The NY Times has been getting much better in its reporting on health care policy. After all David Leonhardt had Shannon Brownlee’s book as economics book of the year! And they’ve been getting Jack Wennberg in frequently.
But every now and again something crops up that worries me about it’s desire to go straight adn reminds me of that dog with the licking problem. Today it’s the idea that concerns about health care costs are global, which I guess is true, and that the rest of the world–where employers often don’t pay for health care–is becoming more like the US where employers do. The short piece is called Going Global With Concerns on Health Costs and the casual reader might think that systems are converging around the idea that employers should pay for health care because governments can’t afford to.
Leaving aside the basic point that the route by which money is raised to pay for health care is not very relevant compared to how it’s spent and the system by which people get coverage, the article makes two tiny confusions.
First, as it says, it’s supplemental health care costs that employers are paying for in most countries–and in many countries like the UK they’ve done that for decades. Here employers pay for everything. that’s a massive difference.
Second, the increase in percentage paid by employers is only big enough to grow really fast in 4 countries. Those are India, China, Venezuela and Russia. Not exactly health care systems that compare to the US. Our health care system is bigger than those economies!
Here’s a classical example of a federal regulatory agency holding fast to two opposing ideas at the same time. I wonder what it means?
Last week the Department of Health and Human Services posted an interesting notice announcing a new program that recognizes 14 (presumably) forward-thinking health care coalitions of providers, employers, insurers and consumers, which it refers to Chartered Value Exchanges, or CVEs. (Who comes up with these names?!) HHS promises that, by summer of 2008, it will provide "access
to information from Medicare that gauges the quality of care
physicians provide to patients." This "physician-group level
performance information…can be combined with similar private-sector
data to produce a comprehensive consumer guide on the quality of care
available" in each community. Cool! Sign me up!
I’m very happy to relate that one of the best pieces ever by me on THCB, Oh Canada, (written when THCB was just finding its feet in 2003) is still as relevant as ever. There are still inordinate amounts of crap talked about the Canadian system by defenders of the current US status quo (not that the far right loonies who dredge this stuff will say that’s what they’re doing). This is dspite the fact that no major US Presidential candidate, with the possible exception of Harry Truman, has ever proposed introducing such a system here.
But over on liberal blog Campaign For America’s Future (the guys who are backing Jacob Hacker’s work and by the way taking credit for the Edwards, Clinton and some of Obama plan) Sara Robinson—a self described “health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border”—has written a very balanced piece called Mythbusting Canadian Health Care.
I can see the Canadian ex-pat trio of Pipes, Gratzer & Graham going into apoplectic fits even as I type!
I don’t know how many of you linked over to Lawrence Brown’s perspective piece “The Amazing,
Non-Collapsing US Health Care System” in the January 24th issue of the New England Journal of Medicine
(buried in Mathew’s “Whisper it quietly. . .” post), but it’s the most useful piece of political analysis of the health reform conundrum I’ve seen in a long time.
What Brown argues, convincingly, is that we really have three healthcare systems: public and private health FINANCING systems (which operate in the lucrative fantasy land of “reimbursement”) and a public CARE system (the safety net urban hospitals, community health centers, public health clinics, the VA, etc.) that serve the rural and urban poor and uninsured.
Other than a few isolated outposts like Kaiser, the third health system that Brown discusses is the only place in the United States where population health is actually practiced. And, most important, it is also is the mysterious resource that prevents the 47 million uninsured, including a very large number of our 12 million undocumented people, from dying in our streets, and causing a huge political crisis. It is invisible to much of the voting public, but thank God we have a safety net healthcare system.
This latter system has been a political stepchild of state and federal governments, and lurches from financial crisis to financial crisis, living off the land. But it has successfully propped up the other two, and, I think, helped prevent a revolution. Precisely because it has succeeded in reaching its target populations and helping them, albeit “too late” in the disease process, it has drained both political urgency (and funding) from making the first two “reimbursement” systems universal.
I missed Friday’s debate but please can we all remember 3 things before we continue to get too excited about the Obama/Clinton faux dispute
a) Mandates alone don’t work to get to 100% coverage–every employer mandate has exemptions–every individual mandate needs exemptions or subsidies AND it needs a fundamental re-set on how ALL health insurers currently operateb) Most likely any mandate bill will get bargained down to less than it needs to be to workc) Unless the recession is really really bad and still that way in mid-2009, the current health insurance problem is not bad enough for there to be a groundswell of support for an actual meaningful bill to pass over the sure to be violent opposition of AHIP, PhRMA, AHA, AMA et al.
Which means we’ll either get nothing or some watered down version of what AHIP/AMA proposes.
Which means we’ll all be back in 2012 asking how to fix health care…
It’s brief, but, being a Giants fan, there is little more to say…
Beware the Experts (reason #2,754)
Another reason why leaving control over our destiny- whether it be our leisure, work, or heath- completely in the hands of ‘experts’ should give us all pause… 9 out of 11 (89%) of Sports Illustrated Experts picked the New England Patriots to win Super Bowl XLII. They lost. (I will leave it to Matthew to make a comment about how the Super Bowl is not really a ‘football’ game.)
Wendy Everett is president of the New England Healthcare Institute. She thinks that the candidates for President from both parties agree on the important stuff for health care–dealing with chronic care prevention. I can’t say that I’m totally in agreement with her political analysis, but her ideas about chronic care and prevention for the basis of bipartisan action are interesting (and as Wendy used to be my boss at IFTF I thought that it would be polite of me to let her have shot on THCB!)
The presidential candidates are doing a disservice to the voters and to themselves when they emphasize their differences over how to fix the broken health care system. They can argue all they want about the likes of universal coverage, tax incentives and employer mandates, but that cacophony obscures the fact that the candidates, regardless off party, actually share a major position on health reform. Though little-noticed to date, there is a breakthrough bipartisan consensus that the key to health reform is to redirect the system to prevention and management of chronic illnesses.
This unanimity is huge. Chronic diseases – including conditions such as diabetes, asthma and hypertension – are a major threat to both our health and our economy. More than half of all Americans already suffer from one or more chronic ailments, and the rate is rising as the population ages.And the price tag is staggering. Some 80 percent of the more than $2 trillion in annual health expenditures already goes to taking care of patients with chronic diseases. A recent Milken Institute study found that in 2003, chronic care cost the country $277 billion for treatment and another $1 trillion in lost worker productivity. If nothing is done to halt the rise of chronic illness, the Milken Institute projects that treatment and lost economic output will rise to $4.2 trillion by 2023.
And yet much of this cost is completely avoidable.
From USA Today:
Three legislators want to make it illegal for restaurants to serve obese customers in Mississippi.
House Bill No. 282, which was introduced this month, says:
Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management established under Section 41-101-1 or its successor. The State Department of Health shall prepare written materials that describe and explain the criteria for determining whether a person is obese, and shall provide those materials to all food establishments to which this section applies. A food establishment shall be entitled to rely on the criteria for obesity in those written materials when determining whether or not it is allowed to serve food to any person.
The proposal would allow health inspectors to yank the permit from any restaurant that "repeatedly" feeds extremely overweight customers.
While it has little support today…
And note that it has both Republican and Democrats as sponsors…
We haven’t heard from our favorite orthopedic surgeon in a while but Eric Novack is back to change the world…or at least express his annoyance at some people in it! I suspect that we’ll be hearing lots of arguments like this in years to come!
The initiative that SEIU aims to get on the ballot this November to amend the Michigan Constitution:
Michigan Health Care Security Ballot Campaign – ‘Health Care That’s Always There’
The State Legislature shall pass laws to make sure that every Michigan resident has affordable and comprehensive health care coverage through a fair and cost-effective financing system. The Legislature is required to pass a plan that, through public or private measures, controls health care costs and provides for medically necessary preventive, primary, acute and chronic health care needs.
Will it pass? Should it pass? Who wins? Who loses?
Just in case you needed to be reminded that the DEA is a refuge of evil scumbags and needs to be abolished, here’s another exhibit (from the good people at DRCNet):
Federal agents arrested Dr. Stephen Schneider, operator of the Schneider Medical Clinic, and his wife and business manager, Linda, on a 34-count indictment charging them with operating a "pill mill" at their clinic. The indictment charges that Schneider and his assistants "unlawfully" wrote prescriptions for narcotic pain relievers, that at least 56 of Schneiders’ patients died of drug overdoses between 2002 and 2007, and that Schneider and his assistants prescribed pain relievers "outside the course of usual medical practice and not for legitimate medical purpose."