Not many health writers -- not many writers of any ilk, for that matter -- can match T.R. Reid's ability to bring a light, witty touch to really serious topics. Like health policy around the globe.

Tom (that's what the "T" in "T.R." stands for) was the featured speaker at the Peterson Institute of International Economics today. Not the usual venue for the book tour for his best-seller, "Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care." Before his talk, he told me he was planning to stress the moral case for covering everyone. Not the approach, perhaps, that this particular crowd was used to hearing. Go ahead, I told him. It is, after all, a roomful of economists eating a free lunch.

And that's what he did.

[Last week, we reported  (see here and here) on the fact that some of the student loan industry's most fervent supporters in the financial aid world are potentially putting their schools and students at risk by refusing to take even the initial steps to prepare for a possible shift to direct lending next fall. Since then, we've been wondering how these aid directors would explain their inaction to students. So, after hearing the comments that  financial aid administrators and lenders made at last week's Lexington Institute event and on the Finaid-L listserv, we decided to write up a fictional account of how these aid officials might explain themselves. We hope you enjoy it.]

Dear Students,

As you may have heard, we have recently taken action that could potentially disrupt your ability to obtain federal student loans next fall. But we want to assure you that there is absolutely nothing to worry about. Our good friends in the student loan industry have a sure-fire strategy in place to stop any efforts in Washington that would force us to change the way we do business. And for that we're very grateful because we can't imagine doing things any other way.

Here's some background. Last month, we received a letter from U.S Secretary of Education Arne Duncan urging us to take at least the initial steps to become "Direct Loan-ready" for the 2010-11 academic year. As you may know, the Obama administration has proposed ending the Federal Family Education Loan (FFEL) program in favor of 100 percent direct lending. Under the plan, tens of billions of dollars in savings from making the switch, and eliminating lender subsidies, would be used to provide a substantial boost in spending on Pell Grants, which go to the most financially needy students. This may sound good but it won't help us much because we don't enroll many of those students. In other words, the upper middle income students we predominantly serve will be left out in the cold!

U.S. Secretary of Education Arne Duncan presented the fullest picture yet of his vision for a birth-to-8 education system in remarks yesterday at the opening of the annual meeting of the National Association for the Education of Young Children. 

 In a wide-ranging speech that emphasized the importance of "raising the bar" on the quality of early learning environments, Duncan said that early childhood advocates now face two challenges. One, he said, is the need for better transitions and "follow through" between pre-K and the K-12 years. The other is what he sees as a necessary shift in thinking about how to measure quality -- moving from "inputs" like teacher qualifications and child-to-staff ratios to "outcomes" that indicate whether children are developing and learning well.

Duncan praised the NAEYC, the nation's largest membership organization of preschools, child care centers, kindergartens and public elementary schools, for its insistence that to close the achievement gap, we must prevent the gap through high-quality early learning experiences.

"I want our schools to get out of the catch-up business," he said. "To prevent the gap," he continued, "we must be ready to dramatically improve outcomes for our children."

Here is more evidence that the uninsured fare worse than the insured. Including trauma patients in the emergency room. 

The AP's Carla Johnson reported on a troubling study published in Archives of Surgery, Downwardly Mobile: The Accidental Cost of Being Uninsured.  She writes that "uninsured [adult] patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance."

Under a 1986 law known as EMTALA (Emergency Medical Treatment and Active Labor Law), anyone who shows up in an emergency room needing emergency treatment will receive treatment to stabilize him or her. That statute is intended to "prevent hospitals from rejecting patients, refusing to treat them, or transferring them to ‘charity hospitals' or ‘county hospitals' because they are unable to pay or are covered under Medicare or Medicaid."

If polling on health reform were a band, we'd call it The Hold Steady.

Several new surveys out this week show the public remains as conflicted as ever on health reform -- convinced of the need for change, but worried about the impact on their lives and the lives of their family.

A Washington Post-ABC News poll released Tuesday shows 48 percent of those surveyed supported the proposed reforms; 49 percent opposed them. An AP poll released Monday found a similar split, with 41 percent in favor; 43 percent opposed and 15 percent undecided.

These even divides are consistent with past polls, suggesting that the uproar in August was more of a bump in the road than turning point. However beneath the topline questions are some interesting trends.

Last week, Medicare's chief actuary (formally known as the Office of the Actuary, or OACT) released an analysis of the financial impact of the health reform legislation recently approved by the House of Representatives (H.R. 3962).  Here are a few thoughts:

Get familiar with the source.  Remember their history.  The Medicare and Medicaid actuarial team's job is to track and understand Medicare spending patterns.  By design, it is also their job -- and their historical pattern -- to be skeptical about proposals for change. Just for context, the office's estimate of the cost of the Medicare Modernization Act in 2003 (the bill that created the Medicare prescription drug program, Part D) was $100 billion, or 25 percent, more than the Congressional Budget Office's (and CBO is also conservative by nature and design).  Last year CMS's Chief Actuary testified to Congress that the 10-year cost of the Medicare drug benefit is 37 percent lower than originally projected in 2003, and 17 percent lower than the previous year's updated projections.   Don't get me wrong. We need conservative estimators to prevent Pollyanna policy from being enacted into law.  But we should take that conservatism for what it is: a useful check on the naturally optimistic expectations of reformers.

In July we analyzed funding for K-12 school facilities in the student loan reform bill, the Student Aid and Fiscal Responsibility Act, as passed by the House Education and Labor Committee. The full House passed the bill in September and preserved the $2.0 billion per year school repair program. Although the Senate has not yet acted on a similar student loan reform bill, a version drafted by the Senate Health, Labor, Education and Pensions Committee was leaked a couple of months ago. The leaked bill suggests the Senate is headed in a different direction than the House when it comes to funding school facilities construction.

Both of these pieces of legislation provide a glimpse into the federal government's first major foray into directly funding K-12 school facilities and neither propose an insignificant amount of money. The most striking difference between the two versions is that the House includes a two-year, formula-based investment in K-12 school facilities, and the Senate bill creates a five year competitive program for K-12 school repair, renovation, and construction.

Senate Foreign Relations Committee Ranking Member Richard Lugar (R-IN) and House Foreign Relations Committee Chairman Howard Berman (D-CA) have jointly written a compelling case to end the travel ban for all Americans desiring to go to Cuba....

The Center on Budget and Policy Priorities concludes that the idea of raising the Medicare payroll tax "on high-wage earners would represent a sound and well-targeted way of paying for health reform."

Senate Majority Leader Harry Reid is reportedly considering raising the Medicare payroll tax  to 1.75 percent (up from 1.45 percent) for individuals earning more than $200,000 a year and couples earning more than $250,000 a year. Reid needs to fill a health reform financing gap if he raises the threshold for taxing the so-called "Cadillac" plans to $8,500 for individual plans and $23,000 for couples (up from $8,000 to $21,000, respectively). Scaling back the reach of that excise tax would please labor unions, among other groups, who have expressed opposition. The Medicare alternative has quickly gained popularity.

The CBPP report has several interesting conclusions:

Even if President Obama weren't getting to China just now, it would be worth checking out the illustrated feature "Nine Nations of China," by Patrick Chovanec, which has just gone up on our site. Given the visit, it's all the more timely...