"...I was fully planning to quit in protest. I’d even started writing op-ed articles. I was going to resign pretty noisily, I’m afraid."

 Richard S. Foster is retiring this week after 18 years as the chief actuary for the Centers for Medicare and Medicaid Services. From an interview in KaiserHealthNews.org:

Q: How do we control health care costs in Medicare, Medicaid and the private sector?

A: Years ago, we thought that converting from cost-based reimbursement to prospective payment systems (a set payment that covers the entire cost of the admission) was the magic answer, and it helped a lot. Then, back in the early 1990s, everybody thought managed care was the magic answer. And that helped some, too, although most of their success was in negotiating lower payment rates, which you can only take so far.

We’ve had other instances -- pay-for-performance and consumer-driven health care -- that people had hoped would be the magic answer. Right now, there’s a great deal of hope that further integration of care, greater bundling of payments and other innovations like that will be the answer. I’m not optimistic that these things will, in fact, be any more successful than the best ideas of the past. I think they can all help.

All the insurers and payers tend to adopt and pay for just about any new technology that comes along -- even in instances where the value of the new technology is nowhere near its higher cost. So we could be a lot more prudent in how we adopt new technology. But that’s controversial. We saw in the Affordable Care Act the pushback on comparative effectiveness. If you do comparative effectiveness right, I think it could be very helpful.

Q: How would you adopt technology more prudently?

A: If you have something that is 10 times as expensive as the technology it would replace, and it really is not any more effective, why should we bother adopting that? And yet we do it all the time.

9:09 AM

Innovating Education In Chicago

Interesting summary of the innovators and incubators reforming education in Chicago: Smart Cities: Chicago's Collaborative and Chaotic Reform Record

"For over a generation, Chicago has served as the epicenter of for-profit, technology-enabled education entrepreneurship and investment."

"According to Patrick Haugh, The Chicago Public Education Fund, "Chicago sports not only an impressive set of ed investors (Sterling, GSV Advisors), established industry leaders, and an emerging cohort of promising edtech startups, it also possesses a vital network of innovative ed organizations with great local leadership, and creative funders."

Understatement of the waning year:  "...Chicago kids would benefit from coherent state policies aimed at equity, options, and innovation." 

9:59 AM

Diabesity: What if our best practices are the wrong practices?

The Daily Beast:   "...what if we are coordinating the wrong kind of care? What if our best practices are the wrong practices? Our toxic industrial diet, our sedentary lifestyle, chronic stress, and environmental toxins cause diabesity and its attendant downstream ills (often mislabeled as something else, such as hypertension, cancer, heart disease, dementia). Drugs and surgery are feeble, ineffective, costly, and often harmful treatments for lifestyle-induced illness. They are misguided efforts at best, dangerous at worst. Mounting evidence proves that the solution to lifestyle- and diet-driven obesity-related illnesses won’t be found at the bottom of a prescription bottle; they will be found at the end of our fork."

[...]

"Health it seems happens outside the clinic, where people live, work, play and pray. We need to rethink how we treat chronic disease. It is not only better medical management, which often just barely if at all staves off complications and death, but with high science, low cost, high touch innovations. A comprehensive integrated strategy can solve this problem. Start with revised screening guidelines to identify the 90% of pre-diabetics and the 25% of diabetics never diagnosed. Build new practice models and reimbursement for group visits to deliver lifestyle medicine in more effective and cost efficient ways. Support and scale proven community-based peer-support models of lifestyle change. Over 20% of Americans are out of work. Train a new army of 1 million community health workers like the barefoot doctors of China who can support their peers in creating health. Set a national goal for America of losing 1 billion pounds in a year."
Read the whole thing.  Then go outside and get some exercise!

6:44 AM

An Apple A Day...

From From Doors Of Perception:  "...between 1995 and 2010, North American taxpayers spent over $260 billion on subsidies of junk food ingredients compared to $262 million - *one thousand times less* - subsidising apples [which is pretty much the only fresh food to get a subsidy at all]."

6:27 AM

David Leonhardt writing in the NY Times: "Health care is far larger, with the United States spending at least 50 percent more per person on medical care than any other country, without getting vastly better results. (Some aspects of our care, like certain cancer treatments, are better, while others, like medical error rates, are worse.) The contrast suggests that a significant portion of medical spending is wasted, be it on approaches that do not make people healthier or on insurance-company bureaucracy."

8:21 AM

Poor Warren Buffet

Words you don’t often see juxtaposed – ‘poor’ and ‘Warren Buffet.’ But perhaps some sympathy is in order.

Omaha’s Oracle has had a few misfires recently, first offering some patently stupid tax  advice to the White House’s current occupant. You know of whom I speak - the leader of a clique believing any tax rates short of 100% are an opportunity-in-waiting.

Next he invests $5 billion in Bank of America. With the check’s ink barely dry, BofA says ‘See ya!’ to 30,000 jobs. Isn’t it swell being an Oracle?

He should’ve allocated that $5 billion among several dozen innovative startups, staying far away from the old-money banking triumvirate of fat, dumb and clueless. Some startups would have crapped out (just ask the White House…cough…Solyndra…cough.) but there’s no way the ensuing wreckage would’ve cost 30,000 jobs.

Now THAT’S change we can ALL believe in.

3:03 PM