DCMedical News: December 21, 2017
DCMedical News
Washington, D.C.
Healthcare, Medical Education
December 21, 2017
Holiday Greetings, In The Manner of Frank Sullivan
At this point in time we celebrate the holidays, several types, none “established.”
Following celebration, we take the holidays off (Congressional model, campaigning at home!), resuming early January.
Stopgap spending, where will it end? Not much for the health field, but more to defend. CHIPs, DHSs, Extenders and more, disaster in P.R. but not in p.r. Veterans get service, but not always as quick; somehow we forget the many ways to be sick. Sixty votes not needed, the Dems are unheeded, “market stabilization,” “reinsurance,” among words we weeded. January approaches, with Alexander and Collins, reinsuring, cost-sharing, stop-gapping again.
This Christmas we post, with a nod to Tim Jost, applause for Medicaid’s Katherine Baicker. Bundled payments all over, from DSRIP to Dover, and hello to Professor Michael Sparer. For the overview larger, John Iglehart’s news, for the trenchant and witty Jeff Goldsmith’s got clues. Michael Dowling growing, as inpatients are not, with urgent, hospital, community, the lot. Some smarter each year, that Howard Berliner, some growing in clout, estimable Jeff Kraut.
Anuj Mehta, Bob Watson, Chuck Blatt, all friends. Douglass Myers, JB Silvers, John Richard, to boot! Then Falguni Sen, Lois Uttley, Mitra Behroozi, Sherry Glied, New Yorkers it’s clear, to them is the Empire dear.
And the doctors we want, the ones who inspire, Lucchesi, Holt, always looking higher. The Physicians Foundation, their champ in the field, Tim Norbeck checks in to see fairness dealed. Larry Brown, Edgar Cahn, very good for our times, and Michael Gusmano aging in pleasant climes. Jack Rowe, a leader, John Rugge a mensch, Paul Levy observing, too long on the bench.
Friends and idols gone, from Reinhardt to Ginzberg, and E. Richard Weinerman, of whom all would say few would be finer men.
“In fine, here’s looking at you, friends, as this preposterous year ends;
Frohliche Weihnachten, liebe Kinder—
And Heaven send us a mild winter!”
(Frank Sullivan, The New Yorker, December 24, 1973)
Top Ten (Entirely Anticipatable!) Events for 2018
(1) House Speaker Ryan will pursue “entitlement” programs. But Republicans have their eye on the calendar, 2018 being one of these years in which, on the first Tuesday after the first Monday in November, scoring takes place. The Pres. has their back, deferring Tax Act signing until January, pushing painful sequestration (Pay-go “fixes”) into overtime, and 2019.
(2) CHIP will limp along, (re-authorized, but not generously appropriated), with occasional bouts of largesse to red states (Texas, near 25% uninsured even before PPACA weakening).
(3) DSH: Will slowly disappear, as anticipated in PPACA. What psychologist would have predicted that 19 states would decide to avoid 100% federal money? And how about the (predictable!) consequence of out-of-pocket burdens which have grown health care bad debt?
(4) Opioid overdoses will continue to be a prominent and growing cause of death and expense. The wild card: lawsuits, which worked for tobacco when little else did.
(5) Pharma will discover that “real world evidence” may be a more difficult basis on which to demonstrate efficacy, compared to carefully curated clinical trials, direct-to-consumer glossies and astroturf “patient” groups. Gottlieb a smart guy, hopefully, our smart guy.
(6) Voters in 48 more states (following California and Ohio) will continue to oppose price controls on drugs that don’t affect them personally, although their views may change at the pharmacy check-out counter.
(7) New ways will be found to use the word “value,” not many of which will prove to be of value.
(8) Practicing physicians will scramble to avoid whirling blades of reimbursement menace, still more throwing in the towel to become execu-meds, with “nonprofit clinical” income exempt from the new excise tax.
(9) Commentators will continue to pump the deconstruction of the hospital. Health costs will rise, unexpectedly.
(10) Health policy experts will rediscover: gaming by Medicare Advantage carriers, gaming by Medicaid managed care carriers, and tax policy.
Best wishes.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com