Politics

POLITICS: The Pollsters Are Calling! How Americans See Health Care Reform

Julie Barnes — Wed, 14 May 2008 15:29:00 -0400

This week we attended a Health Affairs event on Health Reform and the 2008 Election at the Willard (excellent coffee), where Celinda Lake (Lake Research Partners) and Bill McInturff (Public Opinion Strategies) entertained the crowd with the good, the bad, and the ugly stories of polling Americans' great thoughts on health care reform. The pollsters represent different sides of the aisle but agreed that: 1) Americans believe that health care costs are linked to the well-being of our overall economy; and 2) The next American president has a "unique window" to change the health care system early in the first term.

Lake, the Democrat, offered many interesting tidbits about what Americans want in their health care reform:

Prevention (not wellness)
Provider choice (they definitely don't want to lose access to their doctors)
Peace of mind about plan choice (they want to keep their policy and benefits if they like them)
Control (this is related to the previous two elements)
An American Solution (not Canadian-style reform—they want something uniquely American).

Lake also discovered what Americans do not want to hear:

Cost-shifting (people don't understand this concept)
Losing employer-sponsored coverage that they like
Government-run clinics
Scarce resources—people are worried about too-short appointments and being 30th in line for surgeries or tests
Their doctors are part of the problem—people love their doctors and do not believe that many tests are "waste" in the system. People think that the administrative burdens on doctors are the waste in the system.

McInturff, the Republican, offered his sense that the country is poised to undergo radical health care system change. He noted that more than half (55 percent) of Americans want government to do more in health care and a third (36 percent) say they want radical health care change—despite the fact that people are concerned about disrupting the current system that is working for them. McInturff also feels that Americans are not interested in trade-offs (paying more for insurance so their neighbor will have insurance too). Mostly, Americans want the next President to compromise with the next Congress so that they can pick coverage they like, keep it when they leave a job or move away, in a way that creates a more competitive marketplace to bring down health care costs.

McInturff also recently did a poll for the Robert Wood Johnson Foundation, released yesterday, showing that while jobs and the economy has replaced health care as the top domestic concern for most voters, Americans still see a close and clear link between economic security and affordable health care. In fact, given 10 options for how to best improve the economic wellbeing of an average American, making health care more affordable and providing health care coverage for all Americans ranked the top two. (By a more than 2-to-1 margin, voters were more interested in making health affordable than covering the uninsured. )

Sure, no problem. We'll get right on it.

POLITICS: Senate Finance Begins Hearings on Health Reform

Paul Testa — Thu, 08 May 2008 15:27:00 -0400

The Senate Finance committee kicked off a series of hearings on health reform this week, beginning with testimony from two former Health and Human Services Secretaries, Donna Shalala and Tommy Thompson. We were thrilled to see that one of the most powerful committees in the Senate—that will surely play a key role in any major health reform initiative—take on the issue of health reform in an open, bipartisan, and productive manner.

Reuter's Donna Smith has a good summary of the hearing, but having sat just a row behind Shalala and Thompson we'd like to add a few of our own highlights from the hearing.

Senator Max Baucus (D-MT) is a man who not only knows how to quote Goethe (as he did to open the hearing) but clearly knows how to talk about health reform. Stressing the need to move beyond incremental efforts and find a comprehensive way to cover all Americans, he said: "The moral and economic case for reform has never been stronger." We couldn't agree more.

Former secretaries Shalala and Thompson, veterans of the Clinton and current Bush administrations, respectively, had strikingly similar messages:

The time for change is now.
Reform must be comprehensive.
Reform must be bipartisan to reach out and reflect the interests of all stakeholders.

Thompson stressed the urgency, noting "all the stars are aligning" and "that both political parties for the first time are saying something has to be done," on health reform. Shalala emphasized that a system which covered all Americans would result in "healthier citizens, a more robust economy, and billions saved."

The hearing also touched a variety of reform issues from changing the tax code to implementing health IT to increasing the supply of nurses and primary care physicians. On Medicare, both former secretaries agreed changes must be made as part of broader system reform, because the problems facing the health insurance program for the elderly are really the problems of health care cost growth as a whole. As Thompson said: "You've got to transform the whole system," because just addressing "one piece is not going to do it."

Admittedly, neither Thompson nor Shalala sang such a catchy optimistic bipartisan tune when they were in office, but we hope whoever succeeds them under an Obama/McCain/Clinton cabinet was humming along.

VOICES FOR REFORM: Senator Durenberger and the Need for Reform

Paul Testa — Tue, 15 Apr 2008 20:47:00 -0400

If we learned anything from childhood trips to Browerville, it's that good things come from Minnesota. Take Bob Dylan, Garrison Keillor, or our mother's pickle recipe, for examples. Of course, if you're not convinced by pickles and pop, you should try listening to the state's former Senator, Dave Durenberger (R-MN) talk about health reform, as he did today before the Committee on Ways and Means' Subcommittee on Health.

Serving on both the Senate finance and health committees during his three terms in office from 1978–95, Durenberger knows health care. Further, as a man who witnessed firsthand the failings of the 1993–94 reform efforts, Durenberger has a sense of the kind of the bipartisan compromises that it will take to make lasting health reform a reality. When he talks, we and members of Congress listen.

Our quick takes from the former Senator from the Land of 10,000 Lakes:

The time to act is now: "Not since 1992 have individuals been so concerned about their financial well-being," Durenberger noted, and a major part of their concern is the rapid escalation of health care costs. With average family premiums rising from 7 percent of the median family income in 1987 to 17 percent in 2007, we couldn't agree more.

Health reform requires leadership on a national level: Predicting that leadership will be the “biggest factor” in accomplishing reform, he called on the next president to begin by giving “Americans a view of what is possible in a country as rich as ours,” because “unless the people are on board you’re going to lose.”

Payment reform is key: Noting the emphasis by presidential candidates on cost containment, Durenberger stressed the need to move to a system in which we pay for performance. He noted that Republicans and Democrats already agree on such things as the need for comparative effectiveness research and information technology.

Let's see—pay for performance, national bipartisan leadership, and an urgency of action—yeah, you betcha, we'd like to hear more of that. Now pass the pickles.

Primary Watch: Barack Obama's Early Education Agenda

Sara Mead — Thu, 10 Apr 2008 21:49:00 -0400

Yesterday we explored Senator Hillary Clinton’s early education agenda. Today, we’re taking a look at Senator Barack Obama’s early education proposals.

Focusing on Zero-to-Five

The centerpiece of Barack Obama’s early education agenda would be a new program of Early Learning Challenge Grants, which would provide states with funding to support quality child care, early education, and other services for pregnant women and children from birth through age five. States could use Early Learning Challenge Grant funds to support voluntary, high-quality preschool programs for three- and four-year olds, but universal pre-k is not the central focus of Obama’s early education strategy. Instead, states would be given flexibility in how they choose to expand quality pre-k and other early education programs.

In order to receive Early Learning Challenge Grants, states would be required to: match new federal funds, meet quality and accountability standards, develop public/private partnerships, ensure that parents receive valid information, and provide support for both early learning and family support services (such as nurse home visiting). Although Senator Obama’s plan refers to high-quality early childhood care and pre-k, it does not describe the quality standards states would be expected to meet.

The proposal draws from the work of the Illinois Early Learning Council, which Obama helped create as a state legislator. The Illinois Early Learning Council works to support a seamless system of early learning and care in Illinois for young children from before birth through school entry--something Obama's proposals are intended to help other states do as well. Obama would also establish a Presidential Early Learning Council, modeled after the Illinois Early Learning Council, to promote collaboration among various federal agencies that support programs for young children, and to encourage states to better coordinate services across multiple federal early childhood funding streams.

Obama’s plan includes several other steps to expand quality early education, including:

Quadruple Early Head Start: The Early Head Start program provides services to low-income children ages 0-3, and evaluations of the program have produced very positive findings. Early Head Start currently serves about 61,000 children.
Increase Head Start Funding, which has stagnated under the Bush administration. The plan does not include specific targets for funding increases or numbers of additional youngsters served.
Improve Head Start Quality: Provide $250 million to create or expand regional training centers to help Head Start centers implement successful models.
Increase funding for the Child Care and Development Block Grant, which has stagnated under the Bush administration, resulting in the loss of services for 150,000 children. Obama would double quality funding within CCDBG, and would encourage states to use their quality set-aside funding to develop strategic plans that better coordinate all birth-to-five services.
Support Nurse-Family Partnerships: Provide Nurse-Home Visitation for 570,000 new mothers annually. This model, in which nurses visit at-risk mothers during pregnancy and for the first 18 months of their children's lives to provide support, health services, and education, has been shown to be effective in improving children's and mothers' outcomes.

Obama has proposed spending $10 billion annually to support these early education investments. He has also proposed making the Child and Dependent Care Tax Credit refundable, so that low-income families can receive up to a 50 percent tax credit for their child care expenses. Currently, the tax credit is non-refundable and covers only 35 percent of the first $3,000 in child care expenses ($6,000 if a family has two or more children). It’s not clear whether the cost of this proposal is included in the $10 billion or not.

Supporting Work-Family Balance

Senator Obama has also proposed several work-family balance proposals that could affect young children’s learning and development:

Expand Paid Family Leave: Create a $1.5 billion fund to help states with start-up costs for paid family leave programs and offset costs for employers and employees.
Expand the Family and Medical Leave Act to cover employers with 25 workers (it currently applies only to employers with at least 50 workers).
Provide Afterschool Programs to 1 Million More Children: Double funding for the 21^st Century Community Learning Centers program, the federal government’s primary afterschool investment (currently funded at $1 billion).
Promote flexible workplaces: Create a program to inform businesses about the benefits of workplace flexibility and help them set up flexible work arrangements. Increased federal incentives for telecommuting. Make the federal government a model for workplace flexibility.

Both Senator Obama and Senator Clinton have laid out ambitious early education agendas. Next week we’ll raise some questions that voters and the media should be asking about these proposals and discuss their potential to be enacted into law under a Clinton or Obama administration. We’ll also look at what Republican Presidential candidate John McCain is—or, more importantly, is not—saying about early education on the campaign trail.

If you’d like to learn more about Senator Obama’s views on education issues, check out his full PK-12 education plan, or read about his higher education proposals on our sister blog, HigherEdWatch.org.

Photo by flickr user Brian Finifter used under a Creative Commons license.

Primary Watch: Hillary Clinton's Early Education Agenda

Sara Mead — Wed, 09 Apr 2008 20:44:00 -0400

Yesterday, we asked why there hasn't been more attention focused on early education issues so far in this election cycle, noting that both Hillary Clinton and Barack Obama have released detailed and ambitious early education agendas. Today we'll explore Senator Clinton's early education agenda. Tomorrow we'll look at Senator Obama's early education plan.

Supporting High-Quality Universal Pre-K

The centerpiece of Senator Clinton's early education agenda is her Universal Pre-k Plan, which her campaign rolled out nearly a year ago as her first major education policy proposal and one of her earliest big policy releases. Senator Clinton's plan would provide grants to states to establish high-quality pre-k programs. In order to receive funds states would have to:

Ensure that state pre-k programs meet high quality standards, including:
- Teachers with a bachelor's degree and training in early education
- Age-appropriate curriculum
- Small class sizes and teacher student ratios
- Safety and health monitoring.
Provide pre-k at no cost to four-year-olds from low-income homes and English language learners
Develop a plan to make voluntary pre-k universally available for all-four-year-olds in the state.
Include community-based providers in their pre-k system. (The pre-k bill Clinton has introduced in the Senate would require 25% of funds to go to community-based providers.)
Match federal investments dollar-for-dollar.

Once state pre-k programs meet high quality standards and serve all low-income and ELL four-year-olds, they could use federal pre-k funds to serve higher income students, serve younger students, raise teacher salaries, or other activites that expand and improve pre-k. Clinton has proposed providing states with $5 billion in grants to support universal pre-k in the first year and ramping up to $10 billion over the next five years.

Zero-to-Five
More recently, Senator Clinton's campaign announced a broader "Zero-to-Five" agenda that includes their Universal Pre-K program as well as the following elements:

Nurse-Home Visitation: Senator Clinton's plan would provide Nurse-Home Visitation for all at-risk mothers. This model, in which nurses visit at-risk mothers during pregnancy and for the first 18 months of their children's lives to provide support, health services, and education, has been shown to be effective in improving children's and mothers' outcomes.
Triple Early Head Start: The Early Head Start program provides services to low-income children ages 0-3, and evaluations of the program have produced very positive findings. Early Head Start currently serves about 61,000 children.
Expand Head Start to serve 160,000 more children: This would be an almost 20 percent increase above the 833,516 children Head Start currently serves.
Increase funding for the Child Care Block Grant, which has stagnated during the Bush administration, and support the following to improve child care quality:
- Help states improve and enforce child care licensing and safety standards
- Support public-private partnerships to increase the supply of affordable, high-quality child care for working families.
- Promote and support state quality rating systems for child care
- Support workforce initiatives to improve child care workers' training
Allow qualified low-income parents to receive Child Care and Development Block Grant funding to stay home with their children. Right now, low-income parents can only receive CCDBG funds if they place their children in childcare. This proposal would let low-income parents receive payments to care for their children at home.

Clinton has also said she supports reform of the Dependent Care Tax Credit, but hasn't offered specifc policy recommendations for how it should be reformed.

Supporting Work-Family Balance
Senator Clinton has also offered several work-family balance proposals that could affect young children's learning and development:

Expand Paid Family Leave: Senator Clinton would support a variety of initiatives to help parents care for new babies, with the goal of having paid family leave for employees in all states by 2016:
- $1 billion State Family Leave Innovation Fund to providing matching grants to help states start paid family leave programs using a variety of funding strategies,
- Paid maternity/paternity leave for federal workers (they currently have none)
- Expand the Family and Medical Leave Act to cover employers with 25 workers (it currently applies only to employers with at least 50 workers)
Support workplace flexibility and telecommuting: Senator Clinton would create a "model workplace" program to highlight business that establish innovative workplace flexibility models, would promote telecommuting for federal workers, and would provide $50 million annually in incentives for state and local telecommuting initiatives.

Senator Clinton also has a history of supporting and advocating for early education and quality childcare. As First Lady, for example, she hosted the White House Conference on Early Development and Learning, which expanded public awareness about early childhood development and helped raise the national profile of early education issues. Early Ed Watch is pleased to see that she's continuing to support programs for young children on the campaign trail.

Tomorrow, we'll talk about Senator Barack Obama's early education proposals, and next week we'll raise some questions about both candidates' agendas. If you're interested in learning more about Senator Clinton's other education policy proposals, check out the education page on her website, or read our sister blog HigherEdWatch.org's coverage of her college proposals.

Photo by flickr user wausaublog used under a Creative Commons license.

Primary Watch: Ignoring Early Education

Sara Mead — Tue, 08 Apr 2008 17:31:00 -0400

As the Democratic primary campaign season rolls on—seemingly interminably—we’ve read new articles about every imaginable aspect of the campaign (and some we couldn’t imagine). Today we were even treated to a New York Times story about how Democratic superdelegates’ children—and Wisconsin Governor Jim Doyle’s 7-year-old grandson—are persuading them to back Barack Obama. Yet we at Early Ed Watch have seen almost no coverage on a subject near and dear to our hearts—the candidates’ proposals for early education. While it’s certainly fascinating to hear about how children are helping Obama, we think voters would rather know what Obama—and his opponent Hillary Clinton—plan to do to help children learn.

Why should the media pay more attention to early education issues in the campaign?

First, both candidates have put forward big, expensive, and ambitions early education proposals. Both candidates have proposed spending $10 billion a year to expand pre-kindergarten and other early education programs. That would be a huge investment. By way of comparison, the current federal investments in Head Start, Early Head Start, the Child Care and Development Block Grant, Even Start, and the IDEA programs for Infants, Toddlers, and Preschoolers with disabilities combined total less than $10 billion a year. Both Clinton and Obama are both proposing to nearly double federal investment in early childhood education!

Second, this is one issue where there are real policy differences between Clinton and Obama. The general consensus in this election has been that, for all the contention between the two Democratic frontrunners, their actual policy positions and most issues are quite similar. That’s not true when it comes to early education. Sure, both Clinton and Obama propose spending a lot of money to educate young children. But there are big differences in what they want to spend that money on. Senator Clinton would focus investment on expanding access to high-quality pre-k for all four-year-olds, and would improve the quality of state pre-k programs. Senator Obama, by contrast, would allow states to use funds to improve childcare and education for children from birth through age five. His plan does not set standards for pre-k quality or pledge to make pre-k universal. These significant differences in the candidates’ early education plans align with differences in their policy views on other issues—such as health care.

Third, the Democratic candidates’ early education proposals mark a dramatic break from the Bush administration’s record. Under the Bush administration, funding for Head Start and childcare programs stagnated, and the administration even sought cuts for some key programs. But Clinton and Obama are right in tune with the action in the states, where governors and legislators from both parties have been increasing early education investment. That’s certainly true in Pennsylvania where, in 2007, Governor Ed Rendell and the legislature increased dedicated pre-k funding by $75 million to serve an additional 11,000 three- and four-year-olds. Pennsylvania is also widely considered a national leader for its efforts to improve the quality of childcare for children from birth on. Both Clinton’s and Obama’s proposals would help accelerate Pennsylvania’s early education efforts.

So why aren’t the media paying attention to early education issues in this cycle? We can’t say for sure. Numerous media critics have pointed out that campaign coverage tends to focus on the “horserace” and personalities more than policy issues. But part of the problem is that the candidates themselves aren’t talking up their early education proposals all that much—a real missed opportunity, in our opinion.

Both candidates could benefit from talking more about early education issues. Highlighting early education would give Senator Clinton an opportunity to show off her distinguished record of work on early education and childcare issues over the past 35 years—as well as her clear passion for young children’s education and welfare. As for Senator Obama, talking about his ambitious early education agenda might help him score points with women—a constituency where he needs to make inroads in order to seal the nomination. Polling data show that women, as a group, support early education investments.

With two weeks left until the Pennsylvania primary, both candidates still have a chance to tell voters about their early education agendas. Over the next two days, we here at Early Education Watch will be describing the details of both Senator Clinton and Senator Obama’s education plans, and the questions voters and reporters should ask about them. So click back tomorrow to learn more.

POLITICS: Across the Spectrum, Some Common Goals at the AMA

Guy Clifton M.D. — Wed, 02 Apr 2008 17:30:00 -0400

Ten years ago we couldn't even agree on the ultimate goal for health reform. Just a day ago, at the American Medical Association's National Advocacy Conference, I heard a whole lot of agreement on where we want to be -covering all Americans, providing better care, and reducing costs. Two very interesting perspectives on how to get there came from from Senators Ron Wyden (D-OR) and Tom Coburn, M.D. (R-OK).

Wyden and Coburn are of course far apart ideologically. But as I listened to them give their separate speeches, I was struck by how similarly they viewed our health reform challenges (if not how to achieve solutions). In particular:

Both were very clear that 47 million uninsured is simply unacceptable for this nation
Both advocated greater preventive and primary care services in the U.S. to improve health and reduce costs
Both decried the amount of administrative waste in our current system (and as a doctor, I wholeheartedly agreed).

Not surprisingly, the Democratic Oregonian and the conservative Republican Oklahoman differed in their proposed approaches to creating a more sustainable health system. Senator Coburn opposed further regulation of insurance markets and doctors, made the case for the power of the free market, and supported tax credits to make insurance more affordable. Senator Wyden, who is a lead sponsor of a bipartisan compromise that already has more than a dozen backers in the Senate, supported requiring all Americans to purchase health insurance, along with market reforms and subsidies to make sure those insurance policies are accessible and affordable. Wyden envisions a system where insurance companies make their money by adding value to medical care rather than "cherry picking" the healthiest and lowest risk individuals.

We don't want to minimize the real differences between the approaches. But we're glad both sides are talking and that groups like the AMA are listening. These conversations can create a foundation for future constructive and bipartisan progress around a common vision of where we want to be. Now we've got to figure out, together, how we can get there.

POLITICS: Americans skeptical about "best health care in the world" claims

Joanne Kenen — Fri, 21 Mar 2008 16:58:00 -0400

Finally some proof that fewer and fewer people believe that "America has the best health care in the world!" This claim simply doesn't resonate with Americans who have experienced (or heard about) distressing personal encounters with swamped emergency rooms, medical errors, specialists who don't talk to each other, nursing shortages in hospitals, high prices, etc. etc.

According to a new poll from the Harvard School of Public Health and HarrisInteractive, only 45 percent of those surveyed agreed with the statement "the U.S. has the best health care system." Republicans were most likely to agree (68 percent) compared to Democrats (32) and Independents (40). That's a pretty sharp discrepancy - but it also mirrors the approaches and slogans we've heard on the campaign trail this year.

Across the political spectrum, respondents said that the United States does a worse job than Canada, France or Great Britain in making sure that everyone can get affordable health care and control costs. Among Republicans, 40 percent said our country does better than other countries on providing affordable care, but only 19 percent of Democrats thought so. (This particular poll did not test their views on possible solutions to the system).

It's still hard to know whether voters are beginning to connect the dots between the quality gaps they encounter when they seek medical care, and the strains in our insurance and delivery system. We'll do our best to point them out.

For other takes on the poll, see this Wall Street Journal blog post, and this Reuters article.

IN THE STATES: Pennsylvania Governor Backs Coverage Plan

Joanne Kenen — Wed, 19 Mar 2008 22:04:00 -0400

Brief update - As expected, the Pennsylvania House did approve a scaled-back version of Gov. Ed Rendell's health coverage plan this week. Rendell has now embraced the compromise and strongly urged the state Senate—which has been more skeptical about the finances—to pass it. As coverage expansion needs to go hand in hand with insurance market reform, particularly to help small businesses and individuals purchase policies, Rendell is also pushing for an insurance package in the House. AP has the details.

Also in Pennsylvania - Patients can now go to a single user-friendly web site- instead of a confusing array of them - to learn about local hospital quality in four key areas: heart attacks, heart failure, pneumonia, hospital-associated infections. The site was developed by the Pennsylvania Health Care Quality Alliance - a coalition insurers, hospitals, doctors and government agencies, the Philadelphia Inquirer reported.

"Our goal has been to work together on a common way of understanding and sharing the quality measures data that providers are already required to report," Carolyn F. Scanlan, president of the Hospital and Healthsystem Association of Pennsylvania, said in a statement.

POLITICS: Health Care Top Issue for One in Five Missippi Democratic Primary Voters

Joanne Kenen — Wed, 12 Mar 2008 20:12:00 -0400

It's no surprise that the economy was the top issue for Mississippi voters in Tuesday's Democratic primary, but health care still resonated. Just over half the voters surveyed by network exit polls cited the economy as their top concern. But one in five said health care was their number one issue -- the same number as the Iraq war. (We would argue that health cost and coverage can be a component of economic anxiety as well). Voters who cited health as their main concern voted for Barack Obama over Hillary Clinton by a nearly two to one margin (64 to 35 percent).