Thursday, December 06, 2012

Health Wonk Review: Festival of Lights edition

Contrary to popular belief, the Jewish Festival of Chanukah has nothing to do with a can of oil that lasted 8 days (it didn't). It is at once an inspiring and a dark story, about both liberation and intolerance. As with almost all things Jewish, the sweetness is tempered with bitter reality.

On the other hand, the celebration of the holiday (which begins this Saturday evening) is pretty cool: fried potato pancakes (latkes), spinning the dreidl and lighting candles each night serves as a fun and meaningful way of acknowledging our rich heritage.

So for this edition of the venerable Health Wonk Review, I'm going to light up the posts with pictures of some of our favorite Chanukah accoutrements as well as some of the more off-beat ways the holiday is celebrated around the world.

But first:

My mother once gave me two sweaters for Chanukah. The next time we visited, I made sure to wear one. As we entered her home, instead of the expected smile, she said, "What's the matter? You didn't like the other one?"
Bet you'll like these great posts.

■ Our very first entry comes from Adam Fein, who sends in this wonderfully wonky post about new CMS rules on how prescription drugs are to be covered under the PPACA's [ed: known around these parts as the ObamaTax] Essential Health Benefits mandate. Thorough, yes. Dry, nope.

Forbes' Avik Roy draws a line in the sand, arguing that opposing ObamaCare doesn't go far enough, arguing that Republicans need to be offering their own, more conservative set of solutions.

[Our family's secret latke recipe...]

Dr Jaan Siderov offers both an interesting blog post and "aliquots of Aquavit" (the latter guaranteed to "knock the unwary on their behinds").

The former, though, may have a similar effect, as he reviews an evidence-based article from the Journal of the American Medical Association (JAMA) that shows that a state-of-the-art electronic health record (“EHR”) was associated with a significant increase in utilization. Now that's a bitter brew!

Soaring in on the Wing of Zock, Dr Drew Lee (a Fellow at the  American Medical Student Association) examines a proposed $10 million cut in funding for graduate medical education.

Speaking from his own experience, he's concerned that this will lead to major problems in health care, including deterring would-be physicians from considering the critical (but often low-paying) field of primary care.

[The dreidl - a spinning toy - includes the Hebrew acronym for "A Great Miracle Happened There" (left). In Israel, the final letter changes the wording to "A Great Miracle Happened Here"]

Most of us saw the news about a recent factory fire in Bangladesh that claimed over 100 lives.

Julie Ferguson's post deals with some tough questions surrounding that tragedy, including whether WalMart, et al have "an obligation to better control safety in their global supply chain."

The old 60's slogan, "what if they had a war and nobody came?" gets an update, as uber-wonk Dr Roy Poses recasts it as "What If the Institute of Medicine Wrote a Report and Nobody Followed it?"

Dr P has harsh words for guideline developers' failure to follow the reasonable standards for the development of guidelines set forth by the IOM..

[Although we almost always use the term "Menorah" to denote the Chanukah candle-holder, it's technically a "Chanukiah" specifically designed for the task]

Cato's Michael Cannon fires a broadside at the Department of Health and Human Services [ed: and at its director, whom we call Mme Shecantbeserious]. He questions whether that agency has the authority to levy premium taxes in states which opt for Federally-run Exchanges.

Well, what if they call them "user fees" instead? Michael offers his thoughts on that misnomer.

Health Blawger David Harlow has a conundrum: "data, data, who owns the data?"

Here's the challenge: Amanda Hubbard and Hugo Campos cannot get access to the data recorded and generated by the implanted devices in their bodies. While not everyone would want such access, why can’t those that do want it, get it?

Darned good questions, David.

[Most American Jews are of Ashkenazik (Eastern European) descent. But many Jews trace their heritage back to the Mediterranean and are known as Sephardic Jews. Many Sephardic Jews make special jelly donuts - called 'sufganyot' - instead of latkes]
■ Jason Shafrin, my favorite Health Care Economist, reports that Medicare admin's are taking a long, hard look at hospital payments, and have (finally?) figured out that it may be a good idea to reduce payments to lower quality facilities.

As usual, however, Jason digs a little deeper, looking for any unintended consequences to this idea. Did he find any? Click and find out.

Health Business Blog proprietor David Williams offers the intriguing suggestion that hospitals consider themselves as health care factories in order to obtain better results (outcomes).

David's premise is that the current model tends not to reward efficiency, and that this often leads to complications and waste.

■ Louise Norris, of the Colorado Health Insurance Insider Norrises, is struck by the cluelessness of a popular health writer for the biggest publication in Colorado. As she reports, the gentleman goes so far as to ask “is that even insurance anymore, if you’re paying the first $5000?” Comments like that make it hard to have rational discussions regarding healthcare costs and/or health insurance premiums.

Indeed. And as Louise goes on to note, he's not alone.

■ The Health Affairs blog offers this guest post by Dr Ashish Jha, Assistant Professor of Health Policy at the Harvard School of Public Health. Dr Jha believes that CMS got the short end of the stick in a recent Office of Inspector General report on EHR oversight.

 John Goodman offers Congress some timely advice on reforming both Medicare and Medicaid. His take is that meaningful reform of these two programs requires both cutting costs and improving the quality of care, both of which he believes are doable (and he backs that up with concrete proposals).

[Latkes and donuts are certainly delicious options; after all, fried is good! But potatoes and flour aren't the only things that taste delicious cooked in oil - these are smokey, fried chickpeas]

Harold Pollack thinks that President Obama "succeeded" (where President and Mrs Clinton failed) at "health care reform" because Democrats looked at how the Clintons went about it and where they fell short, and President Obama seems to have benefited from an apparent groundswell of support for reform.

Brad Wright has one of the most unique (and interesting) voices in the wonkosphere [ed: is that even a word, Henry?] and he uses it to great effect. This time, he wonders if penalizing hospitals for readmitting patients is a smart use of our health care dollars.

Here's why Brad makes so much sense: he compares hospital admissions to car repair shops. A stretch, you say? At first glance maybe, but read his post and you'll see why that makes so much sense.

 A woman goes to the post office to buy stamps for her Chanukah cards.
She says to the clerk, "May I have 50 Chanukah stamps?"
The clerk says, "What denomination?"
The woman says, "Oy, has it come to this? Give me 6 Orthodox, 12 Conservative, and 32 Reform."

Health Beat Blog's Maggie Maher discounts GOP efforts at raising the minimum Medicare eligibility age to 67, citing research that whatever savings we might see would do little to bring down the overall cost of health care.

■ Our own contribution takes a rather twisted turn: when does a shot beat a shot? The Kiwi's have found, interesting way of treating folks who are (literally) blind drunk.

Many Thanks to all the great bloggers who participated this week, and please join HWR co-founder Julie Ferguson when she hosts on the 20th.

Meantime, I'll leave you with this paean to the late, great Rebbe R Goldberg :

Chappy Chanukah!

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