Republican Debate Ignores Health Care Elephant

The Republican presidential candidate debate was a union of traditional and new media as CNN and YouTube joined forces. This should have been a major step forward in the political process, allowing the public to directly engage potential U.S. presidential candidates. It was certainly colorful and interesting, but troubling as well.

You see, despite repeated studies (like this one from the Washington Post) that place health care as one of the three topics of most concern to American voters, there was absolutely no mention of it in the debate. This lack of attention to an issue of such wide reaching importance already has people typing away on the subject, blogging about the omission.

Roger Simon at Politico.Com minces no words:

One of those woes, by the way, is not a lack of affordable, dependable, effective health insurance that you can retain for life.

Americans must already have that. Because not a single question was asked about it in the entire two hour-plus debate.

The disbelief is spreading across the web as the pundits and bloggers ponder this puzzling omission. The Daily KOS enters the fray with a brief post from nyceve:

I waited.

And waited.

And kept waiting.

But a single question about the plight of 47 million uninsured Americans, or the rest of us who have to wage an unending true holy war against the for-profit insurance industry, just didn't make the CNN cut.

Joe Brewer, a fellow of the Rockridge Institute, has a written a response to this oversight that is being syndicated in a variety of places across the web. Here is a sampling:

It certainly begs the question of why CNN chose to overlook all 40 YouTube questions about health care. Is it perhaps because they know that the Republican candidates don't have much to say about health care? After all, every general Democratic debate has included discussions of candidate plans.

Even CNN was on the ball when the same moderator for both debates, Anderson Cooper, introduced health care at the earlier Democratic YouTube debate with "One of the most popular topics that we got questions on was health care. We, frankly, were overwhelmed with videos on health care, so we put several of them together."

Why did he let the Republicans off the hook?

Think about it. We are in the midst of a health care crisis and a major media source leaves us in the dark about the views of presidential hopefuls who, presumably, will represent all Americans in the White House if they are elected.

I am sure that monitoring the mainstream media, the pundits and the bloggers in the near future will yield a wide variety of comments and conjectures on this subject. The one thing that everyone can agree on, however, is that health care was not a topic in the debates.

SOURCE: "GOP debate Misses The Mark"11/29/07
SOURCE: "I Guess CNN Must Think Healthcare is a "Gotcha" Question" 11/28/07
SOURCE: "Joe Brewer: Where's the Healthy Debate, CNN?" 11/29/07
photo courtesy of irrational_cat, used under this Creative Commons license

List of Nasty Nursing Homes Made Public

Kevin Freking of the Associated Press brings us the story of fifty four nursing homes around the United States that have been placed on a public list of the worst in their states.

Lawmakers and advocacy groups have been pushing the Bush administration to make it easier for consumers to identify poorly performing nursing homes. They complain that too many facilities get cited for serious deficiencies but don't make adequate improvement, or do so only temporarily.

Today being Thursday I believe a link is in order, so here is the aforementioned list. Now that we have that handy, let us return to Mr. Freking:

The homes in question are among more than 120 designated as a "special focus facility." CMS [Centers for Medicare and Medicaid Services] began using the designation about a decade ago to identify homes that merit more oversight. For these homes, states conduct inspections at six month intervals rather than annually.

The homes on the list got not only the special focus designation, but also registered a lack of improvement in a subsequent survey.

The nursing homes to be cited come from 33 states and the District of Columbia, according to a list obtained by The Associated Press. There are about 16,400 nursing homes nationwide.

Later on in the article he clarifies what the Special Focus designation means, as well as sharing the perspective of a U.S. Senator from Iowa:

Every nursing home receiving federal payments undergoes inspections about once a year. In such inspections, surveyors assess whether the facility meets standards focused on safety and quality of care. Among the things inspectors look for are giving residents the proper medicine, assisting them with daily living activities such as bathing, and assisting them with their medical needs and diet, as well as the prevention of accidents and infections.

Typically, homes that get the special focus designation do show improvement. Federal data indicate that about half the special focus homes improve their quality of care significantly within 24-30 months. However, about 16 percent are terminated from Medicare and Medicaid.

Sen. Charles Grassley, R-Iowa, said he's concerned about those homes in between — the ones that don't make much improvement but still continue operating.

"The federal agency responsible for nursing homes is doing the right thing by letting the public know which homes yo-yo in and out of compliance with the minimum requirements of care," Grassley said. "It gives these nursing homes the incentive to get off of that list, and it lets consumers know what they're getting into."

This is concrete progress towards a more standardized and publicly accessible measurement of how health care for the elderly is performing. The AARP thinks so, too. They have issued a statement applauding release of the list.

Last month, the AARP's Public Policy Institute issued a new research report on Nursing Homes written by Ari Houser that is chock-full of info for seniors. In Health Care Reform Now! Mr. Halvorson offers the following as a major component of an "Optimal Health Care Market":

Consumers should have complete and easy electronic access to the information they need to make informed decisions about their care and caregivers.

This is a positive step in that direction, although not a perfect one. There are some concerns over unevenness in the rating process. Mr. Freking's AP article includes a few statements on the subject of fairness:

One of the homes on the government's list was Franklin Hills Health & Rehab Center in Spokane, Wash. Brian Teed, the facility's administrator, said he did not have a problem with Medicare publicizing the list. But he said regional differences play a huge role in how nursing homes are graded. He said he recently helped run a facility in Portland, Ore., and nursing homes were graded much easier there. He took over the Spokane facility in September, and found it to be well run.

"In the Portland, Ore., area, this facility would be deficiency free or close to it. Instead we got 15 tags. We got tagged because there was bird poop on the bench outside," Teed said.

"I would put my mother in here," he added.

Publicizing lists of underperforming nursing homes is another step toward greater transparency in health care. One day, if we're lucky, we'll be reaching nursing home age ourselves and glad for the efforts made today to review and rate these facilities.

SOURCE: "Government Outs Chronically Underperforming Nursing Homes" 11/29/07
SOURCE: "Certification and Compliance- Nursing Homes"
photo courtesy of borya and used under this Creative Commons license

Mandates II: Clinton vs. Obama

Aggressive, increasingly so. That is how staff reporter John McCormick of the Chicago Tribune describes U.S. Sen. Hillary Clinton this morning. In an interview her campaign offered the Tribune she takes off her verbal kid gloves for a direct attack on competing U.S. presidential candidate Sen. Barak Obama. The main topic of this attack? Mandated health care, an issue we also covered in yesterday's post.

Mr. McCormick provides commentary on the clash:

The two Democratic candidates have been sparring in recent days over health care, with Clinton charging that Obama's health plan would not offer true universal coverage because he would not require all Americans to buy into a plan as she would. Obama has countered that his proposal offers guaranteed access at lower costs.

"One of the things Sen. Obama takes credit for as a state senator is a health-care task force that looked into the question of how do you provide universal health care in Illinois," Clinton said. "[That report] was clear: If you want universal health care you have to have a mandate."

Although the task force did recommend a mandate, it also suggested exemptions to penalties for Illinois residents who couldn't buy insurance or get it from an employer. When Gov. Rod Blagojevich unveiled his health-reform proposal earlier this year, he ultimately stopped short of such a requirement.

He goes on to chronicle many of the back and forth accusations and the constant re-framing of this discussion that has occurred between the two candidates. Obama's campaign points out that Sen. Clinton was against mandates in the '90s when last she made headlines with health care reform. Clinton's campaign denies it. The really interesting new statement arising from the Tribune interview is this one:

Clinton said she is puzzled by Obama's approach.

"Sen. Obama [is] now criticizing a mandate, when he has one in his own plan, when he helped to set up a task force that says there has to be a mandate," she said. "And there are lots of ways to do it, through default enrollment, through going to schools, workplaces to enroll people."

The question of who will win this battle of words and policies will be resolved soon, and then it will be time for the presidential race itself. I wonder what sort of things will enter the health care debate over the course of Election Year? I am sure that more comments like this one (also from the Tribune interview) should be expected:

"I have for months tried to stay positively on the issues, to talk about what I will do as president, to set forth my credentials and experience, the strengths that I think I bring to the position," she said.

"But I have been attacked pretty regularly by my two leading opponents, and it's gone on for months. So, at some point, as we get toward the end of these campaigns, you have to stand up and rebut what people are saying and put out the contrasts, and that is what I intend to do."

SOURCE: "Clinton Hits Obama on Health Care" 11/28/07
photo courtesy of borman818 remixed and used under this Creative Commons license

Obama, Clinton Square Off on Mandates

Political columnists everywhere have been having a field day as U.S. Presidential hopefuls Sen. Hillary Rodham Clinton of New York and Sen. Barack Obama of Illinois spar on the issue of health care reform. Both of the candidates have pledged to achieve universal health coverage, Clinton stressing a mandate (requiring the purchase of health insurance much as we do with automobile coverage) and Obama pressing affordability as the main issue.

Mike Dorning at the Baltimore Sun shares Sen. Obama's comments at a Littleton, NH event:

"Sen. Clinton still hasn't explained what this mandate is: What's she going to do if somebody doesn't purchase health care? Is she going to fine them? Is she going to garnish their wages?" Obama said.

"One of the problems with her approach is that she hasn't been straight with the American people about how she's going to impose this mandate. And without an enforcement mechanism, there is no mandate. It's just a political talking point," he continued...

Shortly after Obama spoke, his campaign sent out a memo noting that in Massachusetts, the only state so far to require residents to buy health insurance, hundreds of thousands of people have not purchased insurance despite a fine levied on those who fail to do so through their tax returns.

As the only Democratic candidate who does not support a mandate Obama has good reason to keep a close eye on the Massachusetts plan (originally set in place by Republican Presidential hopeful Mitt Romney, who does not now support a national insurance mandate). According to this morning's New York Times article by Kevin Sack, implementing mandated coverage may not be quite as easy as it seems.

More than 200,000 previously uninsured residents have enrolled, but state officials estimate that at least that number, and perhaps twice as many, have not.

Those managing the enrollment effort say it has exceeded expectations. In particular, state-subsidized insurance packages offered to low-income residents have been so popular that the program’s spending may exceed its budget by nearly $150 million.

But the reluctance of so many to enroll, along with the possible exemption of 60,000 residents who cannot afford premiums, has raised questions about whether even a mandate can guarantee truly universal coverage.

Additional concerns have been generated by projections that the state’s insurers plan to raise rates 10 percent to 12 percent next year, twice this year’s national average. That would undercut the plan’s secondary goal of slowing the increase in health costs.

He goes on to share each of the Democratic frontrunners' views on the subject of mandated health care:

“The sad reality is that the uninsured don’t just struggle with costs themselves, they impose costs on the rest of us,” Mrs. Clinton said in September. “It’s a hidden tax: the high cost of emergency room visits that could have been prevented by a much less expensive doctor’s appointment, the cost of unpaid medical bills that lead insurance companies to raise rates on the rest of us.”

Mr. Edwards echoed those remarks a week later. “The reason the mandate is necessary is because you cannot have universal health care without it,” he said. “Does not exist, and anyone who pretends it is, is not being straight.”

Senator Barack Obama of Illinois sees it a different way. He argues there is danger in mandating coverage before it is clear it can be affordable for those at the margins. While Mr. Obama does not rule out a mandate down the road, his emphasis is on reducing costs and providing generous government subsidies to those who need them. He would mandate coverage for children.

Mr. Sack's article then looks at the penalty system set in place by the Massachusetts plan for those who refuse to get coverage. This year, state residents who do not purchase insurance will lose their tax exemption (approximately $200), next year that penalty will rise to half the cost of the least expensive insurance policy available (with a probable minimum of $1,000). In his interviews he finds that many were not purchasing insurance because they either did not feel the need for it or because the penalty was not yet high enough to force them to do so.

“At 27, it’s not like I’m thinking, ‘Oh, man, what if I need an operation down the line?’ ” said Samuel B. Hagan of Lenox, a courier who remains uninsured. “Furthest thing from my head.”

John E. McDonough, executive director of Health Care for All, an advocacy group based here, said he found it breathtaking that political leaders were calling for an individual mandate well before there was any way to measure the success of the Massachusetts experiment.

"As goes Massachusetts, so goes the Nation?" The pitfalls and successes of that state's health plan will figure largely in future dialog on the subject.


SOURCE: "Obama challenges Clinton on health care" updated
SOURCE: "Massachusetts Faces a Test on Health Care" 11/25/07
photo courtesy of patriarcha12, remixed and used under this Creative Commons license

Health Care Reform: Availability vs. Affordability

Now that the Thanksgiving break is over and turkey sandwiches are the rule of the day, it's time to resume our health care blogging. We hope that all our readers had a healthy and happy holiday!

As the U.S. presidential election brouhaha escalates and the candidates get more vicious in their rhetoric, the subject of health care, like so many others in modern America, comes down to money. Over the holiday this has become a recurring theme as more and more analysts, bloggers, and reporters take a look at the out of pocket expense of health care in our nation.

Lets start with the fellow health care blogger Alan Katz, whose Health Care Reform Blog offers a post on this subject from an underwriters perspective:

At the end of the day, access is about affordability. If families can't afford coverage it doesn't matter what's available to them. If the state can't afford its health care programs, all the public proclamations mean nothing. It's about cost.

Most significant for those who would reinvent the health care system is the reality that the rate of health care cost increases has outpaced the growth rate of the economy as a whole since at least the 1970s. Without exception (not necessarily every year, but every decade). The cumulative effect is substantial: from 1970 through 2005, the nation's Gross Domestic Product grew by 7.4 percent; nominal national health expenditures grew by 9.8 percent. Perhaps 2.4 percent doesn't look like much, but over 30 years it means health care costs doubled compared to the economy's growth. That this trend is unsustainable is indisputable. That there's no clarion call for change is disappointing.

Brad Warthen, editorial page editor of South Carolina's The State gives us a personal perspective on the cost vs. income question:

I make more money than most people do here in the wealthiest country in the history of the world, and I live paycheck to paycheck, in large part because of the cost of being an extremely allergic asthmatic, and needing to do what it takes to keep enough oxygen pumping to my brain to enable me to work so I can keep paying my premiums and co pays. My premiums in the coming year - we're going to a new plan - will be $274.42 on every biweekly check, not counting dental or vision care. And I'm lucky to have it. I know that, compared to most, I've got a sweet deal!

I'm in the top income quintile in the U.S. population, and we can't afford cable TV, we've never taken a European vacation or done anything crazy like that, we haven't bought a new car since 1986, and aside from the 401(k) I can't touch until I retire (if I can ever afford to retire), we have no savings.

Yet I will pay my $274.42 gladly, and I will thank the one true God in whom I actually do believe that I have that insurance, and that I am in an upper-income bracket so that I can just barely pay those premiums, and that neither my wife (a cancer survivor) nor I nor either of the two children (out of five) the gods still let me cover is nearly as unhealthy as the people I see whenever I visit a hospital.

While the majority of the debate seems to focus on the uninsured youth of America or the plight of our elderly, more and more editorials and blogs are recounting the plight of the "average Joe." One recent comment left on this blog stated that the person leaving it was in immanent danger of losing her home due to health care costs. This is not an issue that is isolated to any particular demographic.

Another interesting take on the situation is this morning's post on the Huffington Post by GOOD magazine's Daniel Brook. It addresses the health care plight of that quintessentially American entrepreneur: the freelancer.

The people I know who are worried sick about coverage work for themselves, many in creative fields. Most of these freelancers and entrepreneurs are in the cross hairs of our health-care crisis--and you wouldn't know it from watching the presidential campaign...

The problem with our health-care debate isn't just that it glosses over a huge portion of people who are affected by the crisis, but that by not taking them into account, we may end up achieving universal coverage without unleashing the talented and entrepreneurial. Just requiring everyone to have health insurance won't solve the problem. That's what Massachusetts recently did statewide and what some candidates are suggesting on a national level. But under such a system, unless you're very poor, you still pay more if you have a family; you still have to pay a flat fee unrelated to your business income; and you still have the catch-22 of paying more when you get sick and are earning less. Without a solution funded through progressive taxation, simply requiring everyone to get insurance will still hold back our millions of would-be entrepreneurs. Health-insurance payments will continue to act as an "ambition tax."

The issue of health care reform is a large and complex one. It involves many aspects from the economic and the political to the practical and the ethical. For the average American, as these stories point out, health care reform is not just a matter of availability -- it is about affordability as well.


SOURCE: "Some Affordability Data" 11/24/07
SOURCE: "'Health care reform?' Hush! You'll anger the Insurance Gods!" 11/25/07
SOURCE: "Freelancers Need Universal Health Care, Too" 11/26/07
photo courtesy of yomanimus, used under this Creative Commons license

Azyxxi: Microsoft's Magic Word for Health Care

Azyxxi, it sounds like a fictional word, a magic word from a fairy tale, or the name of a wizardly librarian in some fantastic novel. While it is none of these the latter description is closest to the truth. Azyxxi is a librarian of sorts and it is also said to perform almost magical feats.

So what exactly is Azyxxi? It is Microsoft's new unified health enterprise system. It is an aggregator of financial, clinical, administrative and patient records and is rapidly becoming Microsoft's most well known foray into the field of electronic medical records (EMRs). If the facts match the PR it will put an amazing array of data at the fingertips of health care professionals, allowing them to access that data through computers, laptops, PDAs, tablets and other devices.

Sharon Linsenbach at E-Week takes a glance at things as Microsoft prepares its largest rollout of Azyxxi yet coming in early 2008:

St. Joseph Health System, a network of hospitals in the Southwest with nearly 20,000 employees, is moving over to Microsoft's Azyxxi unified health enterprise platform...

"With Azyxxi, all our physicians -- those in the hospitals, community-based and in group practices -- will have virtually instant access to a patient's health information, thereby increasing connectivity between providers and improving care for patients," Dr. Clyde Wesp, chief medical information officer for St. Joseph Health System, said in a statement.

By then end of 2009 the entire hospital network is slated to be finished. A multitude of physician's groups, fourteen acute care hospitals, and three home health agencies spread across California, Texas, and New Mexico will then be using the platform. They will be joining earlier adopters such as Johns Hopkins, New York-Presbyterian Hospital and Novant Health.

The news keeps getting brighter on the subject of EMRs. Stories like this one and the FCC's Telehealth initiative (see yesterday's post) keep cropping up. Each day, advances in information technology are implemented on a wider and wider scale. George Halvorson writes of a "perfect storm" in favor of health care reform; if current news items are any indication it would seem that storm is on the horizon.


SOURCE: "Hospital Network Adopts Microsoft Health Care Platform" 0/29/07
SOURCE: "Azyxxi- Official Site"
SOURCE: "Azyxxi- Wikipedia Entry"
photo courtesy of Chris Metcalf,, used under this Creative Commons license

FCC's New Telehealth Program Launches in North Carolina

With health care a subject on everyone's lips these days there are many organizations chiming in with their approaches to the subject. The Federal Communications Commission (FCC) joins those ranks as they launch their new "Telehealth" initiative, debuting today in western North Carolina.

Aliya Sternstein reports for the National Journal's Technology Daily supplement (accessed for this story via Government Executive):

The FCC's plan will fund dedicated broadband networks for telehealth activities, like videoconference consultations or second opinions from out-of-state specialists. Telemedicine is intended to cuts costs, travel time and medical errors, especially for people in remote or poverty-stricken regions of the country.

"With this pilot program, the commission will be taking a major step toward the goal of connecting healthcare facilities across the nation with one another through broadband telehealth networks for the benefit of patients," [FCC Chairman Kevin] Martin said.

The plan rests on leveraging existing telehealth networks to build new, more comprehensive systems. Rural providers, nonprofit facilities and county-run institutions that want to participate can obtain funding for up to 85 percent of design, construction and operational expenses.

For-profit entities also can join the new networks but will have to pay their fair share of the costs. The set-up allows larger urban trauma centers and teaching hospitals to serve as telemedicine hubs for smaller, rural hospitals and economically strained facilities.

According to Roy Mark over on E-Week the project is certainly not lacking in scope:

The Federal Communications Commission has allocated $417 million to help build 69 statewide or regional broadband telehealth networks across 42 states and three U.S. territories...

The funding will support the connection of more than 6,000 public and non-profit health care providers nationwide to broadband telehealth networks, which can be used to transmit health records and process transactions securely.

Telemedicine already has a proven track record with one of the groups administering the FCC funds for the West Virginia pilot program: the Eastern Band of Cherokee Indians. Jon Ostendorff of the Ashville Citizen Times reports:

Telemedicine is used in treating diabetes patients in Cherokee, said Dr. Ann Bullock, a physician with the tribal health care system. Doctors on the Cherokee Indian Reservation use the Internet to send images of retinal scans to a specialist in Asheville who then recommends treatment.

“So instead to of sending all those patients over to Asheville or taking his time to always have to come out here and do those screenings, we can do them in our diabetes clinic when our patients come, and he can take a look at those,” she said. “It saves a lot of resources and time.”

This is a major step toward more widespread use of EMRs (electronic medical records). According to E-Week's Roy Mark, those involved in this pilot program will need to "implement information technology standards as set forth by the U.S. Department of Health and Human Services wherever feasible." Are the days of data portability and transparency getting closer? It's too early to tell how far this will go, but access does seem to be improving!

SOURCE: "FCC announces creation of telehealth initiative"11/19/07
SOURCE: "FCC Launches Health Networks Initiative" 10/20/07
SOURCE: "Program brings top doctors to rural areas" 11/20/07
photo courtesy of J. Reed, used under this Creative Commons license

Get Well Cards from Highmark (not Hallmark)

The holiday season has arrived, as the ambient music in every public place will attest, but this year brings something new with it. This year you might just get a card in the mail that will pay your dental bill, or perhaps finance your insulin and your blood sugar meter. Bill Toland at the Pittsburgh Post-Gazette calls them the ultimate get well cards, and he may well be right.

Highmark Inc., the Pittsburgh-based health insurer, hopes its new Healthcare Gift Card will encourage people who might be reluctant to visit the doctor or spend their money on prescriptions -- namely, seniors and college students -- to do so.

The card itself costs $4.95, and can be loaded with as little as $25, which might cover a prescription co-pay, to as much as $5,000, which could pay for an elective surgery, such as Lasik.

Toland says that Highmark is hoping to go national with these and is also pursuing a patent on the "intellectual technology." It's an interesting extension of the gift card phenomenon, but how exactly does it work? Can it be easily "hacked," and used for non health care purposes?

Highmark partnered with Visa in developing the card, which can be used just like a Visa credit card or debit card, but only at merchants that Visa has categorized as health-related. That means, yes, the urologist, but also the dentist, the eye doctor, the gym, the ear doctor and the family physician, not to mention the pharmacy.

But couldn't you just take the gift card to Rite Aid and spend it on a case of Coca-Cola and a bag of Snickers bars? "We obviously don't advertise that," Mr. [Kim] Bellard [Highmark's vice president of e-marketing and consumer relations] said. But the answer is, yes -- for now. In the future though, the purchases could be restricted not just from merchant to merchant, but from product to product. You could use the card on medicine, but not candy bars, in other words.

Additionally, according to the gift card website, the cards are not accepted at ATM machines and cannot be used in exchange for cash. They are also subject to a monthly service fee (currently listed as $1.50/month) as long as they carry a balance, but that fee does not start until after the card has been activated for nine months

These cards are being aimed at the dual demographics of seniors and college-aged kids. In the case of seniors it is being pushed as a way to assist with mounting medical bills, in the case of students mistrust seems to be the watchword. Mr Toland reports that Highmark's Mr. Bellard has said of the average college student, "You give him $200 in cash, he's going to spend it on beer."

SOURCE: "Highmark Offers Ultimate Get Well Card" 11/02/07
SOURCE: "Give Well - The Healthcare Visa Gift Card"
image by George Williams for the Health Care Reform Now! Blog

Hillary Clinton vs. Barack Obama on Health Care

With less than a year to go before the United States decides who will be the country's new chief executive the debates are starting to get heated. Last night's debate among candidates for the Democratic Party's presidential nomination was a perfect case in point. Senator Hillary Rodham Clinton faced off against Senator Barack Obama. The subject of health care reform proved, to no one's surprise, to be the hot button issue.

Michael Cooper of the New York Times reports:

The crux of their dispute centers on their overall approaches to health care.

Mrs. Clinton's plan would require all Americans to get coverage and would provide subsidies to make it more affordable. Mr. Obama's plan would require only children to have coverage; his plan would require employers to provide coverage or contribute to a new public program that would make insurance more affordable to people not covered by their jobs or by the government.

“The only difference between Senator Clinton's health care plan and mine is that she thinks the problem for people without health care is that nobody has mandated - forced - them to get health care,” Mr. Obama said. “That's not what I'm seeing around Nevada. What I see are people who would love to have health care. They desperately want it. But the problem is they can't afford it.”

Aswini Anburajan adds the following on MSNBC's First Read:

Obama has pledged, repeatedly, on the stump to pass universal healthcare by the end of his first term in office. He promises to do so through a mixture of bravado, “If Harry and Louise get up on TV, I'll dip into my campaign fund and run my own ads saying Harry and Louise are wrong;” and by running an open process in which every party will have a seat at the table.

The main quantitative difference between the three main Democratic front runners, Clinton, Obama, and Edwards, is that only Senator Obama's plan does not mandate care (requiring coverage) for everyone. In the debate and on the stump he has questioned the ability of government to enforce such a mandate. Mr. Cooper's article quotes him as saying of Senator Clinton's approach, "She states that she wants to mandate health care coverage, but she's not garnishing people's wages to make sure that they have it.”

From here on out things should continue to heat up in the various debates. Check back with us often as we keep our fingers on the pulse of health care reform!


SOURCE: "It Was Clinton vs. Obama on Health Care" 11/16/07
SOURCE: "What's Obama's Health care Position?" 11/15/07
photo courtesy of swanksalot on Flickr, used under this Creative Commons license

Forbes, HFMA on Improving Patient Billing Practices

Anyone who has had medical care in the United States is already familiar with the large array of forms and bills that can be generated by even a short and simple procedure. This morning Richard Clark, president and CEO of the Healthcare Financial Management Association (HFMA) shares his experiences with medical bills and his thoughts on the subject in a column for Forbes. He begins by recounting the tale of helping his mother handle the mountain of medical paperwork left by his father's demise.

What a mess.

I developed a spreadsheet, downloaded benefit descriptions from my father's supplemental insurance company, visited Medicare's beneficiary's web site, and made a lot of phone calls. In the end, I helped my mother work though the bills (some of which were received for the first time some 12 months after my father's death). In short, I lived the nightmare of our current health care billing system.

It was this unpleasant experience that drove him to begin the project know as "Patient Friendly Billing," which provides tools and data to clinics and hospitals to streamline communication with patients. He reaches many of the same conclusions as our own Mr. Halvorson concerning both the need for unified standards and the impact of economic incentives on health care.

Almost everyone agrees the current method of paying for health care services is broken. It fosters fragmentation of care, rewards inefficiency, and doesn't distinguish between high-quality and low-quality providers. It's a mess. And there is strong evidence that the payment system drives decision making, including the level, frequency, and venue of care. The payment system creates most of this nightmare and must be fixed before any real progress can be made to improve health care in this country.

In Health Care Reform Now! Mr. Halvorson notes that there are over nine thousand billing codes for procedures and yet not a single one to denote an actual cure. He also observes that there are currently no uniform standards or measurements of performance within the industry.

Mr. Clark focuses on revamping the payment system itself as the answer to these woes. Since there seems to be an absence of guiding principles upon which to base this proposed retooling, he has been working through the HFMA to develop some. To do so they have solicited input from many involved sources including government, employers, care providers, insurance agencies, and community groups.

Some of the guiding principles discussed in his column include:

• Quality and safety.


• Simplicity and standardization.


• Fairness and efficiency.


• Community benefits and innovation.


• Transparency.

After noting "most if not all," of these principles are violated by the current system he goes on to briefly examine some possible solutions involving "out of the box" thinking.
All of these potential fixes are aimed at untangling the Gordian knot of our current billing system, with a stress laid on simplification and consolidation.

I believe it is not necessary to move away from our system of public and private insurance coverage, and public and private care providers to improve our health care system. If we design and implement payment methods that achieve a set of principles that are designed to provide high quality, safe, and efficient care, we will go a long way to improving what ills the system. It's time to wake up from the nightmare and fix the mess that is the health care billing and payment system in the U.S.

SOURCE: "The Health Care Billing Nightmare" 11/14/07
photo courtesy of unk's dumptruck, used under this Creative Commons license

Americans Study Netherlands Health Care Program

In the Netherlands universal healthcare is not only the standard but also involves a healthy amount of market competition. Kerry Weens, a senior U.S. Department of Health official, recently lead a delegation of Americans examining the Dutch health care system:

"We're intrigued by many of the ideas that we see, such as moving toward more market based solutions. In general I think there's a lot of consistency between the Dutch system and the US system."

John Tyler and Reinout Van Wagtendonk of Radio Netherlands report on the American delegation’s visit.

Mr. Weens was referring to a recent overhaul in the way Dutch people purchase health insurance which have made the Dutch system more competitive. Two years ago, a new law went into effect requiring every resident of the Netherlands to purchase their own health insurance, while the insurance companies were forced to embrace open market laws and offer competitive prices for their insurances. But unlike in the United States, for those who can't afford insurance, the Dutch state still chips in to cover part of the cost.

Insurance companies are required to provide coverage for anyone who applies for it, so no one can be refused due to pre-existing health problems. To help insurance companies cover some of the costs involved with selling coverage to all comers, the government has a formula in which it contributes to the cost incurred in certain cases.

So while competition has been introduced into the system, the Dutch system is not a completely market-based approach. The taxpayer still subsidizes a not insignificant percentage of care in the Netherlands. But competition helps keep overall costs down.

In Health Care Reform Now!, George Halvorson advocates finding a uniquely American path to universal coverage while learning what we can from other nations who already have their own systems of universal coverage. This sort of fact finding mission is exactly the type of research that needs to be done in order to synthesize our own uniquely American solution.

The Dutch approach also share’s Mr. Halvorson’s views on preventative care and transparency.

"We pay a lot more attention to prevention -- we have a coordinated, multidisciplinary approach. In Holland there's quite a lot of proactive action attached to that aspect of health care," said Nolene Berkhout, a nurse practitioner who served as one of the hosts of the American delegation.

A number of recent changes are meant to improve the quality of care here in the Netherlands. Doctors and hospitals are now required to publish information every year about their performance. That information is available to the public on a website, but it is still too soon to see how much effect it has on patients' choices.

SOURCE: "U.S. Officials Impressed by Dutch Healthcare System" 11/12/07
photo courtesy of Pear Biter, used under this Creative Commons license

Fear of Big Tobacco in California?

This morning Mike Zapler at the Sacramento Bureau of the Mercury News examines the the new tobacco tax proposed in California as a means of funding health care reform. Two dollars a pack could generate a lot of revenue for expanding coverage to the twenty percent of California residents who lack it, but will it be that easy?

Problem is, it might be the very thing that dooms health care reform.

A new cigarette tax would be tantamount to a declaration of war on Big Tobacco, which last year spent more than $65 million to defeat a $2.60-a-pack tax on the California ballot and just this week easily turned back an attempt in Oregon to raise tobacco taxes.

"You can bet they would aggressively fight it, and I don't think they'd be alone," said Sacramento political consultant Frank Schubert, who advised tobacco companies during last year's ballot campaign.

Any attempt to overhaul health care is bound to invite opposition, given the huge financial stakes in the system. The tobacco tax idea is an example of the difficult balance that Gov. Arnold Schwarzenegger and Democrats are struggling to strike at the negotiating table: achieving meaningful reform without triggering insurmountable opposition.

The challenge is amplified by the fact that any health care proposal is certain to end up on the ballot, where interest groups can spend tens or even hundreds of millions of dollars to defeat it.

He goes on to look at the pros and cons of several aspects of the legislation in its current form, paying particular attention to sections of the law that could be contentious. From Governor Arnold Schwarzenegger's lottery lease plan to the Democratic provision for purchasing drugs in bulk, he provides a concise summary of the options being put forth.

As for tobacco, backers of the proposed cigarette tax - which would be on top of the current 87-cent-a-pack tax - acknowledge the industry's political might. But they say the millions of dollars tobacco companies likely would spend against a health care initiative wouldn't necessarily ensure defeat, given the industry's low standing among the public.

"If you have all of the health care community backing reform, I think it can trump the money spent by tobacco," said Kris Deutschman, a political consultant who advised last year's failed campaign to raise the tobacco tax. "Because all they have is money and self-interest."

SOURCE: "Analysis: Tobacco Tax Could Doom Plan for Health Overhaul" 11/09/07
photo courtesy of curran.kelleher, used under this Creative Commons license

California Prepares to Drop Coverage for Kids

The effects of President Bush's recent SCHIP veto are becoming visible in California, where state officials met Monday to prepare for the loss in funding. Anthony Wright, Executive Director of Health Access California, analyzes the ripple effect in a column for the California Progress Report:

In the wake of President Bush's veto of SCHIP and the stalemate over the reauthorization of the federal children's coverage program, board members of California's Managed Risk Medical Insurance Board (MRMIB) on Monday took the first step that would enable the state to put children eligible for Healthy Families on a waitlist, or begin disenrolling eligible children from the program altogether.

Emergency Regulations adopted on Monday can be found here. Healthy Families enrolls approximately 830,000 children in families with incomes between 100% and 250% of the federal poverty level ($20,650 to $51,625 for a family of four).

According to Wright's article the MRMIB's Executive Director, Lesley Cummings, first brought this idea to the table after President Bush's initial veto of the SCHIP legislation. According to Cummings, if the program continued to operate normally Healthy Families would run dry of funding and have to shut down from July through September of 2008.

She and other board members emphasized, ad nauseum, that Monday's adoption of emergency regulations did not necessarily mean that waitlists would be established or children would lose coverage.

Advocates, including Wright's own organization, Health Access California, argued against enacting the emergency regulations at this time. Representatives of 100% Campaign, Community Health Councils, Inc. and other groups were also present to speak against the emergency regulations.

However, after minimal discussion, the chair moved and the board voted to approve the emergency regulations. They did adopt one additional provision to revise the proposed regulation to reinstate previously enrolled children first, before new applicants, when funding was ultimately reauthorized.

The net result is that the waitlisting and disenrollment procedures can start as early as December 5th, 2007 -- less than one month from today. Mr. Wright's column has further details on the board meeting and the mechanics of the waitlisting and disenrolling procedures.


SOURCE: "California Takes First Step Towards Disenrolling Children from Health Coverage Because of Bush Veto of SCHIP" 11/06/07
photo courtesy of Mosseby, used under this Creative Commons

Questionable Claims in the Health Care Debate

On Monday, October 29th, Presidential hopeful and former New York City Mayor Rudy Giuliani debuted a new campaign advertisement centering on health care. Using his own experience battling cancer as the basis of the ad, he drew an unfavorable comparison between American health care and its government run counterpart in the United Kingdom. It was this comparison and the questionable statistics it contained that began to draw fire, as John Whitesides, a political correspondent for Reuters reports:

Giuliani, who has suffered prostate cancer, has taken criticism from British and U.S. health officials for saying in a radio ad this week the U.S. survival rate for the disease was 82 percent while the survival rate under Britain's "socialized medicine" was 44 percent.

Health officials in both countries say the most recent statistics show five-year survival rates for prostate cancer are 99 percent in the United States and 74 percent under Britain's National Health Service.

Giuliani told reporters he was using statistics from 2000 and said "those statistics have changed slightly today" -- but he did not back away from the broader comparison.

This thirty percent variance has raised eyebrows both at home and abroad. The British reaction reported in this same Reuters article is hardly surprising in light of difference.

British Health Secretary Alan Johnson said on Thursday Giuliani's figures were wrong and complained about his attacks on Britain's National Health Service.

"The British NHS should not become a political football in American presidential politics," Johnson told The Times newspaper in London.

Cancer survival rate statistics depend on the number of cancers that are detected and when they are reported, and therefore may not necessarily reflect how well a health-care system performs at preventing cancer deaths overall.

The Times said roughly the same proportion of men -- 25 out of 100,000 -- died of prostate cancer in the United States and Britain each year.

John J. Thyng, Jr., The State Director of New Hampshire for Health Care, attacks the ads in his blog on the Huffington Post:

As early as the day the ad was released -- Monday, October 29th -- ABC News reporter Rick Klein reported that "the data Giuliani cites comes from a single study published eight years ago" and "is contradicted by official data from the British government."

As reporters asked more questions, the Giuliani campaign refused to admit their mistake.

When we issued a call for the ad to be taken down, his campaign still refused.

But we're not backing down. The next time Mayor Giuliani is in town we intend to deliver the message that we expect the campaigns to present strong, accurate statistics when making the case for how they will ensure access to quality, affordable health care for every American.

Health Care Voters will be there to call on him to remove the ad, and to remind him that 67,000 people intend to vote for a Health Care President - one who presents real facts, and doesn't use falsehoods to deflect attention from the lack of any personal ideas about how to fix the health care crisis.

Further analysis of this story is easily found on the New York Times, Washington Post, MSNBC, and Salon.Com websites.

SOURCE: "Giuliani Takes Another Shot at British Health Care" 11/02/07
SOURCE: "Rudy Needs to Pull His Dishonest Health Care Ad Now" 11/02/07
photo courtesy of Traveler54, used under this Creative Commons licence

One Third of Americans Call for Health System Rebuild While SCHIP Faces New Veto

Thursday the SCHIP legislation cleared the senate by a vote of 64-30, still not enough to override the promised veto from the executive branch. This would be President Bush's second veto of this legislation.

The Associated Press analysis of the situation yields the following:

In a situation of bewildering political complexity, Republicans dictated the decision to pass the legislation speedily. It appeared their goal was to short-circuit attempts by supporters of the bill to reach a compromise that could attract enough votes in the House to override Bush's veto.

Attempts by [U.S. Senator Harry] Reid to delay final passage of the bill until next week or longer drew objections from the Republicans.

This new round in the ongoing SCHIP battle comes as Science News brings us the results of a new seven nation study by the Commonwealth Fund, showing that over one third of Americans want a total rebuild of our health care system from the ground up. This is the highest rate of any of the countries surveyed, and cites medical errors, costs, and long waits for treatment as major contributing factors.

As in previous surveys, U.S. adults were most likely to have gone without care because of cost and to have high out-of-pocket costs. In the U.S., nearly two of five (37%) of all adults and 42% of those with chronic conditions had skipped medications, not seen a doctor when sick, or foregone recommended care in the past year because of costs -- rates well above all other countries. In contrast to the U.S., patients in Canada, the Netherlands, and the U.K. rarely report having to forgo needed medical care because of costs.

In addition, one-fifth of U.S. adults report serious problems paying medical bills--more than double the rate in the next highest country. And nearly one third (30%) in the U.S. spent more than $1,000 in the past year out-of-pocket -- a level rare in most of the other countries.

Some additional statistics provided from the report include:

• 1 in 5 report doctors advising treatment perceived as having little to no benefit


• Only in the Netherlands do people spend more time on paperwork and medical bill/insurance disputes


• The U.S. has the second highest percentage of adult visits to the emergency room (36%) out of nations surveyed, exceeded only by Canada.

SOURCE: "Congress Passes New Child Health Care Bill, Setting Up Another Veto Fight With Bush" 11/02/07
SOURCE: "One Third of U.S. Adults call For Completely Rebuilding Health Care System" 11/04/07
remixed photo courtesy of James and Vilija, used under this Creative Commons license