AHLAlerts: American Health Line’s Blog

As health reformers move to implement provisions of the federal health overhaul, they must work to balance responsibilities with insurers, while simultaneously ensuring that the system does not rely primarily on government control. To that end, bloggers have their recommendations, and of course, their skepticism.

Joseph Paduda in “Managed Care Matters” recommends that officials decide whose job it is to manage health care costs under the law. He asks, “In return for getting millions of new members, aren’t health plans supposed to figure out how to manage care and control costs?” Paduda continues, “Suppliers in any business seek to maximize profits,” adding, “Smart buyers will figure out how to find more cost-effective suppliers, develop alternative supply chains, or in very tight supply markets even resort to vertical integration, setting up their own suppliers.” He notes, “I see no reason health plans can’t do the same.” According to Paduda, “There’s far too much ‘old thinking’ among health plans; they remain overly concerned with the size of their network directory, believing large provider networks are essential to success.”

Meanwhile, David Dranove posits in “The Health Care Blog” that Medicare advisors might become “accidental socialists” while seeking to reform health care. He writes that the Obama administration “has hired an army of academics to implement the new reforms,” who mostly agree that the solution to fixing the U.S. health system is “a combination of greatly expanded government insurance and a tightly regulated private insurance market.” However, he writes, “this solution does not end with a government takeover of health insurance.” He notes, “There isn’t a public or private health insurer anywhere in the world that doesn’t directly intervene in the delivery of medical care,” adding, “Socialized insurance necessarily leads to socialized medicine, and if the government controls well over half of the insurance sector through Medicare and Medicaid, and tightly regulates the rest, it is only inevitable that it will also seek to control how health care is bought and sold.” Dranove writes, “I fear that the regulatory behemoth [reformers] have been entrusted to manage is too big for them, despite their talents.” According to Dranove, “Ten years from now, we will look back at these days as the beginning of the end of market-based medicine in America.”

by Matthew Wayt, staff writer

What’s the most-important health care news of the day? Subscribers to First Look find out by 8:30 a.m. ET. Start every morning with First Look, American Health Line’s free roundup of the key policy, strategic and clinical developments shaping health care. See a sample issue or subscribe by clicking HERE.

The body mass index, which is a person’s weight in relation to height, is widely used by medical professionals and health experts to determine if the person is at healthy weight, underweight or obese. However, BMI can be deceptive.

• “Weight Index Doesn’t Tell the Whole Truth“: Some medical experts note that BMI does not “differentiate between fatty and lean tissue,” according to New York Times health columnist Jane Brody. That’s a problem because fat “takes up about four times the space of muscle tissue,” which could cause some people “to look and feel fatter” if their height and weight remain the same as they age and their muscle tissue capacity decreases. Brody also notes that if an individual is classified as being “underweight” or at “healthy weight,” they could be “easily lulled into a false sense of security” as “thinness is not necessarily healthy” (Brody, New York Times, 8/30).

Since November 2008, Dana Jennings of the New York Times has been sharing with readers facets of his life as a patient undergoing treatment for prostate cancer.

• “A Rush to Operating Rooms That Alters Men’s Lives“: In Jennings’ latest column, he writes that although prostate cancer “itself never did any damage” to his physical and mental self, it was “the treatments that razed me — the surgery, radiation and hormones producing a catalog of miseries that included impotence, incontinence and hot flashes.” Jennings writes that “a small voice kept whispering: What if this is all a lie? A dark conspiracy of the global medical-industrial complex?” For the column, he showcases a new book — titled “Invasion of the Prostate Snatchers” — that “effectively confirm[s] my whimsical paranoia” (Jennings, “Well,” New York Times, 8/30).

Since the health reform law was enacted in March, there have been quite a few media reports of companies laying off workers or taking on millions of dollars in additional charges to offset new costs under the reform law. Invariably, critics have used these examples to boost their arguments against the overhaul.

• “As Reform Improves The Overall Market, Inefficient Insurers Could Take Hits“: The New Republic‘s Jonathan Cohn, in a Kaiser Health News column, cites the example of conservative columnist Michelle Malkin, who used the news of Milwaukee-based Assurant Health’s recent decision to lay off 130 employees as an example of “job-killing” effect of the overhaul. However, Cohn cautions against such a quick judgment. He writes, “To be clear, sometimes reform really will reshuffle the health care economy in ways that make it worse,” but adds, “It’s to promote a more efficient economy, while making sure the unemployed have jobless benefits, training for new work and actual jobs they can take” (Cohn, Kaiser Health News, 8/30).

by Santosh Rao, senior writer

What’s the most-important health care news of the day? Subscribers to First Look find out by 8:30 a.m. ET. Start every morning with First Look, American Health Line’s free roundup of the key policy, strategic and clinical developments shaping health care. See a sample issue or subscribe by clicking HERE.

The Obama administration on Tuesday announced that about 2,000 employers and unions will be eligible for a program that would reimburse younger retiree’s medical bills through a $5 billion federal fund created under the federal health reform law, the Wall Street Journal reports. Retirees between ages 55 and 64 are not yet eligible for Medicare but often incur some of the highest costs for employers. The federal program allows employers to access the $5 billion fund and be reimbursed for up to 80% of certain health costs for such retirees.

HHS said that around 1,900 employers have qualified for the funds so far, including Alcoa, General Electric, General Motors, PepsiCo, Procter & Gamble and Pfizer. HHS Office of Consumer Information and Insurance Oversight Director Jay Angoff said the agency is still taking applications for the program but would not say how many applicants have been declined.

The high number of eligible companies has caused some employers to worry that the program will run out of funding before it expires in 2014, when the overhaul will prevent insurers from denying care to older U.S. residents. James Klein, president of the Americans Benefits Council, compared the program to the “cash for clunkers” subsidy, which became unexpectedly popular and ran out of money before its original end date (Adamy, Wall Street Journal, 8/31).

– compiled by Matthew Wayt

What’s the most-important health care news of the day? Subscribers to First Look find out by 8:30 a.m. ET. Start every morning with First Look, American Health Line’s free roundup of the key policy, strategic and clinical developments shaping health care. See a sample issue or subscribe by clicking HERE.