Health Insurance

Baltimore may be the home to some of the country's finest hospitals, but the rate at which they are providing routine medical care that could (and should) be treated in a doctor's office or clinic shows "a fundamental failure" of the city's health system. That blunt assessment, in the Baltimore Sun, comes from the city's health commissioner himself, Dr. Joshua Sharfstein.

Data from a RAND Corp. study shows Baltimore residents are being hospitalized or treated in emergency rooms for conditions like asthma and high blood pressure at rates that are roughly twice those in surrounding counties and statewide. Nearby Washington, D.C., which has a similar proportion of uninsured, low-income residents, has lower rates. (Baltimore: 42 avoidable hospitalizations per 1000 residents, Washington 28 per 1000)

Sharfstein says the problem stems from clinics that are stretched to capacity and a shortage of primary care doctors who serve poor people.

Before heading off to Nashville last weekend, I twisted my finger, took some ibuprofen, and clutched an ice pack. Didn't help. I wandered around an enormous health care conference, amid literally thousands of hot shot doctors and health care innovators, feeling way too ridiculous about approaching any of them to ask if they could fix my poor little pinkie.

I got home midweek, put up with it for another day (it's quite hard to type accurately with nine fingers when the 10th one has doubled in size) and finally caved in. No I didn't go to the ER (not if I wanted to show my face at the office after all we've written about inappropriate use of emergency care). I called my "primary care provider." She's been my physician for more than a decade, and I like and trust her. But I know that she doesn't treat even minor orthopedic problems herself, she refers me to specialists. Sometimes she's even gotten on the phone herself to a specialist to get me in quickly (because all those people who yell and scream about waiting lists in England and Canada sure haven't tried to see a new doctor quickly here in the good old USA...).

I described my injury, and said, "Don't tell me I have to see an orthopedist."

Big Business. Big Health Reform. Has a nice ring to it.

New America's health policy program is hosting a forum at the National Press Club this afternoon with Health CEOs for health reform (HC4HR). Two participants laid out their preview in an op-ed this morning in the San Francisco Chronicle.

Lloyd H. Dean, president/CEO of Catholic Healthcare West and Bruce Bodaken chairman and CEO of Blue Shield of California wrote about the "renewed hope" for national health reform. And they bluntly said that the health care sector must get on board "even if it runs counter to their business models." They are part of a coalition of health care CEOs who recognize that "business as usual is not sustainable, and who are willing to take risks to achieve universal coverage with lower long-term costs."

Dean and Bodaken outlined several steps necessary to achieve an equitable and sustainable system. Among their recommendations:

I just spent two days at the preconference part of IHI's 20^th annual quality forum and the first thing I did when I got home (aside from dealing with my son's now ex-wisdom teeth) was to get right back on the phone to the IHI conference. This post will have two parts based on that conference call with IHI CEO Don Berwick and colleagues. First, we'll tell you about what the Five Million Lives Campaign has achieved and where they go next, and then we'll fill you in on what an Obama administration means for health care quality (keep reading, in Berwick's view it's all very encouraging). In the coming days, I'll post a bit more about what I learned in Nashville.

A few weeks ago, Kaiser Family Foundation president and CEO Drew Altman wrote an essay about the two camps in health reform, on one hand the coverage expansion group and the other, the delivery system reformers. “The health reform field is like a Venn diagram with circles that intersect (though not by a lot),” he wrote. “They think about different problems and often attend different conferences.”

If we have broad, comprehensive reform, no problem. Both agendas advance, in ways that reinforce and complement one another. But if politics, economics, ideology or interest groups break down that big effort, meaning that our remaining option is a scaled back more incremental approach, a rift between the two groups, he wrote, “could stand in the way of progress on health reform if care is not taken to avoid it.”

You've probably seen the latest US jobless numbers—533,000 jobs lost in November.

Many of those people will lose their health coverage along with their jobs. The Kaiser Commission on Medicaid and the Uninsured has estimated that for each one percent rise in unemployment, another 1.1 million people become uninsured, and one million enroll in Medicaid and SCHIP... Meaning that since this time last year, roughly four million have either lost their coverage or went on to one of those public programs because of job loss (and that doesn't count people whose employers are cutting back on health benefits, or who can no longer afford their share of the premiums).

We fear we'll be reminding you of these numbers for some months to come.

Nothing like waking up to a voice on the radio asking, "Can we really afford something like universal health care with everything else that's going on in the economy?" Particularly when the answer is a resounding "Yes!"

 Marketplace's economics correspondent Chris Farrell said spending on health coverage is a stimulus for the economy, particularly as people lose their insurance along with their jobs. He helpfully noted that it's also the "right" thing to do to help "Main Street," which is apparently what we now call the American public.

As a stimulus package for the economy, partly, it's the right thing to do. Rather than this notion that we can't do it, we can't afford it, an economic crisis provides the opportunity for two real benefits. It will be part of the fiscal stimulus, and it will help out those families. Think about families when they lose their job. You know what? You can't time when your kids get sick. And there's all kinds of costs. And what is it—half of all bankruptcies revolve around medical illness? We have lots of uninsured as it is already. So this would really help people out. But it's not one of these notions that, well, we need people to shop more. No, we don't need people to shop more. But people need economic security, they need to feel better, they need to not have to worry about their children getting sick. This is a good fiscal stimulus package—embrace it and go big.

Health care is usually deemed more or less recession proof. Maybe not this time, according to a recent Chicago Tribune article that analyzed several Moody’s Investor Service reports on sectors including hospitals, medical devices and insurance companies. Bottom line: Moody's revised the health care industry’s 12- to 18-month outlook from "stable" to "negative."

Speaking of the auto bailout (well, we weren't, but everyone else seems to be...)

It's a cliché by now to talk about how carmakers spend more on health care than they do on steel, but clichés stick around for a reason. What's happening now in Michigan is not just another blow to our manufacturing sector but another crisis for our whole economy. And our overpriced, inefficient health care system is a big component.

CNN just took a look at the health care element to the Big Three crisis, and quoted New America health policy director Len Nichols on the costs, in particular, of retiree health care. U.S. carmakers used to have a bigger share of the market, and they had more workers than retirees. Now, they have foreign competitors with lower health care costs, and they have more retirees than workers (two times as many retirees in some cases)

GM is now paying about $1,500 per vehicle for health care, and two-thirds of that is for retirees.

PS As you know, this isn't a new topic. Here's a look back at what Health Populi had to say last year, and Huffington Post in 2006...

Our New America health policy colleagues Elizabeth Carpenter and Sarah Axeen in an op-ed in the Philadelphia Inquirer build on their recent paper on The Cost of Doing Nothing (report here, blog summary here) and explain why we can't recover from the economic crash if we allow people to get crushed by health costs.

Some of the Philly piece naturally focuses on Pennsylvania, where health costs have been a factor in the loss of 207,000 manufacturing jobs since 2001. But their overall message applies to the nation as a whole.

In the face of historic job losses and the worst financial crisis in 80 years, why did health care remain a salient issue in the final weeks of a tough campaign? The answer is simple: When people are worried about their jobs, they are nervous about the security of their health coverage. And when people are trying to figure out how they are going to pay their bills, they are concerned about being able to afford medical care.