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

The Return of Elizabeth Edwards: Health Care Sytem Immoral

Elizabeth Edwards has returned to the public health care reform discussion for the first time since last August when news of her husband's affair hit the media. She spoke in Philadelphia, PA, on the night of the 16th.

Melissa Dribben of The Philadelphia Equirer reports:

Speaking knowledgeably and with dollops of relaxed good humor, Edwards told the audience of 200 people at the National Constitution Center that the current health-care system is immoral and "fails everyone except the extremely wealthy."

Seated onstage in a plush chair, the 57-year-old wife of former Democratic presidential candidate John Edwards used her experience as a patient with incurable breast cancer to illustrate lapses in the current system. But she was careful to say that the responsibility lies both with individuals, who need to take good preventive care, and insurance companies, which should be concerned with long-term health instead of short-term savings.

As a sufferer of incurable breast cancer, Mrs. Edwards has a voice that commands attention in matters of health care reform. Her direct experience with the system provides a veracity that is seen as lacking on the part of many in politics today. Another factor is that she does not see either of the current candidate's plans for health care reform to be ideal, although she has no problem in stating which one is her preference.

Except for one subtle remark about the "Republican vice presidential candidate's" opposition to stem cell research, Edwards maintained a relatively neutral political stance. Neither presidential candidate is proposing the kind of universal and comprehensive coverage that Americans deserve, she said. But of the two, Edwards said, Democratic Sen. Barack Obama's plan, which would mandate coverage for children, will move the nation more in the right direction.

In addition to the statements above, she once more reiterated her opinions about John McCain's personal health issues and their impact upon his perspective in this matter. Sen. McCain's multiple melanomas have been treated under his military health plan, which provides extensive coverage even though most private insurance plans in the U.S. would deny coverage on these pre-existing conditions.

The debate continues to heat up, and one must wonder if the media eye will pay more attention to Mrs. Edwards' health care activism or the peccadilloes of her husband. John Edwards has stated that he will stay out of the public eye until after November 4 in order to keep from clouding the issues or distracting from the focus of the Democratic Campaign.

SOURCE: "Elizabeth Edwards calls health-care system immoral" 09/17/08
photo courtesy of ariedana used under its Creative Commons license

Be Bold!

As expected, I am not the only one to immediately jump on the figures presented in the most recent Commonwealth Fund Report. (See yesterday's post.) Chellie Pingree, Democratic nominee for the U.S. House of Representatives for Maine's 1st District and former Maine State Senate Majority Leader, has written a piece that not only looks at the figures, but puts them into a local context for her state. She also provides a call to action to politicians to be bold in their decisions when legislating on health care issues.

Chellie Pingree on The Huffington Post:

Access to quality, affordable health care is particularly important here in Maine, where many of us own small businesses or are self-employed. Many Maine families have put together a way to make a decent living (and often it includes more than one job) -- until it comes time to figure out how to pay for health care.

When I was in the Maine Senate and proposed Maine RX -- a plan to lower prescription drug costs by forcing the pharmaceutical companies to negotiate -- I was told by many people that it was too big an idea, and we couldn't overcome opposition from the drug companies. Those corporations certainly put up a good fight -- all the way to the US Supreme Court -- but in the end we prevailed.

The lesson is that, as elected officials, we shouldn't be afraid of a bold idea. More often than not, the public will already be there while the politicians lag behind. This new survey from the Commonwealth Fund provides the hard numbers to back that up: almost everyone believes we need to fundamentally overhaul or rebuild the system.

It is my belief that no matter what side of the political aisle you are on, the exhortation to be bold is one worth listening to. The health care system of the United States is obviously broken. This is not only common wisdom but extensively documented by a variety of sources. Universal coverage is something I would term a fundamental rebuild. Do you agree?

We need health care reform now. It is a mission critical issue for American citizens. George C. Halvorson said it very well, “It’s definitely time to bite the bullet on universal coverage. The ethnic, racial, and economic disparities in care that exist now ought to push us all into creating universal coverage at the fastest possible speed -- and the new opportunity to link universal coverage to real health care reform using electronic data about actual care delivery ought to give us a sense that the time to act is now.”

Your health is your greatest asset. Isn't it time to treat it as such?

SOURCE: "Healthcare System Overhaul -- 82% of Us Want It" 08/20/08
photo courtesy of jepoirrier, used under its Creative Commons license

Democrats: Health Care For All!

This weekend, the Democrats managed to reach consensus on a platform that "commits the party to guaranteed health care for all." Sen. Obama still adheres to his standing position about not mandating coverage, but finding ways to make it more accessible.

While Sen. Obama still declines to adopt a mandate as part of his strategy, the fact that this plank in the platform has been finalized brings the Democratic Party's overall stance closer to the the approach favored by Sen. Clinton.

Now that the Dems have settled on their stance, I'm sure this will be heating up on the campaign trail. Sen. McCain will now have definite targets for debate, and with the recent scandal over John Edwards' affair keeping his wife Elizabeth out of the ring, the Republicans must be heaving a sigh of relief.

Advisers in both the Clinton and Obama camps seem happy, and activists within the party are mollified enough to have dropped their tougher stance demanding a single payer system.

SOURCE: "Democrats adopt goal of health care guarantee" 08/09/08
photo courtesy of Steve Rhodes, used under its Creative Commons license

Write a Prescription For A Platform

Once again we return to the political side of health care, a side that will be instrumental in shaping its future one way or the other. Right now there is news of interest from the Democratic Party. They have come together to hammer out the details of the official party platform on health care.

Mark Silva at The Chicago Tribune's political blog, The Swamp, brings us the current incarnation of the wording:

The committee charged with crafting a platform for the Democrats agreed today in Cleveland to call health care "a shared responsibility between employers, workers, insurers, providers and government. All Americans should have coverage they can afford."

He also details a low-key tug of war between Obama's people and the Clinton camp concerning the proposed wording, with the Clinton side pulling for stronger language supporting shared responsibility among other things.

The wording agreed upon today is merely a draft, pending approval Saturday when it is presented to the full platform committee in Pittsburgh, PA. The final proposal will be presented to the Democratic convention on August 25 in Denver, CO. I wonder how many permutations it will go through?

SOURCE: "Health care: Democrats start writing Rx: Fulfilling the promise of 'universal health care,' that's the question." 08/03/08
photo courtesy of macwagen, used under its Creative Commons license

The Swiss Approach

One of the things George C. Halvorson stresses in Health Care Reform Now! is that we should look at the systems in place around the world that provide universal care. Not with the idea of adopting a foreign system outright, but rather in order to see what elements we might be able to adopt in order to create a truly American system responsive to our particular needs as a nation. That element of his approach came to mind for me early this morning while listening to NPR with my wife this morning over coffee.

This morning, they aired a program which delved into the way the Swiss system works, and it seems to me that there are a lot of things to consider in their way of administering health care.

Via NPR:

At first glance, Switzerland's health care system looks like it could be the perfect political compromise for the United States.

As Republicans would prefer, individuals — not employers or the government — choose from a broad array of health plans, sold by private insurance companies.

And as Democrats urge, everyone in Switzerland has health coverage (it's required by law), with the government providing generous subsidies for those who couldn't otherwise afford it.

NPR goes beyond that first glance and delves into the system in detail. One of their findings is important but hardly shocking: rising costs are a major issue. While Switzerland's 7.5 million people are very happy with the system as it stands they are not immune to the rising costs that are such an important issue during our own health care debate.

There are many things about their system that are appealing, and the public satisfaction level is unparalleled in the United States. One of the ways in which the Swiss operate (pardon the pun) is that insurers are not permitted to make a profit on basic health plans.

Where Swiss health insurers can and do make profits, however, is on supplemental coverage. This is for things like dentistry, alternative medicine (which is popular in Switzerland), and semiprivate or private hospital rooms. For 30 francs per month, Cecile and her husband have a supplementary policy that covers, "for example, all kinds of prevention, not-on-the-list medication, help at home, glasses, transport, alternative medicine. That's a good one," she says.

Jue Rovner's article for NPR is well worth the read. She speaks with a family that has lived both here in the US and in Switerland and are able to make direct comparisons between the two systems. One thing I found really interesting was the difference in mindset she reveals between the way the Swiss and Americans view the idea of social safety nets such as universal care. Cecile Crettol-Rappaz, one of the women interviewed, states it pretty succinctly:

"You are so used to having this individualistic way of thinking, and that's why you don't have these social [safety] nets. You still have this pioneer mentality where everyone has to take care of themselves."

All in all this is great source material for the debate. I wonder how much attention it will get over the next four months or so.

SOURCE: "In Switzerland, A Health Care Model For America?" 07/31/08
photo courtesy of Fr Antunes, used under its Creative Commons license

From Jersey To Arizona: Reform Legislation

From the Upper East Coast to the dry expanses out West, health care reform is making waves. As the ad campaign of Health Care For America Now! begins to roll out (see my earlier posting), the state governments of both New Jersey and Arizona are in the news because of their actions on this topic.

In the Northeast, we have New Jersey Gov. Jon S. Corzine who just signed a health insurance reform bill into law that includes an expansion of NJ Family Care, a source of low cost insurance options for those who are in need.

Via the Philadelphia Business Journal:

The legislation increases the number of low-income families who qualify for the program and phases-in mandatory coverage for all children in the Garden State. [...]

Corzine wants to see all New Jersey residents have health insurance by 2011.

"While there has been much national dialogue about universal health care, here in New Jersey, we're actually doing something about it," he said.

That quote should be making its rounds of the Internet soon. As always, only time will reveal whether the legislation will prove effective or if it's all just more sturm und drang. The concept is sound, but implementation seems to frequently fall victim to funding problems. Let us wish them well in their efforts. Any steps towards universal health care on the state level have the virtue of testing the viability of the approaches espoused allowing us to form a better picture of what a uniquely American system of universal care will end up looking like.

Now let us shift our view to Sen. John McCain's home state of Arizona. Howard Fischer of Phoenix's East Valley Tribune brings us an interesting story about a battle on the floor of the State House of Representatives.

House Minority Leader Phil Lopes, D-Tucson, said voters should reject an initiative being pushed by some doctors and others to constitutionally prohibit forced enrollment in either private or government-run health insurance programs. The measure also would bar any law which limits an individual's choice of doctors.

"They are trying to protect the system that I think everybody, most people, think is broken," Lopes said.

While Lopes has an interest in stopping this controversial legislation because it would disallow his own universal health care plan for the state, he still has some valid points. If Sen. Obama wins the race for the Oval Office, his proposed mandates, while only involving children, would be directly at odds with this proposed law.

Lopes supports a single payer approach centralizing the payment for health care services through the government. His opponents present an argument that resonates with many Americans, one of independent choice.

But Jeff Singer, a Phoenix surgeon and one of the architects of the initiative, said the measure is not aimed at any specific plan or concept. Nor is it aimed at halting what he said is necessary reform of health care.

"We just want to make sure that whatever kind of health care reform is ultimately instituted, that it doesn't infringe upon the rights of people to make their own decisions regarding what kind of plan they want to be in, or if they want to be in a plan, what kind of health care they want, what kind of doctor they want, whether they want alternative care, whatever," he said.

Emphasis in the above quote is my own.

While I am a fiercely independent individual myself, I have a feeling that enacting universal health care, or at least universal coverage, may well end up requiring mandates in order to ensure that everyone participates. The story above is one that should make everyone consider their exact feelings on the subjects of autonomy, choice, and universal care.

SOURCE: "N.J. 'doing something about' universal health care with law, Corzine says" 07/09/08
SOURCE: "Controversial measure aims to prevent universal health care" 07/08/08
photo courtesy of Alejandro the Great, used under its Creative Commons license

CEOs Talk National Health Care Reform

Whitney Jackson, a reporter for Medill News Service, had an interesting article in the Austin Weekly News recently in which she took a look at the outcome of a recent meeting of movers and shakers in the Health Care Industry:

CEOs from many leading health organizations met in Chicago Tuesday to unveil their consensus plan for national healthcare reform, which calls for increased accessibility and affordability, as well as quality care for all Americans.

The executives, representing the Healthcare Leadership Council, are set to discuss their proposal with U.S. Senate and House committee leaders. The executives said they hope it will impact the Democratic and Republican political campaigns and decisions of the next president.

"I don't think any of [the presidential candidates] have it right," said Denis Cortese, president and CEO of Mayo Clinic. "None of them are really addressing the issue of what we're going to do with the total [health-care] delivery system-how are we are going to generate [quality]? How we reward it?"

This is a very important question considering the perverse nature of financial incentives in the current system -- once again returning us to the refrain "9,000+ billing codes for procedures, no teven one for a cure." Quality of care, not quantity of care, is an area that needs emphasis right now. As Cortese said in his interview:

The most broken aspect of U.S. health care, he insisted, is that "we are paying the most amount of money for bad outcomes, bad safety, bad service, no integrative [and] coordinated care. That's partly why our expenditures are just going up and up and up."

It was not just Cortese speaking up, though. The press conference last Tuesday included a variety of luminaries from the health care field including Mark Neaman, President and CEO of Evanston Northwestern Healthcare; Colleen Conway-Welch, Dean of the Vanderbilt School of Nursing; Mary Grealy, President of the Healthcare Leadership Council; John Hammergren, Chairman and CEO of McKesson Corp.; and Ronald Williams, Chairman and CEO of Aetna.

Points focused on during the press conference included the following concepts central to the reform effort: Every American should have access to health coverage; improve the quality of care through a combination of innovation and sharing of medical knowledge; a fundamental change in the financial incentives used within the industry.

A sound game plan in my opinion.

SOURCE: "Health care industry CEOs offer reform plan: Executives call for more insurance options for consumers" 05/14/08
photo courtesy of Mike Schmid, and used under its Creative Commons license

Women In Massachusetts: Left Behind?

The Boston Herald's Eva Wolchover brings to light and interesting angle on Massachusetts' attempts at universal health care, namely that it fails to provide affordable or adequate heath care for women. A Suffolk University report titled “Women and Health Care Reform in Massachusetts” by Professor Susan Sered is the source of the data:

“Women use the health care system far more than men do,” said Sered. “They use it on behalf of their families, their children, their elderly family members, etc. As we began to interview women we found that some of them couldn't use their insurance because they couldn't afford their co-pays.”

Women largely neglected by the reform bill, she said, include those in the moderate-income bracket; immigrant women, who if undocumented are left out all together; late-middle aged-women once covered under a spouse’s plan; and young adults.

Moderate-income women earn too much to qualify for Commonwealth Care but cannot afford private coverage, Sered said. Young women are lured by low premiums under the Young Adult Plan but are then strapped with vastly expensive co-pays and deductibleswhen the need for care does arise.

The article juxtaposes Sered's study results with a single woman's case. The single woman in question is one who does benefit from the system currently in place. While her story is compelling, it is the story of only one woman. While she is almost certainly not the only one of her gender benefiting from the Massachusetts approach, Sered's study does raise some disturbing questions about how many woman actually do.

Give it a look and tell us what you think.

SOURCE: "AWomen's Care Lags" 04/13/08
photo courtesy of The Alieness Gisella Giardino23, used according to its Creative Commons license

Mind The Gap: The Insurance Gap

Michelle Singletary shares her perspective on why the plight of the American uninsured affects all of us in her column for The Courier-Journal in Louisville, KY:

The cost for those with coverage is escalating in part because the number of uninsured Americans keeps rising, said Ron Pollack, executive director of Families USA, a nonprofit organization that advocates high-quality, affordable health care for all Americans.

Using data from the Census Bureau, the federal Agency for Healthcare Research and Quality, and the National Center for Health Statistics, Families USA determined that the unpaid expenses for the uninsured added an average of $922 in 2005 to the premiums for employer-provided family health insurance. That extra cost could rise to $1,502 in 2010.

Increasingly, employers are shifting a larger portion of their health premiums to employees. You may be able to afford your policy today, but it's possible you may not in the future.

In pure and simple terms, the unpaid balances do not disappear. Instead, they get added to the balances paid by those with insurance. It is not exactly a slow process either. Singletary reports an increase of 78% in family premiums just since 2001!

She also explodes the myth that the uninsured are mostly poverty stricken. According to her reports, eight out of ten are employed, often at multiple jobs just trying to make ends meet. They are workers who fulfill important roles in our communities as caregivers and in small businesses.

The plight of the uninsured does not occur in a vacuum. Its economic impact alone touches every American in every socio-economic strata.

SOURCE: "Health-care insurance gaps affect all of us" 03/30/08
Photo courtesy of fabio, used under its Creative Commons license

Coverage and Care: Two Very Different Things

Monday provided us with a wonderful opinion piece in The Philadelphia Enquirer. It was written by a physician and lawyer who is also a visiting scholar at the Georgetown University Law Center named Caroline Poplin.

Have you noticed that presidential candidates assume that universal health insurance means universal health care? They use the terms interchangeably. They assume that once the law enables or requires everyone to buy health insurance, everyone will have adequate health care.

But anyone who has been seriously ill or cared for a sick relative knows that while health insurance may be the solution, too often it is part of the problem.

In fact, health insurance and health care are two different products for two different markets. Health insurance is for healthy people. Health care is for the sick. What we need to lead full, productive lives is good health care.

Dr. Poplin goes on to address the oft invoked example of auto insurance. While it has come up repeatedly in debate, I am not aware of a more concise comparison than the one presented here.

There was a time when health was like driving. Illness or injury was sudden, unpredictable and brief. You either recovered, or you died. Medical care was not expensive, and (surgery apart) not terribly effective. Insurance did not cover doctor visits for minor problems or for physicals, any more than car insurance covered routine repairs.

Since then, medicine has been transformed. Many people no longer die from heart attacks, pneumonia, cancer, even HIV/AIDS; they may live many years if they are treated promptly, aggressively and often long-term.

These patients are no longer average drivers. They have "pre-existing conditions" and are thus at high risk for predictable, serious, expensive, often chronic complications. A diabetic patient is at high risk for heart attacks and kidney failure. Many cancer patients are at high risk for pneumonia. Even someone with uncomplicated high blood pressure is at increased risk for heart attack and stroke.

Commercial insurance was never designed for situations like this. No one sells flood insurance for a house that regularly floods.

So insurers routinely exclude pre-existing conditions from coverage. Most commercial health insurance, like car insurance, is intended for one-time, unpredictable expenses.

But people with pre-existing conditions, the chronically ill, are exactly the people who need health care the most. They can get it now only if they qualify for public programs like Medicare, or they work for large employers who can spread their expenses over a large, mostly healthy, workforce. The chronically ill are disproportionately uninsured.

Since five chronic diseases account for 75% of all health care expenditures, this should be cause for alarm. As noted in Health Care Reform Now!, management of chronic conditions is cheaper by several orders of magnitude than emergency room visits. Asthma, for instance, requires only a few hundred dollars per year to manage, but one ER visit caused by an asthma attack can skyrocket past the $20,000 mark.

SOURCE: "Health insurance and health care are not the same" 02/25/08
photo courtesy of takomabibelot, used 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

A Libertarian Defense of Universal Coverage?

One way to get a person's attention is to hit him or her where it hurts: in the pocketbook. The average American's attention is now on health care reform for that exact reason. Over recent years, increases in the cost of insurance have far outstripped the pace of inflation and put the squeeze on the middle class and the working poor.

Today we will visit two sites in the Blogosphere that have definite opinions on the matter, each coming from different sides of the political spectrum. Lets start with the Daily KOS where the contributor known as HeartlandLiberal gives us a real world example of the rising expense of health care (Note: emphasis his):

This year the IMA medical services group here in Bloomington, IN, is threatening to withdraw from participation in the preferred provider program run by Anthem and used by Indiana University to manage its self-insured health care program through rational cost controls. They will withdraw unless they get a 23% increase in payment. THAT'S A DEMAND FOR A 23% INCREASE IN ONE YEAR.

Indiana University (IU) has a long and distinguished history of offering health care benefits well beyond the norm for the United States, even in the private sector. Click the link above to see the whole post as it includes a reproduction of the detailed memo sent to IU staff.

Then we bounce over to the other side of the ideological divide and visit the American Thinker web site where Randall Hoven, a self professed small government conservative/libertarian, offers a surprising argument in favor of universal health coverage along with detailed health care cost analysis.

The government provides Medicare for the old, Medicaid for the poor, veterans' hospitals for veterans, medical research funding and whatever else adds up to 6.6% of GDP. The federal government forces hospitals to provide emergency treatment to all comers. State governments mandate over 1,900 types of coverage on health insurance. Health care regulations cost the average household over $1,500.

We already have socialized medicine and we are already paying for it -- twice: once in taxes and once privately. What we are not getting is universal coverage.

But if universal care (via emergency rooms) is already mandated, what's the problem? First, it is not the best way to get treatment. For one thing, the condition has to be regarded as a medical emergency. Also, the law does not relieve you of having to pay for that treatment. In fact, medical bills are the leading cause of bankruptcies in the U.S., accounting for half of them.

So while you might not die, the U.S. health care system does give you the age-old offer of "your money or your life".

He presents a wide array of figures and documentation to back up his argument, giving lie to the idea that universal coverage is a left wing issue. As George Halvorson notes in his book, Health Care Reform Now!, universal coverage done right doesn't cost money, it saves money.

As an addendum, here's a link to the National Coalition on Health Care's document, Health Insurance Cost, an easy-to-read summary of health care costs based on 2005 data -- the most recent year for which data is available. Healthy reading!

SOURCE: "23% Increase Demand. Why We Need Health Care Reform" 12/11/07
SOURCE: "A Conservative Case for Universal Health Coverage" 12/12/07
SOURCE: "Health Insurance Costs"
photo courtesy of greefus groinks, 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

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

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

Clinton Care Chaos

The media and blogosphere are abuzz about what many are calling "HillaryCare 2.0." The presidential hopeful laid out her approach to health care reform yesterday in Iowa. It was shortly afterwards that her new ad debuted.

The attacks and analyses began immediately, with a frequent refrain being about Clinton's stance on the insurance companies. Clinton makes many references to not allowing the insurance companies to control health care prices. That adversarial tone is seemingly quite at odds with the way her plan is being assessed in some quarters. This excerpt from The Nation is a good example:

The Clinton plan maintains the current system of for-profit, insurance-industry defined health care delivery. The only real change is that, in return for minimal requirements regarding coverage of those with preexisting conditions, the government would pump hundreds of billions in federal dollars into the accounts of some of the country's wealthiest corporations. The plan's tax credit scheme would buy some more coverage for low-income families, which is good, but it would do so at a cost so immense that, ultimately, Clinton's plan will be as tough a sell as the failed 1993 "Hillarycare" proposal.

America is ready for health care reform.

But it is not ready for more bureaucracy, more expense and more revenue for insurance companies.

Criticism abounds from all sides of the debate with both Republicans and her fellow Democrats rushing to add their own critiques. Does this avalanche of criticism denote a defensive posture amongst her detractors?

ABC News summarizes the reactions from other candidates and comments on the overall state of the playing field:

Clinton's plan is "European-style socialized medicine" (Mitt Romney); straight out of Michael Moore's "Sicko" (Rudy Giuliani); an "imitation" advanced by a flawed saleswoman (John Edwards); inadequate and advanced by a flawed saleswoman (Barack Obama -- but how would he cover more people without requiring coverage?); and automatically bad because Clinton herself "set back our ability to move toward universal health care immeasurably" back in 1994 (a very aggressive Chris Dodd).

All the attention is a form of flattery; just about any other candidate would have had himself hospitalized (maybe even in Cuba) to be attacked like this when he offered his plan. The obsession with "Hillarycare 2.0" speaks to the control that Clinton exerts over the entire field, as the one person who at this moment looks like she has the best shot of being elected president (and who represents the match-up the Republican base craves the most).

SOURCE: "Clinton's Prescription for Another Health Care Reform Failure" 09/17/07
SOURCE: "Hillary '07 Battles Hillary '93" 09/18/07
photo courtesy of valentinapowers on Flickr.

AFL-CIO Continues Push for Health Care Reform

The American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) announced yesterday that they will begin working towards a late 2009 goal of universal health coverage. The labor organization has 10 million members and 3 million retirees. It plans to recruit at least 1 million of these members for a grass-roots push for universal coverage.

Patrick Howington of The Courier-Journal in Louisville, KY, writes:

The labor organization said it isn't backing a particular presidential candidate or a specific health-care proposal, but it outlined the features a national health-care system should have: It should control 'rising and irrational' health-care costs, provide comprehensive high-quality care to all, and preserve the right to choose your own doctor, among other attributes.

SOURCE: "AFL-CIO Starts Push for Universal Health Coverage" 08/30/07
photo courtesy of cursedthing on Flickr used under the Creative Commons license

California Health Care Battle

In a much watched battle Republicans and Democrats in California are squaring off on the subject of universal coverage for the state's residents.

Governor Arnold Schwarzenegger's plan would impose new fees on employers and medical providers while making coverage mandatory, although subsidized for the poorest. The Democrats, who control both houses of the Legislature, have proposed an alternative that would require an employer contribution almost double that of the governor's proposal.

Via Forbes:

"The governor and the Legislature are inches apart, but neither side wants to give that final inch," said Larry Levitt, a vice president with the Kaiser Family Foundation.

SOURCE: "Schwarzenegger Tries To Save Health Plan" 08/29/07
photo courtesy of Benjamin Earwicker

posted on behalf of George Williams

Wyoming Senator Helps Advance Health Care Reform

In the Casper Star Tribune today, Tom Morton writes about the chairman of the Senate Committee on Health, Education, Labor and Pensions, Edward Kennedy, a Democratic Senator from Massachusetts. The senior Senator from Wyoming, Republican Mike Enzi, previously held the position. Kennedy is entrusting Enzi "to grapple with the finer points of health care reform," according to Morton.

[...] instead of promoting a single comprehensive health care reform bill that could die by a thousand cuts, [Enzi is] promoting 10 different bills, he said.

They include allowing small businesses to band together and cross state lines to obtain group health insurance; allowing individuals to buy into group programs; and fostering coordinated health care technology.

The latter bill would save upward of $160 billion a year, he said. Individuals would have their records on a card that would eliminate the need to fill out multiple forms and inform physicians of previously performed tests to avoid duplicate testing [...]

The committee has been soliciting input from experts, "and has encouraged them to incorporate each other's ideas as it crafts legislation."

SOURCE: "Enzi, Kennedy Join Forces to Reform Health Care" 08/21/07
photo courtesy of "scol22, SXC"