Investment for Health Reform – Escaping the Valley of Death

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The debate about health reform has mostly focused on expanding insurance coverage and controlling costs.  However, successfully improving the US healthcare system will require some long-term quality improving investments.

The stimulus bill (ARRA) included two such investments.  The $1.1 Billion for Comparative Effectiveness Research has been widely discussed because it is important, and a very large percentage increase in the Federal Government’s spending in this area.  But the ARRA bill also included $10 Billion to increase NIH’s funding.

The significance of the increased NIH funding is twofold:  First, it will provide expansion of biomedical research related jobs.  And second, it will help the NIH increase the work it does in translational research, which should help biomedical research build a better bridge over what the Parkinson’s Action Network and others have labelled the “Valley of Death.”…

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30% Off Health Care

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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.)

30% off health care coupon

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.” …

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Humana on Health Reform

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Humana has added another “educational” to its YouTube series – this one is about “why do we need health reform.”

It’s a good question, and since I’ve been somewhat critical of other Human videos, I feel obligated to say that this one is OK – mostly because it doesn’t contain too much substance, i.e. it’s a mile wide and an inch deep.  And I do want to give the writers credit because the video starts by answering the question about what is health reform and why do we need it by stating, “The simple answer is…. Well there is no simple answer.”…

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Butterfly Effect in Health Reform

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A short piece about Tom Daschle in last week’s National Journal made me think about the importance of the presence, actions, and attitudes of individuals for the direction, success and failure of health reform initiatives.  This is sort of like the “Butterfly Effect” of health policy. [Background:  The “Butterfly Effect” is a thought experiment related to chaos theory, and is based upon the theoretical concept that how a butterfly flaps its wings can dramatically change the weather thousands of miles away.]

Senator Daschle was very qualified to lead the Administration’s efforts on health reform, but several factors led to his removing himself from consideration to be Secretary of HHS. …

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Culture of Health Reform

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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. …

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Health Reform With a Public Plan or Not?

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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:

  1. 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
  2. Public and private plans face different financial pressures, i.e.
…

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Comparative Effectiveness, Efficacy, Evidence Based Medicine, P4P, etc…

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Comparative Effectiveness Research (CER) is being talked about more and more as a fulcrum for controlling healthcare costs.  For example:

  • The Congressional Budget Office issued a report on CER in December 2007 and has highlighted it in more recent analyses and reports about health reform options
  • The ARRA legislation included $1.1 Billion for CER
  • ARRA included language for the IOM Committee on Comparative Effectiveness Research Priorities to provide a report by June 30, 2009 about how to spend the $400 million allocated to HHS for CER.

All this discussion has kept me thinking about how CER will be done, how the results from this research will actually be used to improve quality and reduce costs, and what are the scope of healthcare issues that CER is, will, or should be applied to help improving.…

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Health Reform Dialogue – Does and Doesn’t Achieve…..

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The self-named Health Reform Dialogue of executives from 18 leading health and business organizations met for 6 months and released its report on Friday.  Consensus within this group is better than no consensus, but I’d hoped for a bit more substance in their report – which is what usually comes out of projects facilitated by the Keystone Center.

The group apparently did agree on an individual mandate to have insurance – but their inability to agree on a public plan option for all individuals reportedly led to 2 unions leaving the project before its completion. However, the report also includes some items that are so general they don’t pass the head scratching, “that’s so obvious but where are the specifics?”…

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Precedents and Comparisons for Health Reform

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Discussion of health reform this year often touches upon how the process and substance are so different than what occurred in 1993-4, even though many of the people engaged in the current effort were also involved then too.

Historical events are clearly important for setting the political and policy environment for any legislation, and in healthcare there are very clear examples of stagger-stepping to success:

At the Federal level, health insurance/coverage laws and proposals date back to the 1930s:

  • National health insurance for the elderly was supposed to be the second part of a new social safety net – after the creation of Social Security
  • Medicare and Medicaid were created in 1965.
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Transparency & Accountability for Physicians in Health Reform

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Yesterday I had the opportunity to give Medical Grand Rounds at Caritas Carney Hospital in Boston on the topic of “Health Reform 2009 and Beyond.”  Rather than compare and contrast various national health reform proposals, I reviewed the major forces and trends that are reforming healthcare, and explained how they would likely impact different stakeholder groups – particularly physicians.

I started by discussing the major trends in cost, access and quality – noting how the first two are easier to quantify and that the debate over access to healthcare services versus insurance coverage has been resolved in favor of health insurance coverage, because only having access to free clinics and emergency rooms doesn’t enable people to get the type of healthcare that they really need. …

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Medical Case Management – Making It Work

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Jeffrey Krasner had a great article in yesterday’s Boston Globe about his experience trying to manage and coordinate his Mom’s care.  As a very experienced health reporter in a city dense with advanced health care delivery and health policy wonks, his story of problems getting care coordinated amongst her physicians and having her medical records transferred is very illuminating.  However, for those of us who have spent time trying to help friends and relatives navigate the medical care maze, it is not surprising.  (I went through a somewhat similar situation with my Aunt several years ago.)

While some people conclude that the solution to this complexity is a national health system, I believe that creating more standardization and accountability within our existing structure is a much more practical answer. …

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Health Reform Challenges and Prospects

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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. …

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