The New Health Dialogue

"Check please!" may be the easy way out of a bad date, but Americans are finding it increasingly hard to pick up the tab on health care, according to a new survey from the Commonwealth Fund.

Examining data from its biennial survey, Commonwealth finds that in 2007, nearly two-thirds of U.S. adults—or 116 million people—were either uninsured for some or all of the year, were underinsured, had trouble paying medical bills, and/or went without needed health care because of cost.

Reported in the Washington Post, the findings have also been picked up in the blogs. Jonathan Cohn over at The New Republic gives his take on the survey noting, the high costs of health care are hitting home for all income groups. Health Populi's Jane Sarasohn-Kahn takes an in-depth look at the survey's findings on medical debt. (Check out Commonwealth's specific companion brief on medical debt here).

Workers Comp Insider hosts the latest edition of Health Wonk Review, including a post by New America's Len Nichols. Len wrote about how journalists are covering some aspects of the health reform debate, but they aren't addressing some of the confusion about the proposals to cap or scrap the income tax exclusion. (Actually the roundup says I'm the author, but Len wrote it, I just emailed it over to the Workers Comp folks so ignore that part! They call it this week's the Health Wonk Review Beach Blogging Edition, so we're giving them a little slack).

Changing anything as complex as health care can lead to unintended consequences and perverse incentives, and some health care providers see the "Never Event" initiative as chock-full of them. (Here's an article from Health Leaders Media, I'll come back to it in a moment.)

The "Never Event" policy means that Medicare will stop paying for certain avoidable errors; some states and major private insurers are following suit. Patients wouldn't have to pay themselves for the extra care, but the hospital wouldn't get reimbursed for the cost. CMS, the agency that runs Medicare, has announced one set, effective this October, and has proposed a second set for 2009 which is still being evaluated and going through the rule-making process. Medicare based its decisions on work by the National Quality Forum (NQF). We'll add both lists to the bottom of this post.

Newspapers pride themselves on quality reporting, but USA Today today reported quality -- releasing online risk-adjusted death rates for heart attacks, heart failures, and pneumonia for every U.S. hospital over the past two years.

Last year, CMS began reporting these stats along with other quality measures on its Hospital Compare website, listing how a hospital compared to the national average. But it did not then list the specific death rates (or risk-adjusted 30-day mortality rates, to be precise) used to make the comparison. Now, they've decided to make this information available to the public, releasing the numbers in advance to the Nation's Newspaper to help raise awareness of the resource. Not a bad choice, considering the nifty mapping tool USA Today put together, which allows you to compare the death rates for the three measures at every hospital in every state. Check out the screenshot for a query of the heart attack death rates for 2006-07 in the District of Columbia below:

Here at the New Health Dialogue we like to highlight reform at the state level because they serve as "laboratories of democracy." One such laboratory, Massachusetts, is succeeding in its efforts to ensure access to affordable health insurance for all Massachusetts residents.

Most recently, Governor Patrick and the Health Care Finance and Policy Division of the state government put out a report on key indicators of health care in Massachusetts. And, almost all of the indicators point to good news.

The Health Affairs Web site has several perspectives on Health IT, as well as the first in a series of companion essays on what it all means. The main perspectives come from Carol Diamond of the Markle Foundation (read her guest posts on NHD here and here) and Clay Shirky of NYU, who emphasize how IT fits into health, not just the technical standards aspects, Robert Kolodner, HHS's Health IT national coordinator who updates us on federal policy, and David Kibbe of the American Academy of Family Physicians, who sums up what the private sector is doing. If you have followed this issue at all, you'll know these players, but it's a useful recap. Keep in mind that the CBO has emphasized that IT isn't a magic bullet—it's got to be used in a way that improves health and health care if it's going to reap all the savings that everybody's been talking about.

The New York Times continues its "The Evidence Gap" series, this time examining new vaccines that aim to prevent cervical cancer. It's been a terrific series of articles, underscoring what many in the health policy world have come to accept, but too few in the real world of patients (and often their doctors themselves) understand: more and new medicine isn't always better medicine; and, we often spend money on drugs, tests and procedures without really knowing if they are more helpful than simpler or older and cheaper alternatives.

Next week the U.S. Census Bureau will release its updated estimate of the number of uninsured people—now officially at 47 million. David Colby at the Robert Wood Johnson Foundation helpfully assembled some accessible foundation-backed papers and issue briefs on who the uninsured are, what being uninsured means, what the federal environment for change looks like now, and how the states have or have not stepped up. Here's the link to the series "The State of Research on the Uninsured: Putting Census Estimates in Perspective" and we're providing a few of the summaries and abstracts below. We'll post a similar brief guide to some of our own issue briefs and papers on the uninsured before the Census numbers come out.

Harry and Louise are back. Older and ever so much wiser.

The infamous Harry and Louise ads were created by the insurance industry in the early 1990s and widely credited with helping kill President Clinton's health care plan.

Now Harry and Louise are back, urging the next president—whoever that turns out to be—to finally fix U.S. health care.

Lots of things have changed since 1992-94. For starters Harry (whose real name is Bob) and Louise (whose real name is Louise) are married in real life now. They have a website. www.HarryandLouisereturn.com. And naturally they are on YouTube:

The latest Kaiser Family Foundation tracking poll finds that one-in-four Americans are struggling to pay for health care, with lower-income and sicker people predictably facing steeper challenges.

While health care doesn't figure quite as prominently on the political agenda as it did a year or so ago—the economy is by far the top issue for Democrats, Republicans, and Independents alike—it is still on voters' minds, coming in fourth overall (see chart below). Plus health care is part of Americans' economic anxiety. Health care ranks as a "serious problem" above paying for food (18%), problems with debt (16%), and paying the rent or mortgage (15%); but, it ranks below paying for gas (37%) and slightly below getting a good-paying job or raise in pay (26%).

Asked what aspect of health reform should be a priority for the next president, the top priority was making health care and health insurance more affordable (see chart below). Covering the insured placed second overall—for both Republicans and Democrats, although the coverage issue did resonate more for Democrats. Most of those surveyed thought Democratic Obama was more likely to make health reform a priority than Republican McCain.