Saturday, February 28, 2009

Secretary of DHHS

Kansas Governor Kathleen Sebelius has accepted an offer to be Secretary of DHHS.

Friday, February 27, 2009

Change We Can Believe In?

No one can claim President Obama is timid!

His new budget plan, or at least what we know so far, appears to make some bold moves on health care reform.

Stay tuned for detailed analysis, as details are available.

Sunday, February 22, 2009

Stimulus Part IV

The concept of "effectiveness review", in general, states that payers (and especially the government) should not pay for drugs and procedures not already proven effective.

(The political theory is private payers will take the lead and refuse to pay for anything not paid for by Medicare and Medicaid.)

Question: if the drugs and procedures are not paid for, and clinicians do not use them, how do we compile the evidence of effectiveness?

For drugs we do have clinical trials, but many physicians are more convinced when they see the effectiveness in clinical practice.

For surgical techniques and hardware, most progress has been made with years of trial and refinement (such as the immense progress in orthopedic joint replacement).

Will we slow innovation? How will we balance cost versus progress?

Stimulus Plan Part III

While we wait for six more inches of global warming to be cleared from Michigan's highways..... (8 feet so far this year).

Who is spearheading the "effectiveness review" concept inside the Obama administration?

Peter R. Orszag.

Orszag is Director of the Office of Management Budget for the Obama administration.

By all accounts he is a brilliant economist, and an expert on retirement issues.

Best I can determine, he has little or no background in health care.

We love economists here, but wonder about health care reform being driven by economists.

Time will tell.

Update: Apparently Orszag did some HMO consulting during a stint with McKinsey and Co.,

Stimulus Bill Part II

Why is the stimulus bill (H.R. 1) more than 1000 pages?

More than 200 of those pages are health care reform, including a massive health care IT plan.

How much time was spent debating the largest health care reform plan of the past two decades?


Also included are updates on HIPAA security and privacy, and perhaps the provisions that will shape the future of U.S. health care, the "effectiveness review" plan. I just reread Tom Daschle's book, and his brief stint as almost-Secretary allowed him to have immense influence.

In front of me is a full 3" ring binder, perhaps containing the future of our health care system, perhaps not.

First, a few days with the grandchildren. Then, the work continues in earnest.

Update: I was curious. Printed in pieces from the Thomas site, I have 261 pages.

Saturday, February 14, 2009

Stimulus Bill Part I

I spent my Saturday working through the stimulus bill, which looks more like a health care bill with a stimulus package attached.

Printing the health care sections nearly burned up my printer.

Look for analysis coming almost every day.

Surprise - Congress revisited HIPAA, just to add work and confusion to the situation.

Tuesday, February 10, 2009

The Ghost of Tom Daschle?

Recent news reports and commentaries on the stimulus bill allege the bill contains many of the bureaucratic recommendations of former DHHS nominee Senator (retired) Tom Daschle.

This is still developing.

In brief, Daschle wanted massive government data bases of patient information combined with a board to determine which treatments and medications physicians could order for government patients.

More as this develops.

Saturday, February 7, 2009

Secretary of DHHS?

The Associated Press is reporting today that Kansas Governor Kathleen Sebelius may be the leading candidate for the Secretary of DHHS.

Sebelius had reportedly been considered for this and other cabinet posts before Tom Daschle was slotted for DHHS. Daschle melted down in a tax controversy.

Sebelius was Insurance Commissioner before becoming Governor, a back ground that would be helpful in the job.

Sebelius has deep roots in the Democratic Party, her father was a liberal Governor of Ohio.

This appointment is not assured. Stay tuned.

Tuesday, February 3, 2009

Daschle Withdraws

CNN is reporting that Tom Daschle, beset with tax and potential conflict problems, has asked to wtihdrawn from consideration as Secretary of Health and Human Services.

Developing, pending further confirmation.

Update: AP confirms

Sunday, February 1, 2009

News Flashes

Senator (retired) Tom Daschle was on a fast track for confirmation as Secretary of Health and Human Service (and to be a sort of health care reform czar) when his tax returns jumped up and bit him.

Daschle was working as a $1M a year "consultant" to a media private equity fund run by his friend, and receiving free car service, a very substantial benefit in Manhattan's gridlock.

Reports say on one return Daschle forgot an $89k consulting payment, as it was excluded from his Form 1099 (how does an accountant not multiply 89 x 12?).

The Daschle's paid the back taxes this year with interest, but are also reported beneficiaries of a special influential insider penalty waiver by the IRS (how sweet).

Time will tell.

UPDATE: The Daschles may have to re-amend their tax returns. Developing....

In other (better) news.....

Professor David Cutler of Harvard, an influential voice in health care reform discussions, has been selected to serve as a health care advisor to President Obama.