Tag: Policy

Business As Usual: California’s Reform Proposal – Brian Klepper

Dec 21, 2007• 18

Brian_klepper In the world of health reform wonks – the writers on this blog qualify in spades – all eyes
are on California at
the moment. His Republicanism notwithstanding,
Governor Schwartzenegger has developed a generous $14 billion bill that
would extend universal coverage to all Californians by 2010.

Now
that the plan is set, the special interests are lining up. Most of the
health care groups – the physicians, hospitals, the health plans (with
the interesting exception of Wellpoint) – are supportive, fully aware
that if more money can be found for health care, they’ll be the
recipients. Also in the mix are two prominent unions: SEIU (the Service
Workers’ International Union) and the American Federation of State,
County and Municipal Employees. They are both key supporters, each with
health care workers who would benefit from the deal.

POLICY: Overtreated gets huge plaudit

Dec 20, 2007• 4

OK. It’s official. David Leonhardt is a convert, even one who can’t quite leave his past behind. In is NY Times selection for Economics book of the year he picks Shannon Brownlee’s Overtreated. (If you want to hear me and Shannon having a good gossip about the American health care system, see here).

Leonhardt can’t quite shake his Stephen Colbert-like past (the market has spoken so it must be true). He still says this:

As I’ve written before, there is nothing wrong with devoting a large chunk of our economy to medical care. Since the 1950s, doctors have made incredible progress against diseases that were once inevitably fatal. That progress is probably the finest human achievement of the last half century. If we weren’t wasting so much money on overtreatment, it would be a lot easier to repeat the achievement over the next half century.

Of course, and it’s been pointed out ad nauseam here, those results were achievable at a much lower cost than we’ve paid, and the difference could have been spent on something with a higher economic return (or in invading any middle eastern countries we haven’t got to yet).

But it’s great to have Leonhardt on board, at least for the Wennberg thesis. Now he just has to convince the rest of the NY Times editorial board.

POLICY/QUALITY: Uninsurance does indeed kill you quicker

Dec 20, 2007• 2

I’m not going to go into the whys and wherefores of what’s wrong with cancer care in this country. But when the IOM said that people die early because of uninsurance, people scoffed. The same people (and you know who you are David Gratzer) say (pretty disingenuously) that we do cancer care much better than countries with universal insurance, and for at least partly that reason universal insurance is a bad idea.

So presumably they have a good answer for this new report from the American Cancer Society, which essentially shows that–whatever the state of American cancer care maybe overall–you’re much more more likely to have a good outcome if you’ve got insurance. Some tidbits from the release:

For all cancer sites combined, patients who
were uninsured were 1.6 times as likely to die in five years as those with
private insurance.The
relationship between access to care and cancer outcomes is particularly striking
for several cancers which can be prevented or detected earlier by screening and
for which there are effective treatments, including breast and colorectal
cancer. At every level of education, individuals with health insurance were
about twice as likely as those without health insurance to have had mammography
or colorectal cancer screening.

POLICY: As Goes California, So Should Go the Nation, by Mary Kay Henry

Dec 19, 2007• 4

Now I can’t claim to be an optimist about the future of California’s health reform bill. But at least someone is. And that someone is SEIU Executive Vice President Mary Kay Henry. Here’s her take on the latest California news and why the SEIU is at least one union buying in.

ABx1 1: no, it’s not the holiday season’s hot new video game. It’s the bill name for historic legislation approved yesterday by the California State Assembly to make healthcare more secure and affordable for those who have insurance, and provide coverage to millions who don’t.

Months of intense negotiations drew on the collective creativity and wisdom of elected officials, consumer groups, healthcare professionals, and labor and business community leaders to generate the comprehensive plan. The measure has the potential to transform the healthcare reality for millions of Californians, and it will fundamentally change the healthcare debate nationally.

Bad Medicine: How The AMA Undermined Primary Care in America – Brian Klepper

Dec 13, 2007• 44

On Tuesday’s Wall Street Journal website, Dr. Benjamin Brewer describes
physicians’ reactions to the 10.1% cut in Medicare physician payments
that will take effect January 1. He argues that the onus will fall,
once again, disproportionately on primary care physicians, who are
already losing the struggle to keep their heads above water.

He is right, of course. There is no question that Medicare must rein in
cost. But the cuts are approximately the same across specialties and
therefore regressive. Insensitive to its distinct role, its lower
revenues and its high operational costs, they hit primary care harder
than they do specialties. Given its already battered status, the cuts’
impact on primary care could translate to real consequences this time.

POLICY: Try and reconcile these two basic statements

Dec 13, 2007• 4

The National Federation of Independent Business, which says it has 350,000 members with active lobbyists in 50 states, warned politicians and policy makers on Wednesday not to impose new health-benefit obligations on small employers. The group said in a statement of principles that “a health care system built on employer mandates or on pay-or-play taxes is unacceptable.”

***

In its statement of principles the federation called for universal health care, with a government safety net to help the neediest obtain coverage. But it opposed proposals to place health care under an umbrella of Medicare-style “single payer” financing. Government safety nets should not be allowed to “crowd out private insurance and care,” the federation said.

Yup, it’s the math challenged folks at the NFIB staking out their territory–hating the current system, fraudulently demanding universal health care and opposed to any solution.

The incredible thing is that a single pool/social insurance system would be incredibly positive for small business—especially if based on progressive taxation. First, the number one impediment to people starting small businesses is job-lock due to fears over losing health insurance. Second, most small businesses don’t make that much money, so a social insurance scheme would only “hurt” the very few very wealthy small business people. Somehow that group manages to politically dominate the discourse at the NFIB—when they’re not shilling for the richest families in America, that is.

My real analysis of the NFIB was done over at Spot-on last year. It’s well worth a read as it spells out the math on why a universal health care system funded by progressive tax would be a godsend for most small businesses. But sadly they just can’t ideologically get their heads around it.

POLICY: Trading Places was right!

Dec 12, 2007• 5

Trading

Every so often I read an article that (I hope) confirms what we know is right. Remember “Trading
Places”? Dan Akroyd is stripped of his upper-class environment and fails. Eddy Murphy is plucked form the gutter and succeeds, and the experiment “proves” that it’s “nurture not nature.”

In this op-ed, All Brains Are the Same Color, psychology professor Richard Nisbett shows that IQ scores are remarkably influenced by the environment in which kids are brought up, and race has basically nothing to do with it. After he demonstrates that fairly conclusively, Nisbett gets to the punchline:

What do we know about the effects of environment?

That environment can markedly influence I.Q. is demonstrated by the so-called Flynn Effect. James Flynn, a philosopher and I.Q. researcher in New Zealand, has established that in the Western world as a whole, I.Q. increased markedly from 1947 to 2002. In the United States alone, it went up by 18 points. Our genes could not have changed enough over such a brief period to account for the shift; it must have been the result of powerful social factors. And if such factors could produce changes over time for the population as a whole, they could also produce big differences between subpopulations at any given time.

POLITICS: Jonathan Cohn confesses on the Obama 15 million problem

Dec 4, 2007• 2

Apparently the 15m uninsured in Obama’s plan are all Jonathan Cohn’s fault. At least the picking up on that number by Hillary and Edwards in the debates, that is.

I’m still struggling with how Obama is correctly to the left of those guys on the only foreign policy that really matters but in a foolish place on health care. Anyone relying on David Cutler for advice on health care must be seriously internally conflicted over what the aim is! After all Cutler seems to be too.

More on that to come later this week; but my explanation is that Obama shares my belief that health reform is impossible in 2009—so why bother?

POLICY: The Proper ASD Policy Begins with Listening to Parents, By John Whitmer

Dec 3, 2007• 3

On November 24, 2007 Senator Clinton announced her "Plan to Help Children and Families Affected by
Autism." While the Senator should be commended for finally paying attention to the
issue in her presidential campaign and while other candidates should take note, her plan isn’t really a plan at all.

The "plan" calls for spending 700 million dollars to primarily fund research "to identify
causes of autism and monitoring its impact across the country. The Combating Autism Act of 2006, which Clinton co-sponsored, appropriates 500 of that 700 million. Therefore, the plan really only calls for an additional 200 million. Meanwhile, not one penny of that original 500 million has been spent. Perhaps the Senator needs
to look first into seeing that her original policy gets implemented.
In fact, Senator Clinton should lead the charge in Congress to fully fund the Individuals with Disabilities Education Act(IDEA); this would go a long way in solving the issue of "encroachment" that
school districts across the nation are facing.