Biotechnology Healthcare - November/December 2008 - (Page 1) OPENERS EDITOR Michael D. Dalzell EDITOR IN CHIEF, EDITORIAL ADVISORY BOARD Unintended Consequences Michael D. Dalzell, Editor David B. Nash, MD, MBA SENIOR EDITOR Katherine T. Adams SENIOR EDITOR, CUSTOM PUBLICATIONS Amy Krajacic SENIOR CONTRIBUTING EDITORS B Amanda Brower Bob Carlson, MHA John Carroll CONTRIBUTING EDITORS Lola Butcher Scott Kober Schuyler Matthews WEB EDITOR Tony Berberabe, MPH DESIGN DIRECTOR Philip Denlinger PRESIDENT AND GROUP PUBLISHER Timothy J. Stezzi PRESIDENT AND GROUP PUBLISHER Timothy P. Search, RPh EASTERN SALES MANAGER Scott MacDonald SENIOR ACCOUNT MANAGER Kenneth D. Watkins III DIRECTOR, PRODUCTION SERVICES Waneta Peart CIRCULATION MANAGER Jacquelyn Ott The articles in BIOTECHNOLOGY HEALTHCARE are reviewed by appropriate members of the editorial board and/or other qualified experts. The opinions are those of the authors and do not necessarily represent those of the institutions that employ the authors, BioCommunications LLC, or the publisher, editor, or editorial board. Clinical judgment must guide each clinician in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this publication may reflect the clinical experience of the authors, or may reflect the professional literature or other clinical sources, and may not be the same as indicated on the approved package insert. Please consult the complete prescribing information on any products mentioned in this publication. BioCommunications LLC assumes no liability for the information published herein. e careful what you wish for. Growing up, I wished that My Heroes, the Chicago Cubs, would be more successful; now, they break my heart in the playoffs each year instead of doing it from last place. Cuba wished for “change” in 1959 — and got it. You think Jan Brady is thankful her life didn’t turn out like that of Marsha, Marsha, Marsha after all? I’m just saying. The law of unintended consequences has broad application in healthcare, too. Massachusetts is a good example. The state’s universal coverage law, signed by Gov. Mitt Romney in 2006, expanded access to care but instantly created a shortage of physicians that has forced people in some parts of the state to wait for healthcare services. Payers, meanwhile, struggle with out-of-control overhead costs that have compelled them to raise premiums significantly. Another example of unintended consequences may be in the making. Frustrated with their members’ inability to gain accessible, affordable healthcare, labor unions are getting what they long have wished for: control of healthcare benefits. And, frustrated with rising healthcare costs, especially for retirees, large corporations are more than happy to wash their hands of this liability. It’s called a VEBA — short for voluntary employee beneficiary association. Often administered by labor unions, a VEBA is a trust fund for financing healthcare, usually endowed by a one-and-done, lump-sum payment from the employer. If the VEBA money is managed and invested well, it can be a happy arrangement for everyone. Is that the sound of the stock market I hear falling? Just saying. Our cover story on VEBAs, as reported by Bill Atkinson, reveals the potential for trouble. If the VEBA winds up short on funds, access restrictions and out-of-pocket costs could be worse than in the days when deeperpocketed employers ran the show. Consequently, physicians may find it tougher to prescribe cutting-edge therapies, and biologics manufacturers may find unions driving an even harder bargain with them than employers did. I can’t name many labor unions that became successful by backing down. Also in these pages, Milliman’s Bruce Pyenson exposes another unintended consequence. Years ago, the call in managed care circles was for patients to have some “skin in the game” — those $2 copayments of old reflected neither the value nor the scarcity of the service rendered. Well, today’s 20 percent coinsurance certainly has extracted a pound of flesh from the patient, but excessive cost sharing isn’t working. Everyone is looking for a better way to manage biologics — enter Pyenson’s bold idea. Happy holidays, and peace in 2009. CONTACT E-MAIL ADDRESSES: Editors: editors@biotechnologyhealthcare.com Circulation: biotechnologyhealthcare@icnfull.com Advertising: advertising@biotechnologyhealthcare.com Reprints: reprints@biotechnologyhealthcare.com NOVEMBER/DECEMBER 2008 · BIOTECHNOLOGY HEALTHCARE 1
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