Health Reform

In case you missed the ‘Space' section of your daily paper a few months ago, two planets -- one the size of Mercury and one the size of our Moon -- collided in a far off solar system.  The smaller planet went the way of Alderaan. The larger planet suffered a big dent.

My own worlds collided this week when former-professor-in-my-department Kelly Devers teamed up with my former boss (on a research project) and friend-of-the-blog Robert Berenson to publish a thoughtful critique of the panacea fever surrounding Accountable Care Organizations (ACOs).  As much as we have trumpeted ACOs as the best cure-all since Clark Stanley's Snake Oil Liniment, Drs. Devers and Berenson's thoughtful analysis published by RWJF is a welcome contribution to the dialogue.

David Rogers, now with POLITICO, formerly of the Wall Street Journal, may be the least chatty reporter in Washington (trust me, I sat about 5 feet away from him for 12 years in the Senate Press Gallery... although I suppose if you averaged his taciturnity with my extroversion, you would have had two average chat-ers). He's also one of the best and clearest-thinking. He has institutional memory and historical context often lacking in the 24/7 rush-rush of much of the media today. So while so many people are hyperventilating about whether two off-year GOP gubernatorial wins will spell doom for health reform, David comes up with this reassuring and well-reported story, "Dems want to seize historic moment."

Health care is big for House Democrats: big like Social Security in the '30s and civil rights in the '60s, big like the war stories retold now in party caucuses as lawmakers grapple with the floor vote that is just days away.

All politicians live in the present -- or risk perishing, as seen Tuesday night. But history also sits on the shoulders of Democrats these days, and having failed to act on health care in 1994 -- and then having lost power -- they feel an almost inexorable push to seize this moment before it slips away.

The AP reports that the AARP is ready to announce it's support for the Democratic health reform legislation in the House. The endorsment from the influential retiree's lobby should provide a big boost as House Democrats are expected to vote on H.R. 3962 Saturday evening. Streaming video of the AARP announcement, set to begin at 11:30 a.m., is available below.

Meanwhile, the American Medical Association will announce it's position on the House bill's at 12 p.m. More on that after we get off the call.

Residents of D.C. love to talk about their Safeways. Apparently, so do Members of Congress.

During the mark up of Senate Finance Committee's bill in September, Senators John Ensign (R-NV) and Tom Carper (D-DE) introduced an amendment that increased the financial rewards companies could offer their workers for meeting certain health goals and criteria such as losing weight, lowering their cholesterol or quitting smoking. Pushing hard for this change, were companies like Safeway which puts a great deal of stock in their efforts to help manage and improve their employee's health, as explained this week in by the LA Times:

Nationwide, 25,000 nonunion employees in Safeway's health insurance plan are eligible for the premium-reduction program, most of them in California. The company says that 74% have signed up.

Once a year, participants submit to tests of four health risk factors: smoking, obesity, blood pressure and cholesterol. If they pass all four, they receive a $780 annual discount, which is 20% of the total cost of their insurance. If they do not pass initially but make progress in some areas -- quitting smoking or losing 10% of their weight -- they can get a premium rebate.

"Health care is a complicated business and there is no right or wrong way to do it -- that is illustrated by the fact that no two health care systems on Earth are the same. Each is the product of its people, its culture, its history -- and its reform is properly the preserve of domestic political debate," Andy Burnham, the United Kingdom's secretary of state for health, said at the Urban Institute this morning (click here to listen to his full speech).

Burnham wasn't in Washington to criticize the U.S. health system or to interject his thoughts on our reform efforts (although we suspect he has many). But he did have an interesting perspective to share. Like the U.S., the U.K. hopes to move toward a system that focuses on primary and preventive medicine, less "reactive" care after a crisis occurs. And he reminds us that just as a health care system is a product of a country's people, culture and history, so is a country's health. 

There isn't a lot that can make us grimace more than a headline that says that Harry Reid is talking about allowing health care reform to spill into 2010. Just typing the words hurt.

Forget about the fact that it is just not good for our collective mental health. ("Our" meaning everybody that is working on health care reform... right, left, up, down, and definitely those poor folks at the CBO ) It's not good politics.

Doesn't anybody out there remember the month of August?

The longer the debate drags on, the more enemies of reform can tear down and attack and confuse. They've already started.

Today is a national "Women's Day of Action" for health reform, part of the National Women's Law Center (NWLC) campaign, Being a Woman Is Not A Pre-Existing Condition. The campaign works to educate women about the disparities they face in the current health care system and urge them to fight for reform. The day of action features a rally in D.C. where women can share their stories and an online action network that offers information and a portal to contact Congress and demand health reform.

Ceci Connolly at the Washington Post asks the $64,000 question -- or maybe it's more of a $6.4 trillion question. Do the House and Senate health care bills go far enough in reshaping how we deliver health care so that we can control rising costs?

A lot of experts, she notes, see the approach as too timid by far.

"The bills are directionally correct, but they're not going far enough," said George Halvorson, chairman and chief executive of Kaiser Permanente and the author of "Health Care Will Not Reform Itself."

(We are refiling this post to make the paragraph about the SEC a little clearer for our readers.)

"The American people and I are asking a serious question and one that deserves a straight answer -- why are health insurance costs going up each year?" Sen. Jay Rockefeller (D-WV) questioned in a letter (part 1 and part 2) to H. Edward Hanway, the CEO of CIGNA, yesterday. "Are they spending it to make people well when they are sick and keep them healthy? Or is the money they charge going to profits, to executive salaries, and to figuring out how to deny care to people when they really need it?"

Sen. Rockefeller explains:

An early draft of the House Republicans' health care bill is available at BNA. The Republican bill is much more limited in scope than the current House health reform bill, and is focused primarily on cost -- which represents only one aspect of the problems plaguing our current health care system.The bill repackages a lot of the conservative ideas that have been floating around for years -- and which didn't even get enacted when the Republicans were in control of Congress and the White House.

The bill will not end insurance company discrimination against high risk individuals nor will it provide subsidies to help the uninsured purchase coverage, according to Politico:

Boehner hasn't released the full details of the bill but has said that it would make it easier to buy insurance across state lines, impose strict limits on medical malpractice lawsuits and allow individuals and small businesses to pool their resources to buy insurance as a group. That is designed to boost their purchasing power to help lower individual premiums.