Playing Poker with Health Reform

The National Journal’s December 5th issue has a very interesting article comparing President Obama’s approach to key issues to his poker playing style. (The issue cover states, “Obama as Poker Player.”)

Having played poker for over 45 years, I find the article’s discussion of his cautious approach and preference for standard games very enlightening. For many people today, poker is about Texas Hold’em, a game that is great for TV but rather simplistic in some ways because each player only has 2 cards and shares 5 others. The National Journal discusses the intellectual, strategic, and personality difference between this game, and more sophisticated games such as five-card draw and seven card stud – as well as more “wild” games such as baseball, although it doesn’t mention my crazed favorite, midnight baseball.…

Historical Perspectives on Health Policy: Part 3

December 4, 2009 / Michael D. Miller MD / Comparative Effectiveness, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Miscellaneous / 1 Comment

I just found my copy of the book “Improving Health Policy and Management” edited by Stephen Shortell and Uwe Reinhardt. The book’s eleven chapters address many of the hot-button issues in today’s health reform debate:

Creating and Executing Health Policy
Minimum Health Insurance Benefits
Caring for the Disabled Elderly
An Overview of Rural Health Care
Effectiveness Research and the Impact of Financial Incentives and Outcomes
Changing Provider Behavior: Applying Research on Outcomes and Effectiveness in Health Care
Health Care Cost Containment
Redesign of Delivery Systems to Enhance Productivity
Medical Malpractice
Prolongation of Life: The Issues and the Questions
Challenges for Health Services Research

The observant ready will notice one critical issue from today’s debate missing from this list… Information technology. …

More on Medicare Medical Home Demonstrations

October 28, 2009 / Michael D. Miller MD / Health Policy and Communications Blog / 1 Comment

Last week, I wrote about the new “Advanced Primary Care” (APC) model demonstration announced by the Department of Health and Human Services, and how it might interact with the previously announced – but not yet implemented – Medicare Medical Home demonstrations. In that post I noted that the healthreform.gov fact sheet stated the two demonstrations would move forward together in 2010, and the CMS webpage for the Medicare Medical Home demonstration hadn’t been updated since April. Well, both of those situations have changed. The CMS webpage was updated on Monday stating that the Medicare Medical Home Demonstrations will not be moving forward because the House version of health reform legislation would repeal the Medicare demonstration and replace it with two other medical home demonstrations – one independent practitioner-based and the other community-based. …

Wavering Health Reform

July 12, 2009 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Politics / 1 Comment

As news of some disharmony in the efforts to reach consensus for health reform legislation sprayed out from Washington, I’ve been trying to find the words to explain what this means. It’s always been clear that the “devil is in the details” and that when it came time to forge enough agreement to pass legislation, (as it did last week), there would be ups and downs as provisions are modified, dropped and added.

Beyond that simple description, it would take many, many words to explain how the process for achieving success in health reform legislation could work. So instead, below are some pictures, that I hope will be worth thousands of words more than the brief comment below each one.…

Making Health Reform Work

May 1, 2009 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Miscellaneous / No Comments

With momentum for health reform continuing to build, events have overtaken the scope of the book I’ve been writing – which has had the working title “Fixing the US Healthcare System.” Therefore, I’m reconstituting the draft text and outline to increase the focus on how to effectively implement changes in the healthcare system – while still discussing the substance of reform. To highlight the need and importance of effective implementation, the new working title is “Making Health Reform Work.” (A one page summary of the book can be found here.)

“Making Health Reform Work” will be different from other health reform books by going beyond just describing the health system’s problems and recommending solutions, to also exploring processes for effectively implementing positive changes and reforms.…

Butterfly Effect in Health Reform

April 16, 2009 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Politics / No Comments

A short piece about Tom Daschle in last week’s National Journal made me think about the importance of the presence, actions, and attitudes of individuals for the direction, success and failure of health reform initiatives. This is sort of like the “Butterfly Effect” of health policy. [Background: The “Butterfly Effect” is a thought experiment related to chaos theory, and is based upon the theoretical concept that how a butterfly flaps its wings can dramatically change the weather thousands of miles away.]

Senator Daschle was very qualified to lead the Administration’s efforts on health reform, but several factors led to his removing himself from consideration to be Secretary of HHS. …

Avoiding Drug Interactions – Advice from the FDA

December 2, 2008 / Michael D. Miller MD / Health Policy and Communications Blog / 1 Comment

As new and better medicines are developed, people are taking more medicines on a regular basis. (It is estimated that about 20% of people take 3 or more medicines for chronic conditions.) This is a good thing for improving health, but it also presents potential problems when medicines interact with each other, or they interact with foods, over-the-counter medicines, or dietary/nutritional supplements that people are also taking. That is why it is always important to talk with your doctor and pharmacist about your medicines and any other things you are taking.

To provide people with updated information on this issue, the FDA recently released a new Consumer Information document titled, “Avoiding Drug Interactions.…

Spreading the Wealth

November 5, 2008 / Michael D. Miller MD / Economics & Financing, Health Policy and Communications Blog, Politics / No Comments

In the Presidential campaign, one of the criticisms of Barack Obama’s positions was that he wanted to, “Spread the wealth.” This sprung from a comment he made to Joe “the Plumber” Wurzelbacher in Ohio about his tax proposals not increasing taxes for anyone earning under $250,000/year. This was one of the issues that was pretzelized in the closing weeks of the campaign, which is why I was interested to see a graph showing the income distribution in several developed western countries in a recent issue of the Economist in an article titles “Pain all around, please.”

This chart – using OECD data – shows that while all these countries have wide distributions between the highest and lowest income groups, the spread in the United States is by far the greatest. …

Communicating Health Information and this Blog’s Goals

October 30, 2008 / Michael D. Miller MD / FDA, Health Policy and Communications Blog, Information & Communications, Quality of Care & Safety / No Comments

Noting that I’ve written about a wide variety of health and biomedical research issues, someone recently asked me about the focus of this blog. My response was that my goals are two-fold: First, to present synthesized information – created by combining different sources and analyses – in ways that provide new perspectives on important issues so that people have both broader and deeper understanding of these issue. And second, to reach multiple audiences with this information and perspectives so that the spectrum of healthcare stakeholders can better communicate and understand each other. Which is just stating in a different way what I wrote in my first posting, that the reason I started this blog was “to provide stakeholders of all types, (such as patients, clinicians, administrators, payers, researchers, regulators, legislators, etc.)…

Ben Franklin’s Virtues and the Pennsylvania Primary

April 1, 2008 / Michael D. Miller MD / Health Policy and Communications Blog, Nutrition, Politics / No Comments

While reading a Ben Franklin biography (“The First American,” by H. W. Brands), I was struck by a list of 13 virtues he wrote while in his mid-20s to guide his life:

1. Temperance. Eat not to dullness. Drink not to elevation.
2. Silence. Speak not but what may benefit others or yourself. Avoid trifling conversation.
3. Order. Let all your things have their places. Let each part of your business have its time.
4. Resolution. Resolve to perform what you ought. Perform without fail what you resolve.
5. Frugality. Make no expense but to do good to others or yourself: i.e.,…

Technical Difficulties

March 4, 2008 / Michael D. Miller MD / Health Policy and Communications Blog / No Comments

Sorry to have not posted anything recently, but I’ve been having some technical difficulties. I hope to have these resolved in a day or two, and will be posting more about evidence-based medicine ASAP. Thanks for your patience.

Addendum (3/6/08 – 5:00 pm Eastern time) – Many thanks to Chris Carlson for fixing things…. As promised you are a wordpress “genius.” THANKS!!!!…

Health Groups Lobbying & Executives’ $$$s

February 19, 2008 / Michael D. Miller MD / Economics & Financing, Health Policy and Communications Blog, Nutrition, Politics, Public Health / 2 Comments

The February 16th issue of National Journal has its biennial salary report (2006 data) for national advocacy and trade associations. Since most of my posts have been too long I’ll keep this one short with two (OK – actually three) interesting points:

First, in addition to salary information, National Journal reports on lobbying spending of various organizations. It’s not surprising that 3 of the top 10 trade associations [501(c)(6) organizations] in lobbying dollars are from the health industry: PhRMA, AMA, Am. Hosp. Assoc. But what is interesting, is that all of the top 5 non-profits [501(c)(3) organizations] in lobbying spending are health related organizations: Am.…

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