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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Health Wonk Review Review: Of Dartmouth, Doc Fixes, and Droppings



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This fortnight’s Health Wonk Review was hosted by Tinker Ready of Boston Health News. A number of subjects we’ve discussed at The Agenda were on the docket.

The Dartmouth Atlas fracas was foremost on healthcare bloggers’ minds; Kate Steadman of Kaiser Health News compiled an excellent summary of left-of-center opinion on the topic. Today Steadman posted a follow-up of right-leaning commentary, including an outstanding article on the topic by John Goodman. Goodman points out that “this…discussion is very similar—almost word-for-word similar—to the public policy discussion over public education that has been underway for a quarter of a century.” Merrill Goozner finds common ground with conservatives, noting that the Dartmouth data “by itself tells us nothing about why…overutilization [of health care resources] occurs.”

The Senate is presently debating yet another patch of Medicare’s sustainable growth rate formula (SGR), otherwise known as the “doc fix.” Health Care Renewal reviews a number of structural problems with the SGR, and notes that a big part of the problem is the mysterious Resource-Based Relative Value Scale (RBRVS), an exclusive province of the American Medical Association that is used to determine Medicare reimbursements for various medical and surgical procedures. A major new article in the New England Journal of Medicine, HCR opines, fails “to mention the key roles of the RBRVS Update Committee, the obscure, opaque AMA committee that de facto controls the payment system, without public input from any other individuals.” The AMA’s role in setting reimbursement schedules is a significant conflict of interest, and one that explains why the AMA supported Obamacare when so many physicians did not. The Hospitalist Leader also discusses the problems of the RBRVS Update Commttee and its impact on the doctor shortage.

Austin Frakt agrees with conservative complaints that Obamacare incentivizes employers to drop health coverage for their employees, but points out that a gradual elimination of employer-sponsored health insurance is actually a good thing. He’s right, except for the fact that the Obamacare-led individual market is heavily subsidized, and a flood of unexpected entrants into that market will sink the Treasury.

John Goodman asks: “Should everyone be required to have health insurance? The short answer is no. There is nothing that can be achieved with a mandate to buy health insurance that cannot be better achieved by a carefully designed system of tax subsidies.”

The guys at InsureBlog point out how remarkable it is that, at a time that the U.S. health care system is becoming more like Canada’s, Canada’s system is seeking to become more like ours.

In light of Memorial Day, the Veterans Administration health system was on the minds of many. Jason Shafrin of Healthcare Economist points out that the VA outsources a significant amount of its health services, undermining its claim to be a model for single-payer health care. The New Health Dialogue discusses Phil Longman’s book on the VA, Best Care Anywhere. “If it’s good enough for wounded warriors and the American Legion, maybe it deserves a second look.”



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