Obamacare harder to defeat.

Every single Republican presidential candidate will promise to repeal Obamacare; that’s the price of a ticket to the dance. But between election night on November 6, 2012, and the inauguration on January 20, 2013, there will be plenty of opportunities for the president-elect to find excuses for delaying repeal in favor of a “national conversation.” After all, that’s what many business interests will want.

And conservative voters know it, too. Campaign bromides won’t work this time. The winning Republican candidate will have to prove beyond any shadow of a doubt that he (or she) will immediately sign the one-page repeal bill that will be the first legislation to land on the president’s desk after the inauguration. There can be no risk of dithering in favor of a “national conversation.”

I don’t know what a candidate can say to prove that he (or she) will do this. But now I know what he cannot say.

(Crossposted at National Review Online.)

A Pfizer Break Up? That Would Be Something

I have been afforded the great privilege of a perch at Forbes Online from which to communicate my perspective on events where health policy and healthcare finance intersect.  Avik Roy, an equity research analyst at Monness, Crespi, Hardt & Co. in New York City, has invited me to collaborate with him on his blog, The Apothecary, which has been hosted by Forbes for a few months.

What I intend to contribute at The Apothecary is somewhat different than what you'll read in my other media, because I'll be bringing financial analysis to bear on the healthcare space (although not ignoring what the politicians and bureaucrats are doing, of course.  Any healthcare enterprise's success will depend largely on government action.)

Many Wall Street analysts have been after Pfizer, Inc., to restructure and refocus for years.  Under new CEO, Ian Reid, they think they've finally got someone whom they believe can get the job done.  But others think that Big Pharma should grow by acquisitions, instead of shrinking by spinning off divisions.  How credible is it that Mr. Reid will take the latter course?  Read my entire blog entry here.

Mission Impossible: Medicare's Independent Payment Advisory Board

Thos of you who can read 1,500 words will have already read the longer version of this in the recent Health Policy Prescription.  But for thos who prefer a slightly shorter version of my analysis of Obamacare's Independent Payment Advisory Board (IPAB), the new agency that will decide whether granny gets a "blue pill" or a "red pill," please see this blog post over at John Goodman's Health Policy Blog.

Monday, May 16, 2011

Can I Deduct Obamacare On My Taxes?

Here's a column I wrote in Sunday's Washington Examiner describing the benefits of individual ownership of health insurance:

Can I deduct Obamacare on my taxes? The Examiner Op Eds Washington Examiner

Thursday, May 12, 2011

The Lightweight Romney Health Plan

Mitt Romney has outlined his new health plan. He outlined five key steps in an op-ed in USAToday. Here is a summary:Step 1: Give states the responsibility, flexibility and resources to care for citizens who are poor, uninsured or chronically ill.who are poor, uninsured or chronically ill.Step 2: Reform the tax code to promote the individual ownership of health insurance.Step 3: Focus federal

Sunday, May 8, 2011

Neither the Republicans Nor the Democrats Want to Face the Provider Cost Problem But Both Want to Dump the Problem on the Consumer

A key piece of Paul Ryan’s deficit reduction plan is to change Medicare as we know it. It appears his bold Medicare premium support proposal is failing to gain traction--it is dead as part of any deficit reduction deal this year. Worse, his Medicare proposal looks to be giving Democrats lots of political ammunition for the 2012 elections.What lies at the heart of Ryan’s Medicare difficulties is