Whether or not we have quality health care reform appears to depend on how good the Democrats are at getting their waste cutting message across. While the other side claims the sky is falliing, i.e. "the Democrats are rationing your health care". - Orrin Hatch
In the end if health care reform fails because quality processes and waste reduction are not emphasized enough I'll know who to blame. And so should all Americans, but that's not how our politics works.
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In Delivering Care, More Isn't Always Better, Experts Say
By Ceci Connolly
Washington Post Staff Writer
Tuesday, September 29, 2009
A dirty word in health-care reform is "rationing," a term that conjures up the image of faceless government bureaucrats denying lifesaving therapies in the name of cutting costs.
But what if the real issue is not the specter of future rationing, but the haphazard, even illogical, way in which care is delivered today?
Medical professionals say the fundamental problem in the nation's health-care system is the widespread misuse and overuse of tests, treatments and drugs that drive up prices, have little value to patients, and can pose serious risks. The question, they say, is not whether there will be rationing, but rather what will be rationed, and when and how.
"More is not necessarily better," said Bernard Rosof, chairman of the board of directors of New York's Huntington Hospital and a board member of the independent National Quality Forum. "In many cases, less is better."
When the Senate Finance Committee resumes its consideration of health-care legislation Tuesday, the lawmakers will be wading into one of the most complex, emotionally charged aspects of today's $2.4 trillion system. Democrats, feeling politically singed by this summer's talk of "death panels," are struggling to explain how a bill that would take hundreds of billions of dollars out of the system would not affect care.
Republicans, sensing a political opening, intend to highlight provisions they say could lead to the denial of medical services, or rationing.
"We don't want to turn health care over to a bunch of bureaucrats in Washington, who then will determine what kind of health care we have," committee member Orrin G. Hatch (R-Utah) said recently. "And you know that rationing is going to happen."
Critics of the Democrats' bill cite places, such as Canada and Europe, where government experts prioritize the delivery of medical services. Wait times, particularly for specialists, may stretch for weeks or months under such a system, they fear.
"Here in the States, we get access to new drugs and medical devices," said Canadian-born Sally C. Pipes, president of the market-oriented Pacific Research Institute. "I have friends in Vancouver who can't get colonoscopies; they wait six or seven months."
Others, however, see problems of misalignment in the American system, fueled by industry advertising, physician fears about malpractice lawsuits and a culture that craves the latest, greatest everything. The situation here, they argue, is that there is not enough care for some, and too much for others.
Often, people with generous insurance plans can run up large bills and face life-threatening complications from unnecessary care: back surgeries that result in wound infections, when physical therapy might have been a more effective treatment; imaging scans that expose patients to radiation; medication-caused side effects that must be treated.
As much as $850 billion spent on medical care each year "can be eliminated without reducing the quality of care," according to a 2008 report by the New England Healthcare Institute. That is enough money to extend insurance coverage to more than 30 million people, according to the Congressional Budget Office.
Tuesday, September 29, 2009
Friday, September 25, 2009
Overhaul Divides Business and Its Traditional GOP Allies
The Business Roundtable, the US Chamber of Commerce and others are telling the GOP they must have health insurance reform. This may get even more interesting once we start hearing from more businesses who see health insurance at a crisis point.
In particular business groups like the Baucus plan because they see its attempts to control skyrocketing medical costs. Business appears to understand this much better than most of Congress. Now that we have had public town hall forums with citizens, perhaps congressional decision-makeers will start to listen to employers who actually provide 60% of insurance coverage in the US.
The Baucus plan is by no means perfect but it does attempt to control costs and does establish a health insurance exchange for small businesses.
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From the Wall Street Journal- Setp. 25th
By NEIL KING JR.
WASHINGTON -- Business is parting from its traditional allies in the Republican Party on health care as companies and big corporate lobbyists lend tentative support to a congressional overhaul that conservative lawmakers staunchly oppose.
The rift mirrors a similar divide on other issues, including immigration and climate change, where many companies have backed legislative action that Republican lawmakers oppose.
But the health-care debate, in particular, casts a spotlight on the split in the longstanding alliance between economic conservatives and the business community. Republican lawmakers are digging in to oppose the overhaul effort as a big-spending government intrusion. Many companies, on the other hand, cite soaring costs to explain why they continue to back the congressional work under way to revamp the health-care system, despite misgivings over a range of provisions.
"We are now at a crisis point," said Joe Olivo, who has struggled to keep up with rising health costs as the president of Perfect Printing Inc., a 40-employee printing company in Moorestown, N.J.
Mr. Olivo is apprehensive about many proposed Democratic fixes, above all the push to create a government-run insurance program. But he said he was also "disappointed that the Republicans don't seem to be at the table at all."
The business world this summer largely recoiled from legislation put forward in the House, which would mandate that employers provide employee coverage and would create a public insurance option.
But companies have been far more receptive to the plan released last week by Senate Finance Committee Chairman Max Baucus. The Baucus bill, which the committee is now busy amending, wouldn't include an employer mandate. It proposes a national exchange where individuals and small businesses could purchase insurance.
Just as Sen. Baucus was preparing to unveil his plan, the Business Roundtable, a lobbying group that represents major U.S. multinationals, released a study arguing that congressional inaction was not an option.
The study found that without any changes to the current system, the cost to insure a single employee, including the person's own out-of-pocket expenses, would jump to more than $28,000 a year by 2019, from around $11,000 a year now.
"The status quo is a prescription for failure," said Eastman Kodak Co. Chief Executive Antonio Perez, who heads the group's health initiative, in a statement endorsing the study. Mr. Perez, who declined to comment further, gave a plug in his statement for the Baucus bill, calling it "a bold framework...that builds on what works and improves what doesn't."
The U.S. Chamber of Commerce, which represents about three million businesses of all sizes, has run television ads opposing the Democratic-led health-care push. And the chamber, like many other big business groups in Washington, has many concerns about the Baucus bill, particularly the taxes it proposes to help pay for its $774 billion Congressional Budget Office price tag over 10 years.
But the chamber applauded much of the Baucus bill as the first proposal "that will actually...get health-care costs under control." "The reality with the business community is that we want reform, while some Republicans want to stop this train and start over," said Bruce Josten, the chamber's chief lobbyist. "That is just not going to happen."
Republican lawmakers predicted that businesses would soon sour on the Senate health-care package as Democrats heap on various amendments.
"I wouldn't confuse pleasant noises about the Baucus bill with an endorsement," said Republican Rep. David Camp of Michigan. "If this bill tacks left, which it is already doing, business won't support it."
Tennessee Republican Sen. Lamar Alexander said he wasn't disturbed by the interest shown by business groups in the Baucus bill. "They've got a right to say what they think," he said.
Sen. Alexander noted that "one of the ironies" in the debate was that while President Barack Obama often promises to reduce the role of special interests in policy-making, "most of the special interests are for the bill." He pointed specifically to drug makers.
Republicans have been particularly furious at the pharmaceutical industry, whose early willingness to cooperate with the White House and with Sen. Baucus proved crucial in keeping the push for an overhaul alive this summer. In June, the drug makers' lobbying group, PhRMA, cut a surprise deal with Mr. Baucus, offering to slash $80 billion in drug costs in exchange for a range of protections from the government.
That deal was shortly followed by the announcement of $150 billion in concessions by the hospital industry.
House Republican leader John Boehner blasted the PhRMA deal in a letter to the group's president, Billy Tauzin, a former Republican lawmaker.
"We have been criticized by people from both ends of the political spectrum, but we remain convinced that we are doing the right thing," said PhRMA spokesman Ken Johnson. "If health-care reform is going to be successful, it will require a shared sacrifice -- and, in our case, a stiff upper lip."
In particular business groups like the Baucus plan because they see its attempts to control skyrocketing medical costs. Business appears to understand this much better than most of Congress. Now that we have had public town hall forums with citizens, perhaps congressional decision-makeers will start to listen to employers who actually provide 60% of insurance coverage in the US.
The Baucus plan is by no means perfect but it does attempt to control costs and does establish a health insurance exchange for small businesses.
---------------- ------------------ ---------------
From the Wall Street Journal- Setp. 25th
By NEIL KING JR.
WASHINGTON -- Business is parting from its traditional allies in the Republican Party on health care as companies and big corporate lobbyists lend tentative support to a congressional overhaul that conservative lawmakers staunchly oppose.
The rift mirrors a similar divide on other issues, including immigration and climate change, where many companies have backed legislative action that Republican lawmakers oppose.
But the health-care debate, in particular, casts a spotlight on the split in the longstanding alliance between economic conservatives and the business community. Republican lawmakers are digging in to oppose the overhaul effort as a big-spending government intrusion. Many companies, on the other hand, cite soaring costs to explain why they continue to back the congressional work under way to revamp the health-care system, despite misgivings over a range of provisions.
"We are now at a crisis point," said Joe Olivo, who has struggled to keep up with rising health costs as the president of Perfect Printing Inc., a 40-employee printing company in Moorestown, N.J.
Mr. Olivo is apprehensive about many proposed Democratic fixes, above all the push to create a government-run insurance program. But he said he was also "disappointed that the Republicans don't seem to be at the table at all."
The business world this summer largely recoiled from legislation put forward in the House, which would mandate that employers provide employee coverage and would create a public insurance option.
But companies have been far more receptive to the plan released last week by Senate Finance Committee Chairman Max Baucus. The Baucus bill, which the committee is now busy amending, wouldn't include an employer mandate. It proposes a national exchange where individuals and small businesses could purchase insurance.
Just as Sen. Baucus was preparing to unveil his plan, the Business Roundtable, a lobbying group that represents major U.S. multinationals, released a study arguing that congressional inaction was not an option.
The study found that without any changes to the current system, the cost to insure a single employee, including the person's own out-of-pocket expenses, would jump to more than $28,000 a year by 2019, from around $11,000 a year now.
"The status quo is a prescription for failure," said Eastman Kodak Co. Chief Executive Antonio Perez, who heads the group's health initiative, in a statement endorsing the study. Mr. Perez, who declined to comment further, gave a plug in his statement for the Baucus bill, calling it "a bold framework...that builds on what works and improves what doesn't."
The U.S. Chamber of Commerce, which represents about three million businesses of all sizes, has run television ads opposing the Democratic-led health-care push. And the chamber, like many other big business groups in Washington, has many concerns about the Baucus bill, particularly the taxes it proposes to help pay for its $774 billion Congressional Budget Office price tag over 10 years.
But the chamber applauded much of the Baucus bill as the first proposal "that will actually...get health-care costs under control." "The reality with the business community is that we want reform, while some Republicans want to stop this train and start over," said Bruce Josten, the chamber's chief lobbyist. "That is just not going to happen."
Republican lawmakers predicted that businesses would soon sour on the Senate health-care package as Democrats heap on various amendments.
"I wouldn't confuse pleasant noises about the Baucus bill with an endorsement," said Republican Rep. David Camp of Michigan. "If this bill tacks left, which it is already doing, business won't support it."
Tennessee Republican Sen. Lamar Alexander said he wasn't disturbed by the interest shown by business groups in the Baucus bill. "They've got a right to say what they think," he said.
Sen. Alexander noted that "one of the ironies" in the debate was that while President Barack Obama often promises to reduce the role of special interests in policy-making, "most of the special interests are for the bill." He pointed specifically to drug makers.
Republicans have been particularly furious at the pharmaceutical industry, whose early willingness to cooperate with the White House and with Sen. Baucus proved crucial in keeping the push for an overhaul alive this summer. In June, the drug makers' lobbying group, PhRMA, cut a surprise deal with Mr. Baucus, offering to slash $80 billion in drug costs in exchange for a range of protections from the government.
That deal was shortly followed by the announcement of $150 billion in concessions by the hospital industry.
House Republican leader John Boehner blasted the PhRMA deal in a letter to the group's president, Billy Tauzin, a former Republican lawmaker.
"We have been criticized by people from both ends of the political spectrum, but we remain convinced that we are doing the right thing," said PhRMA spokesman Ken Johnson. "If health-care reform is going to be successful, it will require a shared sacrifice -- and, in our case, a stiff upper lip."
Thursday, September 24, 2009
Mandate Minus Price Controls may increase healthcare costs
This is what I've been blogging about since the beginning of Insuring Resources.
Congress has been debating health insurance reform, what we need even more is health care reform to fundamentally reduce costs. To do it we need provider incentives to implement Lean processes. See my other post from earlier today on ThedaCare for more details on how to reform HEALTH CARE.
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With lawmakers reluctant to limit what insurers may charge, there's little to slow soaring premiums. Coupled with millions of new customers, that adds up to higher costs for taxpayers and consumers.
By Noam N. Levey and James Oliphant
LA times
September 24, 2009
E-mail Print Text Size
Reporting from Washington - In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases of recent years.
The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate -- long sought by insurance companies -- that would mark the first time the federal government has compelled consumers to buy a single industry's product, effectively creating a captive market.
"We are about to force at least 30 million people into an insurance market where the sharks are circling," said California Lt. Gov. John Garamendi, a Democrat who served as the state's insurance commissioner for eight years. "Without effective protections, they will be eaten alive."
Soaring premiums coupled with millions of new customers forced to buy policies would likely mean higher costs for taxpayers to cover government subsidies for lower-income families and individuals.
They could also mean bigger bills for people who get benefits through work, as well as for their employers.
"I don't think there is any degree of confidence that our costs won't continue to go up," said Keith Ashmus, chairman of the National Small Business Assn.
If premiums continue to rise as quickly as they have over the last five years, the average annual cost of a family policy will exceed $24,000 in 10 years, up from $13,375 now, according to the nonprofit Henry J. Kaiser Family Foundation and the Health Research & Educational Trust.
"If the government is going to require people to buy an insurance policy, they have to guarantee it is affordable," said Jamie Court, president of Consumer Watchdog. "It is unconscionable not to."
Soaring premiums could eventually stir market forces, increasing competition and potentially restraining costs. But that would be a lengthy process, and potential competitors would face huge start-up costs.
Many experts believe an insurance mandate is vital to a healthcare overhaul. With everyone in the system, the nation's medical bill could be spread more broadly, alleviating pressure on those who have insurance to pay for those who don't.
All of the major healthcare bills would penalize people who do not get health insurance.
But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector.
As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.
"That would be a very substantial additional intervention in the marketplace," said Sen. Jeff Bingaman (D-N.M.), a member of a bipartisan group of lawmakers who worked with Senate Finance Committee Chairman Max Baucus (D-Mont.) on his healthcare bill. "I just don't think the support would be there for that kind of a change."
Nor are lawmakers seriously considering any proposals to regulate what doctors, hospitals, drug makers and other healthcare providers charge -- a strategy used by several European countries to control healthcare spending.
In those systems -- some of which, like the United States, feature a blend of private insurers and government programs -- the government sets prices that providers charge to everyone.
"That is just too tough a row to hoe in America," said Peter Lee, executive director of the Pacific Business Group on Health, an association of large employers in California, many of whom are nonetheless concerned about how much they are getting charged for medical care.
Senior House Democrats have proposed the most far-reaching government regulation of the insurance industry.
Their bill, which is still being debated, seeks to control insurance premiums in part by limiting how much companies can spend on nonmedical expenses such as marketing and dividends to shareholders.
The House bill also features a new government insurance program -- or "public option" -- that advocates believe could offer consumers a lower-priced alternative to private plans and, in turn, pressure insurers to rein in premiums.
Congress has been debating health insurance reform, what we need even more is health care reform to fundamentally reduce costs. To do it we need provider incentives to implement Lean processes. See my other post from earlier today on ThedaCare for more details on how to reform HEALTH CARE.
--------------- ------------------- ---------------
With lawmakers reluctant to limit what insurers may charge, there's little to slow soaring premiums. Coupled with millions of new customers, that adds up to higher costs for taxpayers and consumers.
By Noam N. Levey and James Oliphant
LA times
September 24, 2009
E-mail Print Text Size
Reporting from Washington - In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases of recent years.
The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate -- long sought by insurance companies -- that would mark the first time the federal government has compelled consumers to buy a single industry's product, effectively creating a captive market.
"We are about to force at least 30 million people into an insurance market where the sharks are circling," said California Lt. Gov. John Garamendi, a Democrat who served as the state's insurance commissioner for eight years. "Without effective protections, they will be eaten alive."
Soaring premiums coupled with millions of new customers forced to buy policies would likely mean higher costs for taxpayers to cover government subsidies for lower-income families and individuals.
They could also mean bigger bills for people who get benefits through work, as well as for their employers.
"I don't think there is any degree of confidence that our costs won't continue to go up," said Keith Ashmus, chairman of the National Small Business Assn.
If premiums continue to rise as quickly as they have over the last five years, the average annual cost of a family policy will exceed $24,000 in 10 years, up from $13,375 now, according to the nonprofit Henry J. Kaiser Family Foundation and the Health Research & Educational Trust.
"If the government is going to require people to buy an insurance policy, they have to guarantee it is affordable," said Jamie Court, president of Consumer Watchdog. "It is unconscionable not to."
Soaring premiums could eventually stir market forces, increasing competition and potentially restraining costs. But that would be a lengthy process, and potential competitors would face huge start-up costs.
Many experts believe an insurance mandate is vital to a healthcare overhaul. With everyone in the system, the nation's medical bill could be spread more broadly, alleviating pressure on those who have insurance to pay for those who don't.
All of the major healthcare bills would penalize people who do not get health insurance.
But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector.
As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.
"That would be a very substantial additional intervention in the marketplace," said Sen. Jeff Bingaman (D-N.M.), a member of a bipartisan group of lawmakers who worked with Senate Finance Committee Chairman Max Baucus (D-Mont.) on his healthcare bill. "I just don't think the support would be there for that kind of a change."
Nor are lawmakers seriously considering any proposals to regulate what doctors, hospitals, drug makers and other healthcare providers charge -- a strategy used by several European countries to control healthcare spending.
In those systems -- some of which, like the United States, feature a blend of private insurers and government programs -- the government sets prices that providers charge to everyone.
"That is just too tough a row to hoe in America," said Peter Lee, executive director of the Pacific Business Group on Health, an association of large employers in California, many of whom are nonetheless concerned about how much they are getting charged for medical care.
Senior House Democrats have proposed the most far-reaching government regulation of the insurance industry.
Their bill, which is still being debated, seeks to control insurance premiums in part by limiting how much companies can spend on nonmedical expenses such as marketing and dividends to shareholders.
The House bill also features a new government insurance program -- or "public option" -- that advocates believe could offer consumers a lower-priced alternative to private plans and, in turn, pressure insurers to rein in premiums.
Health Affairs article on ThedaCare's Lean Processes
This is what I have been advocating from the start and now Health Affairs, the prestigious journal on health policy, has published an article on their practices.
The link-
http://content.healthaffairs.org/cgi/content/full/28/5/1343?ijkey=kECL9wF9SR8IE&keytype=ref&siteid=healthaff
This spells out the successes of ThedaCare and lessons for health care reform across America.
Below are small excerpts from the article
------------
Here's the abstract- U.S. taxpayers waste far too much money on health care that is merely average or worse. Some health care providers, including ThedaCare, a major Wisconsin health care company, are using the tools of lean manufacturing to eliminate millions of dollars of waste that obstructs the provision of effective medicine. ThedaCare studies care delivery processes to improve care and lower costs. Lessons from lean manufacturing and the Institute for Healthcare Improvement are lowering incidence of preterm births, improving heart attack response rates, and changing the way care is delivered in hospitals to a collaborative, team-based approach.
ThedaCare's results- Since Collaborative Care began with a pilot unit in 2007, we have cared for 2,400 people and recorded dramatic improvement in patient satisfaction, quality performance, and medication reconciliation (Exhibit 1). The cost of care in a Collaborative Care ward is 30 percent less than in a traditional ward. These data convinced ThedaCare board members to convert all hospital beds to Collaborative Care. This decision was projected to improve the buildings’ net present value by 63 percent, or more than $25 million.
Conclusion-
The changes we have described involve a fundamental shift in the way people think about and deliver care. It is not just about saving money or doing less with more. This is about returning to the core scientific principles of modern medicine.
We begin with a hypothesis that performance could be better. Then we change the process, measure it, study its effect, and incorporate it into daily work. Before we can convince other health care organizations to join us in radically improving performance, however, there must be some incentive. If we prove that lean health care will put more money in a hospital’s pocket, only to have Medicare take it out of another pocket, we will not enlist many converts. Similarly, if a national insurance plan continues Medicare’s rules, paying more money for inefficient health care, we will get a lot more inefficient care. Quality will only thrive when quality is demanded.
There is much more than money at stake. We must find a way to reward and encourage more efficient, better-quality health care, and that’s what we will get.
The link-
http://content.healthaffairs.org/cgi/content/full/28/5/1343?ijkey=kECL9wF9SR8IE&keytype=ref&siteid=healthaff
This spells out the successes of ThedaCare and lessons for health care reform across America.
Below are small excerpts from the article
------------
Here's the abstract- U.S. taxpayers waste far too much money on health care that is merely average or worse. Some health care providers, including ThedaCare, a major Wisconsin health care company, are using the tools of lean manufacturing to eliminate millions of dollars of waste that obstructs the provision of effective medicine. ThedaCare studies care delivery processes to improve care and lower costs. Lessons from lean manufacturing and the Institute for Healthcare Improvement are lowering incidence of preterm births, improving heart attack response rates, and changing the way care is delivered in hospitals to a collaborative, team-based approach.
ThedaCare's results- Since Collaborative Care began with a pilot unit in 2007, we have cared for 2,400 people and recorded dramatic improvement in patient satisfaction, quality performance, and medication reconciliation (Exhibit 1). The cost of care in a Collaborative Care ward is 30 percent less than in a traditional ward. These data convinced ThedaCare board members to convert all hospital beds to Collaborative Care. This decision was projected to improve the buildings’ net present value by 63 percent, or more than $25 million.
Conclusion-
The changes we have described involve a fundamental shift in the way people think about and deliver care. It is not just about saving money or doing less with more. This is about returning to the core scientific principles of modern medicine.
We begin with a hypothesis that performance could be better. Then we change the process, measure it, study its effect, and incorporate it into daily work. Before we can convince other health care organizations to join us in radically improving performance, however, there must be some incentive. If we prove that lean health care will put more money in a hospital’s pocket, only to have Medicare take it out of another pocket, we will not enlist many converts. Similarly, if a national insurance plan continues Medicare’s rules, paying more money for inefficient health care, we will get a lot more inefficient care. Quality will only thrive when quality is demanded.
There is much more than money at stake. We must find a way to reward and encourage more efficient, better-quality health care, and that’s what we will get.
Wednesday, September 23, 2009
Informational website from Humana Insurance
Here's the link- www.myhealthreform.org
To view a very informative, straightforward video go to:
https://www.myhealthreform.org/health_reform_video.php
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This video is very straightforward and provides the basics on the issues involved in health care reform. It discusses reducing the waste currently in the health care system which would help everyone, not just insurers. It does discuss the public plan option but doesn't dis it, and does talk about taxes to pay for subsidies for low-income persons to make insurance more affordable.
When I first heard about the website I thought it would be insurer propaganda and simply be an advertisement for universal, market-based coverage, but its not. It even talks about one potential option being a government plan covering everyone even though that's really not an option currently on the table.
The website also offers a way to contact legislators and give them ideas and your opnion on what health care reform should include.
To view a very informative, straightforward video go to:
https://www.myhealthreform.org/health_reform_video.php
------------------- -------------------- --------------------
This video is very straightforward and provides the basics on the issues involved in health care reform. It discusses reducing the waste currently in the health care system which would help everyone, not just insurers. It does discuss the public plan option but doesn't dis it, and does talk about taxes to pay for subsidies for low-income persons to make insurance more affordable.
When I first heard about the website I thought it would be insurer propaganda and simply be an advertisement for universal, market-based coverage, but its not. It even talks about one potential option being a government plan covering everyone even though that's really not an option currently on the table.
The website also offers a way to contact legislators and give them ideas and your opnion on what health care reform should include.
Monday, September 21, 2009
5 Facts on the Uninsured
Source- Kaiser News
I think most would agree that this is sobering information on the impact of being uninsured. What this information does not factor is in the resulting impact of non-covered pre-existing conditions once an individual obtains health insurance.
In addition medical related expenses played a key role in more than 700,000 home foreclosures in the U.S. in 2008. In a recent study by the Univ. of Pennsylvania the authors found that compared to a sample of residents in the general public, those in foreclosure were more likely to be uninsured (22 percent compared to 8 percent). Nearly 60 percent reported that they had skipped or delayed meals because they couldn’t afford food, and people undergoing foreclosure were also more likely to have forgone filling a prescription because of the expense during the preceding year (48 percent vs. 15 percent).
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1) Most of the 46 million uninsured are in working families and do not have access to employer-sponsored insurance. Eight in ten of the 46 million uninsured in the U.S. come from working families. Most uninsured workers are self-employed or work for small firms where health benefits are much less likely to be offered.
2)About two-thirds of the uninsured have low incomes, meaning their family income is less than 200% of the poverty level (about $44,050 a year for a family of four or $21,982 a year for a single person in 2008). Moderate income families, those from 200-399% of poverty, comprise 23% of the uninsured (Figure 2). The average annual cost of employer-sponsored family coverage has doubled since 2000. Because the cost of family coverage in 2009 was $13,375, many families can only afford coverage if they receive sizable employer contributions.
3) In 2008, an increase in Medicaid coverage helped to offset declines in private insurance. Medicaid’s role in covering children was particularly important. While about 700,000 children lost employer-sponsored coverage in 2008, more than twice as many (1.7 million) gained Medicaid coverage—decreasing the number of uninsured children by 800,000 in a single year. Some states have expanded Medicaid coverage beyond federal minimums and made more of their low-income population eligible. The number of adults in Medicaid has increased as incomes declined due to the recession. Meanwhile, other states have left most low-income individuals ineligible for public coverage.
4) The uninsured suffer from negative health consequences due to their lack of access to necessary medical care. About one-quarter (24%) of uninsured adults go without needed care each year due to cost. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions, including traumatic injuries, heart attacks, and chronic diseases—and many suffer serious consequences. The uninsured receive less preventive care and recommended screenings than the insured. Adults who have been uninsured for more than one year are three to four times more likely to have not received recommended breast cancer screenings or to have had their blood pressure checked.
5) The uninsured pay for more than one-third (35%) of their care out-of-pocket. They are typically billed for any care they receive, often paying higher charges than the insured. Medical bills can put great strain on the uninsured and threaten their physical and financial well-being. The uninsured are nearly three times as likely (14% versus 5%) as those with health insurance coverage to be unable to pay for basic necessities due to medical bills (Figure 5). Additionally, 20% of the uninsured report having used up all or most of their savings because of medical bills. The average uninsured household also has no net assets.
I think most would agree that this is sobering information on the impact of being uninsured. What this information does not factor is in the resulting impact of non-covered pre-existing conditions once an individual obtains health insurance.
In addition medical related expenses played a key role in more than 700,000 home foreclosures in the U.S. in 2008. In a recent study by the Univ. of Pennsylvania the authors found that compared to a sample of residents in the general public, those in foreclosure were more likely to be uninsured (22 percent compared to 8 percent). Nearly 60 percent reported that they had skipped or delayed meals because they couldn’t afford food, and people undergoing foreclosure were also more likely to have forgone filling a prescription because of the expense during the preceding year (48 percent vs. 15 percent).
------------------ ----------------- ---------------
1) Most of the 46 million uninsured are in working families and do not have access to employer-sponsored insurance. Eight in ten of the 46 million uninsured in the U.S. come from working families. Most uninsured workers are self-employed or work for small firms where health benefits are much less likely to be offered.
2)About two-thirds of the uninsured have low incomes, meaning their family income is less than 200% of the poverty level (about $44,050 a year for a family of four or $21,982 a year for a single person in 2008). Moderate income families, those from 200-399% of poverty, comprise 23% of the uninsured (Figure 2). The average annual cost of employer-sponsored family coverage has doubled since 2000. Because the cost of family coverage in 2009 was $13,375, many families can only afford coverage if they receive sizable employer contributions.
3) In 2008, an increase in Medicaid coverage helped to offset declines in private insurance. Medicaid’s role in covering children was particularly important. While about 700,000 children lost employer-sponsored coverage in 2008, more than twice as many (1.7 million) gained Medicaid coverage—decreasing the number of uninsured children by 800,000 in a single year. Some states have expanded Medicaid coverage beyond federal minimums and made more of their low-income population eligible. The number of adults in Medicaid has increased as incomes declined due to the recession. Meanwhile, other states have left most low-income individuals ineligible for public coverage.
4) The uninsured suffer from negative health consequences due to their lack of access to necessary medical care. About one-quarter (24%) of uninsured adults go without needed care each year due to cost. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions, including traumatic injuries, heart attacks, and chronic diseases—and many suffer serious consequences. The uninsured receive less preventive care and recommended screenings than the insured. Adults who have been uninsured for more than one year are three to four times more likely to have not received recommended breast cancer screenings or to have had their blood pressure checked.
5) The uninsured pay for more than one-third (35%) of their care out-of-pocket. They are typically billed for any care they receive, often paying higher charges than the insured. Medical bills can put great strain on the uninsured and threaten their physical and financial well-being. The uninsured are nearly three times as likely (14% versus 5%) as those with health insurance coverage to be unable to pay for basic necessities due to medical bills (Figure 5). Additionally, 20% of the uninsured report having used up all or most of their savings because of medical bills. The average uninsured household also has no net assets.
So What Does Health Care Cost Us?
This article gets several things right. There is a ton of waste in the system. What it gets wrong however, is that it'll take years to amass the evidence to weed it out. The LEAN Institute and The ThedaCare Center for Health Care Value have already studied (www.healthcarevalueleaders.org) it and eliminated it from health care systems. It simply needs to be developed as the model to follow with the right incentives WITHIN health reform. Higher Medicare and Medicaid reimbursment for those implementing LEAN practices, Higher reimbursement under the public plan or co-op models, etc etc.
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"You Have No Idea What Health Costs- If You Did, You Might Just Want Real Reform"- Ezra Klein- Washington Post
The most important health-care document released this week was not Sen. Max Baucus's Healthy Future Act. It was the Kaiser Family Foundation's 2009 Employer Benefits Survey.
While the proposal by Baucus, chairman of the Senate Finance Committee, outlines a direction for policy, the survey, which polls employers about health benefits to assemble a detailed look at the actual cost of health care, fits it squarely in our pocketbooks.
The truth is we all pay, and much more than we recognize, for health care.
For many, it's among the largest investments we'll make, on par, even, with the money we spend on a house or tuck away for retirement. But while it's easy to track our stock portfolios as they tank along with the market, our outlay for health care is less obvious. Employers pay some, and so do individuals, and taxpayers. And some even hides behind the deficit. As such, few of us see the full picture. But to make sense of the proposals for reform, getting a grasp of the cost is critical.
The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.
Three years of slightly above-average health insurance will cost a solid six figures.
Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.
About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages.
As Ezekiel Emanuel, who advises Office of Management and Budget Director Peter Orszag on health-care policy, has pointed out, health-care premiums have risen by 300 percent over the past 30 years (and that's after adjusting for inflation). Corporate profit per employee has soared by 200 percent. Hourly earnings for workers, adjusted for inflation, have fallen. The wage increases have been consumed by health-care costs.
Another 80 million Americans are on public plans, mainly Medicare and Medicaid. Those costs are paid by taxpayers. And about 46 million Americans are uninsured. The costs for their care are shifted to the insured: This raises premiums for the average family by $1,100 each year, according to an analysis by Ben Furnas and Peter Harbage of the Center for American Progress.
Imagine if people who touched a hot stove felt only a small fraction of the pain from the burn. That's pretty much what's happening in our health-care system. It hurts enough that we would prefer it to stop, but the urgency is lost.
That's the dilemma for Washington wonks trying to fix this mess: They look at the numbers and see health-care costs crushing our economy, overwhelming our government, swallowing our wages. But the public isn't feeling it. Virtually no one cuts a $13,375 check for health care. Most pay 27 percent of it, or even less. The surest way to cut health-care spending would be to make people shoulder more of the burden directly, as opposed to hiding it in taxes and lost wages. But that's about as popular as a puppy pot roast.
Thinking Long-Term
Health-care reform concentrates on the people in acute distress: the uninsured and the underinsured and the poor few who've been left to the cruel chaos of the individual or small-group insurance markets. The public insurance option -- if it comes to pass -- would be open to only these groups, and the bill's hefty price tag is almost entirely devoted to helping them afford coverage. But what about the rest of us?
The problem for the White House has been that the proposed health reform policies meant to help the average American aren't specific. They're not a cash transfer or a new insurance card. These are the "curve benders," policies meant to cut long-term health-care costs. The problem is they're abstract, speculative and, at times, even unpopular.
The White House's favorite curve bender is called "comparative effectiveness review" -- a fancy way of saying "evidence." Study after study has shown that we waste an incredible amount of money on medical interventions that just don't work. If we can figure out which ones those are, we can stop using them and save money by not buying what we don't need. That may work. But the evidence will take a long time to amass, and we don't yet know what it will show. What if it finds that some brand-new and incredibly expensive treatments are wildly effective? That could raise spending. Industry stakeholders, however, had little interest in waiting around to find out: They made such a fuss that Congress quickly inserted a provision promising that the government wouldn't use any of this evidence in deciding what Medicare and Medicaid would cover. Because God forbid government programs rely on evidence.
Note from Write Resources- We do know the answer to the above, ThedaCare and others can prove to other plans how to do it.
The favorite proposal of liberals is the public insurance option. If the public plan were open to all Americans and partnered with Medicare, it could negotiate deep discounts with health-care providers. The Lewin Group, a health industry consultancy firm, and the Commonwealth Fund, a liberal-leaning health-care advocacy organization, have both estimated that this sort of plan could save the average American 20 to 30 percent on premiums.
Of course, providers don't much like the sound of that because they would see 20 to 30 percent less revenue. And insurers don't much like the sound of that because they could not compete with that sort of buying power. Republicans and centrist Democrats have banded together to weaken the public plan and maybe even remove it altogether. President Obama now promises that the public plan would be open only to the uninsured and wouldn't offer any advantages over private insurers. It won't, in other words, be allowed to save people money.
Conservatives favor the idea of taxing health-care benefits and popularizing "high-deductible health plans." In short, if people have to pay more for health care, they'll use less of it. This is true, but as you might expect, quite unpopular.
Melinda Beeuwkes Buntin, a researcher at the Rand Corporation, and David Cutler, a health economist at Harvard, recently estimated the savings that could be attained by "modernizing" the system over the next 10 years. The changes they examined weren't dramatic. Replacing paper records with computerized files, making it easier for people to comparison-shop across insurers, "bundling" payments for the treatment of a single illness rather than shelling out separately for each doctor visit -- that sort of thing. Added up, they equaled a startling $2 trillion over 10 years. That's a lot of money for policies that have received virtually no attention in the debate.
And yet, this is the quiet promise of health-care reform. The grand theories might fail. They often do. But making the system a bit better, a bit quicker and a bit more agile -- we can do that. And until the stove gets hot enough, it may be all we can do.
------------- ------------------- -------------
"You Have No Idea What Health Costs- If You Did, You Might Just Want Real Reform"- Ezra Klein- Washington Post
The most important health-care document released this week was not Sen. Max Baucus's Healthy Future Act. It was the Kaiser Family Foundation's 2009 Employer Benefits Survey.
While the proposal by Baucus, chairman of the Senate Finance Committee, outlines a direction for policy, the survey, which polls employers about health benefits to assemble a detailed look at the actual cost of health care, fits it squarely in our pocketbooks.
The truth is we all pay, and much more than we recognize, for health care.
For many, it's among the largest investments we'll make, on par, even, with the money we spend on a house or tuck away for retirement. But while it's easy to track our stock portfolios as they tank along with the market, our outlay for health care is less obvious. Employers pay some, and so do individuals, and taxpayers. And some even hides behind the deficit. As such, few of us see the full picture. But to make sense of the proposals for reform, getting a grasp of the cost is critical.
The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.
Three years of slightly above-average health insurance will cost a solid six figures.
Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.
About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages.
As Ezekiel Emanuel, who advises Office of Management and Budget Director Peter Orszag on health-care policy, has pointed out, health-care premiums have risen by 300 percent over the past 30 years (and that's after adjusting for inflation). Corporate profit per employee has soared by 200 percent. Hourly earnings for workers, adjusted for inflation, have fallen. The wage increases have been consumed by health-care costs.
Another 80 million Americans are on public plans, mainly Medicare and Medicaid. Those costs are paid by taxpayers. And about 46 million Americans are uninsured. The costs for their care are shifted to the insured: This raises premiums for the average family by $1,100 each year, according to an analysis by Ben Furnas and Peter Harbage of the Center for American Progress.
Imagine if people who touched a hot stove felt only a small fraction of the pain from the burn. That's pretty much what's happening in our health-care system. It hurts enough that we would prefer it to stop, but the urgency is lost.
That's the dilemma for Washington wonks trying to fix this mess: They look at the numbers and see health-care costs crushing our economy, overwhelming our government, swallowing our wages. But the public isn't feeling it. Virtually no one cuts a $13,375 check for health care. Most pay 27 percent of it, or even less. The surest way to cut health-care spending would be to make people shoulder more of the burden directly, as opposed to hiding it in taxes and lost wages. But that's about as popular as a puppy pot roast.
Thinking Long-Term
Health-care reform concentrates on the people in acute distress: the uninsured and the underinsured and the poor few who've been left to the cruel chaos of the individual or small-group insurance markets. The public insurance option -- if it comes to pass -- would be open to only these groups, and the bill's hefty price tag is almost entirely devoted to helping them afford coverage. But what about the rest of us?
The problem for the White House has been that the proposed health reform policies meant to help the average American aren't specific. They're not a cash transfer or a new insurance card. These are the "curve benders," policies meant to cut long-term health-care costs. The problem is they're abstract, speculative and, at times, even unpopular.
The White House's favorite curve bender is called "comparative effectiveness review" -- a fancy way of saying "evidence." Study after study has shown that we waste an incredible amount of money on medical interventions that just don't work. If we can figure out which ones those are, we can stop using them and save money by not buying what we don't need. That may work. But the evidence will take a long time to amass, and we don't yet know what it will show. What if it finds that some brand-new and incredibly expensive treatments are wildly effective? That could raise spending. Industry stakeholders, however, had little interest in waiting around to find out: They made such a fuss that Congress quickly inserted a provision promising that the government wouldn't use any of this evidence in deciding what Medicare and Medicaid would cover. Because God forbid government programs rely on evidence.
Note from Write Resources- We do know the answer to the above, ThedaCare and others can prove to other plans how to do it.
The favorite proposal of liberals is the public insurance option. If the public plan were open to all Americans and partnered with Medicare, it could negotiate deep discounts with health-care providers. The Lewin Group, a health industry consultancy firm, and the Commonwealth Fund, a liberal-leaning health-care advocacy organization, have both estimated that this sort of plan could save the average American 20 to 30 percent on premiums.
Of course, providers don't much like the sound of that because they would see 20 to 30 percent less revenue. And insurers don't much like the sound of that because they could not compete with that sort of buying power. Republicans and centrist Democrats have banded together to weaken the public plan and maybe even remove it altogether. President Obama now promises that the public plan would be open only to the uninsured and wouldn't offer any advantages over private insurers. It won't, in other words, be allowed to save people money.
Conservatives favor the idea of taxing health-care benefits and popularizing "high-deductible health plans." In short, if people have to pay more for health care, they'll use less of it. This is true, but as you might expect, quite unpopular.
Melinda Beeuwkes Buntin, a researcher at the Rand Corporation, and David Cutler, a health economist at Harvard, recently estimated the savings that could be attained by "modernizing" the system over the next 10 years. The changes they examined weren't dramatic. Replacing paper records with computerized files, making it easier for people to comparison-shop across insurers, "bundling" payments for the treatment of a single illness rather than shelling out separately for each doctor visit -- that sort of thing. Added up, they equaled a startling $2 trillion over 10 years. That's a lot of money for policies that have received virtually no attention in the debate.
And yet, this is the quiet promise of health-care reform. The grand theories might fail. They often do. But making the system a bit better, a bit quicker and a bit more agile -- we can do that. And until the stove gets hot enough, it may be all we can do.
564 amendments proposed to Baucus plan
Highlights, not all 564, are listed below
Source: Bloomberg.com
Sept. 21 Senate Finance Committee members signaled an aggressive effort to reshape health-care legislation proposed by Chairman Max Baucus, drafting 564 amendments for consideration when the panel meets this week.
Members of both parties want to make a host of changes to legislation designed to lower costs and expand coverage to the uninsured that Baucus introduced last week. They include expanding tax subsidies for low-income people to buy coverage, eliminating a proposed $215 billion tax on high-value health plans, and setting up a government-run insurance program to compete with private industry.
Baucus Plan Overview
Requires almost all Americans to have insurance or pay a penalty, expand Medicaid and provide subsidies to help millions of low-income people get coverage through an online exchange.
The nonpartisan Congressional Budget Office says his plan would lower the budget deficit over 10 years. It utilizes nonprofit cooperatives rather than a government program to compete against insurers, and drops a mandate that all employers provide health care to workers.
To pay for his plan, Baucus seeks savings in programs such as Medicare, the federal insurance plan for the elderly, and new taxes. He’s proposing a levy on costly “Cadillac” health plans and about $13 billion in fees on insurers, medical-device manufacturers, drugmakers and clinical laboratories.
Amendments proposed
Senator Olympia Snowe, a Maine Republican would create a government entity to provide insurance in any state unless coverage is deemed affordable to at least 95 percent of the residents. Coverage is judged unaffordable if the cost of premiums exceeds a percentage of a person’s income, ranging from 3 percent for those at 133 percent of the poverty level to 13 percent for those at 300 percent of the poverty level and above.
Public Option
Senator Jay Rockefeller, a West Virginia Democrat, is proposing to replace the nonprofit cooperatives with a government-run plan. Democratic senators Charles Schumer of New York and Maria Cantwell of Washington favor setting up a public program, with rules that require the Medicare-like system to compete on a more level playing field with private industry.
Rockefeller also wants to require that a series of insurance market regulatory changes -- including a ban on coverage exclusions for pre-existing conditions -- apply to plans offered by self-insured employers.
He wants to increase the number of uninsured who would qualify for Medicaid coverage. Baucus supports boosting the threshold for coverage to 133 percent of the poverty level; Rockefeller wants to lift that to 150 percent.
Tax Subsidies
Democratic Senator Ron Wyden of Oregon is seeking tax subsidies for insurance purchases available to those earning as much as 400 percent of the federal poverty level, rather than 300 percent as in the Baucus plan. Poverty guidelines for 2009 are $10,830 for an individual and $22,050 for a family of four, according to the Department of Health and Human Services.
Senator Robert Menendez, a New Jersey Democrat, is joining three other Democrats in a proposal to ensure that anyone below the 400 percent threshold who is utilizing either a subsidy or tax credit will pay no more than 10 percent of their income before getting the aid. Baucus has a maximum of 13 percent of income for some consumers at the top end of a sliding scale.
Baucus’s proposed new tax on high-valued insurance plans would be pared back under a proposal by Senator John Kerry, a Massachusetts Democrat. While Baucus imposes a 35 percent excise tax on plans valued at $8,000 for individuals and $21,000 for family coverage, Kerry wants to raise the threshold to $9,800 for individuals and $25,000 for families. He would offset the lost revenue by raising the excise tax to 40 percent and closing corporate tax loopholes.
Republican Changes
On the Republican side, lawmakers are taking aim at tax increases and industry fees. Senator Charles Grassley of Iowa, the top Republican on the committee, wants to eliminate $13 billion in fees that would be imposed on the insurance, pharmaceutical, clinical laboratory and medical-device sectors. He would offset that by tapping funds approved as part of this year’s economic-stimulus measure that haven’t yet been spent.
Senator Mike Enzi, a Wyoming Republican, wants to block any expansion of Medicaid that results in cost increases for states. Senator Orrin Hatch, a Utah Republican, wants to cut the Medicaid expansion altogether, as well as the cooperatives -- which under Baucus’s proposal get $6 billion in federal start-up funds.
Jon Kyl of Arizona is offering a requirement that legal immigrants show proof they have lived in the U.S. for at least five years before getting government help to buy insurance.
Baucus has the benefit of numbers in his favor. The committee is comprised of 13 Democrats and 10 Republicans. He and two other Democrats -- Kent Conrad of North Dakota and Jeff Bingaman of New Mexico -- could be a decisive swing bloc of votes against changes if many of the matters are otherwise decided on party lines.
Source: Bloomberg.com
Sept. 21 Senate Finance Committee members signaled an aggressive effort to reshape health-care legislation proposed by Chairman Max Baucus, drafting 564 amendments for consideration when the panel meets this week.
Members of both parties want to make a host of changes to legislation designed to lower costs and expand coverage to the uninsured that Baucus introduced last week. They include expanding tax subsidies for low-income people to buy coverage, eliminating a proposed $215 billion tax on high-value health plans, and setting up a government-run insurance program to compete with private industry.
Baucus Plan Overview
Requires almost all Americans to have insurance or pay a penalty, expand Medicaid and provide subsidies to help millions of low-income people get coverage through an online exchange.
The nonpartisan Congressional Budget Office says his plan would lower the budget deficit over 10 years. It utilizes nonprofit cooperatives rather than a government program to compete against insurers, and drops a mandate that all employers provide health care to workers.
To pay for his plan, Baucus seeks savings in programs such as Medicare, the federal insurance plan for the elderly, and new taxes. He’s proposing a levy on costly “Cadillac” health plans and about $13 billion in fees on insurers, medical-device manufacturers, drugmakers and clinical laboratories.
Amendments proposed
Senator Olympia Snowe, a Maine Republican would create a government entity to provide insurance in any state unless coverage is deemed affordable to at least 95 percent of the residents. Coverage is judged unaffordable if the cost of premiums exceeds a percentage of a person’s income, ranging from 3 percent for those at 133 percent of the poverty level to 13 percent for those at 300 percent of the poverty level and above.
Public Option
Senator Jay Rockefeller, a West Virginia Democrat, is proposing to replace the nonprofit cooperatives with a government-run plan. Democratic senators Charles Schumer of New York and Maria Cantwell of Washington favor setting up a public program, with rules that require the Medicare-like system to compete on a more level playing field with private industry.
Rockefeller also wants to require that a series of insurance market regulatory changes -- including a ban on coverage exclusions for pre-existing conditions -- apply to plans offered by self-insured employers.
He wants to increase the number of uninsured who would qualify for Medicaid coverage. Baucus supports boosting the threshold for coverage to 133 percent of the poverty level; Rockefeller wants to lift that to 150 percent.
Tax Subsidies
Democratic Senator Ron Wyden of Oregon is seeking tax subsidies for insurance purchases available to those earning as much as 400 percent of the federal poverty level, rather than 300 percent as in the Baucus plan. Poverty guidelines for 2009 are $10,830 for an individual and $22,050 for a family of four, according to the Department of Health and Human Services.
Senator Robert Menendez, a New Jersey Democrat, is joining three other Democrats in a proposal to ensure that anyone below the 400 percent threshold who is utilizing either a subsidy or tax credit will pay no more than 10 percent of their income before getting the aid. Baucus has a maximum of 13 percent of income for some consumers at the top end of a sliding scale.
Baucus’s proposed new tax on high-valued insurance plans would be pared back under a proposal by Senator John Kerry, a Massachusetts Democrat. While Baucus imposes a 35 percent excise tax on plans valued at $8,000 for individuals and $21,000 for family coverage, Kerry wants to raise the threshold to $9,800 for individuals and $25,000 for families. He would offset the lost revenue by raising the excise tax to 40 percent and closing corporate tax loopholes.
Republican Changes
On the Republican side, lawmakers are taking aim at tax increases and industry fees. Senator Charles Grassley of Iowa, the top Republican on the committee, wants to eliminate $13 billion in fees that would be imposed on the insurance, pharmaceutical, clinical laboratory and medical-device sectors. He would offset that by tapping funds approved as part of this year’s economic-stimulus measure that haven’t yet been spent.
Senator Mike Enzi, a Wyoming Republican, wants to block any expansion of Medicaid that results in cost increases for states. Senator Orrin Hatch, a Utah Republican, wants to cut the Medicaid expansion altogether, as well as the cooperatives -- which under Baucus’s proposal get $6 billion in federal start-up funds.
Jon Kyl of Arizona is offering a requirement that legal immigrants show proof they have lived in the U.S. for at least five years before getting government help to buy insurance.
Baucus has the benefit of numbers in his favor. The committee is comprised of 13 Democrats and 10 Republicans. He and two other Democrats -- Kent Conrad of North Dakota and Jeff Bingaman of New Mexico -- could be a decisive swing bloc of votes against changes if many of the matters are otherwise decided on party lines.
Thursday, September 17, 2009
Dems and GOP Agree- Baucus bill appears to be DOA
I guess Sen. Baucus has achieved what few others have. He's gotten Democrats and Republicans to agree... this is a horrible healthcare bill... except for widely different reasons.
Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.
Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.
Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.
By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.
The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.
Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104
Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.
On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.
If enacted, this bill in present form will make the system more costly than what we have today.
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From today's Milwaukee Journal Sentinel
Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.
His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.
For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.
He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.
More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.
"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.
Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."
Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.
The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.
Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.
Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.
Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.
AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."
Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.
Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."
House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."
Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."
Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."
More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.
At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.
Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.
Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.
Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.
The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.
And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."
Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.
Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.
Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.
By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.
The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.
Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104
Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.
On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.
If enacted, this bill in present form will make the system more costly than what we have today.
--------------- -------------------- -----------------
From today's Milwaukee Journal Sentinel
Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.
His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.
For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.
He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.
More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.
"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.
Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."
Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.
The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.
Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.
Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.
Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.
AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."
Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.
Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."
House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."
Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."
Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."
More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.
At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.
Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.
Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.
Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.
The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.
And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."
Wednesday, September 16, 2009
Baucus health plan released
Analysis of the key issues-
Pre-existing conditions are eliminated. Okay, that's a no-brainer.
Businesses are not mandated to provide coverage but instead must defray the cost of its employees share. This seems to be a potential administrative nightmare for small businesses. I'll need to look into this very closely. Shouldn't reform make it easier on businesses? What is the encourage ment for them to join the co-ops?
Public Option is nixed- Instead Baucus proposes nonprofit consumer-owned cooperatives. This is a non-issue if they pay the contracted doctors a salary instead of on a fee-for-service basis and put LEAN processes in place. But, why do I have a nagging feeling that they'll get this wrong and set up EVERYTHING on a fee reimbursement basis? Fee reimbursement would only cause health care costs to skyrocket at an even faster pace than we've seen before?
Penalty for non-purchase of health insurance- The devil is in the details on this as I have to research how this will interplay with the non-profit coops. What are the eligibility standards for getting into the co-op insurance, for instance?
Republicans- Every indication appears that few Republicans will support the Baucus plan yet it offers numerous concessions and seriously waters down true reform. The fact that there is no business mandate but instread allows defraying of employee costs just seems ridiculous on its face and thus requires me to do a lot of digging.
As always, stay tuned-in and please provide your feedback to your legislators. I really believe the next three months will be the most important in congress since the mid-60's when we saw the Civil Rights Act and the Great Society legislation.
------- ------- -------- --------
Soure: Politico.com
Senate Finance Committee chairman Max Baucus (D-Mont.) proposed an $856 billion plan Wednesday to overhaul the health care system, releasing a bill after months of bipartisan negotiations without any immediate Republican support.
The bill forces insurance companies to change the way they do business, such as prohibiting them from dropping or denying coverage based on preexisting conditions. To force competition with private insurers, Baucus chose creating nonprofit consumer-owned cooperatives over the public insurance option, which most Democrats prefer.
“This is a unique moment in history where we can finally reach an objective so many of us have sought for so long,” Baucus said in a statement. “We worked to build a balanced, common-sense package that ensures quality, affordable coverage and doesn’t add a dime to the deficit.”
The long-awaited bill sets off a battle over what could be the shape of a health reform deal that wins at least one or two Republicans votes in the Senate. By trying to add measures to appeal to some Democrats and some Republicans, Baucus has managed to upset all sides. But what he came up with could be viewed as the kind of balanced approach that threads the needle to achieve a final compromise.
None of the three Republicans involved in the bipartisan negotiations have signed onto the bill, saying there are outstanding issues that need to be resolved. But they said they would continue talking with Baucus and the other two Democrats in the so-called Gang of Six.
The lack of Republican support — at the outset, at least — suggests Democrats will need to make more concessions if they hope to produce a bipartisan bill. Otherwise, the Senate leadership may have to use a last-ditch procedural maneuver known as reconciliation to move the bill through the chamber with 51 votes.
The absence of Republicans could also damage President Barack Obama's efforts to convince Americans that his reform plan has broad support.
The Finance Committee markup is expected to begin Tuesday. Baucus will meet Thursday with the full committee, and amendments will be due Friday at 5 p.m.
The Baucus plan is a more conservative approach than those produced by three committees in the House and by the Senate's Health, Education, Labor and Pensions Committee, but it tracks closely with the concepts that Obama promoted in his speech to Congress last week. The bill is deficit neutral and fully paid for, and less costly than bills approved by other committees.
Baucus chose an alternative to the public insurance option – nongovernmental consumer cooperatives – to provide competition with private insurers.
The bill requires individuals to buy insurance, or else face penalties as high as $3,800 for a family. It would not mandate businesses to provide coverage for their employees – as the House bills do – but it would require them to defray the cost of any government subsidies for which their employees would qualify.
To pay for the overhaul, the legislation calls for imposing a 35 percent excise tax on high-end insurance plans, assessing fees on industry players, including device manufacturers, insurers and clinical laboratories, and making a series of tax code changes.
The bill expands Medicaid coverage to include adults whose incomes are 133 percent above the poverty line, and requires states to pick up more of the tab for the federal-state cost-sharing program. Government subsidies would be available to families between 100 percent and 300 percent of the poverty line to purchase insurance plans through a new marketplace known as an exchange.
For families with incomes 300 percent and 400 percent of poverty, their annual premiums would be capped at 13 percent of their income. It’s a level that Sen. Ron Wyden (D-Ore.) says is too high, but it would be less than the current average cost of a family insurance plan, which is $13,375, according to the Kaiser Family Foundation.
Sen. Olympia Snowe (R-Maine), the likeliest Republican to support the bill, said she is waiting for cost estimates from the Congressional Budget Office, which she has not yet seen.
Sen. Chuck Grassley (R-Iowa) released a statement Tuesday that was silent on his ultimate decision, but the tone of his message does not bode well for Baucus’s hopes of bringing him on board.
He ticked off a long list of concerns, saying the bill “does not meet the shared goals for affordable, accessible health coverage,” and it does not resolve outstanding issues dealing with abortion and illegal immigration. He suggested the bill does not include his alternative proposal to the individual mandate, nor does it include stronger medical liability reform measures he had pushed.
“We’ve been clear from the start that we’re willing to stay at the table,” Grassley said. “There’s no reason not to keep working until we get it right. In the end, legislation that impacts every American should have strong bipartisan support.”
Pre-existing conditions are eliminated. Okay, that's a no-brainer.
Businesses are not mandated to provide coverage but instead must defray the cost of its employees share. This seems to be a potential administrative nightmare for small businesses. I'll need to look into this very closely. Shouldn't reform make it easier on businesses? What is the encourage ment for them to join the co-ops?
Public Option is nixed- Instead Baucus proposes nonprofit consumer-owned cooperatives. This is a non-issue if they pay the contracted doctors a salary instead of on a fee-for-service basis and put LEAN processes in place. But, why do I have a nagging feeling that they'll get this wrong and set up EVERYTHING on a fee reimbursement basis? Fee reimbursement would only cause health care costs to skyrocket at an even faster pace than we've seen before?
Penalty for non-purchase of health insurance- The devil is in the details on this as I have to research how this will interplay with the non-profit coops. What are the eligibility standards for getting into the co-op insurance, for instance?
Republicans- Every indication appears that few Republicans will support the Baucus plan yet it offers numerous concessions and seriously waters down true reform. The fact that there is no business mandate but instread allows defraying of employee costs just seems ridiculous on its face and thus requires me to do a lot of digging.
As always, stay tuned-in and please provide your feedback to your legislators. I really believe the next three months will be the most important in congress since the mid-60's when we saw the Civil Rights Act and the Great Society legislation.
------- ------- -------- --------
Soure: Politico.com
Senate Finance Committee chairman Max Baucus (D-Mont.) proposed an $856 billion plan Wednesday to overhaul the health care system, releasing a bill after months of bipartisan negotiations without any immediate Republican support.
The bill forces insurance companies to change the way they do business, such as prohibiting them from dropping or denying coverage based on preexisting conditions. To force competition with private insurers, Baucus chose creating nonprofit consumer-owned cooperatives over the public insurance option, which most Democrats prefer.
“This is a unique moment in history where we can finally reach an objective so many of us have sought for so long,” Baucus said in a statement. “We worked to build a balanced, common-sense package that ensures quality, affordable coverage and doesn’t add a dime to the deficit.”
The long-awaited bill sets off a battle over what could be the shape of a health reform deal that wins at least one or two Republicans votes in the Senate. By trying to add measures to appeal to some Democrats and some Republicans, Baucus has managed to upset all sides. But what he came up with could be viewed as the kind of balanced approach that threads the needle to achieve a final compromise.
None of the three Republicans involved in the bipartisan negotiations have signed onto the bill, saying there are outstanding issues that need to be resolved. But they said they would continue talking with Baucus and the other two Democrats in the so-called Gang of Six.
The lack of Republican support — at the outset, at least — suggests Democrats will need to make more concessions if they hope to produce a bipartisan bill. Otherwise, the Senate leadership may have to use a last-ditch procedural maneuver known as reconciliation to move the bill through the chamber with 51 votes.
The absence of Republicans could also damage President Barack Obama's efforts to convince Americans that his reform plan has broad support.
The Finance Committee markup is expected to begin Tuesday. Baucus will meet Thursday with the full committee, and amendments will be due Friday at 5 p.m.
The Baucus plan is a more conservative approach than those produced by three committees in the House and by the Senate's Health, Education, Labor and Pensions Committee, but it tracks closely with the concepts that Obama promoted in his speech to Congress last week. The bill is deficit neutral and fully paid for, and less costly than bills approved by other committees.
Baucus chose an alternative to the public insurance option – nongovernmental consumer cooperatives – to provide competition with private insurers.
The bill requires individuals to buy insurance, or else face penalties as high as $3,800 for a family. It would not mandate businesses to provide coverage for their employees – as the House bills do – but it would require them to defray the cost of any government subsidies for which their employees would qualify.
To pay for the overhaul, the legislation calls for imposing a 35 percent excise tax on high-end insurance plans, assessing fees on industry players, including device manufacturers, insurers and clinical laboratories, and making a series of tax code changes.
The bill expands Medicaid coverage to include adults whose incomes are 133 percent above the poverty line, and requires states to pick up more of the tab for the federal-state cost-sharing program. Government subsidies would be available to families between 100 percent and 300 percent of the poverty line to purchase insurance plans through a new marketplace known as an exchange.
For families with incomes 300 percent and 400 percent of poverty, their annual premiums would be capped at 13 percent of their income. It’s a level that Sen. Ron Wyden (D-Ore.) says is too high, but it would be less than the current average cost of a family insurance plan, which is $13,375, according to the Kaiser Family Foundation.
Sen. Olympia Snowe (R-Maine), the likeliest Republican to support the bill, said she is waiting for cost estimates from the Congressional Budget Office, which she has not yet seen.
Sen. Chuck Grassley (R-Iowa) released a statement Tuesday that was silent on his ultimate decision, but the tone of his message does not bode well for Baucus’s hopes of bringing him on board.
He ticked off a long list of concerns, saying the bill “does not meet the shared goals for affordable, accessible health coverage,” and it does not resolve outstanding issues dealing with abortion and illegal immigration. He suggested the bill does not include his alternative proposal to the individual mandate, nor does it include stronger medical liability reform measures he had pushed.
“We’ve been clear from the start that we’re willing to stay at the table,” Grassley said. “There’s no reason not to keep working until we get it right. In the end, legislation that impacts every American should have strong bipartisan support.”
Monday, September 14, 2009
Negotiations heating up, Closing in on a deal
The latest compromises and my analysis
- Elimination of pre-x- not mentioned in the article
- Payment reform- not mentioned
- Quality incentives- not mentioned
- Elimination of waste- not mentioned
= The AP and other members of the media continue their E News! style reporting and are failing to address key issues. They remain fixated on the fluff issues like the public plan option, immigrants and abortion. When most media outlets have the attention span of a fruit fly it doesn't help the American people to get informed.
Because of our sound-bite oriented news we now get three days of coverage of "You lie!" versus real reporting on what the various proposals will cover and reform.
Stay tuned as I'll dig for better details when the Baucus plan is released Wednesday.
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WASHINGTON (AP) -- Senate health care negotiators said Monday they've narrowed their differences on a host of difficult issues with just a day or so left to seal an elusive bipartisan deal that could change the course of the contentious debate.
After months of closed-door negotiations, Finance Committee Chairman Max Baucus said, "We're getting very close." But it remained unclear if the Montana Democrat could strike a bargain to close the deal.
Negotiators pared the cost of their 10-year coverage plan to under $880 billion, and also reported progress on several issues, including health insurance for the poor, restrictions on federal funding for abortions, a verification system to prevent illegal immigrants from getting benefits, and ways to encourage alternatives to malpractice lawsuits.
With or without Republican support, Baucus said he'll have a formal proposal on Wednesday to meet a deadline for moving ahead.
At the same time, he said the bipartisan talks could continue even as his Finance panel begins its formal bill-drafting session next week.
"It's not just tomorrow or the next day," said Baucus. "We're going to keep working."
The three Republicans - Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine - are under intense pressure from leaders of their own party, some of whom have publicly dismissed Baucus' framework as a Democrat's plan. Baucus may not be able to get any of them to agree. But all three have invested much time and energy in the talks, and Baucus seems to have a chance of persuading at least Snowe.
Sen. Kent Conrad, D-N.D., said the negotiators are close on a verification system to prevent illegal immigrants from getting government subsidies to buy health coverage - a big issue for Republicans.
Negotiators also said they've found ways to reduce the cost of a planned expansion of Medicaid to cover more people near the federal poverty line. The issue is critical to winning support from governors, since the states share in the cos.
On medical malpractice, Conrad said the negotiators agreed that the federal government should provide funding for states to experiment with a range of alternatives to lawsuits.
On abortion, the negotiators are trying to come up with language that would extend current restrictions that prohibit federal funding for the procedure, except in cases of rape, incest, or to save the life of the mother.
Baucus' plan would mandate all Americans to get health insurance, either through an employer, a government program, or on their own. New consumer protections would prohibit onerous insurance companies practices, such as denying coverage because of a prior health problem, or charging more to those who are sick.
Even if Baucus can't get Republican support, the plan already reflects some major GOP priorities. For example, Baucus opted not to include a government insurance plan to compete with private carriers.
"I am very optimistic that we are going to be able to pass a bill that will get us to 60 votes," said Sen. Bill Nelson, D-Fla., a Finance member. "I didn't feel it a week-and-a-half ago, but I'm very optimistic now." Obama's speech last week "hit it head on," said Nelson.
- Elimination of pre-x- not mentioned in the article
- Payment reform- not mentioned
- Quality incentives- not mentioned
- Elimination of waste- not mentioned
= The AP and other members of the media continue their E News! style reporting and are failing to address key issues. They remain fixated on the fluff issues like the public plan option, immigrants and abortion. When most media outlets have the attention span of a fruit fly it doesn't help the American people to get informed.
Because of our sound-bite oriented news we now get three days of coverage of "You lie!" versus real reporting on what the various proposals will cover and reform.
Stay tuned as I'll dig for better details when the Baucus plan is released Wednesday.
------
WASHINGTON (AP) -- Senate health care negotiators said Monday they've narrowed their differences on a host of difficult issues with just a day or so left to seal an elusive bipartisan deal that could change the course of the contentious debate.
After months of closed-door negotiations, Finance Committee Chairman Max Baucus said, "We're getting very close." But it remained unclear if the Montana Democrat could strike a bargain to close the deal.
Negotiators pared the cost of their 10-year coverage plan to under $880 billion, and also reported progress on several issues, including health insurance for the poor, restrictions on federal funding for abortions, a verification system to prevent illegal immigrants from getting benefits, and ways to encourage alternatives to malpractice lawsuits.
With or without Republican support, Baucus said he'll have a formal proposal on Wednesday to meet a deadline for moving ahead.
At the same time, he said the bipartisan talks could continue even as his Finance panel begins its formal bill-drafting session next week.
"It's not just tomorrow or the next day," said Baucus. "We're going to keep working."
The three Republicans - Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine - are under intense pressure from leaders of their own party, some of whom have publicly dismissed Baucus' framework as a Democrat's plan. Baucus may not be able to get any of them to agree. But all three have invested much time and energy in the talks, and Baucus seems to have a chance of persuading at least Snowe.
Sen. Kent Conrad, D-N.D., said the negotiators are close on a verification system to prevent illegal immigrants from getting government subsidies to buy health coverage - a big issue for Republicans.
Negotiators also said they've found ways to reduce the cost of a planned expansion of Medicaid to cover more people near the federal poverty line. The issue is critical to winning support from governors, since the states share in the cos.
On medical malpractice, Conrad said the negotiators agreed that the federal government should provide funding for states to experiment with a range of alternatives to lawsuits.
On abortion, the negotiators are trying to come up with language that would extend current restrictions that prohibit federal funding for the procedure, except in cases of rape, incest, or to save the life of the mother.
Baucus' plan would mandate all Americans to get health insurance, either through an employer, a government program, or on their own. New consumer protections would prohibit onerous insurance companies practices, such as denying coverage because of a prior health problem, or charging more to those who are sick.
Even if Baucus can't get Republican support, the plan already reflects some major GOP priorities. For example, Baucus opted not to include a government insurance plan to compete with private carriers.
"I am very optimistic that we are going to be able to pass a bill that will get us to 60 votes," said Sen. Bill Nelson, D-Fla., a Finance member. "I didn't feel it a week-and-a-half ago, but I'm very optimistic now." Obama's speech last week "hit it head on," said Nelson.
63% of Physicians Support Inclusion of Public Plan Option
Source- Robert Wood Johnson Foundation survey
Survey: 63% of Physicians Support Inclusion of Public Option Robert Wood Johnson Foundation Survey Shows Physicians Support Reform Plan that Includes Both Public and Private Options
A Robert Wood Johnson Foundation survey summarized in today’s New England Journal of Medicine shows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.
In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.
The survey was conducted between June 25 and September 3, 2009 by Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., of the Mount Sinai School of Medicine in New York City. While the survey was conducted in several “waves” over a tumultuous summer for the health reform debate, no statistically significant differences were identified in physician responses throughout the summer.
Survey: 63% of Physicians Support Inclusion of Public Option Robert Wood Johnson Foundation Survey Shows Physicians Support Reform Plan that Includes Both Public and Private Options
A Robert Wood Johnson Foundation survey summarized in today’s New England Journal of Medicine shows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.
In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.
The survey was conducted between June 25 and September 3, 2009 by Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., of the Mount Sinai School of Medicine in New York City. While the survey was conducted in several “waves” over a tumultuous summer for the health reform debate, no statistically significant differences were identified in physician responses throughout the summer.
Post Obama Speech Poll Numbers
Source- Washington Post/ ABC News
According to a Washington Post/ ABC News Poll President Obama continues to face some public resistance to his drive to initiate far-reaching changes to the country's health-care system, with widespread skepticism about central tenets of his plan, according to a new Washington Post-ABC News poll.
Earlier, Sen. Olympia J. Snowe (R-Maine), who has been seeking a bipartisan compromise, urged the president to abandon the so-called public option. "It's universally opposed by all Republicans in the Senate," she said on CBS's "Face the Nation." "And therefore, there's no (bi-partisan) way to pass a plan that includes the public option."
Here are some numbers in polling done immediately after the President's speech.
The idea of reform:
Americans remain almost deadlocked in their opinion of the Democrats' health-care initiative, with 46 percent in favor of the proposed changes and 48 percent opposed.
Individual Mandate: The public also divides about evenly -- 51 percent in favor, 47 percent against -- on the question of whether people should be required to have health insurance, a central element of the plans under consideration.
The public option: This is the major point of contention
55 percent say they like the idea, but the notion continues to attract intense objection: If that single provision were removed, opposition to the overall package drops by six percentage points, according to the poll.
Without the public option, 50 percent back the rest of the proposed changes; a still sizable 42 percent are opposed. Independents divide 45-45 on a package without the government-sponsored insurance option, while they are largely negative on the entire set of proposals (40 percent support and 52 percent oppose). Republican opposition also fades 20 points under this scenario.
The politics of the idea would also probably change dramatically depending on its scope: If it were limited to only those unable to get private insurance, support would rise to 76 percent.
More than seven in 10 Americans, including majorities across party lines, say they think Obama and congressional Democrats should adjust the health-care legislation to appeal to some Republican lawmakers. Half credit the Democrats with making a good-faith effort to do so already, while most, 62 percent, say the GOP is not returning the favor.
There is, however, less backing for the idea of a new tax on insurance companies that offer high-cost, big benefit health plans; 45 percent of Americans favor such a levy, and support plummets if it is suggested that companies would have to raise fees for those policies as a result.
Cut to the Chase: Above it all, Fifty-three percent now call government action essential, while 44 percent see it as doing more harm than good.
According to a Washington Post/ ABC News Poll President Obama continues to face some public resistance to his drive to initiate far-reaching changes to the country's health-care system, with widespread skepticism about central tenets of his plan, according to a new Washington Post-ABC News poll.
Earlier, Sen. Olympia J. Snowe (R-Maine), who has been seeking a bipartisan compromise, urged the president to abandon the so-called public option. "It's universally opposed by all Republicans in the Senate," she said on CBS's "Face the Nation." "And therefore, there's no (bi-partisan) way to pass a plan that includes the public option."
Here are some numbers in polling done immediately after the President's speech.
The idea of reform:
Americans remain almost deadlocked in their opinion of the Democrats' health-care initiative, with 46 percent in favor of the proposed changes and 48 percent opposed.
Individual Mandate: The public also divides about evenly -- 51 percent in favor, 47 percent against -- on the question of whether people should be required to have health insurance, a central element of the plans under consideration.
The public option: This is the major point of contention
55 percent say they like the idea, but the notion continues to attract intense objection: If that single provision were removed, opposition to the overall package drops by six percentage points, according to the poll.
Without the public option, 50 percent back the rest of the proposed changes; a still sizable 42 percent are opposed. Independents divide 45-45 on a package without the government-sponsored insurance option, while they are largely negative on the entire set of proposals (40 percent support and 52 percent oppose). Republican opposition also fades 20 points under this scenario.
The politics of the idea would also probably change dramatically depending on its scope: If it were limited to only those unable to get private insurance, support would rise to 76 percent.
More than seven in 10 Americans, including majorities across party lines, say they think Obama and congressional Democrats should adjust the health-care legislation to appeal to some Republican lawmakers. Half credit the Democrats with making a good-faith effort to do so already, while most, 62 percent, say the GOP is not returning the favor.
There is, however, less backing for the idea of a new tax on insurance companies that offer high-cost, big benefit health plans; 45 percent of Americans favor such a levy, and support plummets if it is suggested that companies would have to raise fees for those policies as a result.
Cut to the Chase: Above it all, Fifty-three percent now call government action essential, while 44 percent see it as doing more harm than good.
Saturday, September 12, 2009
LaCrosse health plan is potential model to build from
http://www.jsonline.com/business/59087997.html
This is exactly the type of health care model we should be utilizing to undertake true reform.
Efficient, quality, and integrated care. I apologize for the length of this entry. I think this is very informative, however, so I'd hate to edit it too much.
-----------------------
Here are excerpts:
La Crosse - The United States would spend less money on health care if more health systems were like Gundersen Lutheran.
This community in western Wisconsin has the fourth-lowest health care costs in the country based on Medicare spending.
Only Honolulu and two North Dakota cities, Fargo and Minot, rank lower. At the same time, the quality of care is as good as or better than most parts of the country.
Gundersen Lutheran, a health care system that employs 6,600 people, including 453 physicians, is one reason. The other is its crosstown competitor, Franciscan Skemp Healthcare, part of the famed Mayo Health System.
Both are among the health systems being cited as proof that the United States can slow the rise in health care spending without hurting quality.
"There are models available, and we happen to be one of them," said Jeff Thompson, a physician and chief executive of Gundersen Lutheran.
Medicare spent 30% less on average for each beneficiary in the La Crosse area than the national average in 2006, the most recent year for which data is available, according to the Dartmouth Atlas of Health Care.
It spent 64.5% less than in Miami and 61% less than in McAllen, Texas, the two most costly areas. And it spent 23% less than in the Milwaukee area.
The huge regional variations in Medicare spending - documented by more than 30 years of research at Dartmouth College - occur after adjusting for age, sex and race.
They also exist among areas with similar poverty rates. And they exist within the same geographic areas, varying from one hospital to another.
The variations show that some parts of the country - and some health systems - simply make better use of health care dollars.
The doctors and hospitals in places such as La Crosse, Eugene, Ore., and Grand Junction, Colo., do a better job of eliminating duplicative and unnecessary care, preventing illness or detecting it earlier, avoiding unneeded or preventable hospitalizations, increasing productivity and reducing administrative costs.
They also challenge the contention that slowing the rise in health care spending will mean denying patients needed care. And they refute the widely held belief that more care is better care, and that expensive care is even better.
The evidence is indisputable that high-cost communities do not have better health outcomes, said Tom Oliver, a professor at the University of Wisconsin School of Medicine and Public Health.
"We are spending billions of dollars that is wasted in our health care system," Oliver said.
Quality care
No simple explanation exists why Gundersen Lutheran or the Mayo Health System can provide quality care at a fraction of the cost of their counterparts in Miami or McAllen. But both are integrated health care systems that employ doctors, and research suggests that integrated systems and large physician practices closely aligned with a hospital often produce better care at a lower cost.
Gundersen Lutheran and other integrated systems also often operate their own health insurance plans. That, too, could contribute to their lower costs by giving them an additional incentive to provide efficient care.
The Gundersen Lutheran health plan accounts for about 28% of the revenue at its hospital and its clinics. But when a patient is insured by the plan, the cost of his or her care isn't passed on to an insurance company. Gundersen Lutheran instead incurs the costs.
Being integrated gives Gundersen Lutheran a huge advantage in coordinating care, getting information on best practices to physicians and creating a culture of shared values, said Thompson, its chief executive.
Doctors run the health system, and they are expected to become involved in its operations and to work to control costs, he said.
The health system's orthopedic surgeons, for example, reduced costs by $900,000 a year just by getting together and agreeing to use medical devices from one supplier.
Standardizing care also is easier in an integrated system. The doctors at Gundersen Lutheran have developed specific guidelines and order sets for specific diseases and procedures.
When Gundersen Lutheran installed an information technology system in its hospital, it had more than 300 order sets, said Brian Mulrennan, an internist. It was told by Epic Systems Corp., the Madison-area company that designed the system, that some hospitals had none.
This means that doctors who specialize in diseases of the ear, nose and throat, for example, have developed standard orders for the post-operative care for children who have had tubes placed in their ears for chronic infections.
The standard orders lessen the variation in cost and outcomes.
At the same time, nurses no longer have to follow slightly different orders from each physician, thereby reducing the chance of error.
All this is harder to do when doctors work for dozens of small practices. First, the doctors have to be willing to take the time to develop and agree on the guidelines or standard orders.
And the hospital may be wary of antagonizing doctors who bring it patients and revenue.
There's a saying in health care that a hospital's first customer is the doctor. That's less of a problem in an integrated system that employs them.
Practice guidelines and standard order sets also can help control discretionary care, such as office visits, referrals to specialists and the use of imaging tests. It is one reason for the huge variation in health care costs.
Culture also plays a part. The doctors at Gundersen Lutheran repeatedly refer to the value placed on cooperation and on a focus on the patient. And the health system works to recruit doctors who understand those values.
Gunderson doctors are well paid and make excellent livings. They just aren't the highest paid.
When recruiting, if a doctor notes that he or she could make more money in a Chicago suburb, Thompson will say, "Then you should go."
The low costs incurred by Medicare in La Crosse also stem partly from a communitywide initiative, begun in the 1980s, to encourage people to have advance directives - legal documents that state patients' decisions about end-of-life care should they become incapacitated.
"It's now so part of the process of care that, when we don't know a patient's wishes, it's upsetting to people," said Bud Hammes, a clinical ethicist and director of medical humanities at the Gundersen Lutheran Medical Foundation.
The program, which has drawn international attention, enables doctors to know when patients don't want heroic measures taken to prolong their lives.
In the last six months of life, Medicare spends 29%, or about $8,000, less on patients treated at Gundersen Lutheran than the national average. And it spends roughly $10,000 less than at Aurora St. Luke's Medical Center and Froedtert Hospital, the two hospitals in the Milwaukee area with the highest costs.
No quick cures
National data on the wide variation in costs is available to researchers only for Medicare patients. But studies suggest that how doctors and hospitals provide care for Medicare beneficiaries indicates how they treat patients covered by commercial health plans.
Gundersen Lutheran gives credence to that research. The health system says that its rate increases for commercial plans for the past three years were below the rate of inflation.
That's almost unheard of in health care.
The challenge is how to make the U.S. health care system look more like Gundersen Lutheran and other integrated systems.
That won't be easy to do.
Integrated systems, including large physician practices closely affiliated with hospitals, such as Dean Health System in Madison and the Marshfield Clinic, are common in Wisconsin. But they aren't the norm in the U.S. health care system.
As recently as 2005, roughly half of all office visits were made to practices with one or two physicians, according to the National Ambulatory Medical Care Survey.
Yet the Dartmouth research suggests that high-cost markets are characterized by a much higher percentage of physicians in solo or two-person practices. That kind of fragmentation is characteristic of the U.S. health care system.
It also will be one of the challenges in slowing the growth in health care spending.
This is exactly the type of health care model we should be utilizing to undertake true reform.
Efficient, quality, and integrated care. I apologize for the length of this entry. I think this is very informative, however, so I'd hate to edit it too much.
-----------------------
Here are excerpts:
La Crosse - The United States would spend less money on health care if more health systems were like Gundersen Lutheran.
This community in western Wisconsin has the fourth-lowest health care costs in the country based on Medicare spending.
Only Honolulu and two North Dakota cities, Fargo and Minot, rank lower. At the same time, the quality of care is as good as or better than most parts of the country.
Gundersen Lutheran, a health care system that employs 6,600 people, including 453 physicians, is one reason. The other is its crosstown competitor, Franciscan Skemp Healthcare, part of the famed Mayo Health System.
Both are among the health systems being cited as proof that the United States can slow the rise in health care spending without hurting quality.
"There are models available, and we happen to be one of them," said Jeff Thompson, a physician and chief executive of Gundersen Lutheran.
Medicare spent 30% less on average for each beneficiary in the La Crosse area than the national average in 2006, the most recent year for which data is available, according to the Dartmouth Atlas of Health Care.
It spent 64.5% less than in Miami and 61% less than in McAllen, Texas, the two most costly areas. And it spent 23% less than in the Milwaukee area.
The huge regional variations in Medicare spending - documented by more than 30 years of research at Dartmouth College - occur after adjusting for age, sex and race.
They also exist among areas with similar poverty rates. And they exist within the same geographic areas, varying from one hospital to another.
The variations show that some parts of the country - and some health systems - simply make better use of health care dollars.
The doctors and hospitals in places such as La Crosse, Eugene, Ore., and Grand Junction, Colo., do a better job of eliminating duplicative and unnecessary care, preventing illness or detecting it earlier, avoiding unneeded or preventable hospitalizations, increasing productivity and reducing administrative costs.
They also challenge the contention that slowing the rise in health care spending will mean denying patients needed care. And they refute the widely held belief that more care is better care, and that expensive care is even better.
The evidence is indisputable that high-cost communities do not have better health outcomes, said Tom Oliver, a professor at the University of Wisconsin School of Medicine and Public Health.
"We are spending billions of dollars that is wasted in our health care system," Oliver said.
Quality care
No simple explanation exists why Gundersen Lutheran or the Mayo Health System can provide quality care at a fraction of the cost of their counterparts in Miami or McAllen. But both are integrated health care systems that employ doctors, and research suggests that integrated systems and large physician practices closely aligned with a hospital often produce better care at a lower cost.
Gundersen Lutheran and other integrated systems also often operate their own health insurance plans. That, too, could contribute to their lower costs by giving them an additional incentive to provide efficient care.
The Gundersen Lutheran health plan accounts for about 28% of the revenue at its hospital and its clinics. But when a patient is insured by the plan, the cost of his or her care isn't passed on to an insurance company. Gundersen Lutheran instead incurs the costs.
Being integrated gives Gundersen Lutheran a huge advantage in coordinating care, getting information on best practices to physicians and creating a culture of shared values, said Thompson, its chief executive.
Doctors run the health system, and they are expected to become involved in its operations and to work to control costs, he said.
The health system's orthopedic surgeons, for example, reduced costs by $900,000 a year just by getting together and agreeing to use medical devices from one supplier.
Standardizing care also is easier in an integrated system. The doctors at Gundersen Lutheran have developed specific guidelines and order sets for specific diseases and procedures.
When Gundersen Lutheran installed an information technology system in its hospital, it had more than 300 order sets, said Brian Mulrennan, an internist. It was told by Epic Systems Corp., the Madison-area company that designed the system, that some hospitals had none.
This means that doctors who specialize in diseases of the ear, nose and throat, for example, have developed standard orders for the post-operative care for children who have had tubes placed in their ears for chronic infections.
The standard orders lessen the variation in cost and outcomes.
At the same time, nurses no longer have to follow slightly different orders from each physician, thereby reducing the chance of error.
All this is harder to do when doctors work for dozens of small practices. First, the doctors have to be willing to take the time to develop and agree on the guidelines or standard orders.
And the hospital may be wary of antagonizing doctors who bring it patients and revenue.
There's a saying in health care that a hospital's first customer is the doctor. That's less of a problem in an integrated system that employs them.
Practice guidelines and standard order sets also can help control discretionary care, such as office visits, referrals to specialists and the use of imaging tests. It is one reason for the huge variation in health care costs.
Culture also plays a part. The doctors at Gundersen Lutheran repeatedly refer to the value placed on cooperation and on a focus on the patient. And the health system works to recruit doctors who understand those values.
Gunderson doctors are well paid and make excellent livings. They just aren't the highest paid.
When recruiting, if a doctor notes that he or she could make more money in a Chicago suburb, Thompson will say, "Then you should go."
The low costs incurred by Medicare in La Crosse also stem partly from a communitywide initiative, begun in the 1980s, to encourage people to have advance directives - legal documents that state patients' decisions about end-of-life care should they become incapacitated.
"It's now so part of the process of care that, when we don't know a patient's wishes, it's upsetting to people," said Bud Hammes, a clinical ethicist and director of medical humanities at the Gundersen Lutheran Medical Foundation.
The program, which has drawn international attention, enables doctors to know when patients don't want heroic measures taken to prolong their lives.
In the last six months of life, Medicare spends 29%, or about $8,000, less on patients treated at Gundersen Lutheran than the national average. And it spends roughly $10,000 less than at Aurora St. Luke's Medical Center and Froedtert Hospital, the two hospitals in the Milwaukee area with the highest costs.
No quick cures
National data on the wide variation in costs is available to researchers only for Medicare patients. But studies suggest that how doctors and hospitals provide care for Medicare beneficiaries indicates how they treat patients covered by commercial health plans.
Gundersen Lutheran gives credence to that research. The health system says that its rate increases for commercial plans for the past three years were below the rate of inflation.
That's almost unheard of in health care.
The challenge is how to make the U.S. health care system look more like Gundersen Lutheran and other integrated systems.
That won't be easy to do.
Integrated systems, including large physician practices closely affiliated with hospitals, such as Dean Health System in Madison and the Marshfield Clinic, are common in Wisconsin. But they aren't the norm in the U.S. health care system.
As recently as 2005, roughly half of all office visits were made to practices with one or two physicians, according to the National Ambulatory Medical Care Survey.
Yet the Dartmouth research suggests that high-cost markets are characterized by a much higher percentage of physicians in solo or two-person practices. That kind of fragmentation is characteristic of the U.S. health care system.
It also will be one of the challenges in slowing the growth in health care spending.
Thursday, September 10, 2009
Analysis of Obama's Speech
President Obama on Wednesday clearly laid out his vision for health care reform. Although the speech was long he actually succinctly stated his goals and laid out his vision in language that should make it difficult for opponents to mis-represent and lie about.
Cost and Waste issues
On my favorite topic the President had this to say:
"We've estimated that most of this plan can be paid for by finding savings within the existing health care system - a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment - it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid."
He's right but I'm going to be very watchful of the details on this as I hope he is talking about instituting health care reimbursement based on "episodes of care" and I hope the plan includes implementing LEAN processes.
There was no mention of either in the speech. As the President said there are many details that need to be worked out to flesh out the basic proposal he announced.
On Medicare and Medicaid there was little detail but he reassured seniors and people with disabilities that he would protect the programs they need and rely on. I'm sure there are important new ideas that will impact these groups within Obama's and Baucus's plans. Please check back here for that analysis soon.
On the public plan
The President said, "An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up." Taxpayers will not be subsidizing this public insurance option. Obama said, "The public insurance option would have to be self-sufficient and rely on the premiums it collects."
This should clear up the idea of a gov't takeover of health care but I doubt it will and in the end I'd bet that health co-ops are what is implemented as a compromise. I've said that before and I'd bet my mortgage on it being the alternative option.
Individual and Small Business Tax Credits
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
Cost of the plan
The President- "I will not sign a plan that adds one dime to our deficits - either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize." The plan will cost around $900 billion over ten years. Most of these costs will be paid for with money already being spent - but spent badly - in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. Obama reiterated the dire need to curb rising medical costs saying, "if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
As always more and more details will be forthcoming. I will research how the plan addresses the waste issue and the provider payment issues. These are the key components and will make or break any bill that becomes law. Please stay tuned, engage, and provide your comments.
Cost and Waste issues
On my favorite topic the President had this to say:
"We've estimated that most of this plan can be paid for by finding savings within the existing health care system - a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment - it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid."
He's right but I'm going to be very watchful of the details on this as I hope he is talking about instituting health care reimbursement based on "episodes of care" and I hope the plan includes implementing LEAN processes.
There was no mention of either in the speech. As the President said there are many details that need to be worked out to flesh out the basic proposal he announced.
On Medicare and Medicaid there was little detail but he reassured seniors and people with disabilities that he would protect the programs they need and rely on. I'm sure there are important new ideas that will impact these groups within Obama's and Baucus's plans. Please check back here for that analysis soon.
On the public plan
The President said, "An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up." Taxpayers will not be subsidizing this public insurance option. Obama said, "The public insurance option would have to be self-sufficient and rely on the premiums it collects."
This should clear up the idea of a gov't takeover of health care but I doubt it will and in the end I'd bet that health co-ops are what is implemented as a compromise. I've said that before and I'd bet my mortgage on it being the alternative option.
Individual and Small Business Tax Credits
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
Cost of the plan
The President- "I will not sign a plan that adds one dime to our deficits - either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize." The plan will cost around $900 billion over ten years. Most of these costs will be paid for with money already being spent - but spent badly - in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. Obama reiterated the dire need to curb rising medical costs saying, "if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
As always more and more details will be forthcoming. I will research how the plan addresses the waste issue and the provider payment issues. These are the key components and will make or break any bill that becomes law. Please stay tuned, engage, and provide your comments.
Tuesday, September 8, 2009
More specifics on Baucus compromise proposal
See the AP article below as there are more details emerging on Sen. Max Baucus' health care reform proposal. Baucus is a Montana moderate Democrat who chairs the Senate Finance Comm.
My Analysis-
When we consider many families of four now pay $400-500 monthly premium for their employee share AND are faced with annual deductibles of $5,000 - $3800 doesn't seem so bad. Likewise for an individual earning a decent income a $950 "fine" seems reasonable.
Again, and I'm getting tired of arguing this... the focus is on the WRONG issues. The public plan option is not the most important issue. There are better ways to drive down costs- get rid of the waste by mandating LEAN processes. It has proven to work in countless health plans from Washington state to Wisconsin and elsewhere. Make it a nationwide mandate by 2015.
In addition, does the Baucus plan eliminate pre-x conditions and individual underwriting? The article and the press at large again miss the target.
Obama must address the real issues when he attempts to re-frame the debate Wednesday evening. He must focus on eliminating pre-x and wasteful medical procedures and taks that do nothing to enhance quality care. It isn't a cost-effectiveness argument. Its pure waste that impedes quality.
-------------------------------------------------------
New plan in Congress says those who go without health insurance face fines up to $3,800
WASHINGTON From the Associated Press-- Sept 8, 2009
Americans who don't get health insurance once the system is overhauled would be fined up to $3,800 under a proposal that circulated in Congress on Tuesday as Democratic leaders cast doubt on prospects for creating a government-run insurance plan.
President Barack Obama prepared what he hoped would be a game-changing speech to a joint session of Congress on Wednesday, his top domestic priority in the balance.
After a month of contentious forums, Americans were seeking specifics from the president. So were his fellow Democrats, divided on how best to solve the problem of the nation's nearly 50 million uninsured.
A government health-insurance option overwhelmingly favored by liberal Democrats appeared to be losing critically needed support.
Into the breach: a bipartisan compromise that Sen. Max Baucus, D-Mont., a moderate who heads the influential Finance Committee, was trying to broker.
Baucus, meeting with a small group of fellow senators, promoted a plan that would guarantee coverage for nearly all Americans at a cost to taxpayers of under $900 billion over 10 years.
Some experts consider that a relative bargain because the country now spends about $2.5 trillion a year on health care. But it would require hefty fees on insurers, drug companies and others in the health care industry to help pay for it.
Just as auto coverage is now mandatory, so would a requirement that all Americans get health insurance. Penalties for failing to get insurance would start at $750 a year for individuals and $1,500 for families. Households making more than three times the federal poverty level - about $66,000 for a family of four - would face the maximum fines. For families, it would be $3,800, and for individuals, $950.
Baucus would offer tax credits to help pay premiums for households making up to three times the poverty level, and for small employers paying about average middle-class wages. People working for companies that offer coverage could avoid the fines by signing up.
The proposed fines pose a dilemma for Obama. As a candidate, the president campaigned hard against making health insurance a requirement, and fining people for not getting it.
"Punishing families who can't afford health care to begin with just doesn't make sense," he said during his party's primaries. At the time, he proposed mandatory insurance only for children.
White House officials have since backed away somewhat from Obama's opposition to mandated coverage for all, but there's no indication that Obama would support fines.
One idea that Obama championed during and since the campaign - a government insurance option - appeared to be sinking fast.
House Majority Leader Steny Hoyer, D-Md., told reporters a Medicare-like plan for middle-class Americans and their families isn't an essential part of legislation for him. Hoyer's comments came shortly after a key Democratic moderate said he could no longer back a bill that includes a new government plan.
The fast-moving developments left liberals in a quandary. They've drawn a line, saying they won't vote for legislation if it doesn't include a public plan to compete with private insurance companies and force them to lower costs.
Rep. Mike Ross, D-Ark., who once supported a public option, said Tuesday that after hearing from constituents during the August recess, he's changed his mind.
"If House leadership presents a final bill that contains a government-run public option, I will oppose it," Ross said.
Obama's commitment to a public plan has been in question and lawmakers hoped his speech to Congress would make his position on that clear.
He's called a public plan an important tool to help check the excesses of private industry. But his aides suggested on the weekend that he could sign legislation even if it does not include a public option.
In the Senate, the public plan is not part of Baucus' proposal. He's calling for nonprofit co-ops to compete in the marketplace instead.
An 18-page summary of the Baucus proposal was obtained by The Associated Press. The complex plan would make dozens of changes in the health care system, many of them contentious. For example, it includes new fees on insurers, drug companies, medical device manufacturers and clinical labs.
It would require insurers to take all applicants, regardless of age or health. But smokers could be charged higher premiums. And 60-year-olds could be charged five times as much for a policy as 20-year-olds.
People working for major employers would probably not see big changes. The plan is geared to helping those who now have the hardest time getting and keeping coverage: the self-employed and small business owners. New purchasing pools would be set up in each state, allowing them to band together and get some of the advantages big companies now have.
My Analysis-
When we consider many families of four now pay $400-500 monthly premium for their employee share AND are faced with annual deductibles of $5,000 - $3800 doesn't seem so bad. Likewise for an individual earning a decent income a $950 "fine" seems reasonable.
Again, and I'm getting tired of arguing this... the focus is on the WRONG issues. The public plan option is not the most important issue. There are better ways to drive down costs- get rid of the waste by mandating LEAN processes. It has proven to work in countless health plans from Washington state to Wisconsin and elsewhere. Make it a nationwide mandate by 2015.
In addition, does the Baucus plan eliminate pre-x conditions and individual underwriting? The article and the press at large again miss the target.
Obama must address the real issues when he attempts to re-frame the debate Wednesday evening. He must focus on eliminating pre-x and wasteful medical procedures and taks that do nothing to enhance quality care. It isn't a cost-effectiveness argument. Its pure waste that impedes quality.
-------------------------------------------------------
New plan in Congress says those who go without health insurance face fines up to $3,800
WASHINGTON From the Associated Press-- Sept 8, 2009
Americans who don't get health insurance once the system is overhauled would be fined up to $3,800 under a proposal that circulated in Congress on Tuesday as Democratic leaders cast doubt on prospects for creating a government-run insurance plan.
President Barack Obama prepared what he hoped would be a game-changing speech to a joint session of Congress on Wednesday, his top domestic priority in the balance.
After a month of contentious forums, Americans were seeking specifics from the president. So were his fellow Democrats, divided on how best to solve the problem of the nation's nearly 50 million uninsured.
A government health-insurance option overwhelmingly favored by liberal Democrats appeared to be losing critically needed support.
Into the breach: a bipartisan compromise that Sen. Max Baucus, D-Mont., a moderate who heads the influential Finance Committee, was trying to broker.
Baucus, meeting with a small group of fellow senators, promoted a plan that would guarantee coverage for nearly all Americans at a cost to taxpayers of under $900 billion over 10 years.
Some experts consider that a relative bargain because the country now spends about $2.5 trillion a year on health care. But it would require hefty fees on insurers, drug companies and others in the health care industry to help pay for it.
Just as auto coverage is now mandatory, so would a requirement that all Americans get health insurance. Penalties for failing to get insurance would start at $750 a year for individuals and $1,500 for families. Households making more than three times the federal poverty level - about $66,000 for a family of four - would face the maximum fines. For families, it would be $3,800, and for individuals, $950.
Baucus would offer tax credits to help pay premiums for households making up to three times the poverty level, and for small employers paying about average middle-class wages. People working for companies that offer coverage could avoid the fines by signing up.
The proposed fines pose a dilemma for Obama. As a candidate, the president campaigned hard against making health insurance a requirement, and fining people for not getting it.
"Punishing families who can't afford health care to begin with just doesn't make sense," he said during his party's primaries. At the time, he proposed mandatory insurance only for children.
White House officials have since backed away somewhat from Obama's opposition to mandated coverage for all, but there's no indication that Obama would support fines.
One idea that Obama championed during and since the campaign - a government insurance option - appeared to be sinking fast.
House Majority Leader Steny Hoyer, D-Md., told reporters a Medicare-like plan for middle-class Americans and their families isn't an essential part of legislation for him. Hoyer's comments came shortly after a key Democratic moderate said he could no longer back a bill that includes a new government plan.
The fast-moving developments left liberals in a quandary. They've drawn a line, saying they won't vote for legislation if it doesn't include a public plan to compete with private insurance companies and force them to lower costs.
Rep. Mike Ross, D-Ark., who once supported a public option, said Tuesday that after hearing from constituents during the August recess, he's changed his mind.
"If House leadership presents a final bill that contains a government-run public option, I will oppose it," Ross said.
Obama's commitment to a public plan has been in question and lawmakers hoped his speech to Congress would make his position on that clear.
He's called a public plan an important tool to help check the excesses of private industry. But his aides suggested on the weekend that he could sign legislation even if it does not include a public option.
In the Senate, the public plan is not part of Baucus' proposal. He's calling for nonprofit co-ops to compete in the marketplace instead.
An 18-page summary of the Baucus proposal was obtained by The Associated Press. The complex plan would make dozens of changes in the health care system, many of them contentious. For example, it includes new fees on insurers, drug companies, medical device manufacturers and clinical labs.
It would require insurers to take all applicants, regardless of age or health. But smokers could be charged higher premiums. And 60-year-olds could be charged five times as much for a policy as 20-year-olds.
People working for major employers would probably not see big changes. The plan is geared to helping those who now have the hardest time getting and keeping coverage: the self-employed and small business owners. New purchasing pools would be set up in each state, allowing them to band together and get some of the advantages big companies now have.
Health Compromise Floated Before Obama Speech
Below are excerpts from a NY times article on Sen. Baucus' health care reform compromise. I've edited the article to highlight what Baucus' plan would do, what it wouldn't and what it will cost.
The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste
The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers
------------------------------------
Health Compromise Floated Before Obama Speech
By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.
To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.
Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.
The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste
The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers
------------------------------------
Health Compromise Floated Before Obama Speech
By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.
To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.
Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.
Wednesday, September 2, 2009
Obama changes course- Major speech on health care next week
Politically speaking this would have been timed much better if the speech took place a week prior to the August recess, rather than at its end. The President could have framed the town hall debates rather than allowing a WWE style free-for-all. Nonetheless, the President has his chance to change the debate toward tangible goals like eliminating pre-x, episodes of care based provider reimbursement, implementation of LEAN healthcare practices and of course providing his vision for the public plan
--------------
By CHARLES BABINGTON, Associated Press Writer Charles Babington, Associated Press Writer – Wed Sep 2, 7:20 pm ET
WASHINGTON – President Barack Obama will deliver a major prime-time health care address to Congress next week, opening an urgent autumn push to gain control of the debate that has been slipping from his grasp under withering Republican-led attacks.
Scheduling of the speech next Wednesday night, just a day after lawmakers return from their August recess, underscores the determination of the White House to confront critics of Obama's overhaul proposals and to buck up supporters who have been thrown on the defensive. Allies have been urging the president to be more specific about his plans and to take a greater role in the debate, and aides have signaled he will do that in the address to a joint session of Congress in the House chamber.
The speech's timing also suggests that top Democrats have all but given up hope for a bipartisan breakthrough by Senate Finance Committee negotiators. The White House had given those six lawmakers until Sept. 15 to draft a plan, but next week's speech comes well ahead of that deadline.
It follows an August recess in which critics of Obama's health proposals dominated many public forums. Approval ratings for Obama, and for his health care proposals, dropped during the month.
White House senior adviser David Axelrod told reporters Wednesday, "We believe this is the best way to kick off the final discussions, the final debate, and bring this thing to a close in a way that is meaningful."
Listeners to Obama's speech will have "a clear sense of what he proposes and what health care reform is not," Axelrod said. He declined to offer details of what the president might discuss.
--------------
By CHARLES BABINGTON, Associated Press Writer Charles Babington, Associated Press Writer – Wed Sep 2, 7:20 pm ET
WASHINGTON – President Barack Obama will deliver a major prime-time health care address to Congress next week, opening an urgent autumn push to gain control of the debate that has been slipping from his grasp under withering Republican-led attacks.
Scheduling of the speech next Wednesday night, just a day after lawmakers return from their August recess, underscores the determination of the White House to confront critics of Obama's overhaul proposals and to buck up supporters who have been thrown on the defensive. Allies have been urging the president to be more specific about his plans and to take a greater role in the debate, and aides have signaled he will do that in the address to a joint session of Congress in the House chamber.
The speech's timing also suggests that top Democrats have all but given up hope for a bipartisan breakthrough by Senate Finance Committee negotiators. The White House had given those six lawmakers until Sept. 15 to draft a plan, but next week's speech comes well ahead of that deadline.
It follows an August recess in which critics of Obama's health proposals dominated many public forums. Approval ratings for Obama, and for his health care proposals, dropped during the month.
White House senior adviser David Axelrod told reporters Wednesday, "We believe this is the best way to kick off the final discussions, the final debate, and bring this thing to a close in a way that is meaningful."
Listeners to Obama's speech will have "a clear sense of what he proposes and what health care reform is not," Axelrod said. He declined to offer details of what the president might discuss.
We've been here before- Will Obama be more like Truman and Clinton or more like Johnson?
From the New York Times-
Changing Health Care by Steps
By DAVID LEONHARDT
Sept 1, 2009
After Harry Truman repeatedly failed to persuade Congress to pass universal health insurance, some Truman administration officials came up with a less ambitious idea. They suggested covering only 8 percent of the population, and an especially sympathetic 8 percent at that: everybody 65 and older.
Truman never really pushed the plan, however. John F. Kennedy later did, yet was stymied by Congress and the American Medical Association, which equated it with Soviet-like socialism. So it fell to Lyndon Johnson. Even after he won a 23-point landslide in 1964, he had to agree to some unseemly deal-making, as Jonathan Cohn of The New Republic has noted, that handed a big payday to hospitals and doctors.
Only then, in the summer of 1965, was Medicare born.
Next week, Congress will return to session, and health care, of course, will be at the top of its agenda. Passing a bill, it’s clear, will be no easier than in previous decades. President Obama’s poll numbers have fallen, while untruths about death panels have made the rounds and members of Congress have been subjected to town hall harangues.
But the job facing Mr. Obama hasn’t really changed: he will have to figure out how to end up more like Johnson than like Truman or, more recently, Bill Clinton. He and Congress will have to figure out how to make some progress toward fixing the country’s troubled health care system.
Any bill they pass will inevitably be flawed. It will not do enough to reduce wasteful spending. It probably will not result in universal coverage. Special interests — like drug companies and, once again, hospitals — will get off too lightly.
----------------------
So is this what our politics have become? Has everything gotten so political that we are doomed to implement poor policy and half-baked reforms?
In today's climate bold politicians run the risk of being removed from office before we find out how effective their policies are.
Hypothetical: Let's say the House (240-195) and Senate (51-48) (through Reconciliation) both pass a bold health care initiative with the controversial public plan as a cornerstone but also includes massive payment reform such as "episodes of care" based payment, mandates for individual and small business coverage, tort reform, elimination of individual underwriting and mandates LEAN health care practices by hospitals and doc's by 2015. Let's say all businesses under 10 employees are pooled in the Health Insurance Exchange where the public option is available to them in addition to private plans. Let's further say that most of the reforms including the individual and employer mandates for businesses above 10 employees are effective Jan 1, 2013. That's a realistic timeframe but its after 67% of the Senate has gone through a re-election and 2 x for the House of Reps.
It will be well into 2014 before we have a good sense of how those changes are working. If you were a member of Congress would you vote yes given our current political climate?
Changing Health Care by Steps
By DAVID LEONHARDT
Sept 1, 2009
After Harry Truman repeatedly failed to persuade Congress to pass universal health insurance, some Truman administration officials came up with a less ambitious idea. They suggested covering only 8 percent of the population, and an especially sympathetic 8 percent at that: everybody 65 and older.
Truman never really pushed the plan, however. John F. Kennedy later did, yet was stymied by Congress and the American Medical Association, which equated it with Soviet-like socialism. So it fell to Lyndon Johnson. Even after he won a 23-point landslide in 1964, he had to agree to some unseemly deal-making, as Jonathan Cohn of The New Republic has noted, that handed a big payday to hospitals and doctors.
Only then, in the summer of 1965, was Medicare born.
Next week, Congress will return to session, and health care, of course, will be at the top of its agenda. Passing a bill, it’s clear, will be no easier than in previous decades. President Obama’s poll numbers have fallen, while untruths about death panels have made the rounds and members of Congress have been subjected to town hall harangues.
But the job facing Mr. Obama hasn’t really changed: he will have to figure out how to end up more like Johnson than like Truman or, more recently, Bill Clinton. He and Congress will have to figure out how to make some progress toward fixing the country’s troubled health care system.
Any bill they pass will inevitably be flawed. It will not do enough to reduce wasteful spending. It probably will not result in universal coverage. Special interests — like drug companies and, once again, hospitals — will get off too lightly.
----------------------
So is this what our politics have become? Has everything gotten so political that we are doomed to implement poor policy and half-baked reforms?
In today's climate bold politicians run the risk of being removed from office before we find out how effective their policies are.
Hypothetical: Let's say the House (240-195) and Senate (51-48) (through Reconciliation) both pass a bold health care initiative with the controversial public plan as a cornerstone but also includes massive payment reform such as "episodes of care" based payment, mandates for individual and small business coverage, tort reform, elimination of individual underwriting and mandates LEAN health care practices by hospitals and doc's by 2015. Let's say all businesses under 10 employees are pooled in the Health Insurance Exchange where the public option is available to them in addition to private plans. Let's further say that most of the reforms including the individual and employer mandates for businesses above 10 employees are effective Jan 1, 2013. That's a realistic timeframe but its after 67% of the Senate has gone through a re-election and 2 x for the House of Reps.
It will be well into 2014 before we have a good sense of how those changes are working. If you were a member of Congress would you vote yes given our current political climate?
Sen. Grassley (R- Iowa) : No public option in health reform
It appears the Public option is out as any compromise between the House and senate versions would seem to eliminate the public option. Its not clear if co-ops remain in play as a pseudo public option to compete against private plans.
-------------
Sen. Grassley weighs in on health reform
By MIKE GLOVER (Associated Press
DES MOINES, Iowa — Iowa Republican Sen. Charles Grassley said Monday he remains hopeful a limited health care reform measure can be negotiated, but that a small bipartisan group of senators working on the issue agrees a government-run public option won't be part of the package.
Senate Finance Chairman Max Baucus, D-Mont., meanwhile, said an overhaul measure will be presented this year with or without bipartisan support — though he said a compromise would be far better than any bill pushed through solely by Democrats.
The senators are among a group of three Democrats and three Republicans on the pivotal Finance Committee who are negotiating a proposal to overhaul the nation's health care system. Both said Monday they were hopeful a bipartisan deal could be reached.
"I think the chances are still good," Baucus told The Associated Press. "I talked to (the Republicans) and they all want to do health care reform. But the sad part is a lot of politics have crept in."
Grassley, the GOP's key negotiator, expressed similar determination, but made clear he doesn't expect a public health care option sought by President Barack Obama to be in a final deal.
"I'm still hopeful, but I'm hopeful based on I think you're talking about something a little less sweeping than what we talked about before," Grassley told the AP in a telephone interview.
Grassley in the past has roundly criticized the public option, but went a step further Monday in saying the core group of senators agreed such a provision would not be in a bill.
-------------
Sen. Grassley weighs in on health reform
By MIKE GLOVER (Associated Press
DES MOINES, Iowa — Iowa Republican Sen. Charles Grassley said Monday he remains hopeful a limited health care reform measure can be negotiated, but that a small bipartisan group of senators working on the issue agrees a government-run public option won't be part of the package.
Senate Finance Chairman Max Baucus, D-Mont., meanwhile, said an overhaul measure will be presented this year with or without bipartisan support — though he said a compromise would be far better than any bill pushed through solely by Democrats.
The senators are among a group of three Democrats and three Republicans on the pivotal Finance Committee who are negotiating a proposal to overhaul the nation's health care system. Both said Monday they were hopeful a bipartisan deal could be reached.
"I think the chances are still good," Baucus told The Associated Press. "I talked to (the Republicans) and they all want to do health care reform. But the sad part is a lot of politics have crept in."
Grassley, the GOP's key negotiator, expressed similar determination, but made clear he doesn't expect a public health care option sought by President Barack Obama to be in a final deal.
"I'm still hopeful, but I'm hopeful based on I think you're talking about something a little less sweeping than what we talked about before," Grassley told the AP in a telephone interview.
Grassley in the past has roundly criticized the public option, but went a step further Monday in saying the core group of senators agreed such a provision would not be in a bill.
Baucus Predicts Reform Will Happen in '09
This is a story by the Associated Press
August 31, 2009
HELENA, Mont. — U.S. Sen. Max Baucus of Montana says a health care overhaul will happen this year even if Republicans back out of bipartisan talks under growing public pressure and that the death of Sen. Edward Kennedy could help hold together a compromise deal.
Baucus is leading a panel of two other Democrats and three Republicans that is being watched closely by everyone from the White House and beyond. Chances of a bipartisan breakthrough appear to be diminishing in the face of an effective public mobilization by opponents during the August congressional recess.
But Baucus says the bipartisan deal is still alive. He said he still speaks frequently with Republican Sens. Charles Grassley of Iowa, Olympia Snowe of Maine and Michael Enzi of Wyoming.
"I think the chances are still good," Baucus told The Associated Press in an interview Monday. "I talked to them, and they all want to do health care reform. But the sad part is a lot politics have crept in. They are being told by the Republican Party not to participate."
If it falls apart, Democrats will have to turn to the "nuclear option" — forcing through an inferior bill through a process that only requires 51 votes instead of 60, Baucus said.
Baucus' panel has not released a proposal yet but is looking at a package of reforms that makes it easier for people to get insurance, including banning exclusions for pre-existing conditions, and makes it more affordable with tax credits and other benefits.
Baucus has taken heat from the left, which wants more liberal ideas considered, such as a Medicare-like public option for the uninsured, and suffered angry criticism from the right, which opposed any of the ideas amid concerns over the costs.
He promised constituents in meetings and in sidewalk encounters Monday that the bill will not increase the deficit, pays for itself over time and is necesary to rein in costs.
Baucus understands that criticism is weighing heavily on the minds of Republicans.
"They are in their home states and they are hearing a lot of what I am hearing: concerns," Baucus said. "In some ways it is easy in the short term to vote against it."
August 31, 2009
HELENA, Mont. — U.S. Sen. Max Baucus of Montana says a health care overhaul will happen this year even if Republicans back out of bipartisan talks under growing public pressure and that the death of Sen. Edward Kennedy could help hold together a compromise deal.
Baucus is leading a panel of two other Democrats and three Republicans that is being watched closely by everyone from the White House and beyond. Chances of a bipartisan breakthrough appear to be diminishing in the face of an effective public mobilization by opponents during the August congressional recess.
But Baucus says the bipartisan deal is still alive. He said he still speaks frequently with Republican Sens. Charles Grassley of Iowa, Olympia Snowe of Maine and Michael Enzi of Wyoming.
"I think the chances are still good," Baucus told The Associated Press in an interview Monday. "I talked to them, and they all want to do health care reform. But the sad part is a lot politics have crept in. They are being told by the Republican Party not to participate."
If it falls apart, Democrats will have to turn to the "nuclear option" — forcing through an inferior bill through a process that only requires 51 votes instead of 60, Baucus said.
Baucus' panel has not released a proposal yet but is looking at a package of reforms that makes it easier for people to get insurance, including banning exclusions for pre-existing conditions, and makes it more affordable with tax credits and other benefits.
Baucus has taken heat from the left, which wants more liberal ideas considered, such as a Medicare-like public option for the uninsured, and suffered angry criticism from the right, which opposed any of the ideas amid concerns over the costs.
He promised constituents in meetings and in sidewalk encounters Monday that the bill will not increase the deficit, pays for itself over time and is necesary to rein in costs.
Baucus understands that criticism is weighing heavily on the minds of Republicans.
"They are in their home states and they are hearing a lot of what I am hearing: concerns," Baucus said. "In some ways it is easy in the short term to vote against it."
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