The Pragmatic Idealist

Abortion Fight Complicates Debate on Health Care - NYTimes .com : Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions. Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation. So, every woman has a right to control her own body . . . if she can afford it. It annoys the h...

Bad Medicine - WSJ .com : But America's health care is not doing badly. Indeed a National Center for Policy Analysis study from last March shows how much better we are doing than countries like Canada, Britain, and other European nations that have government health care control: Breast-cancer mortality is 52% higher in Germany and 88% higher in Britain than in the U.S. Prostate-cancer mortality is 457% higher in Norway and 604% higher in Britain than in the U.S. Eighty-nine percent of middle-aged women in the U.S. have had a mammogram, compared with 72% in Canada. Fifty-four percent of men in the U.S. have had a prostate-specific antigen test, compared with 16% of Canadian men. As for the availability of health care, another study shows that 74% of those in the U.S. meet for scheduled doctors appointments within four weeks, while only 42% of British and 40% of Canadians do. Only 10% of Americans wait longer than two months, while 33% of Brits and 42% of Canadians wait that long. On...

How Much Money Do Insurance Companies Make? A Primer - Economix Blog - NYTimes .com : In this week’s post, I shall walk the reader through the most recent income statement of WellPoint Inc. This is an excellent overview of the income statement of a big private insurer. The conclusion? Insurance company profits are NOT a huge component of the costs - only about 4.5% of premiums paid. By contrast, the administrative and marketing costs were more significant - about 12.5% of premiums. Nevertheless, the overall 17% to profit and overhead does not seem extraordinarily high. The author, Princeton economics professor Uwe Reinhardt, ends with a teaser for his next column suggesting that these cost and profit ratios for individually purchased health insurance policies are much worse. Stay tuned.

Findings - Looking Past Health System to Explain Longevity Gap in U.S. - NYTimes .com : An American’s life expectancy at birth is about 78 years, which is lower than in most other affluent countries. Life expectancy is about 80 in the United Kingdom, 81 in Canada and France, and 83 in Japan, according to the World Health Organization. This longevity gap, Dr. Preston says, is primarily due to the relatively high rates of sickness and death among middle-aged Americans, chiefly from heart disease and cancer. Many of those deaths have been attributed to the health care system, an especially convenient target for those who favor a European alternative. But there are many more differences between Europe and the United States than just the health care system. Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers. This is a crucially important point. The best way to improve the health of a populatio...

War Room - Salon.com : The liberal advocacy group MoveOn has teamed up with a group of actors led by Will Ferrell for a surprisingly effective ad -- one that actually defends health insurance companies. Of course, since it's MoveOn, the ad is actually satirical and they're mocking the insurance companies as a way of making the case for a public option. Funny stuff. Can't help but think this is a pretty good way to engage on this element of the debate. Protect Insurance Companies PSA from Will Ferrell

The Baucus Plan: A Winner’s Curse for Insurance Companies - Economix Blog - NYTimes.com : On Wednesday, Senator Max Baucus of Montana, chairman of the powerful Senate Finance Committee, released his health care proposal, known as the chairman’s “mark.” At first glance, the mark comes across as a victory for the private insurance industry, which is why it was promptly attacked as a sell-out by liberal pundits (see, for example, this). But the health insurance industry may yet come to see it as a variant of winner’s curse — a term economists use to describe situations in which a winner regrets getting what he wished for. . . . Here’s the problem with this plan: The cost-control measures in the Baucus plan alone will not be enough to control skyrocketing health care costs. Whatever the insurance industry may say about its prowess in the market for health services, it has always been relatively much weaker than doctors and hospitals in that market and therefore quite frequently has had to ...

The Health Care Blog: Advance Directives 101 – Do Not Call 911 : Like so many issues in health care reform the hysteria that ‘government’ was posed to step in and dictate our options as to how we would die and what final options we might have is sadly misplaced. Reality holds its own sadness because too few of us get to die the death we would choose and when we do choose our death it’s the current health care system and our trusted friends and family who inadvertently subvert our best intentions. From a nuts + bolts perspective reform is not going to begin to solve this problem. The facts are pretty clear: we spend too many precious health care resources unnecessarily late in life; we decide far to late what we do and do not want modern medicine to do for us; and, far too few of us get to die with the peace and dignity everyone deserves. The solution lies not in the health care system, nor does the blame. The solution and the blame lies with each of us and until we are willing and able...

Books - One Injury, 10 Countries - A Journey in Health Care - Review - NYTimes.com : Mr. Reid, a veteran foreign correspondent for The Washington Post, knows from personal experience that there are indeed a dozen better alternatives. International postings from London to Japan familiarized him with many of the world’s health care systems. Then a chronic shoulder problem offered the opportunity for an unusually well-controlled experiment: Mr. Reid decided to present his stiff shoulder for treatment around the world. One shoulder, 10 countries. Admittedly it’s a gimmick, but what saves the book from slumping into a sack of anecdotes like Michael Moore’s 2007 documentary “Sicko” is a steel backbone of health policy analysis that manages to trap immensely complicated concepts in crystalline prose. I am looking forward to reading this book. I was recently talking to some friends from Canada, and I began to realize just how fundamental were our differences in perspective. I believe that one ...

Poll Finds Most Doctors Support Public Option - npr.org : Now, a new survey finds some surprising results: A large majority of doctors say there should be a public option. When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. This is very interesting. The majority of doctors find Medicare to be (1) better for patients, particularly in accessibility of care and breadth of services and (2) easier to deal with administratively than private insurers. The argument that a government plan will be a bureaucratic nightmare, slower and make it more difficult to get care is certainly belied by this perspective.

Medicare Covers Transplants, But Limits Payments for Anti-Rejection Drugs - NYTimes.com : Melissa J. Whitaker has one very compelling reason to keep up with the health care legislation being written in Washington: her second transplanted kidney. The story of Ms. Whitaker’s two organ donations — the first from her mother and the second from her boyfriend — sheds light on a Medicare policy that is widely regarded as pound-foolish. Although the government regularly pays $100,000 or more for kidney transplants, it stops paying for anti-rejection drugs after only 36 months. WTF? This is one of those things that give anti-government health care folks ammunition. Absolutely unbelievable.

As I have mentioned previously, the extension of health insurance to all Americans by 2013, as proposed by President Obama, will, by itself, do nothing to control the escalating costs of health care. Rather, by increasing demand without correspondingly increasing supply, there is every reason to believe that it will put additional upward pressure on the cost curve. A point of general agreement among health care economists is that the prevalent fee for service model for the delivery of physician, hospital and other professional services is a significant source of the cost problem. This model gives strong incentives to providers to direct patients toward more, and more intensive, services, and for both patients and providers to select services and procedures that have any possibility of a marginal positive result, even if the cost is vastly out of proportion to the possible benefit. Further, economically speaking, the patient and the payer (whether the government or private insurance co...

Claim Denied? Fraud Score May Be to Blame at SmartMoney .com : The political pressure to reduce health-care costs is forcing many health-insurance companies to reconsider how they detect and combat fraud . . . . Now, insurers are increasingly focusing on a new method to fight fraud that they say is more effective and less expensive. They’re trying to detect fraud before paying a claim, says Louis Saccoccio , the executive director of NHCAA . How do they do that? The same way credit card companies try to predict the risk that a consumer will fail to pay their bills: They analyze huge databases of information to generate numeric scores. Before a claim is approved, it is scored for the likelihood that it is fraudulent. The higher the score, the bigger its risk for fraud, waste or abuse. The technology has been in the making for the past five to ten years, but health care reform has made it a more sought-after product by companies eager to show they are doing all they can to cut costs. I s...

All in all, I thought it was a good speech. Ironically enough, I think Joe Wilson's outburst was one of the best things that could have happened. The speech was largely to the undecided middle. Anything that makes the opponents of this reform look wild eyed and uncivil is helpful. Wilson stepped up and fit that bill perfectly. Excerpts from the speech and my thoughts: Text - Obama’s Health Care Speech to Congress - NYTimes.com : I am not the first President to take up this cause, but I am determined to be the last. I love this line. You couldn't ask for a clearer or more eloquent statement of executive resolve. He has doubled down here, and that is good news. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place ...

Despite Fears, Health Care Overhaul Is Moving Ahead - NY Times : While the month of August clearly knocked the White House back on its heels, as Congressional town hall-style meetings exposed Americans’ unease with an overhaul, the uproar does not seem to have greatly altered public opinion or substantially weakened Democrats’ resolve. Critical players in the health care industry remain at the negotiating table, meaning they are not out whipping up public or legislative opposition. Despite tensions between moderate and liberal Democrats, there is broad agreement within the party over most of what a package would look like. Four of the five Congressional committees considering health care legislation have already passed bills. Each would require all Americans to have insurance and provide government subsidies for those who cannot afford it. Each would bar insurance companies from refusing coverage for pre-existing conditions; imposing lifetime caps on coverage; or dropping people when t...

From Robert Reich's Blog , on what he hopes Obama demands from Congress: Most importantly, he'll need to be specific about what he wants -- especially about three things. I hope says the following next Wednesday, and makes clear to individual members that he means business. 1. I will not stand for a bill that leaves millions of Americans without health care. It's vitally important to cover all Americans, not only for their and their childrens' sakes and not only because it's a moral imperitive, but because doing so will be good for all of us . . . . 2. The only way to cover all Americans without causing deficits to rise is to require that the wealthiest Americans pay a bit extra. The wealthy can afford to make sure all Americans are healthy. The top 1 percent of earners now take home 23 percent of total national income, the highest percentage since 1928. Their tax burden is not excessive . . . . 3. Finally, I want a true public insurance option -- not a "cooper...

President's Pollster Sends Congressional Dems a Memo 44 washingtonpost.com : TO: Interested Parties FROM: Joel Benenson RE: Public Opinion and the State of Health Insurance Reform DATE: September 3, 2009 •By large margins, the American people support major reforms to the health care system. --82% of Americans say that the U.S. health care system needs either fundamental changes (55%) or needs 'to be rebuilt' (27%). (CBS, Aug. 31) •A substantial majority of Americans believe that the problems in the country's health care system will eventually affect most Americans if they are not addressed. --65% of Americans believe that the health care system's problems will eventually affect most Americans, while only 31% believe most Americans will continue to get good health care. (CNN, Aug. 31) •The desire for change is driven, more than anything else, by a desire to see a crackdown on the worst practices of insurance companies: --An overwhelming 92% say it is important to the...

Excellent reading - the Brookings Institution released this report on Thursday with a comprehensive look at structural changes to make to slow the rise in health care costs. Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth - Brookings Institution : The proposal starts from the conclusion that the standard short-term measures to address rising costs, like reducing prices, are not sufficient to succeed. Instead, legislation must support necessary changes and improvements in health care by reforming payment systems, regulations, and institutions that currently prevent patients from consistently getting the best quality care at the lowest cost. This strategy consists of four interrelated pillars. First, as a foundation for improving value, all stakeholders in the system need better information and tools to be more effective. Second, provider payments should be redirected toward rewarding improvements in quality and reductions in cost growth, providing s...

Who Will Care for the Newly Insured? - Prescriptions Blog - NYTimes.com : 2013. That’s the year everyone would have to have health insurance under the House version of the health care bill. It may seem like the far distant future — especially if you don’t have insurance now — but many experts say it’s not nearly enough time to beef up the supply of physicians necessary to care for the tens of millions suddenly entering the health care system. This is another problem that will have to be addressed. There are already significant shortages of front line medical personnel in many parts of the country. The economics of the medical educational and delivery systems push doctors toward high-end specialties and away from primary care where they are needed most. The problem gets much worse if you suddenly put millions more people with insurance into the system. One of the big concerns is the operation of simple supply and demand: without structural intervention, the injection of much more demand...

Right now, there is a status message petition cycling around Facebook : No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day. I went ahead and "signed" this, because it's good as a strong, clear statement of a guiding principle. I have some issues with it as a statement of absolutist philosophy. When ever you get into absolute statements , you get to the question of health care as a human right. Break down the statement above: "No one should die because they cannot afford health care". Interpreted one way, that's true - no one should die because they can't afford basic preventative care, well established and effective curative medicine, etc. But what about someone who is in a vegetative state that can survive an extra week only if they have a heart and lung transplant that costs a million dollars? Laying aside the scarcity of orga...

Lois Quam: Health care needs that public option StarTribune.com : Despite the criticism the proposed public option has recently received, existing public options like Medicare remain very popular. The Veterans Administration health budget will be significantly increased, and MinnesotaCare has a record number of applicants. These public options provide access to care. They are affordable. They give us peace of mind and security. There are several advantages to a public plan. It offers a national safety net ensuring that all Americans have access to a good-quality insurance option. Private insurance options are not always available in every part of the country. As it has in Medicare, a public option would guarantee for all Americans that good coverage is available everywhere and all the time. A public option also provides additional choice. Since the 1990s, Medicare beneficiaries have had a choice of staying with the traditional Medicare program or enrolling in a Medicare Advantage healt...

Obama Aides Aim to Simplify and Scale Back Health Bills - NYTimes.com : WASHINGTON — President Obama plans to address a joint session of Congress next week in an effort to rally support for health care legislation as White House officials look for ways to simplify and scale back the major Democratic bills, lower the cost and drop contentious but nonessential elements. Administration officials said Wednesday that Mr. Obama would be more specific than he has been to date about what he wants included in the plan. Doing so amounts to an acknowledgment that the president’s prior tactic of laying out broad principles and leaving Congress to fill in the details was no longer working and that Mr. Obama needed to become more personally involved in shaping the outcome. But the officials said Mr. Obama was unlikely to unveil a detailed legislative plan of his own. And they insisted that Mr. Obama had not given up on the provision that has attracted the most fire from the right, a proposal for a g...

Private, Public Health Plan Subscribers Rate Plans Similarly - Gallup Poll : A Gallup analysis of historical data finds only a slight difference in how Americans with Medicaid or Medicare versus those with private insurance plans rate the quality of care they receive, and no difference in how the two groups rate their coverage. These results are based on aggregated interviews with more than 3,000 U.S. adults, conducted in the 2006-2008 Gallup annual November Healthcare surveys. These include interviews with 1,753 Americans who have a private insurance plan and 1,049 who receive insurance through a government plan such as Medicare or Medicaid. According to the data, more than 8 in 10 Americans rate the quality of care they receive as excellent or good, regardless of the type of plan they have. Although slightly more privately insured individuals (87%) than Medicare or Medicaid recipients (82%) rate their quality of care as excellent or good, the percentage giving their plan an excellen...

Can Obama give 'em hell before it's too late? Salon : The most dangerous deficit that the United States faces is not the budget deficit or the trade deficit. It is the Democrats' demagogy deficit. Franklin Roosevelt, looking down from that Hyde Park in the sky, would not be surprised that conservatives are seeking to channel populist anger and anxiety, not against the Wall Street elites who wrecked the economy, but against reformers promoting healthcare reform and economic security for ordinary people. As he told his audience in 1936, 'It is an old strategy of tyrants to delude their victims into fighting their battles for them.' But FDR would be shocked by the inability of his party to mobilize the public on behalf of reform. I was struck most by FDR's statement about tyrants getting their victims to fight their battles. It has long amazed me how successful the right wing movement has been in getting a huge swathe of middle and lower class America to vote agai...

Who Believes in Health Care ‘Myths’? - Prescriptions Blog - NYTimes .com : A new survey finds that whether someone believes controversial statements about the health care overhaul depends on that person’s political affiliation. The survey, conducted in mid-August for Indiana University, says that when looking at statements that the Obama administration says are myths, Republicans tend to believe the statements and Democrats tend to disbelieve them. Independents, however, could go either way, believing some and not believing others, so their responses seem to be good indications of where the administration has succeeded and where it has failed. Here are the statements that independents believed and disbelieved, with assessments of each statement provided in parentheses by Aaron Carroll, director of the university’s Center for Health Policy and Professionalism Research, which helped design the survey with the university’s Center for Bioethics. Clear majorities of independents believe the...