Real Health Reform in Massachusetts

July 29, 2009 / Michael D. Miller MD / Delivery of Healthcare, Federal Healthcare Reform, Health System Reform, Quality of Care & Safety, State-Level Healthcare Reform / 5 Comments

The Massachusetts Special Commission on Payment Reform recently issued its recommendations for shifting the state’s health care system from Fee-For-Service (FFS) to Global Payments over a 5 year period. The Special Commission’s report lays out a good case for making this change, describing why it needs to be adopted by all payers, (although each payer would still pay different rates, they would all use the same fundamental global payment structure), and some of the challenges for successfully navigating a 5 year transition period from the current mostly FFS system to one dominated by global payments.

The report summarizes its recommendations into 9 areas:

The development of Accountable Care Organizations (ACOs).

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Health Reform Hyperbole Heightens

July 21, 2009 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Politics / 2 Comments

With Congress in the midst of considering health reform legislation, the slanting rhetoric about the proposals is escalating. For example, TV shows such as The Daily Show are covering the debate, and Congressional Republicans have put out a graphic showing their view of the health system the proposal from the Democrats in the House of Representatives would create:

What I find very, very, very interesting in this view, (prepared by Republican Congressional staff), is the top line of the graphic showing the US Congress operating on an equal basis with the President in running the Federal Departments of Treasure, HHS, VA, Defense, and Labor. …

Health Reform Hiatus – or Not

June 28, 2009 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, State-Level Healthcare Reform / No Comments

I’ve been reading so much about health reform that the inside of my eyelids are burning with headlines about draft committee bills, CBO scoring, Republican responses, editorials for and against various amorphous proposals, and multiple organizations advocating about a public plan option, a public plan option, a public plan option…….

I was hoping that for the July 4th Congressional recess week the public’s and pundits’ attention would go elsewhere, but then I saw this week’s Economist cover picture of President Obama. (If you look closely you can see that the syringe is graduated in Trillions of dollars from $0.25trn to $1.5trn – indicating that paying for health reform is likely to be the main cause for political pain.)…

Health Reform’s Line in the Sand

May 27, 2009 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Politics / 4 Comments

The public plan option was expected to be the most politically contentious issue in the health reform debate – and it now clearly is. MoveOn.org has declared it the #1 priority in health reform, and the National Journal’s most recent Insiders Poll has put forth some striking numbers about the clear partisan divide on this issue. The question they asked in the poll published in their May 23rd issue was “What is your view of including a new public insurance plan in health care reform?” And the results are shown in the graph below:

With 62% of Democrats saying they MUST have it, and 83% of Republicans saying they CANNOT have it, the public plan is clearly a partisan line in the sand.…

Healthcare Policy and Healthcare Politics – Summer 2009

May 26, 2009 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, ERISA, Federal Healthcare Reform, Health System Reform, Medicare, Politics / No Comments

As Congressional Committees appear to be steadily walking towards the starting line for considering health care reform legislation next week, I’ve been thinking about various healthcare policy and political events and activities that will influence the substance and process for these efforts over the coming months – and perhaps years.

Because a complete examination of all the important events and documents from the last several months and years would be too long for a single post, summarized below are some of my observations and thoughts about the meaning of 5 touchstones that people will likely reference in the coming months as part of the health reform dialogue:

Massachusetts’ health coverage and reform initiative
The Senate Finance Committee’s 3 Policy Option Papers
Frank Luntz’s health care talking point paper for Republicans
The May 11th letter from 6 national groups to President Obama
The Democratic Party’s development of Organizing for America

As discussed below, each of these activities and documents has dual (or dueling) policy and political goals, (i.e.…

Health Reform Deja Vu All Over Again

May 15, 2009 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Politics / 1 Comment

On Monday the President announced three basic principles for health reform:

“First, the rising cost of health care must be brought down; second, Americans must have the freedom to keep whatever doctor and health care plan they have, or to choose a new doctor or health care plan if they want it; and third, all Americans must have quality, affordable health care.”

After reading this, I was struck how this statement sounded similar to the principles for health reform in 1993 – So I dug out of my archives the “Health Security Cards” I’d gotten while working on that health reform effort:

(Paper card is on the left, and plastic card is on the right)

Comparing the two sets of principles it is clear that cost, choice and guaranteed access have continued to be top priorities. …

30% Off Health Care

April 27, 2009 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Federal Healthcare Reform, Health System Reform, Politics / 4 Comments

I get lots of emails. Some are interesting. Others are Spam – such as the one offering to double my gas mileage by showing me how to run my car on water. (Don’t they know that cars run on air not water!!!!!)

And last week I got one promising to cut health care expenses by 30%. Not just my health care expenses, but the entire countries spending on health care. (See their promotional coupon below.)

As you can see, this is really a call for people to support a public plan as part of health reform. This is a great message and marketing gimmick, but the problem is that nobody has agreed on the definition of a “public health insurance option.” …

Culture of Health Reform

April 13, 2009 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, Federal Healthcare Reform, Politics, State-Level Healthcare Reform / 2 Comments

One of the challenges for health reform legislation is the culture of the policy and political community.

Massachusetts’ insurance and coverage initiatives have been cited as lessons for health reform at the Federal level and other states. However, while observing a meeting of the state’s Special Commission on the Health Care Payment System last Friday, I was struck by how the culture of this group was very different than what I have often seen in Federal processes or within other states.

The Commission had agreed at their previous meeting that global payments should replace fee-for-service as the main payment route for medical services and products. …

Health Reform With a Public Plan or Not?

April 9, 2009 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health System Reform, Politics / 5 Comments

National Journal’s cover story last week (“The Deal Busters“) was about the 4 issues that could kill health reform. And first on the list was creating a public health insurance plan option to compete with private insurers in the push for increasing coverage.

The National Journal does a great job of describing the stakeholder groups’ political pros and cons around a public plan, but it doesn’t delve too deeply into the policy implications of expanding health insurance coverage with or without a new public plan option. That issue was recently discussed in Charlie Baker’s blog – which included several key points about public versus private insurance plans:

Public plans often set the standard that private plans follow, and thus are not neutral actors in the market – Medicare is often ascribed such a market tilting role
Public and private plans face different financial pressures, i.e.

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Health Reform Challenges and Prospects

February 19, 2009 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Politics / No Comments

The prospect for Federal health reform legislation remains high because of the growing need, Democratic control of Congress, and a lower barrier to major actions because of the economic situation. However, opposing these positive factors are the apparent unraveling of broad coalitions supporting fundamental health reform, and lower expectations for bipartisanship in Congress.

Growing conflicts within health reform coalitions was reported in Tuesday’s Chicago Tribune, (and discussed on the HealthBeatBlog), but this dis-cohesion was very predictable when it came time to talk specifics. Unfortunately, the prospects for bipartisan action on health reform also seem to have faded sooner than one would have hoped. …

Managing Expectations for Federal Health Reform

January 28, 2009 / Michael D. Miller MD / Access to Healthcare, Federal Healthcare Reform / 1 Comment

One of the challenges facing health reform legislation are the expectations of different stakeholder groups – many of whom were strong supporters of the Barack Obama’s campaign. Although the new Administration has only been in office a week and a day, a number of signs point to the fact that health reform legislation will not be quickly formed and passed – including an article in today’s Boston Globe titled, “Some fear window is narrow for healthcare overhaul.”

But not rushing health reform was both predictable and a good thing. First, the reasons why it won’t happen quickly:

It takes time for the new Administration and Congress to get organized – and they are rightly prioritizing actions to address the economic “situation”
The US system of government is designed to be deliberative and not speedily make major decisions
For reasons that are not fully apparent, the Senate is taking longer to confirm Tom Daschle as Secretary of HHS – although there are no signs that this won’t happen soon
Senator Kennedy’s health has been a question mark, but his staff has been working diligently to prepare legislative framework and language in conjunction with other Congressional offices such as the Finance Committee
Congressman Waxman’s taking over the Chairmanship of the Energy and Commerce Committee will likely mean some staff turnover in that Committee which also takes time – particularly since Congressman Waxman is known for getting some of the best and brightest staff in Congress

And second, not rushing health reform legislation through the process may be a good thing because no matter what scope and details the legislation eventually includes, getting more groups comfortable with its goals, priorities and specifics will make it more likely to succeed. …

Health Spending, Health Reform, and Physicians

January 15, 2009 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Politics / 7 Comments

The Centers for Medicare and Medicaid Services released 2007 US healthcare spending data in late December. Since then several publications have come out analyzing this information. The most comprehensive is probably a Health Affairs article which highlighted a slowdown in the growth in spending for prescription drugs and government administration.

The Center for American Progress also recently issued a paper comparing the US healthcare system in 2007 to the situation in 1994. This paper concluded:

“The status quo of American health care is spending more money to cover fewer people, yielding disappointing outcomes. Effective reforms, which would invest in measures to improve the quality and delivery of care, reform payment to reward outcomes, and provide affordable, accessible, comprehensive health insurance for all Americans, are long overdue.

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