The Veterans Health Care Budget Reform Act

Even though my father is deceased, I still remember the trials and tribulation he underwent during the years following Viet Nam. Suffering a 100 percent disability, he logged many hours with doctors and even more in attempting to deal with the complexities of the way we handle the health care of our country's veterans. Despite attempts to make sure that I heard none of it, I often overheard discussion between my parents about the troubles they constantly had with delays and shortfalls in the system.

Enter a few courageous U.S. Senators and Representatives and The Partnership for Veterans Health Care Budget Reform.

This partnership, which represents almost 8 million members, came out last Thursday in support of legislation presented in Washington by Senate Veterans' Affairs Committee Chairman Daniel Akaka (D-Hawaii), House Veterans' Affairs Committee Chairman Bob Filner (D-Calif.), and a variety of bipartisan co-sponsors to introduce major and historic reforms in veterans health care. Focusing on budget reform, the goal is to provide "sufficient, timely and predictable funding for veterans' health care programs."

The partnership itself is a group comprised of AMVETS, Blinded Veterans Association (BVA), Disabled American Veterans (DAV), Jewish War Veterans (JWV), Military Order of the Purple Heart (MOPH), Paralyzed Veterans of America (PVA), The American Legion, Veterans of Foreign Wars (VFW), and the Vietnam Veterans of America (VVA).

Via MarketWatch:

The new legislation, called the "Veterans Health Care Budget Reform Act", would authorize advance appropriations for Department of Veterans Affairs (VA) health care programs one year in advance of the start of the fiscal year, an idea favored by more than 80 percent of American voters, according to a survey released today by the Disabled American Veterans.

The Veterans Health Care Budget Reform Act would also require the Government Accountability Office (GAO) to audit VA's budget forecasting model and report to Congress and the public on the integrity and accuracy of the model. With these estimates in hand, Congress would be greatly enhanced in their ability to develop and enact sufficient funding levels for VA health care.

"While funding levels have increased in recent years, particularly over the past two years, Congress has failed to approve a new VA appropriation bill on time for 19 of the past 21 years," said DAV Commander Ray Dempsey. "Our polling results show that the American people overwhelmingly support a proposal to have Congress approve VA's health care funding one year in advance to once and for all end these delays," Commander Dempsey said.

If this works, it should drastically reduce the number of conversation like the ones my parents did not want me to hear. No matter what opinion one may have of the various wars and conflicts in which these men participated, the fact remains that they fought to protect us here at home. We owe them the best we can offer.

SOURCE: "Historic Legislation to End Delays in Veterans Health Care Funding" 09/18/08
photo courtesy of NARA via pingnewsused under its Creative Commons license

Health Care Navigation

Health care. If you cannot access it, it does you no good. This is one of the driving principles of overall health care reform. It has been a frequent theme that millions of people lack this access due to lack of health care coverage. It has also been consistently touched upon that people in rural areas experience a lack of access due to lack of proximity to health care facilities. These are not the aspects of health care access that I will be covering today.

Instead, I would like to draw your attention to the disparity in access experienced by ethnic minorities. Lisa Risetta at The Salt Lake Tribune reports on a new way to help equalize this imbalance:

[Harold] Freeman conceived the patient navigator - a new kind of health care worker who would steer patients through the complexities of the health care system.

Today, Freeman's navigators are seen as one solution to America's well-documented racial and ethnic disparities in medicine. Federal health officials are spending $75 million to test patient-navigator pilot programs around the country, including one that spans Utah and Montana and aims to help American Indians.

American Indians and Alaska Natives, both men and women, continue to have the country's poorest five-year survival rates for most kinds of cancers.

Poverty is one factor here; understanding is another. In the Byzantine processes of the contemporary system, those who speak English as a native language are often confused. Those for whom it is a second language can find it impenetrable. It does no good to see a doctor and be unable to understand or implement his instructions. Navigators help to ease the confusion and encourage participation in the system, improving the overall outcome for many.

SOURCE: "Navigators help minority patients overcome barriers in medicine" 09/19/08
photo courtesy of girl_named_fred, used under its Creative Commons license

Booster Shots: Compare and Contrast

Susan Brink at the LA Times is a jewel! As the blogger for their Booster Shots health care blog, she certainly delivers the goods. I have often stated that self-education on health care matters is incredibly important and have tried to provide the best resources possible for those doing so.

As I was Googling around this morning, compiling resources for a post full of comparative analysis, I stumbled across her column from September 17 which is chock full of them. Instead of re-inventing the wheel, today I am going to showcase this neutral, concise, and fact-filled collection of information with you, our readers.

I must confess, I do love her "no nonsense approach" as evinced in the intro to her Booster Shots piece:

Don't say you didn't know, or can't understand, the presidential candidates' plans for dealing with America's healthcare crisis. Don't say you don't get how they might affect you. It's all out there, analyses from independent, nonpartisan groups as well as from very partisan groups. You can have a quick, thumbnail, side-by-side peek at how each candidate sees the future of healthcare. Or you can dig into papers examining the economic and societal impacts of each plan.

She hits a vast array of resources both partisan and non-partisan beginning with the candidates' own campaign websites. She throws it all out there for you in a few short paragraphs replete with pertinent hyperlinks.

Another thing I really appreciate is her neutrality on the subject:

The bottom line from the healthcare economists who examined each candidates' proposal is that the Obama plan won't curb the escalating costs of healthcare in the U.S., the most expensive system in the world. And McCain's plan won't reduce the number of uninsured, and likely would increase their ranks.

I highly advise bookmarking this one, go give it a read!

SOURCE: "McCain, Obama health plans critiqued" 09/17/08
photo courtesy of happysnapper, 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

Health Care, Politics, and Disputed Numbers

It is to be expected that the claims made by political candidates will not only come under scrutiny, but also be hotly disputed across the board. So it is in the 2008 Presidential Campaign. Since universal care is within reach depending on circumstances, it behooves us to take a good look at the claims being made.

Kevin Sack, who blogs on The Caucus (The New York Times' political blog), brings us one of the aforementioned disputes in the form of quotes from the McCain camp juxtaposed against a panel of economists:

Senator John McCain’s top domestic policy adviser, former Congressional Budget Office director Douglas J. Holtz-Eakin, recently said in a conference call with reporters that Mr. McCain’s health care proposal would “put 25 to 30 million individuals out of the ranks of the uninsured, into the ranks of the insured.” In an article released Tuesday, a panel of prominent health economists concludes that Mr. Holtz-Eakin’s projection is off by, well, 25 to 30 million.

The McCain strategy, as unveiled so far, includes removing the tax exempt status of employer-provided health care while counterbalancing it with individual tax credits to make purchasing individual care less burdensome.

Within a few years, however, the trend would reverse, the study asserts. That is because, according to Mr. Holtz-Eakin, the McCain health care tax credits would be indexed to “regular inflation,” presumably the Consumer Price Index, which is typically lower than annual increases in health care costs. Unless costs can be substantially reined in, the credits would therefore enable fewer people to afford coverage each year, leading to an eventual rise in the number of uninsured.

Their findings agree with those of the Urban Institute and the Brookings Institution last July which also predicts initial effectiveness followed by a steady upward creep in the number of uninsured. According to The New York Times, Holtz-Eakin did not respond to their request for a comment.

SOURCE: "Journal Disputes McCain’s Health Care Claims" 09/16/66
photo courtesy of SoggyDan, used under its Creative Commons license

Senate Finance Committee: Health Care Incentives and IT

Last Tuesday, a Senate Finance Committee hearing saw health care experts calling for adoption of health IT, an overall increase in transparency and pay-for-performance programs to improve care and reduce costs.

These are two issues that we have returned to over and over during the course of this blog. The current incentive system in place is, as George C. Halvorson put it in Health Care Reform Now!, perverse. A move towards performance-based metrics and payments is something that could go a long way towards re-aligning the cumbersome and costly approach used today. Health care IT is well known as a means of not only trimming down administrative costs but also as a way to increase efficiency and eliminate a majority of duplicate testing and paperwork-driven errors.

Via Healthcare IT News:

"We believe that aligning financial incentives is the right approach to pushing quality to a higher level," [Greg] Schoen [MD, regional medical director of Fairview Northland Medical Center in Princeton, Minn.] said. "By creating a positive incentive to improve quality, pay-for-performance is an engine for improvement and can be a framework for fundamental transformation."

He is far from the only one bringing these views to the Senate. Samuel R. Nussbaum, MD, executive vice president of clinical health policy and chief medical officer at WellPoint, Inc., was also present and vocal as was Peter V. Lee, executive director of the National Health Policy at the Pacific Business Group on Health.

Also via Healthcare IT News:

Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee said he would hold two more healthcare reform hearings this year.

With healthcare spending outpacing the overall economy and inflation, "we simply cannot afford to continue paying for inappropriate or inadequate medical care," he said.

The time is right for change. We have labored too long under the non-system that currently holds sway. All of the differing elements needed are aligning to make this the perfect time to implement true reform of American health care. Now.

SOURCE: "Experts push transparency, P4P, and healthcare IT for healthcare reform" 09/10/08
photo courtesy of Marion Doss used under its Creative Commons license

I.T. is It!

John Engler, President and CEO of the National Association of Manufacturers and former governor of Michigan, has a wonderful piece up on The Hill right now about the importance of health care Information Technology and the legislation supporting its implementation.

As the immediacy of skyrocketing gas prices and the economic instabilities of 2008 seem to have overshadowed health care in much of the political discussion surrounding the race for the White House, Mr. Engler reminds us of the importance of the long view.

We have covered the reasons why electronic medical records and other forms of health care IT are a necessary part of the overall equation on many occasions. What Mr. Engler reminds us is why it is imperative to push legislation through Capitol Hill immediately:

On Sept. 8, over 100 associations, businesses, unions, patient and provider groups signed a joint letter to Congress urging passage of health information technology legislation this year. Health IT has overwhelming bipartisan support in both the House and the Senate, and yet the American people are still waiting for Congress to act. [...]

The life-saving, cost-reducing benefits health IT legislation can deliver to the American public make its passage imperative this year. Next year, a new administration will take office and, in the shuffle, health IT legislation could stall, forcing Americans to wait even longer.

Once the transition to a new administration begins, many things will be in flux. One thing that will not change is our moral imperative as a nation to ensure access to health care and coverage to our fellow citizens.

Please take a moment and read Mr. Engler's piece and refresh your knowledge of exactly why this is such an important issue.

SOURCE: "Don’t let health IT legislation flatline " 09/11/08
photo courtesy of Paolo Margari, used under its Creative Commons license