Health Reform Fact and Fiction

August 14, 2009 / Michael D. Miller MD / Health System Reform, Politics / No Comments

In this blog I try to explain the meaning of different aspects of healthcare reform, delivery, financing, research, etc. Sticking to that goal has left me a bit stymied in seeking to write about the current state of the “debate” as it is being played out in Congressional town hall meetings and in the press via partisan talking heads.

My simplistic conclusion is that the balance between policy and politics has now swung so far and hard to one side that the needle is firmly wedged against the peg of politics. While the needle may bend from all this pressure, it doesn’t seem to be leading to any improvement of healthcare costs or quality. …

Unfortunate Diversion from Health Reform Message

July 23, 2009 / Michael D. Miller MD / Health System Reform, Information & Communications, Politics / 2 Comments

It was unfortunate that President Obama answered the question about Professor Gates at his news conference last night because it has dramatically diluted the focus of his message from health care reform to this unrelated story. Many news organizations are covering his remarks on that one subject with less recognition of his health care reform message. While the Washington Post and NY Times lead with the health message, they also include articles about the Professor Gates. Conversely, the Boston Globe (not surprisingly) and CNN.com highlight the Professor Gates story over healthcare. (MSNBC.com and cbsnew.com have health reform coverage more prominently that the Professor Gates story, while abcnews.com…

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. …

Wavering Health Reform

July 12, 2009 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Politics / 1 Comment

As news of some disharmony in the efforts to reach consensus for health reform legislation sprayed out from Washington, I’ve been trying to find the words to explain what this means. It’s always been clear that the “devil is in the details” and that when it came time to forge enough agreement to pass legislation, (as it did last week), there would be ups and downs as provisions are modified, dropped and added.

Beyond that simple description, it would take many, many words to explain how the process for achieving success in health reform legislation could work. So instead, below are some pictures, that I hope will be worth thousands of words more than the brief comment below each one.…

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.…

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. …

Improving Cancer Care in Medicare

May 5, 2009 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Delivery of Healthcare, Innovation, Politics, Quality of Care & Safety, Therapeutic Substitution & Interchange / 1 Comment

This week’s AMA News includes an article about how cancer care for Medicare beneficiaries has improved because of a provision in last year’s Medicare Improvements for Patients and Providers Act (MIPPA). The provision of interest clarified that Medicare Part D plans need to pay for off label uses of medicines to treat cancer when there is supportive evidence in the peer-review literature. This changes became effective January 1st, and for at least one patient, it has improved their care. (See the Medicare Rights Center’s press release about the coverage appeal they won for a client because of the new law.)

However, as I noted in an interview with the American Medical News ReachMD Radio-XM 160, (See MP3 audio file below), because the change only applies to cancer treatments, patients with other serious and life threatening illnesses may still find their treatment options limited. …

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.” …

Butterfly Effect in Health Reform

April 16, 2009 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Politics / No Comments

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. …

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. …

«‹2 3 4 5 6 ›»