The Alliance for Health Reform has released the first chapter in the new edition of Covering Health Issues—an online guide to the major topics in health policy. From national health reform to local health disparities, each chapter provides readers with the basic facts, background on the issue, and overview of the likely policy debates.
The first chapter, written by our colleague Joanne Kenen, tackles the issue of health reform in its entirety. Kenen lays out likely policy debates, noting that "this time around, politicians and policymakers are talking about the intertwined issues of coverage, cost and quality." She provides an overview of the ongoing debates in each, while also addressing related reform issues such as public health and health information technology.
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The stimulus package, signed into law on Tuesday, provided a "down payment" on comprehensive health reform by funding two initiatives, health information technology and comparative effectiveness research, that stand to create jobs and lay the foundation for a high-quality, efficient delivery system.
To prevent states deep in the red from shedding hundreds of thousands from their Medicaid rolls, the stimulus allocated billions to the program. For workers who've lost their jobs—and hence their insurance—since September 2008, the stimulus provides a 65 percent subsidy for COBRA premiums. Those provisions will help many people. But it won't fill in the health coverage gaps for everyone. Noam Levey in the LA Times takes a look at who the stimulus helps and who it doesn't.
The New York Times' Robert Pear examines the content and contentiousness of the comparative effectiveness provisions of the $787 billion stimulus package.
HR 1 provides $1.1 billion (pdf starting on page 156) to AHRQ, NIH and the HHS to evaluate the relative effectiveness of different health care services and treatment options. The goal is to create a process of funding and disseminating comparative effectiveness research that is transparent, professional and free from conflicts of interests. As the Dartmouth Atlas' Elliott S. Fisher, MD, tells Pear, the funding would be used to try to answer questions such as:
Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of "talk therapy" and prescription drugs to treat mild depression?
It's not just the blogosphere that's agog about some of the pretty astonishing things being said about comparative effectiveness. Steven Pearlstein's Washington Post column debunks some of the wild arguments being made against the comparative effectiveness and health IT provisions in the stimulus bill. Pearlstein provides an insightful look at how the controversy got started and addresses the alarmist rhetoric. He rightly points out:
There's nothing particularly new about comparative effectiveness research—the National Institutes of Health, along with the Agency for Healthcare Research and Quality, have been doing it for years, with a budget last year of about $335 million....nearly all experts agree (comparative effectiveness research) is a necessary first step to reforming a broken health-care system.
Pearlstein punches holes in the argument that the research would lead to denial of appropriate care and makes the case that our health system would be, well, healthier if we had better information on what works and what doesn't:
Congress is set to pass a $787 billion economic stimulus package—with more than a $130 billion in health-related funding. The House is expected to vote this afternoon, with the Senate scheduled to follow suit this evening.
Congressional leaders worked late into the night Thursday, to reconcile he House and Senate versions of HR 1. The conference report detailing the compromises in the final legislation is available from the House Committee on Rules. Just how late were lawmakers up hammering out the details? The 496-page pdf is filled with handwritten notes and last-minute edits.
The Washington Post's Ceci Connolly reports that Wal-Mart, once widely critiqued for having many uninsured workers, is now seen as an innovator. She writes about how the huge retailer is expanding coverage, trying to control costs, and experimenting with care management programs to improve outcomes and quality. The company still has its critics, naturally, but its efforts also say a lot about what businesses can (or can't) do in the current health care climate:
In a promising sign for health care delivery system reform, a Pennsylvania nonprofit substantially reduced costs and improved outcomes for Medicare patients with chronic illness in a care management study. The success of this trial—and the limited accomplishments of others in this experiment—provides more evidence of the need to involve physicians in any disease management reform.
The February edition of JAMA describes 15 care coordination trials started in 2002 by CMS. The pilots tested the ability of care coordination programs to keep elderly, chronically ill patients out of the hospital, on diet and exercise regimens, and otherwise improve health and lower spending.
The results demonstrate three major points. First, the concept of a patient-centered medical home may not be easy to put into practice, but it can work. The Pennsylvania pilot gave high-utilization patients monthly
In less than two weeks, on February 24, President Obama will address the Congress in what amounts to his first State of the Union. Health care, The Atlantic decided, couldn't wait that long.
Hosting a State of the Union for Health Care on Wednesday, the magazine brought together experts from across the health care spectrum to lay out where we are and where we need to go in the coming year.
In terms of where we are, much should sound familiar to our readers. Health care costs too much. It covers too few, and the care it does provide is too often mediocre.
As David Walker, President & CEO, Peterson Foundation, told the audience, health care is our nation's single largest fiscal challenge, with the potential to bankrupt our government and cripple our competitiveness. The fact that some 46 million are left without health insurance, Walker said, was shinola.
Imagine plunking down more than $2 trillion a year and not knowing what you are getting for it. Imagine that what you are purchasing gets more complicated and convoluted every year. Imagine that lives, literally, hang in the balance.
Then imagine that someone comes up with a sensible approach to solving or at least shrinking the problem. And they get hit on the head for their efforts.
Welcome to the world of comparative effectiveness.