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Creating Focus and Building on the Opportunity of Health Reform

As I’ve said in past posts, health care reform is much more about insurance reform of the health insurance system than it is about real and fundamental change to the health care delivery or public health systems (see “The Case of the Missing $115 Billion”). The bulk of the dollars included in the Patient Protection and Affordable Care Act (PPACA) …

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The Health Care Industry in Michigan: Staying on the Open Road

When I first came to Michigan from Indiana a year ago, I knew I was coming to a special state for health care. Impressively, hospitals across Michigan have topped the national charts for years when it comes to providing high-quality health care. And compared with most states, Michigan has a long history of innovative pharmaceutical and medical research, excellent private …

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The Case of the Missing $115 billion

The printed version of the final health reform Act (PL 111-148) comes in at 907 pages (yes, lots of white space and pretty small pages – and yes, including an detour into student loans – but still, a very big Act any way you look at it). Many have noted the sweeping nature of the Act and how it touches …

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The Wrong Policy: Physicians, Medicare Payment, and What Congress Could Learn from Private Sector Experience

Bruce Vladeck has a terrific piece in this week’s New England Journal of Medicine describing the problems with how physician fees are currently adjusted under Medicare. The Sustainable Growth Rate (SGR) formula, put in place in by Congress in 1997 – was designed to use physician fees as a tool to control health care spending. That is, total physician payments …

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The Paradox of Accountable Care Organizations

In the run up to health care reform, there was considerable discussion and advocacy for the idea of encouraging the implementation of something called accountable care organization (ACOs). Count me as a hope-to-be proved-wrong skeptic of this idea. The definition of an ACO is somewhat vague. Essentially the idea is to have groups of providers (group practices, individual providers, hospitals) …

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A Challenge and an Opportunity: Health Reform at the State and Local Level

Many commentators have noted that the success or failure of health reform will be determined by how well it is implemented by the Department of Health and Human Services – in particular, the Centers for Medicare and Medicaid (CMS). There is no question this issue is critical, and it is precisely why HHS is quickly issuing regulations for the elements …

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A New Theory of Health Insurance: Preventive Care and Health Care Reform

In all of the commentary about The Patient Protection and Affordable Health Care Act, little has been said about the dramatic change in the theory of health insurance that was embedded in the Act. While there are many changes to health insurance in the bill, most of them affirm the original foundations of health insurance in America: community rating, guaranteed …

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And Now for a Message about Public Health

With all the focus this past week on health care reform with a capital “H” (and a really boring official name, The Patient Protection and Affordable Care Act), a very important development relating to the public’s health could easily have been missed: a seminal ruling by New York federal court judge Robert Sweet. Judge Sweet’s March 29, 2010 ruling invalidates …

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