Tag: Policy/Politics

Could a larger investment in primary care cure the health care system?

Nov 21, 2008• 19

By Deron Schriver

I’m going to go out on a big ol’ limb here by saying that 90 percent of our health care problems could be solved by rebuilding and refocusing our primary care delivery system.

It’s the issue most discussed issue in reform circles (aside from single-payer) and it makes perfect sense. Toyota has succeeded because it goes to great lengths to find the true source of quality issues. They have recognized that addressing root causes significantly limits efforts needed because you avoid treating secondary level problems that occur further down the line.

A highly trained, appropriately paid primary care physician with a focus on prevention, coordination and patient education could solve so many other problems. There are many preventable chronic illnesses out there driving up our costs.

This isn’t the early 1990s

Nov 20, 2008• 10

By Sarah Arnquist

Several stories in today’s papers make it clear that the atmosphere for health reform today truly is different than when the Clinton Administration took over in the 1990s.

Here’s the bullet points in support of that thesis:

Obama selected veteran policymaker Tom Daschle to head up the Department of Health and Human Services, signaling he wants the former South Dakota Senator to head up reform efforts.
The Washington Post quoted Sen. Ron Wyden
(D-Ore.) saying, "Tom Daschle sees this as a once-in-a-lifetime opportunity. On the premier domestic issue of our time, the
president-elect sees Tom Daschle with the skills and abilities to bring
people together and get this over the finish line."

Marking a clear deviation from the past, the Association of Health Insurance Plans announced
it would be willing to accept guarantee issue and community rating in
exchange for a mandate requiring all people to buy insurance.

Seven Senators promised to work together on health care to accomplish something next year. They are: Max Baucus of Montana, Christopher J. Dodd of Connecticut, Edward M. Kennedy of Massachusetts and John D. Rockefeller IV of West Virginia, all Democrats, and Michael B. Enzi of Wyoming, Charles E. Grassley of Iowa and Orrin G. Hatch of Utah, Republicans.

But Bob Laszewski provides WSJ readers with a reality check, "Talk is cheap on the front end of this thing," he told the Journal. "The
rubber hits the road when that 1,000-page document comes out with
specifics."

Daschle Tapped for HHS Secretary

Nov 19, 2008• 7

By Brian Klepper

The Caucus, the New York Times Political Blog, reports that senior Obama aides have said that Mr. Obama offered the nomination for Secretary of Health and Human Services to Tom Daschle of South Dakota, the former Democratic Senate leader, and that Mr. Daschle has accepted.

Mr. Daschle was an early supporter of Senator Obama. Earlier this year, Mr. Daschle published a well-recieved book called Critical: What We Can Do About The Health Care Crisis.

Baucus’ proposal proves no consensus on key reform issues

Nov 17, 2008• 19

By Bob Laszewski Capital_2

Max Baucus will be a key player in the health care debate the next two years. As chairman of the Senate Finance Committee he has jurisdiction on many of the key issues including Medicare and provider payment reform.

He is also a leader in the true bipartisan spirit–something crucial to actually getting reform done.

Last week, he released a 98-page white paper, "Call to Action–Health Reform 2009."

Reading the executive summary, which given the news stories I have read is about all the press has looked at, the Baucus outline is pretty much Barack Obama’s health reform plan. Obama’s campaign health plan is 18 pages long and Baucus has tried to take it a distance further with 80 more pages.

“Spread the Wealth” Controversy Hits Doctors

Nov 17, 2008• 4

By MAGGIE MAHAR & NIKO KARVOUNIS

By now you know that Senator Max Baucus (D-MT) has offered a “Call to Arms” for health care reform by way of a 98-page policy document. There is much to think about in Baucus’ proposal, so you might have missed the section where he talks about increasing payments to primary care providers at the expense of compensation for specialists. But in the future, keep your eyes peeled for developments around this proposition—because supporting primary care is going to be a complex and controversial undertaking.

Baucus rightly recognizes that primary care is “undervalued” in our health care system. The Medicare reimbursement schedule—which is the model for private insurers rates—pays a lot more for removing a wart than it does, say, for talking to patients about their medications. Doing something to a patient (procedural care) is compensated much more than is doing something with a patient (cognitive care). The result is that generalists, including family practitioners, internists, primary care providers (PCPs), geriatricians and palliative care specialists make a lot less than proceduralists.

Today the average annual salary of a radiologist is $354,000, and at the high end they make $911,000. Orthopedic surgeons pull in $459,000 to $1.352 million; cardiovascular surgeons average $558,719 to $852,000. By contrast, internists report average salaries of $176,000; after years of experience, they can hope to make $245,000. In the middle of her career, the typical pediatricians can expect to earn $175,000; later, she may move up to $271,000. The average family practitioner may gross $204,000, at the high end he can look for $299,000.Continue reading…

Maxing out on health reform

Nov 13, 2008• 12

By Sarah Arnquist Sarahmug

Senate Finance Committee Chairman Max Baucus’ unveiling of a health reform proposal yesterday fed speculation about the possibility of Democrats tackling health reform from the get-go of the new Administration.

The Montana Democrat’s proposal is detailed in an 97-page "call to action" document. In his letter of introduction, Baucus says the plan is not a legislative proposal but his vision for policy reforms and the political process.

Baucus says the plan will require an initial investment, but doesn’t name how much. There are no cost figures in the plan, but the Senator writes, "It is my intention that
after ten years the U.S. will spend no more on health care than is
currently projected, but we will spend those resources more
efficiently, and will provide better-quality coverage to all Americans."

Baucus to unveil reform proposal with individual mandate

Nov 12, 2008• 6

By Sarah Arnquist

The Wall Street Journal reports that the Senate Finance Committee Chairman Max
Baucus (D-Mont) will unveil today his plan to overhaul the U.S. health care system.

Laura Meckler, of The Journal, reports the plan is very similar to the one Obama touted on the campaign trail with one major exception: Baucus wants to require all individuals to buy health insurance.

Given this, one could probably more accurately say the plan resembles Sen. Hillary Clinton’s plan. Where is Clinton in these discussions? Time has an update on the health care reform veteran.

Here’s what Jonathan Cohn has to say about Clinton’s involvement: "Exactly what role Clinton can play remains unclear, since she doesn’t
have the committee seniority to assert herself the way, say, Baucus or
Kennedy does. But she remains one of the most visible and, on health
care, one of the most trusted policymakers in Washington. If she wants
to say something, she’ll be heard. And that’s a good thing."

For background on the Senate’s health plans, see Jonathan Cohn’s article in the New Republic.

Will layoffs take us closer to single-payer?

Nov 12, 2008• 12

By David E. Williams Davidwilliams

Only a few months ago, Goldman Sachs was touted as an incredible
bastion of strength in the face of the credit crunch. Sure some other
institutions might have been suffering, but Goldman was savvy enough to
earn record profits in 2007. The average bonus was a whopping $600,000 per employee.
Then very suddenly Goldman and pretty much the whole industry
collapsed. The federal government has stepped in, and a partial
nationalization of the financial industry is underway. That’s not the
free market, it’s socialism.

While actual socialism was being carried out by the Republican
Administration in Washington, out on the campaign trail, McCain and
Palin were bashing Obama for allegedly socialistic policy proposals,
namely rolling back the Bush tax cuts for high earners. Obviously the
voters didn’t buy it.

Thanks to the credit crisis, companies and non-profits are starting
to lay people off. My inbox is filling up with messages from people
who’ve been given the sack and are searching for their next gig. Today
I received such a notice from a close friend at Goldman Sachs itself.

CAP’s Blueprint for reform

Nov 11, 2008• 2

By Joshua Seidman Siedman

The Center for American Progress (CAP) released a new “Blueprint for Reform” that focuses on how to fix the delivery system. This well-constructed
document and provocative forum was spearheaded by CAP CEO John Podesta (former Clinton White House Chief of Staff) and Jeanne Lambrew.

There are a few things that really show good progress in the
national debate. First, the fact that CAP has chosen this critical time
at the precipice of the national health care reform debate to focus
attention on reforming care as well as coverage will be helpful to
facilitating that discussion in 2009 policy debates (they, of course,
support coverage initiatives as well but those aren’t addressed in this
document).

Second, the quality and thougtfulness of the work and recommendations is high. Not surprising given the exceptional collection of authors with each chapter co-authored by a physician and a policy expert. These
include: Don Berwick, Tom Lee, Judy Hibbard, David Blumenthal, Bob
Berenson, Paul Ginsberg, Steve Schroeder, Dora Hughes, Chiquita
Brooks-LaSure, Karen Davenport, and Katherine Hayes.

Proposal for a THCB Healthcare Reform Effort

Nov 10, 2008• 22

By Deron Schriver

THCB regular reader Deron Schriver wants THCB readers to suggest plans to reform the health care system. Here’s his appeal:

I enjoy many of the discussions on THCB. Intelligent people from all vantage points of the health care system congregate to engage in conversations about the most important issues out there. What if there was a way to translate those discussions into treatment plans for the ailments of our health care system?

Meaningful, sustainable reform can only come from a collection of people from the various stakeholder positions (physicians, patients, insurance companies, employers, etc.) who see what’s working and what isn’t on a daily basis. Politicians do not have the exposure to the system that is needed to prescribe effective solutions. However, they are in a good position to assist in the implementation of well-designed solutions.

We need to approach reform much like a physician approaches an ill patient. That involves obtaining some history, examining the system, and then prescribing a treatment plan. It would require a progress note, similar to what a physician uses, in order to document our work. After all, “if it wasn’t documented, it wasn’t done”. All problems considered should be discussed by all stakeholders until solutions are developed that 1) are thorough, 2) treat the problem and not the symptoms, and 3) are not zero sum. We need to follow the system all the way from the time the patient enrolls in an insurance plan, to the time she is treated by her physician, to the time the claim is paid (or not paid).