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Obama remains committed to health reform, White House official tells wonks

Lambrew President Obama remains committed to comprehensive health care reform in 2009 and believes the declining economy emphasizes its urgency, a top White House official told hundreds of health policy experts Monday in Washington D.C.

“The current economic crisis has really highlighted the problems and put them under fluorescent lights," said Jeanne Lambrew, deputy director of the newly created White House Office of Health Reform.

The Academy Health conference is probably the wonkiest of meetings on the increasingly crowded health reform conference circuit. University PhDs and private sector policy analysts are here to discuss and assess the impacts of reform.

Lambrew provided a glimpse of the President's health agenda in the economic stimulus package, SCHIP and long-term reform efforts. She rapidly reviewed the litany of well-known health care problems: costs, access and quality, and then spoke specifically about health care funding in the stimulus bills working their way through the House of Representatives and the Senate.

About one in five dollars of the stimulus package will go toward health care, nearly matching the one in five dollars of GDP spent on health care.

As previously reported, the roughly $150 billion in proposed funding can be broken into three main categories:

  • Immediate expansions to protect people who are losing their jobs from also losing their health insurance by increasing federal Medicaid match, subsidizing COBRA premiums, and allowing the newly unemployed temporarily to buy into state Medicaid coverage.
  • "Downpayments" on longer-term reforms and job creation efforts in information technology, comparative effectiveness research, and health workforce expansion grants.
  • Funding for health prevention services, such as tobacco and obesity prevention programs.

As for long-term reform, Lambrew reiterated Obama's commitment to offering people the option of buying into a public plan. She left it open as to whether this would be a Medicare-like single-payer plan or something more like the options currently offered to federal employees.

This aspect of the reform has already drawn the most criticism and raised alarm among conservatives, who consider it a step toward government-controlled insurance. Lambrew, however said that Obama believes in choice.

"If we really do believe in competition, why not give the public plan a chance?" she said.

Afternoon update:

The business perspective on reform

Peter Lee, the Pacific Business Group on Health's director for national health policy, emphasized employer's desire to move toward a performance-based, high value health care system.

To him, that means greater transparency on costs and quality, comparative effectiveness research, comparative information on clinician performance, payment reform, health system transformation and emphasis on prevention and wellness. That's a tall order, but his bottom line was that health costs are hampering American businesses' ability to compete globally and the value for money spent is far from optimal.

A good starting place, Lee said, is ensuring that everyone has health insurance coverage. Safeway CEO Steve Burd echoed that. Having 47 million uninsured people, he said, is a great inefficiency borne primarily by the employers who provide health coverage.

Moving away from a fee-for-service payment system is a must, as is balancing the board of physicians who advice Medicare on reimbursement, Lee said. Currently, it's dominated by physician specialists whose preference for technical interventions over primary care services is obvious in the current payment system, he said. Lee wants payers to be part of that decision making process.

Comparative effectiveness research on the horizon

The afternoon conversation moved to whether costs should be part of comparative effectiveness research. The payers want costs included. The pharmaceutical and device industries don't.

"To have comparative effectiveness research not used and to not consider costs is irresponsible from a patient’s and an employer’s point of view," Lee said.

Kathy Buto, vice president for health policy and government affairs at Johnson & Johnson, said the idea of having a centralized government agency doing comparative effectiveness research and including costs is scary.

“Cost-effectiveness analysis is used by countries to limit coverage of treatments – and is a poison pill,” she said.

Lambrew spoke briefly this morning about the $1.1 billion in the stimulus bill to fund comparative effectiveness research. She said lawmakers from both sides of the aisle recognize the need for better evidence to guide health decisions and there is strong bipartisan support to fund this research.

The legislation would allow for gathering information on costs but prohibit Medicare from using it to determine coverage. At this point, she said, the goal is to create legislation that allows for the maximum amount of flexibility in design and scope of the research.

Mark Gibson, of the Center for Evidence-based Policy at Oregon Health and Science University, spoke about how states are already using comparative and cost-effective research to make policy decisions.

He got his start in state health policy 20 years ago, during Oregon’s infamous Medicaid experiment to expand care to more people by limiting services based partly on their cost effectiveness. Gibson admitted to feeling a sense of déjà vu, particularly over the rising alarm about the prospect of rationing health care.

“At some point, we’re going to have to realize that we can’t do everything in the health care system for everyone who needs it or wants it,” he said.

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Reform NeededChicken GateCasseyJonathan Leo MichaelsRalph Recent comment authors
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Reform Needed
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Reform Needed

Limo Divers Protest Medicare Mediciad Reform Cuts, It’s rumored this issue could become part of the Tea Party movement. AmeriChoice Health is also rumored to take a position on this reform. Recirculate those tax dollars? Help keep limo drivers working, benefits flowing and overpaid tax dollars remain in abuse. Medicare.gov as well as other Federal agency’s encourage you to report any fraudulent activities, yet, the same government agencys were notified the way this company does business yet did nothing. Three years ago they were reported to these Federal agency’s and as of todays date not only were they allowed to… Read more »

Chicken Gate
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Chicken Gate

Fried Chicken? Mediciad Inducements? The 101 Dumbest Moments In Business 2003 EDITION Whiffed pitch No. 6: blatant stereotyping. By Mark Athitakis April 1, 2003 (Business 2.0)– GRAND PRIZE WINNER, DUMBEST MOMENT OF 2002 Which leads to the question, Who is Chicken Man? & Why were whole fried chickens selected? In September, insurance company AmeriChoice brings trucks to blighted neighborhoods in New York City and gives away coupons for “free chickens” as an incentive for the underprivileged to switch their Medicare coverage. New York state senator Carl Kruger files a complaint with the state attorney general. The 101 Dumbest Moments In… Read more »

Cassey
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Cassey

National Health Insurance Reform in America President Obama’s health care reform bill is to be taken very seriously. Americans can’t sit by and hope things work out for the best. I agree that America needs health reform, currently over 15 percent of our nation is uninsured and far more are under insured. This is the effect of America having the highest health care cost than any other country in the world. The Obama Plan promises that all we will be offered affordable health care regardless of pre-existing conditions, and guarantees insurance renewals. While this sounds great, there is far more… Read more »

Jonathan Leo Michaels
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Jonathan Leo Michaels

I would like to propose a bill to do away with free government employee health care. Why should federal and state employees get free health care included in with their jobs, as a normal part of their package of benefits, when so many of them are saying they are against free health care? There is no reason that they should have healthcare benefits, at this time, paid for from the taxes from the rest of the U.S. citizens — many, who after paying taxes, will not get the same benefits. If so many in the Senate and the House are… Read more »

Ralph
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Ralph

The Cults, Greedy, Racial Profiler’s and Predjudice will always go along with their Kind! No matter if it right or wrong. They are as THREE MONKEYS SITTING ON A STUMP…. Saying SEE NO EVIL..HEAR NO EVIL..SPEAK NO EVIL..and a blind man, a deaf man and dumb man has more sense then they do! And this is FOOLISH and PROPHECY! And as MARTIN LUTHER KING would sum it all up as them HAVING NO “CHARACTER OR CHARISMA”! I am saying support Health Care Reform and Reject Racial and Predjudice Profiling toward’s the Minorities and the Poor! Martin Luther King’s “I HAVE… Read more »

EzSayIz24k
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EzSayIz24k

I was diagnosed with multiple sclerosis THIS YEAR. My injections cost over $2000 MONTHLY. Now that I have a PRE-EXISTING CONDITION, – will you, the PROTESTERS, PAY for the medicine I will NEED for the REST OF MY LIFE if I want to further my career at a different company?!! Private insurance penalizes those with chronic health conditions!!! I pay taxes. Why should I not be able to get health insurance?!? If YOU will not help me pay for my lifelong medical condition, then you should keep your insurance as Obama has said SEVERAL TIMES, and I should be able… Read more »

Dan
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Dan

I am a small Business Owner and because of the new Cobra Rule where even if the employer cannot afford to pay the COBRA Health Insurance for a terminated employee he still has to pay for it and wait for a year for the govt to refund so the best thing to do is not hire a new employee.Isn’t that sad that the govt is passing bills that are preventing people from getting jobs. Why can’t our Government wake up.

michelle
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michelle

Please President Obama and all our US Senators stop this health care bill. You are hurting small business that is the back bone of our great nation.

ray
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ray

how many people can 12 billion dollars cover every year? That is what the top 7 insurance company’s made in 2007 profit after awarding all their fat bonuses to executives. This is where reform should start then tort reform must follow and then open competition among insurers

Amir
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Very interesting post and comments. I have written up many of these ideas on my site about health reform and I think anybody interested in this blog will find the information there very salient. Many of these ideas are things I am studying right now at The Wharton School as an MBA, although I combine thoughts as a practitioner in industry as well.
Please do check it out!
http://www.satvathealthcare.com
All ad profits go to fight ulcerative colitis!
Best,
Amir

Darin
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Darin

What is truly scary is that this blog exists. Anybody that’s ever dealt with TriCare as the military health care insurance program knows that government managed health care, even on a small scale is a disaster. We’ve been waiting since October to get a surgery that we’ve needed in our family. We knew it, and some people around us knew it but by the time we weaved through the minefield of government bureaucrats who enjoy their power the months kept creeping by. Now the problem has developed into a much more dangerous situation due to lack of initiative by paper… Read more »

domino
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domino

I for one do not want to be a guinea pig for Obamas Healthcare reform.

Julian Lieb,M.D
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Julian Lieb,M.D

Access Pubmed, then enter “antidepressants” and “cancer.” You will find more than 60 articles showing that antidepressants kill cancer cells, inhibit their proliferation, convert multidrug resistant cells to sensitive, protect nonmalignant cells from damage by ionizing radiation and chemotherapy, and target the mitochondria of cancer cells, while sparing those of healthy ones. This innovation alone could make a vast contribution to health reform, provided the resistance of vested interests is overcome by political intervention.

John
Guest

While I believe a system like universal health care would be great in certain aspects I still believe that it is not government’s responsibility to provide healthcare. It is unfortunate that the American Dream no longer exists and people have this new found sense of entitlement. The great men who laid the ground work for this country and got it flourishing would roll over in their graves if they where able to see the US today.

Govindan
Guest

With many issues plaguing the health care system, a beginning is better. Secondly it is not possible to be pleasing each and everyone.