Health Care For America Now

Today, I had the chance to sit down with Atul Gawande (former Clinton staffer, author of this great New Yorker piece on health care) and Ron Pollack (Executive Director, Families USA), and see Paul Begala speak. Here are some highlights.

Atul Gawande on how to build on the health care system we have and still achieve transformational change:

Change is transformational when it covers everyone and medical debt disappears. Some called "universal coverage" could have such weak benefits that it doesn't achieve those two goals. Health care is the core root of our economic troubles, it's the inability of employers to cope with costs, it prevents people from shifting out of their jobs, that risk taking is being sapped by our system, so we have to change that. We have to develop a system that holds us collectively responsible for making the care better, safer, and less costly.

Those components would make transformational change. You can build on what we have in so many ways I almost don't care exactly what it looks like. If I were paid tomorrow thorough Medicare, by dealing with AETNA, or by dealing with the VA, I can see using them in ways that achieve those three things above to make transformational change.

In Massachusetts, we have coverage, but it's reaching the point that it's so expensive, that we're now in the debate - we're not debating rolling back the system, it's so popular - but are we are debating cutting benefits, raising taxes, or cutting payments. That is exactly where we need to be. Right now at the federal level, when we get into economic trouble with health care, we cut people off.

On the role of single payer supporters in the political process:

NEWS

Senate Approves Children's Health Bill – NYTimes

The Senate passed a bill on Thursday to provide health insurance to more than four million uninsured children, as a newly empowered Democratic majority brushed aside Republican objections.

Obama's Stimulus Targets Health and Education – Business Week

By directing more money to such "intangibles" than to manufacturing and construction, the plan rightly feeds the sectors that are growing

House Approves $819B Economic Stimulus Plan – Kaiser News Network

The House on Wednesday voted 244-188, with no Republican support, to pass a two-year, $819 billion economic stimulus package that includes funds for health care, the Washington Post reports (Kane, Washington Post, 1/29). The stimulus package includes $153.2 billion in new funds for health care (USA Today graphic, 1/29).

OPINION

Moving forward on SCHIP – The Health Care Blog

The Senate passed its version of legislation to renew the State Children's Health Insurance Program (SCHIP) Thursday, bringing the bill very close to its long overdue White House signing ceremony. The new bill is expected to cover an additional 4.1 million uninsured children by 2013.

Freenomics and Healthcare IT – The Health Care Blog

Electronic medical record (EMR) adoption has remained frustratingly low, despite numerous studies showing improvement in health care delivery resulting from EMR use, measured in many different ways (quality, consistency, cost, etc).

With a vote of 66-32 in the Senate, SCHIP has passed, giving health care to millions of children!

We're ecstatic that this important milestone has been reached, and we're looking forward to working with Congress to take the next step and cover everyone later this year.

At the afternoon panel at the Families USA Health Action 2009 conference, representatives from some of the most powerful committees on Capital Hill with respect to health care reform, the House Energy and Commerce Committee, the Senate Finance Committee, and the Health, Education, Labor, and Pension Committee had and extended discussion about health care reform. Here are the highlights from Yvette Fontenot (Finance), John McDonough (HELP), and Karen Nelson (Energy and Commerce).

On how to expand coverage:

Yvette: Baucus put out a white paper that lays out his vision. Organize the individual market using an exchange like the Massachusetts Connector. Have a public option and private plans, all using a certain set of rules, standardized marketing, enrollment, and rating rules. The market is in dire need of some standard rules. And have a new program focusing specifically on prevention.

Karen: Our #1 goal is to get coverage to everybody through an amalgamation of private and public systems. [Chairman] Henry Waxman's view is the public component is a very important component, and we think it'll make the private system better. He does believe we get a lot of value out of the employer's role of providing health insurance to people; we would be reluctant to give that up.

John: If you think about the key players in the House and Senate and White House, I don't think you'll see such consensus and consistency from all of the key players as you see right now. If you think back to 93, when Daniel Patrick Moynahan, then Chairman of the Senate Finance Committee, was openly contemptible of health care reform, contrasted with where Max Baucus is now.

This effort starts with coverage for every American. Delivery system reform is 2nd, addressing quality and cost and providing better value. 3rd, focusing the system on prevention and wellness. Lastly is financing, particularly how we'll pay for coverage, which is the most expensive piece. There must be fundamental, deep systemic private insurance market reform, eliminating horrific practices. It goes from there into some kind of individual responsibility in line with employer responsibility. And create a fairly massive subsidy structure to make purchasing insurance affordable to all Americans.

On public insurance programs:

I'll have more later, but I've just had a chance to sit down with Uwe Reinhardt and heard a great speech on health care by Chairman Henry Waxman. Here are the highlights.

Uwe Reinhardt on the public plan:

Obama's health care plan wouldn't work well without it. It would limp along without it. Conservatives will argue that the private sector can't compete. Why would they say that? For one, you already have competition, it's called Medicare. Even though privates are payed 15% more, so far they've only got 20% of the elderly. 80% preferred to stay in a program conservatives think is abhorrent. Should America be run by eggheads in conservative think tanks [CATO, Heritage]? Or give people a choice? Put the public plan there, make it actuarially sound, then let it compete.

On choice:

The essential difference between Americans and Canadians, Americans wake up at 4am in a sweat worried about their choice of insurance. Canadians are the other way, they care about freedom of choice of doctor and hospital, and they don't care that there's only one insurance policy. Americans live for the choice of private insurance.

Why have private insurance? In the 80s, private insurance said they could insure people for 25% cheaper, and we let them try. It turns out they never delivered. Eventually, they said they could do it for the same actuarial cost, and they still couldn't do it. And I know why. Medicare has 2% administrative cost, and they've got 15-20%. Bush realized this, and he gave 15% on top of even.

Now, it's unconstitutional to not let them play, but make it a level playing field.

From The Plumline, Greg Sargeant's blog.

With the policy wars ramping up in earnest, one thing to watch for will be efforts by both sides of the fights to present internal polling that, they say, proves that the public is on their side.

Celinda Lake’s Dem polling outfit, Lake Research, just conducted a new poll of 800 likely voters that, according to the firm, finds that the public strongly supports having the choice of a public health insurance plan and strongly rejects the insurance industry’s most cutting attacks on the idea.

Read more.

NEWS

Senate Likely to Pass Bill on Kids' Health Insurance - Washington Post

The Senate is expected to approve a bill today that provides health insurance to about 11 million low-income children, paving the way for President Obama to claim an early legislative victory and collect a quick down payment on his campaign pledge to guarantee care to every American child.

Skyrocketing Health-Care Costs Could Double Premiums for Many Americans - Washington Post

Unless health-care reform becomes a reality, most Americans can expect to pay health insurance premiums that will double by 2016, a new report claims.

Local politicians, members of Health Care for America Now fight for reform - Allentown Express Times

Lehigh Valley political leaders and members of Health Care for America Now are joining forces Thursday morning in the fight for healthcare reform. Lehigh County Executive Don Cunnningham, Allentown Mayor Ed Pawlowski, Bethlehem Mayor John Callahan and Easton Mayor Sal Panto will be in attendance to call for reform as promised by President Barack Obama.

Bill Aims To Subsidize Health Care For Laid-Off - NPR

There are few new ideas when it comes to ways to help those without health insurance gain coverage. But there is one included in the economic stimulus bill now working its way through Congress: providing subsidies to help those recently laid off afford to continue their job-based health
insurance.

Stimulus Bill Calls For Computerizing Health Care - NPR

The economic stimulus package scheduled to hit the House floor Wednesday includes $20 billion for health information technology. The plan's overarching goal is to create jobs — and health experts say the IT provision would do that by boosting the number of physicians who use computers in their practice. Right now, only 17 percent do.

Early kidney disease often missed in blacks - MSNBC
One reason that blacks have high rates of kidney failure is that earlier, treatable stages of kidney disease are not being recognized in this population, according to findings from the Jackson Heart Study reported in the American Journal of Kidney Diseases for February.

Two Senate Committees Approve Portions of Economic Stimulus Package With Funds for Health Care - Kaiser News Network

The Senate Appropriations Committee on Tuesday approved the $365 billion portion of an $825 billion economic stimulus package over which the committee has jurisdiction that includes funds for health care, CongressDaily reports (Sanchez, CongressDaily, 1/27).

Medicare Widens Drugs It Accepts for Cancer - NYTimes

Medicare, with little public debate, has expanded its coverage of drugs for cancer treatments not approved by the Food and Drug Administration.

OPINION

Shortage! Shortage! Shortage??? - Healthcare Economist

In the news, you often hear that there are shortages of nurses and physicians.  We need more nurses and physicians, right?  According to an editorial by Laurence Baker in Health Services Review, we should be a little skeptical of calls for more and more healthcare providers.  If supplier-induced demand is a problem, more providers will only increase the amount of medical care provided.

Medicare covers more cancer drugs, did they cave in to the pharmaceutical lobby? - KevinMD.com

These medications are among the most expensive, and especially in cases of end-stage treatment, there may not be a lot of evidence supporting their use.

I'm heading to the Families USA Health Action 2009 conference in DC tomorrow. For us health wonks, it should be a great event.

A long line of elected officials (and their representatives) will be attending, including Senators Grassley, Stabenow, and representatives from Senator Kennedy's office, Representatives Waxman and Hoyer, and Jeanne Lambrew, Deputy Director, White House Office of Health Reform. Also of note, educators, researchers, writers, and activists like Joe Trippi, Uwe Reinhardt, Atul Gawande, and Paul Begala will be there.

Though a lot of the conference will be focused on state health care reform, as is Families USA's focus, there will be a good amount of attention paid to the national reform effort. Through the plenaries, panels, and workshops, I hope to get a good idea of where reform is headed and how to make it happen, at least in the opinion of those in attendance. And I'll be reporting back what happens here for all of you to enjoy (hopefully).

If all goes as planned, I will also get to sit down as part of a bloggers roundtable with Uwe Reinhardt, Atul Gawande, and Ron Pollack. So, for the sake of interactivity, I'd like the throw the opportunity out to you. What questions do you want me to ask of these distinguished health care experts?

First, some biographies.

NEWS

GOP amendment falls short on health bill - AP

The Senate defeated an effort Tuesday by Republicans to make it harder for states to extend government-sponsored health insurance to children of legal immigrants.

Sicko-nomics - Slate

Health care reformers should look to the banking collapse as a cautionary tale.

Some fear window is narrow for healthcare overhaul - The Boston Globe

Mindful of how delays sapped the political will to overhaul healthcare during the Clinton administration, health advocates hoped to get a major bill during the new administration's first 100 days. Now, it looks like it will take longer, and some observers fear that a historic opportunity could be missed.

Health Care Reform: The High Price of Cheap Drugs - McClatchy

Ten years ago, one in 10 Americans returned home from the pharmacy with a cheaper, generic drug instead of a more expensive, brand-name pharmaceutical. Today, a generic drugs account for nearly 65 percent of all the prescriptions filled in this country each year.

Immigration Debate Roils Children's Health Bill - NPR

The last time the Senate voted to expand the popular State Children's Health Insurance Program, a year and a half ago, it passed by a wide bipartisan margin that was more than enough to override the promised veto from then-President George W. Bush.

Think Progress has new video of Rep. James Clyburn (D-SC) pushing for incremental, as opposed to comprehensive health care reform:

Today, Nancy Pelosi seemed to contradict Clyburn's call for incrementalism, her spokesperson said:

There are some incremental steps that we are taking — first we did SCHIP, then in our economic recovery package, we have money to help stem the tide of people losing health insurance — coverage for Medicaid and COBRA. There is also money for quality, Health IT, comparative effectiveness and wellness, and money for prevention.

And we will take a major step forward this year to increase the number of people who have healthcare coverage.

As Igor Volsky writes, politically as well as policy-wise, comprehensive reform is the answer:

Americans understand, (far too well these days) that unemployment can lead to the loss of health insurance coverage and that an unexpected medical emergency can send a family into medical bankruptcy. Yes people need jobs, but during a time of economic crisis, they also need health insurance to protect their families from financial disaster.

It’s that kind of urgency that will make reform possible. And, politically, isn’t it the easier case to make? As Atul Gawande argues in the latest New Yorker, European nations achieved universal health insurance during a period of crisis: their reforms came out of necessity, not slow investments in community health centers and expansions of a tiny program here or there.

…

Instituting comprehensive reform is the kind of flamboyant political theater that ropes in “the incremental population.” Unfortunately, Clyburn is missing the opportunity for adopting such change. He’s sacrificing a compelling case for health care reform for what’s what’s politically comfortable.

To add to that, there's never been the kind of organization, public opinion, political will, and money on the side of quality, affordable health care for all that there is this year. If this opportunity is squandered, or if we give in to calls for incrementalism and settle for small change, it will be another twenty years at least before we have the opportunity to try again.

Barack Obama's election is historic in many ways. There is more potential for progressive change right now than there may ever be in our lifetimes. Now is not the time to shy away from a fight. As Mike Lux, who looked closely at the history in the course of writing his new book The Progressive Revolution, explained:

What history shows is that nothing important was ever done; no big change was ever made, without a knock-down, drag-out fight between progressives and conservatives.  Our ideas and attitudes and fundamental philosophies are just too different.  One side or another gains the upper-hand politically for a while, but neither side ever gives up or goes away, and the conservatives won't this time either.  We need to strike while the iron is hot, and fight like crazy to make the big changes while we can, because we will fail if we don't understand that we are still, as always, in a war of ideas.

Please give Rep. Clyburn a call at (202) 225-3315 and tell him to make no small plans. Tell him that if he stands with Speaker Pelosi and President Obama for comprehensive health care reform, you and the rest of the country will have his back.