Health Care Reform - "The Great Unfinished Business of Our Society"
Welcome to Health Wonk Review. A special thanks to the stellar group of writers that contributed. And a remembrance to a leader for reform:
"What we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."
Austin Frakt at the Incidental Economist presents Economics Arguments for a Public Option. "Good economics arguments for the public option have finally been made. Will they influence the debate? It may be too late."
Tom Emswiler at New Health Dialogue advocates paying "for expanded coverage, in part, with savings from within the health care system, i.e., by doing a better job than we do now in delivering high quality affordable care."
Doctors Jonathan Skinner, Elliott Fisher, and Jonathan Sutherland from the Dartmouth Atlas Project found that "there is still plenty of potential savings in the U.S. health care system to help pay for health care reform, spending that has nothing to do with health, poverty or urban/rural status... There is a behavioral bias at work, a belief shared across all hospitals that their patients are sicker than average, and this explains why their own spending so high. (This is a “Lake Woebegon Effect” in reverse – the belief that the health of all of their patients are below average.) But this behavioral bias, leading to the denial of the potential for real cost-savings in the U.S. health care system, can potentially derail health care reform – to the long-term detriment of the medical and financial health of the American people."
Bob Vineyard at InsureBlog believes that "nothing proposed will lower the cost of health care, or health insurance. In fact, you could very well see the total cost of health care balloon out of sight and health insurance premiums double overnight."
Elizabeth Carpenter at New Health Dialogue explains why healthcare reform costs close to $1 trillion over ten years. "Subsidies -- financial assistance to help people afford insurance -- are why health reform costs so much. Reform proposals would help many hard-working Americans -- people who make too much money to qualify for programs like Medicaid but make too little to purchase coverage on their own -- buy quality health insurance. People eligible for subsidies would receive a tax credit to help them pay the premium for their choice of plans offered in the new marketplace or exchange."
Mad Kane " limericks" Senator Judd Gregg's flip-flop on the use of the Senate's reconciliation rules, supporting it for Republican votes on ANWR drilling, but not for the Dems healthcare reform:
“Majority rule is just great,”
Said Gregg in the drilling debate. “You’ve got 51 votes, Then you win.” Check his quotes. Yet 51 Dem votes don’t rate.
Anthony Wright, Executive Director at Health Access California, raises concerns over the Baucus Senate Finance Committee bill arguing that "the details matter on key issues on affordability, securing employer-based coverage, and the public health insurance option. And some of those details are very concerning." He provides links and context to the current flashpoints in the debate.
Dr. Jaan Sidorov at Disease Management Care Blog reports on the "Senate Finance Committee's Bipartisan (Gang) of Six Framework for Reform: Complicated is Only the Beginning."
Dr. Roy Poses at Brown University School of Medicine writes in Health Care Renewal that "we will not truly reform health care without making the marketing of health care goods and services honest, getting health care professionals to give up their financial relationships with health care corporations to reclaim their professionalism, and getting academic medical institutions, professional and medical societies, and patient advocacy groups to give up their financial relationships with health care corporations to reclaim their missions."
Harvard Medical School Professor Mike Chernew on the Robert Wood Johnson blog notes that as the health reform debate enters its final phases, it’s not surprising that cost containment is among the last, most intractable issues of contention. There are "serious questions about resource allocation that each side must address as we strive to design a sustainable health care system. For example, can we afford to fund access to all care for everyone? Are we willing to change the tax system or to impose other reforms that may lower prices or restrict choices in order to achieve that goal? What role should the government play in creating and managing this system relative to the market?"
Louise at Colorado Health Insurance Insider asks "how do you tell a person who is desperately ill that they can’t receive treatment because they aren’t in the right country (or because they don’t have health insurance, for that matter)? I have to imagine that it would be tough for a dedicated health professional to turn away truly sick patients because they aren’t supposed to be here in the first place. What if turning them away amounts to a death sentence?"
Kostub Deshmukh at Hoot Hoot Hoot! proposes a plan that "shifts the cost of the treatment from the insurance provider to the patient, while the safety net of catastrophic insurance protects people from bankruptcies due to illness."
Princeton Economist U we Reinhardt expresses doubts about the impact of the proposed "public option," but he also expresses doubts about the co-op approach said to be included in the Finance Committee package. Reinhardt also worries that $900 billion or less will not provide sufficient subsidies to make coverage affordable for all middle-class Americans.
Harold Miller, CEO of the Network for Regional Healthcare Improvement, focuses on the urgent need for payment reform and calls on Medicare to facilitate and learn from the reform efforts already launched by Regional Improvement Collaboratives.
Jason Shafrin at the Healthcare Economist comments that "whether or not you agree with Obama's plan, it is admirable for him to go out on a limb to attempt to solve some of our health care problems. He does, however 'defer reform' for Medicare, since no significant changes to benefit packages or funding was proposed."
UNC Associate Professor Jonathan Oberlander believes that Obama's speech was well received. Oberlander reminds us that Bill Clinton's health care speech was well received, too, but he concludes that the reform fight, while no sure thing, is winnable for the administration.
Ken Terry at the BNET Healthcare notes the lack of details on cost containment in the speech and the probability that, even if a reform bill passes, the legislation will have to be revisited in the near future.
Harold Luft, Executive director of the Palo Alto Medical Foundation Research Institute, focuses on three aspects of Obama's speech: Delaying the implementation of the insurance exchange, malpractice reform, and the proposal for back-up spending cuts in case initial expected savings don't materialize.
Henry Aaron, Senior Fellow at the Brookings Institution, says that by reaching out in his speech to undecided moderates and clarifying his goals, Obama revived a reform effort that had been badly wounded during the August recess, Aaron says.
Brad Wright at Wright on Health documents the history of "Presidential Health Reform Speeches: Then and Now". He comments briefly on the relative importance / unimportance of presidential speeches on legislative outcomes, before comparing and contrasting Bill Clinton's 1993 speech to a joint session of Congress with Obama's recent one, including video and word clouds.
Census of the Uninsured
Anthony Wright at New Republic's The Treatment reports on the political attacks on the 2008 Census' 46.5 million uninsured that "doesn’t just seek to undermine the facts; it seeks to both minimize the problem, and place the blame for being without coverage on the uninsured themselves."
Tinker Ready at Boston Health News reports on the 5.5 - 6% uninsured in Massachussetts in the latest census.
Chris Langston at The John A. Hartford Foundation blog finds that older adults are best served by medical teams--but right now, doctors, nurses, and other medical professionals have little incentive to work together, and efforts to foster team care environments are undermined by each health profession's desire to be in charge.
Vince Kuraitis at Better Health Technologies'e-CareManagement Blog writes that the HIT "Standards Committee recommendations are like mandating that everyone in the U.S. be required to speak Latin by 2013."
Dr. Glenn Laffel at EHR Bloggers discusses Social Media: Disruptive Force in Medicine. He makes the case for implementing a widespread, systematic approach to HIT education in medical schools and CME programs for physicians.
Michelle Snyder at The Health Care Blog discusses a survey exploring the opinions of medical students on issues ranging from the state of the healthcare system and use of technology in medicine to social networking.
Policy Challenges of Diabetes and Obesity
Julie Ferguson of Workers Comp Insider reports on an Indiana court's ruling that an employer must cover the costs of an employee's weight loss surgery under workers comp, which continues to generate controversy and attention.