Healthcare policy Archives - Page 2 of 6

“Real ACOs haven’t been tried yet!”

Michel AccadMay 13, 2018Articles, Healthcare economics, Healthcare policyLeave a comment

What happens when you’re a healthcare policy wonk and the pilot study for your pet program has failed miserably? You declare “Success!” in the editorial pages of the New England Journal of Medicine and demand that the program become nationwide and mandatory.

I kid you not. This is exactly what happens.

Thankfully, Anish Koka is vigilant and explains the blatant obfuscations and manipulations that the central planners engage in to have their way.

In our latest video, we reveal the machinations, take the culprits to task, and discuss pertinent questions regarding health care organization: Does “capitation” reduce costs? Do employed physicians necessarily utilize fewer resources? What happens when a HMO and a traditional fee-for-service health system operate side-by-side in a community?

Enjoy!

Should doctors protect their turf?

Michel AccadApril 26, 2018April 26, 2018Articles, Healthcare economics, Healthcare policyLeave a comment

It’s been a little over a 100 years since medical licensing laws were introduced in the US. If people doubt that slippery slopes are real, they should reflect on that history.

In our latest video, Anish Koka and I discuss a “white paper” jointly written by Jeffrey Flier, former dean at Harvard Medical School, and Jared Rhoads from the Dartmouth Institute, calling for some deregulation of the apparatus that rules the supply of physicians and their scope of work. The paper gives an exhaustive account of the bureaucratic mess and offers some possible remedies.

Anish and I a fun conversation, although we barely scratched the surface of this important topic. Anish is concerned that opening the flood gates willy-nilly without addressing other aspects of the healthcare boondoggle will mainly decrease the quality of care and do little to reduce costs. I feel that Flier and Rhoads are way too timid in their proposals and could at least call for competition among regulatory and accrediting bodies.

We touch on the question of safety, patient sovereignty, alternatives to licensing, and whether protectionism is ever a legitimate option. I’m sure we’ll have occasion to revisit this question. By the way, the can subscribe to the YouTube channel…

Health insurance is not insurance

Michel AccadJune 15, 2017June 17, 2017Articles, Healthcare economics, Healthcare policy16 Comments

Is health insurance a plan to help healthy people mitigate against an unexpected illness, or an income subsidy to help the sick pay for medical care?

Conservatives ought to have a clear answer to that question. Congressman Morris Brooks from Alabama did not and found himself on the receiving end of liberal ridicule.

By suggesting that those who take better care of themselves should pay lower health insurance premiums, Brooks implied that health insurance is indeed a type of insurance arrangement. After all, the risk adjustment of premiums is a practice proper to all other kinds of insurance services: A prudent driver pays less for auto insurance than one with a pre-existing driving record. A home owner pays more for home insurance if the property is on muddy terrain rather than on sturdy ground. A smoker pays more for life insurance than a non-smoker, as does anyone whose risk of dying prematurely is high, even if that predisposition is inherited genetically.

Brooks’ conception of health insurance, however, intuitive as it may be, is wrong.Continue reading “Health insurance is not insurance”

Good health care news from America

Michel AccadJune 2, 2017September 10, 2021Articles, Healthcare economics, Healthcare policy, Medical practice1 Comment

[I was kindly asked to provide an article for Courrier du Medecin Vaudois, the French language journal of the medical society of the canton of Vaud. The article was published as part of an issue on the theme of ‘America First against Obamacare.’ Below is an English version of the piece.]

Health care in the United States: The surprising good news

On the surface, the news from America about health care seems rather grim: cost and dissatisfaction keep rising, reforms are stalling, and, for some, even life expectancy may be declining. If that wasn’t bad enough, President Trump issued a tweet on March 25 predicting that “Obamacare will explode.”

For a small but growing number of doctors and patients, however, the future is surprisingly hopeful. Continue reading “Good health care news from America”

A health insurance CEO daydreams

Michel AccadApril 4, 2017May 3, 2017Articles, Healthcare economics, Healthcare policy3 Comments

Jim was at his desk, looking weary.

The last few weeks had been brutal. Despite working twelve-hour days, he felt that he had little to show for. His annual board meeting was to take place the next day, and he expected it to be tense.

With a replacement bill for the ACA about to be voted on, and with Trump in the White House, the situation seemed particularly precarious. The board members had asked him to present a contingency plan, in case things in DC didn’t go well.Continue reading “A health insurance CEO daydreams”

Three cheers for the statin war

Michel AccadSeptember 15, 2016December 13, 2016Healthcare policy, Medical scienceevidence-based medicine15 Comments

If anyone has any lingering doubts that the promises of evidence-based medicine are quickly evaporating, the recent blog post by Larry Husten on the statin war should quickly dispel them. Husten gives an excellent account of the latest battle opposing the pro- and the anti- camps.

What happened?

The pro-statinists published a 30-page diatribe in The Lancet. Statins save lives, they assert. The evidence is incontrovertible. Yes, they can have side effects such as muscle pain, no one disputes that. But drawing attention to those side-effects—as the anti-statinists do—endangers patients who now find a reason to refuse to take the life-saving drugs. There’s evidence of that happening.

The anti-statinists voiced their position in the BMJ. Statins cause muscle pain and fatigue, they assert. The evidence is incontrovertible. Yes, they can save lives, no one disputes that. But trumpeting the benefits or down-playing the harm—as the statinists do—prevents patients from partaking in the glorious activity of “shared-decision making.” There’s evidence of that happening.Continue reading “Three cheers for the statin war”

The mother of all medical errors

Michel AccadJuly 14, 2016December 13, 2016Ethics, Healthcare policy, Medical science, Philosophy2 Comments

A study published a couple of months ago in the BMJ made headlines for claiming that medical errors are the third leading cause of death. As expected, the reactions were swift and polarized.

For some, the study confirmed that the self-serving healthcare system is utterly careless about the welfare of patients. For others, the claim was complete hogwash, based on faulty methodology designed to justify further regulatory oversight.

The two positions are not necessarily mutually exclusive.Continue reading “The mother of all medical errors”

The pharma-fed doctor

Michel AccadJune 20, 2016December 13, 2016Ethics, Healthcare economics, Healthcare policy7 Comments

In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on.

I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the researchers did not determine if there was a cause-and-effect relationship between payments and prescribing.” To deny that perks have a causal effect on physician behavior invites improbable considerations.

In fact, the data suggests that doctors are particularly easy to manipulate. One of the researchers interviewed by Ornstein was “surprised that it took so little of a signal and such a low value meal [to influence doctors]” A Chick-fil-A is all that it takes!Continue reading “The pharma-fed doctor”

In defense of the employed physician

Michel AccadJune 9, 2016March 18, 2017Ethics, Healthcare economics, Healthcare policy6 Comments

I wish to make one clarification and one prediction regarding employed physicians.

The clarification is this: There is a common misconception that if healthcare operated under free market conditions, it would primarily be a cottage industry of solo practices and of small physician-owned hospitals. Such operations would not develop the capabilities of large healthcare entities that we commonly associate with central planning.

In reality, however, the opposite would be the case. Continue reading “In defense of the employed physician”

Let’s be clear about transparency

Michel AccadJune 1, 2016September 10, 2021Healthcare economics, Healthcare policy2 Comments

Transparency—or its absence—continues to fascinate healthcare analysts and healthcare economists. A study just published in the Annals of Internal Medicine addresses the effects of public reporting of hospital mortality rates on outcomes. Its senior author, Dr. Ashish Jha, offered his perspective on the study results and on the topic of transparency in The Health Care Blog.

According to the study investigators, mandatory public reporting of hospital mortality is not improving outcomes. The result of their analysis surprised them because “the notion behind transparency is straightforward” and the “logic [of public reporting] is sound.” The conclusion, therefore, is to persist in the effort, but to do it better with better metrics, better methods, and better data. Continue reading “Let’s be clear about transparency”