The Rust Belt Is Burning: Republicans Lay Waste to their Base on Health Reform
“Repeal and Replace ObamaCare” was one of the slogans that powered Donald Trump’s upset victory in the November 2016 Presidential election. How ironic, then, that the actual proposals would have badly damaged both the states and working class voters that put the President in office. Read about the cruel paradox of Repeal and Replace and why it ultimately failed.
Oregon’s High-Risk, High-Reward Gamble On Medicaid Expansion
Oregon’s High Risk, High Reward Coverage Expansion This posting explores how Jeff’s home state of Oregon dramatically expanded health coverage under the Affordable Care Act, and its effects on Oregon’s health insurance market and care system.
Fail to Scale: Why Great Ideas In Healthcare Don’t Thrive Everywhere
Fail to Scale In winemaking, some wines only grow in highly defined localities. The concept is terroir. In US health policy, multiple examples of the same phenomenon exist: Kaiser, physician sponsored independent practice associations, hospital system sponsored health plans thrive in some parts of the US and wither in others. Why is this? Why do great ideas in healthcare repeatedly fail to scale up nationally? Read Fail to Scale:
All Risk is Local
All Risk is Local We all knew how this was going to go, or thought we did. Healthcare payment is moving from volume to value, led by the Medicare program’s historic ACO program, and private markets are going to be fundamentally restructured by ObamaCare. Well, it didn’t work out as we expected, and the shift to value is HIGHLY dependent not on the federal government, but rather state Medicaid programs, some of which pay at 65 cents on the dollar relative to cost. Private insurance markets are in turmoil as a result of ACA, and new payment models are taking a back seat to major underwriting losses. What difference does it make? Read All Risk is Local and find out.
The Tangled Hospital-Physician Relationship
The Tangled Hospital Physician Relationship Hospitals have employed tens of thousands of physicians in the past decade, a sixty percent increase from 2003 to 2014. Tens of thousands more depend on hospital subsidies of various kinds. And yet the private practice of medicine is far from dead, as single specialty physician groups increasingly dominate lucrative medical and surgical specialty markets. Power is shifting between hospitals and physicians with the growth in new payment models, but in which direction? How to make sense of this troubled and tangled relationship is discussed in The Tangled Hospital Physician Relationship.
The C Word
The C Word: Why Calling Patients “Consumers” Is an Insulting Caricature: That patients are becoming consumers of healthcare implies both discretionary purchasing power and leverage that, in most real world situations does not accurately reflect either their powerlessness or their priorities. Why we need to find better language to describe the patient role in the health system.
2014 National Health Spending: The Great Moderation Likely Is Not Over
2014 Health Spending: The Great Moderation is Likely Not Over: Health spending growth spiked upward in 2014, after a decade of moderation.
In this posting, Jeff Goldsmith argues that the factors leading to the 2014 spike are one time costs related to the Affordable Care Act’s implementation and does not alter the trajectory of core costs.
Moral Failure And Health Costs: Two Simplistic Spending Narratives
In attempting to explain the seemingly endless rise in health costs, politicians and the health policy community have evolved two explanations of the root cause: moral failure by either care providers or by patients. Read why both conservative and progressive policy narratives are flawed, and should be replaced by a broader and more nuanced explanation, leading to different remedies. Read Moral Failure and Health Costs: Two Simplistic Spending Narratives
Commentary: Shift to population-health payment unlikely to come anytime soon
Population health-based payment (e.g. capitation) is expected by many in the health industry to replace the current fee-for-service methods of paying doctors and per admission or per procedure payment of hospitals. Read why this is unlikely to happen: Shift to Population-health payment unlikely to come anytime soon
Pioneer ACOs: Anatomy Of A ‘Victory’
The Pioneer ACO was certified this spring as the first new Alternative Payment Model to be expanded under the Affordable Care Act. A close look at the program’s performance, however, reveals the use of “Lake Wobegon” accounting. The program lost nearly half its participants, and those with the most managed care experience fared the worst. Read: Pioneer ACO: Anatomy of a Victory