The Lucidicus Project is pleased to present the September 3, 2009 edition of the Health Wonk Review.

First, some introductions may be in order. For Health Wonk Review readers who are new to The Lucidicus Project, we are an independent educational initiative that helps medical students learn about the philosophic case for capitalism in medicine and healthcare. In essence, we help to clarify the moral and economic arguments for free markets and individual rights. Our mission is to give out what we call our "self-defense kit" to medical students. We also regularly publish editorials; the full archive is available online.

For Lucidicus visitors who are new to the Health Wonk Review (HWR), the HWR is a compendium or "carnival" of self-submitted writings from health policy blogs. It is hosted by bloggers and organizations on a volunteer basis, and published every other week. For readers, it serves as a convenient biweekly digest. For contributors, it provides exposure to new readers. The Lucidicus Project hosted the HWR once before, back on August 24, 2006. That edition featured twelve entries; you can see from the number of entries below that the HWR has grown quite a bit.

The next edition of the Health Wonk Review will be hosted by Richard Elmore at Healthcare Technology News. The publication date will be September 17, 2009. The deadline for submissions is 9am Wednesday, September 16, 2009.

Below are this edition's entries. Since the Health Wonk Review is not primarily a political forum, my summaries are intended to be purely descriptive, with no editorializing (even when I disagree with the authors).

NEWS AND CURRENT EVENTS (1 item)

1) Aaron Rogier reflects on the passing of Senator Edward Kennedy in The Twilight of a Dynasty, noting that the Senator has left an indelible mark on American public life. Mr. Rogier also points readers to an interesting Newsweek essay written by Kennedy in which he calls healthcare the political cause of his life.

HEALTH REFORM (9 items)

2) In the aftermath of Senator Ted Kennedy's passing, Dr. Jaan Sidorov wonders whether the mainframe-style one-size-fits-all approach to healthcare will survive in a world that is increasingly networked, organic, and decentralized. Sidorov suspects that part of Americans' discomfort over the Democrats' plan is that many intuit that healthcare needs to be more adaptive, local, and personalized. He calls the new approach "synaptic healthcare."

3) Austin Frakt gives a brief review and some commentary on Professor Jacob Hacker's recent paper on the public option. Hacker sees three roles for a public plan: (1) as a benchmark on cost and quality that private plans will need to meet in order to compete, (2) as a backup option that would provide security to those lacking good group insurance options, and (3) as a backstop to force down costs over time with payment and care delivery innovations. According to Frakt, the reason health reform legislation is currently struggling in Washington is because of the involvement of special interests.

4) Amer Kaissi is writing a multi-part series on issues in the health reform debate. His first installment is on the underinsured, an issue he calls The Sleeping Giant in the Healthcare Crisis. Studies show that underinsured people are less likely to see their doctor, get recommended tests, or fill prescriptions when they are sick. In Kaissi's view, the "problem of the underinsured is just as important to healthcare reform as that of the uninsured."

5) Paul Testa believes that the health reform movement needs the support of "people like Chris," a former nurse from western Ohio who presently works in hospice care and teaches a class on medical ethics. Read the entry: Health Reform: For Chris's Sake.

6) Kostub Deshmukh compares healthcare in the U.S. and India in his piece Obamacare vs Indiacare. According to Mr. Deshmukh, healthcare in India has the vice of being dismal but the virtue of being cheap. Why are costs so much lower in India? According to Mr. Deshmukh, India has a surprisingly free market in healthcare. Consumers are free to go to any doctor they wish to—public hospitals, expensive private clinics, or the neighborhood doctor. Because the consumers bear the entire cost of their treatment, they choose the doctor based on the value and utility of the treatment. Says Deshmukh, "A patient who wants to be mollycoddled and has the resources will go to an expensive clinic while a person who doesn’t want the extras and is content to wait in longer lines will go to the neighborhood doctor."

7) Brian Klepper and David C. Kibbe expose Health Care Reform’s Deeper Problems, writing that the current health reform proposals expand coverage, but do little to reduce cost. Klepper and Kibbe would like to see a proposal that re-empowers primary care, makes quality and cost transparent, and addresses the problems with medical malpractice.

8) Joe Paduda presents a two-part piece on health reform: Part I is The future without healthcare reform, Part II is Your life without healthcare reform. Mr. Paduda outlines the expected cost increases, and suggests that in order to stave off the unsustainable growth, the U.S. may end up with single payer, Medicare for All, or some version of the German or Swiss or French systems. He says that those who champion freedom and the American tradition of independence are "false patriots" and predicts that they will be drowned out by others who are desperate for insurance.

9) Anthony Wright sees Public Options All Over the Place, and wonders why this idea is receiving so much attention in the healthcare debate. Given the existence of the U.S. Post Office, public universities, and other similar entities, he feels that the public option is actually downright American.

10) Mike Feehan, questions whether advocates of ObamaCare understand the implications of creating a government mechanism that has the legal power to deem people not fit to receive medical care. Under the proposed plan for health reform, who exactly would be making those life-and-death decisions? See: The Ultimate Tax Authority.

POLICY AND REGULATION (4 items)

11) James J. Gormley defends the safety of nutritional supplements and questions the need for additional FDA oversight in a recent piece titled Lawmaking and the GAO Report: A Dose of Reality. According to Mr. Gormley, the Serious Adverse Event Reporting (SAER) Law already well protects consumers and has already demonstrated its ability to provide a signal to the FDA for action.

12) Julie Ferguson Reports that states are moving to enact legislation banning texting while driving, now referred to by the acronym "TWD." Ms. Ferguson links to a graphic public service announcement, while Jon Coppelman looks at a new TWD law in New York and wonders whether a half a loaf is better than none. [Editor's note: As the Gregory Brothers warn, "people on the road / can turn an LOL / into a great big OMG."]

13) Louise Norris would like to see homebirth midwifery legalized and regulated in every state. She would also like to see it as a covered expense on any health insurance policy that covers maternity. In Colorado, home birth midwifery is legal and regulated, but midwives have to jump through hoops to get paid on the rare occasions when their clients' health insurance policies cover home birth expenses. Read more at: The Safety Of Planned Home Births.

14) Colin Hockings questions whether should people be punished for participating in an assisted suicide. Mr. Hockings considers the question in the context of U.K. law. Read the full piece: Suicide, euthanasia and the keys to death's door.

HEALTH AND MEDICINE (3 items)

15) Jody Fransch gives a brief primer on Hypertension, a condition that she dubs "The Silent Killer." The causes of high blood pressure include obesity, smoking, high salt intake, low potassium intake, lack of exercise, and other factors. Fransch notes that simple dietary and lifestyle changes can often reverse hypertension in a matter of weeks without drugs.

16) The Concerning Kids Blog warns that Child Obesity Statistics Are Cause For Concern. Childhood obesity is on the rise in America, with experts stating that more than 2.7 million children are currently classified as severely obese. Many obese children grow up to be obese adults, and thus experience higher risks for various medical problems and recurring health issues.

17) Joe E. explains The Difference Between Type I and Type II Diabetes. In Diabetes Mellitus Type I, or insulin dependent diabetes, the pancreas does not produce insulin due to an autoimmune destruction. The patient always needs insulin; this cannot be cured. Type II is often due to an unhealthy lifestyle and/or a reduced insulin sensitivity.

MANAGEMENT, QUALITY, AND EDUCATION (7 items)

18) David E. Williams takes a closer look at the Broader implications of Aetna's new "never event" policy. Under the new policy, providers will forfeit all revenue received as a result of care provided resulting from preventable medical errors. Aetna is also putting into place new reporting requirements. Mr. Williams would like to see Aetna and others expand this type of policy to include other types of errors. If the new policy succeeds, then in true market fashion both Aetna and its patients will benefit as costs are driven down and quality and patient safety are both improved.

19) Dr. Glenn Laffel presents part II of a five-part series on the Impact of EHRs on Medical Education. The Obama administration has set aside $20 billion to promote the dissemination of EHRs because it believes that such technologies will have a favorable impact on the quality and costs of care. Dr. Laffel discusses the positive and negative impacts that this change will have in the education and training of new physicians.

20) Dr. Roy Poses, of Brown University School of Medicine, has posted an initial response as well as a follow-up to a recent NY Times article that proclaims anyone can run a healthcare organization "with a little studying up." Dr. Poses argues that in order to accomplish real healthcare reform, the industry needs healthcare leaders that know something about health care, have experience with the healthcare context, and appreciate the values of healthcare professionals.

21) Jason Shafrin ponders the question, Does Hospice Care Reduce Medicare’s Cost for End-of-Life Care? Over the past 20 years, there has been a trend toward providing greater hospice care. In the late 1980s and early 1990s, increased hospice care substituted for lower end-of-life inpatient hospital utilization. However, despite this trend, Medicare end-of-life expenditures still increased significantly over this time.

22) Jeffrey Seguritan discusses price transparency for health services in Healthcare Prices: Where's the Sticker Shock? Prices for services, writes Seguritan, are unpredictable and often outrageous. Prices should not be handled under the table, negotiated behind closed doors, or hidden from consumers. Greater price transparency, he argues, will increase the attention patients place on the value of the care they recieve.

23) Tom Emswiler argues that the pay-for-performance model will lead to better quality and greater value in his post QUALITY: It's About BETTER Health Care, Granny. He notes the results of the Medicare demonstration program conducted by North Carolina-based Premier, Inc.

24) Brady Augustine ponders why government does not pay for the full cost of care, calling it a chicken-or-the-egg type problem. Namely: do hospitals shift costs to private payers to make up for low government reimbursements, or do high margins from private payers depress the government margin? Mr. Augustine suggests that the answer may lie in wasteful hospital spending on construction and marketing.

HUMOR (1 item)

25) Last but not least, Madeleine Begun Kane shares with us an Open Limerick To President Obama posted on her blog Mad Kane's Political Madness.

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