Health Policy Program: Latest Articles

Making Practices Perfect

Articles — Tue, 26 Aug 2008 11:58:00 -0400

The waiting room of Ramona Seidel's family medicine practice is empty, and she works hard to keep it that way.

After several years in a traditional suburban group practice that blended pediatrics and family medicine, Seidel quit to start her own micro-practice in Annapolis: a low-overhead, high-tech office that gives her more control over how she treats patients and more time to spend with them. She's happier. Her patients are happier. And she's pretty convinced they are healthier having a physician who knows them well.

"It's more friendly; it's personal. She's very good about giving answers. It feels comfortable talking to her," said Ronald Porciello, 41, a contractor… more

Senators Don't Lead Such Charmed Lives

Articles — Tue, 01 Jul 2008 07:16:00 -0400

They’ve lost loved ones to plane crashes and suicides. They’ve survived polio and torture. They’ve had coworkers gunned down. They get diagnosed with brain tumors.

It sounds like an Oprah reunion, but these are members of the United States Senate.

Many people think of the Senate as a place filled with millionaires who lead charmed lives. In reality, their personal lives seem less charmed than the lives of many Americans.

Everyone experiences sadness in life -- a broken marriage, a serious injury, the deaths of loved ones. That holds true for politicians too, but a surprising number of senators have suffered an extraordinary tragedy in their lives.

Even in an… more

Crossroads in Quality

adminn — Tue, 13 May 2008 11:43:00 -0400

Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost. We identify five fundamental building blocks for a high-performance health system and urge action to create a national center for effectiveness research, develop models of accountable health care entities capable of providing integrated and coordinated care, develop payment models to reward high-value care, develop a national strategy for performance measurement, and pursue a multistakeholder approach to improving population health.

* * *

For the full text of this essay, please see the… more

The Long Road To Health Reform Requires Bipartisan Leadership

adminn — Tue, 13 May 2008 09:27:00 -0400

The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10:

make health reform a top legislative priority; be leaders, not partisans; and develop broad policy consensus but leave the policy details to Congress. more

The New Specialty In Cancer Care

Ron Tang — Wed, 02 Apr 2008 07:50:00 -0400

On November 11, 2000, Mark Quasius, then 37, learned that the strange sensation in his right ear was caused by a rare carcinoma in his upper sinuses.

After a variety of treatments, including multiple surgeries on his head, lungs, pancreas, and hip bones, the prognosis for his advanced adenoid cystic carcinoma is pretty good. After consultation with Andrew Putnam, MD, a palliative care specialist at Lombardi Cancer Center and Georgetown University Hospital, his life is pretty good too. Dr. Putnam brought Quasius’s unrelenting pain from the tumor behind his right eye under control after surgeons concluded that, for now, the risk… more

Why the Budget Gap Shouldn't Derail Health Care Reform

adminn — Tue, 15 Jan 2008 15:06:00 -0500

As Gov. Arnold Schwarzenegger has released his budget threatened by $14 billion of red ink, many are asking whether California can afford the ambitious health care reforms that passed the state Assembly in December. Given the social and economic costs of leaving as many as 6.5 million Californians uninsured, the better question may be: Can we afford not to? Those worried by the possible impact of the budget gap on health reform include Senate President Pro Tem Don Perata, whose chamber must vote for the health reform bill for it to move forward. Perata's concerns must be taken… more

On the Moral Superiority Of a Single-Payer System

Ron Tang — Tue, 01 Jan 2008 00:00:00 -0500

David DeGrazia has sketched out a health reform proposal that combines the monopsony purchasing power of a single public payer with managed competition among health plans and implicitly among providers, alone or in groups. The proposal differs from the archetypal “Medicare fee-for-service for all” model in creative ways, and indeed it is developed to address some of the standard fears about whether a single-payer system squelches choice and incentives for innovation. But DeGrazia’s truly novel claim is that this version of single payer is the “most morally defensible reform model.”

That is a strong statement, and difficult to prove or disprove,… more

John Chafee’s Work for Health Reform

Articles — Mon, 10 Sep 2007 13:13:00 -0400

Last month, the Census Bureau estimated that 2.2 million people became uninsured in 2006.

With rising numbers of uninsured Americans, and the administration’s decision to wage war against children’s health insurance in hopes of stifling comprehensive health reform, we would be remiss not to examine the last time our nation seriously contemplated a system of coverage for all Americans.

In March 1993, Sen. John Chafee (R-R.I.), the leader of a bipartisan group of senators trying to strike a deal on health-care reform, made a plea to his colleagues on the Senate floor, “We owe it to ourselves and to the… more

On California's Quest for Health Reform

Articles — Thu, 30 Aug 2007 06:16:00 -0400

Twenty-five years ago, 49er quarterback Joe Montana connected with Dwight Clark on a last-minute miracle pass that changed the history of pro football forever. The metaphor for saving California health-care reform in 2007 resides in that memory.

Several national media reports of the death of reform are premature. But we are truly down to the final minute. Gov. Arnold Schwarzenegger’s original plan was good, but not perfect. Those for whom the perfect is the enemy of the good have effectively blocked it. Republican legislators refuse to consider whether investing in Californians’ health might be worth the cost. Some left-of-center advocates… more

IHS Reforms Long Overdue

Articles — Mon, 27 Aug 2007 13:19:00 -0400

On the Crow Indian Reservation this month, U.S. Sen. Byron Dorgan (D-ND), and Sen. Jon Tester (D-MT), led a hearing of the Senate Indian Affairs Committee, addressing the severe lack of federal funds and management for the Indian Health Service. IHS officials, including acting chief medical officer Dr. Charles North, and tribal members testified to the shortage of qualified health professionals, closure of health facilities and cancellation of programs midway through the fiscal year.

A bipartisan collection of senators primarily from the Senate Indian Affairs Committee are co-sponsoring legislation that would foster improvement within IHS. These changes would include, for example,… more

Health Care, Toyota Style

Articles — Fri, 15 Jun 2007 07:23:00 -0400

Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston and author of the taboo-busting Running a Hospital blog, wrote recently about a dilemma he faced involving the "da Vinci Surgical Robot." Levy has been advised that without purchasing a new da Vinci robot, the hospital’s prostate surgery volume will plummet because others will market this new treatment even if it’s not superior to current procedures -- and it might not be.

Last year, Levy reported that less invasive robotic surgery is proven to be no better than "open" prostate surgery -- on measures such as success removing cancer, retaining… more

Where’s Obama’s Mandate?

Articles — Mon, 04 Jun 2007 06:22:00 -0400

What do John Edwards, Ron Wyden, Arnold Schwarzenegger, and Mitt Romney have in common? They each studied our health care mess and concluded that an individual mandate (along with reformed insurance markets and subsidies for people with low incomes) must be part of any comprehensive solution. This growing consensus makes it all the more puzzling that Barack Obama chose not to make mandates part of his initial health care proposal for the 2008 campaign, which he unveiled last week.

Americans instinctively recoil from mandates and regulations. "Don’t tread on me" reaches out from our Revolutionary heritage and lives on, deep… more

The Moral Case for Covering Children

Articles — Sun, 01 Apr 2007 20:55:00 -0400

Abstract: Before the crucial upcoming debate over reauthorization of the State Children’s Health Insurance Program (SCHIP) and all of the 10,000 general health reform questions that this discussion will engender, we should consider one fundamental moral question, for our answer will reveal the kinds of policies we actually want to pursue: Who should be allowed to sit at our health care table of plenty?

This essay sketches an answer to this question, drawing on the literature of various faith traditions as well as recent health services research. The short answer is: Everyone, but poor kids have a special place reserved for… more

Enable a Moderate Health Care Solution

Articles — Sat, 30 Sep 2006 02:18:00 -0400

From sea to shining sea, many Americans agree: Our health care system is broken. The uninsured now exceed 46 million and health costs keep growing faster than incomes, facts that strain household, employer, and government budgets alike. Awareness of mediocre quality and poor safety performance is spreading beyond academic whispers to mainstream headlines. Still, Washington fiddles and tries to change the subject. Why the chasm between awareness and action?

Consider this: Political extremists, with an iron grip on each party, don’t really want to solve the problem, for that would require acknowledging holes in their world views. This is why power… more

Mr. Businessman, Help Heal the Sick

Articles — Sun, 30 Jul 2006 14:02:53 -0400

Healthcare reform in California is at a potential turning point: Business has taken a seat at the bargaining table.

Some members of the state’s new business vanguard participated at Gov. Arnold Schwarzenegger’s healthcare summit last week. Steven Burd, chief executive of Safeway Inc., talked about his company’s rising health insurance spending and said it usually takes a crisis to bring about change. Calling healthcare costs a crisis, he urged business to get involved.

Business cooperated early in President Clinton’s campaign to reform the nation’s healthcare system in the beginning of the 1990s. But many employers came to fear the politicians, worrying that… more

Prescribe a Smart Fix for NY Healthcare

Articles — Thu, 25 May 2006 16:20:01 -0400

With health care costs entering their fourth straight year of double-digit increases, everyone -- employers, providers, the insured and the uninsured -- is wringing their hands about the rising costs of health care.

To deal with the angst, New York either needs a heavy dose of anti-anxiety medication or an honest solution to the growing health-care mess.

Two starkly different plans now on people's lips in Albany purport to offer the latter. One, modeled after the new law championed by Massachusetts Gov. Mitt Romney, I'll call Romneycare. The other, dubbed Fair Share, is endorsed by unions… more

Real Solutions Needed for Small Businesses

Articles — Wed, 17 May 2006 16:20:01 -0400

The United States Senate is embroiled in a debate over SB 1955, a bill that purports to help small businesses purchase health insurance. Offered by Sen. Mike Enzi, R-Wyo., the dialogue on finding solutions for small businesses is critical.

While most Americans (61 percent) obtain health insurance from employers, this is true for just over half of Californians. Small businesses are California's economic engine, and yet, higher premiums and administrative barriers make it much more difficult for small businesses to purchase insurance. California insurance premiums have increased 60 percent between 2000 and 2004, and small businesses have seen… more

Is Medicare the Cure for State's Gridlock?

Articles — Sun, 19 Mar 2006 00:00:00 -0500

President George W. Bush recently accomplished something almost no one else could in California politics: He got Gov. Arnold Schwarzenegger and the Legislature to put politics aside to pass a new law to meet a real need in real time.

Through the ill-prepared implementation of the new Medicare drug plan, Bush gave the governor a chance to work with the Legislature on an emergency fix to the new federal drug program. The poorest of elderly California seniors, who had been getting their prescription drugs from Medi-Cal, were in danger of getting no drugs because Medicare wasn't ready. In just… more

Wal-Mart Bill is No Solution

Articles — Thu, 12 Jan 2006 00:00:00 -0500

WASHINGTON -- Attacking real or imagined health care villains, though sometimes necessary and always fun, will not make health care more affordable today or tomorrow unless we also face hard facts and reform our system. It is broken and our leaders know it, but courage to talk about real solutions is scarce, so most stick to diversionary tactics.

The ultraliberals' diversion is to blame capitalism and greed, to pretend that employers could just pay more while insurers and providers could charge less, which would occur under the magic of total government control.

Marching toward… more

The Best Care Anywhere

Articles — Sat, 01 Jan 2005 04:00:00 -0500

Quick. When you read "veterans hospital," what comes to mind? Maybe you recall the headlines from a dozen years ago about the three decomposed bodies found near a veterans medical center in Salem, Va. Two turned out to be the remains of patients who had wandered months before. The other body had been resting in place for more than 15 years. The Veterans Health Administration (VHA) admitted that its search for the missing patients had been "cursory." Or maybe you recall images from movies like Born on the Fourth of July, in which Tom Cruise plays a wounded Vietnam… more