Health Wonk Review: Pre-Thanksgivukkah edition


by Henry Stern

Source: Health Wonk Review

Here's an interesting fact about this particular edition of the venerable HWR: it won't happen again for 78,000 years (at which time Julie will still be looking great, BTW).

How's that, you ask?

This year (2013/5774), the first night of Chanukah falls on Thanksgiving, and that happy (if confusing) confluence of events won't happen again for another 78,000 years. At which time, I certainly hope that the host of that 'Review will be kind enough to link back to this one (hey, traffic is traffic, right?).

So the theme of this edition will be freedom and gratitude, which also turns out to be the theme of both Chanukah and Thanksgiving (how serendipitous!):

"He is a wise man who does not grieve for the things which he has not, but rejoices for those which he has." - Epictetus

Although we typically limit participants to one post per 'Review, I'm invoking Host's Privilege with our first entry because:

a) Joe Paduda's the Founder of the Health Wonk Review, and
b) These really are a matched set

First, Joe explains why the Healthcare.gov website isn't going to be fixed by the end of the month. Then, he offers a helpful reminder that the Exchange itself is only one piece of a much larger effort.

"The will of the people is the only legitimate foundation of any government, and to protect its free expression should be our first object." - Thomas Jefferson

Longtime HWR contributor David Williams (who's been quoted - a lot! - in the MSM of late - Mazel tov!) explains that, while 'reference pricing' is a good idea, it's only useful for a fraction of total medical costs and - despite what some observers want you to think-- it's not a great endorsement for the superiority of the free market.

"Make a pact with yourself today to not be defined by your past. Sometimes the greatest thing to come out of all your hard work isn't what you get for it, but what you become for it. Shake things up today! Be You...Be Free...Share." - Steve Maraboli, Life, the Truth, and Being Free

David Harlow reminds us that, aside from the technological snafus, the slow beginning to enrollment in Obamacare plans shouldn't be cause for alarm. After all, when Massachusetts health reform was introduced, it took months before folks started signing up in meaningful numbers.

"The unity of freedom has never relied on uniformity of opinion." - John F. Kennedy

My favorite econ-blogger, Jason Shafrin, observes that according to conventional wisdom, rural areas have poor access to advanced specialists. The CW, however, gets that one quite wrong: recent research indicates that access to oncologists may be much better than previously thought due to visiting consultant clinics.

"Let us be grateful to people who make us happy; they are the charming gardeners who make our souls blossom." - Marcel Proust

It is NOT true that Dr Jaan Siderov's hobby is dumpster diving. A top-secret memo from an insurance carrier's CEO just "happened" to fall into his lap. Hilarity, not to mention health business clarity, ensues.

At least, that's his story,and he's sticking to it.

"Those who deny freedom to others, deserve it not for themselves". - Abraham Lincoln

In the classic Doyle/Holmes tale The Silver Blaze, the absence of an event itself provided a critical clue. In Roy Poses' post, the absence of financial records served the same function, much to the chagrin of the president of the Upstate Medical University.

"As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them." - John F. Kennedy

Brad Wright offers a helpful Q&A on the ACA "fumbling" that's currently making the news, offering his own take on why it happened, what other problems we can anticipate seeing, and (perhaps most importantly) how it affects you.

"Everything that is really great and inspiring is created by the individual who can labor in freedom." - Albert Einstein

Something that a lot of folks haven't really thought through is "where are all the new doc's going to come from?" After all, these newly-insured folks will need someone from whom to actually receive care. Over at Wings of Zock, Jim Lewis notes that students just entering high school would graduate from medical school in 2025, and they'll have access to diagnostic and clinical tools likely even unimagined today. But where will they complete their residency training? The answers may surprise you.

 "You pray in your distress and in your need; would that you might pray also in the fullness of your joy and in your days of abundance." - Kahlil Gibran

Louise Norris has more details on how plans in place today will fare at their next renewal, and predicts that at least a few folks may be pleasantly surprised at what happens to their premiums over the next few years.

"Gratitude is not only the greatest of virtues, but the parent of all others." - Cicero

This may be my favorite post in this edition. Hospitalist Dr Bradley Flansbaum shares his experience with a naive international medical school graduate that opened his eyes to the benefits of working with folks cut from a different cloth.

"Some people grumble that roses have thorns; I am grateful that thorns have roses."- Alphonse Karr

Jonena Relth discusses the ridiculousness of President Obama's recent announcement that insurance companies may now choose to keep their previously cancelled policies. She asks "why would any insurance executive voluntarily choose to do this?" and observes that it doesn't take a mathematician to see the alligators in this swamp!

"When we lose the right to be different, we lose the privilege to be free." - Charles Evans Hughes

At Workers' Comp Insider, Tom Lynch discusses an important new report on how the work population is changing, and the challenges that a diversified workplace will pose to workplace health and safety. In particular, the report focuses on how those delivering healthcare and safety services will need to develop cultural competence, new skills and approaches to communicating with populations that have limited English proficiency. It's an interesting perspective on this brave new world of health care.

"Piglet noticed that even though he had a Very Small Heart, it could hold a rather large amount of Gratitude." - A.A. Milne, Winnie-the-Pooh

Health Affairs' Tim Jost walks us through President Obama's proposal to extend existing policies, and then details the questions it raises, such as state and insurer reactions, the effects on the ACA and the exchanges, and political implications.

"I disapprove of what you say, but I will defend to the death your right to say it." - Voltaire

Also writing about President Obama's "end run" around House Republicans, Maggie Mahar wonders about "the catch." That is, under the proposal, carriers would need to notify their customers about which benefits their existing policies are missing and alert them to other options available in the ACA's marketplaces.

"Acknowledging the good that you already have in your life is the foundation for all abundance." - Eckhart Tolle

At the eponymous John Goodman's Health Policy Blog, guest author Greg Scandlen takes a look at the latest trends in consumer-driven healthcare, aka Health Savings Accounts, and the role they'll likely play as the ACA rolls along.

"Liberty means responsibility. That is why most men dread it." - George Bernard Shaw

Anthony Wright notes that, despite the issues with the federal website, California's ACA implementation is on track, with nearly 1/3 of the national enrollment, and now doing 2,000 enrollments a day, enough to meet state expectations. But, he adds, there's more to do.

And now, our own contribution:

בָּרוּךְ אַתָּה יְיָ אֱלֹהֵֽינוּ מֶֽלֶךְ הָעוֹלָם שֶׁהֶחֱיָנוּ וְקִיְּמָנוּ וְהִגִּיעָנוּ לזְּמַן הַזֶּה

Ba-ruch A-tah A-do-noi E-loi-hei-nu Me-lech ha-o-lam she-he-chee-ya-nu v'ki-yi-ma-nu vi-hi-gi-ya-nu liz-man ha-zeh.

(Blessed are you, Eternal God, Sovereign of the universe, for giving us life, for sustaining us, and for enabling us to reach this season)

This is a very special prayer, which we offer in times of great joy. It's also recited, along with the "regular" blessing, on the first night of Channukah. I offer it here as a token of my gratitude for the opportunity to host this 'Review, and for the freedom to do so.

Our post for this edition is a guest article from an actual expert in Quality Management, and his thoughts on how easy it might (will?) be to "game" the ACA.