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CPBJ Extra Blog

Would it have happened anyway?

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“If no one had ever heard of Obamacare,” Harold Pollack wrote in an Aug. 9 blog, “many of these same provisions would be in-play.”

He was referring to the law’s “myriad of provisions that support pretty much every cost-containment idea proposed by health policy experts over the past thirty years,” and he draws a distinction between those and the ones that expand government regulating insurance markets and transfer “nearly $200 billion per year down the income scale to expand coverage to tens of millions of people.”

Maybe, he said, health care reform would be less polarized if the law had “simply expanded coverage by raising taxes without attempting broad delivery reforms.”

That’s an interesting idea, and if you have thoughts on it, I’d like to hear them.

But I’m more fascinated by Pollack’s assertions that the various delivery reforms were inevitable, that “whatever happens to the politics of health care, medical providers will be increasingly compensated for care episodes based on outcomes and process quality measures.”

Certainly the trends in American health care costs have been headed in problematic directions for a long time. And, yes, some of what we often think of as “health care reform,” such as the Meaningful Use incentive program on electronic health records, was around before Obamacare became law in 2010.

But do you think that if Obamacare didn’t exist, we’d still be looking at all the — deep breath — accountable care organization, accountable care agreement, patient-centered medical home, bundled-payment and pay-for-performance initiatives we are today?

I lean toward no, frankly. The big thing I know about said initiatives is that they require significant change on the part of providers, and I tend to think that such change doesn’t tend to take place on a market-wide basis unless it’s forced. And although health care costs have generally been inflating at an alarming clip every year for who knows how long, it seems to me that it’s just since Obamacare that we’ve seen organizations really pushing the “start” button on them.

What do you think?

• • •

Remember Dr. Harold Paz? You know, the guy who led Penn State Milton S. Hershey Medical Center and the associated medical school for a bunch of years until he left on July 28 for Aetna?

An SEC alert popped up in my mailbox with his name on it, and I thought you might possibly like to know that his new employer gave him a stock appreciation right of 20,321 shares at a conversion price of $75.83. It’s exercisable in three annual installments beginning Aug. 11, 2015.

And if you, like me, have not previously been familiar with the term “stock appreciation right,” I’d like to direct you to this short and helpful definition.

• • •

HHS has stopped issuing reports on how many people have obtained coverage through Obamacare’s marketplaces, but two items of note have emerged on that front recently.

First, CMS announced that it was starting a “hey, NOW we’re really serious” campaign to get about 310,000 enrollees to resolve questions on their citizenship and immigration status; if they don’t, they’ll be kicked off their plans on Sept. 30. Pennsylvania was fifth on the “Got Most Letters” list with 12,600, following Florida, Texas, Georgia and Virginia.

Second, there’s this, which strikes me as a tad hyperbolic in tone but nevertheless has good info: “ObamaCare Enrollment Falling Significantly, Insurers Reveal.”

• • •

And I quote: “The Obama administration has set an Aug. 22 deadline to unveil new procedures for religious nonprofits claiming an objection to the Affordable Health Care act’s birth-control mandate.”

• • •

If you’re pressed for time, just look at the illustration on the second page of this story: “Instant Replay — A Quarterback’s View of Care Coordination.”

• • •

Finally, prevention: “We pay what seems like a lot of money right now, because we will save a lot more money in the future. ... The problem there is that the costs and the savings aren’t felt by the same groups. ... This is one of those moments when a single payer system seems to make more sense.”

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