Tag: Policy

Healthy Americans Act could be the place of compromise for health reform in 2008

Health care reform will be hard to do after the November election. I’ve even called it a long-shot.

Wyden_smilePolls clearly show the voters split evenly between the Democratic and Republican approach to health care reform. I can’t tell you who will win the presidency, but I am willing to make the bold statement that it will be a close election and neither very different approach to health care reform will enjoy any kind of mandate.

So finding common ground between these very different approaches will be more than tricky.

But we may already have an outline.

Sen. Ron Wyden (D-OR) and Sen. Robert Bennett (R-UT) have crafted a health care reform plan that gives both sides the most important things each are looking for.

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Marrying for health care

About 7 percent of Americans recently reported in new Kaiser Health Tracking Poll that someone in their household got married so they could get health benefits. While 7 percent may be a bit high, I have no doubt some people consider health benefits when deciding the timing of their marriage.

I gave similar advice to a friend only a few months back. She had recently moved to Denver with her fiancee, and was temporarily unemployed. She wanted health insurance and could afford to buy it, but she couldn’t get it.

Except for seasonal allergies, she’s a healthy 26-year-old woman. Allergies were reason enough, however, for two insurers to deny her coverage. Her fiancee’s policy only covered spouses. My advice: get married quickly at City Hall and then again eight months later at the planned wedding. (She rejected that idea and found a job after about two months of looking that offered health benefits.)

Under John McCain’s proposed health plan, many more people like my friend may be denied coverage. His solution? Create a high-risk insurance pool. But do allergies make my friend high-risk? I don’t think so. Where do individuals like her fit in?

Over at the Health Access blog, Anthony Wright describes California’s high-risk pool, known as the Managed Risk Medical Insurance Board, or MRMIB. It currently has a waiting list of more than 500 people. Another example of people who want insurance but can’t get it.


The bizzaro world of McCain’s health care politics

I sometimes write two different versions of pieces, one for you wonks at THCB and one for the more general crowd at Spot-on. Well to be more accurate I write one version which gets edited heavily over at Spot-on, so today here I’m putting up the THCB version of the one that went up on Spot-on yesterday.

My 6 weeks of traveling the world on an extended honeymoon is over. Thanks very much to Brian Klepper and the cast of thousands who’ve been keeping THCB rolling excellently while with my lovely wife Amanda I’ve been diving on coral reefs, sleeping under the stars with the Bedouin, exploring 3,500 year-old tombs, watching Lions tear apart a buffalo, and tracking chimps hanging out in the rain forest. (Pictures of all this and more to come, I promise)

So what better way to return than to enter the jungle of US Presidential politics? Yesterday I sat in on 2 conference calls. One from the McCain camp on their man’s health care proposal, the other from the Campaign for America’s Future, which is promoting Jacob Hacker’s plan as the theory behind both Clinton and Obama’s policy intentions. It wasn’t pretty.

McCain’s proxies were Douglas Holtz-Eakin, sensible former CBO director, and Carly Fiorina, the fired HP ex-CEO who has been rehabilitating herself by taking credit for her successor’s success, and been hanging out on the McCain campaign as adviser for tech. Apparently she’s on the VP shortlist, and if so, we got a lot of taste of what we can expect. The choice is between free market choice, and the government telling your family which doctor it can go and see. Yes, you’re going to hear “government run heath care care” alot as if we’re all moving to the Gulag.

(Carly also made an amusing slip when she said that McCain favored importing of generic prescription drugs. Generic drugs are of course usually cheaper here—it’s re-importation of branded drugs that McCain supports, which will lose him the odd contribution from PhRMA).

But no matter competition and choice is always cheaper—trust her.  But then again Carly knows all about succeeding in the free market, right?


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McCain starting to talk about health care

This morning John McCain’s team will be talking about health care. There are some interesting ideas in McCain’s plan, which is the Bush tax deduction idea morphed into a tax credit, plus changes in Medicare payments. The best quick explanation is from our friends at ICYou.

Matthew Holt

An Open Response To HHS Secretary Mike Leavitt – Brian Klepper and Michael Millenson

A few months ago, the two of us – both long-time advocates for
transparency and accountability – posted separate comments on Secretary
Mike Leavitt’s blog
Brian asked Secretary Leavitt to square his
support of "Chartered Value Exchanges” with the attempt to block
release of physician-specific Medicare claims data to Consumers’
Checkbook, which wants to rate doctors. After a court ruled that the
data should be provided to the group
, HHS appealed. Michael urged the
secretary to go beyond supporting Consumers’ Checkbook and use his
“bully pulpit” to promote sophisticated data analysis that could be
used to create national quality comparisons.
Secretary Leavitt graciously asked us to consider and comment on the
department’s proposed "Medicare trigger legislation" calling for the
release of physician performance measures. We are delighted to continue
the conversation.

First, let’s give credit where credit is due. We agree that the proposed legislation is a major step in the right direction.

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We asked THCB contributor Maggie Mahar for her quick take on the health care policies of each of the presidential candidates. We were pretty much expecting one of Maggie’s trademarked dissertations – a meticulously researched critique of each politician’s views on various important substantive issues. Instead this entertaining reply turned up in our email inbox.

“If Clinton wins we have real national health care reform.

If Obama wins, I’m not so sure, given that Cutler thinks we’re getting value for our dollars, and healthcare doesn’t seem to be a big priority for Obama (although his plan seems a lot like hers).

If McCain wins, we all move to Canada. Northern Canada, where will not only have healthcare, but may be able to avoid the fall-out from the nuclear war that he starts.”

You’ve Gotta Spend Money to Save Money …

Or so the thought is by many in the health care world.

Thus, the motivation for chronic care management programs was born.

CMS, the august government body charged with overseeing Medicare (and Medicaid), instituted a 3 year, $360 million, test program to see if these programs would have the effect of saving the system money.

The conclusion after the 3 years:

Using regular phone contact to check on the health of chronically ill U.S. Medicare patients appears to cost more than it saves the system.

More from the article: "[t]he problem is that the fees paid to the companies make the program uneconomic."  (Note that a longer version is available at the NY Times website here.)

My favorite part of the UPI brief: "Sens. John Kerry, D-Mass., and Lamar Alexander, R-Tenn., are pressing for its continuation. Companies involved in the program are based in both of their states."

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Which way to go for health reform? From Birkenstocks to pom-poms

The methods proposed to clean up the health care mess in the United States that leading voices pitched to hundreds of journalists Friday unsurprisingly were as varied as their Birkenstocks and patriotic tie.

David Himmelstein, co-founder of Physicians for a National Health Program and Birkenstock-wearing Harvard Medical School professor of medicine, unrelentingly pushed a single-payer system. "We need a reform that helps the insured as well as the uninsured," he said, adding that the system should "get rid of the insurance companies that provide no added value."

At the other end of the spectrum, Tom Miller, resident fellow at the American Enterprise Institute conservative think tank, wants more tax credits to put consumers in the driver’s seat and deregulation of the individual market.

Between those two ideologies, were Karen Davis, president of The Commonwealth Fund, and Julie Barnes, deputy director of the New America Foundation‘s health policy program.

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Loving Our Children

Among its many less-noticed accomplishments, this Administration has strangled funding for comprehensive sex education. Instead, it has thrown the immense weight of the US government behind abstinence-based education, an impractical ideological approach rooted in religious zealotry and a romantic notion of social mores that no longer exists for most young Americans. In 2005 and 2006, the Bush Administration spent $170 and $178 million, respectively, more than double the 2004 expenditure, much of it allocated to mostly conservative Christian organizations, to encourage children to refrain from sex without explaining the fundamentals of contraception and sexually-transmitted disease (STD). In 2004, a Minority Staff Special Investigations report prepared at the request of Rep. Henry Waxman (D-CA) found that more than 80 percent of federally funded abstinence programs contain false
or misleading information about sex and reproductive health.

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The Myth of Health Care Consumerism

Last weekend I heard several great presentations at a meeting convened by Jeff Goldsmith, but one contained a point I hadn’t heard nailed down before. Kaveh Safavi MD JD, from Thomson Healthcare’s Center for Healthcare Improvement, detailed the results of several large sample surveys on consumers’ attitudes toward web-based health care information.

One of Dr. Safavi’s opening slides came from Solucient’s HealthView Plus 2006 data, and was focused on "Quality-Driven Consumers," people who are "likely to research ratings information on hospitals or doctors," and likely to change providers if the one they originally preferred received a low rating. Strikingly contrary to the conventional wisdom, this group makes up only 19%, or one-fifth, of American adults.


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