Bloggers look at House Speaker Nancy Pelosi’s role in the health care overhaul, whether employers may drop health insurance under the new law and if an individual mandate is necessary. Others are focusing on new studies and proposals unrelated to the health overhaul.

Matthew Green of the Monkey Cage attempts to objectively examine whether Speaker Nancy Pelosi, D-Calif., was as influential in passing health reform as many claim.  Green concludes: “[S]he clearly is an influential speaker: her leadership was critical to the final outcome (whether you agree with that outcome or not) and was impressive enough to be included in future histories of Congress and public policy. Nonetheless, her actions should be evaluated in comparison to what other speakers have done, and are expected to do, as part of their job; and in this respect, I do not think they were themselves sufficient to put Pelosi on a list of the greatest speakers in history.”

Hot Air’s Ed Morrissey looks at new survey of employers and how they think the new health overhaul law might affect their businesses, including whether they might stop offering coverage. Morrissey writes: “Two years ago, dumping employees out of health-care plans would have been unthinkable for competitive reasons.  The Obama administration and Democrats in Congress have made it not just thinkable, but downright rational.  Unfortunately, the positive outcomes of eliminating the employer link to health insurance will not be partnered with a free-market insurance environment, but a top-down government-control system that will force insurers out of business.  It means that we are heading quickly into a single-payer system, thanks to ObamaCare.”

John Goodman argues that “there is nothing that can be achieved with a mandate to buy health insurance that cannot be better achieved by a carefully designed system of tax subsidies. Beyond that, a requirement that everyone obtain insurance (as ObamaCare dictates) creates problems greater than the problem it is designed to solve.”

The New Atlantis’ James Capretta takes a critical eye to budgetary estimates for the health overhaul bill and also focuses on the impact of current proposals before Congress to fix Medicare reimbursements for doctors. Capretta writes, “The truth is the president and his allies in Congress worked overtime to pull together every Medicare cut they could find — nearly $500 billion in all over ten years — and put them into the health law to pay for the massive entitlement expansion they so coveted. They could have used those cuts to pay for the ‘doc fix’ if they had wanted to, as well as for a slightly less expansive health program.”

The Atlantic’s Megan McArdle says, “I had a conversation with someone non-crazy who thinks there is a not-insignificant chance that the Supreme Court will overturn health care reform, or at least the individual mandate. …  Mind you, this person was not suggesting that the chances were, say, 85%; more like 25%.” McArdle explores the various scenarios that would evolve from such a ruling, but writes, “My hope is that in this unlikely event, it would open the way for something more like what I’ve proposed:  catastrophic income insurance for everyone (i.e., the government will cover health care costs above some fairly high percentage of your income), with less support for first-dollar coverage.”

Health Affairs’ Chris Fleming posts several recent articles from Sherry Glied, President Barack Obama’s nominee to be the assistant secretary for planning and evaluation at the Department of Health and Human Services.

The New Health Dialogue’s Joanne Kenen notes that a new study found one in three hospital patients in California are readmitted within a year. The new health overhaul “addresses preventable readmissions, with Medicare penalizing hospitals with very high readmission rates for certain specific conditions starting in October 2012. Medicare and Medicaid will also be experimenting with new payment and care models that may bring down the avoidably high rates by creating more continuity and accountability of care.”

A few bloggers are examining new studies and proposals.

Health Beat’s Maggie Mahar looks at an FDA proposal to increase transparency between the agency, pharmaceutical companies and device makers and says it “deserves attention because it signals that … this administration is serious about regulating those who have a stake in our $2.6 trillion health care industry.”

And Brad Wright discusses a new study on shows patients have a preference for doctors who have the same race or ethnicity as the patients. Wright says, “Given the disproportionately low number of African-American and Hispanic physicians vis-a-vis their proportion of the patient population, more work needs to be done to bolster minority presence in the workforce.”

Bloggers found a lot to occupy their thoughts today–ranging from conservative beliefs about government health care spending to the future of health savings accounts and a study that found increasing out-of-pocket spending among the insured. One blogger even talks to an author about her novel that uses  terminal illness and high medical bills to advance the plot.

Avik Roy writes an article for The National Review Online (titled “The Conservative Healthcare Conundrum”), about a “ contradiction that dogs many Obamacare critics: if we are opposed to Sarah Palin’s death panels, are we simultaneously for unlimited government health spending?” Roy says there is a “contradiction that dogs many Obamacare critics: if we are opposed to Sarah Palin’s death panels, are we simultaneously for unlimited government health spending? … Here is the basic problem. If the state pays for our health care, then the state has a responsibility to ensure that it is paying for cost-effective treatments; otherwise taxpayer dollars are wasted. It is precisely because politicians are afraid to say no to seniors that companies can overcharge Medicare.”

National Journal’s Marilyn Werber-Serafini asks her experts, “What does the future hold for consumer-directed health plans?” Responders so far include Michael Cannon, Paul Fronstin, Paul Ginsberg and John Goodman.

On a similar note, Cato’s Michael Cannon says the new law contains price controls that could affect certain types of plans, elaborating: “As premiums for comprehensive plans spiral upward (ultimately causing comprehensive plans to disappear) and as ObamaCare proves more costly than projected, supporters will be desperate for new revenue.  They will call for the elimination of both HSAs and high-deductible health plans on the grounds that those products — not the price controls, mind you — are causing the market to unravel. …HSAs allow young and healthy consumers to avoid the raw deal that ObamaCare offers them. And that’s precisely why ObamaCare’s supporters will try to kill HSAs. We will end up repealing one or the other.”

In the meantime, Brad Wright of Wright on Health looks at a new study that finds out of pocket spending among the insured continues to rise.

ABC News’ Eleanor Hall interviews author Lionel Shriver about her novel, So Much For That, which is both a harsh critique of the U.S. health system and an exploration of how a family copes with terminal illness. Hall explains, “the start of each chapter in her novel is an account showing the central character’s declining bank account. So there is no way the reader can miss the message about the financial cost of dying in the US. But  [the story] also takes an uncompromising look at the emotional toll as well.” Shriver tells Hall of the health overhaul law President Obama advocated, “As well-intended as I believe he was, I’m worried that what this legislation means is that as far as the American public is concerned, we have now addressed this issue and we won’t come back to it for another 20 years. In the meantime, the cost of medical care in the United States is going to continue to go through the roof.”

The Wall Street Journal’s Kathleen Hobson reports: “Sen. David Vitter sent a letter to HHS head Kathleen Sebelius, asking her to remove from the agency’s website the controversial breast cancer screening recommendations issued last fall by the United States Preventive Services Task Force.” Hobson continues, “We were a bit confused by the letter – does the health-care overhaul bill require HHS to take down the recs? Well, no, explains Vitter’s communications director, Joel DiGrado, in an email to the Health Blog, but Vitter wants them taken down anyway.”

And the Heritage Foundation made a new video “timeline of taxes” under the health law.  Hannah Sternberg writes in an accompanying blog post, “many of the law’s new costs and limitations are still scheduled to kick into effect years down the line, when Congress hopes voters aren’t paying attention anymore.” Video below:

Bloggers mull whether the FDA’s transparency proposals fit the bill, how Kentucky’s physician-turned-Senate nominee will feel about Medicare reimbursements and even more details of the health overhaul law.

AEI’s Scott Gottlieb calls a new set of proposals from the Food and Drug Administration to improve transparency “promising.”  Gottlieb continues, “One recommendation deserves special attention: the FDA’s proposal to start releasing the contents of ‘Complete Response’ or ‘CR’ letters. These are letters that FDA sends to drug companies when it decides to delay approval of a new drug. The manufacturers will oppose this proposal, but they shouldn’t. Right now, drug companies prefer to be the ones that frame for investors why the FDA has decided to delay their drug approval. But it’s in the long-term interests of patients, doctors, and drug companies that these letters be released.”

AHCJ’s Pia Christensen reports that among the transparency proposals released by the FDA, “[a] section of the report addresses concerns raised by AHCJ’s Right-to-Know Committee about the agency’s requirements that journalists and FDA employees notify or obtain permission from an agency official to conduct an interview.”

Wonk Room’s Igor Volsky thinks Democrats seeking to address the Medicare ‘doc fix’ “may find an unlikely ally in hard-nosed libertarian Senate candidate Rand Paul, who just won an upset victory in the GOP Kentucky primary. … Repealing the [sustainable growth rate] would cost about $250 billion, a five-year fix ‘is estimated to cost $88.5 billion‘ and Paul, who as an ophthalmologist has an average salary of some $256,320, supports the more expensive permanent fix.”

And the new health law is still giving bloggers plenty to consider.

Emergency physician Shadow Fax looks at provisions governing some aspects of ER treatment such as covering care in network and out of network at the same rates. He writes, “I will be very interested in seeing how this plays out nation-wide, but I can assure you that in my state once we get our lawyers to review this issue we will be requiting an opinion from our Insurance Commissioner to clarify how this will be implemented. It could really change the relationship between physicians and insurance companies and could substantially add to protections consumers receive from the unfair and unilateral business practices of the insurance companies.”

On the Health Affairs Blog, legal expert Timothy Jost digs into the details released by the IRS on the new health law’s tax credits for small businesses.

Heritage’s Kathyrn Nix continues her “side effects of Obamacare” series with a look at the tax credits: “Bottom line:  qualifying for the small-business tax credit isn’t easy.  If you do qualify, you’ll have to limit hiring and employee compensation to keep it.  And, even then, the credit is only a temporary help.  After six years, the business and its workers have to pick up the whole tab.”

And Louise Norris on Colorado Health Insurance Insider says,  “A recent study by the Mountain States Employers Council reports that 27% of Colorado employers surveyed are offering consumer-driven health plans this year, up from 21% last year.” She also notes the growing popularity of health savings accounts.

It’s a slow start to the week as bloggers look at health spending, insurer profits, whether employers will drop health coverage and a frugal patient.

The Washington Post’s Ezra Klein points to a graph from Congressional Budget Office Director Douglas Elmendorf on federal expenditures, saying, “you’ll notice that the Affordable Care Act, despite being fully in place by 2020, isn’t obvious on these charts (though it is a contributor to Medicaid). That’s because it’s not projected to be very big in comparison to total government spending. Third, foreign aid isn’t present in any serious way, either.” (See image below)

Heritage’s Robert Book critiques a new Health Care for America Now report on health insurance company profits, arguing: “What they don’t tell you – but which you can figure out with a little arithmetic from the numbers in their report – is how much profit the companies made off of each of their insured members.  As of March 31, 2010, the five companies put together had a total of 85.6 million members – and that translates to a quarterly profit of $37.06 per member.  Is that shocking?”

Austin Frakt of the Incidental Economist looks at a paper that found employer take up of health insurance actually rose in Massachusetts following health reform.  Frakt says, “based on what I know now, I’m not too concerned about widespread employer dumping [under the new national law.]”

Critical Condition’s Grace-Marie Turner writes, “The bad news for Obamacare just keeps coming. …An analysis conducted by officials of the White Castle restaurant chain and released by House Republican Leader John Boehner says that just one provision of Obamacare will effectively cut the chain’s net income in half and reduce future job creation.”

Wonk Room’s Sonia Sekhar writes “The GOP is using [Centers for Medicare and Medicaid Services Director Donald] Berwick’s nomination to make their case against the health care law ahead of the midterm elections. But here again the GOP is purposely conflating managing health care services and containing health care spending with malicious rationing.”

On The Health Care Blog, physician Robert Lambert relates a conversation he had with a patient who has a high deductible health plan. The patient did not want to come in for an office visit, but rather have his medications called in to save money. Lambert writes, “I am not a vending machine for prescriptions.  I won’t work for free.  I won’t take risk without expecting to be paid for it.” There’s also a lively comment debate.

And Insure Blog’s Henry Stern hosts a sleek version of Health Wonk Review, the biweekly roundup of health policy blogging.

The Congressional Budget Office earlier this week released a new spending estimate for the health overhaul law that has been noted by a number of commentators. Conservatives have been decrying the increased cost, while administration officials and liberal bloggers say the law doesn’t guarantee new spending.

Today, CBO Director Douglas Elmendorf adds more detail on his blog that is likely to fan the debate: “The potential discretionary costs identified two days ago include many items whose funding would be a continuation of recent funding levels for health-related programs or that were previously authorized and that [the health law] would authorize for future years. (For example, those potential costs include $39 billion authorized for Indian health services that already receive appropriations every year.) CBO estimates that the amounts authorized for those items exceed $86 billion over the 10-year period (out of the roughly $105 billion total shown in the table provided yesterday).”

His clarification came after Peter Orszag, the director of the Office of Management and Budget, on his blog Wednesday said the new CBO estimate of the cost of discretionary authorizations caused some people to draw the wrong conclusions. “The letter simply updates CBO’s calculation of the size of discretionary authorizations included in the legislation. CBO’s tally, which is not included in its estimate of the cost of the law, has led some to erroneously conclude that the law includes more spending and less deficit reduction than CBO has previously reported.” And, because President Barack Obama has pledged to freezing discretionary spending, he said, “any actual new funding would have to fit within this freeze and so would have to be offset by budget cuts elsewhere.”

Ezra Klein was among the first bloggers to note the new information.

Conn Carroll of the Heritage Foundation’ The Foundry yesterday termed it the nation’s continuing “post-passage Obamacare education” when the CBO “confirmed that the federal government will have to spend an additional $115 billion implementing the law, bringing the total estimated cost to over $1 trillion. … This is by far not the only nasty little surprise that has come back to bite Obamacare after passage. Shortly after it became law, U.S. employers began reporting hundreds of millions if dollars in losses thanks to tax changes in the bill.”

Cato’s Michael Cannon looks at another hot topic, the nomination of Elena Kagan to the Supreme Court and says senators should check her ties to the new health law. “Senate Judiciary Committee members should be sure to ask Solicitor General and Supreme Court nominee Elena Kagan, during her upcoming confirmation hearings, whether she or her office played any part in crafting ObamaCare or the administration’s defense to the lawsuits challenging that law.  If Kagan helped to craft either, that would present a conflict of interest: when those lawsuits reach the Supreme Court, she would be sitting in judgment over a case in which she had already taken sides.”

Another Obama nominee, Donald Berwick, who is slated to head the office that oversees Medicare, is also coming in for some rough criticism among bloggers. Pundit and Pundett points to a critical story by Philip Klein at the American Spectator and says, “Here’s hoping that he’ll meet with some serious resistance, and that America will learn more about government-run healthcare and rationing in the process.”

Ben Domenech at Red State.com says, “President Obama’s nomination of Donald Berwick as the head of the Centers for Medicare and Medicaid Services (CMS) is a gathering far less attention than a certain other nominee — but it will be getting more attention in the weeks to come, given his particularly radical agenda when it comes to health policy.” He also links to a speech Berwick gave several years ago on the British health system.

In other health postings, Wonk Room’s Igor Volsky says, “The National Association of Insurance Commissioners (NAIC) — the insurance industry funded group tasked with making recommendations to HHS about the medical-loss ratio standards in the new health care law — released a new draft report Monday,  suggesting that the Secretary should exempt plans in the individual health insurance market from spending 80% of premium dollars on actual medical expenses. … The draft NAIC warns that the rules may be ‘too strict for some individual policies,’ leading some customers to lose coverage.”

Timothy Jost on the Health Affairs blog explores the new regulations for insuring young adults on their parents’ plans. ” Although this age group is on the whole quite healthy, it is far from invincible.  One study found that injury-related emergency room visits were more common for young adults than for either children or older adults, with nearly one-quarter of 18 to 29 year-olds having had an emergency room visit in the preceding year.” He also notes that pregnancies are not uncommon among people this age.

Katherine Nix at the Foundry writes about the effect of the new health law on doctors.

During his weekend address, President Barack Obama said that health reform is already delivering “real benefits” to the American people. On Monday, Health and Human Services  Secretary Kathleen Sebelius built on this theme in a letter to Democratic and Republicans congressional leader detailing  the Obama administration’s early progress in  moving forward with health reform implementation.

These developments have led bloggers to examine both the rule-making process and the bureaucratic efforts to fill in the blanks.

The Wonk Room’s Igor Volsky calls attention to Sebelius’ letter  touting the administration’s accomplishments in implementing the early provisions of the health reform law ahead of schedule. And it seems the progress she mentions regarding state high risk insurance pools, a reinsurance program for early retirees and efforts to allow children to stay on their parents insurance until age 26 are only the beginning.  He lists what the near-term calendar looks like and  focuses on the policy and political dynamics in play as the next implementation save-the-date approaches: June 1 is  when HHS will receive uniform definitions from the National Association of Insurance Commissioners about medical loss ratio definitions.

But InsureBlog’s Bob Vineyard takes exception with Sebelius’ glow of success. “The ink is hardly dry on the law and already Washington is trying to figure out what the law means, and how it will impact health insurance policyholders. In fact, they are making up rules as they go along.” He goes on to explore – with specific examples and scenarios — how the process may have negative impacts on the individual major medical market.

Critical Condition’s Avik Roy revisits a continuing question – “Will any of us be able to keep our current plans?” He draws on recent writings to build his answer.  “The pages of National Review and NRO are no strangers to debunkings of the president’s promise that ‘if you like your health-care plan, you will be able to keep your health-care plan. Period. No one will take it away, no matter what.’ (If you really need proof, check out Deroy Murdock,  Jim Geraghty,  Stephen Spruiell, and Yuval Levin on the subject.) But, believe it or not, the truth may be even worse. Depending, once again, upon the regulatory divinations of HHS bureaucrats, it may turn out that no one with private insurance can keep his or her preexisting plan.”

And, writing for The Foundry, David Weinberger, with a touch of self-congratulation, points to the wisdom of  those who didn’t believe the Obama promise in the first place. As proof, he cites recent news “that AT&T, Verizon, John Deere and others may well drop the health care coverage they now offer their employees. Obamacare makes it much cheaper for these companies to dump their workers into the government-controlled health exchanges and pay a penalty for NOT insuring them.” And he adds, “Congress could have dramatically expanded health insurance without incentivizing employers to end their current health care coverage.”

Meanwhile, in the National Journal’s Health Care Expert Blog, Marilyn Werber Serafini moves beyond the most immediate implementation issues to pose another question. “What is the most effective use of new health care reform money to promote prevention and wellness?”  She also mentions that, by September, health plans will be required by the law to cover preventive services. The experts responded  with very different views. American College of Cardiology CEO Jack Lewin wrote that “if we used the prevention and wellness money to create an additional institute, the National Institute for Keeping People Healthy, dedicated to keeping people healthy even with the presence of a chronic disease, we could reduce the amount of health care dollars spent on end of life care by reducing chronic disease.” But the National Center for Policy Analysis’ John Goodman says “It is too bad that the new health reform law will require all insurance to cover preventive services with no cost sharing. This is the exact opposite of sound policy. With few exceptions (e.g., childhood immunizations), third party insurance should not pay for these services at all. Instead, patients should make their own decisions….”

On a lighter note, and because it is never too early to start a summer reading list, Wright On Health’s Brad Wright offers his picks  for health policy’s great reads. They include Jonathan Cohn’s book “Sick,” “How Doctors Think” by Jerome Groopman  and “Pathologies of Power” by Paul Farmer.

Bloggers ask if states are filing “frivolous” lawsuits against the new health law, investigating more “myths and facts” and checking in on the implementation process.

Slate’s Simon Lazarus and Alan Morrison say that many of the lawsuits against the new health bills face one major hurdle: “Usually it’s Republicans who complain about ‘lawsuit abuse’—frivolous claims brought without legal merit. And yet that description perfectly fits the two complaints filed by state attorneys general to challenge the new health care reform law as unconstitutional. The Justice Department says it intends to ask the courts for immediate dismissal. If DoJ gets its wish, the courts should also seek sanctions against the politically motivated attorneys general who filed them.”

On the Health Affairs Blog, legal expert Timothy Jost takes a detailed look at the first implementation stages of the new law, including regulations for medical loss ratios, early retiree reinsurance and state high risk pools.

Health Beat’s Maggie Mahar continues her series of “myths & facts about health care reform”, this time looking at “hospitals, community clinics, nurses, physician-owned specialty centers, and hospital patients.” Mahar writes, “This post whacks the myth that hospitals cut a “sweetheart deal” with politicians.  I cite Moody’s, the bond-rating agency, to argue that, over the long-term, the legislation will rein in sky-rocketing hospital bills by requiring hospitals to reduce errors, increase patient safety, and provide better value for our health care dollars.”

Insure Blog’s Henry Stern points out that “that key portions of ObamaCare© don’t apply to stand-alone dental coverage (I guess the ADA’s lobby was all gummed up). For example, restrictions on annual and lifetime benefits caps don’t apply, nor does the requirement to carry 20-somethings.”

John Goodman explains high risk pools and says the “almost every feature” of the new health law’s version “defies rational explanation.” Goodman also explores “what a risk pool would look like if politicians ever did manage to get it right,” saying there are three key characteristics.

Heritage’s Marguerite Higgins lists the issues their analysts think HHS Secretary Sebelius should focus on in regards to physicians:

• “Doctors’ fears about medical malpractice lawsuits that has resulted in excessive use of medical tests
• Physicians’ insecurity of taking on any Medicare patients because of Congress’ failure to present a long-term solution to the coming payment cuts
• Their loss of entrepreneurial opportunities because ObamaCare kills the creation of new physician-owned hospital”

Bright Wright of Wright on Health looks at unnecessary tests and procedures and relates one way doctors are currently trying to improve the care of their patients while tamping down on extra tests:

For a time I was employed in a hospital laboratory and had the opportunity to attend the weekly meetings of the “Tumor Board.” While enjoying lunch, a diverse group of radiologists, pathologists, oncologists and others presented cases of cancer patients and debated the various merits of a variety of treatment approaches. This doctoring by committee approach rather often concluded that the patient was too old, the cancer too advanced, the likelihood of remission too low, the side effects of the treatment not worth it–and the decision was made to leave the cancer untreated. Is that a death panel? If so, we need not fear “ObamaCare” because doctors are condemning patients to death already. Or is it an efficient use of medical resources, a genuine understanding of the factors involved, and an appreciation of the fact that the patient may not be able to fully and rationally evaluate these factors?

And Avika S. Roy on Criticial Condition responds to a New York Times editorial on the FDA’s efforts to tighten standards for members of advisory board panels and potential conflicts of interest, saying: “Who should want people with conflicts of interest to advise the FDA? Actually, patients should — because the physicians who have the most knowledge about a given disease are almost always those with the most conflicts. There are two kinds of physicians: the vast majority, who do their job based on adherence to consensus-based standards of care; and the small minority, who investigate the basic biological causes of disease and conduct clinical trials based on the latest science to see if we can come up with new ways to better treat patients. They are the ones who try to change the consensus, for the better.”

Bloggers continue to take a closer look at the new health care law.  Elsewhere, commentators discuss physician behavior and incentives.

The National Journal’s Marilyn Werber Serafini asks her experts if the report by Richard Foster, the actuary for the Centers for Medicare and Medicaid Services, is “a big deal?” Responders include David Cutler, Karen Davis, John Goodman, Ralph Neas and Uwe Reinhardt.

Minna Jung on RWJF’s Users’ Guide to the Health Reform Galaxy takes a crack at defining “bundled payments.”

Robert Power and John Bertko take to the Health Affairs Blog to point out an intriguing change that could happen under the new health law:

Imagine a world in which the credit-scoring industry knows exactly who has creditable coverage and (by implication) who does not.  …Today, a consumer’s insured status has no direct effect on his or her credit score, because the needed data streams are not in place.  Today, health plan sponsors (insurers, self-insured employers, and governments) have no compelling reason to produce uniform data that show which consumers have creditable coverage, except in Massachusetts. This will now change.  Health plan sponsors will be required to send a new 1099-like notification to the IRS for a variety of purposes, including enforcement of the new penalty.  For a tiny incremental cost, health plan sponsors could trade identical data files with private credit scorers, in return for various commercially-valuable services.

Hot Air’s Ed Morrissey looks at a new House resolution seeking to change the abortion-funding language in the health law to something similar to Democratic Rep. Bart Stupak’s orginal wording and notes that the Michigan congressman not one of the current co-sponsors.  Morrissey writes:

That prompts the question: Why aren’t the so-called “pro-life Democrats” who voted for ObamaCare co-sponsoring this bill? It would restore the language for which they fought last November, and for which they threatened to vote against ObamaCare. It ends the reliance on an executive order of dubious legality and entirely based on the whim of a President who declared his fealty to Planned Parenthood, the largest provider of abortions in the nation. Clearly, the term “pro-life Democrat” is mainly an oxymoron, with only a handful of notable exceptions as seen on the co-sponsor list of this bill. Stupak and most of his coalition care less about pro-life principles and more about political kowtowing.

Cato’s Michael Cannon writes, “Shortly after President Obama signed his health care law, French president Nicolas Sarkozy offered this backhanded compliment to the United States: ‘Welcome to the club of countries that does not dump its sick people.‘” Cannon says that many countries with universal health insurance do dump patients, and continues, “Presidents Obama and Sarkozy may prefer the false compassion of a government guarantee.  I’ll take the real thing.”

The Wall Street Journal’s Digits blog reports that “a Seattle startup that provides primary health care for a flat monthly fee is getting some big-name financial backers from the technology industry: Jeff Bezos and Michael Dell. Qliance Medical Management Inc. says it has raised $6 million in new funding in a financing round led by Bezos Expeditions, the personal investment company of Amazon.com’s CEO; additional financing came from MSD Capital, Michael Dell’s investment firm. … Qliance is betting it can profit by wringing many of the administrative costs out of health, especially the overhead that comes with haggling with insurance companies and billing patients.”

Meanwhile, Scott Hensley of NPR’s Shots Blog looks at a new study showing how many unpaid tasks primary care physicians perform during a typical day: “It’s an illuminating snapshot of the current challenges in primary care. For starters, try juggling nearly 24 calls, a dozen prescription refills and about 45 different patient reports for each doctor each day.”

And Brad Wright of Wright on Health is taking in a study that found surgeons greatly increase their number of operations based on the payment system: “In fact, if a surgeon paid on a capitation (i.e., fixed amount per patient per month) basis is switched to a fee-for-service payment system, they are likely to perform 78% more surgery. That’s a pretty sizable effect. The question that isn’t answered is this: Do fee-for-service surgeons provide unnecessary surgeries because it is profitable for them or do surgeons paid on a capitated basis fail to perform surgery in cases where it is clinically indicated? My hunch is that a little of both goes on, but that’s just a guess.”