Health Reform

It's Wednesday (Sunday's football dissapointments seem so long ago) and there is a lot going on in the health care reform world. Where to start?

Reid will unveil his healthcare bill to Democratic Senators today at 5 pm at a special caucus meeting.

Senator Reid is "cautiously optimistic" that he will be able to secure the 60 votes he needs in order to defeat GOP procedural objections and move forward on the bill by this weekend.

But what can we even expect to see included in his bill?

Politico's Chris Frates tells us that:

If polling on health reform were a band, we'd call it The Hold Steady.

Several new surveys out this week show the public remains as conflicted as ever on health reform -- convinced of the need for change, but worried about the impact on their lives and the lives of their family.

A Washington Post-ABC News poll released Tuesday shows 48 percent of those surveyed supported the proposed reforms; 49 percent opposed them. An AP poll released Monday found a similar split, with 41 percent in favor; 43 percent opposed and 15 percent undecided.

These even divides are consistent with past polls, suggesting that the uproar in August was more of a bump in the road than turning point. However beneath the topline questions are some interesting trends.

Last week, Medicare's chief actuary (formally known as the Office of the Actuary, or OACT) released an analysis of the financial impact of the health reform legislation recently approved by the House of Representatives (H.R. 3962).  Here are a few thoughts:

Get familiar with the source.  Remember their history.  The Medicare and Medicaid actuarial team's job is to track and understand Medicare spending patterns.  By design, it is also their job -- and their historical pattern -- to be skeptical about proposals for change. Just for context, the office's estimate of the cost of the Medicare Modernization Act in 2003 (the bill that created the Medicare prescription drug program, Part D) was $100 billion, or 25 percent, more than the Congressional Budget Office's (and CBO is also conservative by nature and design).  Last year CMS's Chief Actuary testified to Congress that the 10-year cost of the Medicare drug benefit is 37 percent lower than originally projected in 2003, and 17 percent lower than the previous year's updated projections.   Don't get me wrong. We need conservative estimators to prevent Pollyanna policy from being enacted into law.  But we should take that conservatism for what it is: a useful check on the naturally optimistic expectations of reformers.

With all the talk of financing and mandates and public options, it's important to make sure the essentials -- that patients are helped, not harmed, by health care -- don't get overlooked. Consumers Union's Safe Patient Project held a daylong event here in DC today to help us keep that in mind.

Roughly 100,000 patients die a year from medical errors and about another 100,000 die of infections acquired in health care settings. "The status quo is not acceptable," Art Levin, director of the Center for Medical Consumers, told the forum.

Consumers Union last May marked the 10th anniversary of the Institute of Medicine's landmark "To Err is Human Report" with a report of its own called "To Err is Human - To Delay is Deadly" (Here's what we wrote about it at the time). The bottom line: not a lot of progress.

The event today highlighted some achievements; the health reform legislation does take some important steps to improve safety and quality. It also sheds a rather depressing light on how much remains to be done.

A new study from America's Health Rankings predicts 103 million American adults (43 percent) will be obese by 2018, if obesity levels continue to grow at their current rate. At that point, the U.S. will spend approximately $344 billion dollars annually on health care costs attributable to obesity, according to the new study.

The study, conducted by Emory University professor Kenneth Thorpe, utilizes weight data, Census statistics and medical expenditure information, according to USA Today. Thorpe's study, The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses, is the first to provide projections for the future medical costs of obesity, and also provides state by state calculations for obesity levels and cost, according to a press release from the United Health Foundation. (Mississippi tops the list for the most obese population, while Colorado is all the way at the bottom.) USA Today has some highlights from the report:

The New York Times had two interesting reports this week on the pharmaceutical industry.

Monday Duff Wilson reported that drug makers have raised the prices of wholesale brand-name prescription drugs by more than 9 percent during the  the last year (more than twice the general inflation rate of 3.8 percent).

The paper reported that this dramatic price increase will boost the U.S. prescription drug tab by more than $10 billion this year. Total pharmaceutical spending is expected to trump $300 billion (up from $230 billion in 2003), and at least one analysis indicates that this will mark the highest annual rate of inflation for drug prices since 1992.

Remember, this is despite the pharmaceutical industry's pledge to reduce the nation's drug costs by $80 billion over 10 years after health care reform kicks in.

Huh?

"Price adjustments for our products have no connection to health care reform," said Ron Rogers, a spokesman for Merck. The drug makers say that several patent expiration dates are right around the corner and that they need to maintain high profit margins to invest in research and development. 

The government paid $47 billion (that's billion with a B) in false or questionable Medicare claims last year, according to a new federal report obtained by the Associated Press.

The report shows a dramatic increase in Medicare fraud from previous years. In 2008, the government paid an estimated $17 billion in improper claims. So what caused this number to nearly triple in the past year? The most likely culprit is not more fraud attempts, writes the AP, but the increased scrutiny on Medicare claims. The Department of Health and Human Services's new  stricter methodology is part of the Obama Administration's effort to crack down on Medicare fraud.

The Center on Budget and Policy Priorities concludes that the idea of raising the Medicare payroll tax "on high-wage earners would represent a sound and well-targeted way of paying for health reform."

Senate Majority Leader Harry Reid is reportedly considering raising the Medicare payroll tax  to 1.75 percent (up from 1.45 percent) for individuals earning more than $200,000 a year and couples earning more than $250,000 a year. Reid needs to fill a health reform financing gap if he raises the threshold for taxing the so-called "Cadillac" plans to $8,500 for individual plans and $23,000 for couples (up from $8,000 to $21,000, respectively). Scaling back the reach of that excise tax would please labor unions, among other groups, who have expressed opposition. The Medicare alternative has quickly gained popularity.

The CBPP report has several interesting conclusions:

It's Monday, the day after Sunday, which in America means a surprisingly large number of Americans are talking trash about their fantasy football teams. (Good hustle Ben, but the Cleveland Steamers are on a roll.) So forgive us for the gridiron gab, as we reset the play clock on health reform.

As you know, the passage of H.R. 3962 in the House two Saturdays ago pushed health reform into the red zone and brought us closer to the goal line than we've ever been before. The problem, as the Senate prepares to take the field, is that the goal posts keep getting pushed back. A slow handoff between Senate Majority Leader Harry Reid (D-NV) and the CBO has delayed the bill's release, but Reid seems determined to keep the ball moving. Roll Call's Emily Pierce lays out the potential Democratic gameplan going forward:

Be careful  what you wish for! Maggie Mahar,  who writes the Century Foundation's Healthbeat blog,  had a piece in the Washington Post's Sunday Outlook section calling for a public plan option -- but telling progressives who had yearned for a fully single payer system to visualize the downside.  Just imagine, she wrote, if a movement conservative like Sarah Palin ends up making the rules.  That could make the current controversy about abortion in the health insurance exchange seem tame. What about coverage of contraceptives? Or the ability to decline life support? Think the government wouldn't intrude on such sensitive private decisions? Ever heard of Terri Schiavo?

Of course, we do usually have checks and balances in our system. The party that controls the White House doesn't always control Congress, and it's even rarer for one party to control the White House, the House and a filibuster-proof Senate. And as anyone who has watched the long and winding road of President Obama's health reform agenda, even a filibuster-proof Senate has a mind (and politics) of its own.  Still, Maggie makes a point: