Critical of Critical

Like legions of other wonks when I discovered that Tom Daschle was going to be Obama’s point guy on health care, I sent off for a copy of his book Critical. It’s a fast and easy read, but in its examination of the problem it doesn’t add much to superior books on what’s wrong with health care (much of the first section reads like an undergrad’s attempt to summarize Jonathan Cohn’s Sick) and there are some pretty weak logic flows and basic editing throughout (he refers to the book Uninsured in America on p155 as though it’s already been introduced before it actually gets introduced on p161). But ignoring all that, what does Daschle suggest we actually do?

First, he promotes himself as a scholar of failed attempts at health reform past, and of course a witness to the most recent attempt.

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A glimpse of what might have been: Palin announces Alaska health goals

PalinAlaska Gov. Sarah Palin announced plans last week to improve Alaskans’ health.

Palin supports expanding Denali Health, the State Children’s Health Insurance Program, to families earning twice the federal poverty level. Expanding the program would make an additional 1,300 children and 225 pregnant women eligible for coverage, The Anchorage Daily News reported.

Palin’s plan also includes creating a Web site  called "Live Well Alaska" "to offer suggestions in
such health-related areas as diet and exercise as well as tips to quit

The hockey mom governor also wants to dedicate an additional $2 million in preschool, $250,000 toward early diagnosis of autism, and establishing a state health commission to further work.

The Daily News says Palin has some "good ideas," but should go further toward universal coverage and recruiting additional primary care doctors to Alaska.

Some good news in health care, really

Even as the economy has fallen into an abyss and I find myself with distressing frequency discussing with people whether Levi Johnston really loves Bristol Palin, it turns out that there is actually some good news out there about health coverage.  Over the past year, 19 states have taken significant strides toward covering more children despite challenging fiscal times. At a National Health Policy Forum last week, three states explained their progress. And, no, the featured states weren’t the usual suspects like Massachusetts with its impressive, but so-complicated-that-you-need-an-MIT-degree-to-untangle-it system or Vermont with its population of 62 people and 4 dairy farms. They were Louisiana, Iowa, and Pennsylvania.

Here are the details of what they’ve done:

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Where does Sarah Palin stand on children’s health coverage?

The entire country now has heard about how Sarah Palin and her husband knew in advance that their son, Trig Palin, would be born with Down Syndrome. The Palins also must have known that they would have health insurance and the financial resources needed to pay for the extensive medical care Trig is likely to need throughout his life.

Here is 3-year old Emily Demko, another child with Down Syndrome, who lives with her
family in Ohio. The family has given permission to share this photo of their beautiful daughter and the story (details here) of their trials securing health coverage for Emily.

As of this spring, Emily was uninsured. Due to her Down Syndrome, the family could not find a private insurer willing to offer them affordable coverage for Emily. If the Bush Administration had not shut down Ohio’s efforts to expand its State Children’s Health Insurance Program (SCHIP), Emily would have been able to continue to secure decent, affordable public coverage. But the Bush Administration in August of 2007 issued a controversial ban on coverage of children in moderate-income families and twice vetoed bills to reauthorize and expand the SCHIP program.SCHIP is a popular, bi-partisan program. Sixty-eight Senators, including 18 Republicans, voted for the SCHIP reauthorization bill that President Bush vetoed (Senate vote). John McCain, however, stood with the President.So, along with knowing about Sarah Palin’s personal decision to have a child with Down Syndrome, it also would be good know if she agrees with her candidate’s decision to stand with President Bush against expanding the State Children’s Health Insurance Program. Right call or wrong call?

Jocelyn Guyer is the deputy executive director at the Center for Children and Families (CCF) and a senior researcher at the Georgetown University Health Policy Institute. This post represents her personal opinion not that of the Institute.

California kids may face triple whammy, leading to more uninsured

After years of seeing decreasing numbers of uninsured children, California is poised to go the other direction.

For years, child enrollment in private health insurance plans decreased as companies scaled back on health care costs by increasing employees’ share of the premiums or by stopping dependent coverage altogether.

But those declines were offset by increased enrollment in public programs. Recognizing that half the uninsured children already qualified for Medi-Cal (California’s version of Medicaid), and Healthy families (the
state’s SCHIP program), school districts and advocates focused efforts on finding and enrolling those children.

But now, things aren’t looking so rosy. State and county budgets constraints threaten to erode the children’s enrollment gains in
Medi-Cal, Healthy Families  and Healthy
Kids programs, county-organized health plans.

"Come next spring, you could have a double or triple whammy of kids
losing health coverage," said Joel Diringer, a consultant who helped
many California counties create the local programs.

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UPDATE: Medicare, SCHIP and Kids

Last night the Senate voted 68 to 31 to renew and expand the State Children’s Health Insurance Program SCHIP). A day earlier the House voted 225-204, largely along party lines, to approve a larger expansion of the SCHIP program. As Matthew notes below, the Senate, unlike the House, would not try to help fund SCHIP by eliminating Medicare’s overpayments to Medicare Advantage for-profit insurers. (See my post below)

Meanwhile, President Bush has said that he would veto either version of the legislation. But the Senate bill garnered enough votes for its version of the bill to overcome a veto. (18 Republicans joined 48 Democrats and 2 Independents in the vote.)

According to PBS, the House and Senate plan to meet after their August recess to reconcile the differences between the two bills before sending a final measure to President Bush.

Below, Matthew offers his best guess as to what will happen next. He suggests if the Senate/House compromise avoids taking a whack at the Medicare Advantage private sector insurers, the President might well sign it. Nevertheless, Matthew believes that Democrats won’t be able to resist the temptation to include the provision cutting over payments to insurers in order to provoke the veto and then campaign on the fact that Republicans hate children.

I’m cynical but frankly, Matthew is so cynical. I take this as an ethnic (i.e. British) trait. On the other hand, I’m Irish, so I probably shouldn’t open a discussion about ethnic Achilles heels . . .

But I am idealistic enough to think that there are enough Democrats and Republicans who care about healthcare for uninsured children that they will eliminate the cuts to insurers in hopes of avoiding a veto.

It’s worth noting that on Tuesday, Sen. Orrin Hatch (R. Utah) and Sen. Edward Kennedy, (D-Mass), told the Washington Post that House-Senate negotiations will aim to keep the final bill within the scope of the Senate’s measure in order to try to avoid that Presidential Nix.In the end, if Congress doesn’t touch insurers’ profits, would President Bush say “no” to expanding SCHIP for kids? I don’t know.

What do you think?

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.