Health Care

There are several bills within the stimulus bill. One of them is called “Health Information Technology and Quality,” which is essentially a fully cooked piece of legislation laying out goals, administration, and funding for a new national system of electronic medical records “for each person by 2014.”

President Obama has often referred to the potential of such records to reduce medical errors, improve care, and cut costs. As it is, any patient who seeks a second opinion, or moves from one city to another, often must haul his or her medical history and diagnostic images along. The absence of unifying electronic medical records among hospitals and practitioners is an absurd and dangerous anachronism in this age when any teen-ager can carry a multi-player hockey video game around on a cell-phone...

Like millions of other Americans, I have a bad back. My personal experience with "degenerative disc disease" is why I am so enthusiastic about comparative effectiveness research, or "CER," a key piece of health care reform. It is also why I get so frustrated when people claim that reform will lead to the government "rationing" care and interfering with the relationship between patient and doctor.

CER is the scientific examination of which medical treatments are the most effective for individual patients. The federal government invested over $1 billion in such research as a part of the stimulus package. Public funds must generously support this activity because private funding frequently biases medical research in favor of prematurely approving new treatments that will harm patients or waste money.  A proposal by the New Democratic Coalition would place responsibility for disseminating this research with an independent board rather than within government.

"If we can fix health care system for cancer patients, we will fix it for millions of others."

That's the mantra of the American Cancer Society Cancer Action Network, which plans on spending $3 million on advertising and grassroots organizing in the next couple of months to push for comprehensive health reform. The cancer society is all too well aware of how the system fails sick people, particularly sick people who have little or no health insurance. For starters, they are more likely to die—even if their cancer is detected early.

ACS CAN released a poll Monday that showed how scary cancer can be. Not the disease. The bills.

Of the 1000 people surveyed, four in 10 said they didn't think they would be able to afford cancer treatment if they got sick. One in five said it's likely that they or someone in their household would lose health coverage in the next year. One in seven have delayed a cancer screening test in the past year because of cost (and the proportion was higher in lower income groups).

A recent ASC CAN study of national health spending data found that only 7 in 10 cancer patients had "adequate" insurance. Nearly 10 percent were uninsured, and 18 percent underinsured.

The Hope Street Group, a nonpartisan, ideologically diverse group of business and policy leaders, has agreed on a core set of  health reform principles aimed at comprehensive reforms that will create a system that is both more economically sustainable and socially equitable.

Here are the 8 main points (in abbreviated form... for more nuance, click the link above)

1. High quality, affordable basic health care coverage for all, including preventive care
2. New payment and incentive models to promote coordinated care and reward higher value and better   outcomes
3. Faster generic drug introductions
4. Strengthen primary care and prevention to improve public health
5. Establish a comparative effectiveness entity with dissemination authority
6. Quality and price transparency  to help people make informed, value-conscious decisions.
7. Promote investments in "wiring" the health care system
8. Promote a health care system that is both fiscally responsible and sustainable, for both the private and public sectors

The administration has taken the health care summit show on the road. After last week's White House summit, the first of five regional summits was held in Michigan this week. They brought together government officials, business owners, health care workers, and uninsured people with dreadful diseases.

One of the themes that emerged in the accounts we read (the Detroit Free Press, AP and Milwaukee Journal Sentinel) was that participants really got the link between our troubled economy and our troubled health care system. It will be interesting to see if that comes through as strongly in other parts of the country, not as hard-hit as Michigan and its limping auto industry.

But as Guy Boulton of the Milwaukee paper noted:

Few of the speakers mentioned the tradeoffs, compromises and hard choices that substantial health care reform is expected to entail. And the forum didn't touch on such contentious issues as requiring people to buy health insurance or the administration's proposal to create a new government health plan for people who don't get health benefits from an employer and for small businesses.

President Obama’s Health Care Summit last week was seen as the opening salvo in the coming battle for health care reform in the United States. But before we gear ourselves up for that conflict, it’s worth pausing for a moment to note that the president - in less than two months in office - already has a substantial legacy of major health reform to his credit. 

Take for example efforts to get doctors and hospitals to use the latest information technology. The “HITECH” bill is one relatively minor component of the mind-bendingly massive $787 billion stimulus package passed last month. This single piece of legislation, though, increases federal investment in health information technology by 12,000 percent, according to the California HealthCare Foundation. This is no mean feat and it comes not a moment too soon.

In his speech to Congress, President Obama stated unequivocally: “Let there be no doubt, health care reform cannot wait, it must not wait, and it will not wait another year.” So should states sit on the sidelines and wait for the federal government to act? Absolutely not. Successful health care reform will require action in the states in tandem with progress in Washington. This is true even if national proposals succeed exactly as they are written, which is far from a foregone conclusion.

Immediate action in the states is especially critical in the area of making health care affordable for everyone.  Since current federal proposals are designed to build upon and strengthen Medicaid, Medicare, and the employer-sponsored healthcare system, they will only gradually alter the way that healthcare is financed and delivered in the United States. Thus, the states and their health care stakeholder communities still have a critical role in reining in the spiraling health care costs of our patchwork non-system of care.

An Arizona ballot initiative that would have prevented health care reform proposals such as the one that passed in Massachusetts (and failed to pass in California) has been defeated. Early returns had shown that Prop 101 was too close to call, but supporters of the initiative all but conceded defeat yesterday. Other good news for would-be reformers: In Wisconsin, a non-binding referendum on whether the legislature should enact health care reform passed easily. The measure said that the reform should guarantee health care coverage for all that is as good as what state lawmakers receive. But no method of achieving such an outcome was specified.

I've spent the past 24 hours in Sacramento. The main piece of scuttlebut, from several sources: that Gov. Schwarzenegger, as part of the special election he's expected to call next year (likely fall), will pursue an initiative that would put in place the health care compromise he reached with then-Assembly Speaker Fabian Nunez in late 2006.

This raises all kinds of questions. One is a practical question: how to turn massive legislation into an initiative short enough that signature gatherers won't hurt their backs carrying it around California? Others are: 1. how the initiative might be structured to reduce the budget impact, given the international economic crisis and the state's budget woes. 2. And what kind of counter-initiatives might liberal groups such as the California Nurses Assn. (advocates of single payer) or more conservative groups (who don't like the fees or the mandates in Schwarzenegger's plan) pursue on the same ballot?

In drafting ballot initiatives, sponsors often face a choice. They can give their measure a better chance of winning by making it vague. A specific provision is easier to attack. But vague provisions often provoke legal challenges that block successful initiatives from taking effect. Such may be the case with Arizona's Prop 101, the ballot initiative designed to prevent the sort of health care reforms passed in Massachusetts and pursued in California. (Speciifically, the initiative bans the state from requiring people to get health care coverage, and would seem to bar a single-payer system). In this Arizona Republic story on the measure, critics suggest the initiative is so ambiguous that its real meaning might be decided in the courts.

And now the head of the state's indigent care system suggests the initiative, if passed, would force his department to close.