Health Reform

This week we attended a Health Affairs event on Health Reform and the 2008 Election at the Willard (excellent coffee), where Celinda Lake (Lake Research Partners) and Bill McInturff (Public Opinion Strategies) entertained the crowd with the good, the bad, and the ugly stories of polling Americans' great thoughts on health care reform. The pollsters represent different sides of the aisle but agreed that: 1) Americans believe that health care costs are linked to the well-being of our overall economy; and 2) The next American president has a "unique window" to change the health care system early in the first term.

Lake, the Democrat, offered many interesting tidbits about what Americans want in their health care reform:

1. Prevention (not wellness)
2. Provider choice (they definitely don't want to lose access to their doctors)
3. Peace of mind about plan choice (they want to keep their policy and benefits if they like them)
4. Control (this is related to the previous two elements)
5. An American Solution (not Canadian-style reform—they want something uniquely American).

Lake also discovered what Americans do not want to hear:

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 ScientificAmerican.com 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."

The Senate Finance committee kicked off a series of hearings on health reform this week, beginning with testimony from two former Health and Human Services Secretaries, Donna Shalala and Tommy Thompson. We were thrilled to see that one of the most powerful committees in the Senate—that will surely play a key role in any major health reform initiative—take on the issue of health reform in an open, bipartisan, and productive manner.

Reuter's Donna Smith has a good summary of the hearing, but having sat just a row behind Shalala and Thompson we'd like to add a few of our own highlights from the hearing.

Senator Max Baucus (D-MT) is a man who not only knows how to quote Goethe (as he did to open the hearing) but clearly knows how to talk about health reform. Stressing the need to move beyond incremental efforts and find a comprehensive way to cover all Americans, he said: "The moral and economic case for reform has never been stronger." We couldn't agree more.

Like most bloggers, we have a thing for celebrities from all walks of life (for years we carried around an autographed napkin from Ben and Jerry in our wallet). So when another famous purveyor of choice, Harvard Business School's Regina Herzlinger, came to town for a CATO Institute briefing on international health care systems the other day, we had to go hear the so-called godmother of the consumer driven health care movement.

Here's our best "Harvard Business Review" of Herzlinger's talk:

• As a country, we're headed toward covering everyone. Herzlinger made this assertion so casually we were a little taken aback. But to hear the author of a popular eulogy for American health care state she believes we're headed toward a future where all Americans are covered is encouraging. Even if we're not in total agreement on how to get there.
• Health care is killing the economy. Herzlinger estimated that GM spends about $900 more per car on health care than its foreign competitors, and cited a recent McKinsey Global Institute study claiming nearly half a trillion dollars of U.S. health care spending provides no added value. In fact, the New America Foundation released a paper today on health care and the global economy, and we're hosting an expert panel discussion this Friday.
  

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.

With John McCain making health care a campaign theme during the past week, there's obviously been a ton of coverage in new media and old about both the proposed changes to the system and the politics of reform. The L.A. Times today has one of the clearest overviews, outlining the big picture differences between the Republicans and Democrats. It also tries to capture how the two approaches would evolve over the long-haul—not just what health care could look like if/when reform is passed but what is likely to occur in the ensuing years. It points out that the McCain plan in particular creates what New America's health policy director Len Nichols is quoted in the article as calling a "Wild West of competition." The fear is that McCain's approach and the amount of his tax credits would leave many people with only bare bones insurance policies. Not much use if you get sick—as The New York Times reminded us this Sunday in a piece on the medical costs insured families can still face when they are underinsured (which they often don't know until the bills pile up). And of course the critics of the Barack Obama/Hillary Clinton approach say it is too "Big Government."

I mentioned that I attended a conference a few weeks ago of the Institute for Healthcare Improvement, where doctors thought about how to reinvent their own clinical practices. The conference was not classic CME (continuing medical education) in the sense that they were not, for instance, learning that this drug was better than that drug for diabetes, or that this device was better than that one for a failing heart. They were addressing how they organize their practices and deliver the care to make it both more efficient and higher quality. And they were encouraged to think about being a doctor—or a patient—in a way they had perhaps not thought about it for some time.

In the big hallway in the convention center (this was Texas, so the hallway was indeed big), conference organizers put up lip charts and invited docs to scrawl their responses to three key questions. People in politics and policy circles are so busy drawing up models and plans and simulations for health care reform, they sometimes forget what the docs may have to contribute. So here are some of their answers from those flip charts, a peek into the minds of caregivers who care.

No, your eyes aren't deceiving you. We CAN guarantee all Americans quality health coverage and improve our delivery system without breaking the bank, according a report released today by the Congressional Budget Office (CBO).

Today's letter signed by CBO Director, Peter Orszag, and Joint Committee on Taxation Chief of Staff, Edward Kleinbard, says the bipartisan Healthy Americans Act would be budget-neutral in its first year and would get better after that. CBO analysts also predict that the HAA, sponsored by Senators Ron Wyden (D-OR), Bob Bennett (R-UT), and 12 others, would actually, "become more than self-financing and thereby would reduce future budget deficits or increase future surpluses," over time.

Stay tuned for more information from the press conference...

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.

"47 million uninsured isn't just a statistic, it's a tragedy. Let's work together to expand health insurance coverage to all Americans." That's the message the American Medical Association is sending to Congress this week, with ads in Congress Daily, The Hill, and CQ Today (see a pdf of the print ad here). Highlighting the annual Cover the Uninsured Week across the U.S. the ads are also part of the AMA's broader Voice for the Uninsured campaign..

For more on Cover the Uninsured Week, check out our post yesterday.