New Health Dialogue
It's an historic day as the Senate begins debating health care reform and www.NewAmerica.net gets a facelift (before we start taxing botox...).
Since the keeper of New America's internets requested we try not to break anything while we migrate to a new website, it will be a light blogging day. Fear not however, as you'll be able to follow the Senate floor debate with us on Twitter starting at 3 p.m. (hashtag: #Senate) and be sure to check back Tuesday for a wrap up of the action and some excellent posts on quality improvements and cost control that made us thankful over the holiday break.
In the meantime check out this excellent piece from Kaiser Health News on the some of the lesser known provisions of the Senate bill and this report from MIT's Jonathan Gruber showing "the House bill will deliver savings ranging from $200 for singles to $500 for families in today's dollars -- even without subsidies."
A New America colleague spotted this story in a Princeton alumni publication. We are sharing, it's a perfect way to pause our blog for Thanksgiving.
Dr. Brian Bonnyman was a successful family physician in a Knoxville, TN suburb. When he referred patients to specialists, they thanked him with a fruit basket, or even crystal.
Once a month, he volunteered at a nonprofit clinic. Gradually, what he experienced there made him think. And then it made him act.
He left his practice and began working full-time at a community health center, the nonprofit Cherokee Health Systems in Appalachia. He takes care of the poor and the homeless. In terms of zip codes, it's only one digit away from his past practice. In terms of access to health care, it might as well be a different planet.
Some of his patients haven't seen a doctor for 20 years. And those who have seen a doctor often can't afford the follow up needed to keep chronic diseases under control. For these uninsured and underinsured and Medicaid patients, 50 isn't the new 30. It's the other way around. People have diseases that are more commonly seen in patients 20 or 30 years older. They have life-limiting conditions that, with more consistent and affordable care, could have been prevented.
We finally had a chance to see the documentary Money-Driven Medicine the other day, and you can download it here, or check out screenings (some sponsored by Consumers Union). It's based on a book of the same name by Maggie Mahar, who blogs over at the Century Foundation's Healthbeat.
Dr. Jack Wennberg, the father of the Dartmouth Atlas, and Shannon Brownlee, the author of Overtreated and a New America colleague, recently posted on the Health Affairs blog, recapping four major goals for repairing the "dysfunctional, disorganized, and wasteful delivery system."
1. Improve the science of health care delivery.
The stimulus package boosted comparative effectiveness research, and the health reform bills in Congress would build on that. But studying effectiveness of treatments, in isolation, isn't enough, they argue. We also need to develop a "science of health care delivery" which they call a "black box." Patients with similar conditions are treated in very different ways and we aren't doing the necessary research into how to best to allocate resources and deliver the most effective care.
2. Foster the expansion of organized systems of care.
The latest Kaiser Health Tracking Poll is in, and the health care reform approval numbers are holding pretty steady. Slightly more people than last month, 54 percent, believe the country will be better off if health reform passes. And 42 percent -- an improvement from earlier this year -- believe that health reform will personally benefit them or their families.
The number who believe health reform will hurt them (24 percent) or the country (27 percent) is down slightly from last month. Roughly the same one-in-four don't think health reform will affect them. Democrats and Independents are more likely than Republicans to view health reform as positive. However, when asked about specific provisions in the health care bills, a majority ranked as "extremely" or "very" important these components of reform: affordable, available health insurance, coverage for people with pre-existing conditions, providing subsidies to help the uninsured purchase coverage, requiring all Americans to have health insurance, filling the Medicare donut hole, and not adding to the U.S. budget deficit.
As a loyal Bostonian, I don't seem to tire of all the talk of health reform efforts in Massachusetts and enjoy noting our successes. We've gone from a 10.3 percent uninsurance rate before reform, to covering over 97 percent just less than two years later. But passing a law and creating new insurance structures is only part of our success. Massachusetts not only built it -- it figured out how to make people come.
A recent Robert Wood Johnson Foundation study, The Secrets of Massachusetts' Success: Why 97 Percent of State Residents Have Health Coverage, explains why Massachusetts' subsidies have accomplished more than other states. Outreach and enrollment is essential. (Make that effective outreach and enrollment.)
Medicare hasn't put the finishing touches on its new dialysis reimbursement policy quite yet (you have until December 16 to get your comments in) -- but has decided to invest in educating the public on various dialysis treatment options. It's part of a longer term effort to give patients more of a say in managing their chronic diseases, and in changing some of the inefficient ways Medicare pays for kidney care.
More than 350,000 Medicare patients with end stage renal disease undergo dialysis. Most patients undergo out-patient treatment three times per week at either an independent or hospital based facility -- in the United States, fewer than a tenth are treated at home. (Rita Rubin of USA Today notes that three treatments per week is the standard not necessarily because it is "optimal but because that's the way it has been done for nearly four decades.")
But Medicare's education campaign will help patients make more informed decisions about where and how often they are treated.
Maine's Republican Senators Susan Collins and Olympia Snowe both voted with fellow Republicans Saturday against the Democratic bid to bring health reform legislation to the Senate floor. Yet both are moderates who have broken with their party in the past, and both have signaled they would consider voting for the health bill -- if Democrats change it enough, reports The New York Times. Collins told the Times,
I have ruled out voting for this bill, but I still very much want to vote for a bill and that is why I am continuing to have discussions. I still cling to the belief that it is possible for a group of us to come together and rewrite the bill in a way that would cause it to have greater support.
Everyone was pretty excited when Senator Snowe decided to vote for Senate Finance chairman Max Baucus's version of a health care reform bill. Yet at the time, Senator Snowe warned her colleagues loudly and clearly that her vote to get that bill out of committee didn't assure her vote on final passage.
The Washington Post ran an interesting chart about how senators voted on Saturday. It included the uninsurance rate back home, and the health industry contributions they have received (although it wasn't clear either there, or on OpenSecrets.org exactly how this particular chart defines the health industry -- and of course some sectors of the health industry favor reform). But no matter how you look at the relationships between the votes and those numbers, it did come down -- no surprise, unfortunately -- to a party line vote.
USA Today also has a piece on the massive amount of lobbying money being spent on the health care battle. It seems that just about everybody has hired a lobbyist, and the total cost exceeded $422 million during the first nine months of 2009. The paper also has a useful run down of what four provider groups (doctors, hospitals, drug companies and insurers) and four health insurance purchasers or consumers (employers, the insured, seniors, and the uninsured) stand to win and lose under current versions of the legislation.
"A Motion to Invoke Cloture on the Motion to Proceed" seems like a pretty obscure way to start the Thanksgiving holiday festivities, but we'll take our victories where we can get them.
We all know the obstacles remaining -- from a (abortion) to z ( we couldn't think of a really great Z on Monday morning -- Xanax only sounds like a Z. For now we'll settle for Zocor as a placeholder for more fights on pharmaceutical pricing). But a supermajority of the United States Senate has agreed to begin the historic debate on health care reform after the holidays. And that's an achievement which gets us closer to another achievement.
We're not going to rehash everything in the weekend papers, because we expect that a ridiculous proportion of our readers were either watching the vote on C-Span or at least tracking it on their Blackberries. But a few good links to point you to:
At the Treatment, Harold Pollack writes on the absurdity of listening to Republicans complain that the Democratic health care bill is too skimpy in its help for the poor.