Coverage

Representing the economically troubled state of Michigan, home to the auto industry, Democratic Sen. Debbie Stabenow just has to look around her to see how sky-high health care costs have eroded the global competitiveness of U.S. industry. Still, she told a New America-sponsored forum on Capitol Hill the other day, it's "nice to be joined by the data in something that I have been talking about for a long time."

Stabenow, the opening speaker at our forum about employer health costs in a global economy, described how the "most expensive and crazy structure in the world"—aka the U.S. health care system—was damaging the economy, hurting industry, threatening the middle class. "We are literally losing jobs," she said, spending more than our competitors on health but having less to show for it. (Click here for the webcast, here for the study, here for our earlier post.)

We've all done a lot of looking back to the lessons of 1993-94, and the long list of reasons the highly complex, ill-timed and politically-polarizing Clinton health care plan failed. But today the journal Health Affairs published an essay looking back not just at the failures of the Clinton plan but at the successful passage of two major health reform initiatives--the truly bipartisan State Children's Health Insurance Program (SCHIP) and the Medicare Modernization Act, which added prescription drug coverage for seniors.

You may have heard about Rep. Steve Kagen, a Wisconsin allergist turned Democratic lawmaker who has spurned Congress's generous health coverage until all his constitutents can get health insurance too. Ivan Oransky, a writer who gets both science and health policy, has a good profile of Kagen at the Scientific American website:

Kagen, 58, is now one of millions of Americans, including at least nine million children, without health insurance. "I have absolutely no health coverage at all," he told ScientificAmerican.com during a recent interview. "I have no health conditions and am pretty darn healthy." And if he gets sick? "I'd be just like the 47 [million] to 50 million American citizens who don't have coverage," he says, "and I'd have to negotiate with hospitals and doctors for the best-priced coverage."

We keep hearing about the role of a "public plan" as an option under health reform, so we paid attention when the Kaiser Family Foundation asked three health policy experts on a webcast exactly what such an option would look like. We watched as Jacob Hacker, Yale professor, New America fellow and author of the “Health Care for America” plan, Linda Blumberg of the Urban Institute, and Stuart Butler of the Heritage Foundation grappled with this question. The hour-long discussion touched on many aspects of the public plan option—how they would compete with private plans, enrollment levels, payment policy, risk selection. You can see the webcast here (and a transcript will be available soon). But here's our impression of the major takeaways from each expert:

Hacker, whose health reform plan has a public option, was the strongest supporter of the idea. He argued that a public option would guarantee good, fixed benefits at a low cost, especially for the most vulnerable Americans. In his perfect world the option would be administered by the federal government, but he was careful to emphasize that it would not be “Medicare for all.” He sees a public option as another competitor with private plans under a shared public/private health system.

First Focus, a children's advocacy group, this week in its Children's Budget 2008 reported that only one cent of each "new" dollar of federal spending (excluding defense) goes to kids. A lot of the report focused on education, so we asked them how does health spending add up. The answer: not so hot.

The overall share of federal, non-defense spending going to children's programs has dropped by 10 percent over the past five years. Real discretionary spending on children has declined by more than 6 percent since 2004, while at the same time all other non-defense discretionary spending has increased by more than 8 percent, the group reported.

Because so much of spending on children' health is through Medicaid, SCHIP, and other entitlements, not out of the discretionary budget, spending on health programs did grow from 2004–08. However, total spending on children's health amounts to less than 2 percent of the total federal budget, and less than 0.4 percent of the Gross Domestic Product.

Outside the mandatory programs, discretionary spending on children's health has declined in real terms. Discretionary spending is down 6.3 percent. As a share of total federal spending, children's health spending has lost ground. Children's health spending currently makes up 1.9 percent of all federal spending, while in 2004 its share was 1.97 percent, a 3.5 percent drop.

Forget pheromones. A new poll from the Kaiser Family Foundation found that seven percent of adults reported that in the past year they or someone in their household decided to get married in order to get health insurance from a spouse. (We don't even want to think about what their bridal gift registry looks like.)

The Kaiser poll had lots of somber news as health care costs are taking their toll on American families (including the middle class) during the economic downturn. Twenty-eight percent report that they or their families have had a serious problem paying for health care, behind paying for gas (44 percent) and about tied with getting a good-paying job or raise in pay (29 percent). Smaller shares report serious problems paying their rent or mortgage (19 percent), dealing with credit card or other personal debt (18 percent), paying for food (18 percent) or losing money in the stock market (16 percent). That 28 percent figure was true as well for middle class families, making between $30,000 and $75,000.

"Many people view health and the economy as separate issues, but the cost of health care is a significant pocketbook issue for many families and paying for health care has become a key dimension of the public's economic concerns," Kaiser Family Foundation President and CEO Drew Altman said.

"47 million uninsured isn't just a statistic, it's a tragedy. Let's work together to expand health insurance coverage to all Americans." That's the message the American Medical Association is sending to Congress this week, with ads in Congress Daily, The Hill, and CQ Today (see a pdf of the print ad here). Highlighting the annual Cover the Uninsured Week across the U.S. the ads are also part of the AMA's broader Voice for the Uninsured campaign..

For more on Cover the Uninsured Week, check out our post yesterday.

We here at New Health Dialogue would like to wish everyone a happy (and productive!) Cover the Uninsured Week. Begun in 2003, by the Robert Wood Johnson Foundation, the initiative seeks to remind us all that whatever week it is, 47 million Americans lack health insurance. And that means they are likely to face lives that are shorter and sicker than the rest of us.

Last year, with more than 3,300 events in all 50 states, Cover the Uninsured Week focused on the 9 million children who lack insurance in our country. (At this time last year, you'll remember, Congress was working on expanding the State Children's Insurance Program but President Bush vetoed the broader version of the program). This year, in addition to fairs, forums, and enrollment events across the U.S., the foundation will be releasing research compiled by the State Health Access Data Assistance Center showing that the cost of insurance has risen far faster than incomes in every state.

Apparently, a lot of Californians shared our disappointment when the state's health reform efforts fell apart earlier this year. A new Field Health Policy Survey shows that Californians are none too confident about the future of health care in their state after lawmakers killed Gov. Arnold Schwarzenegger's plan to cover all Californians in January.

The survey, commissioned by the California Wellness Foundation, found that voters are even more worried now (quite possibly because as the economy worsens, people get more nervous about health costs and job-related insurance). For instance, 59 percent are "very concerned" about not being able to pay all of the costs for a major illness or surgery, up from 48 percent in late 2006. Other findings:

Congress and the President are doing battle yet again about Medicaid , and NPR's Julie Rovner explained in a nice piece this week why we all should care. She illustrated a point we've made ourselves about why insurance matters: the uninsured place an additional burden on already over-taxed Emergency Departments, affecting the quality of care for all of us.

Specifically, the costs associated with uncompensated care for the uninsured and underinsured, and Medicaid underpayment cause many EDs to either close or drastically scale back the number of emergency beds. In fact, between 1993 and 2003, 425 emergency departments closed nationwide. Median ED waiting times for the insured and uninsured increased by 36% between 1997 and 2004.

Rovner drove this point home by recalling some particularly moving testimony Dr. Angela Gardner, Vice President of the American College of Emergency Physicians and an emergency doctor from Galveston, Texas, made before the House Oversight Committee last fall. If you missed Gardner's testimony, here's a must read excerpt:

I worked in the emergency department on Tuesday night, and on my arrival all 48 of my beds were full. We had 22 patients in the hallway. We had 14 patients in the waiting room. We had three ambulances unloading and two helicopters waiting to land. That is a normal day. ...