You’re probably going to start hearing about “Deep Dive,” a huge randomized trial designed to compare an intensive patient-coaching program against a typical telephone-coaching effort.
Trial results, presented by David Wennberg, MD, MPH, president and COO, Health Dialog Analytic Solutions, indicate that more coaching contacts translate into fewer hospital stays, emergency room visits and physician appointments.
The savings? About 5 percent reduction in patient care costs–after the cost of the program–over the 12-month trial period.
Some audience members seemed a bit skeptical, but Wennberg’s co-presenter, Lance Lang, MD, national vice president, Health Net Inc., was not among them. Health Net members were subjects in the trial; after the trial ended, Health Net signed up to have Health Dialog’s intensive coaching intervention for all members who qualify.
Who makes money if intensive coaching becomes commonplace? Health Dialog or whoever provides the coaching, and the payers. Who loses? Physicians and hospitals, for whom a 5 percent reduction in revenues may seem rather daunting.
I missed the press conference at which the book was unveiled this morning, but attendees received advance copies at home and copies of the book are on every table at this conference. Its authors are keen on getting wide attention to their ideas so I share their summary of the health initiatives needed to put the house in order, Schultz-Shoven style:
Private system
Encourage national, rather than state, markets in health insurance, thereby promoting competition, putting downward pressure on costs, and providing reasonable choices of covered services.
Promote enhanced consumer information about health service prices and quality. Medicare records on the quality of hospitals and health service providers and the effectiveness of alternative treatments should be made public while the privacy of individuals is protected.
Strengthen the incentives for company-sponored HSAs and accompanying catastrophic insurance by making them portable across employers and permitting tax-deductible health spending for those who have fully participated in an HSA program.
Make tax-advantaged HSAs and relative low-cost catastrophic insurance available to all those who do not have employer-sponsored plans.
Medicare
Offer consumer choice among plans (Kaiser-style HMO plans, high-deductible catastrophic insurance plus HSAs, and traditional Blue Cross-type plans.)
Use smart means testing: Value of vouchers would depend on lifetime labor earnings.
Ensure gradual transition: Existing Medicare participants would be allowed to stay with traditional coverage.
Finance with dedicated taxes, thereby promoting cost effectiveness.
Medicaid
Provide risk-adjusted vouchers.
Continue to allow states to experiment with structure.
Offer consumers choices, including HSAs with catastrophic insurance.
Provide increased coverage: Replace eligibility notch with phased reduction of the value of vouchers.
Finance federal support with dedicated taxes, thereby promoting cost-effectiveness.
I had promised to attend the press conference at which former Secretary of State George P. Schultz released his new book, “Putting Our House in Order: A Guide to Social Security and Health Care Reform.” But when I realized I would have to miss a presentation, “A Practical Model to Achieve Health Reform,” by George C. Halvorson, chairman and CEO, Kaiser Foundation Health Plans and Hospitals, it became clear that I value decades of health care management experience more than Schultz’s long government career and his Medal of Freedom.
My decision permitted me to hear a rare truth-teller in health care today.
Halvorson said what everybody knows but most hand-wringers refuse to acknowledge: “Smart people do not kill the geese who lay lots of golden eggs.”
Health care delivery is the fastest growing and most profitable segment of the whole US economy.
Health care is winning. It is taking everyone’s money with an amazing low level of accountability.
The people who depend on a cash flow of fees to stay in business will not walk away from those fees voluntarily.
This is why health care reform has not happened and will not happen voluntarily.
Health care reform, Halvorson said, needs to be a “product” that is purchased and paid for by high leverage buyers. He challenged purchasers to take advantage of an evolving market.
While buyers think they have a relatively small amount of leverage, Halvorson pointed out they actually hold the power in today’s marketplace because of several converging factors:
Because of consolidation, there are only a few major plans left.
Buyers are doing total replacements.
Total market is shrinking.
Most plans are for profit and need growth to fuel stock value.
He calls for financing reform and care delivery reform, working together. Read more about this here later.
In the meantime, think about this question: Can health care providers be trusted to lead health care reform?
Halvorson offers a clue: “In today’s world, more efficient and effective caregivers simply deprive themselves of income.”
I did have a chance to read his book before coming to the conference and look forward to see what he has to say about health care reform. For Shultz the story of reforming health care and social security begins with the stability and growth of the US economy. In order to respond effectively to the coming cost catastrophe the economic pie has to growth. Any reforms have to be designed to pass Shultz’s “pie test.” Simply put, proposals that weaken the the GDP fail the test. So making use of the competitive market to discipline costs, raising labor force participation, recognizing labor mobility, growing personal savings, forcing government to confront the cost of over-promised entitlements, increasing taxes only as a last resort — these are some of the dynamics that should be examined when looking at the impact of healthcare reform measures.
Thus the “Shultz-Shoven health care initiative” includes, but is not limited to, the following:
Encouraging national rather than state health insurance markets
Making health insurance benefits portable
Enhancing consumer access to healthcare price and quality information
Risk-adjusted vouchers for Medicare and Medicaid
Offer Medicare and Medicaid beneficiaries choice of private health plans
Fund government programs dedicated taxes rather than general fund to promote cost effectiveness
Replace Medicaid’s eligibility “notch” with phased reduction in the value of vouchers as income increases
Shultz’s ideas are not new but they do enjoy an economic logic that cannot be denied or ignored.
He sums up his proposals in the following way:
. . . we seek to modernize and significantly reform Medicare and Medicaid, improve employer-sponsored health plans, and ensure that those who do not have access to such plans will still be able to obtain affordable major health insurance. We advocate that all Americans have access to strengthened Health Savings Accounts and a more competitive health insurance environment.
The question will be whether in today’s healthcare debate these conservative, market-oriented ideas will seem somewhat tepid in the face of corporate conspiracies and single payer fantasies.
Kevin Kelly, the Senior Maverick at Wired magazine, writes that the future is less fashionable than it was 10 years ago. And it is especially so since the dot.com bust of 2001; the future, it seems, is far less “cool”.
During the industrial and digital revolutions, you needed to discern the future because that was were you were going to spend the rest of your life.
But then something weird happened in the first few years of this decade. The pace of change became so fast that it outpaced contemplation. The future became harder to predict, and exhausting to keep track of. With a long, colorful history of failed predictions, it occurred to almost everyone at once that very little of what we imagined our own futures to be would really happen. So why bother?
We in the US health care industry are very concerned about the future. We always have been. And we’ve spent considerable amounts of money on hiring professional help –scenario planners, futurists and other conjurers — to help us get our short and long term strategies in order. It’s no secret that things like hospitals, information systems, drug development, for example, take considerable amounts of time and money, and we all want to secure the future of those investments one way or another.
But the scale, risks and enormity of resources involved in health care should not blind us to the fact that the only thing we can count on for the future is the unexpected and the unpredictable. (See more here, here and here)
With the kinds of uncertainty we are now facing in US health care — 2008 elections, unsustainable costs and a growing politics of blame and greed — the future is less about, well, the “future” and more about the present, that is our ability to simply hang on for the ride. Both the pace and unpredictability of what now confronts us makes futurists look more like shamans trying to comfort a nervous patient, than professionals who can help us line up, in some understandable order, the drivers of change.
One thing is for sure, however, any official “futures”, at least for now, are DOA. And we don’t need to pay any futurist to tell us how that story will end since the the plot has still yet to be revealed. Stay tuned.
Let’s look at what Wired editor-in-chief Chris Anderson is saying in his soon-to-be-out new book, FREE! — as discussed in this issue of Wired– and reflect for a moment on the implications for healthcare. Anderson argues that there’s a number of models or trends as to why things on the Internet are going to be, well, free.
• Freemium: A basic web service or software is supported by payers of the premium version of that service. One percent of the subscribers pay for the other 99 percent;
• Advertising: Free content, services, or software that’s accompanied by advertising geared to interested audiences;
• Cross-Subsidies: You get something with the intent that it gets you to pay for something else. Get the music free, now you want to go to the concert;
• Zero Marginal Cost: Somethings are so cheap to produce — again music is an example — that people offer it up for all kinds of reasons that have nothing to do with money;
• Labor Exchange: Using a web service, in and of itself, creates value for somebody else. The user is providing information that is worth more than the band width to get it.
• Gift Economy: It’s just altruism and it’s free — Wikipedia, Craigslist for example.
Can we see healthcare in here anywhere? Absolutely. It is everywhere flowing through all these models. There are many examples. But let’s not just list all the sites that you could point to. Let’s just say they are legion.
The real and most interesting question has to do with the impact of free healthcare on those aspects of healthcare for which we pay dearly. Healthcare on the internet is in some ways like the music industry — get the song free, then go to the concert and pay through the nose for the scarce experience of seeing the real thing (or band).
Sure, you can see the many forms of health information, advice, education and peer support, as recruitment strategies for the more expensive real deal — the physician visit, or the drug de jour, for example. In this view the internet creates even more demand for high cost care, and thus higher cost for the rest of us. Nothing in healthcare can really be free. Far from it. It is just a sophisticated bait and switch marketing strategy where the healthcare information, in itself, is a teaser of little value for some other product or service. So back to square one.
But there are some scenarios that move more in Anderson’s direction. Anything that is not tied down can be distributed through the internet under the above models. By this I mean, that anything which does not involve the laying on of hands can go on the net. With all of the interactivity possible now, especially with video capabilities, that inherent limitation — while still quite substantial — is getting smaller and smaller. And if it can go on the net, it will, and thus it will be on there for free.
In addition, an overwhelming percentage of energy consumers invest in “healthcare” is wrapped up in navigating the complexity of the system, determining their clinical options and planning for the repercussions of what ails you — all of which, the services available on the net excel at.
More important than probably anything else I’ve said so far, is the wedding of the emerging transparency in healthcare — price and quality of care ratings for example — to the internet. Value-based, healthcare 2.0 is on America’s doorstep and clamoring to be let in. It will attach itself and be amplified in a new internet-consumer-driven EMR, PHR, and “comparative-effectiveness” heaven that cannot help but have a disruptive impact on healthcare’s current anachronistic economic base.
But how, and how fast, are the only really important questions now, not if or when. What economic pressures will the net put on traditionally conservative healthcare institutions? How will they respond? Which of their highly valued, on the ground services, will be commodified and then free or nearly so?
Healthcare is a late bloomer when it comes to the information technology revolution, but it will, as they say, suffer from 100 percent of the effects of that technology. Are we prepared and being mindful of the changes all around us? That remains to be seen.
At first glance, health insurance plans ought to be major supporters of proactive health management (PHM) for their member populations, at least to the extent that this reduces members’ use of sickness care. Most health plans do offer some kinds of PHM services, and many are into it in a big way, with large plans such as CIGNA and Aetna offering PHM to employers who are not even their health insurance clients.
But the first glance may be too simplistic. Consider the full “systems dynamics” effects of engaging in PHM. True, when done effectively, PHM can significantly, often dramatically reduce healthcare costs for populations affected. But this also reduces the “loss ratios” for the plans, and can threaten their overall profits, since to maintain the same percentage of profits with lower premiums, its total profit amounts will be reduced, even if their margins remain constant. They will enjoy less growth in revenue, which will threaten their share prices, and shareholder as well as Wall Street analyst happiness.
Moreover, there is a built-in risk when engaging in PHM that some portion, perhaps a significant, even the major portion of the benefits of PHM investments will end up aiding some other plan, as members change plan selections at least annually. If employed members have high turnover relative to their employer, or high “churn rates” relative to their plan selections, they may not remain members of a given insurer long enough for any, or at least enough payoff to the insurer that paid for their PHM services.
The upside potential, however, is that health plans that demonstrate success in PHM may deliver such added benefits to their employer clients that the added revenue they derive from PHM, along with perhaps higher loyalty levels among employers who are also clients for their insurance, will end up increasing their total profits and shareholder value. It is impossible to predict with any confidence what might be the overall economic impact on insurance plans that offer PHM services. Too much depends on how well they perform in the PHM marketplace, and what the overall mix of impacts turn out to be.
But plans do enjoy a significant advantage over employers, who might otherwise decide to develop and offer their own PHM programs. Thanks to federal regulations (both EEOC and HIPAA), employers are seriously limited in terms of what incentives they can offer for what things, as well as what they are allowed to know about their employees’ health as individuals. By and large, insurance plans are not so handicapped. Of course, neither are the growing number and size of specialized PHM vendors, which can include hospitals and physician practices in the same community as the employers.
Plans also may suffer from a disadvantage based on whatever reputation and image they have among their own plan members or consumers in general. Given all the scandals about denial of coverage, retroactive termination of individuals after they start using care for conditions the insurer deems pre-existing, and the general hassles that have made employees’ personal physicians antipathetic toward insurers, this may be a significant handicap.
One thing is clear, at least – insurers cannot afford to ignore the PHM market and the impact this can have on their premium revenue, relations with employer clients, and with consumers, for that matter. PHM is too big an elephant to pretend it is not in the room.
I’m attending the AHIP health policy conference in Washington, DC this week and getting an earful about the elections and healthcare reform. Some impressions:
First up on the podium was Chris Matthews, TV commentator of Hardball fame. Matthews is a good speaker and captures the audience right away. He believes anyone of the three presidential candidates could take the election. Yes, there is still a path for Hillary to get the nomination but a lot depends on what happens today at the polls in Texas, Ohio, Rhode Island and Vermont.
To Matthews, America is in a “rut”. The people want change, they want deliverance. And doing nothing is definitely “out”. Obama is different, not your typical politician and he believes that this election is really going to be “transformative”, the likes of which we have not seen for quite a while. While he did not address health care reform in a specific way, Matthews argues that real political change only comes from brilliant, dramatic, unpredictable and grand moves. So I don’t think health care incrementalism is in Matthews’ play book.
Donna Brazile, TV political commentator and Chair of the Democratic National Committee’s Voting Rights Institute, and super-delegate, also believes that voters are in a foul mood. There “will be blood in this election”, she says. The next president will inherit a divided country and healthcare will be right in the middle of it. In addition, the deterioration of the economy will make health care reform doubly difficult. Even so, Democrats will want to get something in healthcare reform on the table quickly after the election.
Michael Murphy, Republican Political Consultant, and TV Commentator, on this point, says a McCain presidency may, contrary to popular thinking, do more for healthcare reform since if it is proposed by Democrats, the Republicans will block it. Like Nixon going to China, you need a conservative to front this kind of liberal change.
Dan Crippen, former Director of the Congressional Budget Office, observes that many people think rising health care premiums are capricious acts; they go up by themselves and are unrelated to cost structure. He asks “How do we change the 30 year old question in healthcare from ‘who should pay’ to ‘what are we buying’.”
Ezekiel Emanuel, Chair of the Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, asks the question of how do we make sure that the process of healthcare reform is legitimate if we need to make sacrifices? What voices need to be heard? He also agrees with many of the other speakers that we need to better assess what we’re spending our money on in healthcare. We need a better strategy. In responding to those who say that cost should not be a consideration in delivering healthcare, he advocates, that cost is an essential ethical consideration in healthcare because cost has an impact on our ability to pay for other critical services and needs. And that fact alone makes it an ethical dimension worth weighing.
In a similar vein, Paul B. Ginsburg, President, Center for Studying Health System Change, provokes the audience on questions about the importance of equity in healthcare, and the public tolerance for administrative control of the distribution of health care services. Containing health care costs will be painful, he reminds us. There is no painless solution. Ginsburg warns that health care financing systems can fail, but that they fail slowly. This health care crisis has been with us for over a decade. However, the affordability problem is now invading the middle class, crowding out other important needs.
The final speaker of the day one was the notable Theodore R. Marmor, Professor Emeritus of Public Policy and Management, and Political Science, School of Management, Yale University. Marmor observes that the lack of consensus should not be surprising since with healthcare we have five Americas: The British model embodied in the Veterans Administration system; the German social insurance program model in Medicare; the 19th century poor laws model in Medicaid; the private health insurance system; and pure charity medicine.
His own criteria for judging health reform proposals are fairly simple: Does is include everyone as payers and recipients for care? Does it cover what ordinary people think is medical care? Does it contain fiscal restraints to prevent the raiding of either the public or personal funds? It is accountable for results? And is the protection portable?
Marmor would like to see a real national conversation about healthcare since right now he feels what Washington is saying up to this point is pure gibberish. How, he asks, can we avoid another mistake like that which was made by the Clintons without a real national dialogue and consensus? We cannot wait another decade for an answer.
US Senator Ron Wyden took the stage first thing the morning of day two of the conference. He’s a frequent speaker at this conference usually focusing on his ‘Healthy Americans Act’ as a step towards real healthcare reform. He says the first 100 days for the new president will be critical for healthcare. Democrats — if they win — will need to put something on the table quickly. Congress is getting ready to act and Wyden does not want a repeat of the now infamous Clinton failure of 1994. This time there is an opportunity to do healthcare reform right. He wants a system where everyone has a basic private portable health insurance plan.
Recent history shows states cannot fix healthcare by themselves because the big drivers are federal, such as Medicaid and Medicare. And if we don’t fix the private market, the country will go single payer. Wyden wants a new private health insurance market that breaks the dependence on employer-sponsored coverage. His plan would still offer a choice of an employer plan. But his ‘Healthy Americans Act’ now before Congress would provide for an alternative to both single payer, and an over-dependence on employer-sponsored healthcare.
But how will health insurers respond to these proposed new changes? Cajoling his audience of health plan representatives, he argues that his approach would be one way to stop playing the healthcare blame game, replete with its usual designated healthcare villain of the day being held responsible for all that is wrong in healthcare. Health plans have all too often shared this distinction.
Andy Stern, President of Service Employees International Union, started his talk with an all-too-familiar tragic story of a healthcare disaster that end bankrupting an American family. He then switched gears to share the changes his own union has had to undergo to confront the new global economy. Healthcare, he believes, has also not reacted well to this new global economy. What we have now is a healthcare sector; what we need to build is a healthcare system. “Change is inevitable but progress is optional,” he lamented.
If there is one truth about healthcare reform, Stern believes, it is that the longer you wait, the worse it gets. And the US employer-based healthcare system is not sustainable for the economy of the future. It is dead and it’s time for hard choices. We need to move on to a more competitive approach. But he doesn’t think the country is ready, willing or able to go for a single payer system. We have to build a broader coalition on healthcare and negotiate a new blend in order to move on.
Stern warned that there is a big target painted on health insurers and the bullets are getting closer. Health insurers will have to walk in a new direction. People are ready for change. But where is the solution? “Be the agents of change”, he charged, “not the assassins of change”.
Gail Wilensky, Senior Fellow, Project Hope and a former Medicare chief, observed that even when we have expanded access to healthcare — such as the recent addition of drug benefits to Medicare, we still have problems with cost and quality. Medicare’s cost is unsustainable and its population is becoming more politically forceful. The program’s provider financial incentives are perverse and its spending constraints are ineffective when it comes to value and quality. It will be an immense challenge to moderate the Medicare’s cost growth.
Bruce Vladeck, Senior Health Policy Advisor, Ernst & Young, and also a former Medicare chief noted that the healthcare reform proposals put forth by the presidential candidates rarely mention Medicare or Medicaid. Problems with Medicare are the problems with the healthcare system generally speaking. He argues that Medicare costs — even with new efficiencies — cannot be sustained without new money. Politicians need to be more open and explicit about this hard fact. And he adds, that we must stop confounding the problems having to do with improving the quality of healthcare, with the problems of moderating the cost of care. It is a fantasy, he says, that improved quality will save serious money in healthcare.
As with so many political issues in this country, there tends to be a polarization between those who favor a single-payer “socialized medicine” approach, such as the UK’s National Health Service, and those who favor a “free market solution”. The trouble with such polarization, of course, is that it disguises the fact that the best answer may be some combination of the two, or at least somewhere between the poles.
A recent example of what would probably seem an outrageous policy adopted by the British National Health Service may be deemed a reason to condemn the socialized medicine idea, even though it is not essential to the single-payer idea. A woman who had metastasized breast cancer had been refused coverage by the NHS of a drug (Avastatin) that has been approved for use in Europe, though not yet in the US. She decided to pay the $120,000 costs of the drug herself, while getting the rest of necessary and covered services under the NHS.
But NHS officials decided that belonging to the national program included a “loyalty” obligation, where patients, in any single episode of care for a particular disease, cannot both get government payment and use personal or other non-governmental funds. When she was denied, the patient went to the news media, as did other patients in similar situations. It came out that patients had been routinely supplementing NHS payments with their own funds to pay for some parts of their treatment that NHS would not cover.
A physician who is a member of Doctors for Reform, a group highly critical of NHS, argued that patients switch from public to private sector healthcare all the time, e.g. if on a long waiting list to see an orthopedist, paying an extra fee to be seen immediately, then using the NHS to cover the surgery required. Patients have had to pay out-of-pocket to get a second opinions before choosing treatment for cancer. They may pay thousands out-of-pocket to get a hearing aid rather than wait a year to get one free from NHS.
Patients’ paying for some of the care they need and want is a common part of cancer care, according to another physician, when providers consider some drugs or treatments too expensive. This may require that patients go to another physician to get the drug, destroying continuity, but is essential when the NHS favors less expensive options, as governments tend to do.
There is already a great deal of variation in what patients can expect from NHS depending on where they live in the UK. Wide variations in waiting lists for seeing physicians and getting treatment are common, as are variations in which drugs will be available. Other patients at the same hospital as the breast cancer patients had been augmenting NHS treatments with self-paid options. NHS has argued that any drugs purchased by patients must be administered at a different visit from those paid for by the government, yet the particular drug in this case has to be administered together with one that is covered.
After being denied, the patients’ condition deteriorated to the point where the controversial drug could be paid for by NHS after all, so she is happy about that, but understandably unhappy at the extended wait and the possibility that her chances of cure and survival were diminished thereby. If the delay has reduced her chances, she feels the government should “be raked over the coals for it.” [S. Lyall “Paying Patients Test British Health Care System” New York Times Feb 21, 2008]
It seems unlikely to me that even a government-financed single-payer system in this country would be allowed to deprive individuals of the right to choose to pay for additional or alternative treatments, or accommodations, access, and amenities, for that matter. But those who favor a “market solution” may well use this example (which may well result in the overturning of the announced NHS policy, given the outcry that it produced) as an argument against a polar opposite “straw man, when a more pragmatic rather than political solution should probably be preferred anyway.
The easiest and most common portrayal of health insurance companies is that of an “evil empire” constantly looking for ways to get out of paying for health care that their customers need, delaying and cutting payment, etc. in order to maximize their own profits and their shareholder value, which is, after all, the job of corporations, according to many economists. The book and film “The Rainmaker” portrayed insurers at their worst, systematically denying almost all claims and only paying a minority of them when complaints were filed, while letting patients die for lack of needed treatment.
Physicians seem to rank health insurers only a little better, with one survey in Texas finding that all the state’s insurers rated were rated poorly. Contrast this to the extraordinarily high consumer ratings given to USAA, the insurer that markets to military personnel and veterans, and made news when it forgave the auto insurance premiums of its clients when they went to war in Iraq.
But while it is probably natural that insurers tend toward very conservative definitions of what is necessary treatment and “experimental” vs. proven treatment, they also serve to control the already skyrocketing costs of health care, and thereby make it more affordable for both individuals and employees covered by their employers’ sponsored plans.
In a recent article, its authors suggested that; “It’s Not More Medical Tests We Should Be Fighting for, But More Information and Choice”. It cites the U.S. Preventive Services Task Force ratings of preventive tests and services, noting that ratings vary from “A” meaning a really good option that should definitely be covered, down to “D” meaning of dubious or mixed quality, compared to negative side effects or risks. It rates some as “inconclusive”, meaning that it is too soon to tell.
It cites examples of tests that tend to produce identification of what are deemed medical problems, even though the person affected by the “problem” has no pain or other symptoms or lost functioning. Many tests have extremely high rates of “false positives”, meaning a lot of people will be treated as if they are sick when they are not, creating risks from treatments, as well as adding significantly to the level of unnecessary care we all pay for.
The side variation in frequency of many treatments across the country, with no signs that the areas with higher frequency have healthier citizens as a result, has frequently been cited as evidence that we should probably get less care, in general, than we do now. [“Geographic Variation in Health Care Spending” Congressional Budget Office 2008] Total spending in 2—4, for example, varied from a low of <$4,000 per capita in Utah, to a high of >$6500 in Massachusetts. Even government-controlled Medicare spending varied from a low of $5600 per beneficiary in South Dakota to a high of $8700 in Louisiana.
The plight patients denied an expensive test that might have saved one or more of them always looks more dramatic and heart-rending than the possibility that had all who thought they needed the test been given it, the results might have caused enormous amounts of unnecessary, dangerous, and wasteful treatment of people who were not really sick. And organizations with financial interests in selling the test are likely to be in the forefront of those demanding its coverage, without mentioning the profits they expect to gain as a result.
The best we can probably hope for is that insurers and patients alike will look for information such as the U.S. Preventive Services Task Force ratings before they demand coverage for themselves, or join others making such demands. Insurers have already begun, though belatedly, the move to promoting wellness and reducing health risks, so that they, along with everyone who benefits more from good health than bad, can reduce the incidence and prevalence of disease in the first place. Conjecture over what good might have been done if a given test or treatment were covered should always be tempered by some insights into the full range of effects on entire population, good and bad, not just the positive possibilities in one case.
Matthew Holt interviews Jonathan Cohn, a senior editor with The New Republic whose book - "Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price” - was recently published.
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