Healthcare, health policy, cognitive science. , and the path to Universal Healthcare..
McKinsey: What Matters: Way too much for way too little
The title says it all. A great review of the American health care non-system.
Goes over administrative waste (83 cents of premium dollars go to actual health care at most in PHI market), outcomes, costs and prices, administrative burden, practice variation, and rationing (QALY’s CER).
Some good response letters as well.
Letter – Schumer Health Care Plan – NYTimes.com:
“Re “Schumer Points to a Middle Ground on Government-Run Health Insurance” (news article, May 5):
There are a number of problems with Senator Charles E. Schumer’s so-called middle ground on universal health care. While your article acknowledges some of the structural ones — like whether a federal program could ever be subject to state laws — it doesn’t acknowledge the major issue: What is best for health care consumers?
What system is going to provide the best care? How can we provide meaningful health care to the greatest number of people with the resources available? What policies can we carry out now to ensure that there will be sufficient caregivers to meet our needs in the future?
These are the questions that we should be asking. As an advocate for consumers, I am distressed to see yet another health care discussion that focuses on the impact on insurance providers’ bottom line. The fundamental purpose of the health care system is to provide health care, not to protect and perpetuate an industry.
Richard Mollot
Executive Director, Long Term
Care Community Coalition
New York, May 5, 2009″
Well said. I was listening to a Center for American Progress Podcast of a talk given to them by Max Baucus, and I kept thinking, where is the vision? It was mostly about how we were stuck with working with our current system and tweaking it into some public-private amalgam that would be “uniquely American.” This is disappointing in many ways, but I primarily am disappointed that he reflects that stubborn conservative world view that we cannot learn from other countries, that their experiences mean little or nothing to us. If you take that view, then transformational change is impossible to envision, and you are stuck with timid change.
But also troublesome is the complementary idea that America cannot do this, because we must think so timidly, in such limited ways. JFK said, “we choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”
Where is THAT America, Senator Baucus, Senator Schumer?
Health Policy Public Opinion Data Aggregation: h/t to Blue Texan at FDL for pointing me to this, thanks to www.pollingreport.com for putting it together!
CNN/Opinion Research Corporation Poll.
Feb. 18-19, 2009. N=1,046 adults nationwide. MoE ± 3
“In general, would you favor or oppose a program that would increase the federal government’s influence over the country’s health care system in an attempt to lower costs and provide health care coverage to more Americans?”
| Favor | Oppose | Unsure | |
| 2/18-19/09 | 72% | 27% | 1% |
CBS News/New York Times Poll
Jan. 11-15, 2009. N=1,112 adults nationwide. MoE ± 3
“Should the government in Washington provide national health insurance, or is this something that should be left only to private enterprise?”
| Government | Private Enterprise | Unsure | |
| 1/11-15/09 | 59% | 32% | 9% |
| 1/79 | 40% | 48% | 12% |
Quinnipiac University Poll.
Nov. 6-10, 2008. N=2,210 registered voters nationwide. MoE ± 2.1 (for all registered voters).
“Do you think it’s the government’s responsibility to make sure that everyone in the United States has adequate health care, or don’t you think so?”
| Think It Is | Don’t Think So | Unsure | |
| 11/6-10/08 | 60% | 36% | 4% |
| Republicans | 34% | 63% | 3% |
| Democrats | 84% | 12% | 4% |
| Independents | 56% | 39% | 5% |
| 5/8-12/08 | 61% | 35% | 4% |
| 10/23-29/07 | 57% | 38% | 5% |
| 2/13-19/07 | 64% | 31% | 4% |
Luntz to GOP: Health reform is popular – Politico.com Print View: “Luntz’s 10 pointers in “The Language of Healthcare 2009”:
(1) Humanize your approach. Abandon and exile ALL references to the “healthcare system.” From now on, healthcare is about people. Before you speak, think of the three components of tone that matter most: Individualize. Personalize. Humanize.”
You know, pretend to be human, to care, to have a soul, and all that liberal sissy stuff.
Schumer Offers Middle Ground on Health Care – NYTimes.com:
“Scorched by Republican opposition to the idea of a new public program like Medicare, Senate Democrats are looking for a middle ground that would address the concerns of political moderates. One way they propose to do that is by requiring the public plan to resemble private insurance as much as possible.
“The public plan,” Mr. Schumer said Monday, “must be subject to the same regulations and requirements as all other plans” in the insurance market. Democrats in Congress hope to shift the debate from the question of whether to create a public health insurance plan to the question of how it would work. In so doing, they look for the support of influential moderates. But in the last few days, three moderate senators — Ben Nelson, Democrat of Nebraska; Olympia J. Snowe, Republican of Maine; and Arlen Specter of Pennsylvania, who switched parties to become a Democrat — have expressed reservations about a public plan.
Insurers also remain skeptical. Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said, “We are very, very grateful that members of ongress have been thoughtfully looking at our concerns.” But she said she still saw no need for a public plan “if you have much more aggressive regulation of insurance,” which the industry has agreed to support.
Linda Douglass, a White House spokeswoman, said that Mr. Obama was for a public plan but that he realized it could be defined in different ways. Mr. Schumer said his goal was “a level playing field for competition” between public and private insurers.
But Ms. Ignagni said, “It’s almost impossible to accomplish that objective.””
…with high corporate salaries, really nice corner offices, expensive buildings, luxury sports boxes and all those other bare necessitites of modern corporate life!
Firedoglake also has a good post on this as a capitulation.
And Rachel Maddow reported tonight about White House talked about offering some concessions in the HC reform debate and that, in return, the Republicans offered (wait for it!) nothing!
Groups strategize for single-payer plan – Politico.com Print View:
“President Barack Obama and Senate Finance Committee Chairman Max Baucus (D-Mont.) rarely pass up a chance to snub single-payer health care — a term that means a government-run system. So opponents on the left who want their voices heard in the debate over health care reform are planning to yell a little bit louder as Congress considers creating a public insurance plan to compete with private insurers.
“Their strategy is simple: By pushing hard for single-payer health care, a robust public insurance option ends up looking like a compromise Democrats could accept.
““The best way to get half the pie is ask for the whole pie,” said Katie Robbins, assistant national coordinator of Healthcare-Now, which will not endorse the public plan but acknowledges the strategy. “It is like horse trading.””
…
“And here is a hint about why proponents and opponents of the public plan talk so frequently about “choice”: It polls really, really well. Support for the public plan jumped to 78 percent when people were told it would give consumers more options. “
Congressional Health Care Caucus
I found this website, apparently the nexus of pushing back on Democratic attempts at halth care reform.
It is fairly lame, in my estimation, largely reminding readers how horrible the rest of the world has it and how the free market and charity care can still fix it all, in spite of a half-century of evidence to the contrary. You know, let private health insurance CEOs and bureaucrats do whatever they choose so that we can be protected from government bureaucrats.
Anyway, one of the things that I always hear from conservatives, and is found in a primer written by Congressman Michael Burgess, MD, is that medical innovation will come to a screeching halt if we get universal health care. He points out that 22 of the past 25 Nobel Laureates in Medicine were Americans.
So, I checked it out on Wikipedia, and I will admit I only checked out the most recent 10 or so, but would you be shocked to learn they all worked at Universities or large, well-funded, non-profit foundations (like the Howard Hughes Insitute)? Me neither.
Paperwork, profits clog health care’s efficiencies:
DEAN CALBREATH, San Diego Union Tribune
“Jim G. Kahn, health economist at the Institute for Health Policy Studies at the University of California San Francisco, found a similar pattern during a study of California hospitals, clinics and doctors’ groups. He found the doctors’ groups were spending an average of 14 cents per dollar related to legal, accounting and processing costs involved with health insurance.
““You have to have teams of lawyers and accountants to negotiate contracts and to figure out who pays for what,” Kahn said. “You have to have whole teams in place to figure out what errors there are (in the paperwork) and how to fix them.”
“Kahn said that in a single-payer system like Canada’s, the data are centralized, resulting in less time, money and effort being spent on administrative tasks. “And then you could apply that savings to provide better health coverage,” he said.
“Critics of a single-payer concept worry that a government-run system would end up being too costly and too bureaucratic, without providing the benefits of innovation and cost-cutting that competition is supposed to bring. But if that were true, why does our system cost more than those abroad?
“The entities that seem to benefit most from the current system are the major pharmaceuticals, which are among the nation’s most profitable companies, and the life insurers, which have also done well.
“Donald Cohen, executive director of San Diego’s Center for Policy Initiatives, a liberal think tank, said the top seven for-profit health insurers made a combined $12.6 billion in 2007, an increase of more than 170 percent from 2003. Part of those profits go toward paying high salaries for the top executives. The seven chief executives received an average compensation of $14.3 million in 2007, with pay packages ranging from $3.7 million to $25.8 million.
“Cohen suggested that one way of lowering costs would be to create more competition, by having a government health plan competing with the private insurers. Government-run programs, he said, typically run with low administrative expenses, often with overhead running at 1 percent to 3 percent of their expenses. In contrast, the privately run insurance firms have overhead costs as high as 20 percent, partly because of their high salaries.
“As Cohen noted, conservative think tanks like the Reason Foundation, Heritage Foundation and others have argued that allowing the private sector to compete with the public sector can benefit the taxpayer. Why shouldn’t the reverse be true?
““Public-private competition in health insurance will squeeze overhead and profits from the middlemen in the system so we can put more money into actual health care,” Cohen said. “
Reforming Health Care – washingtonpost.com:
The WaPo decides a public option is a bizarre fixation…
“Of the many possible issues that could snarl health-care reform, one of the biggest is whether the measure should include a government-run health plan to compete with private insurers. The public plan has become an unfortunate litmus test for both sides. The opposition to a public plan option is understandable; conservatives, health insurers, health-care providers and others see it as a slippery step down the slope to a single-payer system because, they contend, the government’s built-in advantages will allow it to unfairly squash competitors.
“For liberals, labor unions and others pushing to make health care available to all Americans, however, the fixation on a public plan is bizarre and counterproductive. Their position elevates the public plan way out of proportion to its importance in fixing health care. It is entirely possible to imagine effective health-care reform — changes that would expand coverage and help control costs — without a public option.”
The comments excoriate them, for the most part.
“But embracing the eight principles does not mean the AMA necessarily backs every idea on health reform that Obama has revealed so far. For instance, the president has called for creating a public health plan option linked with a national health insurance exchange to serve as competition for private plans. In its letter to the White House, the AMA says it supports a health insurance exchange to ensure coverage choice and portability, but it does not weigh in on the public plan option. To move toward universal coverage, Congress should build on the employer-based system and strengthen the safety net provided by publicly financed programs such as Medicare, Medicaid and the Children’s Health Insurance Program, Dr. Nielsen and Dr. Rohack wrote.
“Dr. Nielsen stressed that the organization is mindful of the need to watch the dollar signs as policymakers work toward the goal of universal coverage. ‘It’s very important for us that all Americans have health care coverage that’s affordable. But we do understand that we can’t afford everything for everybody, so we need to have fiscally responsible conversations.’
“The letter proposes expanding on Obama’s principles in a number of ways, including:
The “8 Principles” of Obama are at the end of the article.
I do wonder why the AMA is pushing back on the public option. It seems to me the only chance physicians have of keeping reimbursement rates reasonable because private insurers will do their darndest to NOT wring savings out of the system (except on the provider side!), and so all that money is money not available to providers. One man’s waste is another man’s revenue.