Archive for Universal Coverage
by Fred Fortin
March 5, 2008 at 10:46 pm · Filed under Insurance, Public Purchasers, Health Plan/Payer CEOs, Policy Makers, Regulators, Universal Coverage, Business of Health, Value-based health care, Ethics
I’m attending the AHIP health policy conference in Washington, DC this week and getting an earful about the elections and healthcare reform. Some impressions:
First up on the podium was Chris Matthews, TV commentator of Hardball fame. Matthews is a good speaker and captures the audience right away. He believes anyone of the three presidential candidates could take the election. Yes, there is still a path for Hillary to get the nomination but a lot depends on what happens today at the polls in Texas, Ohio, Rhode Island and Vermont.
To Matthews, America is in a “rut”. The people want change, they want deliverance. And doing nothing is definitely “out”. Obama is different, not your typical politician and he believes that this election is really going to be “transformative”, the likes of which we have not seen for quite a while. While he did not address health care reform in a specific way, Matthews argues that real political change only comes from brilliant, dramatic, unpredictable and grand moves. So I don’t think health care incrementalism is in Matthews’ play book.
Donna Brazile, TV political commentator and Chair of the Democratic National Committee’s Voting Rights Institute, and super-delegate, also believes that voters are in a foul mood. There “will be blood in this election”, she says. The next president will inherit a divided country and healthcare will be right in the middle of it. In addition, the deterioration of the economy will make health care reform doubly difficult. Even so, Democrats will want to get something in healthcare reform on the table quickly after the election.
Michael Murphy, Republican Political Consultant, and TV Commentator, on this point, says a McCain presidency may, contrary to popular thinking, do more for healthcare reform since if it is proposed by Democrats, the Republicans will block it. Like Nixon going to China, you need a conservative to front this kind of liberal change.
Dan Crippen, former Director of the Congressional Budget Office, observes that many people think rising health care premiums are capricious acts; they go up by themselves and are unrelated to cost structure. He asks “How do we change the 30 year old question in healthcare from ‘who should pay’ to ‘what are we buying’.”
Ezekiel Emanuel, Chair of the Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, asks the question of how do we make sure that the process of healthcare reform is legitimate if we need to make sacrifices? What voices need to be heard? He also agrees with many of the other speakers that we need to better assess what we’re spending our money on in healthcare. We need a better strategy. In responding to those who say that cost should not be a consideration in delivering healthcare, he advocates, that cost is an essential ethical consideration in healthcare because cost has an impact on our ability to pay for other critical services and needs. And that fact alone makes it an ethical dimension worth weighing.
In a similar vein, Paul B. Ginsburg, President, Center for Studying Health System Change, provokes the audience on questions about the importance of equity in healthcare, and the public tolerance for administrative control of the distribution of health care services. Containing health care costs will be painful, he reminds us. There is no painless solution. Ginsburg warns that health care financing systems can fail, but that they fail slowly. This health care crisis has been with us for over a decade. However, the affordability problem is now invading the middle class, crowding out other important needs.
The final speaker of the day one was the notable Theodore R. Marmor, Professor Emeritus of Public Policy and Management, and Political Science, School of Management, Yale University. Marmor observes that the lack of consensus should not be surprising since with healthcare we have five Americas: The British model embodied in the Veterans Administration system; the German social insurance program model in Medicare; the 19th century poor laws model in Medicaid; the private health insurance system; and pure charity medicine.
His own criteria for judging health reform proposals are fairly simple: Does is include everyone as payers and recipients for care? Does it cover what ordinary people think is medical care? Does it contain fiscal restraints to prevent the raiding of either the public or personal funds? It is accountable for results? And is the protection portable?
Marmor would like to see a real national conversation about healthcare since right now he feels what Washington is saying up to this point is pure gibberish. How, he asks, can we avoid another mistake like that which was made by the Clintons without a real national dialogue and consensus? We cannot wait another decade for an answer.
US Senator Ron Wyden took the stage first thing the morning of day two of the conference. He’s a frequent speaker at this conference usually focusing on his ‘Healthy Americans Act’ as a step towards real healthcare reform. He says the first 100 days for the new president will be critical for healthcare. Democrats — if they win — will need to put something on the table quickly. Congress is getting ready to act and Wyden does not want a repeat of the now infamous Clinton failure of 1994. This time there is an opportunity to do healthcare reform right. He wants a system where everyone has a basic private portable health insurance plan.
Recent history shows states cannot fix healthcare by themselves because the big drivers are federal, such as Medicaid and Medicare. And if we don’t fix the private market, the country will go single payer. Wyden wants a new private health insurance market that breaks the dependence on employer-sponsored coverage. His plan would still offer a choice of an employer plan. But his ‘Healthy Americans Act’ now before Congress would provide for an alternative to both single payer, and an over-dependence on employer-sponsored healthcare.
But how will health insurers respond to these proposed new changes? Cajoling his audience of health plan representatives, he argues that his approach would be one way to stop playing the healthcare blame game, replete with its usual designated healthcare villain of the day being held responsible for all that is wrong in healthcare. Health plans have all too often shared this distinction.
Andy Stern, President of Service Employees International Union, started his talk with an all-too-familiar tragic story of a healthcare disaster that end bankrupting an American family. He then switched gears to share the changes his own union has had to undergo to confront the new global economy. Healthcare, he believes, has also not reacted well to this new global economy. What we have now is a healthcare sector; what we need to build is a healthcare system. “Change is inevitable but progress is optional,” he lamented.
If there is one truth about healthcare reform, Stern believes, it is that the longer you wait, the worse it gets. And the US employer-based healthcare system is not sustainable for the economy of the future. It is dead and it’s time for hard choices. We need to move on to a more competitive approach. But he doesn’t think the country is ready, willing or able to go for a single payer system. We have to build a broader coalition on healthcare and negotiate a new blend in order to move on.
Stern warned that there is a big target painted on health insurers and the bullets are getting closer. Health insurers will have to walk in a new direction. People are ready for change. But where is the solution? “Be the agents of change”, he charged, “not the assassins of change”.
Gail Wilensky, Senior Fellow, Project Hope and a former Medicare chief, observed that even when we have expanded access to healthcare — such as the recent addition of drug benefits to Medicare, we still have problems with cost and quality. Medicare’s cost is unsustainable and its population is becoming more politically forceful. The program’s provider financial incentives are perverse and its spending constraints are ineffective when it comes to value and quality. It will be an immense challenge to moderate the Medicare’s cost growth.
Bruce Vladeck, Senior Health Policy Advisor, Ernst & Young, and also a former Medicare chief noted that the healthcare reform proposals put forth by the presidential candidates rarely mention Medicare or Medicaid. Problems with Medicare are the problems with the healthcare system generally speaking. He argues that Medicare costs — even with new efficiencies — cannot be sustained without new money. Politicians need to be more open and explicit about this hard fact. And he adds, that we must stop confounding the problems having to do with improving the quality of healthcare, with the problems of moderating the cost of care. It is a fantasy, he says, that improved quality will save serious money in healthcare.
by Fred Fortin
October 16, 2007 at 7:06 pm · Filed under Uncategorized, Insurance, Policy Makers, Universal Coverage, Business of Health
In an odd mixture of practical recommendations and wishful thinking, the Committee for Economic Development (CED)has issued its plan for health care reform. Of course first we have to suffer through the typical litany of exaggerations when it comes to the failures in US health care such as “No one has an incentive to seek, or provide, quality, cost-effective health care . . .” or “. . . there is no meaningful competition in our employer-based health insurance system” or “There is little or no incentive to utilize cost saving technology. . .” and “. . . employers can generally offer only one plan.”
Really? But, we really shouldn’t whine since we’re used to these opening rhetorical salvos by now. Seems everyone has the same script.
The intent of the plan is to move US health care beyond the employer-based health insurance system through the development of regional “exchanges” that would provide a single point of entry for individuals to choose among competing private health plans. There is also the strong suggestion of national regulation of health care insurance that accompanies this recommendation about which, in truth, I have railed against before.
But just as important, I’ve argued that taking employers out of the loop – as much as they, and many health activists, would love it – removes a critical player, who, for better or worse, provides some serious local and national weight in the balancing of health care demands against economic realities. Take them out and what do we have left — the medical-industrial-complex battling with government bureaucracies? Who is going to be the grown up there?
In contrast to those recommendations, the CED calls for a national “Health Fed” (to set performance standards, collect data, estimate future costs etc) as well as an “Institute for Medical Outcomes and Technology Assessments” – all reasonable and worthwhile suggestions. Both could be done now and with good effect.
As far as the wishful thinking goes, it is spread quite thick in this proposal. One example will suffice. I quote from the report,
“With health plans competing to attract cost-conscious consumers, we can expect our health-care system to change for the better. Health providers would be accountable for quality and cost. To remain affordable while maintaining quality for their customers, providers would need to adapt to new challenges and opportunities. They would move away from fee-for-service episodic treatment of symptoms to emphasizing primary care, health promotion, disease prevention, early detection and treatment, chronic disease management, and cost-reducing innovation and process improvement – including efficient use of technology, such as electronic medical records, knowledge management, and computerized caregiver support tools; better use of physicians’ time, in part through team practice with non-M.D. professionals; matching resources to the needs of the populations served; and regional concentration of complex care, to achieve expertise and economies of scale. To control costs, providers would need to avoid conflicts of interest, and use the best possible evaluation of the efficacy of treatments and therapies.”
No one disagrees with the wish list. The disagreement comes in with the oversimplification of what it will take to get us there.
by Nick Jacobs
September 24, 2007 at 10:45 am · Filed under Insurance, Hospital and Health System CEOs, Policy Makers, Universal Coverage
Let me preface this essay by saying that, I am writing this as a health care provider, a hospital CEO, and a concerned citizen. In the past we have talked almost incessantly about the 47 million uninsured in our nation, and the lack of funding for domestic issues ranging from education to infrastructure. (And in the spirit of full disclosure, I consider myself a moderate and don’t believe that this venue is appropriate for a political rant, but . . .)
An article in the New York Times today by Sarah Kershaw opened with this sobering piece of information, “The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.”
I’m not sure what to say about this. At our hospital the decision to treat or not to treat will remain the same. We will treat.
The Washington Post’s Christopher Lee wrote recently that, “If anything looked like a sure thing in the new Congress, it was that lawmakers would renew, and probably expand, the popular, decade-old State Children’s Health Insurance Program before it expires this year.”
This surely seems like a dream come true for any politician, something that creates a health care safety net for children who, otherwise would not have the coverage or financial wherewithal to pay for this care. What politician would even consider vetoing an already established program that offers health insurance for kids?
Interestingly, President Bush has indicated that he will veto it. It’s important to note that his veto will not be because he is concerned that this program doesn’t work, he has acknowledged that S-CHIP works very well. He has also indicated that he will not veto it because it is fiscally irresponsible? In fact, this plan is, overall, a very reasonable expenditure. Yes, he objects to any expansion of the plan, but, it appears that this will not be the only reason for his veto.
It seems that Mr. Bush’s decision to take this stand is ideological.
The program is diametrically opposed to his philosophy of government. If you take care of kids, and that plan works, then you can take care of adults, too. Expansion of government is not something that this president embraces. But the administration clearly continues to embrace the Iraq war, and that costs money, lots of money.
From the New York Times, January 17, 2007 by David Leonhardt:
“…For starters, $1.2 trillion would pay for an unprecedented public health campaign” a doubling of cancer research funding, treatment for every American whose diabetes or heart disease is now going unmanaged and a global immunization campaign to save millions of children’s lives.
Combined, the cost of running those programs for a decade wouldn’t use up even half our money pot. So we could then turn to poverty and education, starting with universal preschool for every 3- and 4-year-old child across the country. The city of New Orleans could also receive a huge increase in reconstruction funds…”
Is it truly is all a matter of ideology?
by Tony Chen
May 29, 2007 at 9:32 pm · Filed under Insurance, Universal Coverage
Today, Obama unveiled his stance on healthcare. Politically, this is significant because (1) it’s really the first time he’s provided a detailed glimpse into his policy mentality on anything; (2) healthcare has been Clinton’s pet issue up to this point; (3) healthcare has been deemed by some as the “theme of the Democratic primary.” While still fuzzy on total numbers, his strategy would mandate employers to provide (or fund) health insurance, create a new system for uninsured coverage, and establish a new “National Health Insurance Exchange” aimed at regulating insurers. It’ll be funded by eliminating tax cuts (capital gains and inheritance) for the wealthy. Under this plan, big pharma, managed care, big business, and the wealthy are the losers. By 2012, Obama promises a truly universal healthcare solution.
What’s missing in all the candidates’ policies are exactly the issues that we’ve been discussing here at World Health Care Blog. It’s not sexy (unless you are at a healthcare policy analyst party) to talk about investing in preventive health or managing the chronic diseases that will ravage our country for the next 50 years. It’s not appropriate or relevant to talk about personal responsibility and good lifestyle decisions in healthcare on the campaign trail. Is there a candidate out there who is willing to take on healthcare politics AND health politics?
By the way, here’s an excellent rundown of every candidate’s voting record regarding healthcare. And here’s AAFP’s summary of every candidate’s stance on healthcare.
by Tony Chen
April 25, 2007 at 1:25 pm · Filed under Blog News, Hospital and Health System CEOs, Universal Coverage, Prevention and Health Promotion
Thanks to all my fellow bloggers for the great coverage of the conference. I’d be curious to hear if any key themes emerged from the conference. From my read of the 20 posts within the last 48 hours(!), it sounds like healthcare is heading towards a more collaborative future.
While you’ve been at the conference, a few tidbits that have surfaced in the last few days:
- Ezra Klein has a great piece The Health of Nations on the proven results of socialized medicine. Of course, our very own Matthew Holt pokes some holes in the piece.
- Keep your eye out on FierceHealthcare’s upcoming list of top hospital innovators to be published in a week or so. Their previous list of top Healthcare IT Innovators highlighted some undiscovered gems, and I suspect the hospital list will also. My vote is for Memorial Hospital & Health System in South Bend, Indiana. Got a product to test on patients? Give ‘em a call.
- A few weeks ago, it was diabetes that covered every front news page. This week, it seems to be obesity. A new study suggested that “the heaviest employees had twice the rate of workers’ compensation claims as their fit co-workers.” Epocrates issues their 2007 Obesity Report and stated that physicians believe obesity is America’s most severe health problem. One glimmer of good news: In a Swedish study, the number of obese kids dropped by 6% after banning buns, sweets, and soft drinks. US officials are finally looking at this now.
- The HealthAffairs blog has a great interview with innovation guru Clayton Christensen on what healthcare can learn from other industries
