Post Election: Health Care and The Obama Administration

President-Elect Barack Obama will be taking the reigns on January 20, 2009. He takes office amidst a veritable hailstorm of crises: the financial meltdown, the housing meltdown, the wars, and, according to voters, health care.

Rebecca Ruiz over at Forbes brings us a recap of Obama's plans along with an examination of what the next steps will be and what direct effect we will experience. In one of the first of what will no doubt become an endless stream of speculation between now and January 20, she explores the pros, cons, and unknowns of the subject.

One particularly telling quote in her article comes from John Sheils, senior vice president of the Lewin Group, a health care policy research company in Falls Church, VA:

Sheils' analysis found that Obama's plan would decrease the number of uninsured by 26.6 million beginning in 2010. The estimated federal cost of enacting the plan is $1.17 trillion from 2010 through 2019. By 2010, annual spending on health care is expected to reach $2.7 trillion. But Obama's plan is expected to cut spending by $54.1 billion in the next decade. The savings are important, but regardless, the price tag is staggering.

Another thing that Sheils notes is that one crucial flaw remains unaddressed, a crucial flaw that George C. Halvorson has expounded upon in his most recent book: incentives. Currently, incentives in the health care industry are geared towards care services and procedures performed instead of being based on actual health results.

This article is particularly advised reading, especially for its last few paragraphs where Ms. Ruiz looks at the potential interactions on this subject once Obama is sworn in and the discussion moves to the floor of Congress.

On the whole, it seems like there is positive news in the wind.

SOURCE: "What Obama's Health Care Plan Means For You" 11/05/08
photo courtesy of realjameso16, 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

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 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

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

Presidential Candidates and Their Plans For Health Care

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

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

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

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

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

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

"Nationalized Health Care"

It is a phrase used a lot in reference to the plans proposed by both Sen. Hillary Clinton and Sen. Barrack Obama should they attain the post of President. As Kevin Freking of the Associated Press points out in a recent article, it is an inappropriate usage of the phrase:

Last week, Sen. John McCain, the likely Republican nominee, described his challengers' health care plans as a "move closer to a nationalized health care system." But that's a stretch. To nationalize means to transfer ownership or control to the government. There's still a vast distance between what the Democratic candidates have proposed and nationalized health care.

Clinton and Obama aren't proposing government hospitals or government doctors. They want people to have health insurance, and they want people to be able to choose from a variety of policies. The menu would include private plans as well as an option similar to Medicare. Tax breaks would help lower- and middle-income people pay their monthly premiums.

In addition, proposed employer involvement and the rescinding of Bush administration tax cuts for the wealthy assure that there will be others besides the government paying into the program (whichever it ends up being) once it is enacted.

Such a system would continue the split system that the U.S. has when it comes to health coverage. The elderly, poor, disabled and many veterans would continue to get care paid for primarily by the government. Others would get coverage from private companies, usually through their employer, or through the Medicare-like option.

"Their approach is not taking any other country's system. It's building on what we have in the U.S," said Karen Davis, president of the Commonwealth Fund, which conducts health research.

Freking goes on to provide an illustrative comparison between our system here in the United States and those of Great Britain and Canada. He finds that while many more here in the U.S. chose to skip seeking care out of financial fear, residents of the other two countries tend to have much longer waits when specialist care is needed -- waits that are often a month or longer.

He also touches on economic side effects of the high cost of American health care, such as the fact that stateside manufacturers find it harder to compete in the global marketplace due to the high and rising cost of coverage.

"That's why it costs less to build a car in Canada than in the United States because you've got a bunch of money tied up in health insurance," said Steven Lewis, a Canadian health consultant.

As usual, Freking prescribes a solid dose of information for his readers, including an interesting observation about the one commonality that people in all three countries share. I'll let you read the article to find out what it is....

SOURCE: "Insurance model follows American tradition" 05/10/08
photo courtesy of *clarity*, used under its Creative Commons license

5th Annual World Health Care Congress

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

From the press release about this morning's panel:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Elizabeth Edwards backs Clinton on Health Care

Martina Stewart, an Associate Producer at CNN, reports that Elizabeth Edwards has now publicly endorsed the health plan of presidential hopeful Sen. Hillary Clinton. Details appear in Stewart's article on CNN's Political Ticker:

Elizabeth Edwards, wife of former Democratic presidential hopeful John Edwards, is picking sides in the Democratic nomination race – at least with respect to health care. In an interview that aired Wednesday on ABC’s “Good Morning America,” she threw her support behind Sen. Hillary Clinton’s health care plan.

“In order to ensure that we have universal coverage, we need to say everybody has to join,” Edwards told ABC’s Robin Roberts. “So, for that reason, the mandates that Sen. Clinton is talking about, I think are going to be more successful in achieving the goal,” she added.

Both health care plans have the same goals, said Edwards, but “I just have more confidence in Sen. Clinton’s policies than Sen. Obama’s on this particular issue.”

This is not the first time that Edwards, a cancer survivor, has had good things to say about Clinton's approach to health care. Last September she even noted its similarities to the one her husband, John Edwards, espoused during his bid for the Democratic nomination. As noted on this blog, she has also been quite critical of Sen. John McCain's plan, stating that is gives too much leeway for insurance providers to deny coverage based on pre-existing conditions.

This public statement is one that will certainly have an impact on the battle between Clinton and Obama for the Democratic nomination. Even though neither John nor Elizabeth Edwards have made a formal endorsement of either candidate, endorsing Clinton's health care plan carries a lot of weight due to the high profile of the issue in the current race for the Oval Office.

SOURCE: "Elizabeth Edwards backs Clinton's health care plan over Obama's" 04/09/08
photo courtesy of John Edwards 2008, used according to its 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

California Nurses Use Obama's Words Against Schwarzenegger Plan

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

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

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

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

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

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

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

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

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

On The Road With Robert Reich

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

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

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

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

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

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

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

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

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

Mandates II: Clinton vs. Obama

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

Mr. McCormick provides commentary on the clash:

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

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

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

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

Clinton said she is puzzled by Obama's approach.

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

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

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

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

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

Obama, Clinton Square Off on Mandates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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