REFORM: Bringing Down Chronic Disease

When asked why he robbed banks, Willie Sutton supposedly said "because that's where the money is." Ask health reform advocate Ken Thorpe why he spends so much of his time on chronic disease and he'll probably tell you the same thing: that's where the money is—about $1.58 trillion according to the CDC.

Thorpe is the executive director of the Partnership to Fight Chronic Disease, and we heard him speak alongside former Senate majority leader Tom Daschle and a variety of health policy experts, at the organization's symposium last week.

COVERAGE: Learn. Speak. Act

Learn. Speak. Act. The American Cancer Society's latest public service announcement featuring hip-hop and spoken word artist Michael "MIKE-E" Ellison urges all of us to do just that when it comes to covering the "47 million people without health care access," who are "one paycheck away from poverty, one illness or injury from misery." Message and media merge, as MIKE-E's words are more than just rhymes. Paired with a clean beat and stark background, they paint a vivid picture of the current crisis and sound a clear call for reform. See for yourself below:

COVERAGE: The High Stakes of Childbirth

Pregnancy can be nerve-racking. Expectant mothers worry about the baby's health, fret about sleepless nights, ponder proper parenting techniques, and stew over how to fit their child’s needs into their already tight budgets. Now thanks to some insurance companies, women can add a new concern: that a Caesarean section may render them ineligible for future health insurance coverage.

An article in Sunday's New York Times tells the story of a healthy Colorado mom who was denied individual health insurance because she had given birth by Caesarean section. The insurance company refused to cover her because a woman who has a C-section often has another one in a subsequent pregnancy.  Insurance companies have long refused to cover individuals with expensive medical conditions, but it is relatively unusual to include a prior Caesarean section as a preexisting medical condition.

IN THE STATES: Florida Moves Ahead on "Bare-Bones" Policy

Earlier in May we updated you on the passage of Florida's "bare bones" health policies that Republican Gov. Charlie Crist hopes will make a dent in the state's high uninsurance rate (almost one in five under age 65). Today the New York Times updates what's going on in Florida, along with a useful summary of some other state action—and inaction.

Here's a bit of key information about the new Florida policies:

His [Crist's] initiative, which both houses of the Republican-controlled Legislature approved unanimously, enables insurers to create bare-bones policies that the governor hopes will sell for no more than $150 a month. That is about 60 percent less than the average cost of a policy for a single person in Florida, according to state insurance regulators.

The policies would be available to any Floridian 19 to 64 who has been uninsured for at least six months and who is not eligible for public insurance. In a critical provision, insurers would be prohibited from rejecting applicants based on age or health status.

COST: Want It 'Made in America?' Fix Health Care

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.)

POLITICS: Sometimes Health Reform Bills Do Pass...

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.

COVERAGE: This Uninsured Congressman Speaks Out

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 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."

COVERAGE: Three Views of the "Public Plan" Option

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.

COST: Making Sure the Kids Are All Right

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.

COST: What's Love Got to Do With It?

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.