The gloves are off in the fight for health reform, and the insurance industry has decided that it's time to start throwing analytically indefensible punches. Two recent cases in point: (1) the headline grabbing "report" entitled the "Potential Impact of Health Reform the Cost of Private Health Insurance Coverage," by PriceWaterhouseCoopers , for AHIP (the main health insurance industry trade group); and (2) the "Blue Perspective" entitled "Age Discounts ‘A Must' to Encourage Young Adults to Purchase Insurance," by the Blue Cross and Blue Shield Association.
Thankfully the Urban Institute, in work funded by the Robert Wood Johnson Foundation, has recently released a thorough and devastating rebuttal to the Blue claims. So my comments below focus mostly on the AHIP paper.
This American Life devoted a whole hour this weekend -- and plans another hour next weekend -- to the health care crisis, more than it's ever spent on a single topic. Host Ira Glass, who immersed himself in health policy 101, sounded just as amazed and outraged each time he repeated some variant of the following statement: "Rising health care costs are driving everything in the economy. Half of our incomes are going to be going to health care very soon. Unless somebody does something." (I haven't seen Ira in maybe 10 years, but half his charm was that he always sounded amazed.)
The theme of the first segment, "Dartmouth Atlas Shrugged" may be familiar to our readers, but the story was told with a punch, going back to the Jack Wennberg research that eventually gave rise to the atlas. He discovered the extraordinarily high hysterectomy rates in one Maine community in the 1970s -- a rate so high that 7 in 10 women would have the surgery by age 70, nearly three times the rate of a similar community with similar demographics in the same state.
Earlier this week, we looked at insurance coverage on a state by state (or more precisely -- district by district) level. Based on a similar concept, the Commonwealth Fund report, Aiming Higher: Results from a State Scorecard on Health System Performance, 2009, looks at how well -- or poorly -- states are performing on health care. The report looks at a number of indicators that represent health care access, quality, costs, and health outcomes; this includes avoidable hospitalizations, healthy lifestyles (like not smoking), and preventative care, such as routine checkups and screenings.
In health care, everyone has a story, one that shows how our current system fails us and why the need for reform is so urgent.
There's the worried parent whose grown child doesn't have health insurance, either because they can't afford it or don't think they need it. There's the women whose preventive screening caught a chronic disease early, and whose premiums promptly skyrocketed. And then there's the mother who went to three different hospitals before her daughter was properly diagnosed, only to find that her insurance wouldn't cover treatments the company deemed experimental.
Our colleague Julie Barnes, deputy director of New America's Health Policy Program. moderated the panel on "the future of healthcare reform and public funding." With Sen. John Barrasso (R-WY), Rep. Michael Burgess (R-TX), former Rep. Martin Frost (D-TX), and former Rep. Nancy Johnson (R-CT).
In 1993-94, then Senate Minority Leader Bob Dole, a Kansas Republican who had presidential ambitions and a hankering to regain his position as Senate Majority Leader, helped kill President Bill Clinton's health reform initiative.
"I want this to pass," he said. "I don't agree with everything Obama is presenting, but we've got to do something." He added that he expected to see a Rose Garden signing ceremony within months.
Dole joins a lengthening parade of prominent Republicans, including Bill Frist, in endorsing health reform. (They may not change many minds in a polarized Congress, but might be a help to centrists in both parties. Having Frist and Dole on board would make it easier for someone like Republican Olympia Snowe to vote yes... and harder for a moderate Democrat like Ben Nelson to vote no.)
I ran into an old friend the other night at an overpriced grocery store (slowing down the checkout out of anyone unfortunate to be in either of our lines), and as we chatted in the parking lot trying to catch up before our frozen food started to drip, he asked me whether he, a progressive, should be disappointed about health reform.
It depends on your perspective, I said, voicing some of the thoughts that had been clattering around in my brain recently. What's your starting point?
If you start from your most optimistic, sky's the limit moment, say last November 4 or January 20, expecting to get a $1.5 trillion deficit-oblivious bill that covered absolutely everyone immediately and had a robust public plan and completely rebuilt our health care system ... you know, all the things that some hoped for in the "happy talk" stage of reform when the stars were all aligned for change but none of the hard decisions had been made and the Republicans hadn't opted for the "try to beat'em, don't join'em Waterloo strategy.." well, then disappointment is understandable.
The newspapers are full of stories about how the CBO score of the Finance committee health reform bill is good news and good momentum for Baucus. The CBO says the Finance bill (post mark up) will reduce the deficit by $81 billion over the next decade and expand health coverage to 94 percent of nonelderly Americans, at a cost of $829 billion over 10 years.
Democrats rejoiced, reports The New York Times,
The much-anticipated cost analysis showed the bill meeting President Obama's main requirements, including his demand that health legislation not add "one dime to the deficit." Indeed, the budget office said, the bill would reduce deficits by a total of $81 billion in the decade starting next year.
The report clears the way for the Finance Committee chairman, Senator Max Baucus, Democrat of Montana, to push for a panel vote within the next few days, and sets the stage for Democrats to take legislation to the floor for debate by the full Senate this month.
The CBO just released an estimate of the Senate Finance Committee's "America's Health Future Act of 2009" as amended by the committee, and it is full of good news! As Senator Baucus touted: "This legislation is a smart investment on the federal balance sheet, and it's an even smarter investment for American families, businesses and our economy."
First and foremost, according to the CBO and the Joint Committee on Taxation, this legislation would result in a NET reduction of the federal budget deficit of $81 billion over the next 10 years -- and would continue to reduce the deficit in the following 10 years. It is important to note that this is a net reduction which means that even with the projected net cost of $518 billion to expand insurance, the savings and revenues will more than outweigh those costs.
Additionally, the CBO projects that by 2019, if this plan is enacted, 94% of Americans will have insurance, as we see increases in people purchasing insurance through the exchange and taking-up Medicaid or CHIP coverage.
Despite the good news, we still expect to see more debate on how best to provide truly affordable coverage to as many Americans as possible.
A study in the Annals of Internal Medicine (Hat tip Kit Seelye) finds that people who are uninsured in their 50s and early 60s end up costing Medicare a lot more money when they hit 65. The extra cost is about $1,000 a year -- meaning that the savings would pay almost half the $197 billion it would cost to cover them in the first place.
And because Medicare pays a tad less than half of all health care spending for the elderly, the reduction in total medical spending (not just from Medicare but also out-of-pocket spending and from other insurers) after age 65 may be even greater.
A lot of the costs can be attributed to uncontrolled or poorly controlled diabetes and cardiovascular disease such as hypertension, heart attacks or stroke.The uninsured may also delay surgeries such as joint replacement until Medicare will pay for them."For adults with these chronic conditions," Dr. Michael McWilliams and his colleagues at Harvard Medical School and Harvard School of Public Health wrote," improvements in blood pressure, blood glucose, and cholesterol control associated with gaining coverage may substantially reduce subsequent annual health care costs."
The Republican stance on Medicare has Paul Krugman tearing his hair out. Or maybe he wants to tear their hair out. In a column titled "The Politics of Spite," he writes:
At this point, the guiding principle of one of our nation's two great political parties is spite pure and simple. If Republicans think something might be good for the president, they're against it -- whether or not it's good for America.
Now, it's understandable that many Republicans oppose Democratic plans to extend insurance coverage -- just as most Democrats opposed President Bush's attempt to convert Social Security into a sort of giant 401(k). The two parties do, after all, have different philosophies about the appropriate role of government.
But he argues that when Democrats opposed President Bush's plan to privatize Social Security, they did it in an ideologically consistent way. Not so the Republican assault on health reform.