The pre-election health policy debate

Editor’s note – this is perhaps the most serious, thought-provoking edition of HWR I’ve had the honor of hosting. There’s a lot of meat here, so don’t expect to multi-task your way through.
These are momentous times. Not only will we be electing a new President, a third of the Senate, and all of Congress in less than three weeks, we’re also facing the biggest economic crisis in modern times. The combination of these two events looks like it will result in a much broader and deeper role for the Federal government in private industry.
Who would have thought taxpayers would be subsidizing loans to automakers, buying up bank stocks, guaranteeing interbank lending, and bailing out huge insurance companies? (If that ‘who’ is you, I would have appreciated a heads’-up before by portfolio cratered…)
The unthinkable is now the inevitable. I can also sense a subtle but nonetheless significant shift in the health policy world, as politicians and pundits absorb the implications of Federal intervention in the capital markets and begin to consider other areas of market failure – such as health care.
The financial crisis and government’s attempt to solve it are driving the health policy discussion in two distinct directions – one argues that there will be no money for reform, thus any reform will be incremental, while the other argues that the financial meltdown is precisely the time to fix health care and access to care.
For anyone thinking that health care is not that big a deal, Bob Vineyard of InsureBlog‘s post $85,000,000,000,000 and Counting . . .is a big bucket of icy cold reality in the form of the looming $85 Trillion (yes, that’s with a “T”) unfunded Medicare liability.
Okay, now that we have your attention, here’s what the best and brightest are thinking.
Lets frame the conversation with a post from the always-thoughtful Maggie Mahar on the question ‘Is health care an “individual right” or a “moral responsibility” that a civilized society understands that its citizens deserve? Maggie prefers the “moral responsibility” frame; in her view we should look at healthcare collectively, individuals should not have to “demand” health care as a “right”.
Maggie isn’t the only blogging wonk thinking about the right v responsibility question. From a health care perspective, the second McCain-Obama debate was interesting for all of about five minutes. But in that short period of time, Tom Brokaw raised an issue that goes to the very heart of the debate: Is health care a right or a responsibility? It drew this post from Merrill Goozner at GoozNews.
Len Nichols of the New America Foundation also weighs in on the debate. Len gleaned a few nuggets from the brief discussion of health care at HEALTH POLITICS: Truthful–and Helpful–Moments in Presidential Debate
The two men who will have a lot to say about what actually happens are named Obama and McCain. Next up is Health Affairs Blog, where several posts wrestle with the differences between the presidential candidates’ health reform plans. Harvard economist David Cutler and Obama advisor calls the McCain plan “out of touch”, while AEI economist Tom Miller and unpaid McCain advisor defends McCain’s plan.
Over on the Huffington Post, MIchael Millenson doesn’t like the McCain reform plan one bit. In his view, McCain’s plan is radical and reckless.
Bill Scher at the Campaign for America’s Future is one wonk pushing hard for major change. He’s no fan of incrementalism (and gently takes me to task for my advocacy of same), calling for us to stop worrying abut short term budget issues and focus on bigger issues.
(Ed. note – yes, most posts appear to favor Obama/take McCain to task. I had to search on my own to find (instead of relying on folks to submit their posts) for those supporting McCain’s positions. After twenty minutes I gave up. If anyone has any solid, well researched posts send them on and I’ll issue an update to this post.)
My take? We can do a lot to help people get coverage, with no impact on the Federal budget or taxes. If the Feds force insurers to stop denying coverage for pre-existing conditions, outlaw medical underwriting, and require community rating and a basic benefits plan, a big part of the problem would be solved. Note several commenters disagree…
Bob Laszewski is having none of this. His post on the disconnect between political reality and wishful thinking is firmly in the ‘lets get real folks health reform is a non-starter’. As a long time industry vet, astute observer of the realities of Washington, and pragmatist of the highest order, Bob’s views merit careful consideration – especially if you disagree…
Those who actually work on the front lines – selling health insurance and servicing their customers, have a reality-based perspective that is vitally important. Louise at Colorado Health Insurance believes “In order for health care reform to work, it has to work for everyone. We need a solution that spreads the cost of health care evenly across the entire population (adjusted for income, just as taxes are) and doesn’t leave large groups (like people with pre-existing conditions) to fend for themselves with no good health insurance options available.”
Continuing our virtual trip out west, Anthony Wright takes issue with those who believe reform must be either state OR federal in his postAn unspoken, untrue consensus….
Andrew’s colleague Beth Capell takes it to those who claim mandated employer coverage is a Job Killer ; and she’s got some good research to back up her assertions that it isn’t.
Christopher Weaver discusses how the media is writing about health care in the election coverage. Weaver’s observes coverage from the national media is scarce and spotty, while local media does a much better job of translating policy into what it means for real folks.
That’s it for policy. But policy is not the only thing on the minds of HWR contributors. Roy Poses MD’s post digs into the accusations that Pfizer Suppressed and Manipulated Clinical Studies of Neurontin. Roy found a rather awkward quote from a Pfizer exec, to wit: “we are not interested in having this paper published at all because it is negative.”
Brain Blogger reports on the latest recommendations on residency hours, with Are Doctors Super Human?.
From the work comp side of the world, Tom Lynch Of Workers’ Comp Insider offers a tried-and-true primer on managing workers comp costs and getting injured employees back to work in Eight steps to controlling workers comp.
Jon Coppelman takes another peek under the covers of the AIG debacle – hint, it’s nothing to examine on a full stomach.
David Williams did an email interview with Mark Bard of Manhattan Research re: the Revolution Health/Waterfront Media merger; David asks some tough questions about how media companies are evolving their web strategies.
David Harlow (no relation to David Williams, at least none I’m aware of) knows a lot about certification of hospitals – a rather arcane but increasingly important issue. David reports on CMS’ decision to allow DNV to break the stranglehold on acute care hospital certication deeming held for decades by the organization formerly known as JCAHO. ( passing a JCAHO survey means that a hospital is “deemed” to be in compliance with Medicare Conditions of Participation (aka Medicare certified) and can forego a government survey; up till now JCAHO has been the only game in town.)
From an attorney to an economist, our next post from Jason Shafrin addresses the issue of medical licensing, specifically whether it improves or harms the quality of medical care
Daniel Goldberg’s contribution provides much-needed perspective on one main component of health reform – the claims for and potential benefits of ‘prevention’. It may not be all its cracked up to be.
Jaan Sidorov digs into CMS’ medical home initiative, providing some much needed insight into what could be a major change in the way Medicare handles some aspects of primary care. This is a BIG DEAL.
We conclude this edition with a post from north of the border. Sam Solomon presents Coalition urges doctors to reject Ontario pay deal, saying, “An argument over a new contract for Ontario physicians is spiraling towards a civil war inside the doctors’ union. Among the issues: disagreement about the extent to which the current economic climate — and government’s projected budgetary struggles — should affect negotiations.”
I’m shot, and you probably are as well. That’s OK, because you now have two weeks to rest up for the next edition of health wonk review.