Cost

COST: The $64,000 Question (Make that the $6.4 Trillion Question)

Ceci Connolly at the Washington Post asks the $64,000 question -- or maybe it's more of a $6.4 trillion question. Do the House and Senate health care bills go far enough in reshaping how we deliver health care so that we can control rising costs?

A lot of experts, she notes, see the approach as too timid by far.

"The bills are directionally correct, but they're not going far enough," said George Halvorson, chairman and chief executive of Kaiser Permanente and the author of "Health Care Will Not Reform Itself."

HEALTH REFORM: Medical Loss Ratio or Just Medical Loss?

(We are refiling this post to make the paragraph about the SEC a little clearer for our readers.)

"The American people and I are asking a serious question and one that deserves a straight answer -- why are health insurance costs going up each year?" Sen. Jay Rockefeller (D-WV) questioned in a letter (part 1 and part 2) to H. Edward Hanway, the CEO of CIGNA, yesterday. "Are they spending it to make people well when they are sick and keep them healthy? Or is the money they charge going to profits, to executive salaries, and to figuring out how to deny care to people when they really need it?"

Sen. Rockefeller explains:

HEALTH POLITICS: Late In The Game, Republicans Offer New Bill, Old Ideas

An early draft of the House Republicans' health care bill is available at BNA. The Republican bill is much more limited in scope than the current House health reform bill, and is focused primarily on cost -- which represents only one aspect of the problems plaguing our current health care system.The bill repackages a lot of the conservative ideas that have been floating around for years -- and which didn't even get enacted when the Republicans were in control of Congress and the White House.

The bill will not end insurance company discrimination against high risk individuals nor will it provide subsidies to help the uninsured purchase coverage, according to Politico:

Boehner hasn't released the full details of the bill but has said that it would make it easier to buy insurance across state lines, impose strict limits on medical malpractice lawsuits and allow individuals and small businesses to pool their resources to buy insurance as a group. That is designed to boost their purchasing power to help lower individual premiums.

HEALTH REFORM: Back to the Blogger To-Do List....

(Reposting to fix a typo in a Brendan Borrell's name)

A few good reads from this week that we didn't have time to blog about (some travel, two magazine deadlines and Halloween costumes to prepare) but still wanted to share:

Reuters Health, under the relatively new direction of Ivan Oransky, has an investigative piece by Brendan Borrell looking at some of the intrigue and controversy surrounding a couple that has to a certain extent become the face of the growing medical tourism industry.

Kaiser Health News' Julie Appleby (expanding on and explaining some fine analysis by the Center on Budget and Policy Priorities) raises some concerns about affordability under the Finance Bill.  She writes:

Proponents of the Senate Finance Committee's health care bill say the legislation will limit the amount that lower- and middle-income people must pay for health insurance to a maximum of 12 percent of their incomes.

COST: The HEAT Is On For Fraud And Abuse

Would you pay $4,000 for a knee brace, shoulder brace, and a heating pad? Would you pay for physical therapy for an imaginary person? How about two knee braces for a patient with only one leg? Probably not -- which is exactly why federal prosecutors are cracking down on fraud and abuse in Medicare and Medicaid.

How much of health care spending consists of fraud and abuse? And what can we do to stop it? These questions were the focus of a Senate Judiciary Committee hearing, "Effective Strategies for Preventing Health Care Fraud."

Deputy HHS Secretary Bill Corr and Assistant Attorney General Tony West testified about their departments' joint task force on health care fraud. The National Health Care Anti-Fraud Association estimates that fraud makes up about three percent of total health care expenditures (more than $60 billion a year). Other estimates go even higher.

COST: Excise and a Healthy Fiscal Diet?

Senate Majority Leader Harry Reid's decision to include a public plan with state opt-out in the Senate bill may have made the headlines this week, but Christina Romer's remarks Monday may tell us more about what's next for health reform

Speaking at the Center for American Progress, the chair of the Council of Economic Advisers highlighted the importance of health reform to our nation's fiscal future. (Full text of her remarks here). In particular, Romer gave a strong endorsement of the excise high value health insurance plans:

COST: Physicians and Hospitals Working Together?

Getting professionals to work together can be hard. Take Washington's football team, for example. All the players are paid by the same owner. Yet they can't seem to get a win.

USA Today/Kaiser Health News featured a story this week on how to get physicians and hospitals to work together. Featuring Tulsa, Oklahoma's Hillcrest Medical Center, the story explores the new Medicare Acute Care Episode (ACE) Demonstration Project and its effect on providers and patients. Hillcrest, a for-profit hospital owned by the Ardent chain, receives a global or "bundled" payment for certain Medicare services. Then -- in line with previously negotiated arrangements -- it pays physicians from the global payment funds. The idea is to encourage coordination of care between physicians and hospitals, which (due to a relic of history) traditionally recieve not only separate payments but from separate Medicare funding streams (part A for hospitals, B for doctors).

HEALTH CARE: More Evidence about the $700 Billion Waste

We've often cited estimates from the Dartmouth Atlas and others that about one out of every three dollars we spend on health care (which adds up to about $700 billion) adds no value whatsoever to our health. Zilch. Now a paper from Healthcare Analytics at Thomson Reuters confirms that figure, estimating that we waste between $600 and $850 billion a year:

In this white paper, we present evidence that supports the reasonableness of these claims. This evidence has been gathered from published research studies, expert opinion, and findings from our own Thomson Reuters analyses of our large healthcare databases. We describe the types of waste that are recognized by most experts along with estimates of the magnitude of that waste.

Robert Kelley, vice president of healthcare analytics at Thomson Reuters and author of the white paper said, "By attacking waste, healthcare costs can be reduced without adversely affecting the quality of care or access to care." (A copy of the full report is attached below. Here's a summary)

Here are some of the study's key findings and how they categorize the waste:

COST: Help For Those Struggling With Medical Debt

Health care and bankruptcy. The two really shouldn't go hand in hand. Too often they do.

The Senate Judiciary Committee's Subcommittee on Administrative Oversight and the Courts held a hearing on medical bankruptcy earlier this week, "Medical Debt: Can Bankruptcy Reform Facilitate a Fresh Start?" Subcommittee chairman Sen. Sheldon Whitehouse (D-RI) introduced legislation that would make filing for bankruptcy less difficult for Americans with significant medical debt. His legislation, the Medical Bankruptcy Fairness Act of 2009, would also make it easier for those in medical bankruptcy to keep their homes, according to BNA (subscription required).

IN THE STATES: There's More Than One Brady in New England

In the world of state health reform, Vermont often plays the Jan to Massachusetts' Marcia. However, preliminary evaluations suggest that other states and policymakers would do well not to ignore New England's favorite middle child. My colleague previously wrote about Vermont's most recent legislative action on health reform passed in May of 2006. Now, a study published by the Robert Wood Johnson Foundation this week updates us on Vermont's achievements. Here are some of the successes from the Year 1 Interim Report: