What does GOP think will come after they sabotage (or repeal) Obamacare?


Comrade Trump, are you listening?

Just after the election I wrote (Goodbye Obamacare? More like hello single payer!) to lay out my vision of where Republican dysfunction and ideology could ultimately lead. At the time I said:

Trump himself has been at least a liberal and frankly more of a socialist when it comes to health care policy, at least based on his earlier writings. Once he learns that the ideas of the conservatives in Congress won’t produce universal coverage, he may well go back to improving –instead of replacing– Obamacare, moving to a Canadian style single payer system, or opening up Medicare for all, just like Bernie and much more radical than Hillary.

The last six months of Republican flailing on healthcare makes it even more likely that socialism will ultimately come to the US healthcare system. Here’s why:

Americans –and that includes Republicans– now expect insurance to be available without restriction or penalty to those with so-called pre-existing conditions. Everyone wants lower premiums and out-of-pocket costs, and Obamacare opponents are beating up on the ACA for failing to deliver. But nothing the GOP is doing is helping advance these goals. Most of GOP proposals actually undermine these objectives.

Meanwhile, Trump and Congress are creating uncertainty about the exchanges and actively undermining them, e.g., by refusing to enforce the mandate, talking about exchanges failing, and using public money meant for promotion of Obamacare to undermine it.

The Affordable Care Act is a moderate piece of legislations, with free-market concepts like health insurance exchanges that conservatives would like if they looked at them objectively, and which were included in order to generate support from some in the GOP.

But with all the chaos, ill will, and sabotage of Obamacare by the Administration, liberals and centrists are now talking about more radical ideas. In particular, the concept of a single payer health system is now being discussed openly and seriously, something that would not have happened if Congress had done the sensible thing and made improvements to Obamacare.

What happens next? If, for example, repeal without replace goes through, then I think we’ll see single payer come up as a mainstream topic in the 2020 presidential election (assuming we are still holding elections in this country by then).

I also expect that rather than move to a Medicare for all model we may see more talk about Medicaid for all. It’s cheaper, because it pays providers less, and coverage is far more comprehensive. It  could serve as a baseline for universal coverage.

The healthcare morass is keeping Republicans from tackling other legislative priorities that supposedly would be easier to accomplish, such as tax reform –or more likely, straight tax cuts. If you’re an opponent of the GOP agenda, then the extended fight over healthcare is not such a bad thing.

I do worry, though, that as the administration continues to flail from the Russia investigations and lack of legislative success, they will resort to desperate tactics that could have dire consequences. In particular I’m worried that the GOP won’t take seriously the necessity to raise (or better yet, eliminate) the debt ceiling. They may try to tie a lot of unrelated issues, including Obamacare repeal, to this must-pass bill. Once the US is in default, all bets are off.

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

Sorry Fred. It will take more than teamwork to fix GOP healthcare dysfunction


GOP 2017. What a team!

Why can’t the Republican Congress manage to repeal and replace Obamacare, considering the whole party has campaigned for seven years on the promise to do just that? According to Fred Barnes of the Wall Street Journal the answer is simple: the Republicans are not playing as a team. In Barnes’ reality, if the GOP would only treat politics as the team sport it is they could create “a more free-market healthcare system in which people can buy the insurance they want, not what government requires.” It sounds so beautiful I’m sure everyone will put aside their differences and make it happen!

Alas, with two more Republican Senators coming out against the bill the same day the Op-Ed was published, it doesn’t seem that Mr. Barnes is making much headway.

But Barnes has misunderstood the real causes of Republican disarray on healthcare. For his benefit, here are some:

  • The Affordable Care Act is actually a well thought out, moderate piece of legislation, not a looney left-wing one. It contains a variety of market oriented and conservative principles that were designed to encourage Republicans to vote for it. Major facets include the individual mandate (personal responsibility, supposed to be a conservative idea remember?) and the insurance exchanges/marketplaces, where private insurers compete for business.
  • Despite what Republicans say now, there were numerous attempts to bring them into the fold in 2009 and 2010 and enact a bipartisan law. But Republicans decided to stand uniformly against the ACA, showing that there’s plenty of “teamwork” and discipline available, but only when it comes to saying no.
  • Once Obamacare was in place, Republicans did all they could to undermine it: filing frivolous lawsuits, wiping out the risk corridors, lying about death panels, blocking navigators from doing their work, and voting to repeal the law over and over again, but only when Obama was there to veto it. They’re still at it, trying to destroy the insurance exchanges even though Republicans are in charge.
  • Despite talking about “repeal and replace” they never came up with a serious “replace” approach. Most of the so-called ideas were tired talking points trotted out as though they would make a big difference: selling insurance across state lines, enacting tort reform, and promoting drug re-importation. (This is really where the term “nothing burger” should be employed.) House Speaker Paul Ryan’s undeserved reputation as a big thinker should be fully crushed by now.
  • Congressional Republicans have fallen in line behind a president who knows nothing about healthcare policy, has no idea what’s in the House or Senate bills (assuming he even knows how the legislative branch works) and promised “something terrific” but never has and never will explain what it is.

Congressional Republicans should hit the reset button. They should apologize for how horribly they’ve behaved on healthcare policy, and work with Democrats on common sense improvements to the Affordable Care Act. Instead it sounds like the new idea is just to repeal and then spend another couple years trying to figure out what replacement would be.

Truth is, Republican legislators gave up on governing to become the party of no. It worked pretty well in the short and medium term, bringing with it Congressional majorities, the presidency, and a stolen Supreme Court seat.

Now would be a nice time for the GOP to grow up. Healthcare is a good place to start, and if they put country ahead of party they’ll find plenty of Democrats to cooperate. Personally I’m not betting that will happen.

Meantime, maybe Mr. Barnes will start arguing for teamwork when it comes to raising the debt limit. Rah! Go team!

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

Tufts nursing impasse: I’m quoted in the Boston Globe


Who “wins” in a strike?

The first nursing strike in Boston in three decades is an ugly situation. I feel badly about it, especially for patients and their families who are collateral damage. Even if the quality of care is the same with the replacement nurses, the extra stress and aggravation really are a problem.

I’m quoted on the dispute in today’s front page Boston Globe story (At Tufts Medical Center, pressure to cut costs in a city rich with hospitals). I’m not directly involved with Tufts management or nursing leadership, so I commented on the overall environment in which its occurring.

“I think the root cause is that Tufts has to compete with the other academic medical centers in the city, and they don’t get the same level of reimbursement,” said David E. Williams, a consultant at Health Business Group in Boston. “The disparities of the payments actually cause friction in the labor market.”

The story of unequal payments to Boston area hospitals is not a new one, and people have heard about it so often that they’ve tended to zone out. But this is the first time I can think of that labor relations have taken a public hit as a result, so perhaps it will reinvigorate the debate.

Meanwhile, few of the articles about the strike provide broader context about where nurses fit in to hospital finances. A couple of statistics are worth mentioning:

  • A 2015 study published in the Journal of Nursing Administration (Hospital Nursing Workforce Costs, Wages, Occupational Mix, and Resource Utilizationconcluded that nursing labor accounts for just over 30 percent of total hospital costs. That means nursing costs are central to hospital finances and it explains why Tufts isn’t just giving in in the face of the strike.
  • Nurses in Boston earn six-figure incomes. According to Tufts, its senior nurses (which represent 60 percent of the total staff) “earned an average of $152,000 in 2016.” That’s comparable to what some primary care physicians make.

I hope the dispute is resolved soon, so that the nurses and the rest of the Tufts team can get on with the job of caring for patients. If the strike ends up stimulating a serious debate about inequities in hospital reimbursement, that will be its only silver lining.

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

Medial EarlySign: machine learning for population health (podcast)

Medial EarlySign analyzes standard EHR data to identify individuals at high risk for disease. The company’s first solution, ColonFlag uses longitudinal blood test data to identify patients who are at high risk for colorectal cancer.

I spoke recently with Medial executive Tomer Amit, who filled me in on the company’s approach and explained why the company has been named a Cool Vendor in AI by Gartner.

  • (0:15) What unmet need are you serving?
  • (1:05) You talk about using data that’s already available. What kind of data?
  • (3:02) When you mention “historical data” are you talking about longitudinal data for an individual patient or aggregated data for a population?
  • (4:18) Why is colorectal cancer an initial focus for the company, with your ColonFlag solution?
  • (5:13) Does ColonFlag replace colonoscopy or encourage someone to get one if they have an indicator that they are at greater risk?
  • (6:38) I see how it could help an individual. Would it actually help at the population level?
  • (7:45) You started in Israel and the EU, which have strong longitudinal medical records. Can the approach be applied in the US where that’s not the case?
  • (10:41) You have run your tests in different places around the world. Does the model differ by population or is there a universal algorithm?
  • (12:10) How do you protect your intellectual property? Once you are out there, are there just rules of thumb people can use instead of working with you?
  • (13:14) What traction have you gained with customers or partners? What industry recognition have you received?
  • (14:45) Are there other domains you are investigating beyond colon cancer? Other data beyond blood tests?
  • (15:58) What’s your 5-10 year vision of what’s possible and what Medial’s role will be?

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

Welcome to #CareTalk with CareCentrix CEO John Driscoll

In this episode of #CareTalk I banter with John Driscoll  –CEO of post-acute benefits manager CareCentrix—  about the health insurance company mergers, drug pricing, whistleblowers, marijuana and more.

Don’t miss the lightning round at the end!

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