Hard Health Reform Explained Simply

July 7, 2009 / Michael D. Miller MD / Health System Reform / 1 Comment

After talking with people about health reform for almost 20 years I’m no longer surprised by how simple many people think it is to fix the US healthcare system. If people really want to engage in conversation, rather than just vent, I often explain the practical realities, (and complexities), of health reform by breaking it down into 4 levels – which I think it pretty good since Dante had 7:

1. Identifying Problems is Easy
Almost everyone agrees that costs are too high, access is uneven, (including various disparities), and quality is variable – at best. In addition, there is agreement that these problems have negative consequences for economic growth, productivity for companies and individuals, and that lack of health insurance negatively affects individual’s health.…

Health Reform Hiatus – or Not

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 Heating Up

June 23, 2009 / Michael D. Miller MD / Health System Reform, Politics / No Comments

With the House and Senate unveiling draft descriptions of their health reform bills, national health reform activities are heating up. The escalating focus on health reform by Congress and all interested parties was illustrated by the cover and contents of last week’s National Journal.

The cover of the June 13th issue of the National Journal featured Karen Ignagni, head of the American Association of Health Plans (AHIP), the health insurance trade association. The main story inside is about Karen Ignagni, and leaders of other key groups, including Dan Danner (NFIB), Andy Stern (SEIU), and Ron Pollack (Families USA), and how their groups are working much more cooperatively than in the fierce fighting days of the early 1990s.…

Diabetes Updates – New Diagnostics, Increasing Rates, and Implications for Health Reform, CER, etc.

June 17, 2009 / Michael D. Miller MD / Comparative Effectiveness, Delivery of Healthcare, Economics & Financing, Health System Reform, Information & Communications, Quality of Care & Safety / 1 Comment

Changes in the diagnosis and treatment of diabetes is a great example for understanding how healthcare delivery constantly evolves based upon new discoveries. And the history of these changes may help illuminate some thinking about health reform and the development and use of comparative effectiveness research (CER).

First, a little background on diabetes.

Diabetes Background
Diabetes mellitus (or “sugar diabetes”) occurs when the body has problems regulating the level of sugar (specifically glucose) in the blood. This can be because the body’s pancreas doesn’t produce enough insulin, or for some reason the person’s organs become resistant to the actions of the insulin that is present – or sometimes both occur simultaneously. …

Be Prepared for the Outcomes of Health Reform

June 8, 2009 / Michael D. Miller MD / Economics & Financing, Health System Reform / 5 Comments

Predicting the future is easy. Accurately predicting the future is hard. While some people make a living by predicting the future, most will not admit to this truism. But the difficulty of accurately predicting the future of legislation and politically driven processes is what makes it important for policy makers to be prepared with contingency plans.

“Be Prepared” is the Boy Scout motto. As a boy scout many years ago, I learned that this was more than just a saying, it was really used to guide planning and decision making for all sorts of activities: camping, cooking, first aid, sporting events, community service projects, etc.,…

Theory v. Practice in Health Reform

June 1, 2009 / Michael D. Miller MD / Economics & Financing, Health System Reform / 4 Comments

Two great articles came out last week about the role of physicians in health reform – both as the source of problems and the need for them to lead in implementing solutions. (These articles also made me think back about some of my own positions on physicians engaging in health policy – see the bottom of this post.)

The first article was by Atul Gawande in the New Yorker, where he explores how physicians contribute to some communities having higher healthcare costs than others. The second article is in the New England Journal of Medicine, and is written by three distinguished health policy thought leaders, (Elliott Fisher, Don Berwick and Karen Davis), who discuss how physicians can help implement positive reforms.…

Savings from Comparative Effectiveness Research

May 28, 2009 / Michael D. Miller MD / Comparative Effectiveness, Economics & Financing, Health System Reform, Information & Communications / No Comments

The May 23rd issue of National Journal has two very interesting pieces about Comparative Effectiveness Research.

Scoring Savings from CER:
The first is in an interview with CBO Director Doug Elmendorf which includes this Q&A about scoring savings from CER:
“NJ: In the first five years after studying comparative effectiveness, are the savings that CBO can find relatively small?
Elmendorf: The estimates that we’ve done in the past suggest that by the 10th year, you are saving about as much as the cost of the research itself. By the fifth year, you are not. We would expect there to be savings in the private sector. …

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.…

People in Health Reform & Transformation

May 20, 2009 / Michael D. Miller MD / Delivery of Healthcare, Health System Reform, Information & Communications, Quality of Care & Safety / 1 Comment

The importance of the “people factor” in improving the quality and efficiency of healthcare is well understood by experts in health information technology (HIT) and healthcare delivery transformation. In estimating the time and cost for implementing new technologies or processes, they appreciate how behavior change and technology adoption are very time consuming and expensive – factors that are often glossed over in policy discussions.

David Brooks’ recent Op-Ed in the New York Times about the personality traits of CEOs leading successful companies sheds some light on the people factors in health reform. Contrary to a lot of the common wisdom about the importance of good personal connections with coworkers for success in the corporate world, Brooks cites information that the most important factors for successful CEOs are “execution and organizational skills.…

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. …

Making Health Reform Work

May 1, 2009 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Miscellaneous / No Comments

With momentum for health reform continuing to build, events have overtaken the scope of the book I’ve been writing – which has had the working title “Fixing the US Healthcare System.” Therefore, I’m reconstituting the draft text and outline to increase the focus on how to effectively implement changes in the healthcare system – while still discussing the substance of reform. To highlight the need and importance of effective implementation, the new working title is “Making Health Reform Work.” (A one page summary of the book can be found here.)

“Making Health Reform Work” will be different from other health reform books by going beyond just describing the health system’s problems and recommending solutions, to also exploring processes for effectively implementing positive changes and reforms.…

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