From Jersey To Arizona: Reform Legislation

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

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

Via the Philadelphia Business Journal:

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

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

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

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

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

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

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

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

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

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

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

Emphasis in the above quote is my own.

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

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

Ill Will In DC

The DC Council has aimed its sights at providers of care and housing for the developmentally disabled in our nation's capitol. It would seem that continuing reports of substandard care, coupled with research into the salaries of the providers' top executives have reached the confrontational level.

Daniel De Luc at The Washington Post reports:

During a hearing, council members Tommy Wells (D-Ward 6) and David A. Catania (I-At Large) said they were tired of hearing rounds of excuses from the providers of group housing for the approximately 1,200 mentally disabled persons in the District's care. It was the first major council hearing on the developmentally disabled since Mayor Adrian M. Fenty (D) took office last year and marked a new, intensive scrutiny from the council.

"You either have to come up with a strategy to [improve] or get out of business, because you cannot provide substandard care," Wells told several of the providers who appeared at the hearing.

The District has an embattled history when it comes to this particular topic. Three decades ago the District was sued over the poor quality of care offered. Last year a federal judge found that the city officials had failed the disabled residents in question. Then this last May, a court monitor reported that these residents "remain at very serious risk." This history provides the foundation of the Council's dissatisfaction with private and non profit providers, but what really seems to have touched off the powder keg is the revelation of key executive salaries in the companies involved.

Wells and Catania, whose staffs researched tax records, noted that top executives at some providers earn more than $200,000 a year and singled out David Wilmot, president of Individual Development, which operates 11 group homes in wards 7 and 8.

Wilmot, a well-known D.C. lawyer who has been active in politics, is paid $300,000 annually, the council members said. And they noted that Wilmot and another board member had received loans from the company.

"I think that's hard to justify, considering where we're at," Wells said, calling it "extraordinary compensation."

The Post article provides some solid background as well as details of the arguments used by Wilmot and others to justify their salaries in light of the situation. The fur will be flying, I predict, between the providers' justifiable arguments of unqualified workforce and low reimbursement rates to the recent relocation of over 160 patients when their providers moved out of the "low reimbursement zone."

This is guaranteed to be a hot topic as it develops. Valid and worrisome issues that directly effect both patients and providers will be the centerpiece as the drama unfolds.

SOURCE: "City Council Members Criticize Providers" 07/08/08
photo courtesy of eschipul, used under its Creative Commons license

The $40 Million Push

What do Elizabeth Edwards, ACORN, AFSCME, Americans United for Change, Campaign for America's Future, Center for American Progress Action Fund, Center for Community Change, MoveOn, NEA, National Women's Law Center, Planned Parenthood, SEIU, UFCW, and USAction have in common?

They are all pulling together as a unified force in an attempt to storm the airwaves with a message of reform.

On July 8, Health Care for America Now! launched their $40 million campaign with a press conference for the National Press Club in which they unveiled their campaign plans as well as their first $1.5 million ad buy to support it.

Julie Bosman who writes for The New York Times' blog, The Caucus, brings us the money quote when it comes to the overall thrust of the ads:

Its theme? “You can’t trust the insurance industry to fix the health care mess,” said the spokeswoman, Jacki Schechner. “We’re educating the public about our principles and what we’d like to see from the president and the new Congress.”

For those of you who remember the Harry and Louise commercials that were a driving force behind the failure of the Clinton Administration's attempts at health care reform, this should be redolent of a certain "turnabout is fair play" ethos.

Ms. Bosman's post to The Caucus gives a good overview of the group and its aims. Roger Hickey, Co-Director of the Campaign for America’s Future, a founder of Americans United to Protect Social Security, one who helped to create and build Change America Now and the new Americans Against Escalation in Iraq, shares his perspective as a man on the inside of the efforts in this piece on the Huffington Post.

The battle for reform continues. Please feel free to drop us a comment on the ads if you see them aired in your area.

SOURCE: "New Health Reform Group to Spend $40 Million" 07/03/08
photo courtesy of Simon Davison, used under its Creative Commons license

Examining McCain's Proposed Health Care Tax Credits

Jonathan Cohn has a very interesting article up on CBS News. In it, he examines a recently released paper from the Center for American Progress which dissects Sen. McCain's proposed tax credits -- tax credits that are supposed to fix our broken health care system.

Under our current system, group health premiums (e.g., insurance you get through your job) are exempt from both income tax and payroll tax. Sen. McCain has suggested doing away with that exemption and replacing it with a tax credit ($2,500 for individuals, $5,000 for families) tied to the purchase of individual insurance.

Via Mr. Cohn's article:

McCain's advisers say that the credit would grow at the rate of inflation -- that is, it'd get more expensive at approximately the rate of other goods (or, at least, how the government measures the price increases of other goods). Health care expenses, of course, keep going up faster than other expenses, mostly because of medical technology and the (largely unrestrained) demand for it. So if people kept paying for the same level of insurance, the tax credit would quickly fall behind: They'd end up paying more in taxes. According to the report, "In 2009, the credit will cover 36 percent of an average employer-provided family policy (based upon CBO projections). By 2018, however, the credit will cover only 24 percent of the cost of the same policy."

(This is all in addition to the fact that, for many families, the credit will not be enough to buy a policy — even now — because health care for families costs a lot more than $5,000 a year.)

Now, to its proponents, this feature of the tax credit — the fact that it increases so slowly — is a feature, not a bug. It's designed to encourage people to be more thrifty in their purchase of insurance. Ideally, they'll go for less generous policies — ones that don't subsidize so much wasteful care.

Mr. Cohn points out the crude nature of this approach to cost control, noting that it puts the entire weight of the problem on the backs of consumers while providing no guarantee that adequate health care will be forthcoming. No guarantee of available coverage, much less for pre-existing conditions. No limits on the amount of cost out-of-pocket for consumers.

One reason I enjoy Mr. Cohn's work is that he does embrace transparency in his writing. In the beginning of the article he notes that he has not yet had the opportunity to vet the report in full and that these are initial conclusions only. He closes with a reminder:

OK, and now to that caveat I promised at the beginning. Unlike Barack Obama, McCain hasn't been clear about exactly how he proposes to change the tax treatment of health insurance. And there are rumors around that they might not get rid of the existing deduction entirely, preserving it at least for payroll taxes. It's not clear how that'd affect the paper's conclusions, since the paper assumes the entire deduction goes away. But, of course, if McCain keeps some of the existing tax break, then either his plan won't have as dramatic effect period — or it will run up a higher deficit.

All in all, well worth reading, if for no other reason than to remind yourself that in the convoluted discourse on American health care it pays to dig below the surface on all claims and proposals.

SOURCE: "McCain’s Fuzzy-Math Health Care Plan" 07/05/08
photo courtesy of SoggyDan, used under its Creative Commons license

Text For Health, A New Twist on Tech

Technology comes up frequently when you live in the Information Age. On this blog, it rears its head quite frequently as we keep tabs on electronic medical records and online health care tools. Today I will be talking about technology, but not of any kind discussed in my prior postings. You see, today I'm going to take a look at text messaging.

While doing some online research, I ran across an intriguing press release out of the Delaware area. It seems that some doctors are using text messages with excellent results.

People stay healthier when they show up in their doctors’ offices for necessary health check-ups, but it’s sometimes challenging to get them there. Today, one Medicaid program, Delaware Physicians Care, Inc. (DPCI), is using cell phone text messaging to remind members of appointments, let them know if they have missed an appointment and inform them when they should be scheduling tests or additional appointments.

This makes perfect sense to me now that I am aware of someone doing it. A few weeks ago, I was speaking with a friend from DePaul University in Chicago's computer department about online social networking, a pet area of study for both of us. He commented that the younger generation seems to have moved past email and have adopted text messages as their preferred communications mode. If that trend carries over, this could be a program with huge potential.

In the meantime, it has already had verifiable results according to the release:

In the 2006 pilot project with diabetes patients, DPCI found that after six months the percentage of patients receiving a necessary test rose from 52.3 percent to 70.5 percent in members receiving text messages. Furthermore, the results were much higher than the 45.4 percent rate for members of a control group of diabetes patients who did not receive text messages.

A nearly twenty percent increase is nothing to sneeze at. We are a culture that loves immediacy, and using text messages for health maintenance seems apropos. If nothing else, it is an attempt at thinking creatively as we seek solutions to the state of our health care system. Even if it proves not to be viable in the longterm, this still bodes well as a signal that people are actively seeking innovative solutions.

All I have to say is, "Go, Delaware!"

SOURCE: "Text Messaging—a New Way for Delaware Physicians Care to Help Its Members" 07/30/08
photo courtesy of Nesster, used under its Creative Commons license

The AMA on EMRs

Technology is a repeated refrain in the ongoing national health care dialog. The virtues are well known, especially to readers of this blog. Studies have been enacted by numerous foundations and organizations that show the massive savings of both money and time that electronic medical records (EMRs), properly implemented, can provide. By the same token, the discussion of EMRs also brings up a consistent set of issues that are of concern to medical providers: cost of implementation, privacy issues, and technical standards.

Thanks to the online edition of AMedNews, we can take a look at the American Medical Association's views prior to the hard copy's release date of July 7, 2008, addressing this triple header of concerns.

On standards:

As work continues to develop a national strategic plan for health IT, including any coordination of the multiple government initiatives already under way, it is essential that doctors have a strong voice. It is physicians, after all, who will be expected to invest heavily in making the system work.

The AMA also stresses that physicians with small practices should be given a voice in this discussion since they comprise the majority of medical practices in the United States. This push for standards, compatibility and systems thinking is one that is at the core of George C. Halvorson's approach. Involving the actual physicians in the crafting of these standards is extremely important. After all, they will, as pointed out above, be footing the bill.

On privacy:

To boost confidence in an integrated network, the Health Insurance Portability and Accountability Act's privacy and security rules that apply to physicians, as well as other health care professionals and health plans, should be extended to any party that works with confidential health care records. This would include workers' compensation carriers, researchers, life insurance issuers, employers, marketing firms, health IT and personal health record vendors, and health information exchanges.

Doctors, says the AMA, do not need to see an expansion of their HIPAA obligations. The organization states that this would slow down transmission of patient data as new restrictions are implemented. Instead, their proposal hinges upon expanding the privacy strictures of HIPAA to apply to anyone handling this confidential data.

On implementation:

Physician reimbursements already are under intense pressure, and the Congressional Budget Office itself has released a report doubting estimates of extraordinary, health IT-related savings. It's no surprise that many practices, especially small ones, find it justifiable to avoid health IT investment. Meaningful grants, loans and other financial incentives are essential for giving physicians the financial security they need to accept and accrue the benefits of health IT.

With the cost of implementing EMRs quoted at $37, 000 per practicing physician (and that is a starting number that does nothing but increase), these sort of incentives seems to be in order. It would be a nice change from the perverse incentive standards of the modern day medical profession.

The article goes on to relate the AMA's position as it attempts to influence the U.S. Congress, which even now is deliberating the proper ways to push expansion and implementation of health information technology. Go take a look and see for yourself what your opinion is of their stance.

SOURCE: "Removing health IT barriers: The AMA advocates that federal legislation to encourage technology use should incorporate physicians' ideas, particularly in regard to technical standards, privacy and financing." 07/07/08
photo courtesy of Daquella manera, used under its Creative Commons License

21st Century Dynamic Duo: Bankruptcy and Health Care

Since my wife's family is mostly in the Indiana area, I tend to check out the news up there fairly frequently, especially with the recent levee failures and flooding. That is how I stumbled upon this letter to the editor by Fran Quigly, Director of Operations for the Indiana-Kenya Partnership, on IndyStar.com. The introductory paragraphs should be enough to get you started:

It is Friday morning at the federal courthouse in Downtown Indianapolis, and U.S. Bankruptcy Court Trustee Gregory Silver sits behind a low table in a room on the fourth floor calling out names of Hoosiers who have filed for discharge of their debts. In a somber scene with the air of a fiscal confessional booth, many petitioners come forward with slumped shoulders and slightly bowed heads, and then softly answer Silver's questions about the financial collapses that led them to this room.

A young woman from Southside Indianapolis has racked up enormous debt due to the costs of childbirth. A middle-aged couple from the Northwestside was sued for payment of their medical bills. Another woman had the misfortune of being attacked by a dog before health insurance from her new job kicked in. Even after turning a lawsuit settlement over to bill collectors for hospitals and doctors, she still owes them $35,000.

The rest of the letter is well worth reading, and if you have strong stomach the comments are interesting as well. I think the comment streams one finds on articles like this make for an interesting study, most particularly the anonymous comments. People tend to speak their minds pretty staunchly when they do have to worry about being connected to their opinions publicly.The results can often be both vile and illuminating.

On a subject that combines high profile and controversy in the fashion that health care currently does the comments come thick and fast, a maelstrom of invective and opinion that demonstrate just how impassioned our populace is becoming on the subject.

The letter goes on to suggest potential paths for improvement, and quotes a 2005 Harvard study that found fifty percent of bankruptcies in the U.S. stem from medical bills.

Fifty percent. Think about it.

SOURCE: "A day in bankruptcy court would make you sick" 06/30/08
photo courtesy of danesparza used under its Creative Commons license