Dumping on MassCare

In the world of investing, the term pump-and-dump refers to a "scheme that attempts to boost the price of a stock through recommendations based on false ... statements. The perpetrators of this scheme ... sell their positions after the hype has led to a higher share price."

Put more simply, they get in, "use" the system, and get out, generally at a profit. This costs the company, and it costs the other shareholders.

But what, you may ask, does this have to do with health insurance?

Well, before there was ObamneyCare©, there was MassCare. And an integral part of MassCare has been Guaranteed Issue, coupled with immediate coverage for pre-existing conditions. Or, as the Boston Herald's Frank Quaratiello reports:

"A gaping loophole in state insurance rules that lets freeloaders pick up coverage to pay for expensive surgeries — and then dump it once they’re treated — has cost taxpayers as much as $37 million a year"

There's even a term for this: "jumpers and dumpers.” Jump and dump, pump and dump; tomato, tomahto.

But that's just a Bay State problem, right?

Not so much, "according to a study that warns the same wrinkle in Obamacare could add a staggering $2 billion a year to the deficit-wracked federal budget ... similar provisions in the nation’s new health care plan could cost the government at least $1.9 billion a year starting in 2014 when Obamacare kicks in."

Ooops.

Glad we passed the bill to learn what's in it.

MassCare Uh-oh

It will come as no surprise to regular readers of IB, but MassCare (famous for killing health insurance competition and increasing premiums in the Bay State) seems to be a gold-mine for folks gaming the system:

"Illegal aliens, out-of-staters and others who failed to produce proof of Massachusetts residency drained $118 million from the pool of cash the state uses to reimburse hospitals and clinics that care for the poor"

Ooopsies.

As we noted last Fall, Bay Staters were already on the hook to the tune of $93 billion for illegals' health care. As State Rep James Lyons points out:

"If you open a business in the commonwealth, you’ve got to provide documentation of where you live and what the business is ... If we’re providing benefits, all I’m suggesting we do is level the playing field. Don’t just give benefits out if we’re not requiring documentation.”

Yeah, rotsa ruck with that.

Pioneering MassCare, Part Deux

Last week, Kelley posted on the folly of taxing the "RichDoctor," including a video on that new MassCare scheme. Today, the Pioneer Institute presents the second video in that series.

In the video, Josh  Archambault (Pioneer's Health Care Policy Director) interviews Brian Rosman (Health Care for All's Research Director):

MassCare: No Brownie Points

FoIB Michael Cannon (director of health policy studies for the Cato Institute) has published a new study that shows some major cracks in MassCare. For example, it's significantly reduced the number of private insurer options in the Bay State, and it's cost a lot more than originally advertised (which we've long since noted). All the while failing to actually improve health.

Download the study here.

By the way, that may also explain why " [f]ifty-two percent of Bay State voters who were surveyed as the polls closed [on Tuesday] said they opposed the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing his chief domestic initiative."

TNR Swings....and misses

Reality is hard for progressives:

"[T]rue competition can't exist without regulation."

This is of a piece with Sen Reid's recent proclamation that "[m]illionaire job creators are like unicorns. They are impossible to find and don’t exist.”

Tell that to, say, the late Steve Jobs or the very much alive Noah Glass, or even Messrs Ben and Jerry. But the bigger picture is that it is the over-regulation of insurance that has led us to where we are.

Mr Cohn cites his colleague Aaron Carroll, who continues to believe, despite overwhelming evidence to the contrary, that MassCare works (and thus ObamneyCare© is destined to, as well). Mr Carroll's argument hinges on the fact that the individual medical insurance market uses actuarially sound underwriting, which results in folks who develop significant health problems being locked into existing coverage, with no hope of changing for the better.

[As an aside, he's absolutely correct that this is a problem, one exacerbated, rather than solved, by ObamneyCare©s stupid PCIP rules]

But Mr Carroll (and thus Mr Cohn) double down on the fail:

"[S]ince the law [then-Gov Romney] signed in Massachusetts did exactly that. It organized the individual market, so all that people buying on their own can choose from among a variety of plans that they know will provide basic coverage and will always be there for them when they need it."

It's always the half-truths with folks like this. Yes, MassCare "organized" the individual market, if by "organize" one means forcing insurers to flee the state (resulting in less - not more - competition); increasing premiums, elevating the Bay State to the top tier of state debt, and encouraging folks to game the system for (essentially) free health care.

All that, and they still end up reducing choices in health care.

That is the result of "regulating competition."

But of course there's a silver lining here, right?

Not so much:

"The Affordable Care Act does the same thing"

Boy, howdy.

The TNR Boys conveniently neglect to mention, of course, that regulation in the form of mandates continue to drive up health insurance costs. And, of course, ObamneyCare© essentially outlaws consumer-centric health plans (eg HSA's), further decreasing choice and increasing expense.

Good thing we passed it to learn what was in it.

[Hat Tip: FoIB Holly R]

On the Record with Joe Wilson (Again)

Late this afternoon, I had the privilege of speaking (again) with Rep Joe "You Lie!" Wilson (R-SC) about a number of issues, most prominently ObamaCare v?.0. Rep Wilson began by mentioning his new site, Joe Means Jobs, Rep Kucinich's "Retreat from Afghanistan" resolution, and the recent vote in Iraq (interestingly, they had a 62% turnout; we're thrilled to see 55%).

I was joined on the call by Jeff Dunetz of Yid With Lid and Richard Zuendt of Conservatives With Attitude. Both of these fine sites belong primarily in the political sector of the blogosphere (as opposed to IB, which is considered a MedBlog).

Both Jeff and I asked Rep Wilson about the late-breaking Slaughter "Rule" in the House [ed: the SlaughterHouse Rules?]. This is a desperate, almost laughable, attempt to bypass a formal vote on ReidCare (more here for those who are interested). Rep Wilson was unfamiliar with the details of this latest gambit by those bent on the destruction of the world's best health care system, but quickly came up to speed.

I asked the congressman about the dozen or so states taking pre-emptive action to opt out of a gummint-run system, and he replied that not only is he quite pleased, but that it is, in fact, an organized and concerted effort, led by the ALEC (American Legislative Exchange Council). ALEC is a group of state-level legislators working together on a national level.

The congressman also pointed out that the current version(s) of "reform" have been compared to both TennCare and MassCare, both failed systems. In fact, it's his contention (and one with which I agree) that MassCare is the overarching reason that Scott Brown was elected to the Senate.

Mr Zuendt (of Conservatives With Attitude) asked about the impact of "reform" on states' budgets, and Rep Wilson replied that these are classic examples of "unfunded Federal mandates."

I then asked him how firm he felt the vote on the 18th really was, and he answered that, much to his own surprise, he agreed with Rep Waxman that "there's not a date." Looks like I might have to reset (or delete) the countdown timer on our sidebar.

Following up, I asked about reconciliation; his response was to point me to a new report by Representatives Kyl and Cantor which effectively confirms our view on the matter. TThe Kyl/Cantor document can be found here.

Our own Mike Feehan had wondered about whether or not legislators would be bribed with stimulus funds, and Bob had wondered the same about other "favors;" Rep Wilson answered both of them by characterizing the current process as "The Chicago Way." That is, a combination of carrot and stick, regardless of legality or propriety, and felt it would backfire.

He was also quick to point out the value of blogs and social media for breaking through the wall of silence thrown up by the Main Stream Media. I'm sure we all blushed.

All in all, a very interesting call, and I appreciate the Congressman's time.

A very special IB Thank You to Lyndsi Thomas for setting this up.

MassCare Coming Up Short

Over the years, we've chronicled the various pitfalls of RomneyCare (aka MassCare). Long on promises, short on delivering on those promises, it's a glimpse into the (possible) future of how a national health care system would fare. Now, though, the fit has really hit the shan:

"Six community hospitals, squeezed by the economic downturn and the Massachusetts budget crunch, are set to file a lawsuit in Suffolk Superior Court this morning seeking millions of dollars from the state for unpaid health care services."

Hospitals are generally taking major hits as their reimbursement rates continue to fall. In this case, the Bay State's much-touted health care initiative has left them reeling with lower reimbursements and unpaid bills. Of course, that's a direct result of the program's own struggles to control costs.

Adding fuel to the fire is the fact that the half-dozen plaintiffs are among those truly at the bottom of the rung:

"[H]ealth care providers known as “disproportionate share hospitals,’’ institutions at which at least 63 percent of patients ... are covered by public insurance plans such as Medicaid or Medicare."

That last is important: "covered by public insurance plans." It doesn't seem much of a leap to substitute "public insurance plans" with "Public Option," and a whole new can of worms becomes accessible. Whom do the hospitals sue when it's the Feds?

RELATED: Over at Ace of Spades, an intriguing discussion of health care as "supply side" driven. This insight is worth more than a passing thought:

"In the US system, there is a theoretically unlimited amount of health care available, you just have to be willing to pay for it.

You've just the nailed the fatal flaw of the Democrat's health care reform; it isn't reform at all, it's simply more regulation ... real reform would involved increasing the supply of doctors, medicines, and hospitals. ObamaCare does just the opposite, it focuses entirely on demand." [italics in original]

Definitely food for thought.

From the mailbag: MassTravelers

"My husband and I are residents of Massachusetts. We will be quitting our jobs and traveling outside the country for several months. I hadn't planned on using COBRA since we will be out of the country and using travel insurance that covers other medically and otherwise. I am concerned about being fined for this. Is there a way to avoid fees if we can prove we are out of the country?"

This is a great question, with ramifications beyond Massachusetts. ObamaCare©'s (evil) mandate will have the same effect, and will of course affect Americans in the other 56 states, as well. It does seem unfair to require someone who's out of the country for an extended period to purchase insurance they probably won't need.

I contacted the Bay State's Department of Insurance, and was told that, if one is uninsured for less than 90 days, then it's not an issue or a problem. If it's more than 90 days (and it appears that this reader will, in fact, be gone longer than 3 months) then the fine is assessed. However: there's an exemption for folks who were uninsured because they were out of the country (such as our reader). These folks would have to file a special appeals form, but I was assured that this is not a big deal and that the fine would be waived.

The email continues:

"Also, when we return what is our best option for becoming insured if we do not become re-employed full time right away?"

I replied that, once they're back stateside, they can go online to the MassCare Connector to find coverage. Of course, the challenge there will be finding a plan that fits the budget and coverage goals, but is apparently the only real option left to Bay Staters in need of individual coverage.

That deals with the MassCare issue, but not the ReaderCare one. As Bob points out:

"Leaving the country with coverage allows you to have benefits around the world. Even if she is not traveling to a Schengen Convention country, at the very least she needs an international travel policy to supplement the back home stuff. If she relies on something like IMG alone she is exposing herself to some serious potential out-of-pocket.

Seems to me like she is willing to roll the dice and assume she won't need the US based coverage while out of country and assumes she can pick back up where she left off when she returns. Romneycare does not have waiting periods but it doesn't mean she won't come back and be able to get immediate coverage."

Something to consider.

MassCare© = RomneyCare© = ObamneyCare©

Ladies and Gentlemen, I give you ObamneyCare©'s biggest fan:

NY and ObamaCare©: "Your lab results are in"

As we've opined here on numerous occasions, one of the best things about individual state-based health care "reform" is the ability to see how these things work in the microcosm, before implementation on a national scale. Such is the case with MassCare (aka RomneyCare), about which Bob notes below the most recent problems with that system. Each state represents a laboratory, each system an experiment.

Directly west of the Bay State, we can see how New York's "experiment" is faring. In a word: Poorly.

To wit:

"New York’s insurance system has been a working laboratory for the core provision of the new federal health care law — insurance even for those who are already sick and facing huge medical bills — and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients’ advocates say that New York’s extensive insurance safety net for people like Ms. Welles is falling apart."

An "expensive lesson," indeed: according to insurance industry trade group AHIP, the Empire State boasts the highest individual medical premiums in the country. The problem is that, although New York does have a fairly high cost of (medical) care, the plans are designed so that only the unhealthy have any real incentive to buy health insurance. Because "normal" markets attract a mix of healthy and unhealthy, average rates can remain affordable for most. When the scale is tipped to such an extent as we see in New York, though, healthy folks are understandably reluctant to so heavily subsidize those in ill health.

So how does this relate to ObamaCare©? Well, most healthy folks will (correctly) conclude that the ostensible fine (tax, really) for going without insurance is much lower than premiums under a system which rewards those who wait until the last minute to buy a policy. And the policies themselves will be much more expensive because of guaranteed issue, immediate coverage of pre-existing conditions, and a new raft of mandated benefits.

To quote Bob: Can you say "train wreck?"

[Hat Tip: RWN]

MassCare OK

Bob tipped me to a new transparency tool available to Massachusetts' health care consumers. It's called My Health Care Options, and it's an online resource to help folks find health care providers based on location, cost and outcomes.

Pretty cool:

You input your zip code (or city, etc), and then choose to search for hospitals, physicians, or a number of other providers. Once selected, you can also specify what kind of service to research: an operation, baby delivery, MRI or whatever. Based on preference, the results can be sorted by price, or how many ICU beds are available, or a host of other criteria.

There's even consumer ratings (how well they were treated, etc); kind of like "user reviews" at Amazon and the like.

It seems pretty user-friendly, too: you don't have to know CPT codes or other medical jargon, just the service or procedure's name (e.g. "angioplasty" or "Cesarean Section").

And the site will "bottom line" it for you, as well: while there are no actual dollar figures (which seems to me to be a requirement sadly missing here), there are comparative ratings to give you an idea of who's more expensive, and who's less. It may be that, since this seems to be a relatively new service, the actual costs haven't been included yet, but will be down the road. Let's hope so, and soon.

The service itself is provided by the Massachusetts Health Care Quality and Cost Council, which was set up as part of the original Mass Care program. Frankly, this may the best thing to come out of that endeavor.

Another Winger Disses MassCare and Obamacare

President Present has cut a new commercial, ostensibly to help Martha Coakley retain the vacant "Massachusettes" (sorry, but that's how she spells it) senate seat for her party. One of the issues he addresses is, of course, ObamaCare, and how Ms Coakley represents a key vote for its enactment.

Oh, that "winger?" I meant "lifelong Democrat." Posted in the comments section of that Politico story is this little gem:

"I am a lifelong Democrat that will vote for Brown on Tuesday. My main reason is the universal health care plan that is said to be similar to the Massachusetts plan. Under Massachusetts universal health care, I have seen my care and that of my adult children decline during the past year. My daugher has a serious chronic condition and must wait 6 months to see a specialist - she never had to wait more than 4 weeks before the universal health care plan. I have seen my own insurance premiums go up nearly 50%. My son has been assigned a primary care physician who is located three towns away from where he lives and who has a backlog of several weeks. I don't like the plan working through the Congress because there are too many mandates and I believe the cost will be prohibitive. I also believe it analogous to the Mass plan that has given my family poor and deteriorating service. I believe that the federal plan should go back to the drawing board. There should be no denial of coverage because of pre-existing conditions, but there should be fewer other mandates and no one should be mandated to have health insurance. I also think that there is much too much new spending by the federal government. New initiatives used to cost millions, then billions, and now trillions. I don't believe these initiatives are well planned nor efficient. I voted for President Obama -- I thought he was more centrist than he seems to be now. I will be voting for Brown precisely for the reasons that the President outlines as the reasons to vote for Coakley. I am not alone among Democrats in Massachusetts who will vote for Brown -- that is why the polls are so close in this election. - Ben from Boston"

Now, can we guarantee with 100% credibility that "Ben" really is a "lifelong Democrat," or that he even really exists? Nope.

But he's certainly more credible than, say, Jonathan Gruber.

Health Wonk Review: Money Tree edition

As maples and oaks begin to blossom, we turn our attention to another kind of tree, the much vaunted 'Pachira aquatica.' Well, knot really - ours is metaphoric in nature [ed: ISWYDT]. As I leafed through the submissions, it was easy to see where this was headed. Going out on a limb didn't appeal to me, so I decided to let the posts just naturally fall. Into place.

I do realize that some of these posts will be more poplar than others, but please give each one a fair shake. Thank you!

■ First up, Louise Norris takes a look at health insurance costs versus subsidies under the ACA. She notes that, for some folks, paying the penalty (versus premiums) makes good sense. On the other hand, she also points out that some (such as well-off seniors) may find the premiums a better deal.

■ Hospital blogger Brad Flansbaum is a fan (as are we) of transparency in health care. In his post, Brad explores how much financial info really is available to folks interested in knowing, for example, just how many dollars go where. Starting with a simple document (IRS Form 990) he drills right down to the truth.

■ The Sequester has been much in the news lately, from air traffic controllers to White House tours. HWR's co-founder Joe Paduda takes a look at its impact on health care; specifically, how it impacts Medicare (reimbursement cuts), genetic screenings ($365 million up in smoke) and a tidy list of others.

■ I've said this before, but it bears repeating: if you're not reading (my favorite health care economist) Jason Shafrin regularly, you're missing out on important info. This week, for example, Jason digs deep into Medicare Part D, and finds some interesting trends. For example, who knew that the low cost prescription plans were so popular? Well, you will, and you'll know why once you click on over.

■ Health Business Blogger David Williams reports on The Bay State's next big effort: to try to rein in health care costs. As MassCare served as a primary influence for the ACA, I think we're all interested in any lessons we can learn from their efforts.

■ Over at Health Care Renewal, Roy Poses has some sharp words for providers that take advantage of lower-skilled workers to pad exec's paychecks, and especially when the folks involved run an ostensibly charitable institution.

■ I really like this post from Peggy Salvatore: she manages to bring a very human perspective to a typically dry and impersonal subject. She takes a look at health insurance "back in the day" and contrasts it to what it's become (and becoming). She even manages to make MLR understandable; and if you don't know what MLR is, then all the more reason to check out her post).

■ Health Access blogger Anthony Wright takes a look at the President's proposed budget, noting that it includes full funding for the ACA and most of Medicaid. On the other hand, Medicare doesn't fare so well, and Anthony explores the President's priorities. Big dollars indeed.

■ John Goodman has a fascinating piece on a significant care coordination effort that brings together providers, patients and payers in a more cost- and treatment-effective way. He then explains how this concept can apply to a much bigger population (like, the US).

■ Guest blogging at Health Affairs, Paul Ellwood (considered the "father of managed health care") proposes a unique "indexing" system for health care that essentially converts Medicare from a fee-for-service to a capitated model in order to rein in runaway health care costs.

■ Of course, it wouldn't be a Heath Wonk Review without some blatant politics, but this one might surprise folks that know me as a "whinger:" The Stupid Party lives up to its name trying to throw more dollars down the PCIP drain, and is taken mightily to task for its efforts.

Joe Paduda hosts the next edition at Managed Care Matters on May 10th. I'm certainly rooting for him.

MassCare© meets ObamaCare©: Travesty Ensues

It's generally accepted, "conventional" wisdom that RomneyCare© begat ObamaCare© (hence Bob's newest buzzword, ObamneyCare). Along with the (Evil) Individual Mandate, RomneyCare introduced other problems, many of which have (until now) flown under the radar.

Remember back during the original ObamaCare© "debate," when we first learned about the "Cornhustler" deal? Nebraska was vying for the very first ObamaWaiver©, wherein it would be exempted from onerous new Medicaid financing requirements. Well, that particular effort failed to pay off for the Cornhusker State, but over on the east coast, there's a new storm a-brewin':

"Sen. John Kerry inserted a provision into Obamacare that changed Medicare reimbursements for hospital pay ... The Globe reported that Massachusetts hospitals will rake in an extra $275 million a year from the change."

Or, more accurately: hospitals in most of the the other 57 states are on track to be screwed out of almost $300 million. Per year. How many indigents would this pay for? How many new doc's or nurses? How many MRI's?

This pretty much sums it up:

"It is a massive wealth transfer from the rest of the country to those seven states."

Pretty tasty ketchup, Sen Kerry.

It's the Spending, Stupid

One of the primary benefits touted by proponents of MassCare was that forcing people to buy health insurance would drive down the cost of health care. On its face, this was clearly illogical, but enough folks bought into the idea that it became "common knowledge." Still, it was certainly the right of Bay Staters to test the hypothesis, which they have been doing now for some years.

The good news is that this gives the rest of us a way to gauge the relative success of that experiment:

"[A]mbulatory healthcare spending per capita was declining relative to the national average when Governor Romney first took office, but has steadily increased every year since then"

Okay, that's one data point "mittigating" against the thesis. Perhaps there are others which support it.

Or maybe not:

"Governor Romney inherited rising relative expenditures on health facilities, which fell slightly in his second year, but then continued to rise"

Darn.

Still, that's just Massachusetts; perhaps the other 57 states also experienced these trends. Add in the massive expenses associated with Medicaid and other Federally mandated programs, and surely the differential evaporates.

Stay with me here:

"As of 2009, Utah had the 13th least regulated health system in the country whereas Massachusetts had the second most regulated health system and Texas was in between, having the 29th most regulated system."

Now, each of those states has very different demographics, but they are still bound by the realities of budgets and requirements. Neither Utah nor Texas force their citizens to buy insurance, so based on the original hypothesis it would be reasonable to assume that these states would see dramatic increases in the cost of health care.

And yet the actual figures don't bear this out. The empirical evidence fails to demonstrate that forcing people to buy insurance reduces the cost of health care. So what now?

[Hat Tip: Ace of Spades]

MassCare unraveling

We've been covering the Massachusetts health insurance Connector since it was merely a gleam in Johnathan Gruber's eyes. So it comes as less than a surprise to us that it continues to implode under the new ObamaTax regime. Thanks to the intrepid Josh Archambault (senior fellow at the Foundation for Government Accountability), we learn that the noose is tightening. Turns out, Bay State Brahmins:

■ Failed to execute a contract with CGI, the vendor hired to build the site, that would track the progress of the project and ensure on-time delivery of a product that included all required features

■ Failed to implement a governance structure that would ensure ongoing quality of the project

[And worst of all:]

■ Attempted to conceal these shortcomings by misrepresenting the progress of the health insurance exchange to a number of stakeholders including the Centers for Medicare and Medicaid Services [among others]

Major no-no there. In fact, their behavior was so egregious that the Feds "have subpoenaed records related to the commonwealth’s ‘connector’ dating to 2010.”

In other words, this is now a criminal matter, with actual fines and (hopefully) jail time potentially on the table.

One wonders which of the other 57 states will be next...

Health Wonk Review: Spring Hath Sprung! Edition

Well, flowers are a-bloomin' and veggies are a-growin' and we've got a bloomin' bumpercrop of interesting and wonky posts. This time, I'm eschewin' an official theme, and presenting posts in more-or-less the order received.

That qualifier's in there because this first post, from Dr. Bradley Flansbaum, wins my coveted (and extremely rare) "Editor's Choice" nod for his post that's at once informative, accessible, snarky and insightful.

 In his post, Dr. Flansbaum (who's the Director of Hospitalist Services at Lenox Hill Hospital in New York City), discusses the shortcomings of the well intentioned, but imperfect, Choosing Wisely campaign.  This was an effort, led in part by Consumer Reports, to identify questionable medical practices. Dr F notes that, ironically, "[v]oluntary guidelines generally do not command attention."

And he takes it from there. A most excellent read.

☼ Health Business Blog's David Williams, a longtime HWR contributor and host, scores an interview with the CEO of Taxachusetts  Massachusetts Blue Cross/Blue Shield. As we've long noted here at IB, MassCare has its flaws, but David's interview focuses on the role that commercial insurers play in reining in health care costs, and pushing for higher quality of care.

☼ Louise Norris, of the Colorado Health Insurance Insider's Norrises, is also a longtime 'Review contributor and frequent hostess. This week, she offers her insights into whether, as hospitals continue to grow and grow, they become "too big to fail." And if one of these behemoths does bite the dust, are we in for another government bailout (ala GM)?

☼ One of my favorite health care bloggers is the phantom known only as NWS (NotWithStanding)(real name: Geoffrey Prescott). NWS is about to take leave of us for a while to begin prepping for a medical licensing exam, but not before blessing us with this pair of gems about the ongoing "physician brain drain" and whether or not it's a valid claim:

Part 1.

Part 2.

☼ HWR co-founder Joe Paduda takes on the Grand Old Party, noting that while a lot of Republican lawmakers tout overturning [what we here at IB call ObamneyCare©], there seems to be a deficit of alternatives being offered. Further complicating matters, Joe observes, is that some GOP lawmakers want to keep at least part of the law intact. Interesting times, indeed.

☼ The host of the last HWR, Wing of Zock (have I mentioned that this would be a most excellent name for a rock band?) reports on a recent meeting, held in Beantown, about "Avoiding Avoidable Care." While that may seem redundant, WoZ notes that two of the major stakeholders (that being providers and insurers) seem to have competing interests, but are still "probably in the best position to effectively intervene: They are submitting or paying the claims for this care." The resulting stalemate is a challenge, but one which needs to be addressed.

☼ The estimable Dr Roy Poses has an exposé about a highly compensated CEO, whose company just happens to be in the health care business, and which company has also been fined almost $200 million (US) for violating the False Claims Act. Ouch! So how does the CEO square that circle? Well, you'll have to click the link to find out.

☼ At his Evidence Based blog, Michael Gavin offers a post on unintended consequences. What's a payer really on the hook for if treatment for (say) an accident leads to other drug use down the road?

☼ Jon Coppelman, blogging at Workers Comp Insider, ponders the fine line between voluntary and required. In this case, he takes a hard look at the recent Florida kerfluffle over drug testing for those on the dole and those on the state payroll.


☼ Dr Kerry Willis - a practicing family physician in Beaufort, NC - offers his advice on health care reform, from a physician's perspective.

☼ Over at the Disease Management Care Blog, Dr Jaan Siderov thinks we're in for a wave of mergers in the health care field. The key seems to be whether or not these will ultimately redound to the benefit of the consumer (and Dr S thinks it will).

☼ In her guest post at the Health Affairs blog, Diane Meier, Director of of the Center to Advance Palliative Care, takes to task physicians who really don't "get" the value of such care. She uses the case of a woman with Stage 4 breast cancer to make the point.

☼ Maggie Mahar's post claims that health care reform has been a huge victory for women. I think she's wrong, but her post is noteworthy for its analysis of women's health care costs.

☼ Do hospitals engage in aggressive debt collection practices? Anthony Wright lays out the case, including a special cameo.

☼ Greg Scandlen, posting at John Goodman’s Health Policy Blog, thinks that the major problem with individual health plans is that they're not subsidized by the taxpayer, and makes the case that employees and insurers would benefit by moving away from employer-based plans.

☼ Kat Haselkorn offers an interesting take on whether or not artificially lowering cholesterol levels is necessarily a good thing. While that may seem like a dumb question, consider this: all those statins cost real money, and may also offer a false sense of health security to overweight folks. And there's a real cost to all of those.


☼ Finally, exercising Host's Privilege, I'm offering two posts for your consideration. This actually makes sense, though: two of my (awesome) co-bloggers take opposite sides in the debate on whether or not insurance policies should be bought and sold across state lines. Both offer cogent, interesting rationales for their respective positions.

Con.

Pro.

(Any double entendre is in the mind of the reader)

And that wraps up this week's Health Wonk Review. Please join Dr Jaan Siderov, another of my absolute favorite health wonk bloggers, when he hosts the next edition on the 24th.

Video Friday

Cato's Michael Cannon has been on a tear lately, advocating that states pro-actively shun setting up ObamneyCare© Exchanges. Here, he explains why:



If you've been following the Pioneer Institute's series on the latest MassCare Payment Reform train-wreck efforts, here's Part 3:

MassCare Floundering

It's lobster season (or so I've been told), and the water's boiling on the progenitor of ObamaCare::

"Sure enough, 79% of the newly insured are on public programs. Health costs—Medicaid, RomneyCare’s subsidies, public-employee compensation—will consume some 54% of the state budget in 2012, up from about 24% in 2001"

Oy, that's a 225% increase in the overall "curve." Adding insult to injury, health care spending by the state's government has increased almost 60%. And to top it all off, the Bay State "spends more per capita on health care than any other state ... Costs are 27% higher than the U.S. average"

So, more money, but better care, right?

Right??

Maybe not:

"Under [a recently passed “cost containment” bill], all Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure—that is, permission to practice. They’ll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics."

More red-tape means less time for health care delivery.  But wait, it gets even more Orwellian:

"No registered provider is allowed to make “any material change to its operations or governance structure ... without the commission’s approval ... As the commission polices the market, it can decide to supervise the behavior of ... doctors and hospitals that are spending too much on patient care."

Well, I'm sure that will gladden the hearts of actual health care providers. Because that kind of thinking worked out so well in the 70's.

MassDunh!

As we've previously remarked, MassCare's health insurance mandate lacks any real teeth. One reason for that is, of course, that the penalty for failing to purchase health insurance is a joke.

So what's the Bay State's answer?

"Massachusetts residents who do not have health insurance would face a higher financial penalty in 2012 ... the maximum penalty ... would be $105 for each month that an individual is not covered by health insurance"

Seriously? A hundred bucks?

Call that one a bargain and move on.

Oh, and how's that whole mandate working out?

Well, there's this:

"[T]he U.S. Census Bureau reported that at 5% ...Massachusetts had the lowest uninsured rate of any U.S. state."

Sounds good, right?

Aye, but here's the rub:

"Doc Shortages and Rising Health Care Costs"

Ooops.

[Hat Tip: FoIB Holly R]