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Maryland’s Health Care Solution
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Maggie Mahar,
The Century Foundation,
2/8/2010
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While health care reformers argue about what it would take to “break the curve” of health care inflation, the state of Maryland has done it, at least when it comes to hospital spending. In 1977, Maryland decided that, rather than leaving prices to the vagaries of a marketplace where insurers and hospitals negotiate behind closed doors, it would delegate the task of setting reimbursement rates for acute-care hospitals to an independent agency, the Maryland Health Services Cost Review Commission. Continue Reading on the Taking Note Blog.
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The Snapshot: Public Continues to Support Health Care Reform, but Needs Clarity on Congressional Bill
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Ruy Teixeira,
The Century Foundation,
2/5/2010
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President Barack Obama in his State of the Union address doubled down on his commitment to health care reform, which disappointed conservatives who were hoping he’d run away from that commitment. And he left conservatives fuming about his claim that the health care reform plan in Congress suffered from a lack of clear explanation. How can he say that, the conservatives argue, when recent events like the Massachusetts Senate election show that voters have rejected the whole idea of comprehensive health care reform?
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Autism and the MMR: Finally a Retraction
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Naomi Freundlich,
The Century Foundation,
2/4/2010
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Are we finally ready to close the door on the much-disputed link between the MMR vaccine and autism?
On January 30, Britain’s General Medical Council ruled that Andrew Wakefield, a gastroenterologist, had acted “dishonestly and irresponsibly” in conducting his research that established a link between autism and the MMR vaccine. Continue Reading.
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Medicaid Needs More Than A Short-term Fix
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Naomi Freundlich,
The Century Foundation,
2/2/2010
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Health reform may be stalled in Congress, but you need only look to the overburdened Medicaid program to find evidence of the continued toll the current economic crisis is taking on Americans’ ability to afford and access medical care.
At the same time that states are experiencing huge budget deficits, more and more of their residents are unemployed; more and more are joining the ranks of the uninsured and clamoring for Medicaid benefits. Continue Reading on the Taking Note blog
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SOTU and Health Care
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Maggie Mahar,
The Century Foundation,
1/28/2010
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In his address to the nation, President Obama made it clear: Jobs are now his #1 priority. This is what most Americans wanted to hear. They fear that he has spent too much time on health care, and has not paid enough attention to climbing unemployment. This does not mean that they oppose health care reform legislation—it’s just that there are tired of hearing about it. And the need for jobs is more pressing. Continue Reading on the Taking Note Blog.
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The State of the Union and the Economy: Why We Need Health Care Reform Now
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Maggie Mahar,
The Century Foundation,
1/27/2010
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According to the headlines, 10 percent of Americans are unemployed. The truth is that closer to 17 percent of the population cannot find full-time work; this number includes workers who have become discouraged and have given up looking for work as well as those who have settled for part-time jobs because they cannot find the full-time employment that they need. Continue Reading.
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Anecdotal Evidence Does Not Make Good Policy
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Naomi Freundlich,
The Century Foundation,
1/14/2010
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Recently, a series of anecdotes appeared on the website People’s Pharmacy, posted by readers who suffer from depression. They detail how switching from name brand antidepressants to generics—or in some cases from one generic to another—caused a return in symptoms. Here’s one excerpt: Continue Reading.
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The Unions Strike a Deal and The Truth About the Cadillac Tax
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Maggie Mahar,
The Century Foundation,
1/14/2010
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The Washington Post reports that union leaders are close to cutting a deal with Democrats on the so-called “Cadillac tax,” the 40% tax on expensive insurance plans that the Senate has proposed to help fund health care reform. According to the Post, unions would be exempted from the tax, for two years following the 2013 effective date, giving them time to negotiate new contracts with employers. For other reports on the negotiations, see Kaiser Health News. Continue Reading.
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Persuading Canadians to “Hustle Off to Buffalo”
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Maggie Mahar,
The Century Foundation,
1/12/2010
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If you drive from Buffalo, New York to Ontario, Canada, you’re likely to see this message on highway billboards: “Fast-track Your Medical Procedure Here.” The red arrow on the sign points Canadians to Buffalo’s Kaleida Health, a five-hospital health care system located minutes from the U.S.-Canada border. Continue Reading.
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The Snapshot: The Weakness of Conservative Opposition to Health Care Reform
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Ruy Teixeira,
The Century Foundation,
1/11/2010
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In recent polls, more of the public opposes than favors the health care reform bills in Congress. Conservatives would have you believe that the opposition plurality in these polls is a result of public distaste for a big government takeover of our health care system. Not so. In a December CNN poll, a total of 55 percent either favored the Senate health reform bill outright (42 percent) or opposed it at this point because its approach to health care isn’t liberal enough (13 percent). Just 39 percent said they opposed the bill because its approach to health care was too liberal.
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Fact-Check: The Cadillac Controversy
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Maggie Mahar,
The Century Foundation,
1/6/2010
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“Cadillac Health Care Plans.” Even the phrase suggests gilt-edged insurance for Greedy Geezers at Goldman Sachs . No wonder the Senate wants to slap a tax on insurers and self-insured employers who offer over-the-top policies beginning in 2013.
After all, plans that fetch more than $23,000 for families (or $8,500 for individuals) must encourage over treatment, right? Continue Reading on the Taking Note Blog.
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Glass Half Empty / Glass Half Full
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Maggie Mahar,
The Century Foundation,
12/17/2009
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Does anyone remember the original goal of healthcare reform? I could type it in my sleep: “to provide high quality, affordable care for all Americans.”Today, the goal has shrunk; the current Senate compromise aims only to make certain that 30 million uninsured Americans have insurance--which may or may not provide access to the care they need. Continue Reading on the Taking Note Blog.
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Gawande and Berwick on Why Reform Legislation Cannot Lay Out a “Master Plan” – Part 2
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Maggie Mahar,
The Century Foundation,
12/15/2009
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Boston surgeon Atul Gawnde and Don Berwick, the president of the Institute for Health Care Improvement, understand that we can create a sustainable, universal U.S. healthcare system only if we reduce costs. And they recognize that by spending less, we can, in turn, lift the quality of care. As Berwick puts it: “The best health care is the very, very least healthcare that we need to gain the long and full and joyous lives that we really want.” Continue Reading on the Taking Note Blog.
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Gawande and Berwick On Why Reform Legislation Cannot Lay Out A “Master Plan”
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Maggie Mahar,
The Century Foundation,
12/14/2009
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“Where is the plan to make health care affordable?”
“I want to see the savings.”
“Show me the money: Lay it out in simple language-- on one page.”
Critics of health care reform legislation have become increasingly adamant on one point: They want to know how reformers are going to rein in the skyrocketing cost of care. Continue Reading.
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Prevention: An Apple-a-Day Isn't Gonna Cut It
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Naomi Freundlich,
The Century Foundation,
12/11/2009
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There is much to be hammered out before a final health reform bill emerges from Congress. Disputes over the public plan, abortion, financing and when reforms will actually take effect continue to delay progress. But on one thing, apparently, there is broad consensus: Nearly everyone supports prevention. In fact, a recent poll found that 71% of Americans favor increased investment in disease prevention and believe it will save money in the long run. Continue Reading on the Taking Note Blog.
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The Gang of Ten’s “Solution”: This is What Happens When You Give Five People Too Much Power– Part 1
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Maggie Mahar,
The Century Foundation,
12/9/2009
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Last night, the news broke that the “Gang of Ten” (the Senators who have been trying to break the deadlock between moderates and liberals) had come up with a two-part alternative to the public option. Under their proposal, Americans 55 to 65 could buy in to Medicare if they choose—and if they could afford it. Meanwhile, for Americans under 55, the public option would be replaced with non-profit private insurance plans overseen by The Office of Personnel Management, the group that now administers the Federal Employees’ Plan. Continue Reading.
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The CBO Report: Looking Past Premiums to Total Cost
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Maggie Mahar,
The Century Foundation,
12/7/2009
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Those who oppose reform have been using the recent CBO report to claim that, under the Senate bill, many Americans will pay more for health care.
That’s not what CBO said. A careful reading of the report suggests that even people in the individual market will wind up paying less because under reform, insurance is likely to cover more of their health care costs. Continue Reading on the Taking Note Blog.
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The Snapshot: Public Backs Investment in Prevention
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Ruy Teixeira,
The Century Foundation,
12/2/2009
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A blizzard of health care polling is being produced as we get closer and closer to final resolution of the issue in Congress. Much of this polling tends to be duplicative and doesn’t really tell us anything new. But here are some findings that actually expand our understanding of the public’s views in this area
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Merck’s Cholesterol Drugs—Low Hanging Fruit?
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Naomi Freundlich,
The Century Foundation,
11/30/2009
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If an expensive, name-brand cholesterol drug costs four times more than a generic but provides no clear clinical benefit, why do insurers—both public and private—continue to pay for it? The answer, in the case of Vytorin, a combination of two drugs designed to lower LDL or bad cholesterol, is that the influence of big Pharma in maintaining the status quo—even when unsupported by evidence—remains a formidable barrier. Continue Reading on the Taking Note Blog.
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Senate Bill Would Postpone Reform until 2014: The Political Implications
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Maggie Mahar,
The Century Foundation,
11/23/2009
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What if in 2012, unemployment remains relatively high, the recession continues, and voters blame President Obama, voting him and his Congressional supporters out of office?
Consider how that would affect health care reform. If the House bill prevails on the timing of reform, the Exchanges will open in 2013, subsidies will be available, private insurers will be regulated, and the Public Plan will be available to tens of millions of Americans. Conservatives elected in November of 2012 would have only two months to try figure out how to derail the roll-out scheduled for January 1, 2013. Continue Reading on the Taking Note Blog.
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The Snapshot: Public Resisting Conservative Slanders on Health Care Reform
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Ruy Teixeira,
The Century Foundation,
11/20/2009
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Conservatives are putting up a last ditch effort to stop health care reform. They’re doing their level best to scare the public, telling them that passing health care reform will take the country down the road to socialism and ruin the economy, among other things.
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New Mammography Guidelines Hit the Wall of Public Opinion
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Naomi Freundlich,
The Century Foundation,
11/18/2009
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The new recommendation from the U.S. Preventative Services Task Force that women under 50 should not undergo routine mammography is generating a lot of controversy—it is a direct challenge to the strong message women have been receiving for two decades that they should have yearly screening starting at age 40. The task force also recommends that women age 50-74 have a mammogram every two years (rather than yearly) and finds that there is little benefit in screening women over 74 at all. Continue Reading on the Taking Note blog.
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The Half-Full Health Reform Glass
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Maggie Mahar,
The Century Foundation,
11/5/2009
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These days, many progressives are expressing deep disappointment with the health reform legislation now moving through Congress. Some suggest that legislators made deals with lobbyists and let them write the bills. Others complain that both the subsidies and the penalties are too low. Still others don’t like the fact that states can “opt out” of the public insurance option, and decide not to offer Medicare E. Finally, many ask: “Why can’t everyone sign on for the public plan in 2013? Why do we have to wait until 2013? Why can’t they roll out universal coverage next year?” Continue Reading on the Taking Note Blog.
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The Public Option: It’s Not About Politics; It’s About the Economics of Reform
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Maggie Mahar,
The Century Foundation,
10/26/2009
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Last week, I argued that the insurance industry had declared war on President Obama’s plans for healthcare reform because industry leaders sensed—or knew—that support for a federal public insurance option was building. A week earlier, I told an audience at a San Francisco screening of Money-Driven Medicine that I thought the odds were at least 60/40 in favor of a national public plan. They were surprised that I was so optimistic, and this was a very liberal audience in San Francisco. Continue Reading on the Taking Note Blog.
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Why is Health Care So Expensive in Rural Louisiana?
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Maggie Mahar,
The Century Foundation,
10/23/2009
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Most discussions of regional variations in healthcare focus on the nation’s cities. Below, a first-of-its-kind map from a post on the Daily Yonder titled “The Uneven Cost of Rural Health Care.” Continue Reading on the Taking Note Blog.
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The Snapshot: Public Wants Action on Health Care, Backs Public Option
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Ruy Teixeira,
The Century Foundation,
10/22/2009
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We are into the endgame on health care with the passage (finally) of a health care reform bill by the Senate Finance Committee. Conservatives are hoping the public will rise up against a successful conclusion of this process, spurred by conservatives’ unrelenting attacks on any and all health care efforts. But the public is unlikely to do so. In fact, they say, by 61-29, that they will be disappointed if health care reform isn’t passed by the end of this year.
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Why are Health Insurers Launching an 11th Hour Attack on Health Care Reform?
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Maggie Mahar,
The Century Foundation,
10/20/2009
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They are running scared. And why are they so scared? Because they know that the public sector option is still alive. And here I’m not talking about the possibility that some states will offer public plans: Most state plans would be too puny to challenge the strongmen of the health care industry. I’m talking about a federal public plan--Medicare E (Medicare for everyone) a public option for patients under 65, run by the federal government. The scent of real competition is what has insurers on the run. Continue Reading on the Taking Note Blog.
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Should The Swine-Flu Vaccine Be Mandated For Health Care Workers?
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Naomi Freundlich,
The Century Foundation,
10/19/2009
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Mandatory vaccination programs are seldom without controversy. Since the early 1900’s when public health workers went door-to-door inoculating people against smallpox and authorities blocked unvaccinated children from attending school, these widespread campaigns have been met with court challenges and public opposition. The underlying issue has always been that mandates threaten medical liberty—the freedom for individuals to choose which medical interventions they want and which they don’t want. But when it comes to vaccines and infectious disease, in the eyes of the law, protecting public health often trumps individual choice. Continue Reading on the Taking Note Blog.
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Mayo Clinic Family Medicine in Arrowhead Arizona Will No Longer Take Medicare Patients
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Maggie Mahar,
The Century Foundation,
10/13/2009
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The Mayo Clinic now has two family medicine clinics in Arizona. Beginning January 1, primary physicians at one of those clinics will no longer see Medicare patients unless they are able and willing to pay an annual $250 administrative fee, plus $175 to $400 per visit . They will also have to agree to“an appropriate number of visits each year, including physicals. Continue Reading on the Taking Note Blog.
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Some Medicare Advantage Plans Do Provide Value—the HMOs
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Maggie Mahar,
The Century Foundation,
10/6/2009
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When I reported on the waste in Medicare Advantage plans not long ago, HealthBeat reader Don Grunt pointed out that not all MA plans are alike. He wrote: “I'm a Medicare Advantage product manager in Oregon where 45% of beneficiaries sign up for MA plans (highest in the country) because we offer good plans and the competitive market keeps us honest. So I don't work in Miami or any of the wild west of MA plans.” Continue Reading on the Taking Note Blog.
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Class and Health Care Reform
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Maggie Mahar,
The Century Foundation,
10/5/2009
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Over at TNR, special correspondent Thomas B. Edsall raises provocative questions about the coalition of wealthy and poor that elected Obama. Will they stand together? Below, excerpts from his post, and my comments:
“The health care debate has exposed the ideological tension in Barack Obama’s political coalition between moderates and liberals. But it has also offered hints of how another, less obvious divide built into the Democratic majority could wreak havoc on the administration during the years to come. Continue Reading on the Taking Note Blog.
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Will Preserving the “Status Quo” Resolve the Abortion Debate?
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Naomi Freundlich,
The Century Foundation,
10/1/2009
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Earlier this year when President Obama told the graduates of Notre Dame that the country needed to find “common ground” on abortion, it’s likely he envisioned national reconciliation on an issue that has fiercely divided the country for decades. But when it comes to health care reform, Democrats are hoping to find “common ground” through balky legislation that would extend the reach of the current ban on federal funding for abortion to include all plans that participate in health insurance exchanges. Continue Reading on the Taking Note Blog.
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The Snapshot: Public Warms Up to Health Care Reform
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Ruy Teixeira,
The Century Foundation,
9/28/2009
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The president’s speech on September 9, the presentation of a specific plan (finally) by Senate Finance Committee Chairman Max Baucus, and some vigorous pushback by progressives against conservative antihealth care reform hysteria has moved public sentiments about health care reform in a positive direction. Across multiple polls, a consistent pattern of increased support exists for Obama’s handling of health care and for the health care plans before Congress. This pattern can be seen in the latest NBC News/Wall Street Journal poll, where Obama’s approval rating on health care increased by 4 points and support for health care legislation rose by 3 points.
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Nonprofit Hospitals Need to Earn Their Exemptions
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Naomi Freundlich,
The Century Foundation,
9/28/2009
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If nonprofit hospitals spend far less money on providing charity care for the poor and uninsured than the value of their federal, state and local tax exemptions, do they deserve those exemptions? What about if they turn away indigent patients or hound them with aggressive collection practices? In May, the Senate Finance Committee chairman Max Baucus, and ranking Republican Charles Grassley seemed to agree that nonprofit hospitals have to start acting more like nonprofits or they could risk losing their benefits. Continue Reading on the Taking Note Blog.
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The Misleading Attack on the Dartmouth Research
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Maggie Mahar,
,
9/23/2009
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“It’s like whack-a-mole,” a Dartmouth researcher commented in a recent e-mail. He was referring to that fact that, as Congress moves closer to the day when it will reconcile House and Senate versions of health-care reform legislation, critics seem to be popping up everywhere to question more than two decades of Dartmouth University research that exposes the waste in our health care system. Dartmouth’s researchers can barely keep up. No sooner have they responded to one op-ed than another mole appears, attempting to undermine the credibility of the research. Continue Reading on the Taking Note Blog.
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The Great ER Caper
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Naomi Freundlich,
The Century Foundation,
9/15/2009
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Jack Coulehan is a physician and senior fellow at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University in Stony Brook, NY. He describes himself as “not only an experienced physician, but also an advocate—in fact, a teacher—of standard-of-care practice.” But he was no match for the vagaries of the hospital emergency room. In the most recent issue of Health Affairs, Coulehan writes about hearing tales from friends about being “caught in a web of excessive and unnecessary medical testing” when they went to their doctors for seemingly routine problems. Although sympathetic, he couldn't really relate.
Continue Reading on the Taking Note Blog.
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Counting the Uninsured
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Naomi Freundlich,
The Century Foundation,
9/14/2009
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The U.S. Census Department announced last week that in 2008, 46.3 million Americans did not have health insurance, a “not significant” increase from the 45.7 million uninsured the year before. But dig a little deeper into the survey—and understand its limitations—and you’ll find that the 2009 Current Population Survey (CPS) actually provides a compelling snapshot of the country in recession. Besides the new data on the uninsured, the survey also includes information on household income (down 3.6% between 2007 and 2008) and the poverty rate (13.2%, up from 12.5% in 2007). Continue Reading on the Taking Note Blog.
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The Snapshot: Moving Toward Clarity on Health Care Reform
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Ruy Teixeira,
The Century Foundation,
9/14/2009
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Last week I argued that clarity was conservatives’ greatest enemy on health care. Their plans to derail health care reform depend on spreading confusion about what is in the reform bills before Congress, since the basic components of reform are so popular. Indeed, from their standpoint, the more confusion the better.
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Regional Variations in Health Care and the Dartmouth Research
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Maggie Mahar,
The Century Foundation,
9/10/2009
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A story in yesterday’s New York Times begins: “For years, health policy experts have said health care spending is much higher in New York City and Boston because doctors and hospitals there provide more services, practicing medicine in a more intensive way. But new government data show that Medicare costs per patient in those cities are slightly below the national average when the numbers are adjusted for the cost of living and other factors.” Continue Reading on the Taking Note Blog.
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Obama's Honest Speech
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Maggie Mahar,
The Century Foundation,
9/10/2009
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Last night, President Obama gave an excellent speech. He was clear; he was passionate. I did not expect him to draw a line in the sand regarding the public insurance option. That would only have given his opponents a clear target. The decision about the public option will be made at the very end of this process when the House and Senate bills are reconciled. There were no real surprises in the president’s speech. What stood out was the reaction to what he said: “You lie!” Continue Reading on the Taking Note Blog.
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The CBO's Dubious Health Care Cost Estimates
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Maggie Mahar,
The Century Foundation,
9/3/2009
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The Congressional Budget Office (CBO) has warned that progressive proposals for reforming health care will add to the deficit that looms over our economy. But when you stop to think about it, just how likely is it that CBO can accurately predict the cost of health care reform—and the savings that it will generate-- over a ten year period? Virtually any economic predictions that attempt to go out ten years are, at best, guesstimates. Only a very foolish investor would attempt to project a single company’s earnings out over ten years: how can one “score” the effect of very complicated legislation on a $2.6 trillion industry? Continue Reading on the Taking Note Blog.
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Taking Note
