Max Baucus Steps Up for Health Care Reform

Max Baucus, the Democrat who chairs the U.S. Senate Finance Committee, is coming out in a big way for health care reform. He has assembled a council of over 30 medical professionals with the intent of developing five ways in which to improve the health care system, not just in his home state of Montana but across the nation as a whole.

Via Diane Cochran at The Billings Gazette:

"I think in life we only have two choices on most things - try, or do nothing, and clearly we've got to try to crack this nut," Baucus said at St. Vincent Healthcare during one of 10 health care listening sessions across the state. "Doing nothing is not an option."

Reforming the country's health care "hodge-podge" - it's too fragmented to be called a system, Baucus said - will probably be the biggest problem he tackles in his congressional career, the senator said.

One aspect of the problems faced by Americans is especially prevalent in Montana. That would be the plight of small businesses and those employed by them. According to an interview with St. Vincent Health Care CEO Jim Paquette on Montana'sNewStation.com, out of 160,000 uninsured Montanans, roughly 53% of them work for small businesses that do not employ enough people to to create the large pool needed to drive employer provided health care costs down. This among other factors is giving Baucus' efforts a high profile.

SOURCE: "Baucus hears concerns over health care system" 10/21/08
photo courtesy of KimberlyFaye, used under its Creative Commons license

The Doctor Shortage in Massachusetts

We keep checking back on Massachusetts to see how their experiment in expanding health care is going. Since the state's Health-Care Reform Act, an additional 440,000 people have become insured. The path being tread has been a balancing act from the start. A myriad of factors assert their influences upon the day-to-day mechanics of trying to bring health care to the state's entire population.

Each time we bring our gaze back to Massachusetts, we find more practical lessons to learn from their path-finding exploration in the realm of health care and coverage. This time, we discover a growing shortage of doctors to provide for the health care needs of the thousands of newly insured.

Via Christine McConville at The Boston Herald:

The data comes from the medical society’s annual work-force survey.

For starters, it shows a shortage of physicians who practice internal medicine, family medicine, oncology, neurology, dermatology, emergency medicine, general surgery, neurosurgery, orthopedics, psychiatry, urology and vascular surgery.

[Medical Society President Bruce] Auerbach said some of the shortages are due to the gap between the cost of living in Massachusetts, and what insurance companies and the government will pay for certain medical procedures.

There are also widespread fears of being sued.

As we explore the web of factors that influence the path to universal health care, it seems we shall need to keep in mind that providers are an important piece of the puzzle. Access is essential if coverage is to mean anything substantive.

SOURCE: "Study Sees Doctor Shortage" 10/06/08
photo courtesy of Subconsci Productions used under its Creative Commons license

Elizabeth Edwards Speaks: Health Care and the Economic Downturn

Elizabeth Edwards is back in the news, and once more she is lending her voice to the cause of health care reform. Mrs. Edwards is waging two battles currently: one against incurable cancer and another for universal health care and reform of our current system.

On Wednesday, she participated in a roundtable discussion in North Carolina. It is a state whose electoral votes are up for grabs in the current race for the White House due to both an influx of new residents hailing from the more liberal northeastern area of the country and a highly mobilized African-American population that leans toward the Obama camp.

As Wall Street continues its meltdown and the word "bailout" seems to be at the center of almost every conversation about the economy, Mrs. Edwards draws a link between the ongoing crisis in health care and the economic woes facing the country.

Mike Baker of The Associated Press reports:

Elizabeth Edwards said during a conference call Tuesday that medical bills often lead to foreclosure, a primary factor in the lagging housing market that's led to the demise of several Wall Street firms. Those without health insurance are often less productive, she said, because they miss work after failing to get treatment.

"Reform of our health care system is a very important part of the answers we're going to need to solve our economic woes," she said.

I'll be bringing you more info as soon as details of the roundtable are available.

SOURCE: "Elizabeth Edwards ties health care to economy" 10/01/08
photo courtesy of NCBrianused under its Creative Commons license

What's Wrong With US Health Care: Jane's Story

Karen Hover is a doctor in Maine. As such, she is in a prime position to note the shortfalls, mistakes, and outright failures of the American health care system. On Monday, she wrote a guest OpEd column for The Bangor Daily News in which she puts a face on these wide and dangerous gaps in the way we take care of our sick.

In it, she relays the story of "Jane" (not her real name), an administrative assistant who suffered an accident that broke both her elbows after falling off a roof. As you might imagine, the splints used to immobilize the fractures stretched from fingers to armpits. She rapidly discovered that the splints kept her from being able to do, well, anything.

"I couldn’t scratch my nose, or feed myself, or get a glass of water, or pull my pants down." She needed around the clock care. Jane called her insurance company, which told her that her plan included 100 days of skilled care.

Arrangements were made to go to a rehabilitation facility on Friday, which was good because Jane’s friend had to go back to work. When Jane arrived, around noon, administrators told her that the insurance company had denied her claim and that she could not be admitted because she had no need for skilled medical care. After a couple of hours on the telephone, no one had a better idea, so she was sent back to the emergency room. By this time, she needed to go to the toilet, but staff refused to take her because of fear of liability. Her ex-husband helped her.

Can you imagine? Not the runaround -- that is something we have all come to expect (at least those of us who have had to deal with the health care system directly) -- but the treatment. Imagine yourself with both arms in splints, bladder bursting, lots of people around whose job is to help you, and yet no one does. This points up an aspect of the current system I do not often get to touch upon: the fact that often there seems to be no attempt made to help a patient preserve basic dignity.

The emergency room was packed. She was seen by a doctor who asked her if she had cash to pay for a hospital room. He talked to her about going to a local shelter. Jane was hungry, dirty and in pain. "I just need someone to take care of me," she said. A stranger who had been following the story brought Jane supper at 10 p.m. and fed it to her. She was admitted at midnight.

Jane's adventures are far from over though. It took another eight days of refusing her claim before the insurance agency came around and had her transferred to a rehab facility. Sounds like things should have been fine from there on out, doesn't it? Unfortunately not.

She was sent to the same facility that had treated her so badly before and spent three weeks there, enjoying inappropriate food, an accidental injury, an often unclean toilet, miscommunications between staff and her orthopedist, and a banging door that prevented sleep. The splints were removed. Jane went home with a new case of athlete’s foot. She learned to use her arms again and is now back at work. She feels her family and friends were very supportive.

No, this is not a scene from Stephen King's The Kingdom. It is yet another homegrown horror story cultivated right here in the United States. This is why we need to keep health care at the forefront of the Presidential debate, to stop this from happening.

For Jane's sake.

SOURCE: "Karen Hover: How our health care system failed Jane" 08/11/08
photo courtesy of hypertypos, used under its Creative Commons license

Slate Brings US The Health Care Slugfest!

Slate Magazine, an online daily owned by The Washington Post that has attracted numerous awards brings us a really useful collection of links to information from all sides of the health care debate.

As Slate's writer, Timothy Noah, puts it:

If you want to learn the current parameters of the political debate over health care reform, scrutinizing the plans proposed by presidential candidates Barack Obama and John McCain will get you only so far. A sharper picture of where the battle lines are drawn is starting to emerge from two new lobby campaigns recently created by two key opposing groups.

He then goes on to provide capsule descriptions of the Insurance Industry's Campaign for an American Solution and the liberal movement's Health Care For America NOW!

It is, as blog posts often are, a quick read. A plethora of hyperlinks will take the online investigator to a variety of pertinent source material on both sides of the issue, and does so with the usual patented Slate cheekiness.

SOURCE: "Health Care Reform: The Slugfest Begins - Meet the interest groups that will decide the fate of medical insurance." 07/22/08
photo courtesy of d. billy, used under its Creative Commons license

Bernanke Addresses Health Care Issues

On Monday, Federal Reserve Chairman Ben Bernanke addressed the Senate Finance Committee's Health Reform Summit (full transcription here). Bringing his financial acumen to the table, he reframed the question of health care cost, putting into a perspective of "What are we gaining from these expenditures?" rather than the usual absolute and simplified "What does it cost?"

From the economist's perspective, the question of whether we are spending too much on health care cannot ultimately be answered by looking at total expenditures relative to GDP or the federal budget. Rather, the question, whatever we spend, is whether we are getting our money's worth. In general, good information and appropriate incentives are necessary to allocate resources efficiently. In health care, the necessary information should include not only the clinical effectiveness of certain tests or courses of treatment but also their cost-effectiveness. As the regional comparison of health-care costs illustrates, cost-effective approaches may be at least as useful as more costly approaches in delivering good health outcomes.

His remarks were tightly focused on health care cost and its impact on the U.S. financially. Monetary policy and overall comments about U.S. economy were not addressed other than as they affect health care. He also declined to make any solid policy recommendations.

Among other issues, Bernanke pointed out that rising costs of health care are quite liable to reduce access to health care as the lower income elements of the U.S. are priced out of both care and insurance. Hardly an earth shattering observation, but one that is lent weight by his bringing it up in this particular forum.

"The best way to reduce the fiscal burdens of health care is to deliver cost-effective health care throughout the entire system"

Hopefully this will turn some attention towards the inadequacies of the "pay per procedure" methodology that has driven American health care for decades.

SOURCE: "Chairman Ben S. Bernanke At the Senate Finance Committee Health Reform Summit, Washington, D.C. Challenges for Health-Care Reform" 06/16/08
photo courtesy of Ashley Pollack, used under its Creative Commons license

"The FDA Has Become a Joke," Says Specter

A recent ruling by the U.S. Supreme Court states that once the FDA approves a medical device, the manufacturer is immune to lawsuit even if said device causes injury to the recipient. This ruling has now come under fire in the Senate Committee on the Judiciary.

Strange bedfellows keep popping up in the health care debate, probably because health concerns cut across party lines like a laser through a marshmallow. In this case we see two often opposing voices raise in ire at the testimonies presented to them: Sen. Patrick Leahy, D-Vt., and Sen. Arlen Specter, R-Pa.

Harrowing personal testimony from two women in particular brought down anger from both of these veteran legislators. First was Bridget Robb, who on December 7, 2007, suffered a defibrillator malfunction that shocked her heart 31 times in the span of a few minutes. When she arrived at the hospital, luckily still alive, she discovered the device had been recalled months earlier. ABC News recounts the details in an article by Ynuji DeNies, Sheila Evans, and Stephanie Dahl, including the details of how Robb was prevented from taking legal action by the Supreme Court ruling mentioned above.

Then came the story of Maureen Kurtek, a lupus sufferer whose story would shock just about anyone. Her full testimony is transcribed on the U.S. Senate Committee on the Judiciary website here. I would like to share with you her summation from the end of it, especially the second paragraph:

[...] all of this pain and suffering was caused by an insurance company that failed to provide me with a treatment that I had received six times prior at the same hospital under the same insurance provider with good effective results. Previously, this treatment had helped my body increase its ability to fight infection and keep my platelet count at a normal level. This treatment was prescribed for me by at least seven doctors and two specialists and was never considered to be experimental by them. This treatment, although expensive, was necessary for me. And, my insurance company delayed my treatment.

I stand before you today with a tracheotomy scar on my neck, five amputated finger tips and an amputated right foot where I still experience phantom pains. Life ceased as I had known it. I can no longer jog or dance. I can not wear stylish shoes on special occasions such as my son's graduation, and I have to wear an orthopedic shoe which I can assure you is not the dream of any woman. During my time in the hospital, I missed my son's spelling bee, piano recital, his confirmation at church and baseball games. These are events I can never get back.

Due to this law, insurance companies can get away with denying care and delaying treatment without any consequences. This is wrong. We need to change this law so no families will have to suffer the way mine has.

The ABC Article provides us with the responses of our esteemed Senators:

"The Supreme Court has ignored the intent of Congress in passing these measures, oftentimes turning these laws on their heads, and making them protections for bug business rather than for ordinary citizens," Leahy said. "I hear this buzzword of activist judges and I can't think of anything more activist than these decisions."

[...] Sen. Arlen Specter, R-Pa., put the blame on the FDA which approved the faulty device. "The FDA has become a joke," Specter said.

Whichever way this goes, it will have far reaching implications both for medical device manufacturers and the patients who rely on their devices. Specter, the ranking Republican on the committee, was harshly critical of the Bush Administration for delaying requests for FDA funding reportedly calling it "criminal negligence."

The ongoing battle for reform is taking place in courtrooms and governmental chambers across the nation with bipartisan efforts cropping up more and more frequently as cases like these shine a media spotlight on the broken aspects of the American health care system. A "perfect storm" has arrived heralding oncoming change. Becoming engaged and informed on this issue is of utmost importance for us all.

SOURCE: "Young Daughter: 'Mommy's Dying': Bridget Robb Can't Take Legal Action Because Device Was FDA-Approved" 06/11/08
SOURCE: "Testimony of Maureen Kurtek before the Senate Committee of the Judiciary" 06/11/08
photo courtesy of DBKing, used under its Creative Commons license

Presidential Candidates and Their Plans For Health Care

Well, the Internet and conventional media are all abuzz now that Barack Obama is officially the Democratic Party's candidate for President of the U.S. For the Health Care Reform Now! Blog, that means that it is time once more to take a look at his plan for dealing with the health care crisis. With that in mind, I would like to share part of a post I found on Joseph Padua's Managed Care Matters Blog:

The differences between the McCain and Obama plans are big – really big. Philosophically, McCain’s approach is market-based and tax policy driven, relying on individuals to make the best decisions on health care procedures and treatment. His plan would remove the favorable treatment of employer-funded health insurance, instead providing a refundable tax credit of $2500/individual or $5000 per family to help them buy insurance (note – the average individual policy now costs over $4000 and the average family policy cost exceeds $12,000). Conversely, Obama’s plan is more pragmatic, focused on fixing the problems with the current market-based system with a ban on medical underwriting, a comprehensive ‘minimum’ benefit design, financial help for small employers buying health insurance, and some sort of stop-loss insurance for high dollar claims.

Mr. Padua goes on to do a quick but telling point-by-point comparison of the approach taken by each of these Presidential contenders. What really stands out in his analysis is the fact that unlike so much of the politicized polemic being bandied about, he actually illustrates pros as well as cons on each side.

Pointing out that McCain is "dead on when he talks about the need to pay for health, not reimburse for procedures," he then provides criticism of the Arizona Senators proposed methodology. One of his huge criticisms of the McCain approach is the fact that it would cause a massive increase in the nation's budget deficit. Not only that, but these costs would be an immediate expense incurred by implementation of his programs.

The health care aspect of the run for the White House is going to get very interesting in coming months. The ongoing comparison/contrast of the two candidates is sure to be a hot topic, especially now that Sen. Obama has joined forces with Elizabeth Edwards (post and video via Crooks and Liars)

SOURCE: "Obama, McCain, and Health Care Reform" 06/10/08
SOURCE: "Obama To Team Up With Elizabeth Edwards On Health Care Reform" 06/09/08
photo courtesy of ~twon~, used under its Creative Commons license

Salazar Speaks Out

On Tuesday, the United States Senate Finance Committee held a hearing entitled "Seizing the New Opportunity for Health Reform." Goals and principles of health care reform were addressed along with a reaffirmation that reform efforts should be comprehensive, not incremental, and that quality health care should be available to all citizens of the United States.

Senator Ken Salzar of Colorado, a member of the Committee, was one of those who addressed the hearing. Here are some excerpts from his address brought to us via the full transcript on Trading Markets.com:

"While many in our nation go without care, it certainly is not due to a lack of health care spending. In 2005, health care expenditures in the U.S. totaled over $2 trillion dollars - nearly 15 percent of our gross domestic product and the highest spending level of any developed nation by far. So I ask myself - with so much of our money being spent on health care services, how can so many of our people lack access to affordable, high quality care" It is a dynamic we all struggle to understand, and I look forward to hearing the panel's thoughts on this during today's discussion.

"When I go back to Colorado and talk to the people in my state, their number one health concern is the cost of care. The price they must pay drives every decision they make when it comes to their personal health - which is certainly not the way we should be making life-altering decisions for our friends and loved ones. For those people without insurance, the problem is obvious - they cannot afford to pay the staggering "sticker price" for health care services out of their pocket - and they rely too heavily on emergency services which are inefficient, expensive and less than ideal. But the growing plight of the uninsured causes difficulty for individuals with insurance as well, as many of the costs of treating the uninsured are passed along to all consumers and result in increased premiums and cost-sharing obligations. This often means that even those with insurance cannot afford to seek treatment because they cannot afford their high deductibles and copayments, creating a vicious cycle of unmet health care needs.

As someone who has had recurring health issues of various sorts, I can attest to this. Many times I have had to forgo seeking professional care because it was a choice of that or rent. (Writers don't make very much unless they happen to be Stephen King or Tom Clancy.) On one or two occasions it ended up with me having to go to the emergency room, vastly increasing the expense both for myself and or others.

Now I have insurance thanks to my wife's job at a local university, although that does not improve matters much from they way they were before. Several hundred dollars a month go towards coverage, but attempts to use it reveal a labyrinth of paperwork and bureaucracy that often seems designed to prevent our use of the policy.

"As I listen to discussions of health care reform, I can come to only one conclusion - our goal must be universal access to affordable, high quality health care for every person in this country. While I am sure that my colleagues on the Committee may have differing perspectives on how we can achieve this goal, I am convinced that there are common principles that can tie us together and hope that former Secretaries Shalala and Thompson can help us identify those areas. Prevention, health technology, primary care, chronic care coordination - these are concepts that we know hold value - and the time has come for us to delve into the details of incorporating them into our health care system and realigning the system's incentives to make sure they are addressed."

Indeed, these are all issues that George C. Halvorson brings up in his book Health Care Reform Now! as being critical to effecting substantive, positive change in our current "non system." Let us hope that Sen. Salazar finds many kindred spirits on the Senate Finance Committee.

SOURCE: "Senate Finance Committee Takes First Step to Discuss Broad Health Care Reform Solutions" 05/07/08
photo courtesy of Phil Roman, used under its Creative Commns license

Rockefeller, Congress, and Healthcare: The Quote Heard 'Round The Net

One of the big topics in the blogosphere right now is the article by Manu Raju on The Hill that talks about Congressional Democrats crabwalking on the issue of health care reform:

Congressional Democrats are backing away from healthcare reform promises made by their two presidential candidates, saying that even if their party controls the White House and Congress, sweeping change will be difficult.

It is still seven months before Election Day, but already senior Democrats are maneuvering to lower public expectations on the key policy issue.

Considering the profile of the health care debate in the current election, this is news that, unsurprisingly, seems to be spreading like wildfire across the Internet. The most often quoted part is this statement:

"We all know there is not enough money to do all this stuff," said Sen. Jay Rockefeller (D-W.Va.), a Finance Committee member and an Obama supporter, referring to the presidential candidates' healthcare plans. “What they are doing is … laying out their ambitions."

Ezra Klein at The American Prospect has his doubts about the veracity of this report, and that quote is one of the reasons:

That scans oddly for two reasons. The first is money. Obama's aides say the plan would cost between $50 billion and $65 billion a year. Assume they're lowballing, and the real number is $80 billion. That's some cash, to be sure but it's not a level of outlay that tends to make Senators balk. We're spending far more on Iraq, on tax cuts, and a host of other projects. The money could probably be found fairly easily -- and it's certainly not hard for Senators to say it could be found fairly easily. So that looks strange.

When viewed in relation to other governmental expenditures it does seem like a comparatively small sum. Klein goes on to analyze the quote itself and the reporter who provides it:

The second oddity is "all this stuff." A health care bill contains a lot of stuff, to be sure, but it's generally referred to in the singular. It's a bill. It's big, and you can either do it or not do it. Moreover, the only proof we have that he was talking health care is that the reporter says so. It sounds to me like Rockefeller is saying something much broader and more mundane: That if you look at the domestic agendas of Clinton and Obama, there's not enough money nor political will to do all of it. You're not going to get health care and tax cuts and energy policy and housing reform and education and poverty and everything else you promised in the campaign. And even if you could muster the will, you can't find the funds. That leads to the question of priorities, but that's no surprise.

Jonathon Cohn of the New Republic's response is dismayed:

This is pretty discouraging stuff. Rockefeller is a longtime advocate for universal coverage; his moral commitment to the issue is not in question. And Baucus, whose comments were much less negative but still not enthusiastic, chairs the Finance Committee--through which any universal coverage bill must go.

Still, this isn't the last word on the subject. I just got off the phone with Andy Stern, president of the Service Employees International Union, who in recent years has done as much to promote the cause of universal coverage as any single person in politics. And he is not at all happy.

"I thought it was embarassing," Stern said. "I think it showed an incredible lack of appreciation for what most Americans are confronting every day in this health care system. ... What was said in this aritcle is not the kind of leadership that I think Americans are expecting after this election."

Whatever the context of the quotes was, it sure is generating a lot of discussion. I am sure that by the time this is posted there will be a vast array of opinions being voiced from blog pulpits and news outlets everywhere. Go check out these articles and render your own opinion. Our comments section welcomes you!

SOURCE: "Dems hedge on Health Care" 04/23/08
SOURCE: "Is Congress Backing Off health Care Reform?" 04/24/08
SOURCE: " Stern to Congress: Don't Chicken Out on Health Care." 04/24/08
photo courtesy of The Gold Guys /Lumax Art, used under its Creative Commons license

5th Annual World Health Care Congress

A stupendous array of health care expertise is gathered in Washington, D.C., supplemented by the health care policy advisors for U.S. Presidential candidates Sen. Barack Obama, Sen. Hillary Clinton and Sen. John McCain. It's the World Health Care Congress, and as you might expect, George C. Halvorson is there.

From the press release about this morning's panel:

-- Hear the Presidential candidates' platforms for health care reform

-- Compare proposals to address universal coverage and the fiscal
stability of Medicare

-- Reactor panelists provide an in-depth critique by evaluating the
economic and social impact of Democratic and Republican proposals

Panelists:
-- U.S. Rep. Jim Cooper (D-TN), Health Care Policy Advisor to Sen. Barack
Obama

-- Chris Jennings, Health Care Policy Advisor to Sen. Hillary Clinton,
former Senior Health Care Advisor to President Clinton.

-- Thomas Miller, resident fellow, American Enterprise Institute for
Public Policy Research, Health Care Policy Advisor to Sen. John McCain

-- George Shutlz, former U.S. Secretary of State, Labor and Treasury, co-
author "Putting Our House In Order: A Guide to Social Security and
Health Care Reform"

-- George Halvorson, Chairman and CEO, Kaiser Foundation Health Plans and
Hospitals

Health care reform, universal coverage, Medicare woes, and a solid analysis of the positions taken by our current crop of Presidential candidates should make for a fascinating (and hopefully productive) gathering.

The listing above covers on the first panel of the day for this event, in addition to those listed above there is an extensive roll call of movers and shakers in the Health Care scene in attendance who will be combining their expertise:

• Michael Leavitt, Secretary, U.S. Department of Health and Human Services
• James Hagedorn, CEO, Scotts Miracle-Gro Company
• Delos (Toby) Cosgrove, MD CEO, Cleveland Clinic
• Denis Cortese, CEO, Mayo Clinic
• Greg Tullman, CEO, Allscripts
• George Halvorson, Chairman and CEO, Kaiser Foundation Health Plans and Hospitals
• Mack Banner, CEO, Bumrungrad International (Thailand)
• Sam Nussbaum, Executive Vice President and Chief Medical Officer, Wellpoint
• Thomas Miller, health care policy advisor to Sen. John McCain
• Prof. Hans Rosling, MD, PhD Professor of International Health, Karolinska Institutet (Sweden)
• Michael Howe, CEO, MinuteClinic
• Paul Speranza, Chairman, U.S. Chamber of Commerce, Vice Chairman and General Counsel, Wegmans Food Markets
  

Best of all, in my opinion, is the fact that you can stream MP3 audio podcasts of the featured speakers here. Look for Mr. Halvorson's podcast, "Reforming the Delivery of Care to Impact 85% of Total Health Care Costs." It just went live!

Today, I would like to close with a quote about the event:

"This is the largest gathering of health care providers, thinkers and experts anywhere in this world."
—Lee Scott, President & CEO, Wal-Mart Stores, Inc.

Let us hope this massive array of talent and expertise can help us find our way down this complex and emotionally charged path to effective health care reform!

SOURCE: "5th Annual World Health Care Congress Kicks off April 21 With Obama, Clinton, McCain Health Care Policy Advisor Presidential Health Care Agenda Forum" 04/21/08
SOURCE: "5th Annual World Health Care Congress- Podcasts"
photo: Screencap of WHCC Website

Hammergrin on Health Care

While looking around the Internet, I ran across a great little essay on the 800-CEO-Read Blog penned by John Hammergrin of McKesson Corporation, a 175-year-old heath care company. Since he seems to be very much of a similar mind to George C. Halvorson, I thought that sharing parts of that blog might be well received. Here is a bit from the column in which he addresses the issue of our national health care crisis from the standpoint of business and the market:

In most industries, top performing businesses excel by being the low cost producer, putting out the best product, and meeting or beating customer expectations. The market works because consumers are able to choose the services that meet their needs best. In the health care industry, costs are distorted by government interference in the market and quality differences are disguised by a lack of consumer information and choice. Moreover, while we can argue that "customer" is another word for patient, would the customer in any other market make critical decisions without concern for cost or quality and put up with the inconveniences, inefficiencies and high error rates of health care?

The lack of available and consistent information is indeed a huge stumbling block, and one that I have written about here on several occasions. While the argument does seem lucid overall, I must point out that for many in this country medical care is a last resort, mostly due to these aforementioned costs. This means waiting until a trip to the emergency room in unavoidable, at which point cost comparisons and examination of the care quality of the provider are moot.

Chronic diseases account for most of our health care expenditures and require coordinated rather than episodic care. We need to incentivize and organize providers to manage long-term illnesses better. The fear of medical malpractice suits are driving up costs by encouraging unnecessary treatment. We need sensible reform to reduce the preponderance of defensive medicine. Quality of care and outcomes need to be the new measuring sticks by which we assess, select and pay providers for their health care services. We need greater transparency to give primary care physicians and health care consumers the ability to choose the best doctors, hospitals, insurance providers and technicians, while also creating industry-wide standards for the latest in best practice.

No matter which candidate prevails in November, the popular concerns we have about health care right now are going to evolve rapidly once the next administration begins. As a business leader, I support universal access through tax incentives and individual choice (not a de facto expansion of Medicare) because I believe that having everyone in the insurance pool is fundamental to reducing costs and creating a competitive insurance market. But as Governor Schwarzenegger learned when the California Senate Health Care Panel rejected a bill mandating health care for all state residents, sweeping reform is even more difficult when economic times are tough.

And that would seem to be a major concern as we watch the news become more pessimistic each day regarding the American economy. Even so, many other factors do play an important part that is not to be overshadowed by economic insecurity. Hammergrin sums up his position in this regard as follows:

We don't need to control the health care market through mandates and cost containment legislation, we need to unleash it by giving people the ability to make better informed choices. After all, health care is the one product all consumers need, guaranteed.

SOURCE: "An essay from John Hammergren on health care reform"04/14/08
photo courtesy of brykmantra, used according to its Creative Commons license

Asian Americans and Health Care Reform

Marguerite Ro, deputy director of the Asian & Pacific Islander American Health Forum and a former professor of Columbia University Medical Center, shares the concerns of the Asian American and Pacific Islanders (AAPI) community on the subject of health care reform in Asian Week:

New data from the Centers for Disease Control reveals that nearly one out of every five AAPIs is uninsured. Almost one out of every six AAPIs does not have a usual place for health care.

[...]Unfortunately, the presidential candidates have yet to assure Asian American and Pacific Islander communities that they understand or even acknowledge the challenges that our communities face in accessing health care.

She goes on to cite numerous community-specific statistics and concerns including the following:

• Language barrier as a bar to receiving quality health care
• A stress on improving prevention that notes a 10% incidence of hepatitis B in Asian Americans as opposed to a 0.01% incidence in whites as an example.
• A need to tailor the delivery of health information to the numerous disparate communities that exist in order to assure that the information gets across.
• A call for Asian American voters to make their voices heard at the polls.

Once again, we see that the desire for true reform is one that crosses all strata of society, all communities, all ethnicities, and all political boundaries. As we attain the "perfect storm" of reform that George C. Halvorson speaks of in his book, Health Care Reform Now!, we see that, as he puts it, "buyers are ready for a change."

SOURCE: "Health Care Refom: Why It Matters To Us " 02/16/08
photo courtesy of Joka2000

Taking The Nation's Pulse With CodeBlueNow!

Kathleen O'Connor, the founder and CEO of CodeBlueNow!, is serious about health care reform. The consumer advocate is conducting a survey she calls the "CodeBlueNow! Pulse" that gathers people's attitudes about health care reform. You can take the survey online right now at the following link:

http://www.questionpro.com/akira/TakeSurvey?id=788175

The survey takes no more than 15 minutes to complete, your answers are confidential and your identity is not tracked.

Here's a 4-minute video from YouTube in which Ms. O'Connor explains the CodeBlueNow! Pulse? and the organization's mission:

O'Connor was a guest columnist in the Seattle Post-Intelligencer at the end of last week. She began by reminding us that the call for reform is not a new thing, citing the 1932 Report of the Committee on the Cost of Health Care. A wide variety of proposed solutions have failed over the intervening years.

The vision O'Connor presents has several important underpinnings, including universal coverage, emphasis on prevention, transparency within the industry about costs and benefits (especially in situations involving complex health decisions), and greater accountability in the health care industry.

Ms. O'Connor delivers a call to action for the voting public to become informed by facts rather than talking points and to take health care out of the hands of vested interests and politicians.

Our voice -- the public's voice -- hasn't been heard over the choruses profiting from the status quo. The complexity of our health care system is held up as a key reason the public cannot solve the problem -- "it's too complex."

But it's not. The complexity charge is an excuse to maintain the status quo, shouted by the foxes guarding the hen house.

More consensus exists than politicians and pundits lead us to believe. Our CodeBlueNow! Pulse® results from Iowa and Washington state (two very different states politically) clearly show there is astonishing agreement on some core values and key elements. We offer these visions and values as a starting point to create "The Voters' Health Care Platform." We must start with a vision and core values and build consensus along the way. This is a proven path to change with any social movement.

Yankee ingenuity, "can-do" attitude, spirit of innovation -- these are all iconic traits of the American culture. If we can harness those traits in the battle for health care reform, our odds of creating a uniquely American system of universal health care increase exponentially.

The CodeBlueNow! reports linked above show that a consensus at the public level is not lacking in this matter. I will continue to report as they gather and release more data.

SOURCE: "It's time to speak up on health care" 01/25/08
SOURCE: "CodeBlueNow!"

California Nurses Use Obama's Words Against Schwarzenegger Plan

This morning The Nation brings us some interesting news (via Yahoo). Evidently while U.S. Senator Barack Obama is focusing his attentions on other states, his voice is ringing out across California thanks to an ad campaign run by the California Nurses Association (CNA). The ads attack the health care reform plan backed by California Governor Arnold Schwarzenegger, Democratic Assembly Speaker Fabian Nunez, and a group of major insurance corporations.

The radio ads being aired by CNA announce that, "The nurses of California agree with Senator Barack Obama: the government shouldn't punish people who can't afford health insurance."

Then an audio clip from Obama is heard. "I know that there have been some folks who said that it's not possible to provide universal health care coverage unless there's a mandate," says the senator. "Their essential argument is the only way to get everybody covered is if the government forces you to buy health insurance. If you don't buy it, then you'll be penalized in some way. And the reason people don't have health insurance is because they can't afford it."

You may read a transcript of the ad or listen to/download it in MP3 format from the CNA Online Press Release.

The CNA has not gone easy on Senator Obama's plan in the past. Last year the organization's then president, Deborah Berger, RN, criticized it for failing to address pricing practices in the health care industry. She said that those practices, "put so many American families at financial and health risk."

Then there is Iowa. During the recent caucuses the CNA ran an ad aimed at Senator Obama which said: "It's not good enough just to be better than the Republicans on this."

The current ad campaign has potential to be a very powerful one. Senator Obama's voice and face have become ubiquitous, especially after his victory in the Iowa caucuses. The CNA, as we wrote about here, was the group behind the last month's powerful "if he were anyone else, he'd be dead by now," ad campaign that used U.S. Vice-President Dick Cheney's recent medical history as it's basis.

It will be interesting to see what direction things take in response, especially between now and the California presidential primary on February 5.

SOURCE: " Putting Obama to Work for Health-Care Reform" 01/11/08
SOURCE: "Nurses Unveil New Advertising Campaign Against Schwarzenegger-Nunez “Individual Mandate” Plan" 01/10/08
photo courtesy of Transplanted Mountaineer, used under this Creative Commons license

On The Road With Robert Reich

Today our media offering is from The Wall Street Journal. This morning in their commentary section we find Robert B. Reich, professor of public policy at the University of California at Berkeley and former U.S. Secretary of Labor under President Clinton, sharing his views on "The Road to Universal Coverage."

He begins by noting that on the Democratic side of the current race for the White House all three major candidates (Senators Clinton, Obama, and Edwards) have made health insurance issues a major part of their individual platforms. He also notes the despite overwhelming similarities in their plans they are focusing on the small differences in the battle for their party's nomination. "Mandates are a sideshow, and fighting over them risks turning away voters from the main event."

After a lucid and concise comparison of the plans presented by Democratic frontrunners, in which he demonstrates just how similar they are, he continues:

This fight is little more than a distraction, given that a mandate would matter only to a tiny portion of Americans. All major Democratic candidates and virtually all experts agree that the combination of purchasing pools, subsidies, easy enrollment and mandatory coverage of children will cover a large majority of those who currently lack insurance -- even without a mandate that adults purchase it. A big chunk of the remainder are undocumented immigrants, who aren't covered by any of the plans.

Should the remaining 3% of the population be required to purchase insurance, or lured into it by rate decreases and subsidies? Reich's position is that the answer depends on who you think comprises that 3%.

Comparing Senators Clinton and Obama he shows us the difference in views on this topic. Senator Clinton's position is that the 3% are youthful and in good health, which means they would lower the overall cost of health care as their payments subsidize others. Senator Obama's position is that many of them simply cannot afford coverage even with subsidized premiums. His belief is that they would either ignore the mandate or simply be unable to afford it. To Mr. Reich's credit his conclusion after comparing them is cautious and well reasoned. Like much of the current discussion on the topic it also casts an eye towards Massachusetts:

Who's correct? It's hard to know. So far, the Massachusetts experiment suggests Mr. Obama. Massachusetts is the only state to require that every resident purchase health insurance. The penalty for failing to do so could reach $4,000 next year, but the state has already exempted almost 20% of its current uninsured from the requirement. Massachusetts is concerned they can't afford a policy, even with subsidies similar to those in all the Democratic plans. So far, about 50% of Massachusetts's uninsured have complied with the mandate.

He closes with a call to action for Democrats, encouraging them to "stop leading with their chins," in counterproductive arguments over mandates and begin building momentum for large scale and desperately needed change. Change that they all already agree upon.

SOURCE: "The Road to Universal Coverage" 01/09/08
photo courtesy of Kevin Dooley, used under this Creative Commons license

New Year's Health Care Reform Roundup

Welcome to our first health care news roundup of 2008! Most of the health care news lately has been about the politics of reform. From mandates in Massachusetts to the floor of the California State Capitol there is no lack of news on the subject. With that in mind we would like to share a small sampling of health care in the media as we end the first week of the New Year.

Lets start in Iowa, the land of the caucus. CNN brings us text and video about Kathy Strangli, an Iowa voter who is dying of an incurable lung disease called lymphangioleiomyomatosis. She is devoting her final days to changing U.S. health care and has been grilling candidates on the subject across the state of Iowa to do it. So far she has confronted all but two presidential hopefuls on the subject and has attended more than 70 campaign events to do so.
[Story] [Video]

Next stop is California, a state that has held a high profile in the news as Governor Schwarzenegger and the state legislature have wrestled with implementing universal healthcare. Aliza Marcus over at Bloomberg takes a good hard look at Schwarzenegger's battle for health care reform and the lessons it holds for U.S. Presidential candidates.
[Story]

Then we turn our attention to the East Coast of the U.S. The Business Review brings us the scoop on New York Governor Eliot Spitzer's decree to his Health Commissioner and his Insurance Superintendent that they have until May 31 to concoct a plan for universal coverage in New York state.
[Story]

As we move along the coast we find the Boston Globe reporting on Vermont Governor Jim Douglas who is aiming his efforts at preventative medicine. To be specific he is attacking obesity, a major contributor to "more than 15 chronic conditions." The details will be released during his State of the State address next week, but the Globe article gives a basic overview of the plan (adding prevention specialists, allocation of grant money, among other features).
[Story]

Our last stop on this virtual tour is in New Hampshire, the next state to fall under the media microscope now that the Iowa caucuses are finished. As the various contenders for the White House prepare to converge on the state the International Association of Dental and Medical Disciplines (IADMD) has issued a press release calling on the candidates to get input from actual doctors when formulating their approaches to health care reform.

"Health care is such an important issue the candidates should be listening to the IADMD doctors that have the medical training to solve the crisis. I commend Hillary Clinton, John Edwards, Mitt Romney and Barack Obama for talking about health care. But their plans are not viable for many reasons, such as cost and their non-doctor approach," says Dr. Ryan.

Dr. John J. Ryan is the founder of the IADMD and a New Hampshire based family dentist.
[Press Release]

That's all for now, see you next week!

SOURCE: "Schwarzenegger's Health Battle Carries Warning for Candidates " 01/04/08
SOURCE: "Businesses warm to idea of universal health care" 01/04/08
SOURCE: "Governor wants to fight obesity with grants and specialists" 01/03/08
SOURCE: " Dying Iowa voter grills candidates on health care" 01/03/08
SOURCE: "Press Release: New Hampshire Doctors Group Challenges Presidential Candidates on Universal Health Care" 01/04/08

photo courtesy of Benimoto, used under this Creative Commons license

Kaiser Releases Summary of Candidates' Positions on Health Care

It is the third day of the New Year, and tonight the Iowa Caucasus will determine the shape of the upcoming run for President of the United States. Facts, fiction, and anecdote swirl together in a dizzying fashion as all of the hopefuls make one final push for the hearts and minds, or at least the votes, of the Iowa public.

What exactly, you may ask, is a caucus and why is it so important in the run for the White House? Mark Z. Barabak of the Los Angeles Times explains the process and its history in an article this morning.

No matter what part of the political spectrum you embrace one thing is sure: this year's Presidential race is going to be a doozy! This is good news in at least one respect because it means a lot more public debate about our broken health care system, which is consistently listed as one of the most important issues to American voters.

Whether you are in Iowa debating who will receive your vote tonight, New Hampshire where the next fight in this running political battle will be, or anywhere else in the U.S. you will need facts and details in order to properly formulate your decision.

On the subject of health care reform, at least, you have a wonderful resource available in the Kaiser Family Foundation's breakdown on what the candidates and the media are saying about health care. Released on January 2nd, the Kaiser Health Policy Report gathers together in one place the pertinent media coverage, recent developments, polls, broadcast coverage, and opinion pieces concerning the U.S. Presidential candidates' positions on health care reform. The data is summarized, documented, and linked for ease of use.

SOURCE: " Election 2008 | Presidential Candidates Debate Health Care Proposals in Preparation for Iowa Caucuses " 01/02/08
SOURCE: "Why Iowa? And what's a caucus, anyway?" 01/03/08
photo courtesy of John Edwards 2008, used and remixed under this Creative Commons license

Massachusetts Uninsured Penalty to Quadruple

I would like to start off today by wishing all of our readers a healthy and happy New Year from all of us on the Health Care Reform Now Blog Team! May 2008 be a fantastic year for all, and hopefully a year in which we will see substantive strides toward health care reform in the United States.

To kick off 2008 I would like to direct your attention to the Boston Globe's Jefffrey Krasner, who has his eye on Massachusetts.

2008 will be an important year for the state's health care reforms, which were signed into law by U.S. Presidential hopeful Mitt Romney during his term as Governor of Massachusetts in 2006. The maximum penalties for remaining uninsured will increase nearly four fold to almost a thousand dollars a year. The cap for 2007 was $219 and was implemented as a forfeiture of the individual's tax exemption, not a fine.

Mr. Krasner provides a nice breakdown of how the penalty fee structure is supposed to work. The amount of the penalty is directly tied to the lowest cost insurance option using a formula determined by the state's Department of Revenue:

Under the formula issued yesterday, the amount an uninsured resident pays for 2008 varies by income and how long the resident goes without insurance. For instance, those 26 and younger that earn too much to qualify for low-cost insurance and who go the whole year without coverage would pay a $672 penalty. Those 27 and older would pay $912, the maximum. Those who have coverage for part of the year would pay a corresponding amount of the penalty.

In addition, those who earn less than 150 percent of the federal poverty level, or $15,324 for an individual won't face penalty.

The fees are based on half the cost of the least expensive insurance plan available to each resident but are capped to avoid excessive fees. Thus, a 60-year-old resident of Boston, who would pay more than $4,600 a year for health insurance provided by the state, could have been hit with a $2,300 penalty. But the maximum possible penalty is $912 for all residents. The draft regulations are available at the revenue department's website at mass.gov/dor.

There is no accurate estimate of how many Massachusetts residents will have to pay the penalty for 2007 yet, due to the fact that the penalty is tied to individual tax returns which are not due for several months.

This will be the crucible in which the mandate approach is tested, and I am certain that as the U.S. Presidential campaign ramps up many eyes will be on the Massachusetts plan. Mandates have been a central part of the political discussions on health care, with Democratic Presidential hopeful Barrack Obama being the only member of his party not proposing one.

SOURCE: "Penalties to rise for shunning insurance: State healthcare levy could exceed $900" 01/01/08
SOURCE: "Massachusetts Dept. of Revenue"
photo courtesy of koalie, used under this Creative Commons license

Federal Judge Says "No" To Employer Mandates in San Francisco

The gavel has fallen.

Today a United States federal judge has struck down a basic component of the ambitious San Francisco health care plan. The court ruled that employers cannot legally be forced to subsidize the plan. Lisa Leff of the Associated Press brings us the details:

U.S. District Judge Jeffrey White ruled Wednesday that the mandate, set to take effect on Jan. 1, would violate a 1974 federal law requiring consistency in the health coverage afforded employees who work for the same company but live in different jurisdictions.

"By mandating employee health benefit structures and administration, those requirements interfere with preserving employer autonomy over whether and how to provide employee health coverage, and ensuring uniform national regulation of such coverage," White wrote.

The ruling came in a lawsuit brought by the Golden Gate Restaurant Association, which argued that the mandatory contributions the city sought placed a costly burden on members already struggling to make a profit.

Healthy San Francisco, as the plan is called, was developed to provide access to health care for the city's poorest. The goal is to give 82,000 people access to clinics and medical services no matter what their employment or immigration status is. At this point 6,500 people are signed up for the program which began last July.

The estimated financial outlay for the plan is $200 million per year. To offset the expense city officials passed a law stating that:

Companies with 20 or more workers to spend at least $1.17 per hour toward each employee's health care. Those with more than 100 workers would have to pay $1.76 per hour up to a monthly maximum of $180 per worker.

Whichever way the appeal goes, this is going to be a very important case to watch for all of us who are concerned with the path of universal health care in the United States.

SOURCE: "Part of S.F. Health Care Plan Tossed Out" 12/27/07
photo courtesy of Brymo