Category Archives: Policy and politics

A wakeup call from the nanny state

Amber alert alert

Amber alert alert

My cellphone was off Friday night so I was lucky enough to miss the Amber Alert that was sent out at 1:45 am when a mom decided to drive home from Pennsylvania to have her son treated at Boston Children’s Hospital. I heard about it Saturday night from some friends who couldn’t believe this had occurred and were annoyed at being awoken.  From where I sit, the only good thing about it is that it’s literally a wake-up call to the whole community about how the system treats vulnerable people.

It’s hard to say exactly what happened. But from what’s been written, it goes something like this:

  • A nurse practitioner in Wilkes-Barre, PA told a mom to take her 2-month old to a nearby emergency room for treatment of severe dehydration
  • Mom felt she had gotten “the runaround” from the Pennsylvania clinic and decided to drive to Boston Children’s Hospital to have her son treated there. She is from Boston and apparently has a relationship with a doctor there
  • On the way back she dropped off her older son with a niece in Waltham so she could focus on the infant
  • Somewhere along the way, someone in PA decided to issue an Amber Alert –meant to be used when a child is abducted and “believed to be in imminent danger of death or serious bodily injury”
  • The Amber Alert went out, waking everyone up
  • Infant made it to Children’s, where he’s been admitted and is improving –but now in custody of DCF (protective services)
  • Other child was also taken by DCF
  • Mom was arrested in MA as a fugitive from justice in PA. Judge listened to her story and released her on a token $250 bail

As I mentioned I don’t know exactly what happened. But I tend to give the mom the benefit of the doubt. In particular:

  • Who knows the quality of care and clarity of instructions the woman received at the clinic in PA?
  • A general ED is no place for a 2-month old. Many are still totally unprepared for kids, never mind babies
  • Boston Children’s is rated the #1 pediatric hospital in the country and she may have relationships there already. Depending on the kid’s condition, who wouldn’t at least consider making the drive?
  • It’s hard to drag a toddler all over the place during an emergency, so why not drop them off at a relative’s house along the way?

The mom apparently has some moving violations and a charge for prostitution. I wouldn’t be too quick to judge her for those things.

It’s hard to know what to do when your kid is sick and you’re trying to navigate the healthcare system. That’s true even for a well resourced, well educated dad like me who works in healthcare. Without those privileges it appears all too easy to end up with Amber Alerts, arrested moms, and kids taken by the state when a mom tries to do what’s best.

I don’t like it.

Image courtesy of mrpuen at

By healthcare business consultant David E. Williams, president of Health Business Group.

Jeb Bush talks a certain amount of sense on health care

Look at me, I think I have a new idea!

Look at me, I think I have a new idea!

Pity the poor Republican Presidential candidates. When it comes to healthcare, they don’t have much to fall back on besides the usual tired rhetoric:

  • Feel good ideas with limited or no impact (e.g., focus on wellness, tort reform, competition across state lines)
  • Cheap shots and unsupported assertions (e.g., Obamacare is a government takeover, we’ll have waiting lists and rationing)
  • Attempts to preserve popular parts of Obamacare while stripping away the foundations that make those aspects work (e.g., forbid discrimination based on pre-existing conditions but let people wait till they get sick to buy insurance)

As expected, Jeb Bush’s new health plan contains these elements. But I commend him for his plan to limit the tax deductibility of employer-sponsored health plans. Under his plan, any employer contributions to premiums over certain thresholds ($12,000 for individuals, $30,000 for families) will be treated as regular wages and subject to taxation. The impact is almost the same as the so-called Cadillac Tax, but the mechanism is more straightforward and efficient.

He’ll probably get a lot of grief for his idea, but it’s a good one that should be supported. It reduces the tax system’s distortion that causes employers and employees to favor health benefits over wages.

Image courtesy of worradmu at

By healthcare business consultant David E. Williams, president of Health Business Group.

We want death panels!

Can you hook me up?

Can you hook me up?

From Kaiser Health News:

The public overwhelmingly supports Medicare’s plan to pay for end-of-life discussions between doctors and patients, despite GOP objections that such chats would lead to rationed care for the elderly and ill, a poll released Wednesday finds.

Of course it makes sense to pay physicians to discuss these difficult issues. The fear-mongering prompted by Sarah Palin’s characterizing these discussions as “death panels” has been harmful to patients and families.

It’s heartening to learn that most people have been able to cut through the nonsense on this one.

Image courtesy of foto76 at

By healthcare business consultant David E. Williams, president of Health Business Group.

Why drug price regulation should not be ruled out


I’m a proponent of free markets and in general defend drug companies in their price setting, especially when they’re introducing new, innovative products with real clinical and financial benefits. See, for example, Hooray for high-priced hepatitis treatment Sovaldi.

But we have to remember that the reason high prices can persist in the market is that drugs are protected by patents and other restraints on competition such as the orphan drug law. Those rights are monopolies granted explicitly by the government. There’s really nothing free-market about them. Since the government grants these rights it should also be able to regulate the benefits that result from them.

In many cases the government wisely stands back and lets the market do its work. The generic market for small molecule pharmaceuticals is a case in point. When it works well –which is most of the time– prices fall by 90 percent or more once a patent expires.

But there are exceptions, where the government should consider stepping in. One example (highlighted on this blog in 2007: Abusing the orphan drug law to rip off customers) is when an old, generic drug gains new intellectual property protections for a use that is already common.

Another example that’s becoming more common is when large molecule drugs go off patent. The government is making a big mistake with its ‘biosimilar’ approach, which wrongly tries to apply the generic drug precedent to products that can’t be copied exactly. Instead, as I’ve been advocating since 2006 (A better idea than biogenerics) would be better to leave the original manufacturer with a monopoly, post-patent expiration but to regulate the price. This would be fairer and safer for patients.

We’re hearing a lot of noise about drug prices from politicians, doctors, drug companies, and patients. I won’t repeat what they say here, since you can easily find it elsewhere. This is a substantive issue, with no black and white answers. I’m glad to see it being brought forward into the public sphere.

By healthcare business consultant David E. Williams, president of Health Business Group.

Health Wonk Review is up at Colorado Health Insurance Insider

Check out the Fall Colors edition of the Health Wonk Review at Colorado Health Insurance Insider.

You will learn the best and worst days to be admitted to the hospital. Plus view posts on physician ethics, ACA replacements, 2016 premiums, work comp spending, census data, IT, and medical records.

Health Wonk Review is up at Medicare Resources

Steve Anderson at Medicare Resources hosts the latest edition of the Health Wonk Review. I’m flattered that he chose to dub it the Selfie Edition in honor of my blog post.

You’ll find some choice posts on Obamacare, ACOs, Medicare and more when you go check it out.