Cost

COST: Obesity Will Cost US $344 Billion By 2018

A new study from America's Health Rankings predicts 103 million American adults (43 percent) will be obese by 2018, if obesity levels continue to grow at their current rate. At that point, the U.S. will spend approximately $344 billion dollars annually on health care costs attributable to obesity, according to the new study.

The study, conducted by Emory University professor Kenneth Thorpe, utilizes weight data, Census statistics and medical expenditure information, according to USA Today. Thorpe's study, The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses, is the first to provide projections for the future medical costs of obesity, and also provides state by state calculations for obesity levels and cost, according to a press release from the United Health Foundation. (Mississippi tops the list for the most obese population, while Colorado is all the way at the bottom.) USA Today has some highlights from the report:

HEALTH REFORM: Drug Tab To Increase

The New York Times had two interesting reports this week on the pharmaceutical industry.

Monday Duff Wilson reported that drug makers have raised the prices of wholesale brand-name prescription drugs by more than 9 percent during the  the last year (more than twice the general inflation rate of 3.8 percent).

The paper reported that this dramatic price increase will boost the U.S. prescription drug tab by more than $10 billion this year. Total pharmaceutical spending is expected to trump $300 billion (up from $230 billion in 2003), and at least one analysis indicates that this will mark the highest annual rate of inflation for drug prices since 1992.

Remember, this is despite the pharmaceutical industry's pledge to reduce the nation's drug costs by $80 billion over 10 years after health care reform kicks in.

Huh?

"Price adjustments for our products have no connection to health care reform," said Ron Rogers, a spokesman for Merck. The drug makers say that several patent expiration dates are right around the corner and that they need to maintain high profit margins to invest in research and development. 

COST: Medicare Fraud Gets Increased Scrutiny

The government paid $47 billion (that's billion with a B) in false or questionable Medicare claims last year, according to a new federal report obtained by the Associated Press.

The report shows a dramatic increase in Medicare fraud from previous years. In 2008, the government paid an estimated $17 billion in improper claims. So what caused this number to nearly triple in the past year? The most likely culprit is not more fraud attempts, writes the AP, but the increased scrutiny on Medicare claims. The Department of Health and Human Services's new  stricter methodology is part of the Obama Administration's effort to crack down on Medicare fraud.

IN THE STATES: How Health Reform Can Stimulate Colorado Economy, Create Jobs

Talking about health care reform all over the country, I have the opportunity to see many states' health systems up close.  In particular, we spend a lot of time in Colorado -- as evidenced by our study on Grand Junction. In the context of current reform discussions, I began focusing on the state in earnest in 2006 when the Colorado Blue Ribbon Commission for Health Care Reform began trying to identify a sustainable future for the state's health care system. It was a privilege to be consulted by the Commission -- a true bipartisan and multi-stakeholder effort -- about choices they could make to cover more Coloradans, improve the quality of care while reducing health care cost growth, and make the health system economically viable in the long run. At the end of a long and impressive (but surely exhausting) process, the Commission's recommendations look prescient, in that they are structurally and conceptually consistent with the federal health reform proposals under consideration today.

HEALTH REFORM: How to Control Rising Health Care Costs

In its Room for Debate section, The New York Times asks a group of health experts what one or two provisions could be added to health reform legislation to help contain health care costs going forward. Below is my contribution to the discussion. For more on the issue, you can read my colleague's post on the real versus the ideal options for slowing the growth of health care costs.

The Medicare payment reforms in both the House and the Senate bills will help to slow the growth of costs by rewarding value over volume, as will the proposed Medicare commission and the tax on insurers who offer high-cost health plans, which are in the Senate Finance Committee bill. And both House and Senate legislation also includes “innovation centers” which will allow us to test different payment models and health care processes.

Even with these steps, the reform bills could be strengthened. Specifically:

COST: Getting Real. Versus Ideal.

Academics and think tanks (including us) may pump out issue briefs and op-eds and blog posts about how to slow down health care spending, but Washington is still full of skeptics about whether or not health reform legislation will truly bend that cost curve.  

Leave it to Rahm Emanuel, President Obama's Chief of Staff, to give us our favorite quote on the curve-bending ideals versus curve-bending politics. He told the New York Times:

Let's be honest. The goal isn't to see whether I can pass this through the executive board of the Brookings Institution. I'm passing it through the United States Congress with people who represent constituents... I'm sure there are a lot of people sitting in the shade at the Aspen Institute -- my brother being one of them -- who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.

HEALTH REFORM: Passing the Baton

The House's historic vote on Saturday feels almost like ancient history. By Monday, all eyes turned back to the Senate and the progress of the merged legislation being shepherded by Majority Leader Harry Reid.

H.R. 3962 passed by a margin of 220-215 with 39 Democrats voting against the bill and one Republican representative crossing party lines. (The New York Times has a great graphic illustrating the politics of this vote.) Speaking from the White House Rose Garden on Sunday, President Obama thanked lawmakers for their "courageous vote," and called on the Senate "to take the baton and bring this effort to the finish line on behalf of the American people."

The relay is being held up, however, as Reid waits for the CBO to return scores of the various proposals and options he submitted. Estimates are expected to be released by the end of this week, and merged legislation could be released soon after. Still the Senate is not expected to begin debating the legislation until after Thanksgiving, giving Congress essentially four weeks to try and meet President Obama's goal of signing health reform legislation into law before year's end.

It will be a sprint to say the least. You know our stance on the issue, and the White House, too, is stepping up its pressure to not let this slip into 2010.

At the very minimum, it currently seems Reid will try to pass legislation through the Senate before Christmas.That leaves open the option for conferees to work on merging the House and Senate Bills over the holiday recess and clear the way for a vote on final passage early in January.

In addition to the simple logistics of moving historic legislation through the historically slow moving Senate, Kaiser Health News, Slate, and the Wall Street Journal all give a good lay of the land, and here's our quick overview of some of the biggest issues going forward:

COST: Can Health Reform Heal the Federal Budget

Can health reform heal our federal budget? Yes, but whatever passes now is just the beginning, and there will always be room for improvement.

That's our takeaway from an excellent event we tweeted this morning hosted by the US Budget Watch, a joint project between the Committee for a Responsible Federal Budget and The Pew Charitable Trusts.

There was a lot of ground covered by a panel of experts moderated by the Washington Post's Ceci Connolly and featuring New America's director of health policy Len Nichols. They tackled everything from raising Medicaid eligibility rates to fixing the Sustainable Growth Rate formula in a fiscally responsible way. But for now, we'll just give you the highlights of the discussion.

HEALTH REFORM: CBO Confirms GOP Bill Offers Scant Coverage

Last night, the Congressional Budget Office released a preliminary analysis of the House Republican health care bill. The bill focuses mostly on cost and repackages a lot of the conservative ideas that have been around for years (and never came to fruition even while Republicans held the torch.)

According to the CBO, by 2019, the Republican bill would only extend health coverage to three million more Americans and reduce the federal deficit by $68 billion. In comparison, by 2019, the House Democratic bill would insure 36 million more Americans and reduce the federal deficit by $104 billion.

QUALITY: A Thoughtful Critique of ACOs

In case you missed the ‘Space' section of your daily paper a few months ago, two planets -- one the size of Mercury and one the size of our Moon -- collided in a far off solar system.  The smaller planet went the way of Alderaan. The larger planet suffered a big dent.

My own worlds collided this week when former-professor-in-my-department Kelly Devers teamed up with my former boss (on a research project) and friend-of-the-blog Robert Berenson to publish a thoughtful critique of the panacea fever surrounding Accountable Care Organizations (ACOs).  As much as we have trumpeted ACOs as the best cure-all since Clark Stanley's Snake Oil Liniment, Drs. Devers and Berenson's thoughtful analysis published by RWJF is a welcome contribution to the dialogue.