Health Wonk Review

Welcome to this week’s Health Wonk Review!

By way of introduction, for those who are unclear on the medical humanities, some of these posts may be helpful in explaining the context.

As I see it, the key role for a medical humanist – if they wish to be consistent with an ethos of medieval and Renaissance humanists – is to focus on the translation of theory into practice.  Humanists eschewed the logic and abstractions that Scholastics privileged, reasoning that they did little to move those outside the cloisters and universities to live virtuously.

This ideal is perhaps most easily exemplified by Erasmus, who, in the humanist tradition, prioritized the study of rhetoric because, as Petrarch put it in citing Cicero and Quintillian, rhetoric was what moved people’s hearts.

A contemporary of Martin Luther’s and a devoted Catholic, Erasmus saw the handwriting on the wall, and devoted much of his life to a kind of moral epistolary practice, exchanging letters with Luther in the hope of averting bloodshed.  Erasmus deemed the prospect of war obvious given Luther and the ‘schismatics’ belief system.

What could be more virtuous than using scholarship and language in the hopes of preventing violence and horror?

Not even his best efforts could prevent the coming storm, but his ideal remains one worth emulating, in my view.  Such is the need to translate scholarship into practice, and this is a quintessentially humanist precept.

As such, health policy remains a particular province of interest for me, and one in which I submit the medical humanist may have something to offer.  With this said, let us see what rhetoric our interlocutors have prepared for us, and what voices they speak in.

Henry Stern over at InsureBlog challenges some of the claims made in a Reuters article regarding the uninsured, accusing the Commonwealth Fund of political partisanship.

(For the record, I do not necessarily agree with some of Stern’s characterizations.  In any case, if it is true that young persons constitute a disproportionate percentage of the uninsured, and if they are desirable subscribers for insurers, this seems a justification for mandates, doesn’t it? I wonder what Stern thinks about mandates.  Most contacts I have in the insurance industry are generally opposed to new state insurance mandates).

Amanda Herrington gives due propers to the Big Aristotle.  Being a lifelong Miami Heat fan, I can get behind this post, though I tend to get exercised about obesity discourse.

Over at Health Access Weblog, Anthony Wright offers a good primer for some basic access to care problems.

N=1, who does us at MH Weblog the pleasure of hanging around and bringing needed commentary, is the first of several Wonks to post on CMS’s announcement that they will no longer reimburse for (preventable) medical errors.

On the one hand, this makes sense, because it seems perverse to offer monetary incentives for committing errors.  On the other hand, there is the very reasonable fear that hospitals and providers will simply shift the cost of correcting errors onto the patient or the third-party payor.  This seems to fit the definition of a true philosophical dilemma – a word we are convinced is thrown around far too much – in which either course will result in something of value being lost.

As N=1 asks, “who will pay for the resources needed to address the errors?

Most likely, it will be the unfortunate patients who suffer the consequences of these errors with hospital-acquired infections, wrong-site surgeries, blood transfusion reactions, fractures from falls, and burns and other types of injuries from faulty hospital equipment and inadequate staffing.”

At his very fine Managed Care Matters blog, Joe Paduda brings early word of some welcome news: health care costs have dipped below double digits.  But he advises caution, as all is not what it seems . . .

Brian Klepper, who has been guesting for Matthew Holt at Health Care Blog, has a series of interesting and controversial posts on the role of brokers in health services.

Conferencing and health informatics are on the agenda at Informaticopia (cool blog name!).

A driving force behind the Health Wonk Review writ large, Julie Ferguson from Workers Comp Insider discusses a possible exposure incident Deepinthehearta Dallas that implicates some of the saga around Libby, Montana.  Though spent some time practicing toxic tort litigation, and I am familiar with the history of occupational health in the U.S., I was unaware of what happened there, and am looking forward to the documentary.  Recommended!

There is no love lost, apparently, from Robert Laszewski to Karl Rove.  (At least) Medicare Part D came between them.

Jason Shafrin at Healthcare Economist taps in to some of the discussion over P4P by suggesting a better metric for evaluating vaccination and quality.  Sounds like something Medical Economics would be interested in.

At the Health Care Renewal blog, a personal favorite and daily read of mine, the inimitable Roy Poses casts a jaundiced eye on the announcement of a pilot program for evaluating the so-called “patient’s medical home” model of care.  As the program involves collaboration between UnitedHealth and various medical associations, Poses notes the presence of the dreaded “E” and queries whether the goal will be improving patient care or capturing rents for the insurer.

If you are reading this Review and you are generally not reading Health Affairs Blog, for shame.

Here is a series of posts on the staredown between Congress and the President on SCHIP, featuring the views of Sarah Rosenbaum, Grace-Marie Turner, and Leonard Burman.

FYI, Frank Pasquale is always worth reading as well on SCHIP or anything else.

Though readers of this blog note the unhidden and unabashedly liberal sentiments of its primary author, I emulate Erasmus on his requirements for a sermo, which tend to require engagement of interlocutors whose views differ from your own.  I learn much by engaging voices who maintain views very different from mine, like those from the Cato Institute, even if I nevertheless disagree with much of the rhetoric.

(again, to emphasize, MH Weblog is committed to joining the general scholarly reclamation of rhetoric, so this is not pejorative)

Michael Cannon tears into Jonathan Cohn, author of the worthwhile Sick.

He argues that Cohn dramatically understated the efficacy of the Bush administration’s proposal for a standard health insurance deduction, given CBO’s projection that it would reduce the number of uninsured by 7%.

This seems a reasonable criticism, though there may well be other reasons to criticize the deduction, as Ezra Klein points out.  Regardless, it seems unlikely that “Cohn opposes a standard deduction precisely because it would frustrate his desire to separate the American worker from her money,” because, presumably such a sentiment is unlikely to be a desired end-in-itself for Cohn.  The entire question is whether it is permissible as a means to a just end, and this remark hardly resolves this ethical problematic.

Cato also features posts over the past week on the relationship between Romney’s and Clinton’s health care plans, and disagreements among scholars on P4P.

Good lord! Rita Schwab over at MSSPNexus asks with some surprise how language buried in the SCHIP legislation has gone virtually unnoticed amidst the larger fracas: the abrogation of the Joint Commission’s deeming authority.

I agree that this is a tremendously important potential development in accreditation and compliance.  The Joint Commission is actually a private organization, though many mistakenly deem it to be a public authority because of its deeming power.  Under 42 U.S.C.  §§ 1395bb(a),(b), a hospital that meets Joint Commission accreditation is deemed to meet the Medicare Conditions of Participation (which is a requirement for Medicare reimbursement). 

Wow, this would really change the accreditation scene if it was enacted.  Don’t underestimate the significance of the potential wealth transfer here.

At The Sentinel Effect, Richard Eskow surveys a well-written report analyzing the failure of an informatics initiative.

Fellow Cardinal David Williams explains why Medicare does not cover long-term care on Health Business Blog, and interviews Milica Bookman on his MedTripInfo blog (which, as far as I can tell, covers mostly medical tourism).

Last, but never least with such a tastefully designed blog, David Harlow at HealthBlawg discusses evidence in favor of the Green Model for nursing homes.

Thanks for allowing us to host the Health Wonk Review.  Information on upcoming Reviews is always available at the main site.

Comments

[hgstern]

 
Great job, Daniel! That's a LOT of entries to go through and organize.

Thank you for hosting, and for including our entry (at the top, no less!).

And you're correct, I have some major issues with mandates (which increase the costs for all while benefitting a few).
 

[Julie Ferguson]

Great posting, Daniel - thanks for doing such a super job hosting. And thanks for your kind words, too ;-)

[aishwarya]

from HealthBlawg
The latest Health Wonk Review is up at Daniel Goldberg's erudite Medical Humanities Blog, where the discussion ranges from Martin Luther and Erasmus to SCHIP. Added bonus: Daniel's highly evolved design sense