Tuesday, May 31, 2011

PHS Case

An interesting case of PHS brewing.  Interesting because there is no structure to be preserved, people are fighting to protect rat habitat

It’s hard to understand what is going through the heads of local business owners.  That section of Hollywood, bordered by Sandy, Halsey, 39th and say 42nd is extremely dense.  I don’t think I’ve ever parked on the street to patronize a business there, all the significant shops have on-site parking.  So these business owners are saying, gee, it’s really hard to park here and most people get here on foot.  And someone wants to build all this housing next door without parking, meaning lots of people walking around.  Ergo we should oppose it?

The guy from the theater gets bonus points for the inevitable day when he asks for public money via the arts bond.  Maybe if he had a large and ready supply of patrons living next door he wouldn’t need to feed at the public trough.

Saturday, May 28, 2011

Rate Review vs. the Legislature

One thing worth pointing out is the open and democratic nature of the provider pricing regulatory process in MA.  Hospitals will push back and rightly so, whatever doctrine emerges will need their support and consent.  The right way to get at that is through a legislative process.  That may be slow, cumbersome and prone to unwieldy compromises but so is life.

In contrast certain people in Oregon have pushed to twist premium rate reviews into the be-all end-all of healthcare reform.  Rate review is a poor forum for the task, it is dominated by technical calculations that few people understand and has no apparatus or experience with assimilating input from all the interests involved.  With limited input you are more prone to get unintended consequences. 

Case in point, the call to subsidize individual policies at the expense of large group plans.  That would in effect penalize companies who offered health coverage to the benefit of those who did not.  Obviously, it would encourage companies to drop employee coverage which goes against the stated objectives of reform advocates never mind the politics.  It’s an absurd policy on it’s face that would likely not make it out of committee in the legislature.  Rate review on the other hand is basically at the discretion of DCBS.  It merely takes an ambitious Director to put such an ill-conceived policy into practice.

It makes you wonder, why are reformers so reliant on demagoguery?  If it’s good policy bring it through the legislature, make a case for it and make it law.  The back door stuff demeans us all.

Cost Control Efforts in MA

Oregon efforts at health care reform are consumed with regulating insurance in isolation from providers, but eventually people will figure out that the only way to get cheaper health insurance is to get cheaper health care.  Massachusetts, which is a good proxy for life under PPACA is addressing the issue head-on:

The governor recently proposed legislation that would allow the insurance commissioner to scrutinize contracts setting the amounts insurers pay hospitals and doctors and reject health insurance premium increases based on excessive fees for providers.

The administration has scheduled four days of hearings starting June 27 on how to control health care costs. Legislators held their own hearing this month and are grappling with whether to support the governor’s bill, a process they have warned could take months.

Developing an effective doctrine for how, what and why providers should be compensated is the central dilemma of health care reform.  I wish MA good luck.

Sunday, May 15, 2011

Health care reform turns doctors into slaves?

Rand Paul seems to think so.  Histrionics aside, there is a real issue there.  The term Rand Paul seems unfamiliar with is 'public servant', i.e. if health care is to be a public good then care providers are going to be more like fire fighters or police officers and less like lawyers.  That is a big change, for patients and doctors alike.

Saturday, May 14, 2011

Good Government

25 Good Ideas, per Harvard Kennedy School.  Of the bunch I think the Civic Consulting Alliance in Chicago sounds the most interesting, not exactly how I remember Chicago politics.

Vermont Single Payer

That Vermont is on the cusp of adopting a Single Payer health care system is getting notice across the nation. What gets less notice is the structure of that particular arrangement.

At heart, what has been agreed to is a grand bargain between people and providers. Providers will provide necessary care and people will pay for it, under a mutually agreed rate structure and limitations. That is the key hurdle single payer plans must climb, getting providers to accept pricing regulation. Other aspects of single payer have been done before, taxes and government health care are not new but the provider pricing regulation is unprecedented.

In Oregon proponents of Single Payer generally brush aside cost control with hand-waiving about “negotiating”. They ignore the reality that providers have choices, either to not participate and effectively create a second, smaller and much more expensive private market or to even move out of state. Buy-in from providers is critical, as it is from people with respect to limits (i.e. no “death panel” drama). Without the cost control mechanism single payer is nothing but a new tax plan.

I expect Oregon will learn a lot from Vermont, I hope we learn the right lessons.

Correction: Provider pricing regulation isn't totally unprecedented, but Vermont's plan is significantly tougher and broader.

Saturday, May 7, 2011

Things I like: Portland Police Edition

I was impressed with a recent speech by Portland Police Chief Mike Reese to City Club.  A former counselor with Boys and Girls Club with an educational background in psychology and public administration, he seems as suited to run a non-profit as he does a metro police force.

A story in today’s paper suggests his influence on the department, and I like it.