Health Insurance

QUALITY: No Pain=Health Care Gain

If you've been reading this blog, you know I've done a fair amount of reporting in the past few years on palliative care and end of life care (they aren't synonyms, but we'll leave that for another day). I haven't blogged as much about pain management, per se, but untreated pain has huge implications for the health care system (not to mention the toll it takes on the millions of people who suffer needlessly.) People in pain miss work or underperform. They may be less physically active, increasing their risk for chronic diseases or aggravating diseases they already have. A diabetic, for instance, isn't going to get off the couch if he aches terribly because of some other health problem. For our elderly, chronic pain can further isolate them. And if you find yourself in an overcrowded emergency room, look around and find how many people are there simply because their pain—including cancer pain—just got unbearable.

HEALTH REFORM: Insurers Recruit "Activist Army"

The Politico says the health insurance industry is building an “activist army” before any new push for health care reform next year, but you might be surprised at who is enlisting or at least looking favorably upon the “Campaign for an American Solution.”

America’s Health Insurance Plans say they want to involve 100,000 people, including ordinary citizens who are happy with their private insurance coverage. AHIP President and CEO Karen Ignagni plans to kick off the campaign—which includes a national listening tour, advertising and outreach—at a discussion among a group of uninsured people in Columbus, Ohio next Tuesday.

COVERAGE: How the Individual Insurance Market Covers the Sick

USA Today's Julie Appleby takes a detailed look at problems people encounter when they try to buy individual insurance policies, an issue that looms large in both presidential candidates' health plans.

Appleby sums it up like this:

Unlike group plans offered by employers—which provide coverage to everyone, no matter how sick—there is no guarantee in most states that individuals can get insurance. Even if they can, their policies may not cover existing medical conditions such as hay ever, depression or pregnancy.

Insurers "will not cover the sick if they can avoid them," New America's health policy director Len Nichols told the paper. Limits on who can get coverage is one of three problems with the individual market that must be addressed—along with the affordability of a policy, and whether it will cover what's needed when someone gets sick.

IN THE STATES: Massachusetts Tried Reform -- And Liked It

They tried it. And they liked it.

A new poll shows that more than two-thirds of Massachusetts residents approve of the state's health reform, which has halved the uninsurance rate, bringing it down from 13 percent in fall 2006 to 7 percent by fall 2007. The 69 percent approval rating is six points higher than the 61 percent positive rating that the plan had when it was enacted two years ago, according to the survey by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts. Results appeared in the Boston Globe.

The approval was not without some caveats, but overall, when asked if it should be repealed, continued as is, or continued but with changes, 70 percent opted to continue, but with changes. The poll did not ask them to specify what changes they favored.

Survey author Robert Blendon, professor of health policy and political analysis at Harvard, told the Globe the findings show a sophisticated understanding of a complex law.

"They are basically saying it's better to have people covered, even though there are problems here," Blendon said. "People are aware there are costs to this thing, yet they still hang in because they think it's the right thing to do."

VOICES OF REFORM: John Dingell and the Cat that Catches Mice

In more than 50 years in Congress, House Energy and Commerce Chairman John Dingell has seen it all in health care. He can even remember when President Truman tried to get the job done. But Dingell doesn't just look back—here's some of what the self-described "stubborn and optimistic" Michigan Democrat told a Washington policy center about the convergence of interests that make the future of health reform look a little brighter.

"I am starting to see light at the end of this dark road I've been traveling," said Dingell. The spiraling cost of health care, he said, has caught the attention of people and groups who used to oppose insuring everyone. Health reform, he said at an event yesterday at the Center for American Progress, used to be a moral issue. Now it's a moral and economic one, with a greater diversity of business and health industry leaders backing comprehensive reform. Because they need it.

WORLDVIEW: NPR Takes European Health Tour

NPR's recent "Health Care for All" series went beyond a lot of the comparative reporting we've seen before, not just describing how various western European countries achieve and finance coverage for all, but also doing a few very specific case studies—comparing how a multiple sclerosis patient might fare in the U.S. versus Britain or how France treats cancer patients at home, or what the Dutch are doing about diabetes. They did take a good look at the Swiss system—often cited as a potential model for U.S. reforms. Our thanks to the Kaiser Family Foundation for assembling this list.The links will take you to both audio and text versions.



REFORM: Everybody (Anybody?) in the High Risk Pool!

A key feature of John McCain's health care proposal is the "high risk pools" for the uninsurable—people who don't get insurance on the job and can't buy a policy on their own because they have a pre-existing medical condition. Similar pools operate in 35 states, with varying degrees of success.

Kevin Sack in today's New York Times reports that the high risk pools "have served more as a stopgap than a solution." The article goes on to note that:

Though high-risk pools have existed for three decades, they cover only 207,000 people in a country with 47 million uninsured...Premiums typically are high, as much as twice the standard rate in some states, but are still not nearly enough to pay claims. That has left states to cover about 40 percent of the cost, usually through assessments on insurance premiums that are often passed on to consumers.

Some states impose waiting periods, and others limit the number of enrollees. High risk pools do not help people who can get insurance, but not specific benefits they need because of their health history.

REFORM: Watch Out Harry and Louise, Here Comes Elizabeth

Harry and Louise, watch out for Elizabeth Edwards.

The New York Times politics blog reports that Health Care for America Now, a coalition of labor, health care and liberal organizations pushing for comprehensive health reform, will roll out a new television commercial next Tuesday, part of what the group says is a $40 million planned campaign to promote affordable health care under the next administration. The idea is to have a pro-reform media message as powerful as the insurance industry's Harry and Louise ads were in fighting health reform when Bill Clinton was president.

Elizabeth Edwards, breast cancer patient, wife of former Democratic Sen. John Edwards, health policy blogger and visible proponent of health reform, will speak at the group's inaugural event in Washington next week.

The Times reported that after the initial buy of $1.5 million for national television, print and online advertisements, the coalition plans to pour $25 million into additional advertising. The first commercial will run in national newspapers, on CNN and MSNBC and online.

CULTURE BEAT: It's Not Funny, Honey -- Health Reform Meets the Comedy Club

If you're a politician, you know you've hit the big time if a late night talk show host makes fun of you. Ditto for an issue -- it's big time if it makes the leap from  think tank "Issue Brief" to a riff in a stand-up comedy routine.  At the D.C. Improv the other night, it was pretty clear that the state of the American health care system has hit the big time. Jake Johannsen had the packed house doubled-over or nodding vigorously to a series of truisms about our broken system. It was only after I left that I remembered that it's not really funny.

COVERAGE: New AMA President Knows More Than You'd Think About the Uninsured

Dr. Nancy Neilsen is not the first woman president of the American Medical Association but there's a darn good chance she is the first AMA president who at one point had no health insurance for the first three of her five kids, and accepted diapers and free samples of antibiotics from a generous pediatrician.

That was back in the 1960s, when she was a microbiology graduate student, the Chicago Tribune reports. She has also been a primary care physician, an associate dean at a medical school and a health insurance executive. She has seen contemporary U.S. medicine from an unusual number of angles, and at her inaugural speech at the recent AMA annual meeting in Chicago, she put covering the uninsured as the top priority. She declared she would use "all of the power" she has at the helm of the nation's biggest doctors' group "to let the nation know that we must cover America's uninsured."