We asked Leif Wellington Haase, director of New America's California Program, and Micah Weinberg, a research fellow in the California program, to update us on where health reform stands in California a few months after the state's major coverage initiative collapsed.

California Health Reform: Rekindling the Debate? Micah Weinberg & Leif Wellington Haase

Where Things Stand Today

The flame of comprehensive health care reform has been sputtering in California since the Senate Health Committee’s defeat of Governor Arnold Schwarzenegger’s proposal in late January. The conclusion of the regular legislative session in Sacramento hasn’t rekindled it.

Basketball junkies and nostalgic gamers alike know that Oregon is a land for trailblazers. That's because true Oregonians aren't fazed by microfractures in the knee of a 7-footer or drowning oxen in the Snake River. They've got more important issues, like finding a way to cover their state's 600,000 uninsured and make high quality health care affordable for everyone.

Fortunately, they've also got a plan, developed by the Oregon Health Fund Board and released last week for public comment. The authors of "Aim High: Building a Healthy Oregon" listed three objectives of their proposal:

• A healthy population
• Extraordinary patient care for all
• Reasonable per capita costs shared in an equitable way by the entire population.

To meet this "triple aim" the report laid out "eight essential building blocks" to reform:

We had just posted our blog item about the U.S. Census numbers and the worrisome erosion of private insurance and were ducking out for a nice health-minded salad and a bit of fresh air and sunshine, when one more thought occurred to us.... Some of the decrease in the number of uninsured is from Massachusetts. In fact, using very round numbers, more than a fourth of it is. (Massachusetts has insured 439,000 people - roughly 370,00 by the end of 2007, the time covered by the Census). So if we went from 47 million uninsured, to 45.7 million uninsured, a total decrease of 1.3 million, and 370,000 were from the Bay State... Maybe we can conclude that the state's health reform initiative, despite its cost challenges, is doing what it set out to do?

We then checked whether the Boston Globe's White Coat Notes blog had chimed in, and sure enough, it reported that Massachusetts now has the lowest percentage of residents without health insurance in the nation, according to the Census data.

Averaging data from 2006 and 2007, the study found that 7.9 percent of Bay Staters did not have health insurance. From 2004 through 2005, the rate was 10.3 percent.

The news out of the Census Bureau this morning indicates that more Americans had health insurance in 2007 than in 2006. But a closer look at the numbers reveals that our health care system is on an unsustainable path.

The percentage of Americans covered by private coverage—employer sponsored and individually purchased—actually declined. At the same time the number and percentage of Americans enrolled in public coverage, especially Medicaid, increased. In other words, a weakened economy and rising health care costs have led fewer Americans to buy private insurance and more Americans to turn to the government for safety net coverage. Let's keep in mind, however, that the numbers released today are for 2007, before the economy really took a turn for the worse. Therefore, we can expect the reduction in private coverage enrollment and increased dependence on Medicaid to be magnified in 2008. This path places increasing strain on local, state, and federal governments who are already grappling with tough budgetary constraints.

Bottom line: a decrease in the number of uninsured Americans from 47 million to 45.7 million should not distract us from the underlying fact that our current system is unsustainable, that private coverage is decreasing, and state and local governments are faced with higher and higher health care bills.

There is no question that comprehensive health care reform is a moral issue, but we must also remember that a more sustainable health system is an important step towards securing our nation's economic future.

Sen. Kennedy is now planning to appear and possibly speak tonight at the Democratic Convention in Denver. We don't know what, if anything, he'll say, but it's a good time to look back at his memorable speech at the 1980 convention, after his bitter primary battle against President Carter. Health care was among his major causes then, and we know it remains among his major causes to this day. His policies have changed— we don't expect him to repeat a 1980s call for medical price controls tonight —but his fundamental belief in making sure that every American can afford quality health care has not. You can find a text here, and watch the speech here.

Here at the New Health Dialogue we like to highlight reform at the state level because they serve as "laboratories of democracy." One such laboratory, Massachusetts, is succeeding in its efforts to ensure access to affordable health insurance for all Massachusetts residents.

Most recently, Governor Patrick and the Health Care Finance and Policy Division of the state government put out a report on key indicators of health care in Massachusetts. And, almost all of the indicators point to good news.

Harry and Louise are back. Older and ever so much wiser.

The infamous Harry and Louise ads were created by the insurance industry in the early 1990s and widely credited with helping kill President Clinton's health care plan.

Now Harry and Louise are back, urging the next president—whoever that turns out to be—to finally fix U.S. health care.

Lots of things have changed since 1992-94. (The other day, after reading an old Ad Age story online too quickly, I wrote that Harry and Louise had gotten married in real life -- actually Louise married the creator of the ad, not the actor). They have a website. www.HarryandLouisereturn.com. And naturally they are on YouTube:

The presidential nominating conventions are a place for voices to be heard, and the AMA wants to make sure our country's 47 million uninsured are among them. The AMA announced  that it will blanket the convention cities of Denver and Minneapolis/St. Paul  with outdoor advertising featuring doctors and uninsured patients as part of its Voice for the Uninsured campaign. American Medical Association President Nancy Nielsen, M.D said in a statement:

Far too many uninsured patients in the U.S. live in fear each day that they might get sick or injured, and when they do, they often don’t see the doctor until it’s too late. We encourage presidential candidates and other political leaders to engage in a debate about health care reform to help these uninsured patients in need.

Check out one of the ads below and our previous post on the campaign's efforts aimed toward Congress.

What's love got to do with health insurance, our colleague Joanne Kenen asked in April after a survey from the Kaiser Family Foundation found that seven percent of adults reported that in the past year that they or someone in their household decided to get married in order to get health insurance from a spouse. (Explanation of the survey's finding's here).

Last week, the New York Times put a human face to those findings, telling stories of couples who rushed to the altar for insurance or delayed a divorce so the spouse could be treated for breast cancer. One couple even considered getting a divorce so the wife could qualify for subsidized coverage in their home state's high-risk pool.

Not surprisingly, the piece garnered strong reactions, both in the article's comments section and in the letters section of today's paper. Joshua Schulman-Marcus, a fourth-year medical student writes:

Globalization, health care and dry understated wit? The Economist has it all in a piece this week focusing on the rise of medical tourism. Examining the impact of global competition on one the "most local of all businesses," The Economist claims costs alone don't explain the recent trend and suggests two additional factors are at play:

One is that the quality at the best hospitals in Asia and Latin America is now at least as good as it is at many hospitals in rich countries. The second, more worrying, factor is that America's already imperfect insurance safety net is fraying.

Over 45m Americans are uninsured, and many millions more are severely underinsured. Such people may find it cheaper to fly abroad and pay for an operation out of their own pockets than to find the money for deductibles or "co-payments" charged for the same procedure at home. Arnold Milstein of Mercer, a consultancy, calls them America's "medical refugees".

As the article notes, medical tourism is "not a substitute for difficult reforms at home" needed in the U.S. Our colleague, Joanne Kenen, made a similar point last spring, arguing the trends in seeking medical care abroad only strengthened the case for comprehensive reform at home: