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HEALTH WONK REVIEW: All's Fair in Love and Health Reform

There are two things Austin Powers fears: nuclear war and "Carnies. Circus Folk. Nomads, you know. Smell like cabbage. Small hands." But as a modern reading of Homer will tell you, Carnies are "part of a noble tradition. Carnies built this country -- the carnival part of it anyway."

Forgive us for taking this whole blog carnival thing a bit literally, but it's summertime and the Health Wonk Review blog county fair just rolled into town.

The admission's free. The rides are safe, and we've got a recipe for blueberry sour cream pie that would earn a blue ribbon from even a venerable food blogger like Ezra Klein.

So, strip off your shirtsleeves and slacken your belt (or drawstring as the blogger's case may be). It's time to let your inner wonk wander through a spectacle that's as uniquely American as apple pie and health reform.

First stop, the Midway that is Pennsylvania Avenue. The stretch between Capitol Hill and the White House is always a bit of a circus -- even more so now with actual health reform bills working their way though the House and Senate. We knew elephants could be stubborn, but who would have anticipated that Blue Dogs can roar?

While the big tent of bipartisanship is looking a bit empty these days, that hasn't quieted the carnival barkers outside. Kate Steadman, writing at Kaiser Health News' Blog Watch notes that HCAN is targeting Sen, Charles Grassley (R-IA) for his comments on the cost of his health insurance during a recent town hall. Meanwhile Republicans hope to hook the public on a Frank Luntz/Alex Castellanos sideshow being dubbed "The Obama Experiment." Which will ring a bell with the American public? Over at Health Populi, Jane Sarasohn-Kahn 242 pages of a June Zogby International poll describing every kind of permutation of feeling among Americans and health reform, focusing particularly on whether Americans see health care as a human right.

Naturally, things aren't always as they seem -- whether it's in a funhouse mirrors or the health reform debates. Over at the Health Access WeBlog, Anthony Wright compares ugly health cuts in California, with the federal optimism around health reform. He concludes

It's imperative that we work at both levels, at the state level to defend what we can and prevent the worst, while organizing for the best, with the potential of comprehensive health reform that might save us from ourselves.

One of the longest roller coaster rides in Congress has been the ups and downs of whether Americans should be offered a choice of a public health insurance option alongside competing private plans. Joe Paduda at Managed Care Matters thinks the debate is kind like waxing your 1966 Chrysler Imperial before entering it in a demolition derby. What's the point?

If the Democrats succeed in passing health reform with a public plan option, it will have very little impact on system cost. And if the GOP and moderate Democrats are able to stop a public plan yet reform still passes, their 'victory' will have no impact on system costs.

The health reform war is about cost. The battle over the public plan is a fight over a useless piece of ground.

Speaking of grueling contests, the Congressional health reform debate is starting to give Tinker Ready at Boston Health News a headache. Fortunately, Ready has the cure. No it's not two corndogs and funnel cake (We learned that the hard way.) Instead, Ready turns to The Heart of Power: Health and Politics in the Oval Office a book by Brown historian James A. Morone and Obama health IT adviser David Blumenthal. Their lessons -- drawn particularly from LBJ's passage of Medicare -- offer a strategy strikingly similar to the one the Obama administration is currently pursuing.

Meanwhile, Ken Terry at BNET blog worries that restructuring the health care system may lead to greater efficiencies but it will also mean fewer jobs in a sector that has been one of the few areas of growth during the recession. Jason Shafrin at the Healthcare Economist provides a thoughtful look at whether health care reform will really stimulate the economy and reduce costs.

While it might be a bumpy ride, Henry Stern, at InsureBlog is on board with many of Sen. Ron Wyden's (D-OR) basic proposals for changing tax treatment of health insurance.

By extending the tax benefits to those without group options, we make the whole system less expensive, which seems to me a pretty good deal.

Over at Health Care Manumission, John Leppard argues that for Congressional Democrats, allowing market forces to work in insurance is like taking a ride on the Gravitron. Brady Augustine at MedicaidFirstAid thinks "government is both part of the problem and part of the solution in health care," in laying out the Pottery Barn Rule of health care. Meanwhile, Jaan Sidorov at the Disease Management Care Blog looks at the world of difference in how insurers and physicians think about medical home using the oft-cited Community Care of North Carolina as an example.

Personally, in games of chance and risk, we wished there'd been some rule to prevent us from spending $50 to win a giant stuffed dog we didn't really want. Which is why these days we never set foot on fairground without a fanny pack -- the pinnacle of personal security. David Harlow, writing at HealthBlawg, presents a handy primer on the FTC's Red Flags rule which takes effect August 1 and requires health care providers and other businesses to implement new policies and procedures to protect consumer data from identity theft. 

Speaking of theft, back in 1985 we took sixth place and a jar of Similac at the Taughannock Falls Beautiful Baby contest. Our ego never quite recovered.  Over at the Colorado Health Insurance Insider, Louise tells an even more distressing story about a pregnant friend who was told that her baby probably would need surgery as soon as he was born, only to find out the child was completely healthy. Maybe life's just a big game of chance. But it got Louise meditating on overutilization of health care:

Was my friend's doctor practicing defensive medicine? Probably. Was she just trained to see problems, and thus spotted one that turned out to be nothing? Whatever happened, it absolutely had an impact on the healthcare costs associated with my friend's pregnancy and birth. Eight extra ultrasounds and 24 hours of testing and monitoring in the NICU are not cheap

You know what else isn't cheap? Bottled water at a fair. For that matter neither are any of a fair's many caloric creations --anything that starts with "fried" or ends with "Oreo." A day at the fair may require a week at the gym, but Julie Ferguson of Workers Comp Insider wonders whether a recent court ruling in New York sets up a potential unintended consequence: Could employers who offer incentives for or sponsor wellness programs now be responsible for providing workers' compensation benefits for any gym injuries that occur?

Like a judge at the Cock of the Walk Rooster Show, Health Care Renewal's Roy Poses, MD, cries foul over the funding received by professional medical associations (PMAs) like the American College of Cardiology. He writes that when private health care companies fund them, it creates an inherent conflict of interest that's turning non-for-profit medical societies into medical education and communication companies. On the brighter side Rita Schwab, at Supporting Safer Healthcare, looks at credentialing and privileging processes for physicians as way for medical staff and business leaders to ensure that only safe, competent clinicians care for patients.

As for conflicts of interest, we must admit we've always had a bit of carny in our hearts, so we can't resist a bit of shameless self promotion. Our colleague Tom Emswiler has an excellent post on Baylor University Medical System's success at reducing readmissions for heart failure. (Step 1: Skip the State Fair of Texas...) We'd also recommend this series of posts on our Health CEOs for Health Reform -- a New America Foundation coalition of industry CEOs and physicians committed to improving our health system.

That's it for this edition. Thank you to all of our brilliant bloggers and thanks to our readers for putting up with some extended metaphors stretched thinner than a fresh batch of saltwater taffy. We'll leave you with this bit of wisdom from David Foster Wallace's epic tour of the Illinois State Fair which we think is as true for health care as it is a state fair: "The real spectacle that draws us here is us."


Great Job!

What a super job, Paul!

Thanks for hosting, and for including our post.

Stop Obama's Health Care Plan

If this passes you will be forced to buy insurance. If you don't you are going to be fined $2000. What that means is that you are going to have to shell out over $2000 for insurance every year that you don't need. Only 10% of the population needs insurance. That means all the healthy people have to pay for these people's care.

Some of these people that need care smoke, drink and eat at burger king everyday. While you eat right and jog everyday. People that are disabled get Welfare. So they are taken care of.

If this passes you can forget about that New Car or a well earned Vacation you have been looking forward to. You just need to work to pay for all the sick people.

In the end we all die anyway. Insurance can't stop that.