Health Reform

What is comparative effectiveness research? If you need a reminder: comparative effectiveness means comparing two or more treatments for the same health problem to see which one works best for patients. The question has popped up quite a bit since comparative effectiveness research showed up in the economic stimulus package alongside other common sense health reforms, such as health IT adoption. Comparative effectiveness is about giving doctors and patients more information and facts for decision-making, not about taking away their autonomy.

Growing up, we used to tell the days of the week by what was on TV that night. Thursday's were The Simpsons. We remember this because of Louise Norris's perfectly illustrated, Simpsons-themed edition of Health Wonk Review over at Colorado Health Insurance Insider.This weeks a edition features a guest post on our blog from Dr. Ira Byock putting a personal face on advance directives and dicussions of end of life care.

One of the nice things about our jobs here at the New America Foundation is that we get paid to do things like read Gail Collins. So since today is really gray and wet and yucky here in Washington, and we're stuck in one of those capital of the free world moments of Waiting for the CBO, we're gonna share her latest column. You can pretend you are working too.

In troubled times, it is important to try to maintain a certain level of serenity. Right now we citizens have quite a lot on our plate and there is no reason to go completely crazy about the least little thing. 

For instance, at that right-wing tea-party rally in Washington last week, it seemed a little weird when Jon Voight warned the crowd that if President Obama wasn't stopped, the United States would wind up with a health care system like New Zealand's.

At the time, I could not help wondering what New Zealand ever did to Jon Voight. Also if he's made any movies since the one where he got eaten by a really big snake.

The Swiss might eat more chocolate per capita than people from any other nation in the world, but you wouldn't know it by looking at their health care stats.

Some say that Switzerland's health care system can provide inspiration, or serve as a model, for the restructuring of the U.S. health care system. Switzerland spends 10.8 percent, or $7,076 USD per capita (30 percent less than the U.S. spends per capita), of its gross domestic product on health care. They boast excellent health care service and enjoy long and healthy lives. Moreover, according to several indicators, the Swiss are healthier than Americans and are, as Nelson Schwartz of The New York Times reports, "generally happy with their system." (Switzerland does, however, still have high health care costs -- exceeded only by the United States and Norway.)

Harvard University's Regina Herzlinger, whom I listened to speak at an AARP and Swiss Embassy event last week, has done extensive research on Switzerland's health care system. In an article for the Journal of the American Medical Association (subscription only), she selects three U.S. states that have similar socioeconomic and population characteristics to Switzerland and demonstrates how the Swiss have lower health care expenses but equal or better health outcomes than the U.S.:

First, thank you to all our veterans for their service and sacrifice.

This Veteran's day we're a bit caught up in the upkeep of grant reports, so he's a quick run down of the news and issues that caught our attention:

Tuesdays with Harry: Politico reports that Senate Majority Leader Harry Reid took procedural steps yesterday that would allow him to open debate on a bill Tuesday next week. Of course there a lot that needs to happen before then, including the release of bill with CBO scores, but still, it's a good sign that things are moving in the Senate.

My Life, Your Work: Former President Bill Clinton spoke to Senate Democrats at their weekly meeting Tuesday. His message? Git'er Done. "The worst thing to do is nothing," Clinton told reporters.

In its Room for Debate section, The New York Times asks a group of health experts what one or two provisions could be added to health reform legislation to help contain health care costs going forward. Below is my contribution to the discussion. For more on the issue, you can read my colleague's post on the real versus the ideal options for slowing the growth of health care costs.

The Medicare payment reforms in both the House and the Senate bills will help to slow the growth of costs by rewarding value over volume, as will the proposed Medicare commission and the tax on insurers who offer high-cost health plans, which are in the Senate Finance Committee bill. And both House and Senate legislation also includes “innovation centers” which will allow us to test different payment models and health care processes.

Even with these steps, the reform bills could be strengthened. Specifically:

Academics and think tanks (including us) may pump out issue briefs and op-eds and blog posts about how to slow down health care spending, but Washington is still full of skeptics about whether or not health reform legislation will truly bend that cost curve.  

Leave it to Rahm Emanuel, President Obama's Chief of Staff, to give us our favorite quote on the curve-bending ideals versus curve-bending politics. He told the New York Times:

Let's be honest. The goal isn't to see whether I can pass this through the executive board of the Brookings Institution. I'm passing it through the United States Congress with people who represent constituents... I'm sure there are a lot of people sitting in the shade at the Aspen Institute -- my brother being one of them -- who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.

The baton has been passed from the House to the Senate and the latest reports suggest legislation may come to the floor as early as Monday next week. The Hill's J. Taylor Rushing lays out how things could play out in the Senate:

Senior aides and senators say Democrats plan to pivot quickly and file the first procedural vote as early as Monday. A "motion to proceed" vote, which brings the bill to the floor, would require 60 votes -- a first, critical test of the caucus's unity on procedural votes.

Senators don't expect any momentum from Saturday's successful 220-215 House vote, however. They say the most realistic scenario is for a Senate vote by Christmas followed by final passage in mid-January.

That would allow sufficient time for House-Senate conference talks and final House-Senate votes during January's first weeks. Such a scenario would also put final passage around the time of President Barack Obama's State of the Union address.

Roll Call's Emily Pierce has more on the logistics and politics of this move:

Health bloggers were so busy linking to David Leonhardt's excellent New York Times Magazine piece on the lessons about cost and quality drawn from Intermountain Healthcare that we nearly overlooked another piece in the magazine -- a profile of conservative activist Dick Armey -- that tells another, more alarming, story about the politics and ideology of health reform.

Armey and FreedomWorks had a hand in the angry and chaotic town hall meetings of last summer. (Freedomworks isn't the same as the Tea Party, but they overlap.) And health care, for Armey, isn't just about health or care.  It's a vehicle for the rise of the right. The economic conservative far right. The right that wants to stop government in its tracks. Or shrink it. The right that believes the American way is all about the rights of individuals, not the needs of community. And of course, the "rights" of individuals have to do with things like the flat tax, not health coverage. The right to health care, however, doesn't seem to figure in here too much.

The U.S. lags behind other leading industrial democraties in primary care, according to a new study from the Commonwealth Fund. The report, A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences, surveyed doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. It found the U.S. falls behind significantly in access to care, the use of payment incentives to improve health care quality, and utilization of health information technology.  

Health IT. The U.S. lags behind every surveyed country except for Canada in health IT adoption. In the Netherlands, New Zealand, Norway, the U.K., Australia, Italy, and Sweden, over 90 percent of doctors use health IT, while in the U.S., only 46 percent of doctors use health IT. (It's worth noting that the U.S. has prioritized funding for health IT through economic stimulus package, and approximately $1.2 billion in grants has gone out to health IT development and implementation since data collection for this study concluded in July 2009.)