Health Wonk Review: Going for the Gold Edition

It’s February 15 … and a day too late for a Valentine Edition of Health Wonk Review this week. The good news? I’m all swept up in the Olympic spirit and ready to award some hardware to this week’s Health Wonk Review contributors.

No medal awarded.

Is the JPMorgan/Amazon/Berkshire Hathaway healthcare alliance the “worst idea ever?” Joe Paduda – over at Managed Care Matters – doesn’t think so. In fact, it’s not the proposal that’s getting low marks from Paduda.

In Media coverage of Amazon/Berkshire/JPMorgan misses the point. Paduda gives critics of – and coverage of – the healthcare alliance a thumbs down. He also speculates on some outcomes of the A/B/J alliance.

Meanwhile, David Harlow has a medal-worthy rundown of the Amazon/Berkshire/JPMorgan alliance and also Apple’s foray into personal health records. David asks, “Are they both less than they seem? What would it take for these announcements to really capture our attention?”

David shares his thoughts on what it will take for these behemoths to succeed in A tale of two tech titans hoping to help healthcare.

And speaking of behemoths and healthcare, in Anthem Insurance & Emergency Room Visits That Go Uncovered Louise Norris offers a great explainer about unexpected ER bills and a controversy over how insurers pay for trips to the ER.

Norris is, of course, writing about Anthem, which issued new rules in Georgia, Indiana, Missouri, and Kentucky in 2017 that shift the cost of ER visits to the patient if a review of the claim determines that the situation was not an emergency after all.

An infraction worthy of a DQ

At Health Care Renewal, Roy Poses brings us the tale of an Olympic-level assault on freedom of the press – one that rises to the level of not doping but perhaps dopiness.

In Free Press? Don’t Need No Stinkin’ Free Press – Center for Medicare and Medicaid Services (CMS) Tries to Intimidate Modern Healthcare Journalist, Poses tells the story of a ham-handed CMS attempt to bully (unsuccessfully) Modern Healthcare journalist Virgil Dickson into changing a January 23 story.

It’s a must-read.

Head-to-head action that will make you hit Instant Replay

This week’s submission from #CareTalk – Mr. Azar Goes to Washington – actually required me to tune in to a 10-minute discussion on YouTube. And I’ve gotta say I was both entertained and enlightened by the banter between David Williams (Health Business Group) and John Driscoll (CareCentrix) as they made predictions about the impact of newly appointed HHS Secretary Alex Azar.

Come for the zingers. Stay for the Lightning Round.

The American ‘judge’ scores Peru

International flavor is, of course, what the Olympics is all about – and Jason Shafrin definitely fills the bill with his fascinating look at Health care in Peru.

Let’s just say that if health systems competed for medals, Peru would have a tough time overcoming its apparent underdog status. Spoiler: life expectancy in Peru is ranked 126 out of 224 countries. (Before 2007, more than 60 percent of the population had no health insurance coverage.)

A medal for members of Congress?

Over at, Charles Gaba has the dirt on efforts by Senate Democrats to help stabilize the Affordable Care Act by pushing for increased ACA subsidies. Should Patty Murray get a medal for her efforts? Not sure, but Charles should definitely get a Gold for his tireless work to deliver health reform updates and analysis to us all.

But wait. Tom Lynch at Workers’ Comp Insider is also awarding high marks to * gasp * legislators in DC. In Who’d A Thunk It? Something Good Out Of DC!, Lynch explains how “in a rare Washington Kumbaya moment,” legislators dedicated a little pork to “poor people who are aging and sick: America’s Dual Eligibles.”

“Finally, this Congress has done something that will benefit our most vulnerable citizens. Let’s hope it’s not a one-off,” Lynch writes. (And we concur.)

Something else we can all cheer for

And speaking of news that gives us hope and inspiration … Henry Stern at Insureblog had a post that elicited a cheer from Yours Truly this week.

In Something different (and potentially quite helpful), Stern adds his voice to an apparently growing movement intended to give us all more coverage when we go to the hospital. I won’t spoil the post for you, but I will drink to Henry’s sentiment with a wink and a “Bottoms up!”

A recap from the podium. No, not THAT podium.

OK. So it wasn’t a medalist podium somewhere in South Korea, but Andrew Sprung did make it to that OTHER important convo in 2018 – Health Action 2018, Families USA’s annual confab of healthcare activists.

Andrew reports that the event was “largely devoted to taking the measure of the political power somewhat miraculously tapped by a wave grassroots passion and action that staved off repeal – and groping toward a path by which Democrats can build on or move beyond the ACA in years ahead.”

His recap of the conference – Democrats and activists prepare health care offensive – examines what kinds of next steps – or false starts – the conference conversations pointed toward.

And finally – a story of indomitable spirit

The thrill of victory in defeating ACA repeal. The agony of Obamacare sabotage. It’s a great story.

Also great? A story on this site: Shawn Dhanak’s account of four consumers who are ignoring news of health reform setbacks and continuing to put their faith in the ACA’s protections. They’re still enrolling – like their lives depend on it.

So put on your giant foam finger and join me in waving a little American flag for this week’s contributors.

You stuck that landing!

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Fresh Health Wonk Review for a Fresh New Year

n-GENIUS-628x314Joe Paduda gets the year started with his  fresh edition of Health Wonk Review: Ring in the New year with the latest and greatest…  posted at Managed Care Matters.

Here’s Joe:

“Blog posts!

Health Wonk Review returns to the inter-webs after a holiday hiatus. Refreshed, renewed, and revitalized, we bring you the best from the brightest!”

Thanks much for kicking off the new year, Joe!

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Late Days of the Empire Edition of Health Wonk Review

aaron-burden-97663From Andrew Sprung  of xpostfactoid: We’re addled on many fronts here in Trumpville, and this week’s Health Wonk Review reflects that. We have snapshots of a country that continues to trail its peers in population health measures; an opioid vendor looking to short-circuit potential tobacco industry-level liability; an individual market for health insurance offering unaffordable plans to many of the unsubsidized, and freakish bargains to some of the subsidized; and, for a little futuristic relief, a human resources tech vendor that may chain healthcare data to a block, where it shall remain unaltered forever and ever.

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A Conversation at #CareTalk and the Short and Sweet Disaster Edition of Health Wonk Review

David WilliamsLet’s talk.

In this month’s episode of #CareTalk, CareCentrix CEO John Driscoll and your host, David Williams from Health Business Group chat about the recent hurricanes that have impacted the US and what can be done to protect vulnerable populations.

And while you are there, check out Health Business Blog David Williams’ Disaster Edition of Health Wonk Review this week. It’s short. It’s full of big pictures. And to paraphrase David, it features “quality over quantity.”

Thank you to David and the faithful HWR Class of 2017 who populated this edition.

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Health Wonk Review: Pink Edition

msabc-logoMother nature and man’s inhumanity to man have given us no shortage of opportunities to reach out and help our fellow citizens here in the US in the last few weeks where hurricanes, fires and terrorism have taken an ugly toll on life, property and any sense of security you might have enjoyed.

So, while you have your wallet and your heart open, here’s a reminder that it is Breast Cancer Awareness month at Health Wonk Review, too.

Click here for the Pink Edition hosted by the inimitable Hank Stern at InsureBlog where you can find out how to sponsor Hank’s team on his walk to raise money to fight breast cancer.

‘Til next time, stay safe out there.

AAtjntrFires in Wine Country north of San Francisco continue to burn out of control as of this writing.

Photo by Nick Giblin/DroneBase via AP


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Health Wonk Review: Suffering from Repeal Fatigue?

xavier-sotomayor-191950Ready for a recap of the ACA repeal efforts? For a litany of the long and winding road, visit Brad Wright at Wright on Health at this link. And, for those who don’t need another rendering of the legislative shenanigans, Brad includes other health policy topics, too.


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Never-Ending Summer of Healthcare Legislation from Health Wonk Review

Yesterday was an eventful day in the health policy world with a Medicare for All bill and Graham-Cassidy both being introduced almost simultaneously … but despite this, Louise Norris was still managed to compile The Neverending Summer of Healthcare Legislation Edition of the Health Wonk Review at Colorado Health Insurance Insider.

Louise says:

Throughout 2017, nearly every week has seemed like a very big deal for health care reform. But this week is especially noteworthy, with  bipartisan efforts to stabilize the individual insurance markets (cough… fund CSRs… cough), along with not one, but two major pieces of legislation unveiled on Wednesday: Senator Sanders’ single-payer bill (which garnered 16 co-sponsors, up from zero when he introduced single-payer legislation in 2015), and Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson’s ACA repeal/replace bill. To say it’s a whirlwind in the health care reform sphere would be a bit of an understatement.

healthcareAnd yet, there is more to healthcare and healthcare reform than the merry-go-round of federal legislation, as evidenced by the wide range of topics covered by our health wonks in this edition.


Here’s a link to this week’s full edition:

Thanks much for hosting a great edition, Louise!

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The Summer Lull Edition of Health Wonk Review


Summer of 2017 is fading quickly into the memory books, but some of the happenings on the healthcare scene will be with us to bemoan, analyze and reform for years to come. Now that’s summer fun that lasts!

Let’s start with the philosophical underpinnings of the ongoing political healthcare debate – free market or socialism? Nobody is better equipped to take this on than David Williams of the Health Business Group who is a self-professed free market fan knee deep in the business of healthcare. With his background in economics and an MBA, as well as entrepreneurship, he acknowledges there are some limits to the free market. The healthcare system is one place where capitalism is tested. “Capitalism has a place in healthcare, but in developing policies we should also recognize the limits of free market approaches and be open to the benefits of socialist ideas,” David says. In this post, What Free Market Healthcare Really Looks Like, David walks us through a payment example and explains how a socialized medicine system fashioned on the Medicare model avoids some of the costs and shell games that happen in a free market model. Definitely take this one in.

Who really needs the social safety net public option solution anyway? Maybe the very people who oppose it, suggests Harold Pollack at In this entry, Who Really Needs the Public Option? Trump Country, Harold says Trump Country is most in need of a way to bypass the ACA marketplaces entirely. Democrats’ favorite policy option – the public option – would be most valuable in precisely the deep-red areas that went most fervently for Republicans and the President. Come for Harold’s great analysis. Stay for his groovy cartograms. Get it all here.

More guest blogging gems, this time from InsureBlog where Henry Stern pulled in guest blogger Patrick Paule who wrote about The Creation of ObamaCare’s Individual Market Mess. Patrick traces the history of the decline and fall of ObamaCare, letting no one – and we mean *no one* – off the hook in the process. Go here to get the full scoop.

And for those who wonder how the free market health insurance programs work, Louise Norris gives us a very cogent explanation of actuarial value in her guest blog for Verywell this week, What is Actuarial Value and What Does it Mean for My Health Insurance? She discusses what is actuarial value, how it is calculated and what it means for the individual member. Catch her explanation here.

Meanwhile, the health care reform debate in the US – which has really been about health insurance and specifically whether to repeal and/or replace the Affordable Care Act – is currently on hiatus. Roy Poses tells us, “This gave me a chance to list some of the major issues and causes of health care dysfunction which we have gone on about on Health Care Renewal but which rarely appear in polite conversation.” His list of issues includes: threats to the integrity of the clinical evidence base (which has had little public attention), deceptive marketing, distortion of health care regulation and policy making, and bad leadership and governance (which have had much less attention), concentration of power, abandonment of health care as a calling, perverse incentives putting money ahead of patients, education and research, the cult of leadership, managerialism, impunity enabling corrupt leadership, and taboos. Roy says true health care reform requires ending the taboos on discussing all of the above, and then addressing the real causes of health care dysfunction. Roy makes a very good start in that direction in What the US Healthcare Reform Debate Did Not Address here at Health Care Renewal.

Sometimes medicine is lost in the policy debates in healthcare. Joe Paduda turned over the blogging reins to David Deitz MD, PhD, who wrote a guest post on a subject with which he is quite familiar – opioids. David unpacks the National Academy of Sciences, Engineering and Medicine’s report to give us his perspective, and he draws a conclusion. Simply put, opioid exceptionalism means that the FDA, as well as other public agencies, should go beyond the risk/benefit paradigm they currently use for new drug approvals that is based on individual patients and consider the implications of an individual opioid to patients’ families and society. Read his rationale in Opioid Exceptionalism: Why These Drugs are Different Than All Others at Managed Care Matters here.

Tom Lynch at Workers’ Comp Insider poses the question, Medical Care Experts: Where Would We Be Without Them? Tom notes that in recent years, workers’ compensation cost control has focused mainly on lowering medical costs, which is almost always an outsourced function. Consequently, many employers have relinquished control over their workers’ comp program, migrating away from best practices that are at the heart of true workers comp cost control. Read the full blog here.

Hospitals have reduced length of stay about as much as possible, and now it is time to take the longer view on the total cost of patients who are discharged to post-acute care. In this post, Bradley Flansbaum shares some data and discusses that a new measure, home-to-home care, will come to reframe the LOS debate as the total cost of home-to-home care becomes a measure of true cost. Read more in You Have Lowered Length of Stay. Congratulations. You’re Fired at The Hospital Leader.

Photo by Eddie Kopp on Unsplash


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CBO Estimates How Many Will Flee ObamaCare if Given the Chance


Those who control the language, control the debate. Let’s look at the language surrounding the Congressional Budget Office estimates that the Republican ACA alternative, AHCA, will result in about 22-23 million more uninsured over the next 10 years.

The meme is that the AHCA leaves more than 20 million more Americans without health insurance than under the current ACA (ObamaCare). And if the estimates are correct – which they rarely are! – it means that many people will cold-heartedly be thrown out into the streets without health insurance.

The truth is that many of those 20-some million only have health insurance, but they still don’t have affordable health care. The financial burden of buying ever-more-explosively-expensive health insurance makes actually using said insurance nearly impossible because the deductibles and copays aren’t manageable after paying premiums that rival the cost of most home mortgages. That’s not hyperbole. One friend over lunch a few months ago told me his premiums for just he and his wife are now $2,000 a month, more than his mortgage payment, which he attributes mostly to the fact his wife has a disease, psoriasis,  that requires monthly injections of a biologic that costs more than the monthly premium. They figure they are up a few hundred a month by paying the protection money…er, insurance premium.

We know that health insurance does not equal affordable health care because another statistic released this week highlights the unaffordability of using the insurance.

Update June 28: Health insurance does not always equal affordable healthcare, but pays the bills for most expensive procedures. One mom displayed her $231,000 hospital for her 3-year-old’s operation and her actual out-of-pocket of $500 in this MSN story.

According to an article in FierceHealthcare this week, MOST people who use hospital services do not pay their hospital bills. Here are the details of a report presented to the Healthcare Financial Management Association’s Annual National Institute.

Nearly 70% of patients with hospital bills of $500 or less didn’t pay off the full balance in 2016…

That’s a significant increase in the percentage of patients who didn’t pay their hospital bills in full in 2015 (53%) and 2014 (49%), the TransUnion Healthcare analysis found.

Other findings on payment patterns between 2014 and 2016 include:

  • 63% of hospital bills were $500 or less; of those hospital bills, 68% were not paid in full in 2016.
  • 4% of hospital bills were $3,000 or more; of those hospital bills, 99% were not paid in full in 2016.
  • 10% of hospital bills were $500 to $1,000, of those bills 85% were not paid in full in 2016.

“There are many reasons why more patients are struggling to make their healthcare payments in full, the most prominent of which are higher deductibles and the increase in patient responsibility from 10% to 30% over the last few years,” said Jonathan Wilk, author of the book “Healthcare Revolution: The Patient is the New Payer”…[italics mine]

Bolting the System

Another article by Doug Badger in National Review (a conservative publication) shares the details of how most of those 22 million people identified in the CBO estimates will become uninsured. About 15 million people who are forced into taking the insurance today will bolt the system.  He shares the CBO estimates that repealing the tax on the uninsured will “induce 7 million people to cancel their individual insurance policies, 4 million to drop their job-based overage and 4 million others to abandon Medicaid, even though the government provides it free of charge in most cases.”

Theoretically, compelling the purchase of health insurance should be good for the citizen, good for the medical community and good for society. It isn’t working out that way.

Under the current ACA, many (even covered!) patients still can’t afford care, the providers still wait for insurance payments or are parts of narrowing networks forced to take reduced rates, and the government is becoming the largest payer of healthcare. That’s not private insurance protecting citizens against an expensive illness. That’s a shell game moving money from the government to the insurance companies with the doctors and hospitals grabbing crumbs falling off the table during the exchange.

And, let’s face it, even the insurance companies aren’t making ends meet under the ACA. They are getting out of any marketplace where they see a crack in the door.

I can’t reasonably declare that the AHCA is a solution to the problems of the healthcare system exacerbated by the ACA, because I am not sure that it is. But I also don’t think that liberating people from purchasing insurance they don’t want, can’t afford to use and neither the government nor the patients can afford to maintain is such a bad idea either.

Health insurance is not health care. We have the data to prove it.

You can be insured and not be able to afford healthcare, so being “uninsured” is not the problem. We need to change the language and change the debate.

Medical care for all. It’s a different story.


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Wow! Special DOUBLE Edition of Health Wonk Review – ACA and “Other”


Here it is…the FIRST EVER Double Edition of HWR. Part One is all ACA and Part Two is everything else you have come to expect from the Wonkers who wander through healthcare land. Enjoy. And comment below. We love hearin’ from ya.

Also, thank you to The Precision Medicine Daily this week that saw fit to include Health System Ed’s blog on CMS Meaningful Use Payments to Providers: Incentives or Sophie’s Choice.

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