Health Care Reform Research on Election Day

Okay, folks. As someone who has become addicted to using his iPhone for web surfing when stuck in lines, I'm going to provide an election day resource list for those of you doing just that. Here are some of the pertinent pages available online so that you can do any last minute research while waiting for your opportunity to be part of the process. With record level voter turnout expected, and long lines across the nation during early voting a few days ago, I am willing to say it's a safe bet you may find some time on your hands.

• Scott Whipple of The New Britain Herald takes a look at likely outcomes for health care should either side win. [link]
• Channel 6 Action News, an ABC affiliate, provides video comparing the candidates' plans. [link]
  
• Paul Krugman compares the plans in an Op-Ed for The New York Times. [link]
• The AP Fact Check article by Calvin Woodward covers many issues as well as health care [link]
• The Kaiser Family Foundation's Daily Health Policy Alert [link]

Let us hope that we all have the opportunity and the motivation to participate in this election. No matter which way things go, it will have a drastic impact on health care for every American. In the meantime, I hope that some of today's post is useful for the iPhone, Blackberry, and Google Phone set!

Thank you for being part of the process! Let us hope for a healthy four years!

photo courtesy of SanFranAnnie used under its Creative Commons license

Will Health Care IT Get a Leg Up Under the New President?

One thing that both of our current contenders for the Oval Office have in common is the fact that they both support the use of information technology to help fix our broken system. Since every poll I have seen for the past year agrees that reform is vital, and this approach is one that is central to George C. Halvorson's views on the subject, I would say this is a very good thing.

For analysis, I would like to avoid the usual round of health care publications and instead take a look at Information Week where Marianne Kolbasuk McGee is at it again -- writing intelligent and insightful commentary about IT and health care, that is.

Regardless of the outcome of the presidential election, there's potential for a lot of change in the health care industry in the next four years. Barack Obama and John McCain have very different visions when it comes to health care reform, but there is one thing they both have in common, and that's an emphasis on using technology to digitize patient records and eliminate paper-based processes that are inefficient, redundant, costly, and potentially deadly.

Now we all know that implementation of these sort of systems is a costly scenario, one that many providers balk at. As we watch the bizarre and disturbing ups and downs that Wall Street and the economy have been undergoing, one could easily assume that costly measures like EMRs would be back-burnered while other more seemingly pressing issues get funded.

At least one Senator disagrees:

"We need to make money available for direct grants" and via other avenues to promote the deployment of IT in health care, said Massachusetts Sen. John Kerry (and Democratic presidential nominee in 2004) during a keynote speech in Boston yesterday at a technology symposium put on by the Center for Connected-Health, a division of Partners HealthCare, which operates several Boston area hospitals, including Mass General and Brigham & Women's.

Health care reform can't be deferred by the weak economy because health care is such a big part of the economy -- or $1 out of every $6 dollars spent in the United States, says Kerry. Addressing the health care system's big cost issues will "help the economy move," he says.

One-sixth of the economy. A perversely incented system, to use Mr. Halvorson's words, that is rife with redundancies and top heavy with bureaucracy is one sixth of the American economy. This fact alone should help put things into perspective. For an excellent summation of the situation and the options before us, go take a quick moment and read Ms. McGee's latest. As always, it is a highly informative gem of a column!

SOURCE: "Could Health Care IT Get A Boost Next Year?" 10/28/08
photo courtesy of Violator3, used under its Creative Commons license

The Obama Plan: Economists Speak Out on Forbes

Forbes brings us an interesting piece by a pair of research associates at the National Bureau of Economic Research. The topic, unsurprisingly, is health care and the approach taken on the subject by the Democratic nominee for U.S. president.

The first of the pair, David M. Cutler, is the Otto Eckstein professor of applied economics at Harvard's Department of Economics and Kennedy School of Government, and is also an adviser on health care to Barack Obama. I think we can guess what side of the issues he comes down on. The second one, J. Bradford DeLong, is a professor of economics at U.C. Berkeley.

Between the two, they have crafted a exploration of why their chosen candidate is the one who can save the current health care system. I'm just going to point out two ways in which Sen. Obama's plans agree with our own George C. Halvorson's analysis of the current health care crisis.

First, let's take a glance at one of my favorite topics, Electronic Medical Records. Via the Forbes article:

One element of reform is information: Doctors, patients and administrators simply do not know enough about which treatments work and which are ineffective or harmful. An estimated one-third of medical costs go toward care with no value. Obama proposes to jump-start the long-overdue information revolution in health care with $50 billion to computerize the medical system and spread the word about best practice.

If you have any questions on why this is important, I suggest using this blog's internal search function and looking for "electronic medical records." I have written extensively over the past year on the subject from a variety of angles. Let it suffice to say that administrative costs -- the dreaded paperwork that elicits groans from almost everyone -- is one of the areas where spending can most easily be curtailed. To make it a true win-win scenario, doing so will increase efficiency of treatment across the board.

A second element is to fix perverse incentives in medical care. Doctors and hospitals today are paid for performing procedures, not for helping patients. Insurers make money by dumping sick patients, not by keeping people healthy. Obama proposes to base Medicare and Medicaid reimbursements on patient outcomes in a coordinated effort to drive the entire payment system toward paying for improved health rather than just more care.

Perverse incentives is exactly the way Mr. Halvorson puts in in his book, Health Care Reform Now!. There is a vital need to switch from the pay by treatment attitude to results-oriented incentives. With over 9,000 billing codes, there is not one for a cure. That speaks volumes.

The article goes on to cover other health care issues that we return to consistently here: the massive importance of prevention, accessibility of care, affordability of coverage, and more. A very nicely presented piece, and since it is penned by economists, it is of additional interest as we watch the DOW bounce up and down like a rubber ball.

Good reading!

SOURCE: "Obama Can Cure Health Care's Ills" 10/28/08
photo courtesy of bobster1985, used under its Creative Commons license

Oval Office: One Week Away

It is one week until Americans everywhere cast their vote for the future of our nation and the future of its health care system. This is an historic year and one in which the choices we make are of incredible importance.

With that in mind, I'd like to point you towards a piece from USA Today that is great for an overview of the candidates' plans. Composed by the publication's editors, it endorses a strongly bipartisan approach similar to the one that Sen. Ron Wyden has proposed.

Nonetheless, it does help dispel some of the fog of rhetoric that has surrounded the claims on both sides since the election cycle began. Citing highly pertinent, impartial sources like The Annenberg FactCheck and the Kaiser Family Foundation, and deconstructing the media/advertising spin, it does a pretty concise job of laying everything out for the thoughtful voter.

Ultimately, the best health care plan might combine elements of both McCain's market-based reforms with mandates to make sure that everyone has access to coverage. Given how contentious the campaign has been, that might seem far-fetched. But Sen. Ron Wyden, D-Ore., has a plan to do just that.

Even if Democrats pad their congressional majorities on Nov. 4, many of the tough issues that this nation faces won't be solved without bipartisanship. Health care reform is no exception.

Certainly well worth examining. Follow the Fact Check link when you read it.

SOURCE: "Health care Rx: Mix up McCain's and Obama's plans" 10/27/08
photo courtesy of Jeff Milner, used under its Creative Commons license

Candidates Claims Under The Magnifying Glass

Yesterday, we looked at what the American people seem to think of the candidates and their approaches to health care reform. Today, we will be looking at both the things that have been distorted by each side and what the experts have to say about the effectiveness of both proposals.

Unlike prior generations, we are inundated with media at every turn: radio, TV, Internet and, with increasing frequency, mobile devices. This not only allows extensive opportunity to be exposed to each side's position but also allows access to numerous non-partisan groups that exist solely in order to get to the substance beneath the glitz. One of my own personal favorites is the Annenberg Political Fact Check.

On the October 14, the Anenberg crew produced their own analysis of the candidates' plans, the mis-statements used to sell them, and the input of a variety of health care experts concerning the contents of said plans. I highly advise checking out the detailed analysis, but for the general edification I will include their summary statement here:

McCain and Obama have sharply different health care plans, and each has made sharply worded attacks that are either false or misleading. McCain proposes a market-based system that relies on tax incentives, which one Obama ad falsely characterizes as the "largest middle-class tax increase in history." Obama proposes new subsidies to expand private insurance coverage and some expansion of government insurance, which McCain falsely claims "will rob 50 million employees of their health coverage."

Neither candidate has offered enough specifics about his plan to allow experts to assess the cost or impact without making various assumptions. Studies agree generally, however, that Obama’s plan would cover more of the uninsured than McCain’s would.

The original piece includes archives of pertinent campaign advertisements, point by point breakdowns of what the candidates have said on the subject, and the results of numerous fact finding polls and studies. As always there is a full bibliography of sources and all claims are hyper-linked to the supporting documentation.

Happy Reading!

SOURCE: "Health Care Spin - McCain and Obama each make false claims about the other's health care plan. We sort through the misinformation." 10/14/08
photo courtesy of Okko Pyykko, used under its Creative Commons license

Who Do the Voters Prefer on Health Care Reform?

The big question -- when not discussing the economy -- is who will win the U.S. presidential race this year. It is an historic ticket of each side of the aisle combined with a colorful, and at times shocking, stage show before the media. Discussion of which way things will go is far beyond propriety for this blog to address.

What we can address and investigate is the positions of these two fine men on health care's future course. Today, thanks to a poll recently released, we can take a quick pulse on the American public and see how they feel about the proposals put forth by the White House hopefuls via News-Medical.net:

According to a report released today by the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health, the majority of likely voters polled selected Obama as their top presidential pick to handle the country's biggest health care issues, including the high cost of health insurance, and the millions of U.S. adults and children without insurance.

One deviation from that was found amongst voters over the age of 65 who felt McCain has a better grasp of the prescription drug cost issue. Other than that, those polled generally show a marked leaning towards Obama's proposed handling of the health care crisis. Here are some of the numbers from the report broken out by health care issue:

• Health insurance is too expensive for families. The vote: McCain (38 percent) / Obama (62 percent)
• Many people can't afford prescription drugs. The vote: McCain (43 percent) / Obama (57 percent)
• Millions of children are uninsured. The vote: McCain (35 percent) / Obama (65 percent)
• Millions of adults are uninsured. The vote: McCain (35 percent) / Obama (65 percent)
• Some people get lower quality of health care than others. The vote: McCain (38 percent) / Obama (62 percent)

On this subject, it would seem that the Democratic Party is much more in line with the will of the (polled) people. Only time will tell how much influence that will have on the final election outcome. I would suspect that a lot of it will ride on the news about the economy. After all, it was the meltdown on Wall Street that bumped health care down the priority list of the American public. Extreme good or bad news on the economy will profoundly affect how much impact this data ends up having.

For the complete report and a podcast about its results, go visit C.S. Mott Children's Hospital National Poll on Children's Health.

SOURCE: "Voters pick Obama to tackle nation's health care problems" 10/13/08
photo courtesy of Torley, used under its Creative Commons license

Coin: Democrats Press Health Care In Ads

Well, well, well. While I was writing yesterday's post, the Obama camp was delivering the second part of a one-two punch comprised of advertisements focused on health care. We saw the first one in my last post; now the Dems have aired another ad entitled "Coin."

Martina Stewart, an associate producer for CNN's Political Ticker blog, has a great resource addressing the divergent positions taken by the candidates. Her Political Ticker post made on October 5 not only give a synopsis of the commercial along with a video link, but also includes some great responses and rebuttals from each camp.

On Sunday, the [Obama] campaign also held a conference call about health care reform policy that featured Kansas Gov. Kathleen Sebelius, who was the Kansas Insurance Commissioner prior to becoming governor, and the Pennsylvania and Ohio insurance commissioners. The call focused on criticizing Sen. McCain’s health care reform proposal.

The day before, the McCain campaign held a conference call of its own where it sought to refute the Obama campaign’s assertions about the McCain health care reform plan and, at a campaign event in Virginia, Obama called McCain’s plan “radical.”

The audiocasts of these two conference calls add a much needed additional dimension to the issues presented in the advertisement. Links to them are near the bottom of the Political Ticker post cited at the bottom of this entry.

The chaos of these recent months has included its own health care aspects in each of the major issues. In the wake of Hurricanes Gustav and Ike, we saw firsthand, palpable proof of the importance of electronic medical records. As Wall Street melts down and the Dow plummets, the impact of health care costs on our economy is massive. During the Presidential race, it is once more rising to the surface.

We may see health care moving back towards its proper position as a centerpiece issue for the next President.

SOURCE: "Obama camp releases another health care ad" 10/05/08
photo courtesy of KevinDooley, used under its Creative Commons license

Health Care Returning to the Presidential Race?

As the pundits rail about the race for the Oval Office and the newscasts are filled with baleful economic predictions, the American public continues to find health care reform of utmost importance. Unfortunately, the topic seems to have drifted out of the media coverage zone, eclipsed by political spots and visions of a failing Wall Street. This is especially a shame considering many have tied the ills of the health care industry directly to the economic hardships we are now facing. (See last Thursday's blog post for Elizabeth Edwards' take on the subject.)

Now that the first two debates -- Presidential and Vice Presidential -- are passed, it would seem that this vitally important topic may be returning to the spotlight it so richly deserves. Sen. Obama has brought out a new ad which brings the subject to center stage, evidently sensing a weakness on the subject in his competitors. Foon Rhee, deputy national political editor at Boston.com, has posted the video...



This is heartening to see since it was not that long ago that I wrote an entry here entitled "Health Care Falls Off the Radar".

SOURCE: "Obama sees opening on healthcare" 10/03/08
photo courtesy of Chesi Photos CC, used under their Creative Commons license

American Heart Association

Health care. Meaningful health care. Affordable health care. These are central to the American Heart Association's call to both of the current Presidential candidates.

Via MarketWatch:

The American Heart Association today unveiled six principles on healthcare reform as the presidential candidates begin a series of debates, the first scheduled for Friday, Sept. 26, at the University of Mississippi. With a vision of a stronger healthcare system, the association's 2008 Statement of Principles on Health Care Reform outlines critical issues that must be addressed to ensure high-quality, affordable healthcare for all Americans.

"We are committed to approaching healthcare reform from the perspective of the patient," said Daniel W. Jones, M.D., Immediate Past-President of the American Heart Association and Vice Chancellor of the University of Mississippi. "The goal is to create a dialogue among our elected officials, particularly focusing on the needs of individuals who have or are at risk for cardiovascular disease and stroke."

And a lovely list of principles it is indeed:

• Everyone in America should have meaningful, affordable health care coverage
  
• Benefits of a preventative nature should be an essential part of that coverage
• Everyone should have high quality and affordable health care
• All health care disparities based on gender, race, or geographic location must be eliminated
• National prioritization of biomedical and health services
• The pool of health care workers needs to be expanded through a substantial, sustained program of support for medical and clinical education/training

The MarketWatch press release has a lot more on the subject to help provide some context. Click the "SOURCE" link below for more information.

SOURCE: "American Heart Association Calls on Presidential Candidates to Adopt the Organization's New Principles on Healthcare Reform" 09/24/08
photo courtesy of CarbonNYC, used under its Creative Commons license

Benefits Executives Chime in on Presidential Health Care Plans

One group of Americans that has been following the health care propositions of our presidential candidates very closely is the one made up of benefits executives across the nation. No matter which way things fall, they will find their jobs and approach seriously impacted.

Sen. McCain's approach wold remove the tax exclusion for workplace-supplied benefits. Sen. Obama's would force all employers to offer health benefits. Neither option thrills those whose job it is to administer said benefits. American employers provide the majority of non-governmental health care benefits and either stance stands to cause major changes and complications in the way they do business, a particularly stressful thing to contemplate during the times of economic uncertainty. Still, of the two unpopular plans, Sen. Obama's is seen as the lesser of two evils.

Catherine Arnst of BusinessWeek reports:

The Washington law firm Miller & Chevalier Chartered, together with the American Benefits Council, a trade association, surveyed 187 benefits officers this summer at large U.S. companies to determine their views on the direction of health-care policy in 2009. The respondents were asked their opinion of several health-care reform proposals, without identifying the reforms with any candidate or political party. When asked about "pay or play," the position favored by Obama that would require employers to either provide health care for employees (play) or pay a tax to the government, 46% of respondents said it would have a strong negative effect on their workforce. But 74% said a repeal of the employee tax exemption for employer-based health coverage—McCain's proposal—would have a strong negative effect.

So while both plans are greeted with a less than enthusiastic reception, almost exactly three quarters of benefits execs find the McCain plan to be far more damaging to them. James Klein, president of the Americans Benefits Council, has an explanation of why:

[...] "Companies know they are going to end up paying the bill anyway so they want to continue to have an influence on how those benefits are designed and who is held accountable," he says.

What they don't want, however, is a patchwork system of state reforms. Several states, led by Massachusetts and Maine, have enacted or are considering some form of universal coverage involving employers. But 81% of the respondents support maintaining federal standards, and 84% oppose regulation of employer-sponsored health plans at the state level.

The logic is pretty obvious, especially when you consider the way large companies generally have assets and holdings in multiple states. Federal standards can keep things consistent across the playing field whereas if the individual states regulate the industry, companies could be facing as many different sets of divergent regulations as there are states that they operate in.

The administrative costs alone would probably skyrocket considerably.

SOURCE: "Benefits Execs Prefer Obama's Health-Care Plan" 09/18/08
photo courtesy of I am K.E.B., 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

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

Biden Speaks on Health Care, Slams McCain Plan

Well the airwaves, newspapers and Internet are full to bursting with news and commentary related to the Presidential race, particularly now that the VP choices have been made on both sides of the aisle.

On the Democratic Party's side, Sen. Joe Biden is moving forward as an outspoken and determined VP choice for Sen. Obama. In a recent speech in Mehlville, Missouri, speaking to a socially conservative, predominantly blue collar crowd, he tied the growing unease about health care to the rising unemployment that the community has recently experienced. He then issued a no nonsense warning to the crowd about the net result of the McCain proposal on this subject.

Via Jo Mannies at STL Today:

[...]taxing American workers' health care is not the answer, he said. Under McCain's plan, Biden said, a person earning $50,000 a year, with employer-provided health care worth $12,000 a year, would be subject to income taxes on all $62,000. Now, no taxes are levied on their health care benefits.

McCain has been highlighting his proposed $5,000 a year tax credit to offset some of that tax hike, but Biden said that at least $7,000 would still be subject to the tax.

Sen. Biden then went on to state that the change in structure proposed by the McCain ticket would cause more employers to drop health care coverage. An assertion that carries quite a punch, especially in the context of the American working class.

At a town hall earlier that day, Sen. Biden called it a "moral obligation" for the government to make health care available to all U.S. citizens.

SOURCE: "Bid focuses on healthcare, rips Republicans, in Mehlville stop" 09/10/08
photo courtesy of IowaPolitics.com, used under its Creative Commons license

Health Care In Campaign 2008

Ladies and Gentlemen, fasten your seat belts! The next 60 days or so will be abuzz as our esteemed candidates make their final lap in the race for the Oval Office. It's the final stretch and the point where the voting public really crystallizes their decision on whom to vote for.

Making an informed decision requires sound information. I hope the following is helpful in that regard.

• Research!America's President, Mary Woolley, talks with NPR about the findings of a questionnaire sent to both campaigns. A questionnaire requesting "policy details on issues such as health care coverage, stem cell research, the Medicare prescription drug benefit, and funding for NIH, FDA and CDC." [Listen Here]
  
  
• The Kaiser Network presents a new regular feature, Blog Watch. "Blog Watch, published on Tuesdays and Fridays, tracks a wide range of blogs, providing a brief description and relevant links for highlighted posts." [Blogwatch]

I will try to share as many resources as I can over the next two months. These are important decisions for our nation and the health of its citizens. It is our responsibility as citizens to become engaged for the benefit of both ourselves and our children. It is up to us to do our part. Our country needs health care reform now!

SOURCE: "Questionnaire Distills Candidates' Health Policies" 08/13/0
SOURCE: "Kaiser Network BlogWatch" 09/05/08
photo courtesy of CommandZed, used under its Creative Commons license

Credit Cards, Health Care, and McCain's Vision

Robert Gordon of Slate offers a prescription of comparison as a cure for rhetoric. While examining the health care proposals of Senator McCain, he examines a similar situation in recent history: the treatment of the credit industry in the late 1970s.

Let's start with his recap of the way that credit-card business migrated to the states that had the least regulation:

Until the late 1970s, South Dakota and Delaware didn't have an outsized share of the credit-card business. Banks had to obey the interest caps of the states where borrowers lived. So, for example, loans to New York residents were always subject to New York's limits on interest rates. At 12 percent back then, and with high inflation, these laws sharply limited profits on credit cards.

Then in 1978, the Supreme Court said banks should follow the rate cap in their home states. This meant that as long as a credit-card company relocated to a state with a higher interest-rate limit, the company could lend to borrowers anywhere under that higher limit. Following the court's ruling, Citibank chairman Walter Wriston offered Gov. Bill Janklow a deal: If South Dakota lifted its rate cap altogether and formally invited Citibank to the state (as federal law required), the banking giant would move its credit-card operations to South Dakota—along with 400 good jobs.

The bill was introduced and passed in the space of a day. Soon after, Delaware lifted its cap, too. Voilà, South Dakota and Delaware became the hosts of most credit-card companies.

An excellent illustration of the fact that one needs to looks not only at the proposed actions to be taken, but also at the ramifications of those actions. This brings us to the Senator's statements about "allowing families to purchase insurance across state lines." Seemingly sound upon first glance, the actual repercussions bear scrutiny.

McCain argues that different states' regulations "prevent the best companies, with the best plans and lowest prices, from making their product available to any American who wants it." Although he hasn't given details, his supporters say that he favors an approach, endorsed by President Bush and championed by McCain's Arizona colleague John Shadegg, that would allow insurers to choose the state laws under which they are regulated. (I e-mailed the campaign about the specifics of McCain's approach and didn't hear back.) An insurance company that chose to be regulated under Arizona law could sell policies in New York without following New York rules. Arizona, like most states, lets companies charge what they want to people who are sick—or simply deny them coverage altogether. Under Shadegg's bill, insurers wouldn't even need to pick up and move their operations; it would be enough to file some paperwork with a state insurance commissioner and pay that state's relevant taxes.

Now the classic Libertarian argument about credit-cards would probably be that no one forced anyone to get a credit card in the first place. However, that argument is incomplete. It fails to take into account the usurious practices that tend to flourish in an environment where consumer protections and regulation are minimized to this extent.

With the individual market for health care, the libertarian argument fails on its own terms: Sick people can't get coverage they can afford. It's as though the rafts are reserved for people who already have life preservers. Americans with pre-existing conditions—cancer, asthma, diabetes, and the like—would need to pay even more than they do today. Through no fault of their own, more of them would end up without insurance. Meanwhile, insurers would improve their own profits by offering targeted policies to people with the fewest health expenses. As with the history of credit cards, it's Robin Hood in reverse. Apart from the obvious injustice, this approach could add to spiraling health costs. The sickest 10 percent of Americans are already responsible for 70 percent of the nation's health expenses. When more such Americans go uninsured, skip checkups, and land in the emergency room, they end up costing taxpayers more.

It is hardly shocking that once again we come full circle to one of the points in George C. Halvorson's book Health Care Reform Now!. Chronic conditions are the lion's share of health care expenses in the U.S. The looming financial specter of the emergency room casts a very long shadow across the health care crisis. Despite President Bush's famous remarks last July (“The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room.”) this approach does nothing but drive overall costs upward while overextending the ER's to the point of massively increasing wait times and decreasing quality of care. Besides, when was the last time you know of someone going to the emergency room for chemotherapy?

There are many measures that can be taken to help pull our nation out of its downward spiral, but they all require careful thought and practical implementation. Both regulation and deregulation and powerful things and both have far reaching effects that will ripple across America. We need to be decisive yet act with care, especially those of us who are getting older.

Check out the original article and see what you think.

SOURCE: "Reverse Robin Hood Why is John McCain wrong on health care? Think credit cards." 05/19/08
photo courtesy of SoggyDan, used under its Creative Commons license

Clinton Campaign Behind on Staff Health Care Benefits

Today, we are going to take a look at an aspect of the ongoing debate about health care amongst the U.S. Presidential candidates that is, for a change, new.

Politico's Kenneth P. Vogel broke this news:

Among the debts reported this month by Hillary Rodham Clinton’s struggling presidential campaign, the $292,000 in unpaid health insurance premiums for her campaign staff stands out.

Since health care reform is a major plank in Senator Clinton's campaign, this news has great potential to damage her efforts and credibility on that front.

Clinton campaign spokesman Jay Carson assured Politico that there was no interruption in staff benefits as a result of this situation. He also stated that Aetna Healthcare and Blue Cross Blue Shield, the health care providers for campaign staff, had been paid in full this month.

“Sometimes invoices are not paid immediately because we need additional information for our records, or to verify expenses,” Carson said in a statement e-mailed to Politico. “Sometimes invoices arrive at the very end of the month at the cutoff of the reporting period, which means that we are required to report them as a debt on the current FEC report, even where they are paid in regular course during the next month.”

But the unpaid bills to Aetna were at least two months old, according to FEC filings.

They show the campaign ended last year owing Aetna more than $213,000 for “employee benefits.”

During the first two months of the year, the campaign did not pay down any of that debt. In fact, it accrued another $16,000 in unpaid bills last month, and it finished the month owing Aetna $229,000.

Just like any other business, the Clinton Campaign faces employee benefits as one of their most major expenditures. Also just like other businesses, it is not uncommon to carry an unpaid balance from month to month. Carson emphasized that the campaign follows normal business practices in dealing with their bills, which are paid "regularly."

By contrast, Senator McCain had no unpaid health provider bills as of the end of February, and Senator Obama had a balance of $908 owed to AIG American International Group for "insurance." The contrast is already being touted across media and internet sources.

In a race that involves the issue of universal health care as a fundamental component, this news has potential to upset the political apple cart in fairly short order.

SOURCE: "Clinton didn't pay health insurance bills" 03/31/08
photo courtesy of Center for American Progress Action Fund , used under this Creative Commons license

Consensus Among Voters, Candidates Out of the Loop

Regular readers are aware of the efforts of Kathleen O'Connor over at Code Blue Now! The last time we checked in on her efforts was back in January when we shared her efforts to poll the voting public for their input on what would constitute a national health care solution.

Well, she is at it again. Now that the numbers are in from their surveys, CodeBlueNow! has released their findings, many of which agree with George C. Halvorson's proposals in Health Care Reform Now. The Seattle Business Wire brings us the details and information collated for CodeBlueNow! by the Gilmore Research Group of Seattle, WA:

Republicans, Democrats and Independents typically think very differently about many issues. But when it comes to health care, widespread agreement exists among all voters on key issues including:

• Universal coverage
  
• Basic benefit package
  
• Support of preventive care over high-tech cures
  
• Health care as a shared responsibility of employer, individual and government

There was also universal agreement that a basic benefit package should include many licensed health care professionals, not just medical doctors. Ironically, none of the current candidate proposals would gain support from the public because the proposals don’t address concerns across party lines or the concerns of Independents.

To see how the results of this research compare to the plans proposed by our Presidential candidates, you can download a PDF which graphs the results. It's available on the front page of the Code Blue Now! website. It is quite interesting to observe how many times the phrase "no provision," appears next to almost every candidate's name while you go through the data.

Members of the CodeBlueNow! Honorary Board see this data as confirmation that a Voters Health Care Platform of a non-partisan nature could become a reality. If so, that platform could serve as the bedrock for effective reform efforts that cut across the rigid ideological lines of the established parties. Governor Richard Lamm (D-CO), also on the organizations honorary board, said, "It is lack of political courage -- not lack of public support -- that keeps America from Universal Coverage."

[O'Connor] says the findings about Independents are particularly interesting in this election year, because Independents are seen as a key voting group for the presidential candidates.

“The key is Independents. They shift back and forth between Republicans and Democrats depending on the issue. This means we have the chance to have a safe, problem-solving conversation that won’t explode in our faces. We Americans have more in common than we are told. We shine as a people when we toss aside party lines and focus on solving a problem.”

SOURCE: " New Research Commissioned by CodeBlueNow! Finds Surprising Agreement on Health Care Reform But None of the Current Proposals by Either Party Are Supported" 03/03/08
SOURCE: "CodeBlueNow!" 03/03/08
photo courtesy of tsanfranannie, used under this Creative Commons license

Health Care: A Picture is Worth A Thousand Words

Craig Stoltz, a former editor of Health, has designed an interactive Web tool for Health Central. This tool, which Stoltz featured in an article in this week's Washington Post, allows readers to see exactly where the various Presidential hopefuls stand on different aspects of the health care issue. It also allows users to graph their own position in relation to said candidates.

The caveats: We report candidates' stated positions, not what they'll do if elected. Underlying the health-care debate is the matter of cost. Democrats' plans involve regulating insurers and offering all Americans a menu of insurance choices similar to those available to federal workers. Republicans would deregulate insurers, arguing that a free market will reduce costs and boost quality. All say savings will come from technology such as digital medical records and from disease prevention and chronic care.

And a note: Some say the focus on health care is not enough. A former assistant surgeon general, Douglas Kamerow, writing last week in the journal BMJ, says candidates' proposals don't address the "crisis" in U.S. primary care, the need for better pay for primary care doctors or ways to reward continuity of care.

Click here for an interactive tool that looks at the candidates positions.

They say a picture is worth a thousand words. It is our hope that this visual aid will help you to develop a picture of where the various candidates stand in relation to your own views on this urgent issue.

Where do you find yourself on this graph?

SOURCE: "Poligraph Web Tool" 01/12/08
SOURCE: "The Candidates on Health Care: Where Do They Stand?" 02/13/08
Screencapture IMage taken from Poligraph Web Tool

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