The Commonwealth Fund recently reported that almost nine out of every ten Americans who seek individual coverage never buy a plan, due to astronomical premiums and medical underwriting, and about two in five of those who apply are turned down or charged more than they expect. Ezra Klein points out that the absence of affordable individual insurance drives younger Americans into the employer-based system, which can stifle their creative and entrepreneurial drive.

Meanwhile, Dr. Deborah Serani explores a maddening feature that faces the nominally insured, trying to find a doctor through her managed care plan, and the Catch-22s that ensue.

From across the Atlantic, Rod Ward reports interesting lessons, though indifferent catering! from a study day on current developments in e-learning in the UK’s National Health Service and pointers about future developments in the field. Shadid Shah at The Healthcare IT Guy brings up an important IT issue: how to ensure that CIOs get control of their healthcare databases. He analyzes issues associated with using Microsoft Excel and Access and advises why documents created in those applications might be difficult to manage and what to do about it. Dimitriy Kruglyak at the Medical Blog Network wonders if bloggers will be able to shake up the world of health care communications.

In a related vein, David Williams at the Health Business Blog dissects the debate over whether doctors need to be well-versed in statistics. Doctors  have little training in statistics, leaving them ill-prepared to interpret new studies. But does the answer have to be a traditional stats class in the medical school curriculum, or would it be better to teach docs-to-be how to be skeptical consumers of statistical claims?

On insurance and coverage themes, Dale Hunscher at FutureHIT calls attention to the poor comparative performance of the U.S. healthcare and social welfare systems, based on the EPI’s recent State of Working America Volume. Bob Vineyard at InsureBlog pens a witty dialogue in response to the roadblock facing a single-payer proposal in California. When it come to workers comp reform, it’s always a good idea to follow the money. At Worker’s Comp Insider, Jon Coppelman follows this money trail to see just who benefits from reforms in the Ohio and New York systems.

At Health Care Renewal, Dr. Roy Poses praises Daniel Golden’s newly-published The Price of Admission. According to Poses, its most important premise, backed up by lots of anecdotes and some quantitative data, is that there has been a secret alliance between leaders of institutions of higher education and the most wealthy and famous in American society. This results in the latter being able to de facto trade some of their wealth for special treatment, such as admission of their otherwise-not-qualified children. One anecdote describes how two children of the CEO of a large device company got into a prestigious university (which has a prestigious medical school), and the "go-to man" who helped arranged their admission, an important if somewhat shadowy figure in the university's hierarchy, ended up on the board of the device company. The complexity of the potential conflicts of interest here defy easy analysis.

Fard Johnmar asks me to include a reminder about the healthcare blogging survey he is running with Dmitriy Kruglyak of the Medical Blog Network. As announced in a previous edition of HWR, The Medical Blog Network (www.healthvoices.com) and Envision Solutions, LLC (www.envisionsolutionsnow.com) are running the first global survey of healthcare bloggers. The final survey results will be presented during the Healthcare Blogging Summit 2006 in Washington, DC (www.healthvoices.com/conference). Learn about this important survey at ( http://www.envisionsolutionsnow.com/survey). The poll closes on September 29. Please do participate in this survey, and send in your posts early and often for the next round of Health Wonk Review on October 5th.

Leif Wellington Haase is a senior program officer and Health Care Fellow at The Century Foundation.