2010 Annual Roundup

Today’s Managing Health Care Costs Indicator is 313

Happy New Year – although it appears that we’ll be revisiting much of 2010 over the coming 12 months.  This is the 313th post, and I figured I would revisit some of my posts from 2010 as we start the new year.

In January, I recapped the final lecture of my 2009 public health school class on managing health care costs.   I also linked to a NY Times article on Baumol’s Law,  which suggests  that health care costs will always increase at a rate faster than inflation.

In February, I had a two part blog on the cost of “doing nothing” – why the status quo in terms of health care costs and financing is untenable.  Part One   Part Two  

I spent a few posts in early March considering how likely  it was that a for-profit takeover of the Caritas Christi hospital system in Massachusetts would lower health care costs.  Part One  Part Two  Part Three  

In the wee hours of a morning in late March, I was sitting in a coffee shop in Luang Prabang, Laos.  I had a spotty wifi connection, and was watching the New York Times play by play of the debate in the House of Representatives that led to approval of the reconciliation bill that made health care reform law.   3 AM in Washington DC is mid-afternoon in Laos– I probably knew that the Patient Protection and Affordable Care Act had passed before my Boston colleagues.    I did a blog of my bike trip to Vietnam and Laos.  I ignored most health care issues for the two week trip. Here’s a link to some thoughts on my plane ride back about health care in developing countries;  Laos spends $85 per year per person on health care, compared to over $7000 per person in the US. 

In April, I pointed out a trillion dollar question was whether or not health care providers would shift the costs of lower Medicare and Medicaid payments on to other payers.  

In May, I evaluated claims that more osteoporosis screening would lower future health care costs.   I wasn’t impressed.   I also reviewed an ingenious study from Mass General demonstrating the physician office administrative costs of multiple different insurance rules.  A later post quotes a figure of $7 billion a year in such waste.

In June, I looked at the potential savings from lowering variation.  There are dollars to be saved, but not as many as advocates suggest. 

I started using the Managing Health Care Cost Indicator in July; one of the indicators was a hospital that saved $180 million by implementing Toyota “lean” techniques.  

In early August, as I was setting out on the Pan Mass Challenge, I wrote a post on end of life care.    We need to respect people’s wishes better to improve care.  It might save money too –but that’s not the main reason for reform of end of life care. 

September brought an excellent Health Affairs with a quartet of articles on malpractice reform.   September also brought a column by Peter Orszag suggesting that the increases in the cost of Medicaid have led to $30b of underfunding of public colleges around the country.

In October, I embedded the first Youtube video in this blog.     I also pointed out that getting discounts on drugs can be very costly  

November brought another report of low prices being bad rather than good – we spend less per dialysis session than most developed countries – but get even less value for our investment.  

The Wall Street Journal did a great series on fraud and data mining during December.  Here’s a link to my blog on one of these articles, and here is a link to the series.   December also brought the first death panel –and it was not part of “Obamacare.” 

All in – 2010 was a big year for health care policy. Here’s hoping we’ll make some real progress in 2011.  Some things to watch this year:

  •         What will states do about Medicaid? It’s a challenge even in traditionally liberal northeastern states.  Governor Cuomo has pledged billions of dollars in Medicaid cuts, and Massachusetts is challenged by increases in Medicaid costs.
  •         What will states do about implementation of the health care exchanges?  As of mid-fall, many states were making great progress.
  •        What will the Supreme Court say about the individual mandate?  If it’s overturned, it will be hard to get to near-full coverage without a large refundable tax en lieu of the penalty,  and the House is highly unlikely to pass such a tax.
  •        Will Massachusetts find a path from fee for service to bundled payments? 
  •         How many health care lobbying dollars will flow into Washington?   Prediction – a LOT!

Happy New Year.