Contributing Member of the Legal, Economic & Regulatory Affairs Councils

All News Analyses by this Author

Too Few Questions About Public Option Are Being Asked

October 27, 2009

Analysis of:Snowe Rejects Public Option as Senate Democrats Weigh Measure | www.bloomberg.com

There is a nice, warm glow about a "public option" in health care, but what is it? What benefits will it have? How much will it pay providers? Who will actually run it? What is the evidence that any of the goals set for a public plan can actually be met? These and other questions need answers before Congress should be asked to vote on a "public" option. The bottom line is that currently health insurance and health plans are state regulated, private entities. A "public" option is different.

Don't Spend the Milk Money Bankrolling Lawsuits

June 4, 2009

Analysis of:investors finance lawsuits and reap any benefits - nytimes.com | www.nytimes.com

1. Lawsuit results are unpredictable. New information comes out, a myriad of laws limit recovery, and parties often drop out. No one can be sure what will happen. 2. Costs of lawsuits are unpredictable. The new electronic discovery rules combined with the need to respond to whatever the other side can file makes the costs and course of the suit unpredictable. 3. Most suits are settled. Most defendants have insurance, and insurers like to settle. Counsel that can "soften" the other side and is persistent can often convince even the most reluctant of defendants to settle thus yielding a good return on an investment in a case.

It Will Be a great Christmas for Managed Care Companies

June 4, 2009

Analysis of:Health Plans Would Add to Controls on Insurers | www.nytimes.com

1. Managed care companies are regulated by 50 state governments, ofgten by more than one agency. Having the Federal government promulgate one standard with regulation by one Department makes compliance a much easier task for managed care companies. 2. Established managed care companies do not want regulation too easy or new entities will enter the field to compete. The projected intense Federal regulations will keep out new competition. 3. Employer-based coverage is no longer profitable for managed care plans. The providers are free to charge anything, and employers with healthy populations are going self insured leaving the sick to manaaged care risk programs. "Reform" will managed care plans more customers, abolish the inequity between insured and self insured programs, and limit provider reimbursement.

What are the Goals?

February 17, 2009

Analysis of:Failure to Rise | www.nytimes.com

1. The Administration has not explained its goals. Is it to get stock prices to rise? Is it to increase housing prices? Stabilize them? Help subprime borrowers obtain credit? If goals aren't explained, the public cannot measure if the stimulus package makes any sense. 2. Leaders in the private sector continue to turn a deaf ear to main street. 401ks and investments were sold as solid strategies to give financial security. Suddenly, values have plummeted. Instead of showing leadership and inspiring confidence by demonstrating restraint, too many executives have used public money for bonuses, salary increases, and golden parachute payments. The publc feels ripped off and this is conntributing to the loss of confidence. 3. The article is important because it shows no one can understand what is happening. It appears to be "every man for himself."

Recognizing Reality

January 2, 2009

Analysis of:Dr. Leavitt's Scary Diagnosis | www.washingtonpost.com

1. Evidence of what actually will control costs in health care is scarce. Most of the proposals for controlling such costs are based on intuition not fact. The record so far shows that the more care that is given, the greater the costs. Advances in care and technology have increased costs in health care so far and there is no basis to believe the future will be any different. 2. The democratic nature of the U.S. Government means that public desires to have care provided based on want rather than need, "punt" on issues such as limiting care, and have job security as a major goal make health care true "reform" difficult. 3. No one can predict economically where the United States will stand in just a few weeks must less several years ahead. If there is a real lack of resources requiring tough choices, the government will take action but such action may not be rational.

A Short Term Pricing Problem

March 19, 2008

Analysis of:Health insurers take a dive on WellPoint's warning | www.marketwatch.com

1. Managed care companies have run into a temporary problem of setting their prices too low in order to compete with eachother. Expect prices to rise and profitability to return. 2. Part of the problem was caused by providers becoming more sophisticated at fighting for higher reimbursement often aided by government regulators. 3. Most managed care companies have a strong insurance aspect with the "float" an important component of profit. As interest rates have fallen and the price of certain securities fallen because of the subprime crisis, the investment profits have dipped affecting profitability. 4. Litigation costs and government fines have also cut into profits. It is hoped the companies will have learned from this and not repeat the mistakes that led to these costs. 5. As employers have cut back on health care options, the companies cut commercial premiums to maintain market share. 6. The new Medicare Part D program has tricky reimbursement formulas are hard to learn.

What are the goals of Pay for Performance?

March 3, 2008

Analysis of:Managed-care company sees benefits of pay-for-performance | www.tennessean.com

1. Pay for performance is designed to incentivize certain provider performance. It does not actually pay for achieving better health by a population. 2. Pay for performance incentivizes certain patterns of utilization of care. These patterns may actually create additional costs. For example, encouraging certain prvenetive care increases utilization in areas in which no proof exists that such care reduces long term costs or actually improves care. 3. Integrity of data becomes a major task in pay for performance, and audits and guidelines will be necessary to assure there is no "gaming the system."

Is Insurance the Solution? Depends on What is the Problem.

February 6, 2008

Analysis of:Blue Cross proposes fix for uninsured Americans | news.yahoo.com

1. Insurance facilitates payment. It does nothing on its own to resolve issues of access, quality, or unmet health care needs. 2. Is the right care readily available with only cost being the obstacle for some of the population, or is there a distribution problem? 3. Would increased assistance to FQHCs, inner city hospitals, rural clinics, and enhanced school health programs do more to meet the needs of the key segments of the population than insurance?

Every System Has Incentives

January 25, 2008

Analysis of:New therapy for old woes, Blue Cross measure aims to slow runaway costs, improve quality of healthcare | www.boston.com

1. A system that pays solely fee for service encourages overutilization. 2. A system that pays solely capitation encourages underutilization. 3. A system that gives incentives for certain kinds of behavior encourages that behavior. 4. Medicine is more art than science. No one knows if encouaraging certain treatment patterns is actually better for a given patient. 5. The more government becomes involved, the more tinkering with payment can be expected.

Regulators Have Found Their Niche

November 1, 2007

Analysis of:Government Raid Snares WellCare Directors | blogs.wsj.com

1. Although government entities have many activities, the role of "cop" is very much a favorite. As more government dollars roll into health care, we can expect more policing by the government, especially at the Federal level, over how those dollars are handled. 2. Disgruntled ex-staff provide a number of serious risks to all entities. However, the regulatory environment in health care financing creates special problems for health plans and insurers because of the potential of whistle blowing. 3. Government compliance activities are becoming more public and newsworthy. The role of electronic information means the surprise seizing of computer data before it can be deleted is important along with the hope that publicity will act as a deterrent. 4. The timing of the raids at the time of a Board of Directors meeting indicates greater exposure of Board members in government health care investigations.

The Electronic Chickens Are Coming Home to Roost

October 26, 2007

Analysis of:E-discovery law a boon for lawyers | www.washingtonpost.com

1. Although computers are a manstay in every business setting, it must be remembered that this has only become widespread in the last 10-20 years. Thus, the long term effects of them are only now becoming clear. 2. Electronic records are quite different from paper. They are easier to create so there are more of them, they are harder to dispose so they last longer, and they give an air of informality that lead to unguarded and irresponsible statements that can hurt in litigation. 3. Lawyers who used to do the "thinking" and leave the technical issues of document retrieval to others now must become conversant in these issues.

Saving Lives and Saving Money Are Not Necessarily the Same

October 26, 2007

Analysis of:IBM to Help Pay for Plans To Curb Childhood Obesity | online.wsj.com

1. The article puts a focus on a very serious health problem, childhood obesity, and serves an example of good corporate citizenship that other should follow. 2. The article does not present evidence that prvention and wellness programs actually save money for the health care system. There is actually no proof that a healthier population actually has lower health care costs than a population that is less healthy. The healthier population will live longer thus incuring chronic health problems that a less healthier population will not face because of higher death rates at earlier ages. In addition, healthier populations tend to eb more health aware and use costly preventive services a less healthy population will ignore. 3. The article inadvertently shows the great flaw in the employer-based health insurance system. What happens to the obese child receiving assistance in this program when the parent leaves IBM for other employment? 

Number of services given is not the same as quality

October 12, 2007

Analysis of:Quality Found Lacking in Medicaid Managed Care | www.medpagetoday.com

1. The article looks at patterns of care for different populations. Taken in that context, it raises interesting questions about how diferent populations and the providers who serve them utilize health services. 2. The article overreaches in its conclusions. It extrapolates utilization of services to quality using the assumption the more services used, the better the quality. This is a common error that mudies discussion of medical care and health. 3. It takes data reported by a wide variety of entities and accepts such information as "gospel." It does not sufficiently warn that different organizations may collect data differently and some organizations will do a better job of collection than others. Blind acceptance of all numbers as totally accurrate is a major flaw of most studies like this. 

From this acorn, a mighty tree may rise

October 9, 2007

Analysis of:Supreme Court to Address Pharmaceutical Companies' Protection From State Suits | www.law.com

1. The issue of Federal versus state law is always important as both levels of government expand their regulatory scope. When the two clash, which will predominate? 2. This case involves the issue of rules made by a state legislature versus the authority of a Federalr regulatory agency. Are regulatory agencies staffed by unelected technocrats more powerful than elected legislators? 3. In changing tort law, is influencing Federal agencies and Federal law a better approach than working on the state level?

Evaluating Litigation Early On -- A Key to Strategy

September 12, 2007

Analysis of:Handicapping Litigation Part I: | www.thepiracylawyer.com

1. A 3 ring binder needs to be prepared for each filed or contemplated matter of litigation. The binder needs the basic documents of the case: (a) the Complaint or correspodence raising the issues, (b) any contracts involved, and (c) memos and e mails from either side that either summarize matters or are crucial to the case. 2. Inhouse or outside counsel needs to review this "book" and prepare a "privileged" memo that: (a) Sumamrizes each side's position, (b) Estimates what witnesses each side will need and their availability, (c)Guesses what documents are currently known and where there are gaps discovery will have to fill, (d) Projects what each side might recover/pay and potential legal costs fior each side, and (e) Based on available information, estimates chance and magnitude of recovery for each side. 3. Business and legal staff (both inhouse and outside) need to prepare an evaluation of settlement looking at potential recovery, chance of recovery, and the case as it stands.

Americans Want Bargains On Many Things But Surgery Isn't One of Them

August 17, 2007

Analysis of:American's Gamble for Bargain Surgery Abroad | www.medpagetoday.com

Patients, who are really consumers of medical services, want their care close to home where family and friends can easily visit and support them. There are health risks in traveling great distances with severe conditions. Different cultures with different languages are not where most people want to be when their lives are hanging in the balance during complex medical procedures. For these reasons, few Americans will ever voluntarily seek surgery abroad. One well publicized major lapse of quality in one of these procedures will seal the fate of this activity as something on the fringes of medical care. This article is important because it shows how an idea with little real potential can be sold in glowing terms with one sided comments from those who have an economic interest in its acceptance.

Page : 11 to 16 of 16