December 28, 2008
Op-Ed Contributors | Transitions
Health Care With a Few Bucks Left Over
By ALAIN ENTHOVEN
Stanford, Calif.
HEALTH care drained the federal budget of more than $1 trillion this year. That includes direct health care programs like Medicare, plus insurance for federal employees and the cost of excluding employer health-care contributions from workers’ taxable incomes. If present trends continue, in 10 years the number will almost double.
President-elect Barack Obama has proposed some good ideas for cutting health care costs, but his proposals will not create the savings we need.
He has suggested, for example, that electronic medical records could save Americans nearly $80 billion per year. But information technology cannot bring meaningful savings if it is used in a health care system that regularly rewards waste and punishes efficiency, as ours does.
Similarly, Mr. Obama proposes to save more than $80 billion per year by better management of chronic conditions like high blood pressure, heart disease, diabetes and asthma, and by preventing more diseases in the first place. It is true that most American doctors are weak on prevention and chronic disease management. But they will not improve until they are given economic incentives to buy the equipment and hire the personnel they need to actually deliver these services.
The only truly promising way to save money is to change the way health care is organized and delivered. In the United States, 85 percent of doctors work in small, fee-for-service practices. Many of these doctors are very good and hard-working. But they are autonomous, not members of teams. They do not systematically share information with one another. They are unable and unwilling to be held accountable for the quality and cost of the care they deliver.
The employment-based health insurance system has created this situation by not encouraging people to consider the value for their money when they choose doctors.
Some American medical practices do emphasize economy. They are very large, multispecialty group practices in which doctors work together to improve quality and keep costs low. Their doctors share values and cultures of teamwork. They keep comprehensive electronic medical records, they share information, and they emphasize disease prevention and chronic disease management as a matter of course.
These doctors are usually paid salaries, not fees for services. Research and experience suggests that these practices — which exist in all regions of the country, including both rural and urban communities — can reduce costs by 30 percent.
And a few employers — some universities and companies, the federal government, the state governments in Wisconsin and California — allow their workers to choose such practices, and then keep the money saved by that choice. At least 70 percent of employees offered this option choose it, even when it involves restrictions on doctor selection.
Unless all Americans are given this choice — along with the right to keep the savings — we will not be able to get health care costs under control. But making this change won’t be easy. Employers and insurance companies are likely to resist it. Doctors and consumers will have to change. It will take time.
Right now, most employers offer workers no choice of insurance companies. They say it would be too expensive to administer more than one. And insurance companies offer employers better deals when they can be the sole supplier.
Even at companies where employees have choices, many employers pay 80 percent to 100 percent of the premiums of an employee’s chosen plan, so there is little opportunity for the employee to realize savings. This market does not reward cost-conscious behavior. The tax code makes this problem worse by exempting employer contributions to health insurance from taxes, no matter how large they are.
Efficient, organized medical systems need to be able to compete with — and ultimately replace — the fee-for-service model. Working with Congress, the next president should establish a national health-insurance exchange, through which people can choose among several competing health plans, including those affiliated with organized systems of care. Individuals could then select which plan they judge best to meet their needs, and save money by choosing less expensive options. The insurers in the exchange would agree to accept all who want to enroll, and to charge their same price to all individuals, no matter the state of their health.
Then, to ensure that enough people participate in the health-insurance exchange, Mr. Obama and Congress should phase in a requirement that the tax-free status of employer contributions to health care be dependent on employers buying health care for their workers through the exchange — and making fixed-dollar contributions, so workers can reap the savings when they choose less expensive plans. All employees would have a wide range of choices, with an incentive to be cost-conscious. (Eventually, the government should help everyone buy insurance through the exchange, regardless of employment.)
Right now, Mr. Obama’s plan is to create an exchange through which people who have difficulty buying affordable health insurance could buy coverage. Unfortunately, participation in exchanges cannot be voluntary. Voluntary exchanges have been tried and failed. The first people to join are the sickest, which drives up the premiums.
To make exchanges work, a broad sample of people, healthy and sick, must be included so that health risks can be spread widely. Large exchanges would also lower the administrative costs for insurers.
By combining organized systems of medical care with the competition created by a health insurance exchange, Mr. Obama could achieve large savings. In 10 years, costs could be reduced by 30 percent, saving more than $700 billion a year — all driven by incentives and voluntary actions.
Alain Enthoven is a professor of management at Stanford.
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Tuesday, December 30, 2008
Monday, December 29, 2008
Computer Health Records
Modern computerized systems have links to online information on best practices, treatment recommendations and harmful drug interactions. The potential benefits include fewer unnecessary tests, reduced medical errors and better care so patients are less likely to require costly treatment in hospitals.
The widespread adoption of electronic health records might also greatly increase evidence-based medicine. Each patient’s records add to a real-time, ever-growing database of evidence showing what works and what does not. The goal is to harness health information from individuals and populations, share it across networks, sift it and analyze it to make the practice of medicine more of a science and less an art.
The widespread adoption of electronic health records might also greatly increase evidence-based medicine. Each patient’s records add to a real-time, ever-growing database of evidence showing what works and what does not. The goal is to harness health information from individuals and populations, share it across networks, sift it and analyze it to make the practice of medicine more of a science and less an art.
Friday, December 12, 2008
Commonwealth Care
Boston - The state’s subsidized health insurance program for low-income residents, Commonwealth Care, an exclusive network of four insurers since its inception, is preparing to throw open its doors to new bidders in an effort to cut costs, stabilize premiums and pay fair rates to carriers.
“It’s really about achieving those three things,” said Jon Kingsdale, executive director of the state’s Connector Authority, which oversees Commonwealth Care. “We don’t want the premiums going all over the place and people having to switch plans.”
With a three-year deal of exclusivity for BMC HealthNet Plan, Fallon Community Health Plan, Neighborhood Health Plan and Network Health expiring in July 2009, the Connector board on Thursday explored ways to bring new insurers into the fold and to provide incentives to bring costs down for taxpayers and program enrollees.
Under the upcoming round of bidding, carriers would be limited to offering plans with maximum $404 monthly premiums, a 2 percent increase from this fiscal year and a figure that includes $35 per month in administrative costs, according to a plan proposed by Connector staff at a board meeting at One Ashburton Place. Rates would vary based on the health of the covered population, and plans would be rewarded financially if their enrollees more regularly receive primary care.
The premiums envisioned contrast sharply with actual increases in health care premiums over the years. Last year, Commonwealth Care premiums rose more than 9 percent, a lesser increase than in previous years but far above the 2 percent cap proposed by Connector staff.
A spokesman for the Connector said the trend of double-digit increases in the rate of health care costs “appears to have certainly slowed down in Massachusetts.” The spokesman, Dick Powers, added that under the proposal, the state would share half the burden with carriers whose costs exceed the cap set by the Connector.
Powers said that if trends continue, the $869 million budgeted for Commonwealth Care this fiscal year would be sufficient, despite warnings from lawmakers during budget debate that the account was underfunded.
Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, said health care costs continue to outstrip inflation, even though the explosion in costs has somewhat slowed. She said she hadn’t reviewed the Connector board’s proposal but that “we don’t want this to adversely affect any of the health plans.”
Kingsdale said increasing the pool of insurers, or managed care organizations (MCOs), would loosen a rigid system that failed to fully account for the sickness of the populations covered and could not protect against drastic shifts in premiums.
Under the proposal, insurers bidding 2 percent below the maximum premium would be eligible to win a share of enrollees who are auto-assigned to carriers in their region. Enrollees are auto-assigned when they sign up for Commonwealth Care but fail to select a specific carrier.
Patrick Holland, chief financial officer of the Connector Authority, estimated that 7,500 new enrollees sign up each month, including 1,800 who are auto-assigned. Despite the stream of new enrollees, program enrollment remained flat this month at 162,726 members as departing members offset the gains.
Board members weighed incentives for enrollees to choose the lowest-cost plans but worried that longtime patient-doctor relationships could be disrupted, which would undercut the fiscal benefits.
“They’re not just commodities that we can, kind of, move around,” said board member Nancy Turnbull.
Health Care for All officials agreed.
“We absolutely oppose disrupting people’s relationships with their providers,” said Lindsey Tucker, reform policy manager for the consumer advocacy organization.
“There’s a lot of questions that still have to be answered,” she said. “Until there’s a sort of next draft, I don’t feel like I have any idea of what the plan will be.”
Tucker said the Connector should avoid plans that result in an increase in redeterminations because confusing paperwork required to enroll in Commonwealth Care could lead to unnecessary loss of coverage or plan changes.
Among options staff recommended included inducing patients with $10 or $15 cards for certain health care services or to designate a two-month period in 2009 to require enrollees to actively choose a carrier. Those who don’t would be auto-assigned to the cheapest available plan.
Dolores Mitchell, a board member and executive director of the state Group Insurance Commission, described herself as “lukewarm” to using cards to sway people to switch plans.
“Something about it doesn’t feel comfortable to me,” she said, calling it “an inappropriate use of financial incentive for people making an important personal decision.”
The proposal also included increasing from $1 to $2 the co-pay for most generic medicine for non-premium paying enrollees, a change mandated to comport with Medicaid rules.
The board will meet next week to finalize a procurement plan for new carriers. If an existing insurer fails to win the state’s blessing, its members would have the opportunity to pick a new plan or be auto-assigned.
Saturday, December 6, 2008
Medicare Advantage Plans
Beneficiaries choose from an average of 35 private Medicare Advantage plans in each county, Mr. Zarabozo and Mr. Harrison report. But they say, “Payment increases have been so large that plans no longer need to be efficient to offer extra benefits.”
Payments to health maintenance organizations are, on average, 12 percent higher than what the government would spend for beneficiaries in traditional Medicare, they write, while payments to private fee-for-service plans were 17 percent higher.
Insurance company executives and Bush administration officials defend the role of private plans.
“Medicare Advantage plans are offering an average of over $1,100 in additional annual value to enrollees in terms of cost savings and added benefits,” said Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services.
Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said two types of plans — H.M.O.’s and preferred provider organizations — had produced tangible benefits by coordinating care. As a result, she said, disease is detected earlier and people have fewer visits to hospital emergency rooms.
But, Ms. Gold said, “these are not the types of plans that have been growing most rapidly.” Instead, the private fee-for-service plans are growing fastest, and they, she said, “are not set up to coordinate care.”
The Medicare Payment Advisory Commission has said the payments to private plans should gradually be reduced to the level of traditional Medicare.
In a campaign statement, Mr. Obama declared, “We need to eliminate the excessive subsidies to Medicare Advantage plans and pay them the same amount it would cost to treat the same patients under regular Medicare.” In a debate on Oct. 15, Mr. Obama described the subsidies as “just a giveaway” to private insurers.
Similar views have been expressed
Wednesday, December 3, 2008
SINGLE PAYER HEALTH INSURANCE
Leaving the bloated insurance industry in place perpetuates the pain and cost of the current health care system.
Massachusetts pays the most in the nation for its health care, and yet it’s plagued by an ongoing crisis of access, affordability, and quality. Although our experiment in health care reform already has deep problems, policy wonks influencing the country’s health care debate tout Massachusetts as the model for universal health care nationwide.
If Massachusetts is a model, it’s a model of what not to do.
When the legislature passed “shared responsibility” legislation two years ago, nearly every suit in the state’s health care industry celebrated. The concept grew from an October 2005 assembly convened by the Blue Cross-Blue Shield Foundation of Massachusetts that made a bald assertion: there was no way to achieve universal coverage in Massachusetts without an “individual mandate,” the enforceable legal requirement that everyone have health insurance.
OFF THE TABLE
The problem was that the assembly was not allowed to consider Canadian-style single-payer health care—which would eliminate private insurance companies—as an option. It was off the table.
So a new bureaucracy was established, the Commonwealth Health Insurance Connector Board, with broad powers to set rates, approve cut-rate private policies, and define affordability.
Subsidies are offered on a sliding scale for those earning up to 300 percent of the federal poverty line (about $63,000 for a family of four). Those earning below the line are covered free.
The tangle of private insurance companies, with their expensive bureaucracies and profits, remains in place.
The only new source of revenue for these subsidies is the $295 per employee fee paid anually by employers of 11 or more workers who fail to show that they are making a “fair and reasonable” contribution to their employees’ coverage.
The tangle of private insurance companies, with their expensive bureaucracies and profits, remains in place.
Given these constraints, how does the system measure up?
Access. The ability to get care has expanded for some, with an increase in Medicaid enrollment for some of the poorest. But this comes at the expense of many, particularly undocumented workers and their families, who in the past had depended on the uncompensated care pool, or free-care pool, through community health centers and safety-net hospitals.
The pressure is now on to deny free care to low-income immigrants who would be eligible for subsidized programs if their papers were in order.
Out of a population of six million, a quarter of a million residents remain uninsured. About 60,000 have been granted waivers as unable to afford even the subsidized plans.
Others fall through the cracks of a complex bureaucracy, and an unknown number simply defy the system and refuse to fill out the additional pages of questions about their insurance status with their state income tax form.
Affordability. For many, paying for health care without the threat of bankruptcy or giving up other necessities of life remains impossible. Governments and many employers are staggering, too.
Rising costs for public employees’ and retirees’ health insurance has led to round after round of service cutbacks, affecting every resident who uses public services. Attempts at cost-shifting have provoked strikes by teachers and turnovers in city halls.
Employers successfully pressure the Connector Board to keep copays and deductibles high in the subsidized health plans. This keeps those covered by commercial plans from switching to the public ones.
But ironically, those high deductibles and copays are not counted when calculating who qualifies for taxpayer subsidies.
A diabetic stay-at-home mom on the subsidized plan, for example, pays $110 a month for insurance. But the array of drugs and procedures she requires and the limits on her coverage leave her with copayments of about $165 a month.
Quality. The new system doesn’t seem to have improved patient outcomes. A recent study showed that 45,000 patients are injured and 2,000 patients die in Massachusetts each year from hospital-acquired infections and accidents. That’s six patients dying each day.
And hospital executives fiercely resist steps to improve quality. In July they blocked a bill—again—to establish minimum nurse-to-patient ratios. Such ratios have made California hospitals much safer.
STILL NEED SINGLE PAYER
In July Massachusetts Senator Ted Kennedy announced a bipartisan initiative to achieve “universal health care” quickly, in the first days of a new administration. And then came Health Care for America Now, a new 80-member coalition that includes the AFL-CIO, SEIU, and AFSCME. HCAN champions a system—similar to Massachusetts’s—that would leave the insurance companies at their troughs.
During the Great Depression, FDR was elected with a mandate for change, but the specifics were vague and the direction of the new administration nebulous. Like today, an upsurge of grassroots action was needed to set a progressive agenda.
It took 3,000 locals, for example, ignoring AFL President Bill Green’s aversion to “the dole,” as he called it, to establish unemployment insurance.
This may well prove to be just as fluid a moment in history. Nothing of consequence—like universal, single-payer health insurance—will succeed without solid grassroots organizing that sets the agenda for the next administration.
Sandy Eaton is Region 5 president of the Massachusetts Nurses Association and vice chair of the Massachusetts Campaign for Single Payer Health Care.
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Massachusetts pays the most in the nation for its health care, and yet it’s plagued by an ongoing crisis of access, affordability, and quality. Although our experiment in health care reform already has deep problems, policy wonks influencing the country’s health care debate tout Massachusetts as the model for universal health care nationwide.
If Massachusetts is a model, it’s a model of what not to do.
When the legislature passed “shared responsibility” legislation two years ago, nearly every suit in the state’s health care industry celebrated. The concept grew from an October 2005 assembly convened by the Blue Cross-Blue Shield Foundation of Massachusetts that made a bald assertion: there was no way to achieve universal coverage in Massachusetts without an “individual mandate,” the enforceable legal requirement that everyone have health insurance.
OFF THE TABLE
The problem was that the assembly was not allowed to consider Canadian-style single-payer health care—which would eliminate private insurance companies—as an option. It was off the table.
So a new bureaucracy was established, the Commonwealth Health Insurance Connector Board, with broad powers to set rates, approve cut-rate private policies, and define affordability.
Subsidies are offered on a sliding scale for those earning up to 300 percent of the federal poverty line (about $63,000 for a family of four). Those earning below the line are covered free.
The tangle of private insurance companies, with their expensive bureaucracies and profits, remains in place.
The only new source of revenue for these subsidies is the $295 per employee fee paid anually by employers of 11 or more workers who fail to show that they are making a “fair and reasonable” contribution to their employees’ coverage.
The tangle of private insurance companies, with their expensive bureaucracies and profits, remains in place.
Given these constraints, how does the system measure up?
Access. The ability to get care has expanded for some, with an increase in Medicaid enrollment for some of the poorest. But this comes at the expense of many, particularly undocumented workers and their families, who in the past had depended on the uncompensated care pool, or free-care pool, through community health centers and safety-net hospitals.
The pressure is now on to deny free care to low-income immigrants who would be eligible for subsidized programs if their papers were in order.
Out of a population of six million, a quarter of a million residents remain uninsured. About 60,000 have been granted waivers as unable to afford even the subsidized plans.
Others fall through the cracks of a complex bureaucracy, and an unknown number simply defy the system and refuse to fill out the additional pages of questions about their insurance status with their state income tax form.
Affordability. For many, paying for health care without the threat of bankruptcy or giving up other necessities of life remains impossible. Governments and many employers are staggering, too.
Rising costs for public employees’ and retirees’ health insurance has led to round after round of service cutbacks, affecting every resident who uses public services. Attempts at cost-shifting have provoked strikes by teachers and turnovers in city halls.
Employers successfully pressure the Connector Board to keep copays and deductibles high in the subsidized health plans. This keeps those covered by commercial plans from switching to the public ones.
But ironically, those high deductibles and copays are not counted when calculating who qualifies for taxpayer subsidies.
A diabetic stay-at-home mom on the subsidized plan, for example, pays $110 a month for insurance. But the array of drugs and procedures she requires and the limits on her coverage leave her with copayments of about $165 a month.
Quality. The new system doesn’t seem to have improved patient outcomes. A recent study showed that 45,000 patients are injured and 2,000 patients die in Massachusetts each year from hospital-acquired infections and accidents. That’s six patients dying each day.
And hospital executives fiercely resist steps to improve quality. In July they blocked a bill—again—to establish minimum nurse-to-patient ratios. Such ratios have made California hospitals much safer.
STILL NEED SINGLE PAYER
In July Massachusetts Senator Ted Kennedy announced a bipartisan initiative to achieve “universal health care” quickly, in the first days of a new administration. And then came Health Care for America Now, a new 80-member coalition that includes the AFL-CIO, SEIU, and AFSCME. HCAN champions a system—similar to Massachusetts’s—that would leave the insurance companies at their troughs.
During the Great Depression, FDR was elected with a mandate for change, but the specifics were vague and the direction of the new administration nebulous. Like today, an upsurge of grassroots action was needed to set a progressive agenda.
It took 3,000 locals, for example, ignoring AFL President Bill Green’s aversion to “the dole,” as he called it, to establish unemployment insurance.
This may well prove to be just as fluid a moment in history. Nothing of consequence—like universal, single-payer health insurance—will succeed without solid grassroots organizing that sets the agenda for the next administration.
Sandy Eaton is Region 5 president of the Massachusetts Nurses Association and vice chair of the Massachusetts Campaign for Single Payer Health Care.
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Thursday, November 6, 2008
Health Care Adenda
Democrats Pick Up House, Senate Seats; Newspapers Examine Implications For Health Care, Other Issues
06 Nov 2008
KaiserDemocrats on Tuesday increased their majorities in the Senate and the House and next year likely will seek to pass legislation to expand health insurance to more U.S. residents, among other bills, the Wall Street Journal reports (Hitt/Mullins, Wall Street Journal, 11/5). In the Senate, Democrats and two independents who caucus with them will increase their majority from 51 seats to at least 56 seats, with four races still undecided as of Wednesday morning. Republicans will hold at least 40 seats. In the House, Democrats will increase their majority from 236 seats to at least 252 seats, with 10 races undecided. Republicans will hold at least 173 seats (CNN.com, 11/5).
According to the Boston Globe's "Political Intelligence" blog, Democrats next year first will "address the low growth, high unemployment and economic strain on American workers," and in the "longer term," they are "hopeful they can complete a health care plan." The larger majorities might allow Democrats to pass a "slew of legislation that was blocked by the Bush administration" or that "failed to pass by small margins in the House or Senate," such as bills to expand SCHIP and allow expanded federal funding for embryonic stem cell research, the Globe's "Political Intelligence" blog reports (Milligan, "Political Intelligence," Boston Globe, 11/4).
However, as a result of the record federal budget deficit, the recently enacted $700 billion bailout for Wall Street firms and the "threat of a deep recession, Democrats will have to limit or postpone any big new spending programs, such as ones to expand health care," Reuters reports (Ferraro/Cowan, Reuters, 11/5).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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Article URL: http://www.medicalnewstoday.com/articles/128375.php
Main News Category: Health Insurance / Medical Insurance
Also Appears In: Public Health,
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06 Nov 2008
KaiserDemocrats on Tuesday increased their majorities in the Senate and the House and next year likely will seek to pass legislation to expand health insurance to more U.S. residents, among other bills, the Wall Street Journal reports (Hitt/Mullins, Wall Street Journal, 11/5). In the Senate, Democrats and two independents who caucus with them will increase their majority from 51 seats to at least 56 seats, with four races still undecided as of Wednesday morning. Republicans will hold at least 40 seats. In the House, Democrats will increase their majority from 236 seats to at least 252 seats, with 10 races undecided. Republicans will hold at least 173 seats (CNN.com, 11/5).
According to the Boston Globe's "Political Intelligence" blog, Democrats next year first will "address the low growth, high unemployment and economic strain on American workers," and in the "longer term," they are "hopeful they can complete a health care plan." The larger majorities might allow Democrats to pass a "slew of legislation that was blocked by the Bush administration" or that "failed to pass by small margins in the House or Senate," such as bills to expand SCHIP and allow expanded federal funding for embryonic stem cell research, the Globe's "Political Intelligence" blog reports (Milligan, "Political Intelligence," Boston Globe, 11/4).
However, as a result of the record federal budget deficit, the recently enacted $700 billion bailout for Wall Street firms and the "threat of a deep recession, Democrats will have to limit or postpone any big new spending programs, such as ones to expand health care," Reuters reports (Ferraro/Cowan, Reuters, 11/5).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
--------------------------------------------------------------------------------
Article URL: http://www.medicalnewstoday.com/articles/128375.php
Main News Category: Health Insurance / Medical Insurance
Also Appears In: Public Health,
--------------------------------------------------------------------------------
Save time! Get the latest medical news headlines for your specialist area, in a weekly newsletter e-mail. See http://www.medicalnewstoday.com/newsletters.php for details.
Send your press releases to pressrelease@medicalnewstoday.com
IMPROVING HEALTH CARE
November 6, 2008
Letter
Improving Health Care
To the Editor:
Re “Don’t Blame the Uninsured” (editorial, Oct. 30):
I agree with your clarion call to action for universal health coverage. But expanded coverage needs to be coupled with comprehensive change in how health care is provided and how it is reimbursed. Simply insuring the 45 million uninsured under the current system is economically unsustainable and doesn’t cure what really ails the system.
To improve care, reduce the burden of illness and be cost-effective, access to primary care emphasizing prevention, wellness and disease management must be financed adequately, and all health records must be made electronic and universally portable. Our technological infrastructure allows us to withdraw money at any A.T.M. in the world, yet two physicians practicing in the same neighborhood have no way to gain access to or share crucial patient information.
Let’s hope that the next administration will see the wisdom of acting — not just talking — so Americans get the care they deserve, at the right place and time.
Steven M. Safyer
Bronx, Oct. 31, 2008
The writer, a medical doctor, is president and chief executive of Montefiore Medical Center.
Letter
Improving Health Care
To the Editor:
Re “Don’t Blame the Uninsured” (editorial, Oct. 30):
I agree with your clarion call to action for universal health coverage. But expanded coverage needs to be coupled with comprehensive change in how health care is provided and how it is reimbursed. Simply insuring the 45 million uninsured under the current system is economically unsustainable and doesn’t cure what really ails the system.
To improve care, reduce the burden of illness and be cost-effective, access to primary care emphasizing prevention, wellness and disease management must be financed adequately, and all health records must be made electronic and universally portable. Our technological infrastructure allows us to withdraw money at any A.T.M. in the world, yet two physicians practicing in the same neighborhood have no way to gain access to or share crucial patient information.
Let’s hope that the next administration will see the wisdom of acting — not just talking — so Americans get the care they deserve, at the right place and time.
Steven M. Safyer
Bronx, Oct. 31, 2008
The writer, a medical doctor, is president and chief executive of Montefiore Medical Center.
IMPROVING hEALTH cARE
November 6, 2008
Letter
Improving Health Care
To the Editor:
Re “Don’t Blame the Uninsured” (editorial, Oct. 30):
I agree with your clarion call to action for universal health coverage. But expanded coverage needs to be coupled with comprehensive change in how health care is provided and how it is reimbursed. Simply insuring the 45 million uninsured under the current system is economically unsustainable and doesn’t cure what really ails the system.
To improve care, reduce the burden of illness and be cost-effective, access to primary care emphasizing prevention, wellness and disease management must be financed adequately, and all health records must be made electronic and universally portable. Our technological infrastructure allows us to withdraw money at any A.T.M. in the world, yet two physicians practicing in the same neighborhood have no way to gain access to or share crucial patient information.
Let’s hope that the next administration will see the wisdom of acting — not just talking — so Americans get the care they deserve, at the right place and time.
Steven M. Safyer
Bronx, Oct. 31, 2008
The writer, a medical doctor, is president and chief executive of Montefiore Medical Center.
Letter
Improving Health Care
To the Editor:
Re “Don’t Blame the Uninsured” (editorial, Oct. 30):
I agree with your clarion call to action for universal health coverage. But expanded coverage needs to be coupled with comprehensive change in how health care is provided and how it is reimbursed. Simply insuring the 45 million uninsured under the current system is economically unsustainable and doesn’t cure what really ails the system.
To improve care, reduce the burden of illness and be cost-effective, access to primary care emphasizing prevention, wellness and disease management must be financed adequately, and all health records must be made electronic and universally portable. Our technological infrastructure allows us to withdraw money at any A.T.M. in the world, yet two physicians practicing in the same neighborhood have no way to gain access to or share crucial patient information.
Let’s hope that the next administration will see the wisdom of acting — not just talking — so Americans get the care they deserve, at the right place and time.
Steven M. Safyer
Bronx, Oct. 31, 2008
The writer, a medical doctor, is president and chief executive of Montefiore Medical Center.
Monday, November 3, 2008
Overview and Recommendations
Concern about the state of the American health care system has reached a slow boil. Health care consistently ranks among the top three issues that the American public wants policymakers to address, and it is increasingly intertwined with growing worries about economic insecurity. High costs, gap-ridden coverage, and sporadic quality are the health care problems that most concern Americans. Yet most of the policy discussion is focused on the issue of coverage.
To ensure that the other problems are not forgotten and that delivery system reform is central to any plan, the Center for American Progress and the Institute on Medicine as a Profession partnered to develop the book, The Health Care Delivery System: A Blueprint for Reform. In the health policy arena there is a dearth of specific policy recommenda¬tions to improve the delivery system. Yet these ideas are often disconnected from the current system, with no policy path¬way, backed by leadership and organization, to get from here to there.
This book offers recommendations and path¬ways to systematically promote quality, efficiency, patient-centeredness, and other salient characteristics of a high-performing health system. The blueprint it lays out is a vision of how different parts of the system should be structured and how they should function. Even more specifi¬cally, it proposes policies that the next administration and Congress could enact over the next five years to improve our health system. Different areas of focus in the book include:
Infrastructure: Health care depends on a highly trained, balanced, and motivated workforce; current and accurate information; and technologies that enable health professionals to use information in the right place, in the right way, and at the right time. People, knowledge, and the means for their application are the founda¬tion upon which an efficient, high-quality health system rests.
Organization: The most effective way to address our cost and quality challenges is to confront the root cause—the chaos in everyday health care. Efforts should focus on accelerating the organization of health care providers into team-like configurations so that they can adopt systems that are likely to reduce errors of overuse, underuse, and misuse, and improve the overall coordination of care.
Quality: Improving the quality of services delivered is paramount to enhancing health system performance. Currently, an apparent contradic¬tion exists between the fact that the United States has the highest quality health care in the world, yet also has a quality “chasm.” To truly improve the quality of the health care delivery system, policies must focus on the individual and population level.
Payment reform: Provider payment structures play an important role in how well the health care delivery system meets the goals of delivering efficient and high-quality care. Policies must work to align the desires of practitioners and health orga¬nization managers to serve patients with the incentives that come from how they are paid.
Patient activation: Polices on the demand side of the equation must focus on how best to engage individuals in their own health and care. This is increasingly important in the face of a growing chronic disease epidemic.
Population health: Improving the health care delivery system is key to improving the health of all Americans. Even if the access, quality, and cost problems in the medical system are resolved, a traditional view of the delivery system must expand to include population-wide programs in order for the system to reach its full potential.
The signs that such a debate could take place in the near future are strong. Both presidential can¬didates have proposed to reform the health care system, demonstrating the polit¬ical ripeness of the issue. When that opportunity presents itself, it will be essential to be ready with grounded policies that are more than patches and can serve as pathways toward a high-performing health system.
Infrastructure
Health information technology
Promote the use of electronic health records through grants and loans to selected essential health providers.
Provide federal matching funding to states and localities to create local information exchange networks.
Direct action to safeguard the privacy of electronic health information.
Workforce
Invest in scholarship and loan repayment programs for newly trained health care providers.
Boost capacity in nursing education through a mix of new federal funding and changes in nursing graduate study.
Leverage the Workforce Investment Act to build the long-term care workforce.
Strengthen training and licensing standards for geriatric care.
Enact strategies to increase wages and benefits for direct care workers.
Information
Provide federal support for comparative effectiveness research.
Develop a federal strategy for the dissemination and application of comparative effectiveness research.
Organization of Health Care Delivery
Promote a flexible payment reform strategy in public programs to encourage the formation of more organized groups.
Engage providers in the development of public reporting methods to increase transparency for consumers and provide useful feedback to providers.
Develop a federal commission to oversee system innovations, including new organizational models, by modifying regulatory protections that were developed in the context of fee-for-service reimbursement, among other things.
Encourage the adoption of information technologies.
Provide government oversight of accountable care organizations to ensure basic protections to the public.
Quality of Care
Improving individual care
Strengthen oversight in Medicare and Medicaid by supporting programs that designate, monitor, and support progress in health care facilities.
Encourage public-private payer cooperation that will specify, enforce, and support care improvements.
Increase funding for the Agency for Healthcare Research and Quality and expand its role in quality research and development.
Hold hospital boards legally accountable for quality and safety improvements.
Support no-fault malpractice demonstration projects.
Improving care across the population
Simplify and standardize health care administration, such as codes and billing, across health care industries.
Implement comparative effectiveness studies for treatment practices.
Develop a national initiative to reduce preventable hospital admissions and readmissions.
Expand hospice through support to community-based programs.
Provider Payment Incentives
Short term
Revamp the process for updating the relative value scale used in Medicare’s physician fee schedule so that relative values more accurately reflect relative costs.
Reduce relative values for services undergoing high rates of growth in volume.
Adopt incentives for additional processes that improve patient care such as electronic health records.
Long term
Promote bundled payment covering all providers for acute episodes of care and post-acute care.
Support capitated payment for the management of chronic disease. The medical home can be seen as a first of such an initiative.
Revise or eliminate Sustainable Growth Rates in conjunction with a major package of payment reforms.
Patient Activation
Fund research to identify key elements of effective self-management programs.
Support self-management through benefit design such as using financial incentives for patients to encourage the use of care that is proven to be effective and discourage care that has less evidence for efficacy.
Support self-management through provider incentives, linking payments to increases in patient activation.
Ensure that information technology enables self-management by improving patients’ access to personal health information.
Promote provider support for patient-centered care.
Population Health
Set national goals of improved health performance, both absolutely and in comparison with other developed nations, and fix organizational responsi¬bility and authority for achieving those goals.
Enact comprehensive tobacco control policies, including a federal smoke-free policy, increased tobacco taxes, warning labels, countermarketing strate¬gies, and smoking cessation efforts.
Reduce obesity through policies such as updating nutritional standards for school lunches, expanding social marketing, eliminating “food desserts,” and promoting physical activity through workplaces and schools.
Author Biographies
Robert Berenson, M.D., is a senior fellow at the Urban Institute. From 1998 to 2000, he was in charge of Medicare payment policy and managed care contracting at the Centers for Medicare and Medicaid Services. He is clini- cal professor at the George Washington University School of Medicine and an adjunct professor at the Fuqua School of Business at Duke University.
Donald Berwick, M.D., M.P.P., F.R.C.P., is the president and CEO of the non- profit Institute for Healthcare Improvement. An elected member of the Insti- tute of Medicine, he served two terms on the Institute of Medicine’s gov- erning council. He also served on President Clinton’s Advisory Commis- sion on Consumer Protection and Quality in the Healthcare Industry. He is clinical professor of pediatrics and health care policy at the Harvard Medi- cal School, and professor of health policy and management at the Harvard School of Public Health.
David Blumenthal, M.D., M.P.P., is director of the Institute for Health Policy and a physician at the Massachusetts General Hospital/Partners HealthCare System in Boston, Massachusetts. He is also Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Harvard Medical School.
Chiquita Brooks-LaSure, M.P.P., is currently professional staff on the House Ways & Means Committee. Prior to joining the committee, she was a director at Avalere Health, LLC. From 1999 to 2003, she worked in the health division of the White House Office of Management and Budget.
Karen Davenport, M.P.A., is the director of health policy at the Center for American Progress. Previously, she served as a senior program officer at the Robert Wood Johnson Foundation, as a legislative assistant for Senator Bob Kerrey (D-NE), and as a Medicaid analyst with the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services).
Paul B. Ginsburg, Ph.D., is the president of the Center for Studying Health System Change and has been named six times to Modern Healthcare’s list of the 100 most powerful persons in health care. Previously he served as the founding executive director of the Physician Payment Review Commission (now the Medicare Payment Advisory Commission), a senior economist at RAND, and as deputy assistant director at the Congressional Budget Office.
Katherine Hayes, J.D., is the vice president of health policy at Jennings Policy Strategies, Inc. Prior to joining JPS, Inc., she served as health counsel to Senator Evan Bayh (D-IN) and legislative assistant to Senator John Chafee (R-RI). Her private sector experience includes serving as policy director to Ascension Health and legal practice as an attorney with the Washington-based law firm Hogan & Hartson.
Judith Hibbard, Dr.P.H., M.P.H., is a professor of health policy at the University of Oregon. Her research is supported by the Robert Wood Johnson Foundation, the Agency for Health Care Research and Quality, the Health Care Industry Forum, and the AARP Public Policy Institute. She has served on several advisory panels and commissions, including the National Advisory Counsel for AHRQ, the National Health Care Quality Forum, United Health Group Advisory Panel, and the National Advisory Council for the Robert Wood Johnson Foundation.
Dora L. Hughes, M.D., M.P.H., serves as health policy advisor to Senator Barack Obama (D-IL). She previously served as deputy director for health for Senator Edward M. Kennedy (D-MA). Prior to working on Capitol Hill, she served as senior program officer at The Commonwealth Fund.
Jeanne M. Lambrew, Ph.D., is a senior fellow at the Center for American Progress and an associate professor of public affairs at the Lyndon B. Johnson School of Public Affairs at the University of Texas. From 1997 to 2000, she worked on health policy at the White House as the program associate director for health at the Office of Management and Budget and as the senior health analyst at the National Economic Council. She was the White House lead on drafting and implementing the Children’s Health Insurance Program, and helped develop the president’s Medicare reform plan and initiative on long-term care.
Meredith King Ledford, M.P.P., is an independent health policy consultant. Previously, she served as the health policy research analyst at the Center for American Progress and as the Medicaid research analyst at the Health Assistance Partnership of Families USA.
Thomas H. Lee, M.D., MSc., is an internist and cardiologist, and is network president for Partners Healthcare System and chief executive officer for Partners Community HealthCare, Inc. He is a professor of medicine at Harvard Medical School and a professor of health policy and management at Harvard School of Public Health.
John D. Podesta, J.D., is the president and chief executive officer of the Center for American Progress. He served as chief of staff to President William J. Clinton from October 1998 until January 2001. He also served from 1997 to 1998 as both an assistant to the president and deputy chief of staff. Earlier, from January 1993 to 1995, he was assistant to the president, staff secretary, and a senior policy adviser on government information, privacy, telecommunications security, and regulatory policy. He is currently a visiting professor of law on the faculty of the Georgetown University Law Center.
David J. Rothman, Ph.D., is the director of the Institute on Medicine as a Profession at Columbia University. He is the Bernard Schoenberg Professor of Social Medicine and Professor of History and serves as the direc- tor of the Center for the Study of Science and Medicine at the College of Physicians and Surgeons at Columbia. He specializes in social history and the history of medicine.
Steven A. Schroeder, M.D., is Distinguished Professor of Health and Health Care at the University of California, San Francisco, where he also serves as the director of the Smoking Cessation Leadership Center at UCSF. Previously, he served as the president and CEO of the Robert Wood Johnson Foundation from 1990 to 2002.
Acknowledgments
The Center for American Progress and the Institute on Medicine as a Profession would like to thank all of the authors who contributed their personal time and commitment to the project and the development of this book. We would also like to thank the project’s advisory board, consisting of Sabrina Collette, Sen. Tom Daschle, Gerry Shea, Glenn Steele, and Jim Tallon, who provided guidance, perspective, and feedback throughout the project and throughout the production of the book. Special thanks go to Meredith King Ledford, who both contributed to the substance and managed this project with skill and dedication.
To speak with our experts on this topic, please contact:
For print and radio, John Neurohr, Deputy Press Secretary
202.481.8182 or jneurohr@americanprogress.org
For TV, Sean Gibbons, Director of Media Strategy
202.682.1611 or sgibbons@americanprogress.org
For web, Erin Lindsay, Online Marketing Manager
202.741.6397 or elindsay@americanprogress.org
Issue Alerts
Sign up to receive email alerts for new content on your issues.
Subscribe to Our InProgress Newsletter
Related Articles
Small Businesses, Large Problems, by Lester Feder, Ellen-Marie Whelan
Health Policy and the Economic Crisis, by Jeanne Lambrew
Tales of Teacher Absence , by Raegen Miller
A Close Look at the Issues
Creating Postsecondary Pathways to Good Jobs for Young High School Dropouts
© Center for American Progress | About Us | Contact Us | Press Room | Privacy Policy | Reuse Policy | Terms of Use
Concern about the state of the American health care system has reached a slow boil. Health care consistently ranks among the top three issues that the American public wants policymakers to address, and it is increasingly intertwined with growing worries about economic insecurity. High costs, gap-ridden coverage, and sporadic quality are the health care problems that most concern Americans. Yet most of the policy discussion is focused on the issue of coverage.
To ensure that the other problems are not forgotten and that delivery system reform is central to any plan, the Center for American Progress and the Institute on Medicine as a Profession partnered to develop the book, The Health Care Delivery System: A Blueprint for Reform. In the health policy arena there is a dearth of specific policy recommenda¬tions to improve the delivery system. Yet these ideas are often disconnected from the current system, with no policy path¬way, backed by leadership and organization, to get from here to there.
This book offers recommendations and path¬ways to systematically promote quality, efficiency, patient-centeredness, and other salient characteristics of a high-performing health system. The blueprint it lays out is a vision of how different parts of the system should be structured and how they should function. Even more specifi¬cally, it proposes policies that the next administration and Congress could enact over the next five years to improve our health system. Different areas of focus in the book include:
Infrastructure: Health care depends on a highly trained, balanced, and motivated workforce; current and accurate information; and technologies that enable health professionals to use information in the right place, in the right way, and at the right time. People, knowledge, and the means for their application are the founda¬tion upon which an efficient, high-quality health system rests.
Organization: The most effective way to address our cost and quality challenges is to confront the root cause—the chaos in everyday health care. Efforts should focus on accelerating the organization of health care providers into team-like configurations so that they can adopt systems that are likely to reduce errors of overuse, underuse, and misuse, and improve the overall coordination of care.
Quality: Improving the quality of services delivered is paramount to enhancing health system performance. Currently, an apparent contradic¬tion exists between the fact that the United States has the highest quality health care in the world, yet also has a quality “chasm.” To truly improve the quality of the health care delivery system, policies must focus on the individual and population level.
Payment reform: Provider payment structures play an important role in how well the health care delivery system meets the goals of delivering efficient and high-quality care. Policies must work to align the desires of practitioners and health orga¬nization managers to serve patients with the incentives that come from how they are paid.
Patient activation: Polices on the demand side of the equation must focus on how best to engage individuals in their own health and care. This is increasingly important in the face of a growing chronic disease epidemic.
Population health: Improving the health care delivery system is key to improving the health of all Americans. Even if the access, quality, and cost problems in the medical system are resolved, a traditional view of the delivery system must expand to include population-wide programs in order for the system to reach its full potential.
The signs that such a debate could take place in the near future are strong. Both presidential can¬didates have proposed to reform the health care system, demonstrating the polit¬ical ripeness of the issue. When that opportunity presents itself, it will be essential to be ready with grounded policies that are more than patches and can serve as pathways toward a high-performing health system.
Infrastructure
Health information technology
Promote the use of electronic health records through grants and loans to selected essential health providers.
Provide federal matching funding to states and localities to create local information exchange networks.
Direct action to safeguard the privacy of electronic health information.
Workforce
Invest in scholarship and loan repayment programs for newly trained health care providers.
Boost capacity in nursing education through a mix of new federal funding and changes in nursing graduate study.
Leverage the Workforce Investment Act to build the long-term care workforce.
Strengthen training and licensing standards for geriatric care.
Enact strategies to increase wages and benefits for direct care workers.
Information
Provide federal support for comparative effectiveness research.
Develop a federal strategy for the dissemination and application of comparative effectiveness research.
Organization of Health Care Delivery
Promote a flexible payment reform strategy in public programs to encourage the formation of more organized groups.
Engage providers in the development of public reporting methods to increase transparency for consumers and provide useful feedback to providers.
Develop a federal commission to oversee system innovations, including new organizational models, by modifying regulatory protections that were developed in the context of fee-for-service reimbursement, among other things.
Encourage the adoption of information technologies.
Provide government oversight of accountable care organizations to ensure basic protections to the public.
Quality of Care
Improving individual care
Strengthen oversight in Medicare and Medicaid by supporting programs that designate, monitor, and support progress in health care facilities.
Encourage public-private payer cooperation that will specify, enforce, and support care improvements.
Increase funding for the Agency for Healthcare Research and Quality and expand its role in quality research and development.
Hold hospital boards legally accountable for quality and safety improvements.
Support no-fault malpractice demonstration projects.
Improving care across the population
Simplify and standardize health care administration, such as codes and billing, across health care industries.
Implement comparative effectiveness studies for treatment practices.
Develop a national initiative to reduce preventable hospital admissions and readmissions.
Expand hospice through support to community-based programs.
Provider Payment Incentives
Short term
Revamp the process for updating the relative value scale used in Medicare’s physician fee schedule so that relative values more accurately reflect relative costs.
Reduce relative values for services undergoing high rates of growth in volume.
Adopt incentives for additional processes that improve patient care such as electronic health records.
Long term
Promote bundled payment covering all providers for acute episodes of care and post-acute care.
Support capitated payment for the management of chronic disease. The medical home can be seen as a first of such an initiative.
Revise or eliminate Sustainable Growth Rates in conjunction with a major package of payment reforms.
Patient Activation
Fund research to identify key elements of effective self-management programs.
Support self-management through benefit design such as using financial incentives for patients to encourage the use of care that is proven to be effective and discourage care that has less evidence for efficacy.
Support self-management through provider incentives, linking payments to increases in patient activation.
Ensure that information technology enables self-management by improving patients’ access to personal health information.
Promote provider support for patient-centered care.
Population Health
Set national goals of improved health performance, both absolutely and in comparison with other developed nations, and fix organizational responsi¬bility and authority for achieving those goals.
Enact comprehensive tobacco control policies, including a federal smoke-free policy, increased tobacco taxes, warning labels, countermarketing strate¬gies, and smoking cessation efforts.
Reduce obesity through policies such as updating nutritional standards for school lunches, expanding social marketing, eliminating “food desserts,” and promoting physical activity through workplaces and schools.
Author Biographies
Robert Berenson, M.D., is a senior fellow at the Urban Institute. From 1998 to 2000, he was in charge of Medicare payment policy and managed care contracting at the Centers for Medicare and Medicaid Services. He is clini- cal professor at the George Washington University School of Medicine and an adjunct professor at the Fuqua School of Business at Duke University.
Donald Berwick, M.D., M.P.P., F.R.C.P., is the president and CEO of the non- profit Institute for Healthcare Improvement. An elected member of the Insti- tute of Medicine, he served two terms on the Institute of Medicine’s gov- erning council. He also served on President Clinton’s Advisory Commis- sion on Consumer Protection and Quality in the Healthcare Industry. He is clinical professor of pediatrics and health care policy at the Harvard Medi- cal School, and professor of health policy and management at the Harvard School of Public Health.
David Blumenthal, M.D., M.P.P., is director of the Institute for Health Policy and a physician at the Massachusetts General Hospital/Partners HealthCare System in Boston, Massachusetts. He is also Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Harvard Medical School.
Chiquita Brooks-LaSure, M.P.P., is currently professional staff on the House Ways & Means Committee. Prior to joining the committee, she was a director at Avalere Health, LLC. From 1999 to 2003, she worked in the health division of the White House Office of Management and Budget.
Karen Davenport, M.P.A., is the director of health policy at the Center for American Progress. Previously, she served as a senior program officer at the Robert Wood Johnson Foundation, as a legislative assistant for Senator Bob Kerrey (D-NE), and as a Medicaid analyst with the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services).
Paul B. Ginsburg, Ph.D., is the president of the Center for Studying Health System Change and has been named six times to Modern Healthcare’s list of the 100 most powerful persons in health care. Previously he served as the founding executive director of the Physician Payment Review Commission (now the Medicare Payment Advisory Commission), a senior economist at RAND, and as deputy assistant director at the Congressional Budget Office.
Katherine Hayes, J.D., is the vice president of health policy at Jennings Policy Strategies, Inc. Prior to joining JPS, Inc., she served as health counsel to Senator Evan Bayh (D-IN) and legislative assistant to Senator John Chafee (R-RI). Her private sector experience includes serving as policy director to Ascension Health and legal practice as an attorney with the Washington-based law firm Hogan & Hartson.
Judith Hibbard, Dr.P.H., M.P.H., is a professor of health policy at the University of Oregon. Her research is supported by the Robert Wood Johnson Foundation, the Agency for Health Care Research and Quality, the Health Care Industry Forum, and the AARP Public Policy Institute. She has served on several advisory panels and commissions, including the National Advisory Counsel for AHRQ, the National Health Care Quality Forum, United Health Group Advisory Panel, and the National Advisory Council for the Robert Wood Johnson Foundation.
Dora L. Hughes, M.D., M.P.H., serves as health policy advisor to Senator Barack Obama (D-IL). She previously served as deputy director for health for Senator Edward M. Kennedy (D-MA). Prior to working on Capitol Hill, she served as senior program officer at The Commonwealth Fund.
Jeanne M. Lambrew, Ph.D., is a senior fellow at the Center for American Progress and an associate professor of public affairs at the Lyndon B. Johnson School of Public Affairs at the University of Texas. From 1997 to 2000, she worked on health policy at the White House as the program associate director for health at the Office of Management and Budget and as the senior health analyst at the National Economic Council. She was the White House lead on drafting and implementing the Children’s Health Insurance Program, and helped develop the president’s Medicare reform plan and initiative on long-term care.
Meredith King Ledford, M.P.P., is an independent health policy consultant. Previously, she served as the health policy research analyst at the Center for American Progress and as the Medicaid research analyst at the Health Assistance Partnership of Families USA.
Thomas H. Lee, M.D., MSc., is an internist and cardiologist, and is network president for Partners Healthcare System and chief executive officer for Partners Community HealthCare, Inc. He is a professor of medicine at Harvard Medical School and a professor of health policy and management at Harvard School of Public Health.
John D. Podesta, J.D., is the president and chief executive officer of the Center for American Progress. He served as chief of staff to President William J. Clinton from October 1998 until January 2001. He also served from 1997 to 1998 as both an assistant to the president and deputy chief of staff. Earlier, from January 1993 to 1995, he was assistant to the president, staff secretary, and a senior policy adviser on government information, privacy, telecommunications security, and regulatory policy. He is currently a visiting professor of law on the faculty of the Georgetown University Law Center.
David J. Rothman, Ph.D., is the director of the Institute on Medicine as a Profession at Columbia University. He is the Bernard Schoenberg Professor of Social Medicine and Professor of History and serves as the direc- tor of the Center for the Study of Science and Medicine at the College of Physicians and Surgeons at Columbia. He specializes in social history and the history of medicine.
Steven A. Schroeder, M.D., is Distinguished Professor of Health and Health Care at the University of California, San Francisco, where he also serves as the director of the Smoking Cessation Leadership Center at UCSF. Previously, he served as the president and CEO of the Robert Wood Johnson Foundation from 1990 to 2002.
Acknowledgments
The Center for American Progress and the Institute on Medicine as a Profession would like to thank all of the authors who contributed their personal time and commitment to the project and the development of this book. We would also like to thank the project’s advisory board, consisting of Sabrina Collette, Sen. Tom Daschle, Gerry Shea, Glenn Steele, and Jim Tallon, who provided guidance, perspective, and feedback throughout the project and throughout the production of the book. Special thanks go to Meredith King Ledford, who both contributed to the substance and managed this project with skill and dedication.
To speak with our experts on this topic, please contact:
For print and radio, John Neurohr, Deputy Press Secretary
202.481.8182 or jneurohr@americanprogress.org
For TV, Sean Gibbons, Director of Media Strategy
202.682.1611 or sgibbons@americanprogress.org
For web, Erin Lindsay, Online Marketing Manager
202.741.6397 or elindsay@americanprogress.org
Issue Alerts
Sign up to receive email alerts for new content on your issues.
Subscribe to Our InProgress Newsletter
Related Articles
Small Businesses, Large Problems, by Lester Feder, Ellen-Marie Whelan
Health Policy and the Economic Crisis, by Jeanne Lambrew
Tales of Teacher Absence , by Raegen Miller
A Close Look at the Issues
Creating Postsecondary Pathways to Good Jobs for Young High School Dropouts
© Center for American Progress | About Us | Contact Us | Press Room | Privacy Policy | Reuse Policy | Terms of Use
Wednesday, October 15, 2008
President Bush Signs Bill
December 20, 2006
HP-209
Washington, DC- President George W. Bush signed the Health Opportunity Patient Empowerment Act of 2006 today, enhancing Americans' access to tax-advantaged health care savings. The law, part of the Tax Relief and Health Care Act of 2006, provides new opportunities for health savings account (HSA) participants' to build their funds.
"Health savings accounts are improving the way Americans obtain the care they need. This bill makes HSAs more flexible and makes it easier for participants to put money aside for their personal health care," said Treasury Assistant Secretary for Tax Policy Eric Solomon.
HSA provisions of the Act include:
Allow rollovers from health FSAs and HRAs into HSAs through 2011. Employers can transfer funds from Flexible Spending Arrangements (FSAs) or Health Reimbursement Arrangements (HRAs) to an HSA for employees switching to coverage under an HSA-compatible health plan. The amounts rolled over to HSAs from FSAs or HRAs are over and above the amounts allowed as annual contributions. The maximum contribution is the balance in the FSA or HRA as of September 21, 2006, or if less, the balance as of the date of the transfer. The provision is limited to one distribution with respect to each health FSA or HRA of the individual. If an individual does not remain an eligible individual for the 12 months following the month of the contribution, the transferred amount is included in income and subject to a 10 percent additional tax.
Increase in annual HSA contribution. Previously, the maximum HSA contribution was the lesser of the deductible of the individual's HSA-eligible plan or a statutory maximum. The new rules make the limit the statutory maximum contribution, regardless of the individual's deductible. For 2007, the maximum contribution for an eligible individual with self-only coverage is $2,850, and the maximum contribution for an eligible individual with family coverage is $5,650. These limits are indexed for inflation.
Full HSA contribution regardless of month individual becomes eligible. Normally, the HSA contribution is pro rated based on the number of months that an individual during the year a person was an eligible individual. The new provisions provide an exception to this rule that will allow individuals who become covered under an HSA-eligible plan in a month other than January to make the maximum HSA contribution for the year based on their coverage in the last month of the year. This eliminates a common barrier to switching to HSA-eligible coverage. If an individual does not stay in the HSA-eligible plan 12 months following the last month of the year of the first year of eligibility, the amount which could not have been contributed except for this provision will be included in income and subject to a 10 percent additional tax.
One-time transfer from IRAs to HSAs. The new rules allow for a one-time contribution to an HSA of amounts distributed from an Individual Retirement Arrangement (IRA). The contribution must be made in a direct trustee-to-trustee transfer. The IRA transfer will not be included in income or subject to the early withdrawal additional tax. The transfer is limited to the maximum HSA contribution for the year, and the amount contributed is not allowed as a deduction. Generally, only one transfer may be made during the lifetime of an individual. If an individual electing the one-time transfer does not remain an eligible individual for the 12 months following the month of the contribution, the transferred amount is included in income and subject to a 10 percent additional tax.
Certain FSA coverage treated as disregarded coverage. Under previous law, if an FSA had a grace period following the end of the plan year allowing participants to incur additional reimbursable expenses, participants were treated as having disqualifying coverage, reducing their HSA contribution for that year, even though they had switched to HSA-eligible coverage at the first of the year. The new rules treat certain FSA coverage during a grace period as disregarded coverage, eliminating any resulting reduction in the HSA contribution for the year. First, the coverage is disregarded if the balance in the health FSA at the end of the plan year is zero. Second, the coverage is disregarded if the year-end balance is transferred directly to an HSA fom the FSA, as noted above.
Earlier indexing of cost of living adjustments. Previously, indexing was based on a 12-month period ending on August 31. The new rules change the base period to the 12-month period ending on March 31 and require that adjusted amounts for a year be published by June 1 of the preceding year. This change will provide employers and health plans with more time to design qualifying HSA-eligible plans and individuals with more time to make decisions about their health care for the next year.
Allow greater employer contributions for lower-paid employees. Previously, employer contributions under the comparability rules had to be the same amount or percentage of the deductible for all employees with the same category of coverage. Consequently, employers could not contribute higher amounts to lower-paid employees. The new rules provide an exception to the comparability rules allowing employers to contribute more to the HSAs of non-highly compensated individuals. For this purpose, the definition of "highly compensated employee" is based on same definition used for qualified retirement plans.
-30-
HP-209
Washington, DC- President George W. Bush signed the Health Opportunity Patient Empowerment Act of 2006 today, enhancing Americans' access to tax-advantaged health care savings. The law, part of the Tax Relief and Health Care Act of 2006, provides new opportunities for health savings account (HSA) participants' to build their funds.
"Health savings accounts are improving the way Americans obtain the care they need. This bill makes HSAs more flexible and makes it easier for participants to put money aside for their personal health care," said Treasury Assistant Secretary for Tax Policy Eric Solomon.
HSA provisions of the Act include:
Allow rollovers from health FSAs and HRAs into HSAs through 2011. Employers can transfer funds from Flexible Spending Arrangements (FSAs) or Health Reimbursement Arrangements (HRAs) to an HSA for employees switching to coverage under an HSA-compatible health plan. The amounts rolled over to HSAs from FSAs or HRAs are over and above the amounts allowed as annual contributions. The maximum contribution is the balance in the FSA or HRA as of September 21, 2006, or if less, the balance as of the date of the transfer. The provision is limited to one distribution with respect to each health FSA or HRA of the individual. If an individual does not remain an eligible individual for the 12 months following the month of the contribution, the transferred amount is included in income and subject to a 10 percent additional tax.
Increase in annual HSA contribution. Previously, the maximum HSA contribution was the lesser of the deductible of the individual's HSA-eligible plan or a statutory maximum. The new rules make the limit the statutory maximum contribution, regardless of the individual's deductible. For 2007, the maximum contribution for an eligible individual with self-only coverage is $2,850, and the maximum contribution for an eligible individual with family coverage is $5,650. These limits are indexed for inflation.
Full HSA contribution regardless of month individual becomes eligible. Normally, the HSA contribution is pro rated based on the number of months that an individual during the year a person was an eligible individual. The new provisions provide an exception to this rule that will allow individuals who become covered under an HSA-eligible plan in a month other than January to make the maximum HSA contribution for the year based on their coverage in the last month of the year. This eliminates a common barrier to switching to HSA-eligible coverage. If an individual does not stay in the HSA-eligible plan 12 months following the last month of the year of the first year of eligibility, the amount which could not have been contributed except for this provision will be included in income and subject to a 10 percent additional tax.
One-time transfer from IRAs to HSAs. The new rules allow for a one-time contribution to an HSA of amounts distributed from an Individual Retirement Arrangement (IRA). The contribution must be made in a direct trustee-to-trustee transfer. The IRA transfer will not be included in income or subject to the early withdrawal additional tax. The transfer is limited to the maximum HSA contribution for the year, and the amount contributed is not allowed as a deduction. Generally, only one transfer may be made during the lifetime of an individual. If an individual electing the one-time transfer does not remain an eligible individual for the 12 months following the month of the contribution, the transferred amount is included in income and subject to a 10 percent additional tax.
Certain FSA coverage treated as disregarded coverage. Under previous law, if an FSA had a grace period following the end of the plan year allowing participants to incur additional reimbursable expenses, participants were treated as having disqualifying coverage, reducing their HSA contribution for that year, even though they had switched to HSA-eligible coverage at the first of the year. The new rules treat certain FSA coverage during a grace period as disregarded coverage, eliminating any resulting reduction in the HSA contribution for the year. First, the coverage is disregarded if the balance in the health FSA at the end of the plan year is zero. Second, the coverage is disregarded if the year-end balance is transferred directly to an HSA fom the FSA, as noted above.
Earlier indexing of cost of living adjustments. Previously, indexing was based on a 12-month period ending on August 31. The new rules change the base period to the 12-month period ending on March 31 and require that adjusted amounts for a year be published by June 1 of the preceding year. This change will provide employers and health plans with more time to design qualifying HSA-eligible plans and individuals with more time to make decisions about their health care for the next year.
Allow greater employer contributions for lower-paid employees. Previously, employer contributions under the comparability rules had to be the same amount or percentage of the deductible for all employees with the same category of coverage. Consequently, employers could not contribute higher amounts to lower-paid employees. The new rules provide an exception to the comparability rules allowing employers to contribute more to the HSAs of non-highly compensated individuals. For this purpose, the definition of "highly compensated employee" is based on same definition used for qualified retirement plans.
-30-
Sunday, October 12, 2008
Health care takes a back seat in the election
By: Lelia Chaisson
Posted: 10/9/08
Two years ago, Americans couldn't get enough of the health care debate. With Massachusetts leading the way to universal coverage, health care dominated the headlines. Forty-seven million uninsured, staggering U.S. expenditures on medical technology and lagging U.S. health statistics were disturbingly familiar, and it seemed certain that America was on its way to health care reform.
So what happened?
Right in the middle of our attempt to fix the "broken system," health care lost its momentum, much as it did in the 1990s with Hillary Clinton's failed attempt to revolutionize it. In both cases, huge movements swiftly lost their authority and eventually faded into the background, leaving Americans to deal with the ever increasing costs of health care. It seems that, despite the perpetual health care calamity in America, every time we get close to making some progress, health care disappears from the headlines.
Health care has once again taken a back seat in the 2008 election, despite the fact that recently published reports show that access to health care remains a considerable problem for more American families than ever before. Indeed, the Center for Studying Health System Change recently disclosed that almost one in five families struggled to pay medical bills last year; Twenty percent of those having problems even considered declaring personal bankruptcy. Nor is the issue limited to those without medical insurance. Reports indicate that of the 57 million Americans under pressure, 43 million have some form of insurance. The health care crisis is far from over, yet real reform is not even on the horizon.
Why is it so hard to get the ball rolling on health care? It's not because Americans don't want health care reform. While the issue has slipped behind the financial crisis and the Iraq war in the current election, it remains firmly in the top three issues among all demographics. Nor is it for lack of ideas. Over the years myriad diverse plans have been proposed by Republicans and Democrats alike.
I can only conclude that the standstill is due to the public's wishy-washiness. Americans simply don't know what they want. Or, rather, they know what they want, but they aren't willing to take any of the necessary steps to get it. What is perhaps the most interesting thing about this debate is the combination of America's conviction that every person should have access to affordable, high-quality care, and its simultaneous skepticism concerning every proposed plan for change.
Just look at the public's reaction to some of the ideas for reform. To the suggestion that we require coverage for every American to promote preventive care comes the loud retort that forcing everyone to have insurance is un-American. To the notion that we should cut spending on costly, infrequently used procedures comes the cry that Americans should have access to any medical procedure they could ever possibly want, nevermind the price tag.
Now, I'm not saying that all of these ideas are perfect. I'm just pointing out the irony that Americans demand affordable coverage and access for all, yet reject any policy that has the potential to address these problems.
America's fickleness has reared its head once again in the current election. On the one hand, Barack Obama has suggested creating a national health plan available to all Americans, with guaranteed eligibility, benefits similar to those offered in the plan available to members of Congress and subsidies for those who do not qualify for Medicaid or SCHIP but still need financial aid.
Seemingly, his plan has addressed every criticism. No mandate for universal coverage. Affordable care for every American. Guaranteed access. Choice between private and employer-based coverage.
The public's reaction? Obama's plan is too costly and will create too much regulation.
Senator McCain, on the other hand, wants nothing close to a national health care plan, and instead advocates stimulating the private market and doing away with tax breaks for employer-based health insurance.
Now, come on. Voters say they want to ensure affordable coverage for every American. They say they want to take some of the power away from greedy insurance companies that deny care to the sick and disadvantaged. Is there really any question as to which plan will better address these issues? Granted, Obama's plan is going to be expensive. But let's be serious. Doing away with tax breaks will encourage employers to do away with their health care plans. And a $5,000 tax credit will be a drop of water in a sea of health care costs, which now average $12,680 a year for U.S. families. In addition to this, it is widely speculated that McCain's plan will leave millions of people uninsured and give more power to the insurance companies everyone despises.
But, in the end, no matter who gets elected, I doubt we'll ever get far enough to see either of these plans enacted. America loves to talk the talk, but won't walk the walk. When given the choice of actually addressing their constantly reiterated concerns about health care or doing nothing, Americans consistently choose the latter.
Posted: 10/9/08
Two years ago, Americans couldn't get enough of the health care debate. With Massachusetts leading the way to universal coverage, health care dominated the headlines. Forty-seven million uninsured, staggering U.S. expenditures on medical technology and lagging U.S. health statistics were disturbingly familiar, and it seemed certain that America was on its way to health care reform.
So what happened?
Right in the middle of our attempt to fix the "broken system," health care lost its momentum, much as it did in the 1990s with Hillary Clinton's failed attempt to revolutionize it. In both cases, huge movements swiftly lost their authority and eventually faded into the background, leaving Americans to deal with the ever increasing costs of health care. It seems that, despite the perpetual health care calamity in America, every time we get close to making some progress, health care disappears from the headlines.
Health care has once again taken a back seat in the 2008 election, despite the fact that recently published reports show that access to health care remains a considerable problem for more American families than ever before. Indeed, the Center for Studying Health System Change recently disclosed that almost one in five families struggled to pay medical bills last year; Twenty percent of those having problems even considered declaring personal bankruptcy. Nor is the issue limited to those without medical insurance. Reports indicate that of the 57 million Americans under pressure, 43 million have some form of insurance. The health care crisis is far from over, yet real reform is not even on the horizon.
Why is it so hard to get the ball rolling on health care? It's not because Americans don't want health care reform. While the issue has slipped behind the financial crisis and the Iraq war in the current election, it remains firmly in the top three issues among all demographics. Nor is it for lack of ideas. Over the years myriad diverse plans have been proposed by Republicans and Democrats alike.
I can only conclude that the standstill is due to the public's wishy-washiness. Americans simply don't know what they want. Or, rather, they know what they want, but they aren't willing to take any of the necessary steps to get it. What is perhaps the most interesting thing about this debate is the combination of America's conviction that every person should have access to affordable, high-quality care, and its simultaneous skepticism concerning every proposed plan for change.
Just look at the public's reaction to some of the ideas for reform. To the suggestion that we require coverage for every American to promote preventive care comes the loud retort that forcing everyone to have insurance is un-American. To the notion that we should cut spending on costly, infrequently used procedures comes the cry that Americans should have access to any medical procedure they could ever possibly want, nevermind the price tag.
Now, I'm not saying that all of these ideas are perfect. I'm just pointing out the irony that Americans demand affordable coverage and access for all, yet reject any policy that has the potential to address these problems.
America's fickleness has reared its head once again in the current election. On the one hand, Barack Obama has suggested creating a national health plan available to all Americans, with guaranteed eligibility, benefits similar to those offered in the plan available to members of Congress and subsidies for those who do not qualify for Medicaid or SCHIP but still need financial aid.
Seemingly, his plan has addressed every criticism. No mandate for universal coverage. Affordable care for every American. Guaranteed access. Choice between private and employer-based coverage.
The public's reaction? Obama's plan is too costly and will create too much regulation.
Senator McCain, on the other hand, wants nothing close to a national health care plan, and instead advocates stimulating the private market and doing away with tax breaks for employer-based health insurance.
Now, come on. Voters say they want to ensure affordable coverage for every American. They say they want to take some of the power away from greedy insurance companies that deny care to the sick and disadvantaged. Is there really any question as to which plan will better address these issues? Granted, Obama's plan is going to be expensive. But let's be serious. Doing away with tax breaks will encourage employers to do away with their health care plans. And a $5,000 tax credit will be a drop of water in a sea of health care costs, which now average $12,680 a year for U.S. families. In addition to this, it is widely speculated that McCain's plan will leave millions of people uninsured and give more power to the insurance companies everyone despises.
But, in the end, no matter who gets elected, I doubt we'll ever get far enough to see either of these plans enacted. America loves to talk the talk, but won't walk the walk. When given the choice of actually addressing their constantly reiterated concerns about health care or doing nothing, Americans consistently choose the latter.
Tuesday, September 2, 2008
DONUT HOLE MEDICARE PART D PROBLEM
September 2, 2008
Editorial
Medicare’s Troubling Drug Gap
Probably no aspect of the new Medicare drug program has caused more confusion and irritation than the notorious “doughnut hole,” a gap in coverage that forces people who had been getting their drugs cheaply to suddenly pay the full price out of pocket. Now, for the first time, an analysis has quantified what happened last year when millions of beneficiaries fell into the gap. For patients with serious chronic conditions, the medical implications were very troubling.
Congress crafted the “doughnut hole” to limit federal spending on the drug benefit. Beneficiaries pay only deductibles and co-payments, with the rest covered by their insurance plan, until their drug purchases reach a specified limit. Last year, the gap began when beneficiaries purchased $2,400 worth of drugs. Then they fell into the doughnut hole and had to pay the full cost until their out-of-pocket spending reached $3,850, at which point they qualified for catastrophic coverage.
Last year, an estimated 3.4 million beneficiaries reached the coverage gap, according to a study by researchers at the Kaiser Family Foundation, Georgetown University and the National Opinion Research Center, or NORC, at the University of Chicago. Beneficiaries taking drugs to treat such chronic conditions as Alzheimer’s disease, diabetes, depression, osteoporosis and high blood pressure were especially likely to reach the gap.
What’s disturbing is that 15 percent of the beneficiaries taking drugs in eight categories said they stopped taking their medications when they reached the gap. Another 1 percent reduced their use by skipping doses, and 5 percent switched to another drug that was cheaper but might or might not be as effective.
For the 10 percent of diabetics who stopped taking their medication after reaching the gap, the health consequences could be immediate and serious. For those with high cholesterol or osteoporosis, the harm could take longer to show up but could still be serious.
There is no easy solution short of increasing federal spending or finding a way to drive down the cost of drugs. The program has helped millions of older Americans. The next administration and Congress will have to revisit the wisdom and need for the gap.
Home
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Copyright 2008 The New York Times Company
Editorial
Medicare’s Troubling Drug Gap
Probably no aspect of the new Medicare drug program has caused more confusion and irritation than the notorious “doughnut hole,” a gap in coverage that forces people who had been getting their drugs cheaply to suddenly pay the full price out of pocket. Now, for the first time, an analysis has quantified what happened last year when millions of beneficiaries fell into the gap. For patients with serious chronic conditions, the medical implications were very troubling.
Congress crafted the “doughnut hole” to limit federal spending on the drug benefit. Beneficiaries pay only deductibles and co-payments, with the rest covered by their insurance plan, until their drug purchases reach a specified limit. Last year, the gap began when beneficiaries purchased $2,400 worth of drugs. Then they fell into the doughnut hole and had to pay the full cost until their out-of-pocket spending reached $3,850, at which point they qualified for catastrophic coverage.
Last year, an estimated 3.4 million beneficiaries reached the coverage gap, according to a study by researchers at the Kaiser Family Foundation, Georgetown University and the National Opinion Research Center, or NORC, at the University of Chicago. Beneficiaries taking drugs to treat such chronic conditions as Alzheimer’s disease, diabetes, depression, osteoporosis and high blood pressure were especially likely to reach the gap.
What’s disturbing is that 15 percent of the beneficiaries taking drugs in eight categories said they stopped taking their medications when they reached the gap. Another 1 percent reduced their use by skipping doses, and 5 percent switched to another drug that was cheaper but might or might not be as effective.
For the 10 percent of diabetics who stopped taking their medication after reaching the gap, the health consequences could be immediate and serious. For those with high cholesterol or osteoporosis, the harm could take longer to show up but could still be serious.
There is no easy solution short of increasing federal spending or finding a way to drive down the cost of drugs. The program has helped millions of older Americans. The next administration and Congress will have to revisit the wisdom and need for the gap.
Home
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Copyright 2008 The New York Times Company
Saturday, August 30, 2008
Funding health care uninsured
In New England, several states have turned to one-time sources of revenue to initially
fund coverage expansions. For example, Maine, Massachusetts, and Vermont have redistributed
federal funding obtained through Medicaid waivers to expand eligibility and coverage to certain segments of the population.
Maine, Rhode Island, and Vermont have used their tobacco settlement allocations to seed partial funding.
A problem with one-time sources of revenue
is that when they run out, states may need additional money to sustain expansions
in coverage. With this in mind, Rhode Island has created a trust out of its tobacco settlement to fund in perpetuity a program to reduce the health insurance premiums for small businesses. Other states have implemented
or are exploring excise taxes on tobacco
to fund coverage expansions.
One New England state—Massachusetts—
is using a unique source of revenue to fund its coverage expansion, gradually tapping
its $693 million uncompensated care pool. Massachusetts’ pool—the only one of its kind in the nation—is funded by assessments
levied on hospitals and insurers. The money in the pool was previously used to reimburse hospitals and health care clinics for services that were provided to uninsured individuals. In redirecting these funds from care to insurance coverage, it is unclear how much revenue individual hospitals and clinics
may lose and whether they will be able to continue to provide care in the face of such losses. “This issue,” said Nancy Turnbull, President of the Blue Cross Blue Shield of Massachusetts Foundation, “is so touchy that nobody wants to directly answer questions about it.”
Many reform plans are funded upon the belief that coverage expansion will induce more cost savings because hospitals will no longer have to incur large costs for bad debt and charity care and more of the uninsured will receive routine medical care, which will reduce their reliance on expensive emergency
room visits. Combined with a diversification
of the insurance risk pools through the addition of relatively young and healthy uninsured populations, states are hoping that these savings will curb the growth of private insurance premiums and allow for future coverage
expansions.
However, states will encounter significant
fiscal difficulty if such cost savings fail to materialize. In Maine, the DirigoChoice plan was designed to be partially funded by an assessment on the amount of cost savings the insurer saw as a result of providers reducing
their fees in response to less charity care and bad debt. But disagreement over the size of the cost savings and the subsequent size of the assessment ultimately ended up in court. Currently, Maine is searching for new sources of funding for its fledgling plan.
Employers are another source of potential
revenue for states. Health care legislation
passed in Massachusetts and Vermont in early 2006 requires annual fees of $295 and $365 per full-time employee, respectively, to be paid by employers that do not offer health benefits to their employees, subject to some exemptions. But these assessments are not large enough to cover the complete cost of expanding coverage to employees who are not offered insurance, especially as the cost of health insurance continues to rise. The current
political climate makes the possibility of higher taxes to pay for coverage unlikely.
Businesses may respond by encouraging eligible employees and their dependents to enroll in Medicaid and SCHIP. Commenting
during the second panel discussion at the conference, Trish Riley, Director of the Governor’s
Office for Health Policy and Finance in Maine, wondered whether increased coordination
between large employers and the state would address this contentious issue. For example, it might be more efficient if coverage for low-wage and part-time workers were administered through a Medicaid program,
with partial funding from employers.
As long as health care spending decelerates
and state revenue collections remain strong, state fiscal conditions for coverage expansions remain on steady ground. But over the long term, any sort of fiscal stress will affect a state’s implementation of reform and expansion of coverage, especially as aging
Baby Boomers place additional pressure on the health care system. Moreover, a significant
amount of funding for state coverage
Over the long term, any sort of
fiscal stress will affect a state’s
ability to expand coverage.
fund coverage expansions. For example, Maine, Massachusetts, and Vermont have redistributed
federal funding obtained through Medicaid waivers to expand eligibility and coverage to certain segments of the population.
Maine, Rhode Island, and Vermont have used their tobacco settlement allocations to seed partial funding.
A problem with one-time sources of revenue
is that when they run out, states may need additional money to sustain expansions
in coverage. With this in mind, Rhode Island has created a trust out of its tobacco settlement to fund in perpetuity a program to reduce the health insurance premiums for small businesses. Other states have implemented
or are exploring excise taxes on tobacco
to fund coverage expansions.
One New England state—Massachusetts—
is using a unique source of revenue to fund its coverage expansion, gradually tapping
its $693 million uncompensated care pool. Massachusetts’ pool—the only one of its kind in the nation—is funded by assessments
levied on hospitals and insurers. The money in the pool was previously used to reimburse hospitals and health care clinics for services that were provided to uninsured individuals. In redirecting these funds from care to insurance coverage, it is unclear how much revenue individual hospitals and clinics
may lose and whether they will be able to continue to provide care in the face of such losses. “This issue,” said Nancy Turnbull, President of the Blue Cross Blue Shield of Massachusetts Foundation, “is so touchy that nobody wants to directly answer questions about it.”
Many reform plans are funded upon the belief that coverage expansion will induce more cost savings because hospitals will no longer have to incur large costs for bad debt and charity care and more of the uninsured will receive routine medical care, which will reduce their reliance on expensive emergency
room visits. Combined with a diversification
of the insurance risk pools through the addition of relatively young and healthy uninsured populations, states are hoping that these savings will curb the growth of private insurance premiums and allow for future coverage
expansions.
However, states will encounter significant
fiscal difficulty if such cost savings fail to materialize. In Maine, the DirigoChoice plan was designed to be partially funded by an assessment on the amount of cost savings the insurer saw as a result of providers reducing
their fees in response to less charity care and bad debt. But disagreement over the size of the cost savings and the subsequent size of the assessment ultimately ended up in court. Currently, Maine is searching for new sources of funding for its fledgling plan.
Employers are another source of potential
revenue for states. Health care legislation
passed in Massachusetts and Vermont in early 2006 requires annual fees of $295 and $365 per full-time employee, respectively, to be paid by employers that do not offer health benefits to their employees, subject to some exemptions. But these assessments are not large enough to cover the complete cost of expanding coverage to employees who are not offered insurance, especially as the cost of health insurance continues to rise. The current
political climate makes the possibility of higher taxes to pay for coverage unlikely.
Businesses may respond by encouraging eligible employees and their dependents to enroll in Medicaid and SCHIP. Commenting
during the second panel discussion at the conference, Trish Riley, Director of the Governor’s
Office for Health Policy and Finance in Maine, wondered whether increased coordination
between large employers and the state would address this contentious issue. For example, it might be more efficient if coverage for low-wage and part-time workers were administered through a Medicaid program,
with partial funding from employers.
As long as health care spending decelerates
and state revenue collections remain strong, state fiscal conditions for coverage expansions remain on steady ground. But over the long term, any sort of fiscal stress will affect a state’s implementation of reform and expansion of coverage, especially as aging
Baby Boomers place additional pressure on the health care system. Moreover, a significant
amount of funding for state coverage
Over the long term, any sort of
fiscal stress will affect a state’s
ability to expand coverage.
Thursday, August 28, 2008
Cost of Health Care out of control
Health care costs are rising. The price of oil is at an all time high. Americans are struggling to save for the future. But when I turn on the TV or read a newspaper, the story too often seems to be the latest poll, gaffe, or controversy.
We need to hear less about the process, and more about the substance. We deserve serious, in-depth investigative reporting on plans to ensure all Americans have access to quality health care and long-term financial security.
When the next President of the United States takes office in January, what will he do for Americans who can't afford their health care bills? How will he guarantee that Americans who work hard are able to save for retirement, or plan for the unexpected?
More importantly: how will he cut through the partisan gridlock and work across the aisle to actually deliver for American families?
I sincerely hope you will dig into the substance and specifics of the plans of our elected leaders. I'm looking to the media for hard-charging investigative reporting - not sound bites and the horserace. And I'm sure I'm not the only one.
We need to hear less about the process, and more about the substance. We deserve serious, in-depth investigative reporting on plans to ensure all Americans have access to quality health care and long-term financial security.
When the next President of the United States takes office in January, what will he do for Americans who can't afford their health care bills? How will he guarantee that Americans who work hard are able to save for retirement, or plan for the unexpected?
More importantly: how will he cut through the partisan gridlock and work across the aisle to actually deliver for American families?
I sincerely hope you will dig into the substance and specifics of the plans of our elected leaders. I'm looking to the media for hard-charging investigative reporting - not sound bites and the horserace. And I'm sure I'm not the only one.
Tuesday, August 19, 2008
Small Business Health Care Comment
Their top concern, according to a survey conducted by the National Federation of Independent Business and Wells Fargo, was the expense of being in business, and the entrepreneurs singled out those factors “that are difficult to control, such as health insurance, energy and inflation.”
The survey is conducted every four years, and the high cost of health care has been the No. 1 in the last five surveys.
“For four years, the economy provided a good, stable foundation for Small Business
The survey is conducted every four years, and the high cost of health care has been the No. 1 in the last five surveys.
“For four years, the economy provided a good, stable foundation for Small Business
Wednesday, August 13, 2008
Health Care Insuance Reform
FOR IMMEDIATE RELEASE Contacts:
Aug. 11, 2008 David Himmelstein, M.D., (518) 794-8109, (617) 312-0970
(cell), Benjamin Day, (617) 777-3422, director@masscare.org , Mark Almberg, (312) 782-6006, mark@pnhp.org
Copy Massachusetts' health reform?
Not so fast, researchers say
Citing the failure of seven state-based health reforms over the past two
decades - initiatives that bear a strong resemblance to the
Massachusetts health reform of 2006 - a group of Massachusetts-based
researchers cautions that early declarations of the latter's success may
be premature.
In an article titled "State Heath Reform Flatlines," published in the
most recent issue of the International Journal of Health Services, three
researchers, two of whom teach at Harvard Medical School, examine the
experiences of earlier reforms in Massachusetts, Oregon, Minnesota,
Tennessee, Vermont, Washington state and Maine. The plans were enacted
from 1988 through 2003.
All seven reforms, which when launched were widely trumpeted by
political leaders and leading newspapers as breakthroughs in providing
universal health care, were based on the expansion of private insurance
coverage, the authors say. But in each case the plan had little impact
on the state's number of uninsured persons and produced no sustained
improvements in delivering care.
Dr. David Himmelstein, a co-author of the study, said the 2006
Massachusetts reform appears poised to follow the pattern of the 1992
Tennessee plan, which featured a large expansion of coverage under a
Medicaid-like program. "In Tennessee, the number of uninsured dipped for
two years, then rose to levels higher than ever," he said. "And the plan
proved to be unaffordable in the long term.
"According to the latest figures on Massachusetts from the National
Health Interview Survey," he continued, "the uninsurance rate has fallen
by only 2 percent, from 7.7 percent to 5.8 percent, since the reform was
passed, while the plan is already $147 million over budget."
Himmelstein, who is an associate professor of medicine at Harvard and a
primary care physician in Cambridge, Mass., said the seven failed plans
incorporated virtually all of the reform elements being advanced today
by leading Democrats, including Sen. Barack Obama. The problem, he said,
is that such reforms leave the private health insurance industry in a
dominant position.
"Politicians like to claim they've passed bold health reforms, but
they're afraid to rock the private insurance boat," he said. "So they
keep pushing gussied-up versions of reforms that have failed time after
time. Our health care system is sick to death, and our politicians keep
prescribing placebos."
The authors note that all of the failed plans included expansions of
Medicaid or similar programs for the poor and near-poor. Three states'
reforms (Massachusetts in 1988, Oregon in 1989-1992 and Washington state
in 1993) included mandates requiring employers to cover their workers,
and the Massachusetts and Washington plans also included an individual
mandate on the self-employed.
The authors analyzed Census Bureau data on uninsurance rates in each of
the seven states. Massachusetts' uninsurance rate rose from 7.2 percent
to 9.7 percent in the three years after the passage of then-governor
Michael Dukakis' universal health care reform in 1988. Uninsurance went
from 14.1 percent to 14.7 percent in the three years after
implementation of Oregon's universal health care reform in 1993. The
percentage of residents lacking coverage in Washington state increased
from 10.7 percent to 11.6 percent in the three years after passage of
its universal health care initiative.
Similar patterns occurred in Vermont and Maine. Tennessee's program
(which included the largest Medicaid expansion) was probably the most
successful, dropping the share of uninsured in the state from 12 percent
to 9 percent in its first year, before a rebound to 14 percent by year
three. (See charts in links below.)
All of the plans eventually "flatlined," or died quiet deaths, the
authors said.
According to Benjamin Day, executive director of Mass-Care, a health
care advocacy coalition based in Boston, "It's easy to build political
consensus for expanded health coverage. But experience shows that you
can't achieve universal coverage at an affordable price unless you throw
out the insurance companies with their massive overhead and profit, and
replace them with a more efficient single-payer national health
insurance program.
"Senator Obama should learn this lesson," Day said. As for Sen. John
McCain's health care proposals, "they are so obviously unworkable that
it's hard to take them seriously."
*******
The text of the study is available in PDF to the press at
www.pnhp.org/states_flatline
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=zNcwNfjJAnJf0TMLo94BkfXmr35TzF3j
Password: *himmelstein*
Additional charts in PowerPoint format are available at
www.pnhp.org/five_states
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=YNqed33VWwZ3%2FwCWnJiiV%2B8pcMbyAF%2B6
"State Health Reform Flatlines," Steffie Woolhandler, MD, MPH; Benjamin
Day; and David U. Himmelstein, MD. International Journal of Health
Services, Vol. 38, No. 3.
Physicians for a National Health Program, a membership organization of
over 15,000 physicians, supports a single-payer national health
insurance program. To contact a physician-spokesperson in your area,
visit www.pnhp.org/stateactions
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=W1SCD%2BJYJOe309bI23pT%2B%2B8pcMbyAF%2B6
or call (312) 782-6006.
*Physicians for a National Health Program*
29 E Madison Suite 602, Chicago, IL 60602
Phone (312) 782-6006 | Fax: (312) 782-6007
www.pnhp.org
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=cGQcvuaDs3pWB3gv9jboUO8pcMbyAF%2B6
| info@pnhp.org mailto:info@pnhp.org
PNHP 2008
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=mgJJAv5YFLJ2XnjhLax%2Fe%2B8pcMbyAF%2B6
--------------------------------------------------------------------------------
Looking for a car that's sporty, fun and fits in your budget? Read reviews on AOL Autos.
Aug. 11, 2008 David Himmelstein, M.D., (518) 794-8109, (617) 312-0970
(cell), Benjamin Day, (617) 777-3422, director@masscare.org , Mark Almberg, (312) 782-6006, mark@pnhp.org
Copy Massachusetts' health reform?
Not so fast, researchers say
Citing the failure of seven state-based health reforms over the past two
decades - initiatives that bear a strong resemblance to the
Massachusetts health reform of 2006 - a group of Massachusetts-based
researchers cautions that early declarations of the latter's success may
be premature.
In an article titled "State Heath Reform Flatlines," published in the
most recent issue of the International Journal of Health Services, three
researchers, two of whom teach at Harvard Medical School, examine the
experiences of earlier reforms in Massachusetts, Oregon, Minnesota,
Tennessee, Vermont, Washington state and Maine. The plans were enacted
from 1988 through 2003.
All seven reforms, which when launched were widely trumpeted by
political leaders and leading newspapers as breakthroughs in providing
universal health care, were based on the expansion of private insurance
coverage, the authors say. But in each case the plan had little impact
on the state's number of uninsured persons and produced no sustained
improvements in delivering care.
Dr. David Himmelstein, a co-author of the study, said the 2006
Massachusetts reform appears poised to follow the pattern of the 1992
Tennessee plan, which featured a large expansion of coverage under a
Medicaid-like program. "In Tennessee, the number of uninsured dipped for
two years, then rose to levels higher than ever," he said. "And the plan
proved to be unaffordable in the long term.
"According to the latest figures on Massachusetts from the National
Health Interview Survey," he continued, "the uninsurance rate has fallen
by only 2 percent, from 7.7 percent to 5.8 percent, since the reform was
passed, while the plan is already $147 million over budget."
Himmelstein, who is an associate professor of medicine at Harvard and a
primary care physician in Cambridge, Mass., said the seven failed plans
incorporated virtually all of the reform elements being advanced today
by leading Democrats, including Sen. Barack Obama. The problem, he said,
is that such reforms leave the private health insurance industry in a
dominant position.
"Politicians like to claim they've passed bold health reforms, but
they're afraid to rock the private insurance boat," he said. "So they
keep pushing gussied-up versions of reforms that have failed time after
time. Our health care system is sick to death, and our politicians keep
prescribing placebos."
The authors note that all of the failed plans included expansions of
Medicaid or similar programs for the poor and near-poor. Three states'
reforms (Massachusetts in 1988, Oregon in 1989-1992 and Washington state
in 1993) included mandates requiring employers to cover their workers,
and the Massachusetts and Washington plans also included an individual
mandate on the self-employed.
The authors analyzed Census Bureau data on uninsurance rates in each of
the seven states. Massachusetts' uninsurance rate rose from 7.2 percent
to 9.7 percent in the three years after the passage of then-governor
Michael Dukakis' universal health care reform in 1988. Uninsurance went
from 14.1 percent to 14.7 percent in the three years after
implementation of Oregon's universal health care reform in 1993. The
percentage of residents lacking coverage in Washington state increased
from 10.7 percent to 11.6 percent in the three years after passage of
its universal health care initiative.
Similar patterns occurred in Vermont and Maine. Tennessee's program
(which included the largest Medicaid expansion) was probably the most
successful, dropping the share of uninsured in the state from 12 percent
to 9 percent in its first year, before a rebound to 14 percent by year
three. (See charts in links below.)
All of the plans eventually "flatlined," or died quiet deaths, the
authors said.
According to Benjamin Day, executive director of Mass-Care, a health
care advocacy coalition based in Boston, "It's easy to build political
consensus for expanded health coverage. But experience shows that you
can't achieve universal coverage at an affordable price unless you throw
out the insurance companies with their massive overhead and profit, and
replace them with a more efficient single-payer national health
insurance program.
"Senator Obama should learn this lesson," Day said. As for Sen. John
McCain's health care proposals, "they are so obviously unworkable that
it's hard to take them seriously."
*******
The text of the study is available in PDF to the press at
www.pnhp.org/states_flatline
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=zNcwNfjJAnJf0TMLo94BkfXmr35TzF3j
Password: *himmelstein*
Additional charts in PowerPoint format are available at
www.pnhp.org/five_states
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=YNqed33VWwZ3%2FwCWnJiiV%2B8pcMbyAF%2B6
"State Health Reform Flatlines," Steffie Woolhandler, MD, MPH; Benjamin
Day; and David U. Himmelstein, MD. International Journal of Health
Services, Vol. 38, No. 3.
Physicians for a National Health Program, a membership organization of
over 15,000 physicians, supports a single-payer national health
insurance program. To contact a physician-spokesperson in your area,
visit www.pnhp.org/stateactions
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=W1SCD%2BJYJOe309bI23pT%2B%2B8pcMbyAF%2B6
or call (312) 782-6006.
*Physicians for a National Health Program*
29 E Madison Suite 602, Chicago, IL 60602
Phone (312) 782-6006 | Fax: (312) 782-6007
www.pnhp.org
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=cGQcvuaDs3pWB3gv9jboUO8pcMbyAF%2B6
| info@pnhp.org mailto:info@pnhp.org
PNHP 2008
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=mgJJAv5YFLJ2XnjhLax%2Fe%2B8pcMbyAF%2B6
--------------------------------------------------------------------------------
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Thursday, July 31, 2008
Cost of Health Care VS Gas prices
Gas prices are in the political spotlight right now; this year's spike has been painful and the calls for action — and heads — have pushed other issues to the side. But it is worth remembering that when it comes to real, sustained growth in costs, when it comes to real, sustained erosion of families' disposable income, gas still can't hold a candle to the real elephant in the room: health care.
Tuesday, July 8, 2008
HEALTH CARE COST ---UNIVERSAL COVERAGE
John F. Wasik July 2, 2008
Healthcare will become one of the most onerous personal-finance issues in coming years unless the system is changed to ensure universal access, cost control, and long-term financing.
US families now pay more than $12,000 a year for health coverage, according to the Kaiser Family Foundation. Yet why doesn't any presidential candidate fully endorse a comprehensive national plan?
What would make healthcare available to more than 47 million who don't have coverage and the majority of American families whose premiums have risen 78 percent since 2001? Massive buying power through consolidation of separate programs and a public-private partnership.
To understand what a pervasive problem medical spending is, you need to digest some numbers. Health expenditures consume about 16 percent of US gross domestic product. Translated to an individual family, medical insurance claims 20 percent of median income. That's compared with 8 percent in 1987, according to the nonpartisan New America Foundation. Life expectancy is directly connected to medical coverage. Uninsured and underinsured (an additional 25 million) Americans visit doctors less frequently, pay more for care, and have the highest rate of preventable deaths before age 75, according to the Institute of Medicine.
Employers who do offer coverage are less competitive in a global marketplace. Workers who don't have policies end up in emergency rooms demanding costly care that taxpayers will ultimately finance.
Unless the growing bite of health costs is addressed, related spending will double by 2017 from 2007 levels, consuming one out of every five dollars produced in the United States, according to the Center for Medicaid and Medicare Services.
How do you save the best of US healthcare while providing it to everyone at a reasonable cost? Creating one new, entirely government-run public program may be untenable and politically unacceptable. The road to a solution can merge both private and public interests. What would such a hybrid look like? It would:
1) Outsource cost controlling. That means hiring audit firms to see where costs can be cut. The government could act like a huge accounts-payable department; a private firm would police billing and implement best practices.
2) Negotiate the best price. Maybe Wal-Mart's purchasing practices could be the model.
3) End fees for service. Medical expenses should be based on performance and outcomes, not on number of procedures.
4) Make technology a big part of the system. A major overhaul focusing on efficient technology use is in order.
The healthcare picture of the future isn't cloudy. There will be devastating financial consequences if we don't hunker down and prepare for a much more severe fiscal storm.
John F. Wasik is a Bloomberg News columnist. He can be reached at jwasik@bloomberg.net. Copyright 2008 Globe Newspaper Company.
http://www.boston.com/business/healthcare/articles/2008/07/02/healthcare_costs _must_be_brought_under_control_or_the_economy_will_surely_suffer/
Healthcare will become one of the most onerous personal-finance issues in coming years unless the system is changed to ensure universal access, cost control, and long-term financing.
US families now pay more than $12,000 a year for health coverage, according to the Kaiser Family Foundation. Yet why doesn't any presidential candidate fully endorse a comprehensive national plan?
What would make healthcare available to more than 47 million who don't have coverage and the majority of American families whose premiums have risen 78 percent since 2001? Massive buying power through consolidation of separate programs and a public-private partnership.
To understand what a pervasive problem medical spending is, you need to digest some numbers. Health expenditures consume about 16 percent of US gross domestic product. Translated to an individual family, medical insurance claims 20 percent of median income. That's compared with 8 percent in 1987, according to the nonpartisan New America Foundation. Life expectancy is directly connected to medical coverage. Uninsured and underinsured (an additional 25 million) Americans visit doctors less frequently, pay more for care, and have the highest rate of preventable deaths before age 75, according to the Institute of Medicine.
Employers who do offer coverage are less competitive in a global marketplace. Workers who don't have policies end up in emergency rooms demanding costly care that taxpayers will ultimately finance.
Unless the growing bite of health costs is addressed, related spending will double by 2017 from 2007 levels, consuming one out of every five dollars produced in the United States, according to the Center for Medicaid and Medicare Services.
How do you save the best of US healthcare while providing it to everyone at a reasonable cost? Creating one new, entirely government-run public program may be untenable and politically unacceptable. The road to a solution can merge both private and public interests. What would such a hybrid look like? It would:
1) Outsource cost controlling. That means hiring audit firms to see where costs can be cut. The government could act like a huge accounts-payable department; a private firm would police billing and implement best practices.
2) Negotiate the best price. Maybe Wal-Mart's purchasing practices could be the model.
3) End fees for service. Medical expenses should be based on performance and outcomes, not on number of procedures.
4) Make technology a big part of the system. A major overhaul focusing on efficient technology use is in order.
The healthcare picture of the future isn't cloudy. There will be devastating financial consequences if we don't hunker down and prepare for a much more severe fiscal storm.
John F. Wasik is a Bloomberg News columnist. He can be reached at jwasik@bloomberg.net. Copyright 2008 Globe Newspaper Company.
http://www.boston.com/business/healthcare/articles/2008/07/02/healthcare_costs _must_be_brought_under_control_or_the_economy_will_surely_suffer/
Monday, June 23, 2008
Health Care Massachusetts Health Care Reform
Universal Health Care Education Fund, 33 Harrison Ave, 5th Floor, Boston, MA 02111-2040
To the Editor:
Re "The Massachusetts Model" (editorial, June 16):
As a Massachusetts primary care physician, I dearly wish that your optimism for our state's health care plan were well placed. My fear, however, is that any plan that does not eliminate the colossal waste of multiple competing private health insurers is doomed to failure.
Costs can never be contained while supporting bloated private bureaucracies and for-profit medicine. Most physicians now support single-payer, national health insurance ("Medicare for all").
Alan Meyers, Boston, June 16, 2008
The writer is associate professor of pediatrics at Boston University School of Medicine and a founding member, Physicians for a National Health Program.
To the Editor:
You hail Massachusetts’ health reform as a promising model for the nation. But within the last year both the State Senate president and the executive director of the agency implementing the new law have publicly recognized that it will collapse if health care costs continue to rise by double digits, which they have.
No effective cost-control legislation is in sight. In Massachusetts we see history repeating itself: a large expansion of Medicaid in the mid-1990s added more than 300,000 residents to the rolls, cutting the uninsured population almost by half. A few short years of rising costs, however, were enough to erase those gains and place the state back to where it started.
Similar fates have befallen many "universal" state reforms hailed as models for the nation. Without eliminating the waste inherent in commercial health care systems and making comprehensive coverage a right, no country has ever been able to achieve universal health care.
We need a single-payer health care system that will be there for our children, not another unsustainable experiment with obvious math problems that won't be there just a few years from now.
Benjamin Day, Executive Director
Mass-Care: The Massachusetts Campaign for Single Payer Health Care
Boston, June 17, 2008
To the Editor:
Your editorial lauds the Massachusetts health care reforms as "off to a good start" and "heartening." The editorial addresses the reforms' higher than projected costs thus:
"The shortfall occurred mostly because the state underestimated the number of uninsured residents and how fast low-income people would sign up for subsidized coverage. It is a warning to other states to keep projections realistic."
I'm sorry, but if states can low-ball the cost of reforms to get them enacted, and still get praised by the paper of record, that's exactly what they'll do. Some "warning."
Michael F. Cannon, Director of Health Policy Studies
Cato Institute, Washington, June 18, 2008
http://www.nytimes.com/2008/06/19/opinion/l19health.html
*******************************************************************************************************
Anxiety Over Health Insurance Shapes Life Choices
By VICTORIA E. KNIGHT, The Wall Street Journal 6/10/08
Anxious over being caught uninsured or paying sky-high premiums, some people -- especially those with health problems -- are going to great lengths to get or keep job-based health coverage.
Wedding dates are being moved up to quickly get both husband and wife on a company plan. On the flip side, married couples are holding off on getting divorced so they will both stay on their existing plan. In some cases, those who are self-employed are going so far as to hire employees to qualify for group insurance.
Concern over coverage also is affecting a host of other major life decisions, insurance-industry watchers and financial advisers say, including the age of retirement and the state where people choose to live.
"People are turning themselves inside out to get health insurance," says Karen Politz, a research professor at Georgetown University's Health Policy Institute in Washington.
Under federal law, insurers are required to charge all participants the same for premiums in employer-sponsored group plans regardless of health status. In state-regulated individual markets, by contrast, people with health problems may end up paying high premiums, face exclusions for past or existing medical conditions or be denied coverage.
Financial advisers say health-coverage worries are rampant among clients. For those with medical conditions, conversations increasingly center on how to get or stay on a group policy or segue into the individual market in a way that prevents insurers from denying coverage or excluding pre-existing conditions.
In certain circumstances, two federal laws -- Cobra and Hipaa -- provide such protections, but the rules can be complicated. Insurers may not be limited in what they can charge participants, although some states may set limits. If you are young and healthy, you will likely find a less-expensive policy in the individual market.
"Access to coverage is a huge issue," says Leon Rousso, a certified financial planner in Ventura, Calif. "You may have the financial means to pay for premiums but not be able to get coverage, leaving you exposed to potentially catastrophic losses if you become ill."
Obtaining insurance through an employer is often the easiest way to get comprehensive coverage for those who don't qualify for Medicare or federal or state programs for the very poor.
Employers tend to subsidize premiums, making it more affordable for those in poor health who benefit from being part of a larger risk pool. The coverage tends to be more comprehensive and cost-effective in group policies.
*******************************************************************************************************
--------------------------------------------------------------------------------
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To the Editor:
Re "The Massachusetts Model" (editorial, June 16):
As a Massachusetts primary care physician, I dearly wish that your optimism for our state's health care plan were well placed. My fear, however, is that any plan that does not eliminate the colossal waste of multiple competing private health insurers is doomed to failure.
Costs can never be contained while supporting bloated private bureaucracies and for-profit medicine. Most physicians now support single-payer, national health insurance ("Medicare for all").
Alan Meyers, Boston, June 16, 2008
The writer is associate professor of pediatrics at Boston University School of Medicine and a founding member, Physicians for a National Health Program.
To the Editor:
You hail Massachusetts’ health reform as a promising model for the nation. But within the last year both the State Senate president and the executive director of the agency implementing the new law have publicly recognized that it will collapse if health care costs continue to rise by double digits, which they have.
No effective cost-control legislation is in sight. In Massachusetts we see history repeating itself: a large expansion of Medicaid in the mid-1990s added more than 300,000 residents to the rolls, cutting the uninsured population almost by half. A few short years of rising costs, however, were enough to erase those gains and place the state back to where it started.
Similar fates have befallen many "universal" state reforms hailed as models for the nation. Without eliminating the waste inherent in commercial health care systems and making comprehensive coverage a right, no country has ever been able to achieve universal health care.
We need a single-payer health care system that will be there for our children, not another unsustainable experiment with obvious math problems that won't be there just a few years from now.
Benjamin Day, Executive Director
Mass-Care: The Massachusetts Campaign for Single Payer Health Care
Boston, June 17, 2008
To the Editor:
Your editorial lauds the Massachusetts health care reforms as "off to a good start" and "heartening." The editorial addresses the reforms' higher than projected costs thus:
"The shortfall occurred mostly because the state underestimated the number of uninsured residents and how fast low-income people would sign up for subsidized coverage. It is a warning to other states to keep projections realistic."
I'm sorry, but if states can low-ball the cost of reforms to get them enacted, and still get praised by the paper of record, that's exactly what they'll do. Some "warning."
Michael F. Cannon, Director of Health Policy Studies
Cato Institute, Washington, June 18, 2008
http://www.nytimes.com/2008/06/19/opinion/l19health.html
*******************************************************************************************************
Anxiety Over Health Insurance Shapes Life Choices
By VICTORIA E. KNIGHT, The Wall Street Journal 6/10/08
Anxious over being caught uninsured or paying sky-high premiums, some people -- especially those with health problems -- are going to great lengths to get or keep job-based health coverage.
Wedding dates are being moved up to quickly get both husband and wife on a company plan. On the flip side, married couples are holding off on getting divorced so they will both stay on their existing plan. In some cases, those who are self-employed are going so far as to hire employees to qualify for group insurance.
Concern over coverage also is affecting a host of other major life decisions, insurance-industry watchers and financial advisers say, including the age of retirement and the state where people choose to live.
"People are turning themselves inside out to get health insurance," says Karen Politz, a research professor at Georgetown University's Health Policy Institute in Washington.
Under federal law, insurers are required to charge all participants the same for premiums in employer-sponsored group plans regardless of health status. In state-regulated individual markets, by contrast, people with health problems may end up paying high premiums, face exclusions for past or existing medical conditions or be denied coverage.
Financial advisers say health-coverage worries are rampant among clients. For those with medical conditions, conversations increasingly center on how to get or stay on a group policy or segue into the individual market in a way that prevents insurers from denying coverage or excluding pre-existing conditions.
In certain circumstances, two federal laws -- Cobra and Hipaa -- provide such protections, but the rules can be complicated. Insurers may not be limited in what they can charge participants, although some states may set limits. If you are young and healthy, you will likely find a less-expensive policy in the individual market.
"Access to coverage is a huge issue," says Leon Rousso, a certified financial planner in Ventura, Calif. "You may have the financial means to pay for premiums but not be able to get coverage, leaving you exposed to potentially catastrophic losses if you become ill."
Obtaining insurance through an employer is often the easiest way to get comprehensive coverage for those who don't qualify for Medicare or federal or state programs for the very poor.
Employers tend to subsidize premiums, making it more affordable for those in poor health who benefit from being part of a larger risk pool. The coverage tends to be more comprehensive and cost-effective in group policies.
*******************************************************************************************************
--------------------------------------------------------------------------------
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Tuesday, April 22, 2008
Massachusetts Health Care Containment
Dear Howard:
>
> Thank you for your advocacy – it made a difference!
>
> Last night, the Massachusetts Senate approved a health care cost containment bill with key provisions that may help to keep prescription drug costs down by limiting the marketing practices of the pharmaceutical industry.
>
> Did you know that the pharmaceutical industry spends over $7 billion annually marketing to physicians, and that 94% of physicians receive meals and other payments from pharmaceutical companies? The cost of that marketing is passed along to consumers and other purchasers in the price of prescription drugs.
>
> Today, pharmaceutical industry salespeople are the primary source of providers’ information about medications. The Senate bill includes a program in which medical professionals will provide physicians with unbiased data they need to make appropriate prescribing decisions, unlike pharmaceutical sales representatives who provide promotional information.
>
> There are several additional steps in the legislative process before this becomes law but now is the time to thank the Senate for their leadership.
>
> Thank you for your advocacy – it made a difference!
>
> Last night, the Massachusetts Senate approved a health care cost containment bill with key provisions that may help to keep prescription drug costs down by limiting the marketing practices of the pharmaceutical industry.
>
> Did you know that the pharmaceutical industry spends over $7 billion annually marketing to physicians, and that 94% of physicians receive meals and other payments from pharmaceutical companies? The cost of that marketing is passed along to consumers and other purchasers in the price of prescription drugs.
>
> Today, pharmaceutical industry salespeople are the primary source of providers’ information about medications. The Senate bill includes a program in which medical professionals will provide physicians with unbiased data they need to make appropriate prescribing decisions, unlike pharmaceutical sales representatives who provide promotional information.
>
> There are several additional steps in the legislative process before this becomes law but now is the time to thank the Senate for their leadership.
Sunday, April 20, 2008
CVS PHARMACY
has asked Massachusetts health officials for approval to open the first of 20 to 30 planned "MinuteClinics" in Boston-area stores that executives said will offer patients fast, inexpensive care in a region struggling with packed emergency rooms and closed doctors' practices.
RETAIL CLINICS Show how the lure of profits creates opportunities for competition and quality care at an affordable price.
In a world where consumers are able to control more of their own routine health care spending.
The presciption for the clinics success;
Strict protocols to ensure high-quality care
Low prices that are clearly posted
Convenience
RETAIL CLINICS Show how the lure of profits creates opportunities for competition and quality care at an affordable price.
In a world where consumers are able to control more of their own routine health care spending.
The presciption for the clinics success;
Strict protocols to ensure high-quality care
Low prices that are clearly posted
Convenience
Competition won't ail you
The convenient-care clinic model arose from the mitmatch between what consumers need and what the Health care System was offering them.
QuickMedx runs stripped-down medical clinics in Cub Foods stores in the Twin Cities. Patients pay a flat $35 fee, and the clinics try to get people in and out in 15 minutes.
The clinics can charge lower fees than other clinics because they use nurse practitioners who diagnose and prescribe medications for about a dozen common ailments. They refer more complicated problems elsewhere.
This year marks the first time since opening in May 2000 that the company is taking its kiosk outside of a grocery store. Whitman said a local corporation — yet to be announced — has invited QuickMedx to open a clinic on its campus
Sunday, April 13, 2008
Senior Long Term Care
Baby boomers beware: The safety net you might be relying on to take care of you when you're old and sick is full of holes, a new study warns.
Many are relying on Medicaid, the government's health-care program for the needy, to pick up the tab for their nursing home and other long-term care expenses one day.
But there's a catch: Medicaid won't cover long-term care until your own resources are exhausted, warns Jeffrey Brown, director of the Center on Business and Public Policy at the University of Illinois College of Business and a co-author of the study.
"Medicaid basically forces you to impoverish yourself before it will pay for long-term care," he said. "Then you come out of care, and you've got nothing left."
What's more, the study contends, the government is encouraging people to rely on Medicaid by loading the program with disincentives to buy private long-term care insurance – which would be a better option because it protects assets and provides broader coverage.
Brown said economists have been puzzled about why so many Americans spurn long-term care insurance when they typically insure themselves against other financially damaging events and they face about a 40 percent chance of needing care in a nursing home one day.
"And if they need it, it can be financially devastating for many families, because a nursing home can cost $60,000 or $70,000 a year," he said.
As it turns out, the study found, Medicaid is choking the demand for private insurance because people prefer bad benefits at no charge to good benefits they'd have to buy.
And even for those who want private insurance, Medicaid makes it "not a good deal" for many, Brown said.
Once the benefits Medicaid picks up for free are factored in, the net benefits of long-term care insurance are just 20 cents to 40 cents on every dollar spent on private coverage premiums, the study found.
Another disincentive: Medicaid is a secondary payer, meaning it pays only after a private policy has paid first. So even when people do invest in private coverage, they might still end up exhausting all their resources.
"It will just take them longer to do so," Brown said.
Why not just rely on Medicaid, then?
Because it's not free. Taxpayers are footing $135 billion worth of long-term care expenses a year through Medicaid, and the burden can only grow as more baby boomers age, the study points out.
If there's a good way out of this conundrum, Brown said he hasn't found one yet.
The country could eliminate Medicaid coverage and let taxpayers spend their money on their own long-term care coverage, but there will always be people who won't have coverage and won't be able to afford nursing home care, Brown said.
"Are we as a society prepared to tell these people, 'You didn't insure, you didn't save enough, you're on your own?' I don't think this country is prepared to do that," he said.
Should Medicare, the government's health program for the elderly, take over long-term care expenses?
Talk about really breaking the federal budget, Brown said.
"We've already got under-funded (Medicare) benefits," he added.
Should the government require people to purchase long-term care insurance?
How could that be enforced? Brown said.
"One of the difficult things about this study is we've identified a very difficult public policy problem for which there is not an obvious solution," he said.
The nation's long-term care insurance industry is a bit more optimistic that more Americans will buy policies.
Some 400,000 long-term care policies were purchased last year, says Jesse Slome, executive director of the American Association for Long Term Care Insurance.
"It's growing slowly and steadily," he contends.
Last year, long-term care insurers paid out $3.5 billion in claims, about $200 million more than 2006, Slome said. As more people have positive experiences with this kind of coverage, he predicts more will want to buy it.
But it's going to take time. Before the baby boomer generation, the elderly lived closer to their children and didn't need to rely so heavily on nursing home care. People didn't live quite so long, either, Slome said.
"Prior generations didn't have to think about long-term care," he added.
Slome thinks the real impediment to buying long-term care insurance is human nature: Many folks just aren't good planners, and they procrastinate.
"The fact of the matter is, first of all, people don't live their lives planning to go on welfare. They live their lives without planning, but nobody who's 65 looks and says, 'Gee, I've worked my whole life. I was independent. I saved. I had a retirement plan. I did everything I was supposed to, and in my last years, I want to go on welfare to see what it's really like,'" he said.
The long-term care industry's challenge is to convince more people to start thinking about the costs of nursing home care before they become so old, or their health deteriorates so much, that insurance is going to be prohibitively expensive, he said.
Nearly 45 percent of people applying for long-term care coverage in their 50s qualify for good health discounts, but only about 19 percent of those who wait to apply in their 70s qualify for these discounts, a 2006 report done by Slome's association found.
Another challenge may be today's economy.
Slome said a single person at age 55 can buy decent long-term care coverage for about $1,000 a year, and a married couple at that age can buy decent coverage for both people at about $1,300 a year.
But with the rising cost of health care, many people are finding it difficult enough to pay for insurance they need right now, let alone pay for coverage they may need in their golden years.
Slome's advice for getting the best deal: Work with a professional who can find you the best long-term care insurance coverage for your needs and lock in the rates. The price of coverage varies widely, and every company has its own premium rate sweet spot depending on the client's age, marital status and health status, he said.
"Medicare and Medicaid are already strapped, and it's only going to get worse," Slome warned. "The government can only tax so much."
Should you buy long-term coverage?
It depends on what you've got to lose, says Paul McNamara, a professor and Extension specialist at the University of Illinois Department of Agricultural and Consumer Economics.
His advice:
— Consider buying coverage if you can afford it and want to have assets to leave your heirs or a surviving spouse.
— Know the premiums are more reasonable before you become elderly and fall into poor health. But keep in mind when you buy coverage younger that you're going to have to keep up the premium payments for a long time.
— Don't neglect the bigger picture: Consider long-term care insurance as part of your overall retirement planning. It wouldn't make sense to pay for a long-term care policy if you can't afford to fund your retirement savings.
— When it's not a good deal: If your income is anywhere near Medicaid eligibility level, you don't have a lot of assets now and likely won't have enough assets at retirement to protect.
Find this article at: http://www.news-gazette.com/news/2008/04/13/seniors_warned_about_longterm_care
Comments
Many are relying on Medicaid, the government's health-care program for the needy, to pick up the tab for their nursing home and other long-term care expenses one day.
But there's a catch: Medicaid won't cover long-term care until your own resources are exhausted, warns Jeffrey Brown, director of the Center on Business and Public Policy at the University of Illinois College of Business and a co-author of the study.
"Medicaid basically forces you to impoverish yourself before it will pay for long-term care," he said. "Then you come out of care, and you've got nothing left."
What's more, the study contends, the government is encouraging people to rely on Medicaid by loading the program with disincentives to buy private long-term care insurance – which would be a better option because it protects assets and provides broader coverage.
Brown said economists have been puzzled about why so many Americans spurn long-term care insurance when they typically insure themselves against other financially damaging events and they face about a 40 percent chance of needing care in a nursing home one day.
"And if they need it, it can be financially devastating for many families, because a nursing home can cost $60,000 or $70,000 a year," he said.
As it turns out, the study found, Medicaid is choking the demand for private insurance because people prefer bad benefits at no charge to good benefits they'd have to buy.
And even for those who want private insurance, Medicaid makes it "not a good deal" for many, Brown said.
Once the benefits Medicaid picks up for free are factored in, the net benefits of long-term care insurance are just 20 cents to 40 cents on every dollar spent on private coverage premiums, the study found.
Another disincentive: Medicaid is a secondary payer, meaning it pays only after a private policy has paid first. So even when people do invest in private coverage, they might still end up exhausting all their resources.
"It will just take them longer to do so," Brown said.
Why not just rely on Medicaid, then?
Because it's not free. Taxpayers are footing $135 billion worth of long-term care expenses a year through Medicaid, and the burden can only grow as more baby boomers age, the study points out.
If there's a good way out of this conundrum, Brown said he hasn't found one yet.
The country could eliminate Medicaid coverage and let taxpayers spend their money on their own long-term care coverage, but there will always be people who won't have coverage and won't be able to afford nursing home care, Brown said.
"Are we as a society prepared to tell these people, 'You didn't insure, you didn't save enough, you're on your own?' I don't think this country is prepared to do that," he said.
Should Medicare, the government's health program for the elderly, take over long-term care expenses?
Talk about really breaking the federal budget, Brown said.
"We've already got under-funded (Medicare) benefits," he added.
Should the government require people to purchase long-term care insurance?
How could that be enforced? Brown said.
"One of the difficult things about this study is we've identified a very difficult public policy problem for which there is not an obvious solution," he said.
The nation's long-term care insurance industry is a bit more optimistic that more Americans will buy policies.
Some 400,000 long-term care policies were purchased last year, says Jesse Slome, executive director of the American Association for Long Term Care Insurance.
"It's growing slowly and steadily," he contends.
Last year, long-term care insurers paid out $3.5 billion in claims, about $200 million more than 2006, Slome said. As more people have positive experiences with this kind of coverage, he predicts more will want to buy it.
But it's going to take time. Before the baby boomer generation, the elderly lived closer to their children and didn't need to rely so heavily on nursing home care. People didn't live quite so long, either, Slome said.
"Prior generations didn't have to think about long-term care," he added.
Slome thinks the real impediment to buying long-term care insurance is human nature: Many folks just aren't good planners, and they procrastinate.
"The fact of the matter is, first of all, people don't live their lives planning to go on welfare. They live their lives without planning, but nobody who's 65 looks and says, 'Gee, I've worked my whole life. I was independent. I saved. I had a retirement plan. I did everything I was supposed to, and in my last years, I want to go on welfare to see what it's really like,'" he said.
The long-term care industry's challenge is to convince more people to start thinking about the costs of nursing home care before they become so old, or their health deteriorates so much, that insurance is going to be prohibitively expensive, he said.
Nearly 45 percent of people applying for long-term care coverage in their 50s qualify for good health discounts, but only about 19 percent of those who wait to apply in their 70s qualify for these discounts, a 2006 report done by Slome's association found.
Another challenge may be today's economy.
Slome said a single person at age 55 can buy decent long-term care coverage for about $1,000 a year, and a married couple at that age can buy decent coverage for both people at about $1,300 a year.
But with the rising cost of health care, many people are finding it difficult enough to pay for insurance they need right now, let alone pay for coverage they may need in their golden years.
Slome's advice for getting the best deal: Work with a professional who can find you the best long-term care insurance coverage for your needs and lock in the rates. The price of coverage varies widely, and every company has its own premium rate sweet spot depending on the client's age, marital status and health status, he said.
"Medicare and Medicaid are already strapped, and it's only going to get worse," Slome warned. "The government can only tax so much."
Should you buy long-term coverage?
It depends on what you've got to lose, says Paul McNamara, a professor and Extension specialist at the University of Illinois Department of Agricultural and Consumer Economics.
His advice:
— Consider buying coverage if you can afford it and want to have assets to leave your heirs or a surviving spouse.
— Know the premiums are more reasonable before you become elderly and fall into poor health. But keep in mind when you buy coverage younger that you're going to have to keep up the premium payments for a long time.
— Don't neglect the bigger picture: Consider long-term care insurance as part of your overall retirement planning. It wouldn't make sense to pay for a long-term care policy if you can't afford to fund your retirement savings.
— When it's not a good deal: If your income is anywhere near Medicaid eligibility level, you don't have a lot of assets now and likely won't have enough assets at retirement to protect.
Find this article at: http://www.news-gazette.com/news/2008/04/13/seniors_warned_about_longterm_care
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Saturday, April 12, 2008
Fix Health Care Problems
Brody prescribes fix for health care problems
By: Marie Cushing
Posted: 4/10/08When it comes to fixing the American health care system, politicians are failing. That was the message University President William Brody delivered during a lecture Monday on the major issues facing the health care system in America. The soon-to-retire president says the major problems with the health care system are not being discussed - and that college students will be the ones to suffer. "This is your future we're describing. I turn 65 next year. I'll go on Medicare, and you'll have to pay for it. And guess what? I can spend as much as I want and you will foot the bill," he said. With the cost of the health care system near two trillion dollars, polls show that health care is among the leading domestic issues for Americans today. But for Brody, politicians have not been taking a strong stand on the issues. He cited the lack of involvement by high-profile presidential candidates in the Hopkins-sponsored series of health care forums as an example. "Other than Mitt Romney, we struck out. They didn't want to talk about the issue ... people running for office are scared to have to commit themselves to a policy," Brody said. Assistant to the President Michael Field, who has helped organize the forums and helped Brody draft his remarks, said coordinators have not given up on attracting the top candidates. "We have been trying and we're continuing to try. It has something to do with this being such a topsy-turvy campaign cycle. Nothing went according to people's plans. And I think it has something to do with the fact that some politicians prefer not to talk," Field said. Although New York Senator and Democratic presidential hopeful Hillary Clinton agreed to film a forum earlier in the year, a date has not been set. Field attributed the delay to the hectic campaign schedule. "Sens. Obama and Clinton, who do want to talk, are so frenetically tied up that it's difficult to get on their schedules. We'll see if this changes after the party conventions," he said. No agreement has been made with Arizona Sen. John McCain, the likely Republican presidential nominee. "John McCain is essentially coasting. Since he has no battles he would seem to have the time, but he's not going out of his way to talk about it," Field said. Brody's retirement has not yet affected the forums, but Field expects it will at some point. A forum will soon be filmed with Senator Ted Kennedy in his U.S. Senate office. Former Speaker of the House Newt Gingrich has already taped a forum, and current Speaker Nancy Pelosi has agreed to film a counterpoint piece. In two weeks a forum will be taped with former congressman Billy Pauzin, president of pharmaceutical manufacturer PhRMA. Field also hoped to schedule a forum with George Halvorson, the head of Kaiser Permanente, who has agreed to participate in the series. Until then, health care issues will continue to fill the airwaves."You really can't pick up the paper or turn on the television without hearing about cost and coverage," Brody said. But it was three other "C's" - consistency, complexity and chronic illness - that he said are being neglected by politicians and the national media. According to Brody, the "dirty secret" of American health care is that accurate and complete care is given only 55 percent of the time, according to studies. "We're not talking about the kind of weird disease you have to come to Hopkins for," he said. Brody cited a study by the RAND Corporation, which found that doctors prescribe aspirin, beta-blockers or cholesterol-lowering medication for only half of heart attack outpatients. But other initiatives, such as teaching interns how to properly insert blood lines, have helped. Hopkins reduced the number of blood line infections from two times above the national average to eight months without a single infection in some ICUs. "That saves us between 11,000 and 22,000 dollars, as well as morbidity and mortality for the patient," Brody said. The United States is the leader in health care costs, and, according to Brody, the American medical system leads the world in another area: complexity. "If you ever tried to look at your hospital bill, you need to hire an accountant," Brody said. Throughout the years, Hopkins Hospital has seen the number of insurance plans rise to 770, each with their own rules and regulations. Dealing with the complex billing and collections system takes its toll - the Hospital spends 20 percent of costs on administration. While Brody saw a simple solution to this issue through the adoption of billing standards, such a proposal would take a political force that does not yet exist."Nobody is driven to enforce this because of the fear that it would be socialized medicine. Everybody's well-intentioned but it just gets worst and worse," he said. But with the government the major payer in health care, "whether you believe in socialized medicine or you hate it, it's here," Brody said. The final "C" in Brody's analysis of the health care system was chronic illness. "If you want to deal with health care costs you have to deal with the chronic patients because that's where the money is," Brody said. While in 2005 almost half of all Americans lived with a chronic illness, these diseases account for more than 75 percent of all medical care costs, according to the Centers for Disease Control. Brody cited a study by the National Institutes of Health, which found that older generic drugs were just as effective as the more expensive patented drugs. "If Medicare would implement the simple policy of generic substitution except when there are clinical disparities, we would have conservatively saved 5 billion dollars a year," he said. What seemed like a simple solution was complicated by politics. Pharmaceutical companies have restricted Medicare from negotiating medicine prices. Brody acknowledged two high-profile medical professionals in the audience: Nobel Laureate Peter Agre and Board of Trustees Vice Chair Mark Rubenstein. "I probably have to rewrite my speech because they'll be fact-checking it," he quipped.
© Copyright 2008 News-Letter
By: Marie Cushing
Posted: 4/10/08When it comes to fixing the American health care system, politicians are failing. That was the message University President William Brody delivered during a lecture Monday on the major issues facing the health care system in America. The soon-to-retire president says the major problems with the health care system are not being discussed - and that college students will be the ones to suffer. "This is your future we're describing. I turn 65 next year. I'll go on Medicare, and you'll have to pay for it. And guess what? I can spend as much as I want and you will foot the bill," he said. With the cost of the health care system near two trillion dollars, polls show that health care is among the leading domestic issues for Americans today. But for Brody, politicians have not been taking a strong stand on the issues. He cited the lack of involvement by high-profile presidential candidates in the Hopkins-sponsored series of health care forums as an example. "Other than Mitt Romney, we struck out. They didn't want to talk about the issue ... people running for office are scared to have to commit themselves to a policy," Brody said. Assistant to the President Michael Field, who has helped organize the forums and helped Brody draft his remarks, said coordinators have not given up on attracting the top candidates. "We have been trying and we're continuing to try. It has something to do with this being such a topsy-turvy campaign cycle. Nothing went according to people's plans. And I think it has something to do with the fact that some politicians prefer not to talk," Field said. Although New York Senator and Democratic presidential hopeful Hillary Clinton agreed to film a forum earlier in the year, a date has not been set. Field attributed the delay to the hectic campaign schedule. "Sens. Obama and Clinton, who do want to talk, are so frenetically tied up that it's difficult to get on their schedules. We'll see if this changes after the party conventions," he said. No agreement has been made with Arizona Sen. John McCain, the likely Republican presidential nominee. "John McCain is essentially coasting. Since he has no battles he would seem to have the time, but he's not going out of his way to talk about it," Field said. Brody's retirement has not yet affected the forums, but Field expects it will at some point. A forum will soon be filmed with Senator Ted Kennedy in his U.S. Senate office. Former Speaker of the House Newt Gingrich has already taped a forum, and current Speaker Nancy Pelosi has agreed to film a counterpoint piece. In two weeks a forum will be taped with former congressman Billy Pauzin, president of pharmaceutical manufacturer PhRMA. Field also hoped to schedule a forum with George Halvorson, the head of Kaiser Permanente, who has agreed to participate in the series. Until then, health care issues will continue to fill the airwaves."You really can't pick up the paper or turn on the television without hearing about cost and coverage," Brody said. But it was three other "C's" - consistency, complexity and chronic illness - that he said are being neglected by politicians and the national media. According to Brody, the "dirty secret" of American health care is that accurate and complete care is given only 55 percent of the time, according to studies. "We're not talking about the kind of weird disease you have to come to Hopkins for," he said. Brody cited a study by the RAND Corporation, which found that doctors prescribe aspirin, beta-blockers or cholesterol-lowering medication for only half of heart attack outpatients. But other initiatives, such as teaching interns how to properly insert blood lines, have helped. Hopkins reduced the number of blood line infections from two times above the national average to eight months without a single infection in some ICUs. "That saves us between 11,000 and 22,000 dollars, as well as morbidity and mortality for the patient," Brody said. The United States is the leader in health care costs, and, according to Brody, the American medical system leads the world in another area: complexity. "If you ever tried to look at your hospital bill, you need to hire an accountant," Brody said. Throughout the years, Hopkins Hospital has seen the number of insurance plans rise to 770, each with their own rules and regulations. Dealing with the complex billing and collections system takes its toll - the Hospital spends 20 percent of costs on administration. While Brody saw a simple solution to this issue through the adoption of billing standards, such a proposal would take a political force that does not yet exist."Nobody is driven to enforce this because of the fear that it would be socialized medicine. Everybody's well-intentioned but it just gets worst and worse," he said. But with the government the major payer in health care, "whether you believe in socialized medicine or you hate it, it's here," Brody said. The final "C" in Brody's analysis of the health care system was chronic illness. "If you want to deal with health care costs you have to deal with the chronic patients because that's where the money is," Brody said. While in 2005 almost half of all Americans lived with a chronic illness, these diseases account for more than 75 percent of all medical care costs, according to the Centers for Disease Control. Brody cited a study by the National Institutes of Health, which found that older generic drugs were just as effective as the more expensive patented drugs. "If Medicare would implement the simple policy of generic substitution except when there are clinical disparities, we would have conservatively saved 5 billion dollars a year," he said. What seemed like a simple solution was complicated by politics. Pharmaceutical companies have restricted Medicare from negotiating medicine prices. Brody acknowledged two high-profile medical professionals in the audience: Nobel Laureate Peter Agre and Board of Trustees Vice Chair Mark Rubenstein. "I probably have to rewrite my speech because they'll be fact-checking it," he quipped.
© Copyright 2008 News-Letter
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