Paul Mahoney, Account Director
Bio
Paul brings our clients deep knowledge and experience in strategic communications, public affairs and crisis management. He leads our teams for Blue Cross and Blue Shield of North Carolina and other health care clients, drawing upon his rich experience in the health care industry to provide strategy, marketing and public relations counsel.Articles
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Repealing Insurers Anti-Trust Exemption a Political Contrivance
Mar 4, 2010 :: Paul Mahoney :: 0 CommentsKaiser Health News posted a terrific article today debunking the popular -- but utterly misguided -- notion that repealing health insurers' limited anti-trust exemption will reduce health care costs. It is remarkable to me that members of Congress and public option fans are so passionately devoted to a concept that is obviously a red herring upon even a cursory review of the facts.
The authors – a Seattle anti-trust attorney and a Boston University health economist – also point out that overregulation on the health insurer side could well have the unintended effect of raising health care costs if it tips market balance in favor of large hospitals and provider groups.
Eighty to eighty five cents on the premium dollar goes to hospitals, doctors and drug companies. No matter how unpopular insurers are, their cut just isn't big enough to significantly change health care costs no matter how hard you squeeze it.We need health care reform -- not just health insurance reform.
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Health Care Summit -- or Nadir?
Mar 2, 2010 :: Paul Mahoney :: 0 CommentsAny remaining hopes that Congress might abandon the battle for partisan advantage to get something done on health care were definitively dashed by the recent Health Care Summit. Both sides stuck like glue to the intractable positions that have deadlocked the issue. Is anyone really surprised?
Both parties' stances are disheartening – poll-driven, cynical and oblivious to practical policy decisions that must be made to move forward. For their part, the Democrats continued to hang their hats on the vilification of insurers, an approach that polls well, but shoots the messenger while ignoring the real cost drivers in the system. Repealing health insurers' anti-trust provisions or creating additional layers of rate regulation will be popular with the left flank of the Democratic base, but do nothing to rein in health care costs or expand access.
Too much of the debate was wasted arguing over whether the CBO found that costs would go up or down under reform. Republicans are right that there is a fundamental difference between bending the cost curve and shifting costs through taxpayer subsidies. But they're wrong in asserting that this means doing nothing is the answer. The President would be better served by admitting there is a hefty cost, and explaining the long term benefits that investment could buy.
Republicans say legally requiring Americans to buy a product is a slippery slope. Fair enough, but I believe we have already crossed the Rubicon on that issue. Under 1986's Emergency Medical Treatment and Active Labor Act (EMTALA), anyone who shows up in an ER gets treated, regardless of their ability to pay. So if Federal law already requires health care to be provided to citizens, then it has to either compel them to contribute towards its provision or come up with another funding mechanism. Once again, government proves equal to the popular task – guaranteeing care – and unable to complete the considerably less popular task of paying for it. Hence our crazy quilt of cost shifting and hospital charges that bear little relation to actual costs.
I find it intriguing that in 1993 some of these same Republicans argued in favor of mandates on individuals to buy health insurance. At that time the individual mandate was seen as an "individual responsibility" approach superior to the employer mandates championed by the Clintons. Now, they argue that such mandates are patently unconstitutional. This is not a simple issue and it is very possible that the U.S. Supreme Court will agree with them.
Even more painfully, Rep. John Boehner (R-OH) trotted out the old saw about the U.S. having the "greatest health care system in the world." Such mindless boosterism ignores the inequity and inefficiency of health care in America.
We have already created a system where there is guaranteed access to care – too little, too late in many cases, but guaranteed nonetheless. Fair enough. Now Congress needs to find the backbone to require everyone to pay their fair share, too.
Unfortunately, the GOP has apparently decided that its members can comfortably run on "defeating" health care. Getting Democrats to commit to a difficult and complex reconciliation approach to run over them will be difficult – especially with unfavorable polling on health care looking like a major liability to moderate Democrats nervously facing stiff mid-term opposition.
It makes you wonder. If neither the majority nor minority party can get what it wants done, why are they fighting so hard to run Washington?
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Polls Show Discontent with Both Parties
Feb 9, 2010 :: Paul Mahoney :: 0 CommentsIf there is any agreement among political pundits these days, it is a sense that the GOP has the grabbed the political "mo." That's not unreasonable, what with President Obama's poll numbers dropping like a rapper's pants, a dismal economy, and the stunning loss of Teddy Kennedy's seat to a GOP neophyte in blue-blue Massachusetts. But the latest polling data from Rasmussen highlights some significant problems for both parties.
The rightward swing has been undeniably unkind to the President. Only 21 percent of Americans believe one of the central claims of President Obama's State of the Union address: that he's cut taxes for 95 percent of Americans. A majority (53 percent) say that has not happened and nearly half expect their own taxes to rise under Obama.
But Rasmussen data also suggest some challenges for their party's traditional candidates as well. In a number of races, GOP front-runners are losing ground to more conservative candidates. After an early lead in the Florida Senate race, Governor Charlie Crist is now trailing conservative Marco Rubio by 12 points. In the Texas gubernatorial race, support for Tea Party activist Debra Medina has quadrupled since November and she was recently asked to participate in a televised debate with incumbent Rick Perry and leading GOP challenger Kay Hutchinson.
And while the number of registered Democrats has fallen, the GOP lost ground as well. According to Rasmussen, the percentage of voters not affiliated with either party is at its highest point since 2007. Is it possible that Americans have simply had enough of DC gridlock and the ugly sausage-making evident in House and Senate passage of health care legislation?
Perhaps the most alarming finding from Rasmussen is that people don't seem to grasp that fully half of the federal budget goes to national defense, Medicare and Social Security. Although budget documents released by the Obama administration clearly document this, only 35 percent of Americans believe it.
That neither party has been able to communicate where all the money is going bodes ill for the formation of sound fiscal policy. With the public lost in the weeds, it's no surprise that Tea Party conservatives calling for draconian government layoffs are gaining steam.
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Reason no match for emotion, politics in health care
Feb 3, 2010 :: Paul Mahoney :: 0 CommentsThe prestigious British medical journal Lancet made big news this week by retracting a 1998 article citing a link between autism and the measles, mumps and rubella vaccine(MMR). The study had claimed that eight out of 12 children attending a routine hospital clinic had reported problems with GI disturbances that led to autism-like symptoms within days of MMR injections.
A vaccine required for school enrollment might trigger autism? Profoundly troubling. Parents abandoned vaccines in vast numbers, leading to a resurgence of measles. Multiple, rigorous studies have since been unable to substantiate an autism link. The methodology of the original study was questionable at best, and was further compromised by an unreported conflict of interest – parents already convinced of the MMR-autism tie helped fund it. Even after the Lancet retraction, some parents may remain wary of vaccines, preferring to risk virulent diseases rather than vaccines that repeated studies say are safe and effective.
MLOS - Mothers and Apple pie
Sadly, emotion's predominance over reason in health matters is hardly unusual. In the mid-1990s North Carolina passed a "maternity length of stay" (MLOS) law guaranteeing insurance coverage for a minimum 24-hour hospital stay after childbirth. The MLOS law came into being through a floor amendment proffered on the final day of the Legislative Session, after a new mother was sent home too quickly from the hospital in the opinion of her mother-in-law, a state legislator.
Sure, there had been no committee debate and the database was a single case, but talk about motherhood and apple pie! The vote was not close. Only several years later did data emerge showing that the average stay for a normal, vaginal birth at the time the bill passed was already about 24 hours. (After the law passed, of course, the average stay crept up considerably, because discharges don't happen in the middle of the night. A 2006 study published in Pediatrics showed the longer stays produced no change in the one-year mortality for infants.)
Breast Cancer and Bone Marrow
In the late 1990s, a raging controversy emerged over coverage for high-dose chemotherapy plus autologous bone marrow transplant or “HDC-ABMT” in the parlance of dedicated supporters. Insurers were denying coverage for the procedure based on its high ($80,000) cost, combined with a dearth of evidence of advantages over cheaper and less risky treatment options.
Despite extremely limited evidence of HDC-AMBT’s effectiveness for breast-cancer patients, hysterical media coverage featured tales bean-counting insurers withholding payment for life-saving care. Intensive lobbying and a rash of legal challenges built into a backlash that lead many states to mandate coverage for the treatment. Numerous, rigorous studies have since raised serious questions about the efficacy of the approach relative to other options. An article published in Health Affairs suggests that "health insurers spent more than $3.4 billion during [a] ten-year period on a treatment that turned out to offer no appreciable medical advantage over standard-dose chemotherapy, which can be had for less than half the price."
Death Panels
Which brings us to… Death Panels. As I've blogged before, the idea that President Obama planned to cut Medicare costs by whacking your grandma was based on a pretty selective reading of legislative language guaranteeing coverage for counseling on end-of-life issues. Yet the concept caught fire along ideological lines, overwhelming a reasonable attempt to encourage people to consider the issue and execute living wills.
Then there's the recent flap over cancer screening. A government panel weighed evidence that suggested the benefits of early screening for younger women were outweighed by the risks inherent in additional exposure to radiation. Government rationing was the immediate and predictable response from conservatives and right-wing nut jobs, but disease advocates also fanned the flames and respected organizations like the respected American Cancer Society dug in hard in support of early screening. The Obama Administration, unwilling to give the GOP another shibboleth, missed the opportunity to champion evidence-based medicine by backing off the new standards almost immediately.
If all this makes you a bit worried about America's ability to translate scientific evidence into rational health policy, well, yeah -- me too. The health care debate is so polarized along partisan and ideological grounds that people seem unable to think clearly. Those of us who communicate on health issues must remember the ideological and emotion filters through which information on health care passes.
I'm open to ideas on how to get people to turn off Bill O’Reilly AND Keith Olbermann in pursuit of more even-handed analysis. In trying to give reason a better shot, promoting The Health Care Blog or Health Affairs Blog might be a good place to start.
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Obama wants to whack your grandma – and other, less obvious, lies.
Aug 25, 2009 :: Paul Mahoney :: 2 CommentsHealth policy issues, which are big news again, should be a boon for an alpha insurance geek like me. Finally, I can expound on cost-shifting at cocktail parties without guests beating me senseless. And yet the daily circus that passes for health policy debate has been profoundly disappointing, hijacked by non-issues, assault-weapon-toting nut jobs and big, fat lies.
Let's start with the infamous "death squads." Political pundits have created a sense of panic around a provision in proposed legislation that allows doctors to be reimbursed for providing patients with end-of-life counseling. The aim of the provision is to make sure that if patients seek a doctor's assistance in making decisions about what life sustaining processes they want to pursue – or not pursue – the doctor can get paid for that counseling. (There was similar language in Medicare Part D legislation, and I don't remember lots of senior citizens going missing.) Having dealt with end-of-life issues for both parents, I can attest to the value of patients understanding the options and making their wishes known while they are still lucid.
Those stirring this pot divide into four camps: the irrevocably disgruntled, the profoundly stupid, the clinically paranoid, and those who manipulate the afore-mentioned groups for personal, business or political gain. Fox News' Sean Hannity hyped "death squads" as though Obama planned to march grandma-hunting GIs down Main Street, USA at any moment. At one point, I felt we were about a week away from Sean or Glenn Beck suggesting Obama will replace food stamps with Soylent Green. (Google it, Millennials.)
MSNBC, the Obama Nation Station, flails hard in the opposite direction, effectively debunking "evidence" that there are plans to liquidate the elderly. But in his relentless quest for the truth, Keith Obermann apparently hasn't mastered the right turn. His support for a single payer system, a public option and co-ops (in sharply decreasing enthusiasm), is itself based on a Big Lie: that insurer greed is why health insurance costs so much. Keith says government has to get into the insurance business because insurers can charge anything they want until it does.
Insurance premiums certainly have shot up in the last 10 or 15 years. And of course, high executive salaries aren't popular with working folks raising families or small employers struggling to meet payrolls. But insurance costs pretty closely follow trends for health care costs, especially increasing utilization of care. Insurers are the bearer of an unpopular cost message, but are they THE cost driver? No.
I can tell, you still want to blame insurers. It just feels so... right. Doesn't it? But the math just doesn't work out. Insurance premiums go up in response to increases in the cost and frequency of health care claims. Insurers' "cut" is not really as large as you would think. Don't believe me? Break out the premium dollar: 80-83 cents goes to doctors, hospitals, pharmaceuticals and medical devices. Somewhere between 1 and 4 cents goes to insurer profit. The majority of the balance goes to essential functions like claims payment, customer service and reserves – things that I doubt anyone wants to eliminate. Even Medicare hires the private sector to process claims.
Are executive salaries too high? Personally, I think lots of folks are overpaid in this country – I mean, twenty million dollars for a left fielder batting .143? Not to mention rock stars, movie idols, investment bankers and Hannah Montana. Representative Henry Waxman (D-CA) is on a fishing expedition for information about insurance executives who make more than $500,000 year. Why not get a list of everyone in health care with earnings in that lofty range? You'll find that insurance companies do not dominate that list.
But you still want to blame the insurers, don't you? Okay, then, let's eliminate all insurance executives' salaries. Take that, fat cats. Your annual premium will now plummet from $6,000 a year to, say, $5,998. Feel better now? It's fun – and politically expedient – to bash the rich dudes, but it won't address our nation's very real cost problems.
This is probably going to ruin your day, but I have to tell you the truth. Those nasty insurance guys actually save you money on a regular basis. Try a little experiment the next time you go to the doctor: Tell the receptionist you lost your insurance, so you'll be paying your whole bill. But you'll only pay the reduced rate that the biggest plan in town gets. Then get ready to deal with a collection agency. Because you don't have an insurer's clout, you can't haggle over rates. Check out what a great deal your insurer gets you in "the amount you do not owe" column on claims statements. Big money, every time you need health care.
With any difficult, complex issue, it's human nature to crave a simple solution. And insurers make a terrific scapegoat. No one understands their business. You never talk to them unless something has gone wrong. There's always a paperwork hassle that your doctor's office insists is their fault. Sometimes it is; Lord knows there's a lot of room for improvement in the administration of every sector of the health care business, including insurers.
We don't need to waste our time talking "death squads" to death or trying to prove that insurers are the Snidely Whiplashes of the health care world. What our nation really needs is for all the health care players to work together better – more collaboratively and more efficiently. Designating one player in this complex system the villain won't help us find the answers we seek, and it will make collaboration that much harder to achieve.
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Everything Old is New Again
Jul 17, 2009 :: Paul Mahoney :: 0 CommentsThere's an article in today's Wall Street Journal about a radically new idea in Massachusetts: pay global fees to groups of doctors to encourage efficiency and better coordination of services. Wow, what a radical notion. Man, that's never been tried.
Oh, wait. That does sound a bit like the capitation models pioneered and eventually abandoned by managed care companies. You know, those (onimous major chord here) HMOs that were bigger than grunge rockin the early 90s?
Problem was then that NC's supposedly integrated groups (primary care plus multiple specialists) weren't really all that integrated. Flat, shared fees or not, doctors pretty much practiced as they always had. Fast forward a few months to the stunning, conclusive failure of many of these early integrated groups.
Doctors argued that capitation didn't work because 1) the fees just weren't high enough and 2) incentives "to withhold care" are a fundamentally bad idea anyway.
We can argue endlessly whether the fees were "right." But it's not like the practices came up a little short. Some of them were 90 percent off the utilization rate needed to be profitable. My sense is that the potential savings from more efficient patient handoffs never materialized, because such teamwork never really happened. Doctors can be fiercely independent and neither traditional medical training nor fee-for-service payment systems foster teamwork skills.
And as for capitation encouraging overly parsimonious care, you have to balance that concern with the tendency for traditional-fee-for-service payments to promote unnecessary, duplicative or inefficient care. Organized medicine at the time seemed to argue that with incentives to do too much, doctors could be trusted to make good choices, but with incentives to do too little, they couldn't. Huhn?
As the stories of Michael Jackon's final days indicate, doctors actually have a pretty hard time telling patients no, even when the services they're are dubious or just plain dangerous.
So here we are again, twenty years after capitated fees were decried as a horrible, demonic plot by HMOs and other nefarious characters. (As an HMO lobbyist, I was once called a fascist and a communist in the same physician rant).
In the end, doctors will have to operate on some kind of budget. Either it will be of their making (capitation or something similar) or a top-down rationing system that no one will like. Too early to tell which the people of Massachusetts should expect.
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Time to stop bailing out a leaky boat
Jun 4, 2009 :: Paul Mahoney :: 0 CommentsThere was a terrific article in the New Yorker last week that points out why the debate is Washington over how to "fix" health care is focused on the wrong things.
Fans of a single-payer system -- as legion and ardent as any crowd of Deadheads you'll ever meet -- subbornly equate "reform" with a government run system. Period. Anyone with doubts about putting 16 percent of our nation's GDP in the hands of the same folks who brought us FEMA trailers are painted as reactionaries, obstructive, self-interested or worse.
This confuses universal coverage with public sector control. Yes, Canada and England have a single system, but Germany and Australia get the job done with a public-private mix. Or think about how Medicare and private supplemental coverage works. While our current system doesn't pool risk as effectively as it could, the primary problem is not the funding mechanism.
Which brings me to a terrific article in the New Yorker by Atul Gawande. Dr. Gawande examines two Texas towns of similar demographics and health status, but startlingly different health care costs. Why, Gawanda asks, is McAllen, Texas, the "most expensive town in the most expensive country in the world?" An interesting question, especially since Medicare costs in the demographically similar population in nearby El Paso county are HALF what they are in McAllen.
The good folks at the Darmouth Atlas program have been documenting such oddities in great detail for a quarter of a century. Yet local health care providers, from specialists to hospital administrators, couldn't explain this cost differential, and some were surprised to find that their costs were high in comparison to other markets.
The evidence supports none of their guesses as to why this is. We give better care. (But outcomes aren't measurably better.) We have so many sick and poor people here. (But McAllen's population is not very dissimilar from many other locations with much lower costs.) Our town is more litigious. (But Texas tort reform has significantly curtailed malpractice costs.)
What seems to be the problem is that McAllen's health care providers simply provide more care, LOTS more care, of virtualy all kinds. And there are more of them in McAllen doing it. Why not? That's what our do-more, earn-more reimbursement system rewards.
We could, instead, pay for the most cost-effective care. Federal stimulus legislation funds studies on comparative quality in health care that would make this possible. Creating a comprehensive database on what methods, devices and drugs work best should be a road map on how we should reimburse health providers and manufacturers.
Resistance to this small section of the bill was fierce, and it only passed when it was specified that this research would not impact reimbursement practices. See, you can't cut health care costs without someone making less money. And what group or organization will volunteer to do that?
Any system, public or private, that doesn't break this logjam won't give us the real reform we need.
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Is Old Media Dead?
Mar 26, 2009 :: Paul Mahoney :: 0 CommentsTough times are nothing new for the news business. Long before the economy tanked, print publishers knew times had passed their business model by. But huge layoffs by McClatchy and other major players in recent weeks indicate that their troubles may only be getting worse. Have newspapers and traditional mainstream media become irrelevant? Is communications now all about Twitter, Facebook and blogs? What does this mean for PR? Turns out Old Media may not be quite dead after all. -
MD gags the wrong way to go
Mar 5, 2009 :: Paul Mahoney :: 1 CommentsThere is a company in Greensboro, North Carolina that reportedly helps doctors prepare waivers by which patients agree not to comment online about physician "expertise or treatment." While I can understand physicians' concern over snarky or unfair assessments appearing online, I'm amazed that some doctors apparently think it's okay to ask people to blithely waive their First Amendment rights.
Could anything fly more in the face of a consumer-driven view of health care or the growing online world of candid, two-way conversations between businesses and their customers? Locally, doctors' organizations weren't thrilled when North Carolina's Blue Cross plan began carrying online rankings of physicians managed by Zagat, the folks who serve up restaurant reviews in many cities. One physician grumbled to the Raleigh paper about how awful it was to be rated by Blue Cross staff, apparently unaware of what Zagat's reviews are – first person accounts of patient experience.
Doctors make a valid point that the average person is unqualified to rate a physician's scientific or technical expertise. (I'll save the crying need for expert information on comparative quality for another post.) But there is plenty of first-hand experience that patients can and should share with each other, including wait times, administrative efficiency, ease of scheduling, bedside manner, out-of-pocket costs, etc.
I really want to believe that only a tiny minority of doctors think that stifling debate is the best way to defend their reputations. Personally, I plan to rate each and every one of my doctors. Most of my reviews thus far have been very positive, but where the service provided was really bad (e.g., I couldn't reach a live person by phone – ever), my reviews note this. No bomb throwing, no character assassination, but an honest opinion on how I felt I was treated, for good or ill.
What business expects to survive without listening to that kind of feedback?
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Who’s Destroying Journalism? Oh Snap, My Bad.
Nov 5, 2008 :: Paul Mahoney :: 3 CommentsI recently did something that would have been unthinkable just a few years ago. I canceled my print newspaper subscription to the News and Observer. (Well, actually, I backtracked to a Friday-through-Sunday subscription after my wife pitched a fit over the cancellation.)
For the first time in nearly a half century, I do not wake up every day to find a newspaper at the end of my driveway. When I was a kid growing up in Buffalo, New York, we got two daily newspapers – the Courier Express and the Buffalo Evening News. It’s hard to imagine that level of competition existing today.
Why cancel? Well, money was part of it -- an annual subscription now costs nearly $200 and that particular month all three of my kids seemed to need shoes. And food. And the two big ones were petitioning for yet another cell phone bailout.
There was also the huge pile of paper that seemed to pursue me relentlessly: in my car, in my living room, on my workbench. Read me. Read me. Read me. I generally scanned each issue, but except for Sunday, never really READ them. (Skim-reading is an occupational hazard for PR people.) I felt like I was falling behind, never, ever, to catch up.
Secondly, hard-copy publications are hardly “news you can use,” Research, client communications, comment and analysis – all this now happens online. That darn hard copy was always somewhere else when I needed it.
Thirdly, my family stopped using the newspaper as an advertising medium years ago. An ad for a neighborhood garage sale costs $26, about half the take for some of our less successful events. Need to sell something? Craig’s list is better, faster and free. Full-color pictures, unlimited words, and crazy people don’t get your phone number.
Finally, there was the green issue. I was accumulating hundreds of pounds of paper every year. Sure, I tried to recycle it, but found out that our town discards newspaper if it gets wet on rainy collection days. So a good part of our hoard went in the landfill anyway.
So I cut back my newspaper purchases. And then the News and Observer layoffs started. Coincidence? Maybe. But if an English/History major in the PR business isn’t subscribing, what does that mean for the future of newspapers?
Based on what’s happening at the N&O, it means no more true “beat” reporters. Such specialization is a luxury in the short-staffed bullpen of the future. We can expect even less reporting on dry (but important) subjects like state and local government, taxation or insurance, and probably not a whole lot of primary research or investigative journalism. Too time-consuming, too labor intensive, too expensive.
Perhaps most concerning, we can expect journalistic points of view to skinny down to, well, one. The Charlotte Observer and the News and Observer are really one publication from a business standpoint. So the viewpoint of Bill Kruger – now editor in charge of the newspapers’ joint state capital staff -- will likely establish the political point-of-view at both publications. One guy decides what news hundreds of thousands of readers will get? Makes me long for the days of two daily newspapers.Oh, I forgot. I killed them.
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