Starting a flame war with @SusannahFox because I can’t get Tweetdeck to work and therefore feeling grumpy
Above the Fold
Why Wait Four Years?
I was struck during President Obama’s health care speech before Congress several months ago that the reforms he advocates would not go into effect for four years, until 2014. This timetable, too, is written into both the House and Senate versions.
Why the delay? It is hard for me to imagine, even given the federal rulemaking process, that it should take four years to establish an insurance exchange from which people can buy coverage. This is the exchange that would eliminate the nasty practices of insurance companies: Denying coverage because of pre-existing conditions; limiting annual or lifetime payments; and rescission of policies. It is hard for me to imagine, too, why it should take four years to fully deliver targeted subsidies to lower income people so they can afford insurance.
As noted by Princeton Professor Paul Starr in an article in the New York Times earlier this week: “By comparison, when Medicare was enacted in 1965, it went into effect the next year.”
This leaves me with a bad feeling. It looks like the Obama team does not want implementation of the health care bill to take place during their first term. Why? Perhaps they know that the cost of the plan is higher than they are saying. Or maybe they know that the options available to consumers will be less attractive than currently portrayed.
The Patient Safety Movement Turns Ten
On December 1, 1999, the Institute of Medicine released a report entitled To Err is Human: Building a Safer Health System. Although its authors hoped to spark a national movement, they had little cause for optimism. After all, early efforts by advocates like Berwick and Leape and organizations like the National Patient Safety Foundation had barely moved the needle of public and professional attention.
The IOM Report succeeded beyond its framers’ wildest dreams, and the movement they spawned turns ten today. Please indulge me while I spend a nostalgic moment recalling the remarkable spin that launched the patient safety field. I’ll then segue to a summary of my assessment of what we’ve accomplished over the past decade (I outline this more fully in an article in this week’s web version of Health Affairs, which I hope you’ll take a look at).Continue reading…
The Leaning Tower of Jello: Why No-one Believes Health Reform will be Deficit Neutral
By JEFF GOLDSMITH
President Obama has promised not to sign any health reform legislation that increases the federal deficit. This promise recognized rising public concern about an Argentinean fiscal trend that, unchecked, could leave us with $19 trillion in federal debt in a decade.
Without that pledge, given the current economic climate, health reform would be one dead mackerel.
Some clarifications are essential here. I’m a Democrat and fervent Obama supporter. I voted for him twice (and that was just in the Virginia primary). I’m proud of our President. He has first class economic and healthcare teams. He deserves credit for not postponing health reform. He’s right: it’s simply not tolerable, morally or economically, for a wealthy nation to continue having close to 50 million uninsured people.
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Death by a Thousand Cuts
The Congressional Budget Office (CBO) issued a report today saying that if the Reid bill becomes law, the price of non group policies would be about 10 percent to 13 percent higher in 2016 than it would be under current law. The CBO projects that small group and large group premiums would be about the same in 2016 as they would have been anyway as the benefits of the bill would offset some of its new costs.
But what is likely to happen to health insurance rates in 2010, 2011, 2012, and 2013 before any of the bill’s benefits occur for both the insurance markets and consumers?
I would suggest Democrats not overlook the potential for political fallout in those years.
By delaying the start of most health insurance reform benefits—including insurance subsidies and underwriting reforms—until January 1, 2014 the Reid health care bill creates a real risk of unintended political consequences for the Democrats.
Or, maybe I should have said almost certain consequences that Reid may not have thought of.
Paul Starr agrees with me (or I steal from him–take your pick)
Paul Starr and I have been agreeing a lot lately. Not that Paul knows or cares what I think or say, but a while back we both expressed fear that private health plans will end up channeling bad risks into the public option. That time I beat him to the punch (but I happen to know his piece was on the way before I hit “publish” on mine).
This time he was out first. Last Saturday he reminded Democrats that the big deal is not what happens with the public option, but instead what matters is how aggressive and effective Federal regulation of insurance (via the exchanges) will be.
For these reforms to succeed, there needs to be effective regulatory authority to prevent insurers from engaging in abusive practices and subverting the new rules. The bill passed by the House would provide for that authority and lodges it in the federal government, though states could take over the exchanges if they met federal requirements. The Senate bill would leave most of the enforcement as well as the running of the exchanges to the states. Yet many states have a poor record of regulating health insurance, and some would resist passing legislation to conform with the new federal law.
Of course Paul was a major author/player of the Clinton plan in 1993–4, which had it been enacted would have been way more extensive and impactful than the current legislation—and in a good way. I fear that this time his influence will be equally lacking in terms of the end result. Which is a big pity.
Spotlight on Health 2.0: Consumer Aggregators from SF ’09
Every week we bring you a video from the world of Health 2.0. This week we're featuring a video from our latest conference in San Francisco on October 6-7, 2009. Hear the latest from WebMD, Google Health and Microsoft.
To see more videos from past Health 2.0 conferences, or to purchase the entire conference DVD sets from '07 & '08 click here. 2009 DVD sets will be available shortly, please check back for updates.
Can’t A Man Grow a Mustache for Money?
Hey Folks,
This is Ian Kibbe, Associate Editor at THCB, with a request for your help.
This
month, I've become involved in a global charity that is bringing much
needed attention to cancers that affect men, namely prostate and
testicular cancer. Movember, is an international
organization that raises funds and awareness in support of men's health
by encouraging men to grow mustaches or "Mos," as they say in Australia, in the month of November.
I'm currently growing my Mo while raising funds and awareness for prostate and testicular cancer
research. It's like I'm running a marathon, but I've replaced the
running with the awkwardness of trying to grow facial hair, which if
you saw me you'd think was just as painful. (There's a mustache in that picture of me, I swear!)
This is the final week to collect donations before the Movember Gala, and I'm reaching out to all those who are able to contribute. Please take a minute to donate if you can.
I realize that this all sounds pretty silly, but to date, Movember has raised $47
million globally making it the world’s largest charity event for men.
The
funds raised go to the Prostate Cancer Foundation and the Lance
Armstrong Foundation (LIVESTRONG).
The post-reform insurance market, or will Mega survive?
I had an interesting call from a member of the legal profession the other day, and it got me thinking about the post-reform prospects for my own particular collection of bete noirs—the insurers who prey on desperate people in the individual market. Yes, you can expect the subject of Mega Life & Health to appear later in this article.
Now some dummies are starting to complain about what, to this point, have been broadly accepted parts of the upcoming reform legislation. Robert Samuelson is a typical advantaged recipient of community-rated insurance yet complains about the same concept being extended outside his community-rated group made up of Washington Post employees. AARP suggests in response that he should be sending (his much younger WaPo colleague) Ezra Klein a check, as Ezra is in effect subsidizing Samuelson’s health insurance.
While the political cognoscenti is struggling with the public option and payment rates to rural hospitals (and other bribes needed for DINO Senators from Nebraska & Louisiana, and the NEDINO one from Connecticut), the real issue of health insurance regulation is getting scant attention. In particular three huge issues remain to be resolved:
