Health Insurance

HEALTH REFORM: A Feisty Lesson in History from Medicare

We wrote last week on a public opinion poll about attitudes toward health reform, and some of the history of failed health reform attempts going back to the Truman administration. We promised to post the comments of long-time health warrior Max Fine, who was in the audience at that event, as he looked back to that era and ahead to the challenges of our own. Also here's the promised  transcript for that Kaiser Family Foundation forum. (pages 48-50 for Fine):

"Hi. I'm Max Fine. I was around during the Truman era....I'm the sole survivor of President Kennedy's Medicare taskforce and we decided early on after the Truman defeat that we had to have a confluence of four forces if we were to enact Medicare.

First and foremost, the President of the United States had to make it his highest priority for a period of time.

Secondly, we did have the support of the key leaders of Congress, the chairman of the Ways and Means and Finance committees.

Thirdly, we had to have the large national organizations, the church groups and the labor groups, and the civil rights groups, and the civic groups. They had to give it their high priority.

HEALTH POLITICS: "Happy Talk" Might Get Us Somewhere

Rebecca Adams has a nice piece in CQ Politics on how we get from the "Happy Talk" stage of health reform to action. She explains what the various interest groups are doing, how they've changed since 1993-94, and what attempts are being made early in the game to craft compromises, thrash out problems and avoid misunderstandings. So far, there's still a lot of disagreement about issues like mandates or a public plan to compete with private insurance plans.

This time, many of the erstwhile opponents of national health care plans, such as insurers and employer groups, say they're open to a health care overhaul—and are jockeying to gain a foothold in early negotiations over health care legislation, which President-elect Obama already has flagged as a major domestic policy priority. Industry lobbyists are meeting weekly with officials from groups that supported prior reform efforts and Capitol Hill staff to work through their many differences and thrash out workable compromises.

COST: More People Skimping on Drugs Because of Costs

One in seven nonelderly Americans skipped a prescription drug in 2007 because of costs, a jump from one in 10 in 2003, according to a study by the Center for Studying Health System Change (HSC). That translates into roughly 36.1 million working-age people and children, an increase of 11.7 million people from 2003.


Both the rising cost of medications and less generous drug coverage in insurance plans (meaning more out-of-pocket expenses) likely contributed to the increase, and as might be expected, the greatest unmet needs were among low-income people, those with chronic diseases, and the uninsured. In fact slightly more than a third of uninsured working age Americans, reported trouble getting prescription drugs, up from 26 percent in 2003.

But the problem is growing even among the insured, rising from 8.7 to 10.7 percent of Americans under age 65 with employer-sponsored insurance.

"The number of Americans who cannot afford prescription medications is likely to grow as the economy continues to decline and the ranks of the uninsured grow," said Laurie E. Felland, M.S. an HSC senior health researcher and coauthor of the study, More Nonelderly Americans Face Problems Affording Prescription Drugs.

HEALTH REFORM: In the Beginning...

Welcome back.

Yes we noticed that President Barack Obama mentioned health care in his inaugural address. We were pleased, but not surprised. He's made clear that health reform is a priority.

We see there's a new look at We didn't see much new on the health care agenda portion of the site—looks like it's what we heard during the campaign and transition. But it's nice that it has found a new home.

HEALTH REFORM: Free Lunches and Filled Doughnuts

Americans want health reform. They want coverage expansion and insurance reform. As long as they can keep the health plan they have now, save money, and finance it all by taxing an upper income smoker. You know, like that guy on the Monopoly board.

They also want to fill the Medicare drug benefit doughnut hole, cover kids, and provide more care to our veterans. By taxing that same rich smoker.

 OK, we're exaggerating. The Kaiser Family Foundation did its traditional poll on the health care agenda for the new president and Congress. There was definitely some good news for those hoping for comprehensive health reform this year. A solid majority of Americans (61 percent) believe that during our economic meltdown "it is more important than ever to take on health reform now."

 But the poll also highlighted serious obstacles that reformers need to keep in mind. That includes deep partisanship and a huge amount of economic anxiety,  according to analysis offered at a Kaiser forum with three of our favorite health policy experts, Kaiser CEO Drew Altman, the foundation's public opinion research director Mollyann Brodie and Harvard professor Robert Blendon, who is an expert on health reform politics and public opinion. (webcast here, transcript in a few days)

COSTS: How Should We Pay Hospices For Long-Stay Patients?

After all these years of writing about health policy, I finally attended my first MedPAC meeting the other day. (Not sure what it says about me that I found it interesting.) They recommended a significant change in how hospices are paid under Medicare starting in 2013. Instead of one daily per diem, the rates would be higher at the beginning of a hospice stay and after a death, the two points when care is most intensive. (Transcript here, policy brief here, background from June MedPAC report here) First a bit of back story...

COST: Cutbacks for the Poor Coming Fast and Furious

If the headlines aren’t depressing enough for you, here’s more glum news. States are slashing health services to poor people at such rapid rates that even a federal rescue package might not be able to restore services, the LA Times reports. And the faltering economy “has all but killed trailblazing state campaigns to expand coverage for the working poor—once seen as hopeful signs for national healthcare reform.”

In Illinois nursing homes facing bankruptcy because of slow state payments may have to relocate old and frail patients.

South Carolina has cut treatment for poor women under age 40 with breast or cervical cancer, and stopped providing nutritional supplements for kidney failure patients.

In Nevada some cancer patients, are struggling to get their chemotherapy after the largest public hospital stopped outpatient cancer services. They’ve been dubbed “medical refugees.” And the list goes on to other states, across the country.

CULTURE BEAT: "The Old Man and the Storm"

PBS's Frontline on Tuesday night (January 6) airs a documentary about post-Katrina New Orleans. The story revolves around Herbert Gettridge, 82, and his extended family. The Gettridges became part of the storm-created diaspora when their home in the Ninth Ward flooded. The collapse of the city's health care system, and the role that chronic disease and medical needs played in slowing the Gettridges' return and recovery, is one of the themes that ties the narrative together.


HEALTH REFORM: Our Year In Review

Before we give this blog (and our bloggers) a holiday break and wish our readers all the best for the New Year, we wanted to take a moment to look back at 2008 and look ahead, with some optimism, to 2009. Amid our challenges are opportunities, and amid those opportunities are the best chance in many years to fix our health care system so that it is both more equitable and more sustainable.

A year ago at this time, we weren't even sure whether health care would emerge as a leading issue in the 2008 primaries, whether it would resonate with voters. To the extent that candidates were talking about health reform, it was to a large extent a squabble among Democrats about mandates that most Americans probably didn't understand. But as the primary season wore on, we heard more and more about health care—and, as former Arkansas Gov. Mike Huckabee reminded us, about wellness and prevention. Health care, after all, isn't just about payments and insurance and financing (and politics). It's about our health.

HEALTH REFORM: Submit Your Thoughts Here. Beware of Special Interests

Former Minnesota Republican Sen. David Durenberger widely emails periodic musings and commentaries which give rather frank and illuminating glimpses inside the heart and mind of a somewhat disillusioned moderate. (He's currently excited about the prospect of Jeb Bush becoming a senator from Florida and Caroline Kennedy taking the seat from New York.) Durenberger remains active in health policy circles and is reasonably optimistic about coming changes in the way we finance and deliver health care, a little more worried about how far we'll get with coverage expansion. Still he's impressed by a lot of what he is seeing from the incoming administration and likes that incoming HHS Secretary Tom Daschle has issued an open invite to the American people to send in their views about health care reform. But Durenberger, who also knows the power of lobbies and special interests, is also worried that this great democratic debate can be subverted. Here's his take: