Health Reform

Like true love, the road to health reform seldom runs smoothly. Just as a good therapist helps couples identify their emotional pitfalls, the Politico's Chris Frates gives health reformers a bit of counseling about their vulnerable points.

Frates highlights five important questions in the health reform debate. But just like in any good therapy session, we really should "talk it out."

• The economy. Frates argues that while the economy could "spawn trouble" for the health reform debate, it could also allow Congress and the Administration to sell health reform as "the next step in our nation's economic recovery." As Len Nichols said in a recent blog post, our economic crisis has only made the flaws in our current system more evident. Further, the connection between health care and the economy has never been clearer. We will soon invest some $800 billion to spur job growth, but if we are going to stabilize our economy for the long-term, we must also fix our health care system.
• Turf War? Under different circumstances, the jurisdictional duties of the Senate HELP and Finance Committees could stall health reform. But as Frates points out, Baucus and Kennedy (on the heels of the Daschle withdrawal) sent a joint letter to President Obama reaffirming their commitment to work together to enact health reform this year. All indications point to serious collaboration between the two committees.
• Speaking of... (who should be the next Daschle?) As David Axelrod said following Daschle's withdrawal, "[health reform] has great power of its own." Losing Daschle is a bump in the road to health reform, but it doesn't diminish the urgency for reform.

California is among the states currently experiencing mind-bending budgetary shortfalls. Eventually returning to a period of wealth wisely will depend on fixing health care systems that were strained to a breaking point even before the crisis began. Here are some highlights from an event on Monday that The New America Foundation's Next Social Contract Program and its California Program co-hosted at the Commonwealth Club in San Francisco: "California, the Crisis, and the Next Social Contract: Staying Healthy, Wealthy, and Wise in Challenging Times." (We'll link to the webcast when it's available in a few days.)

Reinventing Government guru David Osborne kicked off the event with a presentation that laid out starkly how, unless brought under control, spiraling health spending will keep the states in permanent fiscal crises. Throughout the rest of the morning, the issue of health care costs kept rearing its head in panels on topics from economic development to education. As it turns out, making progress on any policy issue of importance to state governments will first require getting these costs under control.

We've written repeatedly about quality and safety, checklists, infection control, the Institute for Healthcare Improvement—and about pockets of resistance to achievable change that will improve patient care (and usually save money). Today's Washington Post has a story by and about an infectious disease consultant, Dr. Manoj Jain, whose skepticism evolved into conviction. In two years, his hospital cut ICU infection rates in half and reduced costs by 21 percent per ICU discharge. Good for the health care system. Definitely good for the patients. And more satisfying for the health care team.

 
The whole column is a quick good read, but here's a good excerpt:

The latest employment numbers continue to paint a bleak picture for the economy. Almost 600,000 Americans lost their jobs last month, increasing the nation's unemployment rate from 7.2 percent in December to 7.6 percent in January.

Losses continued to be largest among manufacturing (207,000 jobs) and construction (111,000 job). Health care remained one of the few areas of job growth, adding 19,000 jobs in January.

Also released today, was a new analysis by the Lewin Group for Families USA looking at insurance coverage among the unemployed—specifically those with incomes below 200 percent of the federal poverty level ($44,100 in annual income for a family of four). Key findings:

Very rarely is an industry willing to reform itself. But a diverse coalition of six CEOs from across the health care industry came together yesterday to form Health CEOs for Health Reform (HC4HR). The group brings together leaders from across the health care industry who share a unique willingness to transform their business models to create a more sustainable health system.

The founding six CEOs of HC4HR are:

• Bruce Bodaken, Chairman and CEO of Blue Shield of California;
• Lloyd H. Dean, President and CEO of Catholic Healthcare West;
• Kenneth Frazier, President of Global Human Health for Merck & Co.
• Patricia Gabow, CEO of Denver Health
• Gary Kaplan, Chairman and CEO of Virginia Mason Medical Center in Seattle;
• Nicholas Wolter, CEO of the Billings (Mont.) Clinic.

The CEOs unveiled their new coalition in an event at the National Press Club yesterday (video below) and you can find statements from each of the group's members in this press release. The group's efforts will be facilitated by the New America Foundation's Health Policy Program, directed by Len Nichols.

HC4HR is built on the following three principles:

We really liked this piece by James Kvaal at the Center for American Progress on health care costs. We've made a lot of the same points ourselves (in fact he quotes one of our studies) we liked how he pulled it all together, and agreed with his conclusion: "Health reform can generate large economic benefits." See for yourself.

CAP also has a memo on some of what went wrong in 1994. We do see some differences this time around, a potentially constructive dialogue unfolding with some interest groups that blocked reform in the 90s, new leaders at some of these organizations who are making a different assessment of health care's role in economic recovery. So we don't think history is doomed to repeat itself; we hope it won't. Still, it doesn't hurt to look back and remember where we've come from and hope we don't go there again.

A few weeks ago we wrote about a small study indicating that health costs had contributed to the mortgage meltdown which in turn has wrought havoc with the entire global economy; it found that 49 percent of foreclosures had a health-spending factor (and keep in mind that people miss work or lose their job—and their insurance—when they or a family member become seriously ill) Today's Wall Street Journal takes a look at people squeezed between paying for medical bills or the mortgage. The Journal didn't come up with a firm number of how many foreclosures are health related—except that it's a lot.

Just how many people are being forced to choose between home and health care is hard to tell. Freddie Mac, the big government-sponsored home-loan investor, says illness appears to be a growing reason homeowners with some of the company's 12 million mortgages are falling behind in payments. Illness was the chief cause for 15% of Freddie Mac's delinquencies in the first half of this year, behind such reasons as loss of income and too much debt. Although that percentage is down from previous years, the actual numbers are higher because more people are delinquent on their loans.

 

 

 

 

For Jeff Bridges in The Big Lebowski, doing nothing was an art. But while the Dude abides, in health care, doing nothing is simply no longer an option.

This is more than "just, yeah, well, you know, your opinion man," as the film said. It's the conclusion of a growing number of policy makers and pundits, who look at numbers and see that the cost of doing nothing to fix our broken health care system is greater than cost of reforming the system to make it work for all Americans.

A new report, released yesterday by the New America Foundation, helps make this point at both the state and national level.

We've mentioned Community Care, North Carolina's innovative Medicaid program for chronic disease management, briefly in the past but today's News and Observer takes a detailed look. Community Care has been shown to save money —and improve the quality of care for Medicaid patients with conditions such as diabetes and asthma. The savings are impressive—$100 million a year, or $2 for every $1 the state spent on the program, which covers 810,000 Medicaid patients in "medical homes" through 14 nonprofit networks around the state.

The patients are monitored closely, so that conditions are kept in check and complications and hospitalizations are minimized. Case managers work with physicians and other providers, hospitals, public health and social service agencies to coordinate comprehensive care and make sure that patients don't fall through the cracks and that transitions—say after a hospital admission—are handled smoothly. Doctors get paid a fee to compensate them for the time-consuming aspects of care coordination and management that are often go not reimbursed.

"When Representative Tom Price spoke to the Roswell Kiwanians the other day, the first three questions concerned health care. When he appeared four days later before the Sandy Springs Rotarians, no one asked about it at all."

That's the lead on a New York Times story today on how health care is playing with voters. As Kevin Sack wrote, "Health care is an issue that can seem to vacillate in importance by the day, the place, and the audience." But he quotes Price, a conservative Republican physician from Georgia who holds Newt Gingrich's old seat, as saying that it's still one of the top three issues for every demographic group. While focusing on the presidential race, the piece also looks at how health care is playing out in congressional elections too.

We hope both parties keep talking about health care, because health care is one of those things where if there's no talk, it's unlikely that there will be any action. And just in today's news, here are some good reasons to keep talking:

1) Voters are confused. Very confused. They want to slow down health spending, but are having trouble figuring out which candidate would do what with which consquences. As Gary Andres writes in the Washington Times: