Health Reform – what’s happening and why

It’s here. Almost.
At long last, health reform is no longer just an idea, a glimmer in the distance, a subject of interest only to those writing doctoral theses, policy papers, and other intellectually interesting but practically useless missives.
Dare we say it; reform is actually possible, perhaps more possible than at any time since 1964.
There are currently no fewer than six (6) health reform bills before Congress, plus about a dozen more waiting in the wings (well, maybe just a couple). Now that there’s actually something concrete to review, discuss, and dissect, the experts from Health Wonk Review’s editorial board have unlimbered their virtual electron microscopes, dusted off their intellectual scalpels, and fired up their mental PET scanners.
Here, laid bare for the benefit of health wonks everywhere, is the combined wisdom of the greatest minds inhabiting the wonk-o-sphere…(click here for the soundtrack, and turn those speakers up)
First, why?
For that, we asked Senator Byron Dorgan (D ND) to tell HWR’s readers why he thinks now is the time to act on reform. Here’s the Senator’s contribution.
“After months of preparation and study, the U.S. Senate is beginning to draft health care reform legislation. The Health, Education, Labor and Pensions (HELP) Committee is writing its bill this week, and the Finance Committee is expected to begin drafting its own version of health care reform legislation next week [emphasis added].
The Senate Democratic Policy Committee (DPC), which I chair, has also just issued a new policy paper which documents the urgent need for health care reform. It lays out the facts on what the cost of inaction over the past eight years has been.
Health care reform is also economic reform. Ever-rising health care costs contribute significantly to the current economic crisis. People between jobs – and that too often means that they are also without health insurance coverage – often face potential financial catastrophe. Even people with jobs and health insurance struggle to cope with high insurance premiums, co-payments and prescription drugs.
You can view video clips of some of the first floor speeches in the health care reform debate by several of my colleagues who are working to advance health care reform in the Senate are here.
Democrats know that, for our economy to truly recover and prosper, we must help middle-class families, businesses, and federal, state, and local governments cope with skyrocketing health care costs. We are committed to enacting health reform that addresses the health care cost crisis and ensures quality, affordable health care for all Americans.”
From Senators to students, HWR welcomes all. Emma Walsh-Alker asked her fellow fifth-graders why kids need health reform; their answers echo Sen. Dorgan and add their own thoughts – which are wise indeed.
The public plan option

The public plan has incited and excited all, from de facto leaders of the GOP to undergrad student debating societies. It is variously viewed as a way to ensure all Americans get good, affordable health care or a devious way for single-payer advocates to slowly but surely kill off the private insurance industry. While there are lots of opinions out there, our good friends at Health Affairs have perhaps the most comprehensive perspective from a variety of posters, guest and otherwise. We’ll start out with their contributions…
Policy vet Jeff Goldsmith doesn’t think the plan is worth the risk, but Joe White disagrees, arguing that there’s ‘dangerous’ confusion about Medicare’s ability to control costs.
A trio of experts want to make sure policymakers think thru the lessons we’ve learned from Medicare, some of them quite painful (and wildly expensive to boot).
Some wonks believe there are better alternatives to the Medicare for Everyone plan, with Hal Luft proposing one alternative, and your author proposing to use the VA system (it has better outcomes, lower costs, and happier patients than pretty much any other delivery/payer system).
And colleague and good friend Bob Laszewski thinks the public plan option may really be a well-disguised way to cut reimbursement, instead of what the country actually needs – a way to “sweat the waste out of the system”.
Me? I’m thinking the Public Plan Option is a great way to distract reform’s opponents from key issues, a bargaining chip to use when the Dems need a few GOP votes to pass a ‘bipartisan’ bill.
David Williams digs into the differences of opinion between ‘experts’ and the public on all things health care. His review of Drew Altman’s piece provides interesting insights into the core issue of explaining/understanding/debating health reform.
A terrific companion/supporting post comes from Louise at Colorado Health Insurance Insider (one of the few bloggers actually in the health insurance brokerage business). Louise discusses the public’s belief that private health insurers have profit margins over 20%…Hello, AHIP, is anyone there awake?!
Ken Terry argues that the focus on the public plan could kill any chance that a reform bill will pass.
Brian Klepper and David Kibbe urge the administration’s Health Reform Team to take notice of the health industry’s Achilles Heel in their planning. They make the case that universal coverage should be off the table unless the industry relents on specific aspects of current business models.
The Benjamins…

This is going to be really really expensive, so expensive that it will be unaffordable from the get go. That’s my interpretation from reading a post from the actual, real live insurance real world’s InsureBlog. Bob Vineyard takes Sen Baucus to task; “Baucus proposes tax subsidies for those making up to roughly $88,000 per year for a family of 4. Isn’t that just about everyone?”
Merrill Goozner’s post is a terrific synopsis of “where’s the money going to come from.” He discusses cost reductions, potential tax revenues and sources thereof, and concludes with thoughts on the potential impact of raising taxes on the middle class.
Michael Tanner over at the Cato Institute makes the rather compelling point in his post that the current proposals do precious little to address costs. Tanner’s point is a valid one; cost control requires saying ‘no’, and so far no one’s even whispering the word.
RIchard Eskow reminds us that any reform plan must address the huge impact of health care costs on the middle class; he notes that almost two-thirds of bankruptcies in 2007 were caused by medical problems.
Anthony Wright expands on Richard’s trenchant observation, noting “people expect health coverage to prevent them from going into bankruptcy. If it doesn’t do that, then it doesn’t deserve to be called coverage.”
Reform’s impact on hospitals, docs, and others

Brady Augustine has an intriguing post about the knuckleheaded way hospital and their advocates have responded to health reform, drawing parallels to the auto industry. He contends that instead of hiding behind lobbyists and legislative protection (like the Big Three did for so many years) they should get their rears in gear and actually try to make themselves better.
DrRich (his name, not his economic status) laments the downtrodden status of the primary care provider, putting it in historical context, describing CMS’ impact on PCPs, and taking on the American College of Physicians’ support of a bill before Congress that, among other things, “renders nurse practitioners as full-fledged primary care providers”.
‘Ill and Uninsured in Illinois’ makes DrRich’s case – maybe better than he does, with her/his post on why retail clinics aren’t the answer for the medically underserved.
Adam Fein sees more consolidation among PBMs (pharmacy benefit managers) in the future; he makes a compelling case.
And from our good friend Jon Coppleman comes this comparison – If health care is the proverbial 800 pound gorilla, then the medical portion of workers comp is a 15 pound Maine Coon cat. Jon wonders whether health care reform will crush workers’ compensation.
The MassExperiment or, is that lighthouse working?

Pro- and O-pponents of national health reform can find much in the Massachusetts experiment to support their respective positions, but those in neither camp can provide the most Mass-based insight. Here goes.
Relative newcomer Tinker Ready’s video-rich post on a Boston-based debate between single payer and mandated insurance, as well as a meeting between single-payer advocate Dr Steffie Woolhandler and Senator Max Baucus (D MT) (Bet that was fun…) gives readers interested in learning lots about Mass just what they need.
David Harlow’s post identifies the holy trinity of reform – quality, access, and cost, noting that in Massachusetts they began with access. He opines that President Obama should back off his apparent goal to get all three done at once.
Not strictly Mass-related, but definitely Harlow-related is the post from Walter Jessen at HighlightHealth. Jessen observes that a recent study shows Americans value access to providers as their “most essential and highest valued health priorities.”
Newly-minted Ph.D Economist Jason Shafrin (congratulations, Jason) has studied the impact of Massachusetts’ health reform on waiting times. His data indicate it takes longer to see a primary doc and some specialists, but less time to get into a cardiologist these days.
Hold on a second, says Joanne Kenen; the USAToday study used by Jason has a lot of other data about waiting times in lots of other towns here in the US of A. Joanne’s review presents a decidedly mixed picture – both of Mass and many other cities. The top stat is this – over the last four years, the average wait across the US to see a doc for nonemergent care more than doubled – from 8.6 to 21 days.
(These last two posts are but one example of why the blog-o-sphere is so great)
The Politick-ing

Ya gotta love Jaan Sidorov! Really, ya gotta! His post dismantles the various signatories to the now-infamous ‘Dear Mr President, we’ll save $2 trillion’ letter. Here’s an appetizer: “Representing the medical device and remote monitoring industry, this group [AdvaMed] promises that overuse of their technology will reduce overuse of other medical care.”
Not to be outdone Glenn Laffel MD PhD at the difficultly-named Pizaazz recommends Sens Baucus and Kennedy caucus, and do it quickly, before they are forced to settle their differences on the White House hoops court. (my money’s on the skinny black guy…)
Maggie Mahar’s posts are always relevant and precise; she knows of what she speaks. Maggie’s coverage of Sen Jay Rockefeller’s (D WV) bill to greatly expand MedPac’s power to and reduce Congress’ role in determining Medicare benefits is a prime example. Few are following this, but it could well be the key to controlling Medicare’s costs in the future.
Jonathan Cohn has the scoop on the meeting wherein President Obama voiced support for Rockefeller’s bill.
The always-interesting American Spectator has an insider’s view of GOP Senators’ perspectives on yesterday’s release of ‘the Kennedy bill’. Snippet – “Enzi was “very disappointed” with the release of the Kennedy bill, and said the senator feels that all the time Republicans spent talking to Democrats may have been in vain since the majority wasn’t listening to them.”
Not sure where it goes but it definitely deserves mention
HWR has been around for more than three years, and Roy Poses MD has been one of the reasons for that longevity and credibility. Roy is one of the blog-o-sphere’s most perceptive industry watchdogs, and his current post is no exception.
Don’t change that channel!
Health reform will be leading the headlines for the summer and well into the fall. And Health Wonk Review will keep you informed, educated, and up to date with the best of the blog-o-sphere.
Jason Shafrin hosts the next edition of HWR at Healthcare Economist; his perspective and expertise will undoubtedly make the June 24 edition one of the best.