Wednesday, March 30, 2011

Hospital Profits

I noticed the Lund Report was showing rising profit margins for health insurers in 2010.  That’s good news for insureds, as they can expect that to translate into relatively lower rate increases.  It also got me wondering about hospital profits, how do their margins compare to insurance?  Fortunately, Oregon has easily accessible data on the financials.  Here are the 8 largest hospitals and the state wide total:

Fiscal Year 2009
  Operating Income Operating Margin 4 Year Avg Operating Margin
Legacy Emanuel Hospital -2,313,000 -0.4% 0.8%
OHSU Hospital 56,581,768 5.9% 4.7%
Providence Portland Medical Center 13,709,002 2.3% 3.2%
Providence St. Vincent Medical Center 59,341,480 8.4% 8.5%
Rogue Valley Medical Center 26,624,000 7.9% 3.3%
Sacred Heart Medical Center Eugene -15,026,259 -3.0% 7.0%
Salem Hospital 7,157,704 1.5% 2.9%
St. Charles Medical Center (Bend) 26,762,158 7.1% 5.6%
172,836,853 3.9% 4.7%
Total Statewide 330,548,996 4.0% 4.2%

Other then Legacy I’m not seeing any angels.  And the 3% insurers made in 2010 seems pretty light given that they have capital at risk.

Monday, March 28, 2011

How throwing rocks at insurers hurts reform efforts

I’ve gotten into arguments with people about why focusing on insurance is a dead end if you want to reform health care. I think it is actually worse than that, not just an absence of good but an actual bad. Why? Because it encourages the belief that the only thing wrong with health care is that insurers won’t pay claims.  If people adopt that mindset, why would they ever accept any kind of cost control?  For instance…

Here is a pretty good proposal for cost control, through the creation of CCO’s. Those entities would sit between providers and the insurer (the state), and act to coordinate and plan care across disciplines, including oral, behavioral and physical care. They would also promote individual accountability and seek to prevent unnecessary care.

This seems like a cut and dry ACO reform that will save a lot of money for the state. I also think that politically it is dead meat. The CCO concept will be tarred as an HMO, a comparison that is essentially correct. HMO’s were actually even more detested in their day then insurers are now.  I don’t see how the public will accept them without a cogent argument* based on costs and benefits.  Bashing insurers promotes a view antithetical to that argument, that the only thing that matters is getting care paid for and where the money comes from is irrelevant.  It makes it that much harder for cost control efforts like the CCO proposal to succeed.

Maybe I’m wrong about the fate of this proposal, I’d be happy if I was. Time will tell either way.

*I look to the left for this argument because I’m pretty sure there won’t be one coming from the right.

Saturday, March 26, 2011

POW: Scorpions (not the band)

After Words produced a nice interview podcast with Noah Feldman discussing, Scorpions: The Battles and Triumphs of FDR's Great Supreme Court Justices.  The story is how FDR nominated four great liberal judges, and the surprising manner in which their careers on the bench played out.  It makes for a neat parlor game to pick four comparable contemporaries.  I come up with Cass Sunstein, Eliott Spitzer, Hillary Clinton, and Eric Holder.  Politics was a very different animal back then…

Monday, March 14, 2011

POW: Robert Fisk

Here is a very good lecture by Robert Fisk, sponsored by Georgetown’s Center for International and Regional Studies from about a year ago.  He discusses how western and US media in particular have become subservient to government authority, and how that perverts public discussion of foreign policy.  The themes will be familiar to fans of Glenn Greenwald, but it is more powerful hearing about them from someone inside and “on the ground” among foreign correspondents.

Worth listening to for the story of the soldier from the 82nd airborne 33 minutes in.

Friday, March 11, 2011

People Against Controlling Health Care Costs

I’ve seen a lot of discussion on the need to control health care costs, but rarely do I see someone take up the other side.  It’s odd, no one ever says they are for higher health care costs, yet that has been the dominant policy of the last 20 years.

Here are some people unafraid to state this position openly: Congressional Republicans en masse.  As Austin Frankt says,

There really is no cost control solution if something like the IPAB can’t work.

You can follow the fate of it here.

Someone needs to take Ginkgo…

In a discussion of why Portland is unusually hostile to the Joint Terrorism Task Force, the Oregonian cites three contributory factors:

  • Lack of military bases
  • A politically active citizenry
  • The absence of a strong mayor/executive

You can tell the reporter’s politics by what he doesn’t bother mentioning:  Brandon Mayfield.  Mayfield, a Portlander,  was the guy the feds tried to railroad into a guilty plea for the Madrid train bombings.  He was held for two weeks in isolation with only limited contact with legal representation, based on the flimsiest evidence: a fingerprint match the Spanish themselves repudiated even before the arrest.  Mayfield’s treatment vividly demonstrated for Portlanders the consequences of an unrestrained and careless security apparatus.  Maybe, just maybe, that has some influence on their view of the JTTF.

Thursday, March 10, 2011

Things that do not make me proud of America

Per Glenn Greenwald, here is a legal filing by Bradley Manning’s attorney protesting the conditions of his detention in a military prison.  The interesting parts begin on page 7, where he describes why he was put on suicide watch.

It’s noteworthy how the prison staff are using protocols of psychological treatment as a form of coercion/punishment.  It reminds me of how the Soviets used to put dissidents in mental institutions.  It’s hard to understand how these people can sleep at night.  If it bothers you, consider writing a letter.

Wednesday, March 9, 2011

Recession? Not in Health Care

I’ve heard some people intimate that health care costs declined with the recession and that health insurers would see windfall profits.  Not likely…