It would be great if we could get the US to a system of health insurers competing over the right things. With a universal individual mandate that worked, risk adjustment between insurers, and social solidarity mixed with market incentives — the best of both worlds. The Dutch (pound for pound) have better football, beer and drug laws than anyone else. And now a very sensible health care system too.
Here’s a video on the new health care system in the Netherlands.
It’s been really great getting to know the new voice of the Dartmouth school, Shannon Brownlee. She’s interviewed in her local paper about the concept that the American health care system delivers More money, but less health. Hopefully we’ll have her writing more on THCB soon!
A wonderful meeting (Full disclosure: They brought me in to blog my impressions.), The Families USA conference that ended Saturday brought together some impressive Congressional politicians – Nancy Pelosi, Tom Daschle, Ken Salazar, Blanche Lincoln – and true health care experts – Don Berwick, Tony Fauci – with "consumer advocates" from around the country.
I thoroughly enjoyed the people at the conference. They were, for the most part, knowledgeable about health care and committed to driving a better system. (My favorites were a group of California Gray Panthers, all of whom were VERY up on the issues). There were also bright young people relatively early in their careers, and representatives from community health advocacy organizations around the country, all fervently dedicated to a better, more equitable health system.
One of the pleasures of the Families USA Health Action conference was that the speakers represented a nice blend of top politicians and genuine health care experts. Tony Fauci MD, the wonderful head of NIH’s National Institutes for Allergies and Infectious Diseases, who talked about Global Health, was followed by the equally impressive Don Berwick MD, the Founder and leader of the Institute for Healthcare Improvement. I’ve heard Dr. Berwick speak several times and am always delighted by his cogent, comfortable, sensible presentations.
I can think of several people who, if they gave one, deserve a health care Nobel Prize for the positive impact they’ve had on millions of people through their work to change the industry. Dr. Berwick is one. (Others include Jack Wennberg MD, the founder of the Dartmouth Atlas, and David Eddy MD, who leads the Archimedes Project and who coined the term "Evidence-Based Medicine.")
By BRIAN KLEPPER
I first met, heard and came to admire Tony Fauci several months ago at the Aspen Health Forum. Dr. Fauci heads the National Institute of Health’s National Institute of Allergy and Infectious Diseases. In addition to his spectacular medical contributions, he is, equally importantly, a passionate and wonderfully articulate explainer of the importance of infectious disease and global health to common people. Unfortunately, I was called unexpectedly out of the meeting for a call, but here are my notes on his comments. They provide a clear view of the value of his work.
Plagues and epidemics have shaped societies since the beginning of civilization. Gradually, though, and with progress in hygiene and the management of disease, the dangers from infectious diseases to ordinary people have been significantly lessened, though the idea that we’re home free is seductive and illusory. In 1967, Surgeon General William Stewart testified a little prematurely that “the war on infectious disease has been won.”
Former Senator and Majority/Minority Leader Daschle gave the opening address on the 2nd day of the Families USA Health Action conference. Mr. Daschle has a new book coming out in March on America’s health system and our past efforts to fix it.
I was honestly impressed with Mr. Daschle’s grasp of the sweep of health care problems and how they play out. Mostly importantly, he was clearly aware of the deep challenges associated with getting meaningful change, given the industry’s control of Congress and the policy-making process.
Ezra Klein, who I think is hanging with Brian Klepper at Families USA — where Don Berwick is hopefuly showing the link between system reform and insurance reform Friday— has a nice article out on the The Lessons of ’94. I, being biased and an arrogant git, slightly prefer this take on the matter.
But the basic question is, will things be bad enough to override the coming opposition of the health care industry to going after their goose? Remember that we need three convergent factors to actually get health care reform that means anything. 1) The Democrats to win big enough in November to both take White House in a canter, and a bigger chunk of the Senate. 2) A new spirit of political ruthlessness (perhaps they could hire Karl Rove, who seems to have time on his hands?) and 3) radical increase in middle class and more importantly middle-class voter insecurity about their continuity of insurance coverage. Translation for #3 is a bad mother of a recession that seems to have no end.
I don’t think we get any of the above….but at least one guy who seems to understand markets a little better than I (around $6bn better) thinks that #3 is coming.
The featured highlight address at the opening session of the Families USA conference is by Nancy Pelosi, Congress’ first woman Speaker. In person, Speaker Pelosi clearly comes across as a brilliant and warm woman, a friend of Families USA, and she was introduced as a champion of social justice and equality in the 110th (2007) Congress, passing the first minimum wage increase in a decade and making college more affordable for working families. While I’m not certain this is true, I heard comments beforehand that this speech was slated as a major health care policy statement by the Speaker.
In it, she succinctly laid out several core principle of her view of reform.
"I want to start by talking about something that we all agree on: that everybody in America has a right to quality health care. But what is it that this health care should look like? What are the principles that this approach should have?"
Along with other familiar voices like Maggie Mahar and Ezra Klein, I’m in DC today writing from the Families USA Health Action 2008 conference. Families USA is a progessive (liberal) consumer advocacy organization dedicated to universal coverage, driven by mobilizing the nation’s passionate citizen advocates. I am here at their invitation, but I should note, as an objective observer, not necessarily a cheerleader for the approaches advocated here. My perspective will undoubtedly be colored by my own experiences and realizations working on the dynamics of reform.
The idea that citizen involvement can drive meaningful change was a core theme of the conference’s opening speaker, Senator Blanche Lambert Lincoln, the senior senator from Arkansas. She serves on the Senate Finance Committee, which has oversight of Medicare, Medicaid, SCHIP, and other health care programs. She was a champion of the SCHIP reauthorization bill, and advocated for small employer health care purchasing pools.
Apparently in an interview I had with journalist Thomas Day from Medill reports news service which showed up in this article I said:
If you look at California and Blue Cross-Blue Shield, their biggest provider, they came out against the Schwarzenegger bill because it essentially said the same thing [as Democratic proposals],” said Matthew Holt, a San Francisco-based health-care advocate.
What I hope I meant to say was this:
If you look at California
andBlue Cross-Blue Shield,theirthe biggestprovider, insurer in the small group markettheycame out against the Schwarzenegger bill because it essentially said the same thing [as Democratic proposals], such as limiting underwriting in the individual market and limiting the amount of money insurers could make” said Matthew Holt, a San Francisco-based health-careadvocate.blogger/consultant/wise-ass
There’s that’s better!
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