This is a blog by a former CEO of a large Boston hospital to share thoughts about negotiation theory and practice, leadership training and mentoring, and teaching.
I found your blog following a link about the death of A. Stone Freedburg by his grand-niece Susan Estrich. I would like to point you to an article written in The Atlantic Monthly which I thought you and your readers would find to be of interest, ..."Please forward this on to your friends, tell them that I found it and tell them to read every page. It is absolutely worth it and so much more true than any republican or democrat spin." http://www.theatlantic.com/doc/200909/health-care/3
So cogent that we even transcribed parts of it over at the Albert Schweitzer Fellowship's blog: http://schweitzerfellowship.wordpress.com/2009/08/21/asf-board-member-paul-levy-talks-health-care-reform-on-necn/ Your NECN interview brings an interesting perspective to our blog, especially since most of the Fellows we've interviewed so far in our health care reform series (http://schweitzerfellowship.wordpress.com/?s=fellows+weigh+in+on+health+care+reform) have favored a public option. Thanks for sharing this interview, Paul!Patrice TaddonioThe Albert Schweitzer Fellowshiphttp://www.schweitzerfellowship.orghttp://schweitzerfellowship.wordpress.com
Well, there's nothing more informative than listening to a couple of well-off white guys talk about what they think is good for everybody else.I was a little surprised that you dismissed the charge that a public option is just a back door to a single payer system right out of the box (you said it was "overstating" the matter, whatever that means), even though you headlined a recent blog entry 'Back door single payer will not happen.'Then, with 5 minutes to go on the interview, you finished up on the reasons why you don't favor a public option by saying that you're afraid it'll be a back door to a single payer system.I'd love to see you sit down with a real news person. You know, a reporter with health policy cred who's interested in doing more than just hacking up stale bits of conventional wisdom. (And I'm someone who thinks Chet Curtis is one of the best we have on TV in these parts. That's sad.)For example, when you say that "people" (I guess you mean the folks who chose you as their spokesperson) want to know "what are the actual tangible benefits" of health reform, a good reporter would follow that up by asking you to lay out the tangible benefits of having health insurance companies in the equation to begin with.Yeah, we've been over this before, though I've given up on ever getting a straight answer from you. And I wouldn't expect you to go all deer-in-the-headlights over the question, but it would be interesting to see if you could say out loud your written response to me in this blog, and still keep a straight face.Anyway, since fewer people watch NECN than had a cold gin and tonic in their vacation homes on the Cape last weekend, not too much harm has been done.
Jerry,You skirt the boundaries of racism in the first sentence of this comment, but I decided, for the sake of allowing all points of view, to post it nonetheless.The people submitting comments on this blog for the last three years have found ways of expressing their opinions without resorting to these kind of characterizations. There has been a lot of good give-and-take.If you would like to try to do the same, you are welcome to stay. If not, please go to one of the other health care and political sites in which that kind of comment is welcome.This is not about your point of view, which is interesting and valuable to hear. It is about the standard of conduct for this blog, which I intend to enforce.Paul
Jerry, it's so hard to respond to you because you like to throw dirtballs, not ideas. I've read this blog since the beginning and it has served a great public purpose. You don't walk into a place like that and start messing it up with personal attacks. To imply that Paul Levy is in ANYBODY's control is hilarious. To attack Chuck Curtis, well, I deeply disagree. He is a terrific journalist. And I hate rich people as much as the next person, but Paul is not in that category. Check around town to see how much he gives. Jerry, please take your comments to a higher level.
Paul, thank you for summarizing the health care debate so well. I for one find it impossible to follow. The debate is a mess and it is us at our worst, and there's no one plan to figure out. I finally "get" what the issues are. I needed this kind of smart discussion.Thanks.
Jerry,Are you by any chance Jerry Springer?Mary
Did you want Chuck Curtis to throw a chair at Paul Levy? He's a wonderful journalist. The fact that he has standards of journalistic behavior is why I like him so much.Jerry,we readers are grateful to Paul for this blog, even when we disagree so strongly that WE want to throw a chair at him! The point is that when you feel rage you let it out before writing. Otherwise, you're in danger of becoming one of those yahoos on TV. Don't go down that road - your ideas are valuable.
Racism? Are you saying you're not well-off?Seriously, I think it's interesting that, rather than address the substance of my comment, you choose to focus on my use of the expression "well-off white guys" as a way to make me the problem.What's up with that? I guess it's a convenient way for you to dodge the issue. I call it "pearl-clutching."Wann stop clutching long enough to address the seeming disparity between what you first said to Chet, and what you've written on this blog (and also later said to Chet)?BTW, thanks for saying that my point of view is "interesting and valuable to hear."I didn't know you felt that way ;^)
Test your sentence this way, Jerry. Put in another category of people, instead of "white guys" -- Catholics, lesbians, Asians, residents of Maine -- in a sentence like yours to get a sense of how offensive it is when you label someone as part of an attempt to denigrate his or her presentation or point of view.Likewise with regard to income. It is the oldest trick in the world to try to undermine someone's argument by stating that they have a certain economic status. But it is simply mean to do so and, as with regard to race and other characteristics, tells you nothing about a person's values -- or the merits of their point of view.
I like what you said in this interview. At times I feel really hopeless about health care in this country and am worried which direction it may take. The idea of subsidizing those that need it, but keeping it competitive by keeping the providers private, makes good sense.I think I'll read more about the Netherlands' system: what has worked and what could be improved, plus how it would translate here. I AM scared of paying more (enough, already!!!), but don't want anyone in a rich nation such as ours to go uncovered.And your comments about primary care are so true; my husband and I haven't had a family physician, ever, and frankly avoid doctors. Not very smart.
There was a brief blurb somewhere recently, indicating that there is actually little competition among health insurance companies, with single large companies dominating the market in places like Maine (where one company has 71% of the market) and smaller players at a distinct disadvantage. It seems that it was this distortion that led to the consideration of a public option. Some people think that this is due to their antitrust exemption and favor repeal.I am interested in what you might think of the link below concerning "redefining competition" from Porter and Teisburg (I am determined to resurrect their construct!). Note it came out in 2004, before the current debate:http://hbr.harvardbusiness.org/hbr-main/resources/pdfs/comm/philips/redefining-competition-health.pdfEven if one agrees that their redefinition would require huge changes in the industry, I think their analysis of what is wrong with the current system is quite accurate.nonlocal
I was not so keen on much of the Porter-Tiesburg book, although I might be persuaded otherwise. See today's post and the article referred to there for an interesting point of view that Michael and Elizabeth might like: http://runningahospital.blogspot.com/2009/08/and-now-for-entirely-different-view.html.
Part 1 of 2OK, Paul, I’ll play this one straight. Let’s see if I get any responses based on the substance, and not on the style.Your little talk with Chet was pretty much a faithful video version of what you say here on the topic of health policy. I think you’re too often glib and superficial in both venues, at best. At worst, I think you’re disingenuous.I’ll just point out your most egregious offenses.You tossed out the terms “extreme right” and "extreme left” to characterize a wide range of opinion. Those terms have absolutely no meaning, except as overt stereotypes to demonize or dismiss people without bothering to provide any context.That’s not just lazy, it’s patently offensive. Put another way: It is the oldest trick in the world to try to undermine someone's argument by caricaturing their politics. But it is simply mean to do so and tells you nothing about a person's values -- or the merits of their point of view.Who were you talking about, exactly – either known individuals or specific groups? What points of view, concerns, or criticisms do you include in this characterization?I’ve watched you indulge in this kind of sloppy shorthand before, and you seem to do it all too easily. It poisons any attempt to conduct an informed discussion.It also conveys a false equivalence, where everything gets lumped together and is treated with equal disdain.Are you saying, for example, that the nutjobs waving signs showing Obama with a Hitler mustache are no different than members of the Congressional Progressive Caucus who’ve signed a letter to Speaker Pelosi pledging to vote against any bill that does not include a robust public option?You used a cheap rhetorical trick, Paul.
Part 2 of 2As noted previously, I was surprised at the start of your little talk with Chet when you said that calling the public option a backdoor to a single payer system was “overstating” things, even though you titled a recent post Backdoor Single Payer Will Not Happen.You then finished up your reasons for opposing a public option by saying that you're afraid it's just a back door to a single payer system.So, you get to portray yourself as the voice of reason and moderation, beyond the taint of unnamed ideological extremists in one breath. In the next, you parrot the very same kind of critique you attribute to them.Now, I would expect an attentive journalist to catch that cute trick, and to confront you with a follow-up question to settle the matter. Heck, I’d expect a green-horned blogger to at least skim your posts prior to your little talk, and to scroll down far enough to see the title of your August 16th entry. That’s a no-brainer, especially if the whole intro to the video is based on the whimsy that you write online.But I guess Chet didn’t bother himself with that rudimentary task or, if he did, that he forgot about it or decided not to bring it up, so as not to ruffle any feathers.We could analyze the whole transcript. There are plenty more examples.But really, what would be the point?You’ve shown some people that you can help turnaround a failing hospital, and you’ve shared pieces of that story, for whatever reasons you’ve chosen. Fine. As long as you write about what you actually know, you’re on solid ground.I guess the best way to express my disappointment in how you’ve exploited your visibility to promote vague half-truths and present your own opinions as facts, all in the interest of maintaining a dangerous status quo, is to point back to a comment by someone who appears to be a BIDMC employee. It comes at the end of a thread(scroll down) that started July 27th, and that everybody else had probably moved on from long before it was posted:” I think you are on the wrong side in this, Paul. It saddens me because I know how much you care about the patients in our facility. This is one time when I really hope you come out on the losing side.”We’ll deal with your pearl-clutching another time.
Jerry,Thanks very much for your thoughts.I am sorry if you feel that comments made in a 6-minute live interview are inconsistent with comments made here, or that I somehow used poor rhetorical techniques.As to promoting half-truths, I think that most readers here know that I express my opinions as opinions, based on my knowledge at the time.As for "exploiting my visibility," I really wonder what you mean. I am only visible in the blogosphere if people choose to read this blog. Blogs rise or fall in viewership depending on the extent to which people find them valuable in some way. If enough people share your low opinion of what I say, pretty soon I won't be even a blip on a Google search.
And by the way, Jerry, I did not publish your next comment because it's entire purpose was to link to an article filled with profanity. If you think it is worth having people see it, why don't you link to it on one of your blogs?
Avoiding all the grenades thrown in the last few comments, I actually did take Jerry's advice and review the July 27 "waving the magic wand" post. Yes, I had seen Brenda's comment. Once again, I advise people to read the entire comment rather than partial quotes taken out of context.I do wish to address, however, one point of Jerry's made in that comment thread - to wit, his desire that for-profit insurance companies be eliminated from the equation. Today's Washington Post had an article on p. B3 describing the practices of insurance companies in foreign countries.(I will post the link in next comment when I find it.) It said:"The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health care coverage."This is an interesting statement. Anybody know if it's true?nonlocal
The Washington Post link to which I referred previously (see item #5):http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.htmlnonlocal
Here's a nice summary of the Netherlands plan -- http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2008/May/Universal-Mandatory-Health-Insurance-in-The-Netherlands--A-Model-for-the-United-States.aspx. The article makes no mention of a limitation on profitability of those firms, so I am not sure whether it answers your question. I'll keep looking, and others can, too.
And here's the Wikepedia refernce to the same -- http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands. Likewise, it talks about private insurance companies, but makes no mention of a limitation on profitability, so it too may be inconclusive. It would have been an odd omission, though, don't you think, for that would surely be an important feature to mention if it were the case. Let's see if others can offer more information.
Finally found a good one! A paper from the Commonwealth Fund: THE SWISS AND DUTCH HEALTH INSURANCE SYSTEMS: UNIVERSAL COVERAGE AND REGULATED COMPETITIVE INSURANCE MARKETS Robert E. Leu, Frans F. H. Rutten, Werner Brouwer, Pius Matter, and Christian Rütschi January 2009 AbSTRACT: As the United States resumes debate over options for achieving universal health coverage, policymakers are once again examining insurance systems in other industrialized countries. More recent attention has focused on countries that combine universal coverage with private insurance and regulated market competition. Switzerland and the Netherlands, in particular, have drawn attention for their use of individual mandates combined with public oversight of insurance markets. This paper provides an overview of the Swiss and Dutch insurance systems, which embody some of the same concepts that have guided health reforms adopted in Massachusetts and considered by other states and by federal policymakers. The two systems have many features in common: an individual mandate, standardized basic benefits, a tightly regulated insurance market, and funding schemes that make coverage affordable for low- and middle-income families. Differences include degree of centralization, basis of competition among insurers, availability of managed reliance on patient cost-sharing to influence care-seeking behavior.And, on the question you raise, it says: "The Netherlands operates a national insurance market for its 16 million residents. Plans may operate on a for-profit or nonprofit basis.""In Switzerland, only nonprofit insurers may participate.""Since 2006, premium competition in the Netherlands has been vigorous, with carriers accepting initial losses under the new system to build market share. Both Dutch and Swiss insurance systems operate with relatively low overhead costs by U.S. standards: administrative and profit-margins account for about 5 percent of premiums. ""The Dutch health insurance system is a work in progress, with the 2006 universal coverage law just the latest in a series of gradual reforms overseeing regulated insurance markets. This process has required consensus and ongoing commitment by successive governments to a basic framework for health reform. The Swiss program has been in place since 1996. Some of its shortcomings, in areas such as risk adjustment and provider contracting, have proved difficult to address, in part because of split responsibilities for health care under Switzerland’s federal system of government. This may have important implications in considering the right balance of federal and state responsibilities in health reform in the United States. Despite the challenges, both systems can boast many successes as well. Both have achieved universal health coverage among their citizenry, with patient choice, broad access, and low disparities. Residents in both countries enjoy among the longest life expectancies in the world (Switzerland is second only to Japan), and both systems have wide support of the citizenry. These achievements highlight the potential value of investigating the experiences of both countries."
Now we're really getting wonkish, but it beats throwing ideological bombs. Since Barry Carol seems to best understand this stuff, I'd be interested in his comments on these paragraphs in Paul's cited paper from the Commonwealth Fund:(1) "The Netherlands operates a national insurance market for its 16 million residents. Plans may operate on a for-profit or nonprofit basis. The insurance market is highly concentrated, with the top five plans accounting for 82 percent of enrollment. Plans typically offer coverage in all areas of the country and include all providers, although selective contracting is allowed. Children are covered in full through public funds. Premiums charged for adults represent 50 percent of the expected annual costs. In addition, plans receive allotments from a national risk equalization fund, financed by income-related contributions. The allocation uses a sophisticated range of risk factors. As a result of this process, the premiums facing Dutch adults when selecting a plan vary within a narrow range.(2)In both countries, funds are redistributed among insurers on the basis of measures of population need. The measures in the Netherlands have grown steadily more sophisticated and have proven better able to predict utilization than the simpler system adopted in Switzerland by the government. As a result, differences in insurer prices in Switzerland often reflect levels of enrollee risk, rather than relative efficiency. It is expected that the modification of the risk formula in 2012 will substantially reduce these differences.My questions:Translate the national risk equalization fund into English? Is there an analogous structure in the U.S.? It's financed by "income-related contributions"? Does that mean a regressive tax?"In both countries, funds are redistributed among insurers...."Are they talking about the national risk equalization fund monies? Again, how would this transfer to the U.S.? Does the Mass plan contain anything like this on a state level, Paul?If you're getting tired of me, just ignore me. I am retired, after all, and have more time than others. (:nonlocal
And look at a parallel discussion between Barry and Epatient Dave on the "How to deal with the public option" post.
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