The State of Employer-Sponsored Health Coverage

BRIAN KLEPPER

First published on THCB.

New data make it clear that America's employer-based health coverage system is increasingly in shambles, providing adequate coverage to a rapidly diminishing percentage of the population. We can fix it or replace it but, for the good of the nation, we need to do one or the other. To let it languish causes enormous unnecessary suffering and cost.

A detailed new study from the Economics Policy Institute confirms what many of us suspect but haven't had the data to easily nail down. This weightily titled report by Jared Bernstein and Heidi Shierholz - A Decade of Decline: The Erosion of Employer-Provided Health Care in the United States and California, 1995-2006 - provides more granular information about the enrollment dynamics over time in employer-sponsored health coverage than we've seen in a while. Based on an analysis of the March 2007 Current Population Survey, the numbers reported here are mostly in sync with (but deeper than) similar studies that have attempted to size the enrollment and erosion characteristics of the employer-sponsored coverage market. Strap yourself in; this isn't pretty.

An Open Response To HHS Secretary Michael Leavitt

BRIAN KLEPPER and MICHAEL MILLENSON

First published on THCB.

 

Under the Bush Administration, HHS officials keep telling us how they support health care pricing and performance transparency. But in withholding Medicare physician data from public scrutiny - they have followed the AMA's advice that doctors have a right to privacy - they demonstrate that their interest in transparency is selective.

A few months ago, the two of us – both long-time advocates for transparency and accountability – posted separate comments on Secretary Mike Leavitt’s blog.  Brian asked Secretary Leavitt to square his support of "Chartered Value Exchanges” with the attempt to block release of physician-specific Medicare claims data to Consumers’ Checkbook, which wants to rate doctors. After a court ruled that the data should be provided to the group, HHS appealed. Michael urged the secretary to go beyond supporting Consumers’ Checkbook and use his “bully pulpit” to promote sophisticated data analysis that could be used to create national quality comparisons.

Rebuilding the Medical Home: What Walgreens Surely Sees

BRIAN KLEPPER

First published on THCB.

In March 2007, Walgreens suddenly acquired the two largest worksite clinic firms. Combined with their convenience care clinics, this gave them more than 500 primary care sites nationally. They estimate that there are 7,600 employer campuses in America with 1,000 or more employees onsite. Is this the beginning of the true corporatization of primary care. And if corporations come to own primary care's referral base, can't they capture all of health care?

Loving Our Children

BRIAN KLEPPER

First published on THCB.

 

New data clearly show that one in four American teens have at least one sexually transmitted disease. One in seven have more than one. A refusal to confront this news directly by changing the abstinence-only sex education policies of the last decade is tantamount to child abuse.

Among its many less-noticed accomplishments, this Administration has strangled funding for comprehensive sex education. Instead, it has thrown the immense weight of the US government behind abstinence-based education, an impractical ideological approach rooted in religious zealotry and a romantic notion of social mores that no longer exists for most young Americans. In 2005 and 2006, the Bush Administration spent $170 and $178 million, respectively, more than double the 2004 expenditure, much of it allocated to mostly conservative Christian organizations, to encourage children to refrain from sex without explaining the fundamentals of contraception and sexually-transmitted disease (STD). In 2004, a Minority Staff Special Investigations report prepared at the request of Rep. Henry Waxman (D-CA) found that more than 80 percent of federally funded abstinence programs contain false or misleading information about sex and reproductive health.

The Myth of Health Care Consumerism

BRIAN KLEPPER

First published on THCB.

Contrary to the prevailing wisdom, most people surveyed say they absolutely won't use the Web to investigate a health condition and then change their behaviors accordingly. But they will do something their sister-in-law tells them. What does this mean for the future of consumerism?

Last weekend I heard several great presentations at a meeting convened by Jeff Goldsmith, but one contained a point I hadn't heard nailed down before. Kaveh Safavi MD JD, from Thomson Healthcare's Center for Healthcare Improvement, detailed the results of several large sample surveys on consumers' attitudes toward web-based health care information.

Health Care and the Gathering Storm

Here are two very interesting and frightening charts that my good friend Warren Brennan, the CEO of SMA Informatics in Richmond, passed along this AM, with this question, aimed at the CFOs of hospitals and other health care organizations:

What do these mean for bad debt and for the health care sector's future financial performance?

Here's the text that accompanied the chart on wages:

This chart, from the NYT, shows annual growth in real wages. What that means is that workers today are earning significantly less, in real terms, than they were a year ago: their January 2008 earnings were down 19 cents per hour or $8.31 per week from January 2007.

Cognitive Dissonance and HHS' Position on Medicare Physician Data

Just as it launches a new program aimed at allowing local organization access to physician profiling information, HHS has blocked access to that same information by a national consumer group.

Here's a really classical example of a federal regulatory agency holding fast to two opposing ideas at the same time. I wonder what it means?

Last week HHS posted  an interesting notice announcing a new program that recognizes 14 (presumably) forward-thinking health care coalitions of providers, employers, insurers and consumers, which it refers to Chartered Value Exchanges, or CVEs. (Who comes up with these names?!)