Health Reform

Massachusetts doctors strongly support their state's three year old health reform initiative, according to a study appearing in the New England Journal of Medicine.

Seventy percent of practicing physicians in Massachusetts -- specialists and primary care doctors -- support health reform, and 75 percent want to continue the policies (although nearly half want some changes), according to the Harvard School of Public Health study funded the Robert Wood Johnson Foundation and the Blue Cross Blue Shield of Massachusetts Foundation.  

Only 13 percent of physicians in the state oppose the health reforms created through the legislation, and just seven percent believe the policies should be repealed.

The findings suggest that it is possible to provide near-universal coverage of the population and have a resulting system that most physicians believe improves care for the uninsured without undermining their ability to provide care to their patients," said Harvard professor Robert Blendon, one of the study's authors, (and as our regular readers know, a favorite go-to guy for insights into to the politics of health reform.)

When it comes to health reform at a state level, the state that gets the most attention is usually Massachusetts. But other states, such as Vermont, Hawaii, and recently, Wisconsin, are starting to get recognition for their innovations. Different states have different priorities and strategies to accomplish the goals of reform. While Massachusetts, for example, focused on expanding coverage with an individual mandate to purchase health insurance, Wisconsin started simplifying and building on existing public health programs to expand coverage, says a new report.

In the world of state health reform, Vermont often plays the Jan to Massachusetts' Marcia. However, preliminary evaluations suggest that other states and policymakers would do well not to ignore New England's favorite middle child. My colleague previously wrote about Vermont's most recent legislative action on health reform passed in May of 2006. Now, a study published by the Robert Wood Johnson Foundation this week updates us on Vermont's achievements. Here are some of the successes from the Year 1 Interim Report:

The Nationals may have never had a shot at the playoffs, but Washington's senators are still playing hardball in October.

Much of the action centers on the public plan, which has reemerged as one of the central issues in merging the Senate's HELP and Finance bills.

Senate Finance Chairman Max Baucus told reporters on Monday that he believed a "pure public option" did not have the votes to pass the Senate, but that there were many options on the table that could form the basis of a compromise.

People hear "medical home" and they aren't exactly sure what it means. Judith Graham of the Chicago Tribune explains.

It's a new model of primary care that can address a lot of what drives us crazy in U.S. medicine  (at least those of us with doctors and insurance). There isn't yet precise agreement on what a medical home is, or who it should serve, but usually the idea is a way to improve primary care, with particular emphasis on prevention and control of chronic conditions such as asthma or diabetes.

So instead of long waits and rushed visits, Graham writes, imagine this:

Shocking news from the Boston Globe's Liz Kowalczyk: minimally invasive prostate removal, often performed with surgical robots like the da Vinci, more than doubled the rates of incontinence or impotence experienced by patients compared to those who opted for traditional open surgery.

Not good.

The study, which has solid but imperfect methodology, was published recently in the Journal of the American Medical Association. Other findings: success at controlling the cancer was about the same; minimally invasive got patients home in two days instead of three, and those patients also had fewer short-term complications like respiratory problems. In a nutshell, short-term effects were better with minimally invasive; long-term effects were better with traditional surgery.

According to the Globe, the study's lead author doesn't think the surgical robot itself is the problem:

Every Christmas, our Uncle Billy makes Italian sausage. In addition to various ground meats, he uses a rotating cast of cheeses and spices, along with the some well-guarded Testa family secrets (our guess: orange zest added to the fennel seeds). It's a big undertaking, full of cranks and casings. But it's nothing compared to the sausage making ahead for Congress on health reform.

The New York Times sets the stage in the House and Senate, laying out the challenges faced by Speaker Nancy Pelosi and Senate Majority Leader Harry Reid as they try to craft legislation that can pass their respective chambers of Congress and be merged into a final bill that President Obama can sign into law.

The challenge for Ms. Pelosi is to write a measure with sufficient coverage and benefits to appease the left wing of her caucus without alienating too many of the moderate and conservative Democrats whose votes she needs. [...]

Mr. Reid may have the more difficult job since Ms. Pelosi, of California, has a larger majority as well as stricter House rules that limit opportunities for Republicans to slow the process.

"Phil Ellis may be the most powerful guy you've never heard of in the health-care debate," Lori Montgomery of the Washington Post writes. She's right. We confess that most of us were none too familiar with the guy who sticks the price tag on health reform.

Meet Phil Ellis. He recevied his undergraduate degree from Stanford, a Masters in public policy from Harvard and a Ph.D. in economics from MIT. He used to work for the Treasury Department and at the Department of Health and Human Services. He joined the Congressional Budget Office in 2002 and now heads its health insurance modeling unit.

And boy has he got influence.

The CBO, recognized for its objective analyses, is responsible for determining the impact of health reform on the federal budget. Ellis has the final judgment call, and his estimates already doomed two legislative proposals.

Hawaii is a popular destination for anyone seeking sun, sand, surf, or even volcanoes. It's also a top spot for affordable health care coverage.

As The New York Times reported this weekend, Hawaii has the lowest Medicare costs per beneficiary and is tied with North Dakota for the nation's lowest health care premiums. People in Hawaii also tend to live longer than those elsewhere in the United States. As we've mentioned before, Hawaii ranks as one of the top states when looking at health indicators that represent health care access, quality, costs, prevention and treatment, equity and health outcomes.

There are many different theories as to what causes relative health and longevity in Hawaii's population. April Donahue, executive director of the Hawaii Medical Association, told American Medical News Hawaii's population typically has a healthy diet. The Times interviewed a number of doctors and hospitals, and found answers ranging from an active population to a significant military presence to dominance by just a few non-profit insurers in the market.

Unlike many university presidents, former HHS secretary Donna Shalala makes time to teach, and she offers a course on health reform.  When she assigned a paper on how to fix US health care, one student handed in a one-sentence paper:

"Campaign Finance Reform."

Shalala, now president of the University of Miami, gave him an "A."

As an academic, HHS secretary during Bill Clinton's health reform effort (and its aftermath), the head of a large university (which means a large purchaser of health insurance) and, for a time, a member of a health insurers' board of directors ("I wanted to see it from the other side") Shalala has seen health policy from many perspectives.

Addressing  a workshop for writers who specialize in health and health policy in Miami the other night, Shalala said she is increasingly confident that reform will pass.  "I think we are going to get a bill," she said. "You can see the contours of a deal." 

The center of the Democratic party, she continued, was pretty close to where the center of the country is.  Consensus is in reach -- even if we have "a lot of people moaning and groaning."