Health Reform

HEALTH REFORM: Krugman's View on Why It's So Urgent

"The whole world is in recession. But the United States is the only wealthy country in which the economic catastrophe will also be a health care catastrophe—in which millions of people will lose their health insurance along with their jobs, and therefore lose access to essential care."

That's how Paul Krugman began his latest column, reminding us what's at stake. Today's economic indicators are grim, and the headlines are full of more job cuts.

Krugman asks, "Why has the Obama administration been silent, at least so far, about one of President Obama's key promises during last year's campaign—the promise of guaranteed health care for all Americans?" We aren't quite as impatient. The inauguration was only 10 days ago, HHS Secretary-designate Tom Daschle hasn't been confirmed, we know there's a ton of preparatory work being done on the Hill, and we've been hearing for a while that health reform wouldn't really start moving until March anyway.

But it's still worth listening to Krugman's reminder of why we can't be lulled into thinking health reform can wait:

Let me address three arguments that I suspect Mr. Obama is hearing against moving on health care, and explain why they're wrong.

HEALTH REFORM: False Choices: Health Reform or the Economy?

In today's New England Journal of Medicine, MIT economist Jonathan Gruber asserts that the choice between saving our economy and making high-quality, affordable health insurance available to all Americans is a false one. He continues, "a smart health care reform bill, which has at its center universal health insurance coverage...can improve both individual health and the economy's health, both today and in the long run". We agree wholeheartedly with Gruber's thesis; and, want to highlight how Congress and the White House have recognized the important interplay of health coverage and healing our economy in the pending stimulus bill.

In his article, Gruber outlines five ways that enacting comprehensive health reform will help our economy.

First, health reform will provide resources to cash-strapped states for their public insurance programs. Gruber cites incentive payments in the SCHIP re-authorization bill for enrolling eligible children in health coverage.

Understanding the need to move quickly, the House has already passed the re-authorization of SCHIP and the Senate is likely to follow when it votes today on the bill.

HEALTH ACTION 2009: You Can Take the Senator off the Family Farm...

But Sen. Chuck Grassley (R-IA) will still show up at 8 am to give a special breakfast presentation at the Health Action 2009 conference—hosted by Families USA. We were up bright and early as the ranking member on the Senate Finance Committee began the day's events with a spirited town-hall style discussion.
Next up, the opening plenary session featured House Majority Leader Steny Hoyer (D-MD) and Senator Debbie Stabenow with Princeton Professor Uwe Reinhardt giving an entertaining closing presentation. Chairman of House Committee on Energy and Commerce Henry Waxman (D-CA) just gave the luncheon keynote to standing applause from packed house in the Continental Ballroom of the Mayflower Hotel.
Here are some highlights from the morning's action.

COVERAGE: Lessons from a Consumer Drive-Thru

Americans crave innovation. Witness Taco Bell, which despite having only six base ingredients, continues to produce new products. The process is one of evolution and not revolution, and a parallel can be seen in the ever-evolving market for health insurance.

While our drive-thrus are dominated by crunchwraps and combo meals, the movement for more consumer-driven health care (CDHC) has proven to be a more complicated order—one detailed brilliantly in a new web exclusive in Health Affairs by economists Paul Ginsburg and James Robinson. It's one of the clearest and most even-handed overviews of CDHC we've read, laying out the promise, performance and prospects of the movement:

The Promise: The CDHC movement arose as a backlash to managed care. The goal was to replace collective management with consumer choice. Individuals, not employers, would make coverage decisions. High Deductible Health Plans (HDHP) coupled with Health Savings Accounts would replace HMOs and utilization management programs. The consumer, like the crunchwrap, would reign supreme.

COVERAGE: Medical Mallrats

Although the name might lead you to think of retail clinics, Lola Butcher's new article from HealthLeaders Magazine titled "Medicine at the Mall" actually talks about taking over THE WHOLE mall.  Yes, really.

But it's not as crazy as it seems.  The article highlights the experience of Vanderbilt University Medical Center, who after watching the costs and headaches rise from expanding its downtown campus, looked at the cost of taking over an aging, half-vacant shopping center.  They could get quite a bang for their buck, it turned out.

EVENT: Health Action 2009

We'll be attending the Health Action 2009 conference today and tomorrow. Hosted by Famies USA, the event pulls together an impressive lineup of speakers and workshops on health reform. You can check out the agenda here. Wireless connection pending, we'll be blogging throughout the day, so check back for updates, and maybe, just maybe, some musings on the political satire of the Capitol Steps.


HEALTH REFORM: Yes We Can and Yes They've Already Started

A few weeks ago, New America hosted an event with Health CEOs for Health Reform—a diverse coalition of health care leaders that New America has helped organize. Some of those execs later participated at a similar gathering hosted by the Committee for Economic Development, New America, Better Health Care Together, and the McKinsey Global Institute. One of the execs, Dr. Gary S. Kaplan, Chairman and CEO of the Virginia Mason Medical Center in Seattle, posted on the Health Care Blog about what he, his organization and like-minded colleagues involved in Health CEOs for Health Reform are going to do to bring about change.

"Our goals are lofty and the challenges immense. What struck me in recent months, with the current state of the economy, is the tremendous sense of urgency we all feel and the confidence we have that now is the time to truly transform health care," he writes. Read his essay "CEOs Urgent, Shared Commitment to Change" here.

QUALITY: Safety Is Not An Accident

Robert Wachter, MD, a respected patient safety expert, has a long but fascinating dissection of the recent US Airways landing in the Hudson River, where everyone survived, versus the worst crash ever, when KLM and Pan Am jets crashed on the runway in Tenerife in 1977 . Safety, we conclude after reading his account of how training, culture and technology have changed in the intervening years, is not an accident. He writes:

COVERAGE: COBRA Out of Reach For More Jobless

It's worse than we thought. No not just the economy, although we say that pretty much every time we look at the headlines. We're talking about the cost of COBRA.

We've posted recently on the high cost of COBRA, and the relatively few people who lose their jobs who can afford to extend their job-linked health insurance this way (here and here). Congress is likely to include significant COBRA subsidies as well as more short-term Medicaid and SCHIP options in the stimulus package to help more people stay covered in the economic crisis. A recent Commonwealth Fund study suggests the problem is more severe than we thought; earlier studies put the COBRA take-up rate at about 12 to 15 percent, but Commonwealth finds that 2007 data suggests that only about one in 9 or 10 percent of unemployed workers have COBRA coverage. (Some are able to get on a spouse's health plan, or find alternative health coverage). Here's the summary:

HEALTH REFORM: The Way We Are is the Way to Where We Could Be

We are a bit late getting to Atul Gawande's New Yorker article on health reform, and we wondered whether to post, or whether many of you had read it. But then we remembered a lesson from a complicated pregnancy: even during three months of strict bedrest, it's impossible to keep up with the New Yorker. So for those of you who still have the magazine with this excellent piece on your bedside table, here goes:

The essay, "Getting There From Here," starts with the obvious: people who don't have health insurance have sad stories to tell, and sad stories can compel a society to change. At least it compelled every other major industrialized democracy (and some non-industrialized, non-democracies, but Gawande doesn't dwell on those) to make sure people get health care. But maybe we are at the point finally when we, as a society, with a new leader, will find those stories not just sad but unconscionable.