Code Red

AHIP (America’s Health Insurance Plans) is lobbying hard in advance of tomorrow’s Senate vote on Senator Baucus’ health plan.  AHIP claims that proposed cuts in Medicare payments will add to private health insurance costs due to “cost shifting,” as hospitals raise their prices in order to make up for Medicare shortfalls.

For the past few months, I keep reading and hearing about medical bankruptcies. Newspapers, NPR, politicians, even President Obama.  First it was “half of all bankruptcies are caused by medical spending.”  Then it was seventy percent.  And it didn’t matter if you had health insurance – medical bankruptcy was always just around the corner.  The Democrats even want to cap out of pocket payments in private health insurance so that Americans don’t go bankrupt. Some think we need a single payer system to eliminate the threat of medical bankruptcy.

Like Rodney Dangerfield, the U.S. healthcare system gets no respect.  There is no denying that we spend twice as much per capita as anywhere else in the world.  And our health statistics are nothing to crow about, with average life expectancy and below average infant mortality. 

I am breaking my recent vow to post just one blog a week because I have finished reading a pre-publication draft of “Health Insurance and Mortality in US Adults” by five Harvard MDs (Amer. J of Pub Health, December 2009) and that paper has really got my dander up.  Some of the authors of this paper also gave us the “half of all bankruptcies are due to health spending” paper.  I have a paper and blog forthcoming on the latter claim but the journal has placed a pre-publication embargo on it.

Last week, I had the privilege of speaking at the Tenth Congressional District Democrats Town Hall meeting on healthcare reform. I was quite literally the only Republican in the room; at least the tea party folks didn’t show up. But I am a weird sort of Republican. I am ashamed at what my representative (Mark Kirk) has proposed and I actually sort of like the latest take on Obamacare. So here is one issue where I side with the Democrats. A lot of good my support will do. It was clear from this meeting that the chances of meaningful health reform are all but nil. And the Democrats will have no one to blame but themselves.

In a virtual carbon copy of their previous Wall Street Journal op-ed pieces, John Kogan, Glenn Hubbard, and Dan Kessler recently (9/25/2009) offered the standard Republican critique of Democratic health reform proposals before laying out their own agenda.  They are long on anti-government ideology and often fall short on economic principles.  But mainly, their ideas lack the power to bring about real change.  Daniel Burnham once said, “Make no little plans. They have no magic to stir men’s blood.”  Republicans have become the anti-Burnhams.

The passing of Senator Ted Kennedy is a sad reminder that it is easier for a camel to pass through the eye of a needle than it is for the U.S. Congress to enact comprehensive health reform.  All the arrows are pointing down.  There are now only 58 solid votes for reform in the Senate (Joe Lieberman is wavering).  The moderate Republican block in the Senate supports a plan that falls far short of what the House leadership has proposed and there are no longer any strong Democratic senators willing to work out a compromise.  To make matters worse, the budget deficit is now projected to reach $9 trillion over ten years. sobering up those Democrats in Congress who actually care about the future of our economy.  And thanks in part to a brutally effective anti-reform campaign, conservative Democrats are scared of their own constituents.  I just don’t see anything significant emerging from this Congress.

The stunning news from the CBO that health reform may cost a trillion dollars and only put a dent in the crisis of the uninsured has us thinking more about tax reform.

The health policy debate is getting serious.  Expanded coverage means higher taxes.  Who will pay?

President Obama has ambitious plans for reforming the health care system.  But how can he succeed when politics has doomed so many others?

It has been suggested that President-elect Obama will be unable to expand health spending due to the budget crisis.  But perhaps he can turn crisis into opportunity!

We never thought we would say this. 

In a new research paper, Alan Garber and Jonathan Skinner ask “Is American health care “uniquely inefficient?”  Read what we have to say and then tell us what you think?  Is the U.S. uniquely inefficient?  Are we getting worse?  Is technology the culprit?

A Cubs fan friend of mine asked me if I wanted to lay odds on a White Sox-Cubs World Series and if I would take the Sox straight up.  I didn’t want to fleece the guy but his question got me thinking.  So here is my morning line on health care legislation.  Let us know what you think.

About once every eight years, concerns about health care access rise to a fever pitch.  Unfortunately, this always occurs the year before a major election.  What can be done after the confetti is picked up, the next President is sworn in, and Congress again turns its back on health care reform?  Here is a modest plan “B.”

Will and I have seen health reform proposals come and go.  Will Obama/Clinton/McCain’s proposals share the same fate?

The Democratic battle continues, and Hillary Clinton will try to draw distinctions between her health plan and Barack Obama’s.  But how different are they?  We take a look at the major point of contention—enrollment mandates.

Is it possible for the United States to have too much health insurance and too little health insurance at the same time?  Is it possible to identify one simple policy change that would simultaneously improve efficiency, save money, and free up the resources needed to cover the uninsured?  Is there a policy issue about which economists are in near universal agreement?  All of these questions have the same answer.  Read on!

We want to know what you think about these issues.  Please feel free to send in your comments.  We will publish them unedited, provided you keep them clean!

It now looks like John McCain has sewn up the Republican nomination.  I went to his web site and was pleased to find a long list of talking points about health care, even if there is no detailed proposal (such as those offered by Obama and Clinton.)  let’s look at his health reform platform.

All of the leading Presidential candidates are talking about the importance of measuring and reporting hospital and physician quality.  But rhetoric and reality are likely to remain nodding acquaintances at best, if my recent experience is any indication. 

We hope to trigger a conversation about the best ways to think about cost containment.  This exchange suggests that a focus on costs may not be such a good idea.  Tell us what you think!

The portability of health insurance is one of the most important policy issues facing this nation, yet it seems to have been overlooked in the ongoing debate about health reform.  I recently heard from my dear friends, Don and Sue (not their real names), and their unsuccessful effort to obtain health insurance is a startling reminder of how our health care system remains screwed up.   

You remember Don and Sue.  They were successful consultants who loved to sail.  They had always wanted to cross the Pacific Ocean and realized that they had better get going before they got too old.  So they left their jobs, bought a beautiful boat, and set out for the journey of their lifetimes.  They have been at sea for two years, living out their dream.  Unfortunately, Sue has developed a chronic disease that is only going to get worse.  She can still perform her duties on the boat, but not for much longer.  In the years to come, she is going to require a lot of medical care that won’t come cheap.  Don and Sue did okay for themselves in their careers, but not so well that they can ignore the medical bills.  And like everyone else, there are other unpredictable illnesses that await them. 

The recent 5-0 ruling by the FTC Commissioners in the Evanston Northwestern Healthcare (ENH) antitrust case was a real body blow to those of us who support competition in healthcare.  The Commissioners agreed with a federal district judge’s ruling that Evanston and Highland Park Hospitals had achieved excessive market power by forming ENH.  But instead of affirming the judge’s order to force ENH to split up, the Commissioners instead ruled that ENH could remain intact provided that the member hospitals set prices independently.  The FTC seems to be saying that it is okay for hospitals to dominate a market, so long as they do it with a nod and wink.