MyPolicy Healthcare Discussion HQ

Congress vs. Drug Sales Reps

Jon @ my policy health discussion central — Thu, 31 Jul 2008 15:43:38 EDT

An interesting bill was just introduced in Congress with the goal both of controlling prescription drug costs and improving care. The bill proposes a program to better educate medical professionals about prescription drugs – including training experts who would make house calls to doctor’s offices. Those of you who have been in medical waiting rooms with (usually attractive) pharmaceutical sales reps and their samples know where this idea is coming from.

It is part of an effort by the Prescription Project, a non profit (funded by the Pew Charitable Trust), the stated purpose of which is to eliminate conflicts of interest through education and policy change. Now, I wouldn’t argue that pharmaceutical sales reps should not help educate doctors. There is a legitimate role there much like the legitimate role many lobbyists play on Capitol Hill. But it is good to see these smaller efforts to effect change in the system in advance of the larger reform effort.

It's The Health Care Economy Stupid?

Jon @ my policy health discussion central — Mon, 28 Jul 2008 15:32:00 EDT

Now that Senator Obama’s trip overseas is done, he has signaled a shift in emphasis back to the home front and the US economy . . . which brings us back to healthcare. The fact is that if we are going to enact meaningful health care reform – including the efficiency and other cost saving measures in Senator Obama’s plan – we are going to have to come to grips with the potential effect on the US economy.

For better or worse health care has become one very major growth sector in terms of jobs and spending. See this 2006 Business Week article for some background: What’s Really Propping Up the Economy. By at least one calculation, the health care sector accounts for over 15% of US GDP. That is staggering. What happens if we cut a big chunk of that spending off?

Of course I’m not saying this should slow health care reform down. Providing health care more effectively and efficiently will have enormous benefits, economic and otherwise. The question is how we deal with the potential short to medium term economic side effects of reform. Do we depend on the free market to reallocate resources efficiently? Does major health care reform need a major economic policy element? What should that be?

Coming to a Health System Near You: Personal Health Records

Jon @ my policy health discussion central — Wed, 21 May 2008 01:11:06 EDT

Monday Google launched Google Health, its entry into the online personal health record sweeps. Google joins several other entrants, most notably Microsoft, in an effort to create complete, updateable, accessible yet secure online health records. Check some of the early entrants out: http://www.healthvault.com/ (Microsoft health vault); https://www.google.com/health; http://www.webmd.com/phr; http://www.revolutionhealth.com/my-revolution/promo; http://www.medicalrecords247.com/.

Some early features of these systems include apps to allow you to import medical records from various sources, allowing access and updating by authorized health care providers, interfacing with certain health care devices, providing a gateway to services like prescription refills and maximizing your health benefits through interface with health plan providers, building community around health care.

What may be most important in all of this is how standards develop for hospitals and other health care providers to update information and talk to each other about patients. In the end these consumer directed sites are windows (with varying functionality to be sure) on what will be an enormous back end system of information storage and exchange. Whether Google and Microsoft themselves (or Oracle or others) are the ones who create the standard remains to be seen.

What features would you look for in a personal health record system? How do they need to work truly to make a difference in creating a more effective and efficient health care system?

Is There a McCain Health Care Plan?

Jon @ my policy health discussion central — Mon, 12 May 2008 11:44:18 EDT

At the risk of getting ahead of ourselves just a little bit (but isn’t it about time!) let’s talk John McCain and health care. I’ve been listening to what McCain says about health care reform and reading his website on the subject. It is truly underwhelming stuff. What you have from him essentially are a bunch of bullet point level platitudes form the old Republican play book. The core of it – to the extent there is one – seems to be this: encourage portability which will create more insurance company competition which will solve all problems. Right.

What McCain’s “plan” reflects is not a desire to solve the health care problem, but rather a desire to say something sufficient and then get off the subject. As with so many other issues, that just won’t fly this time around. We need solutions.

You can read McCain’s supply side speak on health care here. Also see Paul Krugman’s critique which really got me going on this here.

Any comments out there on McCain’s plan or related alternatives you’ve seen out there?

Downsizing . . . and shortages?

Jennifer from Washington, DC — Tue, 08 Apr 2008 23:26:48 EDT

I think Jon is absolutely correct to flag the likely downsizing of the health care system as an unintended consequence of reform. It's yet another argument for why the next president will have to reverse the current administration's pattern of cutting the federal job training budget – but that's another story.

So on the one hand there will probably be downsizing in certain sectors of the health care system but, on the other, we may also be looking at some shortages. For example, as this article from the Times points out, people in Massachusetts are facing long delays before seeing general practitioners. Some of the problem is a part of a larger trend; nationally, particularly in rural and many urban areas, there is a widening gap between the number of general practitioners and the need for their services. But the situation is exacerbated in Massachusetts, where you suddenly have a large number of newly-insured people who are looking to make appointments with doctors when they previously would have gone to the emergency room or just forgone treatment altogether.

Once we have health care reform, any shortage of general practitioners/primary care providers is likely to become a bigger problem. It would be a tragic irony to trade a system where people can get in to see their doctor relatively easily (at least in part) because so many cannot afford health care for one where everyone can afford health care but no one can get in to see a doctor. The Times article touches on a few possible solutions: recruiting more foreign medical school graduates, student loan forgiveness for those who go work in underserved areas, and altering the reimbursement scheme for primary care providers. What are some other possibilities? Perhaps we could take some of the resources that are freed up as a result of having a more efficient system and reinvest in programs that would make sure there are enough primary care providers?

Oh, and speaking of job training programs, also noted in the Times is President Bush's proposal to eliminate $48 million in federal support for primary care training programs . . . .

Healthcare Reform As Economic Downsizing

Jon @ my policy health discussion central — Wed, 02 Apr 2008 15:23:35 EDT

In my post yesterday I talked about our most expensive healthcare system in the world and how, according to one commentator at least, about 20 to 35 % of our $2.1 trillion annual healthcare bill represents unnecessary care and simple inefficiency. Do that math and you have $400 to $700 billion a year in unnecessary cost.

This points to another important consideration for health care reform. If we reform the system to provide better care and eliminate inefficiency we could be looking at a serious downsizing of a huge sector of the economy which employs many people. There are real economic implications. Of course, I am not suggesting we avoid meaningful reform to keep the money flowing artificially -- and the savings from lower health care bills (for business, government, individuals) – should free up resources for more efficient spending/investment elsewhere – but the displacement that would occur is something to be planned for.

Is this a real potential problem? A legitimate part of the debate? How do we deal with these issues?

Not the Best System . . . the Most Expensive

Jon @ my policy health discussion central — Tue, 01 Apr 2008 18:00:26 EDT

You often hear the old saw “the US has the best health care system in the world” with the follow on being that we need to be very careful not to ruin all that quality care through health care reform. But read Overtreated: Why Too Much Medicine is Making the US Sicker and Poorer, by Shannon Brownlee of the New America Foundation (the New York Times’ 2007 economics book of the year). Her essential point is that we don’t have the best medical care in the world, just the most expensive. In fact if you look at typical quality of care measures, Ms. Brownlee says, our system ranks somewhere in the mid-30’s.

Among the book’s most interesting points: We spend $2.1 trillion per year on health care (greater than the entire GDP of Italy) with about 1/3 of that being for care that is unnecessary. We pay 2X per capita what Western Europe pays for healthcare. We rank low in the developed world in infant mortality, life expectancy and other key measures.

Why the low ranking and waste? Among the reasons the book cites: a fee for service system the encouraged procedures rather than managing outcomes (some of the best outcomes come from facilities that have salaried doctors . . . see the Mayo Clinic), lack of overall good case management (for example, we tend to go to a disparate group of expensive specialists rather than GP’s who know us and manage the big picture), and flat out chaos in the system (citing especially lack of strong care management in hospitals and of good electronic medical records).

There’s a road map for reform here reflected, though still high level, in the initial Obama and other Democratic health care plans. We should follow it. In doing so we won’t be ruining a best in class system but establishing one.

Garden State health care reform

Jennifer from Washington, DC — Thu, 20 Mar 2008 01:25:11 EDT

In previous posts, we have noted the ways in which several states, in the absence of a federal solution, have tried to fix the problem that is our broken health care system. We can add another to that list: a bipartisan group of legislators have unveiled a proposal that would make New Jersey the fourth state to provide some form of universal health coverage. Under the plan, the state would work on cutting costs and establish a self-financed, state-run plan that would provide individuals with coverage at affordable costs on a sliding scale depending on income. There would be an individual mandate but, unlike Massachusetts (which requires individuals to purchase the insurance on the private market), New Jersey would require its residents to purchase insurance from a single, state-administered plan.

As noted in the Times' article, reaction has been mixed. Groups representing employers and health care providers indicate approval because of the plan's proposal to lower costs. Union and consumer groups, however, expressed concern with the plan's underlying proposal to shift costs from a shared responsibility between employers and employees to one between consumers and taxpayers, which could cause employers to drop their health care plans.

I think both groups have it right: clearly, lowering the cost of coverage has to be a top priority of any health care reform. But I'm not sure if that will make as much of a difference in a system that from the beginning eliminates employer involvement. If employers were to dump their health care plans in response to the availability of the state-run plan, the result could be a (possibly significant) gap in coverage – at least initially.

This also raises a broader question: if we were to have a single, state-run plan (or, possibly, any well-regulated private market system) that has lowered costs so that they are affordable or subsidized for all, should employers still be a part of the equation? What do you think?

Where's The Bill ? . . . Issues With Frictionless Healthcare

Jon @ my policy health discussion central — Fri, 29 Feb 2008 14:29:19 EST

My 8 year old son had a run in with a brick wall the other night playing football in the dark. He had a nasty looking bump on his forehead and was complaining about a little dizziness. Normally I'd let a kid-wall collision like this go with only some ice. But the dizziness got me and I took him to the nearest emergency room.

The emergency room docs and nurses did a great job looking my son over (he's fine, by the way). When they told me we were ready to go I asked them where to pay. They said I was all set. Wow. Seemless. No direct economic pain for me other than through my health care plan payments. This is how it should be right? Or is it?

Is it good for our system (and can we really get a handle on rising healthcare costs) if in many instances there is no direct economic connection between consumers and the medical services they consume. Can medical services be too frictionless? Certainly many of our Republican friends, and many economists, would answer "yes." Intuitively, if there is no economic pain people will be less discriminating about when and where they go for service.

But inserting economics can get very dicey very fast. Isn't it good to encourage medical decision making based only on perceived health care needs and not economics? This is why we believe all should have access to quality health insurance in the first place.

Where is the balance? Tough questions.

Discouraging Prevention

Jon @ my policy health discussion central — Tue, 26 Feb 2008 23:50:49 EST

Would you get tested for genetic disorders if it would potentially save your life? Would you risk getting tested if you thought the results could be used to significantly raise your insurance premiums or lead to problems with potential employers? Too many people are choosing to avoid tests to avoid the risks. With no real clarity in the law on this point (no significant court cases have decided the matter and there is a bill pending in Congress which remains unpassed) there is still al lot of uncertainty out there. The result is that people and their doctors may not be getting what could be critical information in managing their health. The result also is cost on the backend for treating serious illnesses versus practicing prevention.

We have this great technology resulting in new medical prevention capabilities. Shouldn’t we get people comfortable enough so they can use it? How do we do that? What would you do if something serious ran in your family?

For more on DNA screening for genetic predisposition for illnesses see the Mayo clinic site here. Also see more general information on the issue here as well as the text of the Genetic Information Nondiscrimination Act of 2007, which has passed the House but is on hold in the Senate, here.

Health Care Mandates -- The WRONG Focus

Jon @ my policy health discussion central — Sat, 23 Feb 2008 20:31:05 EST

Coming out of this week’s Democratic presidential debate in Texas, there has been more focus on health coverage mandates as the defining difference in health care reform on the Democratic side. See the NY Times’ interesting review of the issue here. This focus at best is a distraction from the core issues in health care reform and at worst lead to a political arms race of punitive measures allowing someone to claim broadest coverage.

As the Times article points out, there is a lot of debate out there about how many people exactly would be “left out” of a plan that does not mandate that individuals purchase health insurance. And ultimately how effective a mandate is depends on two things – the price of obtaining coverage and the magnitude – and enforcement -- of the penalties. As the Massachusetts experience shows, this is not an easy balance to strike. The Massachusetts plan offers exemptions from its mandate for those who can demonstrate financial hardship and as of the end of 2007 fully half of the state’s uninsured remained uninsured. There are penalties in the plan but how far do they go to get people to join in?

Mandates simply are the wrong focus for the healthcare discussion. They distract from the main issues which are broader availability, improving quality of care, and overall cost containment (through better case management, better preventative care, better use of technology, among many other measures – all far more important than incremental savings from the next x people who buy insurance due to threats).

Very Presidential

Jon @ my policy health discussion central — Tue, 19 Feb 2008 22:59:34 EST

This blog is supposed to be reserved for discussion of health care issues and by and large we stick to that. But that is not the story tonight. I am sitting here watching Barack give his speech tonight in Houston after winning Wisconsin. It is substantive and inspiring. It is specific and visionary. It lays out disagreement with the old way of doing things while reaching across the aisle and without demonizing. It is the best State of the Union address I’ve heard in 7 years.

Along the way he also subtly started to shift to looking at the general election in how he articulated his program and addressing John McCain as someone to be admired but who is part of the old failing policies. And by the way, if you saw McCain’s speech tonight, as a Democrat you have to be heartened. He sounded a bunch of tired themes and is just awful on the stump. Will people buy the old Republican platitudes anymore? On healthcare or anything else?

Hilary Clinton spoke as well of course and touched on many of the same themes. But there wasn’t the same unifying vision. There was a laundry list of stuff trying to show that she is substantive. But it is Barack’s new overlay on all of this that has it making sense to many more people now. He is providing the substance and the vision that people will follow.

And on health care . . . again Hilary tried to differentiate her plan by citing people that Barack is “leaving out” of his health care plan by not mandating coverage for everyone. But as Barack said, he wants to make coverage available and affordable to everyone. Isn’t that really what is important here? If that is the kind of “substance” that she is hanging her hat on to differentiate herself now, then she has big problems.

Take a look at Barack's speech from Houston tonight. What do you think?

Creeping Republican Healthcare Reform

Jon @ my policy health discussion central — Sun, 17 Feb 2008 22:55:07 EST

Another in the running series of measure proposing to change how Medicare works was delivered by the Bush administration last week. The Republican sponsored package includes the beginning of means tested premiums for the Medicare prescription drug benefit and requirements that better information be released to Medicare recipients on cost and quality of care (with the idea that consumers of health care will be empowered to make better choices). The former is designed to save money for the Medicare trust fund – currently on course to run out of money in 11 years – but is a drop in the bucket in the scheme of things. The latter is another piece of an admirable, though piecemeal, effort to look at ways to reduce long term costs and have the health care system operate more efficiently. Read more about the package, rejected by the Dems in Congress, here.

What we have here really is another piece of creeping incremental health care reform from the Bush Administration when what is needed is coherent, significant reform on a number of fronts as has been proposed by Senator Obama and the other Dems. The Republicans say they want to get to a more efficient system based more on private choice. I am not against that. The problem is the forgotten millions who don’t have the money or coverage to make choices. The problem also is the need to push the coordinated measures on many fronts likely necessary to get to a more efficient health care system which actually improves quality of care.

Why don’t the Republicans get that? I think in the back room they probably do. It is just more important for them politically to keep equating real health care reform with socialism than to join the discussion on real solutions. This is the test the new Democratic President will face in passing health care reform. Can we frame the debate differently this time and reach across constituencies to make it happen. I like Hilary and think her heart is in the right place on this. But I think Barack is more likely to make it happen. What about you?

Health care reform and the intertubes

Jennifer from Washington, DC — Thu, 14 Feb 2008 21:46:02 EST

One of the things I like to do when trying to stay abreast of health care reform-related news is keep my eye on what the health care bloggers are saying. The internet is a treasure trove of serious and informed discussions on health care issues and health care reform. A great source for discovering new (and old) health care blogs is the Health Wonk Review: every two weeks, a different health care blogger "hosts" the Review by receiving submissions from various health care bloggers and culling through them to find the best-of-the-best posts for that period.

The last Review, hosted by Doug Williams of Health Business Blog, was chock full o' postings on health care reform. Over at the Health Care Blog, for example, Jeff Goldsmith writes that all of the political discussion about health care reform is focused only on two of our health care "systems" – public and private financing systems – but does not address the third system, the public care system (such as safety net urban hospitals and community care centers). Of course, there are two interesting posts making arguments for and against the health care reform topic du jour – mandates. And, just for a change of pace, Michael Millenson writes at Health Affairs blog that "Huckabee seems to be saying that fixing American health care is as simple as getting smokers to put their butts down and fat people to pick theirs up."

So, have you read any interesting postings out there on reform? Also, do you think there is any way to use these well-informed blogs and bloggers to push for or help achieve health care reform?

Billion with a "B"

Jon @ my policy health discussion central — Tue, 29 Jan 2008 14:50:23 EST

The pharmaceutical company Eli Lilly announced strong Q4 ’07 results today -- $854.4 million in net income on $5.19 billion in revenue, a 10% earnings and 22% revenue bump over Q4 the previous year handily beating analyst estimates (yes, that is 5.19 billion with a B in the fourth quarter alone). See more detail on the results here. Nice job considering all the concern out there that generics will start to eat into profits.

I am a private sector guy who’s worked in high growth companies. So you will not find me railing against the system (too much) and generally begrudging a company pushing performance for its shareholders. But seeing these, and other drug and insurance company results, does raise a question as we think about the health care system. Isn’t there something out of whack when the system produces these kinds of numbers for companies and at the same time so many businesses, families and individuals are literally priced out of the market for fundamental products and services.

The drug market is a good example of how complex a question this is. Our system has depended on large drug companies to make money, reinvest big numbers in R&D, and bring resulting drug breakthroughs to market. This had resulted in an impressive record of innovation and an impressive cycle of profits for the drug companies. At the same time it is a system under which many people can’t afford, or otherwise get access to, the drugs that result.

How to remedy this? Don’t we need to allow the private R&D shops to continue to do their thing? How and how much can policy direct big research dollars versus letting the market do it? Are there levels of profit for drug, insurance and other health industry companies relative to access problems that really set off the alarm bells?

I think there are ways to make the supply and demand curves work better in areas like prescription drugs (for example, consortia to negotiate better rates, allowing Medicare to negotiate prices, among others). What about you? How do we reconcile this?

Wal-Mart increases enrollment in its health care plan

Jennifer from Washington, DC — Fri, 25 Jan 2008 11:35:47 EST

Wal-Mart reported this week that, for the first time in the company's history, more than 50% of its employees had enrolled in the company's health insurance plan. This is up from about 45% of its employees five years ago, and it means that Wal-Mart now insures significantly more of its employees than Target, which insures 40% of its workforce. Wal-Mart was able to increase enrollment by offering a wider range of premium/deductible combinations, allowing people to enroll after one year of employment (as opposed to two), and eliminating certain fees. Now, 92.7% of Wal-Mart's workforce has health insurance either through the company, a spouse's plan, Medicaid, or some other source.

I am not a big fan of Wal-Mart because of its various, well-reported labor practices. I am willing to admit, however, that this is a step in the right direction. Of course, as pointed out in the linked-to article above, 7.3% of Wal-Mart's workforce still thinks it is better to have no insurance than to enroll in Wal-Mart's plan. This might be in part because some of the plans with low premiums have deductibles as high as $2000 for an individual – this equals 10% of the average Wal-Mart employee's $20,000 annual earnings. Still, a step in the right direction is always a good thing, as long as the company keeps working to increase participation.

The question is whether there is anything we can learn from what Wal-Mart has done. What do you think?

National health care spending hits $2 trillion

Jennifer from Washington, DC — Mon, 14 Jan 2008 20:49:52 EST

As discussed in this Times article, national health care spending exceeded $2 trillion for the first time in 2006, which is nearly double what it was a decade ago. The main point of the article, and as discussed elsewhere, is that much of the increased spending is due to the advent of the Medicare drug benefit, which has impacted spending throughout the entire health care system.

Two smaller points, though, deserve mention: first, data shows that spending on hospitals, doctors, and nursing homes grew at a slower rate in 2006 than it did in 2005, but that spending on administrative costs increased at a greater rate – almost twice as fast. "One reason [for this] is that private insurance companies have a larger role in Medicare, and they typically have higher administrative costs than the traditional fee-for-service Medicare program, federal health economists said."

Second, Medicare’s share of drug spending soared from 2 percent in 2005 to 18 percent in 2006, while Medicaid's share fell from 19 percent to 9 percent in the same period; this is because drug costs for six million people shifted from Medicaid to Medicare. As noted by the article, "[p]rivate insurers, which manage the drug benefit for Medicare, negotiate discounts with pharmaceutical companies. The discounts were generally smaller than those provided under Medicaid, the report said."

I call attention to these two smaller points because they implicate what tends to be a broader argument against health care reform that includes greater government participation: that the private market will be better at keeping health care costs and spending down. On at least a superficial level, these points appear to provide some evidence against that argument.

Healthcare Mandates: A Distinction Without A Difference?

Jon @ my policy health discussion central — Sun, 06 Jan 2008 23:47:07 EST

Only one thing to say about the results in Iowa and the latest poll numbers in NH. Wow. But back to healthcare . . .

One of the things you are hearing Hilary Clinton say to attack Barack coming out of his Iowa win relates to health care reform -- that Barack’s health care plan doesn’t go all the way since it doesn’t mandate that all adults get coverage while her plan does. She asks, why just mandate coverage for children (which his plan does) and not for adults?

Barack’s response to this is that if you make coverage affordable, most adults will make the choice to get it. You mandate for children because they don’t get their own choice. Good points, but I think Senator Clinton’s distinction is a false one in a more basic way. Her plan and others out there which set out a full mandate only barely touch on the real world implementation and enforcement of it. These are some very difficult questions left unanswered. And I believe this is where the differences will come out in the wash and Barack’s encouragement mechanisms and Hilary’s enforcement mechanisms will start to look an awful lot closer together (toward the encouragement side) than she is suggesting now. This is true both due to the political reality of what enforcement mechanisms will be palatable and the realities around what you can in fact force people to do on the ground in the very personal area of health care.

What do people out there think about whether a mandate is necessary? How would you enforce it?

Breaking news: health coverage improves the health of the uninsured!

Jennifer from Washington, DC — Thu, 03 Jan 2008 17:44:54 EST

The Times has an article from yesterday about a recent study demonstrating that, for the uninsured who are 55 years or older, Medicare significantly reduces their risk of declining health after they enroll at the age of 65.

This is one of those things that seems kind of obvious but, when thinking about it in terms of the broader health care reform debate, it's implications are huge. If there is such success at staving off poor health after the uninsured person turns 65 (e.g., as noted by the article, "[u]ninsured people with heart disease and diabetes radically cut their expected rate of decline, to a point where they were almost as healthy at 72 as they were at 65"), imagine what could happen if coverage were extended to everyone? Although the article does not get into this, intuitively it would seem that the costs associated with reducing the risk of declining health would rise in accordance with the rising age of the uninsured individual.

Also from the article: “

Our findings provide some of the strongest evidence yet that expanding health coverage to the uninsured improves their health,” said Dr. J. Michael McWilliams, the paper’s lead author and a research associate at Harvard, particularly older people with “conditions like hypertension, diabetes and heart disease, for which there are effective therapies.”

This seems obvious but, for some, I guess it hasn't been. Food for thought as we enter a new year. Let's hope that, as 2008 comes to a close, real health care reform is just around the bend.

A Year Of Progress . . . But Miles To Go

Jon @ my policy health discussion central — Fri, 28 Dec 2007 15:29:05 EST

The New York Times ran an interesting article this week updating state efforts on health care reform. Read it here. In short, there has been a lot of progress but not many have closed the deal mostly due to hang ups around financing mechanisms. I suspect the federal efforts at health care reform we will see over the next several years will mirror this state experience.

In other words, despite some strong consensus on need and high level policy direction, there is still the hard part left – paying for it. Is it about employer payments? Additional taxes? Better preventative care and case management? The right incentives? Better system efficiency? Maybe most importantly, what financing solutions can survive the political process? Since just about any financing solution will be very controversial, leadership from the top on this issue will be crucial.

Is It The Health Insurance Companies' Fault?

Jon @ my policy health discussion central — Wed, 26 Dec 2007 11:33:26 EST

Interesting holiday dinner discussion at my family's table this week. We got into it on health care reform which is a loaded conversation since my two siblings work for a big health insurer and a big pharmaceutical, respectively I was surprised at the level of consensus that big changes are needed now. Where the disagreements start is when you get to talk of the cause of the problems and how to fix them.

Not surprisingly, you will hear from my health insurance industry sibling that our problems are more about hospital and doctor costs and overall health care management. Others at the table pushed back insisting that big insurance companies -- and their strong profits and margins as well as underwriting policies -- are the problem.

In the complex world of health care policy, I think the answer is all of the above . . . another reason we need a comprehensive reform program. But I do think it is an interesting and complex question in itself as to how much you can blame the health insurance companies for lack of affordability and availability of health insurance. Do large company financial metrics naturally push us toward the problems we are having? How would you change that short of a single payer system (which I believe is off the table and certaintly has plenty of its own problems)?

The Real Cost of Leaving People Uninsured

Jon @ my policy health discussion central — Fri, 21 Dec 2007 13:21:13 EST

The American Cancer Society has come out with a report that uninsured cancer patients are significant more likely to die from the disease than insured cancer patients; 50% more likely to die within 5 years in fact. You could name the reasons this would be the case – the uninsured are less likely to get screening that would catch the disease early, are more likely to put off treatment, and are not likely to have access to higher quality, cutting edge treatments. You could also extrapolate from this how much care for advanced and terminally ill cancer patients costs the system relative to those cases that are caught early.

Does this surprise anyone? Do you agree that, in addition to addressing the enormous human costs here, there would not be net savings to the system of covering and screening people early?

Reducing health care costs

Jennifer from Washington, DC — Fri, 21 Dec 2007 13:18:19 EST

This past week, the Commonwealth Fund, a prominent health care “think tank,” issued a report looking at 15 ways that the federal government could reduce national health care spending by as much as $1.5 trillion over 10 years. A lot of the suggestions are focused on reducing Medicare costs, but would have broader impact if implemented as part of any health care reform. As noted by an editorial in yesterday’s NY Times, the report does not look at the savings that might be generated by expanding Medicare into a program that would replace private insurance. You can read the full report here, but the policy options that would result in cost-savings are:

1) Producing and using better information: promoting health information technology, creating a “Center for Medical Effectiveness and Health Care Decision-Making,” and requiring providers to educate patients about alternative treatment options.

2) Promoting health and disease prevention: reducing tobacco use and obesity, and using federal funds and incentives to encourage individuals to engage in wellness programs and healthy behavior, and to cover preventive services.

3) Aligning incentives with quality and efficiency: establishing a hospital pay-for-performance program, transforming the fee-for-service payment system to an episode-of-care system, strengthening primary care and care coordination, and limiting federal tax exemptions for premium contributions.

4) Correcting price signals in the health care market: reset benchmark rates for Medicare Advantage plans, establish competitive bidding among Medicare plans, give the federal government the authority to negotiate prescription drug prices for Medicare plans, and limiting payment rate updates in high-cost areas.

As an interesting aside, one of the Fund’s suggestions for reducing obesity is to establish a nominal tax on sugar-sweetened soft drinks to help finance national and state obesity-prevention programs. The Mayor of San Francisco just proposed something similar, a surcharge for large stores when they sell sugar-sweetened sodas, for his city.

So, what do you think of the Fund's suggestions? What are some other ways to reduce the nation's health care spending?

Eyes on California

Jon @ my policy health discussion central — Tue, 18 Dec 2007 18:39:57 EST

Yesterday the California Assembly passed a broad health care reform plan supported by Governor Schwartzenegger (still have trouble saying that with a straight face). The plan tracks many aspects of reform plans passed in Massachusetts, Maine, and Vermont (as well as the plans of the major Dems running for President). The big difference of course is scale. California bares watching closely because it is a much more realistic laboratory for reform plans on a national scale.

Two hurdles remain for the California plan. First, it must be passed by the state Senate which has expressed concerns about the plan in light of the widening state deficit. Second, and most significant, the Governator and his supporters have decoupled funding from the substance of the plan. If/when the plan passes the Legislature, it would trigger a referendum process for the voters to approve the funding mechanism (including significant tax increases). This preserves Arnold’s pledge not to raise taxes (doesn’t count if the people raise their own taxes) and avoids a 2/3 vote requirement in the Legislature for new taxes. But it sure does add a twist – not to mention a big delay -- to the process.

But, as usual, keep your eyes on California. It will be interesting and instructive for the coming debate on national reform. Read about the California plan here. What do you think about the situation there? The substance of the plan?

Small Business Weighs in on Health Care Reform

Jon @ my policy health discussion central — Thu, 13 Dec 2007 17:24:20 EST

The National Federation of Independent Businesses just came out with its 10 principles for health care reform. Why should you care? Because small business, and NFIB in particular were instrumental in killing the Clinton health care reform plan in the 90’s and will be a very loud voice in the debate on reform this time around.

Three top level takeaways from the NFIB’s 10 points are 1) its agreement on the need for fundamental, comprehensive reform; 2) its opposition to pay or play requirements on employers (i.e. a mandate to provide insurance to employees or pay into a fund in lieu of that) and 3) its opposition to a government single payer system.

I would not minimize the significance of point number 1. These guys are a key constituency and they seem to be agreeing with Barack and the other Democrats that real reform is necessary and not just the tax cuts and piecemeal tweaks that our Republican friends suggest.

But the devil is in the details. No surprise about NFIB’s opposition to employer mandates and single payer, but I’d like to see how they think we pay for the kind of comprehensive reform they agree we need. If you put two and two together on their 10 Principles, they point toward a heavily publicly financed, privately serviced health care system. Nice idea . . . Only the very beginning of the discussion.

What do you think of NFIB’s health care reform principles?

Backsliding on Teen Pregnacy Rates

Jon @ my policy health discussion central — Mon, 10 Dec 2007 15:36:50 EST

A recent Centers for Disease Control study finds that for the first time since 1991, the teen birth rate in the US went up last year (see NY Times piece on this here). This is disturbing but totally unsurprising. Teen pregnancy is a health issue affected by a broad range of factors including poverty and education levels. In case you hadn’t noticed these areas tend not to be Republican strong points and this Administration especially doesn’t have the inclination or the patience for complex solutions to complex problems.

However, if you want to see our health care system’s issues continue to grow, just sit back while the teen pregnancy trend line slopes up. It presents a great illustration of root causes which could swamp our health care system (and the reforms we might otherwise try to implement) and the need for broader set of policy responses.

What do you think has caused the up-tick in teen birth rates? Is it a health care reform issue? What can we do about it?

To mandate or not to mandate: is that really the question?

Jennifer from Washington, DC — Thu, 06 Dec 2007 01:18:02 EST

One of the hottest health care reform topics in the blogosphere and the opinion pages recently has been the issue of "individual mandates." All of the top three candidates, Barack, Hillary Clinton, and John Edwards, have proposed health care reform plans that would be a wholesale change from the system we currently have. There are differences, though, between their plans, and one of those is whether there should be an individual mandate – in other words, whether individuals should be required or forced to purchase insurance from private insurers. The three candidates have different approaches to this question. To summarize, John Edwards's health plan would have a mandate that he would enforce through collection agencies and wage garnishment. Hillary Clinton's plan would have a mandate, but she has not yet explained how it would be enforced. Barack's plan has a mandate to require that children be insured, but uses other mechanisms (as discussed in Robert Reich's post that Jon linked to the other day) to ensure that everyone will be covered, and would revisit the possibility of a mandate for adults later if necessary.

This difference between the candidates' on individual mandates for adults has resulted in differences of opinion on several fronts, including: whether individual mandates are the best way to get as many people as possible covered (as opposed to, say, lowering health care costs to make insurance more affordable); whether mandates are actually enforceable; whose plan will cover the most people; and whether a mandate is even politically viable.

So, what do you think about mandates? Do you think they are good/bad, necessary/unnecessary? Is the "mandate issue" important, or much ado about nothing?

Update: more on medical tourism

Jennifer from Washington, DC — Mon, 03 Dec 2007 21:59:11 EST

A little over a month ago, I wrote a post about medical tourism and how some in the health care industry are predicting that, within the next few years, U.S. health insurers will cover trips overseas for non-emergency surgeries. Thailand, specifically Bumrungrad Hospital in Bangkok, was mentioned frequently in the linked articles in that post as a popular medical tourism destination for Americans. Bumrungrad is, after all, a private downtown hospital, with a sushi bar, interpreters, and VIP suites with marble bathrooms.

One of the articles noted the difference in medical care received by tourists compared to Thais. NPR has an interesting article that ties the two together: due to how much money Thai doctors can make at private hospitals like Bumrungrad, few are willing to work at public hospitals, which serve the majority of Thais. As a result, Thais are having a hard time finding a doctor and getting medical treatment. As NPR notes, though, Thailand has already had a doctor shortage. Many Thai doctors left to join the U.S. military during the Vietnam War and, more recently, moved to other countries in order to make more money. The pay difference between private and public hospitals is just continuing the problem. Still, this is a reminder that an influx of "medical tourists" from America and Europe could have unintended and very negative consequences for the locals.

The article also contains an earlier Q & A on what to look for if you are thinking of traveling overseas for medical care. You can also listen to a bit of the author's interviews that led to the story.

Robert Reich On Barack, Hilary And Health Plans

Jon @ my policy health discussion central — Mon, 03 Dec 2007 14:39:09 EST

Interesting post recently by Robert Reich on his blog among other things comparing Dems health plans (and generally praising Barack for his willingness to tackle social security and health care issues in a more realistic manner). See the full post here. This is worth a look since it really is in the finer details of funding and implementation that the plans will differ.

Quoting directly from Mr. Reich who is talking about what he deems unfair attacks by Hilary Clinton on Barack with regard to Social Security and then Health Care:

“I’m equally concerned about her [Hilary’s] attack on his [Barack’s] health care plan. She says his would insure fewer people than hers. I’ve compared the two plans in detail. Both of them are big advances over what we have now. But in my view Obama’s would insure more people, not fewer, than HRC’s. That’s because Obama’s puts more money up front and contains sufficient subsidies to insure everyone who’s likely to need help – including all children and young adults up to 25 years old. Hers requires that everyone insure themselves. Yet we know from experience with mandated auto insurance – and we’re learning from what’s happening in Massachusetts where health insurance is now being mandated – that mandates still leave out a lot of people at the lower end who can’t afford to insure themselves even when they’re required to do so. HRC doesn’t indicate how she’d enforce her mandate, and I can’t find enough money in HRC’s plan to help all those who won’t be able to afford to buy it. I’m also impressed by the up-front investments in information technology in O’s plan, and the reinsurance mechanism for coping with the costs of catastrophic illness. HRC is far less specific on both counts. In short: They’re both advances, but O’s is the better of the two. HRC has no grounds for alleging that O’s would leave out 15 million people.”

Interesting stuff from a former Clinton Administration official and someone in a good position to make a judgment. What do you see as the most significant differences in health reform plans? What do you think about the tone of the campaign among Democrats to this point?

The AIDS Fight On World AIDS Day

Jon @ my policy health discussion central — Sat, 01 Dec 2007 12:26:06 EST

Today is World AIDS Day 2007. The worldwide fight against AIDS arguably is the one health and humanitarian issue on which the Bush Administration has not embarrassed itself and this country. Under the President’s Emergency Plan for AIDS Relief (PEPFAR) the US has committed $15 billion over 5 years on international AIDS prevention and treatment programs, and the President is talking about doubling that amount.

Still the number of worldwide AIDS cases stands at over 33 million according to recent UN estimates (and by the way the CDC has just noted what looks to be an upward tick in new AIDS cased in the US to between 55,000 to 60,000 a year). The fight continues.

Both Barack Obama and John Edwards weighed in over the last few months on the issue of increasing AIDS program funding and they were joined over the last few days by Hilary Clinton as well (see article here). We should recognize the international AIDS fight (as Senator Obama has) both as a moral, health issue and as a foreign policy imperative for the US as an international leader. As JFK recognized with the Peace Corps, showing leadership that does not involve bombing someone can be most effective foreign policy.

What do you think about the President’s efforts on international AIDS? What additional steps should the next President take?

The rising costs of health care

Jennifer from Washington, DC — Thu, 29 Nov 2007 00:09:47 EST

Over the weekend, there was a very interesting editorial in the Times that takes a broad look at the rising costs of health care in this country. The effects of high costs are somewhat obvious:

Workers complain that they cannot afford high premiums for health insurance. Patients forgo recommended care rather than pay the out-of-pocket costs. Employers are cutting back or eliminating health benefits, forcing millions more people into the ranks of the uninsured. And state and federal governments strain to meet the expanding costs of public programs like Medicaid and Medicare.

As noted in the editorial, controlling costs is important because, if health care costs continue to rise as they have been, eventually "every penny of the annual increase in gross domestic product would have to go for health care." The editorial begins to offer solutions for controlling costs, including preventive care, managed care, disease management, and making better use of information technologies. It also discusses other saving mechanisms, such as paying providers less and/or emphasizing primary care, as well as possible system-wide changes such as moving to a consumer-driven model (where people pay more for health care, and are given more information about doctors and treatments, so that they think harder and make wiser decisions about health care) or a single-payer system.

The editorial is really just a jumping off point for a very important aspect of health care reform: how should we reduce and control health care costs? What should we prioritize?

Another Toe In The Water On Reform

Jon @ my policy health discussion central — Tue, 27 Nov 2007 22:20:32 EST

A few months ago I wrote a post talking about a move by Medicare to deny reimbursement to hospitals for additional treatment necessary due to a hospital’s own preventable mistake. Now comes an even bigger proposal from the Medicare powers that be to provide an outcomes overlay to the entire hospital reimbursement system. The proposal would cut hospital payments by a flat 2% to 5% and would distribute the resulting pool of money to hospitals that meet or surpass certain thresholds on a variety of quality measures and/or show significant improvement in outcomes.

The risk here is how to implement this system – which would require legislation from Congress -- when Medicare is almost half the revenue of many hospitals working off already very thin margins. It is another toe in the water by the Administration on health care reform while it, and the Republican presidential candidates, continue to deny that comprehensive reform is necessary.

What do you think of this proposal (read more form the Kaiser Family Foundation here)? Can one-off measures like this – tempered through the legislative process -- work well relative to broader, more systematic reform?

'Tis the season . . . to check your prescription drug coverage!

Jennifer from Washington, DC — Mon, 19 Nov 2007 01:20:47 EST

For the folks out there who are age 65 or older (or who have friends or family members that fit the bill), you've probably heard that the open enrollment period for Medicare Part D began on November 15, and lasts until December 31. For those who don't know what Medicare Part D is, it's the Medicare prescription drug benefit that went into effect on January 1, 2006. To receive the benefit, individuals enroll in a participating stand-alone prescription drug plan from a private health insurance company. The plans are regulated by Medicare, but unlike Medicare Parts A (Hospital Insurance) and B (Medical Insurance), aren't standardized. This means that different plans cover different drugs, have different price tiers for different drugs, etc.

To say choosing a plan is confusing would be an understatement. In Minnesota, for example, Part D beneficiaries will get to choose between a mere 151 plans! Investigating whether to stick with your current plan is important, though: as noted here and here, premiums for a lot of plans are going up this year. Other plans may be changing their coverage. There are resources on the web that offer advice on choosing a plan, including the official government site that lets you compare plans and what drugs they cover side-by-side. Some pharmacies are also going to help beneficiaries figure out which plans best serve their needs.

As noted in at least one of the above linked articles, Part D was controversial when it was passed as part of 2003's Medicare overhaul. Health Affairs, an influence health policy journal, has an interesting blog piece here examining renewed calls for a Medicare-run prescription drug plan.

So, as it is about to enter its third year of existence, what has your experience been with Part D? What has worked for you, what needs changing?

A System That Encourages MORE Time With Your Doctor

Jon @ my policy health discussion central — Thu, 08 Nov 2007 17:57:23 EST

One criticism you hear about the health reform plans out there goes something like this: Even if we greatly expand health insurance coverage, in the long term any system will collapse under its own weight if costs don’t come under better control; and plans out there only begin to scratch the surface on how to control costs. Two elements to control costs that we have discussed in this space before are 1) changing the way doctors are compensated to eliminate incentives to order more procedures for their own sake, and 2) encouraging more effective prevention and holistic case management to get to better outcomes.

Good news. There ARE systems out there that aim at both of these factors at once. They reimburse doctors for spending more time with patients up front and for managing cases to more effective outcomes. A group called the National Committee for Quality Assurance is proposing such a system and several well known doctors’ professional organizations and insurance companies are joining in to test elements of it. See the NY Times piece on this here.

Will this direction work? Is this a way to make bean counters happy without inserting themselves between doctor and patient?

Carrots or sticks?

Jennifer from Washington, DC — Sun, 04 Nov 2007 23:06:51 EST

It is understandable that employers would want to cut costs associated with their employees' health care. But, in their effort to do so, to what extent should employers dictate or influence their employees' behavior?

This NY Times article discusses the recent trend of employers paying for "corporate wellness programs" to help employees quit smoking and lose weight.. Some even go as far as to provide monetary awards for employees who succeed. This can provide employers with big savings (compare the $900 in smoking cessation costs with the estimated $16,000 in additional medical bills the average smoker accrues over a lifetime). Plus, no one can deny that offering these programs provides a great benefit to employees.

Some employers go the opposite route: they penalize employees who engage in unhealthy behaviors like smoking, such as by charging them higher premiums or deducting small amounts from their pay. Some employers have even gone as far as firing smokers. A recent Wall Street Journal poll, however, does not find much support for these more punishing approaches. Only approximately one-third of the people polled think it is fair that employees who engage in "unhealthy lifestyles" pay higher premiums or deductibles, while there was barely any support for firing employees who smoke or are seriously overweight.

What do you think? Should employers be able to require higher premiums for employees who do not make healthy choices? Should they be able to require participation in wellness programs? Or should it be the employees' choice?

How about combining that knee replacement with a trip to Thailand?

Jennifer from Washington, DC — Sun, 28 Oct 2007 18:49:54 EDT

When I lived in San Diego, I had a few friends who would head south to Mexico for routine visits to the doctor and the dentist. I never tried it, but these friends swore that this much cheaper option, known as "medical tourism," was the way to go. It seems that some in the health care industry agree. In a recently released "white paper," David E. Williams and John Seus predict that, in an effort to control costs, U.S. health insurers will begin to cover medical tourism for non-emergency care in 2008, and that state governments will "embrace" medical tourism by 2010. They note that Blue Cross Blue Shield of South Carolina has already added a hospital in Thailand to its network and started Companion Global Healthcare to assist other health plans with establishing overseas networks. Given that an estimated "hundreds of thousands" of Americans now leave the U.S. for less expensive health care, it is no wonder insurers are considering their options.

Clearly, medical tourism raises quality-of-care concerns. While many attest to great experiences with both the treatment received and customer service, there have been plenty of horror stories of botched surgeries. Even if quality-of-care could be assured (such as by the Joint Commission International, which inspects overseas hospitals and analyzes whether they meet American standards of care), the possibility that health insurers could routinely offer medical tourism as an option raises a number of flags. Will patients be pressured to travel overseas for care as a cost-saving measure for employers and insurers? Will the costs for family members to travel with the patient be included in the coverage? Is a return trip necessary if complications should arise after the patient has returned, or will the patient be able to receive treatment here? What recourses will patients have if the treatment received ends up being sub-standard?

So, what do you think about traveling to another country for medical care?

Would You Put Your Health Records Online?

Jon @ my policy health discussion central — Thu, 11 Oct 2007 10:04:02 EDT

More from Slate.com on Microsoft's online health records effort (link here):

Microsoft launched a Web site for storing and sharing individual health records. Google and major health insurers are developing similar plans. Sample uses: 1) Your doctor puts your records on the site, where you can access them anytime. 2) You check your blood pressure or glucose at home, and your monitor automatically sends the data to your online records, where your doctor can access them. Microsoft's spins: 1) This will improve health care. 2) All your doctors will know all the medications you're taking. 3) We'll keep your records encrypted and totally private; only people you designate can look at them. 4) Consumers will get used to this just as they have with online banking. Skeptical reactions: 1) Private? Riiiight. 2) Even if the system is safe, people won't believe it, so they won't use it. 3) People don't care enough about their health to eat vegetables, much less manage their medical information. Would you put your records on the Web?

Good question. WOULD you put your medical records online?

Dial Tone for Digital Health Care

Jon @ my policy health discussion central — Sun, 07 Oct 2007 13:10:23 EDT

This past week Microsoft announced its HealthVault service – offering free (presumably secure) personal health care records online. This is an attempt (Google is working on another) at creating a standard platform for storing and using health records online. It appears Microsoft is following its Windows model trying to get big name partners to build on the platform, announcing projects with a number of prominent health care institutions (like the Mayo Clinic) and organizations (like the AMA and American Heart Association).

I am no big Microsoft fan, but taking the next step in better managing health care, both for outcomes and efficiency, requires a workable, secure digital health records standard (or set of standards). This will be the dial tone of the more efficient health care system called for by the Obama reform plan and others.

Microsoft undoubtedly will try to be the sole standard setter. This is what they do. Whether we need one standard or several and who is best equipped to provide it remains to be seen. However, it is a welcome sign that any number of large players, along with numerous smaller ones, are taking the first steps down this road.

You can read more about Microsoft’s HealthVault introduction here.

SCHIP Shot

Jon @ my policy health discussion central — Wed, 03 Oct 2007 15:07:56 EDT

Well he actually did it. The President actually vetoed the bipartisan proposed expansion of the State Children’s Health Insurance Program (SCHIP), despite it being the one of the only workable solutions to bring more children under the health insurance umbrella under the current system. And this after the Administration handed down new rules governing SCHIP that actually would narrow eligibility (read what papers around the country had to say about this here).

You have to admit – the President sticks to his principles. They are just ill informed and flat out wrong principles.

Patchwork Benefits Packages

Jon @ my policy health discussion central — Mon, 01 Oct 2007 15:40:16 EDT

Interesting story in the NY Times recently about what small businesses are doing to maintain some health coverage for their employees. Read To Keep Health Plans, Many Firms Shift Costs. It points out that, according the Kaiser Family Foundation, 59% of small businesses provide some kind of health insurance, down from 68% six years ago. Even to maintain that percentage, small businesses are having to turn to measures like the “superhigh deductible” and/or greatly reduced benefit plans (though they are also trying to get some of that money back to employee pockets through other benefits like pre-tax health savings/reimbursement accounts which can be used to pay deductibles and other non-covered health care costs). The states are also pitching in with ways to help small businesses provide benefits. Just another piece of the patchwork US health care system.

Health Policy By Wal Mart

Jon @ my policy health discussion central — Fri, 28 Sep 2007 15:34:48 EDT

There was some good news this week relating to health care costs. The inflation rate in drug prices over the last 12 months came in at a low 1%. That compares with a rate of 4.4% in 2005 (a rate more representative of recent years). Several factors are at work here. Maybe most importantly, some widely used drugs have recently come available as generics. But there is also what the New York Times calls “the Wal Mart effect,” the effect of lower generic prescription drug offerings at large retailers like Wal Mart. Read about Wal Mart’s program here.

In many ways you can applaud Wal Mart’s direction here putting downward pressure on the price of many prescriptions drugs. Let’s leave aside for now the issues with pay and benefits for Wal Mart’s employees – whole other (though certainly related) can of worms. But there is something scary here as well. Essentially you have retailer marketing decisions significantly effecting accessibility of prescription drugs. Wal Mart wants to go young? Birth control pills are affordable.

I do not begrudge Wal Mart’s power to decide what to discount or not. The problem is lack of accessibility overall, making Wal Mart’s (and Target’s, etc.) decisions critical to putting certain drugs within reach. I realize that the Republicans in the room might say letting the market work is exactly the point. But is this really the kind of market action we want to depend on for access to medicines in a rational health care system?

Think Real Reform Is a Sure Thing This Time? Think Again.

Jon @ my policy health discussion central — Tue, 25 Sep 2007 23:39:18 EDT

As usual, one of the best summations of the healthcare reform situation comes from the New Yorker this week. Read it here. In the piece, Hendrick Hertzberg recognizes the consensus building on the Democratic side and among the public, and contrasts what is still coming from the Republicans with statements like: “People have access to health care in America . . . After all, you just go to an emergency room” (spoken by President Bush who recently confirmed his intention to veto the broadening of SCHIP proposed by Congress) and the Democratic plans are “European-style socialized-medicine” (spoken by Mitt Romney who strangely enough supported a very similar plan for the state of Massachusettes when he was governor).

Hetzberg points out that these kinds of traditional “rhetorical zombies” the Republicans are rolling out seem to be losing power with the public as the problems become more obvious and widespread. However, we should not forget that a Republican President in the White House after 2008 likely means there will NOT be meaningful reform (with a risk of this even with a Democrat in the White House if Congressional majorities narrow or disappear).

Just one of many reasons the stakes are so high in 2008. Don’t sit on your hands. If you think healthcare reform is critical, get out there and work.

The Health Care Establishment Candidate?

Jon @ my policy health discussion central — Sun, 23 Sep 2007 17:40:29 EDT

The big news in health care reform last week was that Hilary Clinton finally announced her health care plan. No surprise that if you do a side by side with the other major Dems’ plans -- by Obama and Edwards -- they have very similar major headings. Once again, the consensus building out there is striking.

More interesting to me is how Hilary seems to have become the establishment health care candidate. Among those saying good things about her (and giving her plenty of money) are no less than the pharmaceutical and insurance industries – two of her most vocal critics during her first foray into health care reform in the 90’s.

So the question becomes whether being the establishment candidate is good – enabling a reform plan to pass – or a dangerous thing – hurting the chance for the real reform necessary. There is the potential for both I think as things play out. The stakes are incredibly high. As the experience in the early 90’s shows, if you squander an opportunity like this it is hard to say when the stars will align again.

Very interested to hear your thoughts out there on this . . .

Bad Trends

Jon @ my policy health discussion central — Thu, 20 Sep 2007 10:42:09 EDT

Late last month the Census Bureau came out with its 2006 survey of health insurance coverage rates in the US. Sobering highlights include a jump overall in the number of uninsured from 44.8 million in 2005 to 47 million in 2006, the main culprit being the continued erosion in employer based health coverage. Also the number of uninsured children – a number that had been steadily declining over 10 years from 1994 to 2004 -- rose by 600,000 to 8.6 million.

But even this does not tell the full story. As the consumer group Families USA points out, these census numbers really understate the problem since the Census Bureau counts as “uninsured” only those who have been without insurance for a full year. Families USA puts the number of uninsured at 89.6 million, counting all those who were uninsured at some point in 2006.

Of course the question of how to reverse this trend is the whole point of this discussion. Is comprehensive reform the only way to go or are there spot measures to stop it? Obviously I would say the former is the only way really to get at this long term but floor is open to any and all thoughts.

The Mayo Clinic Weighs in On Health Care Reform

Jon @ my policy health discussion central — Mon, 17 Sep 2007 11:43:08 EDT

There was a big name new entry into the health care reform debate late last week -- no less than the Mayo Clinic. The Clinic's Health Policy Center brought together 400 plus health care "thought leaders" from different sectors to discuss issues and come out with a series of recommendations. Read about the effort and see the results at the Mayo Clinic site here.

The basic outline will look familiar to those of you who have read the Obama plan or have otherwise been following the debate -- universal coverage through more portable insurance with subsidies for those who need them (and with employers still playing a role); better coordinated care; better information and outcome measures to enable consumers of health care to make better choices; reform of the way health care providers are paid to better align incentives. See the NY Times report on the effort here.

The drumbeat keeps getting louder and high level consensus continues to build. Now we need the leadership at the top.

One Patient's Run In with "The System"

Jon @ my policy health discussion central — Thu, 13 Sep 2007 12:54:56 EDT

Just read the story of Shirley Loewe and her run in with the health care system (from the front page of the WSJ today) by clicking through to the full version of this post. Incredible job by the Journal in capturing this. If you are not appalled by what is going on out there, you are not paying attention.

The Internet, Technology, and Health Care

Jon @ my policy health discussion central — Thu, 13 Sep 2007 11:40:33 EDT

Most health care reform plans out there, including the Obama plan, talk about creating a more efficient system with better overall health management. How do we do that? For starters, we need improved health care infrastructure that allows access to and sharing of critical information and better ways for consumers to manage their own care and make choices. Enter the internet and technology companies who see huge potential given the size of the health care marketplace.

The two primary strains of new services out there are 1) services like WebMD and Revolution Health which aim to provide health care information – on particular conditions, treatments, doctor quality and even advice to users . . . and eventually even to help them manage their health resources like benefit plans and 2) software and services being planned by Microsoft, Google and others (see: Google and Microsoft Look to Change Health Care from the NY Times last month) to bring health records online and make them more readily accessible while sufficiently protecting privacy concerns. Then there is everything in between from better internet searching for health information (see Healthline as well as Google itself) to efforts by insurance providers, benefits plan administrators and employers themselves to make sense of the system, to more traditional health management software providers like Oracle and others.

And therein lies the rub. There are a lot of good ideas out there, but how do we make sure the right people are working together to provide the right information in a way that is sufficiently standardized (including security) to result in something broadly useful. Will the market do a sufficiently good job in shaking all of this out? Likely there will be some very skillful, targeted policymaking necessary to encourage things along the right path . . . potentially a very long path.

"Good News" On Premiums?

Jon @ my policy health discussion central — Tue, 11 Sep 2007 13:11:01 EDT

The Kaiser Family Foundation just released it’s annual survey of health care premiums. The “good news” is that premiums rose 6.1% in for 2007, less than the 7.7% increase in 2006 and the lowest increase since 1999. However, the increase in premiums still far outpaced inflation and growth in wages and brought the total average annual cost of premiums for family coverage to $12,106. Also there is some thinking that the decline in the rate of increase has as much to do with insurers reducing or narrowing coverage than anything else. See the report at the KFF site here.

A couple of other interesting points from the press coverage I’ve seen on the study: The price of health insurance is spurring some interesting efforts to improve health and control costs, including insurance purchasing cooperatives with built in incentives for attaining good health milestones and consumer directed plans which give consumers more of a direct stake in the health care choices they make and the economic consequences of those choices. Insurers themselves also may be realizing that covering more preventative care simply may be a good (i.e. cost effective) idea after all. See coverage from the WSJ here and the NY Times here.

Prescription for Pennsylvania: Universal Coverage and Cost Control

Jon @ my policy health discussion central — Sat, 08 Sep 2007 01:53:33 EDT

Among the state efforts at health care reform is Governor Ed Rendell's "Prescription for Pennsylvania" plan. The Governor recently discussed the plan with US news. Read the interview here.

The plan aims for universal coverage in Pennsylvania but it is also interesting to see how much Governor Rendell emphasizes health care management and the cost control side as a competitiveness issue for the state's businesses providing health care coverage for employees. Among the measures in the Pennsylvania plan: 1) implementing a team approach to treating chronic diseases, stressing overall case management (and providing reimbursement accordingly), to reduce high hospitalization costs, 2) increasing controls required of hospitals designed to reduce costly, hospital-acquired infections, and 3) plans to encourage the use of primary care physicians over trips to the emergency room.

To read more about Prescription for Pennsylvania, you can click here. What do you think? Will the state by state approach to health care reform be effective?

Helping Inform Health Care Consumers

Jon @ my policy health discussion central — Mon, 03 Sep 2007 22:55:16 EDT

For the last week or so I’ve been writing about the beginnings of a move to adjust the incentive structure around our health care system – including discussion around how doctors in the US are paid and a policy shift by Medicare not to pay for costs resulting from the preventable mistakes of hospitals.

Now comes a decision from the US District Court for the District of Columbia requiring the government to make public Medicare claims information about procedures performed by individual doctors. See the Washington Post report on the decision, the result of a lawsuit by a consumers group, here. The decision does not appear to require any reporting on outcomes, but does allow comparison shopping to some extent based on experience with a particular procedure.

So the tide appears to be shifting toward the kinds of measures that should result in better case management, better consumer information, and better incentives. A shift I hope will be completed as it should, in a more systematic way through a new President’s comprehensive health care reform plan.

Huge Medicare Move . . . No Pay for Mistakes

Jon @ my policy health discussion central — Sat, 01 Sep 2007 11:14:57 EDT

In my last post I talked a little bit about the effect on health care system efficiency of how we pay doctors in the US. Then the Bush Administration announced that it will no longer pay the costs of treating preventable errors that occur in hospitals or “conditions that reasonably could have been prevented.” Private insurers reportedly are looking at making the same change. See the NY Times article on the announcement here.

This is a very significant policy change, resetting the incentive structure and even moving toward an outcomes based reimbursement system (not to mention directly saving Medicare money). I give the Bush Administration credit for the direction here. However there are enormous potential implications depending on how the change is implemented. How do Medicare and hospitals define what is preventable or not? What is the financial effect on hospitals and other medical institutions? Not to mention . . . do patients get caught in the middle financially if Medicare/private insurers and hospitals argue about what is preventable and therefore reimbursable? These significant implications show the value of reasoned, comprehensive reform.

There are some really interesting questions here. What do you think of this change? What is likely to happen on the ground in implementation?

Tobacco for None?

Josh Friedman — Thu, 30 Aug 2007 15:45:57 EDT

In the online magazine Slate, William Saletan has written a provocative piece discussing the international campaign against tobacco usage. Saletan is conspicuous as to his own bias, “I hate smoking. It's a filthy habit. It kills hundreds of millions of people, including bystanders. Just being around it nauseates me. Cities, states, and countries all over the world are banning smoking in public, and I couldn't be happier.” Still, Saletan takes issue with some recent anti-smoking efforts, including efforts to outlaw eating in smoking rooms, as has recently occurred in Holland and Slovenia, among other countries.

What do you think about these efforts? Is this zero tolerance approach one we should applaud? Just today this topic is again the topic of conversation, as Governor Mike Huckabee committed to signing a nationwide ban on public smoking, should it pass Congress. Saletan suggests that this approach may not be the best if our goal is purely to reduce (but not necessarily eliminate altogether), the negative effects of tobacco. What do you think?

The High Cost of . . . Doctors?

Jon @ my policy health discussion central — Wed, 29 Aug 2007 15:14:46 EDT

Is reforming how and how much doctors are paid in this country an important part of health care reform? Some commentators argue that it is. As an example, see the article, “Sending Back the Doctor’s Bill,” from the New York Times last month attached to the complete version of this Post. It makes the arguments that (i) doctors’ salaries are much higher in this country than in other developed countries and are a significant part of our health care cost problem and (ii) maybe more importantly, the way doctors are paid – essentially by the procedure – incents doctors to prescribe costly, marginally necessary procedures versus more efficiently managing care.

There are many factors to point to in explaining higher doctor salaries in this country: quality of doctors, the high cost of a medical education (versus other countries where it may be paid for by the government), malpractice costs, among others. But that doesn’t explain away the issue for the health care system as much as it underscores the need for comprehensive reform. Most of the comprehensive plans out there include provisions to make the system more cost efficient through preventative care, better case management, and technology, among other measures (including the Obama plan) and the current incentive structure for doctors does seem to work at cross purposes with this goal.

Studies show that American’s tend not to begrudge doctors their high salaries. Do you agree? Do we just need to change the way that they are paid to get to a more efficient system?

Rudy Care

Josh Friedman — Fri, 24 Aug 2007 11:02:41 EDT

As one of the few Republican candidates to offer details about their respective health care proposals, we owe it to Rudy Giuliani to consider the merits of what he outlines. The former Mayor’s plan, available here: http://www.joinrudy2008.com/commitment.php?num=7, is one that he argues will “give Americans more control over and access to health care with affordable and portable free-market solutions.”

This emphasis on “portable free-market” solutions is clearly not just an idle suggestion. Mayor Giuliani’s most substantial reforms consist of reforming the tax code and the provision of a Health Insurance Credit, rather than expanding Medicare, Medicaid and SCHIP or by creating a similar alternative program. This is a fundamentally different vision than that set forth by Senator Obama and every other democratic candidate to have spoken on the matter.

The proposal was met with some criticism, and not just for it’s brevity. Slate’s Daniel Gross sub-titled his analysis “Rudy Giuliani’s Health-Care Plan is Great for Insurance Companies.” (Available at: http://slate.com/id/2171998/.) The Wall Street Journal defended it, I believe, though I do not have access to this article. (Available at: http://online.wsj.com/article/SB118618665945187926.html?mod=Letters.) This suggests at the very least that the plan has to be taken seriously.

What is your reaction to Rudy Care? Do you think this is a plausible vision for the reforming health care?

Can Health Care Reform Happen Without Lobbying Reform?

Jon @ my policy health discussion central — Tue, 14 Aug 2007 17:26:50 EDT

Barack Obama, more than other candidates out there, has focused on the need not just to change the party in the White House but to change politics generally -- including the tone of the debate in Washington, how we work together across different viewpoints, and whose voices get heard (i.e. campaign finance and lobbying reform).

This last point is especially relevant to the health care reform debate. The health care industry has some of the biggest, best financed lobbying interests in Washington -- especially the insurance and pharmaceutical lobbies. These industries and their lobbies represent viewpoints that should be heard, but at best we can say that they have disproportionate influence and at worst a fairly significant lock on policy makers and process. Over the last decade, the drug and insurance industries spent $1 billion give or take on lobbying, and you can bet a good chunk of this went to protecting the status quo.

So, is the need great enough and the consensus strong enough now that meaningful health care reform can happen under the current system in Washington? Or will the powerful special interests be able to work their magic again unless there first is meaningful lobbying reform and that "new kind of politics" Barack has been talking about?

As background, see the outline of the Obama ethics/lobbying reform package here.

We're number . . . 37?

Jon @ my policy health discussion central — Mon, 13 Aug 2007 10:28:05 EDT

A recent NY Times OpEd makes the point that the US generally fares very poorly in health care system comparisons using broad measures of quality and access to care. Examples: Several years ago the World Health Organization studied and ranked the health systems of 191 nations. The US landed 37th. More recently the Commonwealth Fund looked at the health systems of the US and 4 other developed countires -- Australia, Canada, New Zealand and the United Kingdom -- and the US again did not fare well. In fact by many health care related measures (infant mortality, access to care, life expectancy, others)the US teeters on the brink of looking more like a third world country than a first world country. And all this with a GDP about three times the size of the next largest economy, Japan, and about 4 times the size of the largest European economy, Germany.

To be fair there are many ways to look at how "good" a health care system is. So are these studies right? Are they missing some key benefit of the current US system? Seems to me that health reform is more likely to happen now precisely because we in the US are starting to look at the performance of our system as these studies tend to do -- with a broader set of measures, including things like access to care, better prevention and overall efficiency. That is also why health care reform needs to attack the broader issues (as the Obama plan and other Democratic plans tend to do) versus putting band aids on pieces (as Republican plans tend to do, for example focusing on tax breaks and incentives to help pay for the current system without much more).

If anyone has seen other ranking studies worth bringing to peoples' attention please forward them along.

Staffing Shortages in Health Care

Josh Friedman — Mon, 06 Aug 2007 18:36:57 EDT

Hi everyone. This is my first post, so in addition to your thoughts on the questions I pose, I welcome any comments and criticisms about the post itself.

With that said, I'd like to try something a little different. Recently, the candidates all took part in the CNN/YouTube debate, in which all questions came from public submissions to YouTube. Perhaps indicating that the debate was a success, there were simply too many great questions that went unanswered. Since a good portion dealt with health care reform, we thought it might be worthwhile to discuss some of them in this forum.

Here is a question from Robert Fogarty, which concerns mental health in post-Katrina New Orleans: http://www.youtube.com/watch?v=BWmxiS_EMAY.

This video raises a lot of issues, but the one I thought it might be interesting to start with is staffing shortages. The video highlights that in New Orleans, 80% of the mental health profession has still not returned. As Raven and Carl's story suggests--and we can no doubt easily imagine--staffing shortages pose significant obstacles to a functioning health care system.

To be clear, what is happening in New Orleans is a tragedy beyond tragedy. But, for some, recognition that New Orleans is such a tragedy is an excuse not to consider how the problems in the Gulf region are in fact universal problems. So, I'd like to use the video to start a discussion about the larger question of staffing shortages in the health care system. And, in the context of a presidential campaign, what I wonder is what role the federal government should play in ensuring an adequate supply of health care professionals? I can think of a few very broad solutions (though their breadth does not make them surefire successes), and so I am interested to hear of any specific policy approaches that you are floating around?

Health Top 5

Jon @ my policy health discussion central — Sun, 29 Jul 2007 18:32:04 EDT

We've had this blog going long enough now that I've seen wide ranging comments on problems with the system and what solutions will and won't work. I want to take a deep breath at this point and ask . . . what are the TOP 5 PROBLEMS (or at least top few) you see with the current health care system? The number of uninsured? Rising costs out of line with inflation? Lack of incentives to be smart healthcare consumers?

Also, what are the TOP 5 GOOD THINGS (or again, at least the top few) about the current system you would not want to lose? Quality of the docs? The current insurance choices out there? Large employer participation in the system?

In other words, what are the top things we need and what are the top things to make sure we don't lose in the process?

Obesity and Social Networks

William from Honolulu, HI — Thu, 26 Jul 2007 20:33:43 EDT

Any discussion of reforming the health care system ought to include prevention and public health. A new study in the New England Journal of Medicine focuses on obesity, one of the most pressing public health problems in this country, and the ways in which it can spread like an epidemic.

The study tracked more than 12,000 people over 32 years, and concluded that social networks proved to be a significant factor in the probability that a person would gain – or lose – weight. If a spouse became obese, for instance, the likelihood that the other spouse would also become obese in the next two to four years was 37 percent in comparison to other couples. Also, if a friend became obese, a person’s chances of also becoming obese increased by 57 percent. If the results of the study turn out to be correct, tackling the problem of obesity in America may require examining the influence of social networks more closely.

You can read about the new study here and here. What are ways we can promote prevention and strengthen public health in America?

Health Policy Victory in the Current Health Care Wilderness?

Jon @ my policy health discussion central — Mon, 23 Jul 2007 19:03:18 EDT

See this very interesting article on community health centers from USA Today.com: Health Centers Offer Safety Net, But Rising Demand a Strain. It highlights the rare health care policy success these days represented by community health centers (a war on poverty era program). The centers are providing critical health care services to millions who otherwise would have little or no access to health care. Let's give credit where credit is due on this . . . according to the article, funding for the centers has more than doubled to $2 billion annually since 2000. But the community health center story also serves as another illustration of the critical need for health care reform, especially expanding insurance coverage. With all of the funding increases, the centers cannot remotely keep up with growing demand and can only provide a limited set of services. Ironically, if the Bush administration leans on programs like this without real system reform, it will get exactly what it says it doesn't want -- a government run system representing a larger and larger piece of the health care puzzle. Or maybe it is okay with that if limited to certain (if large) populations. I'd be interested in, among other things, whether anyone out there has experience with the community health center program as a patient or provider. How is it working? What are your thoughts about it?

'Sicko'

William from Honolulu, HI — Mon, 23 Jul 2007 14:48:27 EDT

Have you seen "Sicko," the new Michael Moore documentary about the American health care system? What did you think? Click on "Write a Comment..." below, and share your thoughts.

Humanity Versus Efficiency

Jon @ my policy health discussion central — Fri, 20 Jul 2007 11:41:08 EDT

I heard from a family friend the other day about a situation that no one should have to go through and which highlights the tough issues raised by our current health care system. The father/grandfather of the family had cancer. He got to the point where the hospital didn’t feel there was anything further they could do for him and his health insurer determined that it did not make sense for him to remain in the hospital, but rather should be moved to hospice care. However, several doctors involved -- and the family -- felt that taking him off some of the hospital equipment and moving him itself would kill him. So the family spent the last days of this man’s life meeting with hospital, hospice and insurance reps fighting his being moved.

No one would argue that a family should have to go through something like this. However, it happens under the current system and we can’t assume the issue will go away in a reformed system. Most comprehensive health care reform proposals rely to some extent in their cost assumptions on achieving a more efficient healthcare system – better case management, better information sharing, better technology and health record keeping. So can we effectively balance quality of care issues with the need for efficiency in the system? It seems to me this balance will be one of the key questions to answer in the ongoing health care reform debate. How do we manage effectively and control costs while restoring more humanity to the system? Good ideas welcome. I haven’t seen many specific ones.

Health Insurance for Children

William from Honolulu, HI — Thu, 19 Jul 2007 13:19:14 EDT

Last weekend, the New York Times reported that the current administration plans on vetoing a proposed plan that would expand the Children’s Health Insurance Program. The program is financed by both the federal and state governments, and administered by the states; it provided insurance to 7.4 million children at some point in the last year. There are approximately 9 million children who lack health insurance right now, and according to the Congressional Budget Office, the proposed plan would extend health insurance to 4.1 million of those children. One argument that the current administration makes in vetoing the proposal is that expansion of the program would encourage many to discontinue their private coverage in order to enroll in the Children’s Health Insurance Program.

The article can be read here. The Washington Post also covered the story today (read it here), and the NYT published a follow-up story today as well (check it out here).

In your opinion, should the Children’s Health Insurance Program be expanded?

UPDATE: More legislative movement on this issue, which you can read about here.

Mental Health Coverage

William from Honolulu, HI — Tue, 17 Jul 2007 12:04:10 EDT

One resident of Henderson, Nevada, who submitted her story through the My Policy program, found that her employer-based insurance plan posed too many restrictions on mental health services for her teenage son, who suffers from bipolar disorder.

“We are only allowed a certain number of counseling visits per year, certain services are not covered at all, and there are very few psychiatrists and clinicians participating in our plan,” she wrote. In order to get her son proper treatment -- in this case, a residential treatment program -- she had to spend over $30,000 of her savings. Even though she had “some savings to tap into,” it was still a “serious financial and emotional struggle to go through.”

Have you had similar experiences with mental health coverage? Please share your stories by clicking on “Write a Comment…” below.

State Governments and Health Care Reform

William from Honolulu, HI — Fri, 13 Jul 2007 12:13:56 EDT

A recent article in the venerable Washington Monthly magazine examined whether state governments are better equipped to provide universal health care than the federal government. The author traced health care reform efforts in such states as Washington, Hawaii, Tennessee, and Oregon. Some of the various approaches to reforming health care systems at the state level included focusing on cost-effectiveness and replacing fee-for-service structures with health maintenance organizations that received fixed fees. In the end, the author concluded that “providing health care for all citizens is one of those tasks, like national defense, that the states are simply unequipped to manage on their own.” Read the article here.

Speaking of states trying to enact health care reform, check out a recent NYT article about Pennsylvania’s current efforts to do just that here.

UPDATE: Here's an interesting news article in the Wall Street Journal about California's efforts to achieve universal health care: LINK.

Do you think providing universal health care is best achieved at the state or federal level?

Addressing the Medical Malpractice Conundrum

William from Honolulu, HI — Thu, 12 Jul 2007 13:31:32 EDT

Medical malpractice seems to be a particularly thorny issue. One reader of our blog, talkingmountain, highlighted the issue of medical malpractice as a key piece of health care reform. There’s no doubt that high health care costs overall can be attributed, in part, to high medical malpractice insurance rates. For instance, a study by the Government Accountability Office in 1994 estimated that malpractice premiums accounted for 1% of total health care expenditures. While one percent may sound small, that comes out to about $14 billion dollars, according to a report by the Department of Health and Human Services in 2003.

Some argue that large jury awards and settlements in malpractice cases have led to higher malpractice insurance rates. Others, however, contend that the problem stems from the desire of insurance companies to reap higher profits, pointing out that premiums have risen while insurers’ claims have slowed at the same time. Insurance companies typically determine rates and invest the money they collect from premiums before paying claims. The New York Times has reported that a variety of factors such as declines in investment earnings have led to the escalating costs of malpractice insurance.

The NYT articles can be read here and here. What do you think is the primary cause of rising medical malpractice costs, and how can we best address the issue?

To Mandate Or Not To Mandate

Jon @ my policy health discussion central — Thu, 12 Jul 2007 11:44:15 EDT

One of the comments to my initial post last week (sent in by Peter Erickson) raised the question of arguments for and against mandating that all obtain health insurance coverage, versus simply making sure it is available with subsidies for those in need. It is a question worth bubbling up. The Obama plan mandates coverage for children. The two most publicized state plans -- enacted in Massachusetts and proposed in California by the Gov -- require all to obtain coverage. . .

"All in the Name of Health Care"

William from Honolulu, HI — Mon, 09 Jul 2007 16:19:14 EDT

This is the first in a series of posts that recount stories that have been sent to the campaign through its My Policy program (see the blue box on the right-hand column of this page).

One resident of Grantham, New Hampshire submitted a story about the difficulties that health care costs have posed to her small business. She has owned her small business for more than 17 years, but is now thinking of liquidating it because of rising health care costs. "Yet another small business will go out of business," she wrote. "All in the name of 'health care.'"

She can't afford to provide health care benefits for her six part-time employees because her business is too small. Two of her key employees have applied to jobs at larger companies -- not because they necessarily dislike their current positions, but because they need health care benefits. Over the long term, the small business owner from Grantham noted, "well-trained employees will be leaving me out of necessity to find employment they do not wish to attain, just because of health care benefits." In turn, she must deal with the costs of searching for new employees and training them, not to mention lost productivity.

What in your mind is the best way to help a small business in a situation like this?

UPDATE: Here's a recent Reuters article that's relevant: LINK.

Consensus around reform?

Jon @ my policy health discussion central — Wed, 04 Jul 2007 10:29:08 EDT

Interesting op ed in the NY Times several weeks ago making a key point about the health care debate (read it here). The question has shifted from whether we need significant health care reform to what that significant reform should be. Also, while candidates will try to differentiate their health care plans, there seems to be a developing consensus high level (on the Democratic side at least) on what key pieces are needed. As the op ed piece points out, this changes the question from "who has the best plan?" to "who is best equipped to pull the pieces together and make it happen?" Interesting in itself.

Many questions come out of this, but I will raise the basic ones: Is there a developing consensus on health care reform and what are the main elements?

Join the health policy discussion

Jon @ my policy health discussion central — Mon, 02 Jul 2007 15:45:40 EDT

Welcome to the “My Policy” health issues discussion. The discussion represents the next step in the Obama for America “My Policy” effort to bring your stories and views squarely into the issues debate (see the blue “My Policy” box at right here). Step One has been to ask you to submit your ideas and real life experiences relating to the health care system. You have responded with thousands of stories, concerns and suggestions. See just one example of a family’s story that Barack himself discussed in announcing his health care plan several weeks ago here.

Now we need to take the next step and get the discussion going about these stories, the issues that surround them, and refining solutions. Through this online collaboration, we can help give voice to all Americans and build a movement for change.

Thanks to the Obama campaign for facilitating this. It is one thing to put a plan out there (you can see the Obama health plan summary here; other candidates have announced plans and no doubt more will follow suit). It is another to provide a real forum for discussion and debate as a way to refine understanding and evolve solutions. The campaign is providing some prime web site real estate here to do that.

The other thing to make clear is that this blog does NOT represent the opinion of Barack Obama and the campaign. That would run counter to the whole purpose which is open discussion and debate. This includes our central posts. While we are working with the campaign to get and keep this discussion up and running, going forward we will be looking primarily to facilitate a useful, lively discussion.

With that, we want to know what is on your mind on healthcare. What are the biggest issues and best ideas? More from discussion central soon.