Author: John Goodman

What Difference Has RomneyCare Made?

Most conservative critics of the Massachusetts health reform have focused on any piece of bad news about the program they can find. After all, if this is the model for the federal legislation everyone calls “ObamaCare” it’s got to have a lot of defects. Right? Not so fast. The real story coming out of Massachusetts is that the whole thing is a yawner. Health reform in the Bay State has been mainly about money: who writes the checks and who cashes them. That shouldn’t be a surprise. That’s usually what health reform is about. But what about the effect on patients? As it turns out, there has been very little change at all. Does that mean that health reform at… View Article

347 Pages of Regulations; 811 References to Mandates

This is hot off the press from Chris Jacobs: HHS just released part of its Exchange regulations—a 244-page regulation regarding the establishment of Exchanges, and a separate 103-page regulation regarding risk adjustment.  While the Administration is trying to sell Exchanges as providing competition and flexibility, the 347 pages of regulations contain the word “require” a whopping 811 times (628 instances in the Exchange regulation, and 183 in the risk adjustment regulation).  It’s worth asking:  How flexible can a piece of regulation that has 811 separate references to mandates and requirements be? As noted previously, the documents just released comprise only “part” of the regulations necessary for states to implement health insurance Exchanges under Obamacare.  Page 11 of… View Article

Getting There

Imagine you are in a room full of diverse people, with differing political views and differing levels of understanding of economics and social science. You are discussing health care. Yet despite all this diversity there is amazing agreement. You agree on the problem, you agree on the general direction of a solution and then ….. WHAM …. you discover an opinion gap so wide it’s like the difference between night and day. This happens to me all the time. I find that I am in general agreement with the Obama administration, my friends at Dartmouth and even Don Berwick on four of five steps needed to get from where we are now to a better health care system. Here, for… View Article

Rationing Care for Children in Medicaid and CHIP

Physicians experience much greater difficulty referring children in Medicaid and CHIP to specialty care, compared to privately insured children. On the basis of the physician survey, more than three times as many participating physicians—84 percent—experience difficulty referring Medicaid and CHIP children to specialty care as experience difficulty referring privately insured children—26 percent. For all children, physicians most frequently cited difficulty with specialty referrals for mental health, dermatology, and neurology. Full GAO report here. View Article

Why is There a Primary Care Physician Shortage?

This is Richard Posner, writing at the Becker/Posner blog: Third-party payment is a pervasive feature of American medicine. Why anyone should want health insurance other than “major medical”—that is, insurance against catastrophic medical bills—is a great mystery, as is the fact that Medicare subsidizes routine health care of upper-middle-class people. Since disease and injury tend to be unpredictable, health insurance smooths costs over time, which is efficient, but a person could achieve that smoothing simply by saving the money that he now pays in health-insurance premiums and investing it to create a fund out of which to pay future health expenses as they occur. But we are stuck with third-party payment, and it systematically favors specialists over primary-care physicians,… View Article

Pharma R & D Spending is Down

And that’s probably bad news. Here is Megan McArdle, writing in The Atlantic: For the first time ever last year, the global drug industry cut its R&D spending.  The trend is expected to continue, at least in the near term. You might initially think that this is good news for cost control–the expensive brand name drugs will all go generic, and we’ll save a bunch of money on prescription drugs.  And indeed, this is absolutely true.  But this will have repercussions for other areas of health care, and those repercussions are not good.  While some drugs are simply an added expense (think chemotherapy prolonging the lives of people who would otherwise have died sooner), many of the real… View Article

I thank you for what you do. For 15 years you’ve been researching and writing on issues that matter. You take on tough questions, you apply innovative thinking, you push for action, and you do it all without regard to politics.

President George W. Bush more quotes