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Kaiser Daily Health Policy Report
Thursday, December 04, 2008
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Recent Releases in Health Policy
Special Notice
'Ask the Experts' To Address Role of States in National Health Reform
[Dec 04, 2008]
Today at 1:30 p.m. ET, join kaisernetwork.org's "Ask the Experts" for a live webcast covering the role of states in a national health reform effort. The experts will discuss whether reform should proceed state-by-state or nationally, and how states might test various approaches to inform the national debate. In addition, panelists will address how much flexibility states could have with structuring reform and outlining coverage and subsidies as well as what financial and operational responsibilities should rest with state governments. Larry Levitt, Kaiser Family Foundation vice president and editor-in-chief of kasiernetwork.org, will moderate the panel discussion with Henry Aaron, senior fellow of economic studies at the Brookings Institution; Stuart Butler, vice president of domestic and economic policy studies at the Heritage Foundation; Alan Weil, executive director and president of the National Academy for State Health Policy; and Judy Feder, professor at Georgetown's Public Policy Institute. Please e-mail your questions before and during the show to ask@kaisernetwork.org.
Election 2008
Incoming Obama Administration Begins To Lay Groundwork for Health Reform
[Dec 04, 2008]
Former Senate Majority Leader Tom Daschle (D-S.D.), President-elect Barack Obama's nominee for HHS secretary, on Wednesday launched an effort by the incoming administration to "lay the groundwork" for health care overhaul, the Washington Post reports. On a conference call with 1,000 Obama supporters who have expressed interest in health issues, Daschle discussed how the transition team and administration will use the Internet -- including online videos, blogs and e-mail alerts -- to initiate a grassroots overhaul effort.
In addition, Daschle said, "We'll have some exciting news about town halls, we'll have some outreach efforts in December," adding that "we'll be making some announcements" during a Thursday health care summit with Sen. Ken Salazar (D-Colo.) in Denver. Salazar said, "President-elect Obama believes that change really comes from the ground up, not from Washington," adding, "The drumbeat for change is one which goes across every single state -- red, blue and purple. That kind of a drumbeat will be very effective in achieving the change needed on health care."
Obama's staff will use the Internet in other areas but chose to begin with health care because "every American is feeling the pressure of high health costs and lack of quality care, and we feel it's important to engage them in the process of reform," transition team spokesperson Stephanie Cutter said. The online health care effort began with a 63-second video posted on Change.gov, in which health advisers Dora Hughes and Lauren Aronson posed the question, "What worries you most about the health care system in our country?" The video triggered 3,700 responses, which were turned into a "word cloud," featuring the 100 most frequently used terms. The cloud's largest words -- those that were used most frequently -- include "insurance," "system," "people" and "need." The feature also was interactive, allowing participants to reply to other users' comments and rate responses.
In a second video, Daschle said, "We want to make sure you understand how important those comments and your contributions are," adding, "Already we've begun to follow through with some of the ideas." In addition, Daschle lauded a suggestion of creating a "Health Corps," modeled after President John F. Kennedy's Peace Corps.
Andrew Rasiej, co-founder of Personal Democracy Forum, said, "It will be a lot easier to get the American public to adopt any new health care system if they were a part of the process of crafting it" (Connolly, Washington Post, 12/4). Medicare Prescription Drug Benefit
Obama's plan to allow the federal government to directly negotiate drug prices for the Medicare prescription drug benefit has left "drugmakers feeling ill," Dow Jones reports. The 2003 legislation that created the drug benefit allows health insurers to negotiate prices with drugmakers. According to Dow Jones, "The industry views the proposal as a frontal assault on sales and profits." According to the Boston Consulting Group, such a change could reduce industry revenue by 10%, or about $30 billion. According to Dow Jones, the "indirect impact could be even greater" because such a change could prompt private insurers that offer Part D plans to attempt to negotiate similar prices in their commercial plans.
Dow Jones reports that such a change "could deal a big financial blow to companies such as Pfizer, Merck and Wyeth, which are already hard-pressed to sustain historical profit growth rates because of generic competition and stumbles in their own efforts to bring new drugs to market." According to drugmakers, a decrease in revenue would force them to reduce spending on research and development. Billy Tauzin, president and CEO of the Pharmaceutical and Research Manufacturers of America, said, "I don't know if they want to declare war like that when there's so much room to work together and so much willingness to work together." However, Tauzin acknowledged that Obama and Congress "could do it -- they've got the votes."
Dow Jones reports that if such a change emerges as a top priority for Obama, it could pass early next year and take effect as early as 2010 (Loftus, Dow Jones, 12/2). Broadcast Coverage
 American Public Media's "Marketplace" on Thursday reported on Daschle's discussion regarding health care overhaul and examined whether the U.S. can afford change during the recession (Jagow, "Marketplace," American Public Media, 12/4).
WBUR's "Here and Now" on Wednesday included a discussion with Atul Gawande, a Boston surgeon, author and health policy adviser to President Clinton, about the state of health care in the U.S. The discussion included the prospects of an individual mandate, transparency, treatment efficiency and reducing costs ("Here and Now," WBUR, 12/3).
Coverage & Access
AHIP Announces Universal Health Care Plan That Aims To Slow Growth of Health Care Costs by 30% Over Five Years
[Dec 04, 2008]
America's Health Insurance Plans on Wednesday announced a universal health coverage proposal that would be funded in part by slowing the growth of health care costs by 30% over five years and reducing inefficiencies, the Wall Street Journal reports. Under the plan, a public-private advisory group would be established to make recommendations to reduce wasteful spending, change the provider payment system and reduce administrative costs (Zhang, Wall Street Journal, 12/4). AHIP said its goal is to slow the growth of health care spending from 6.6% annually to 4.7% annually, which would save more than $500 billion over five years (Lengell, Washington Times, 12/4). The savings would be used to provide coverage to the uninsured and reduce costs for the insured.
AHIP restated its position announced last month in support of requirements to offer coverage to people with pre-existing health conditions as long as all U.S. residents would be required to obtain coverage. AHIP's plan would not require employers to provide health coverage for workers, but it would provide tax incentives to encourage small businesses to offer coverage (Wall Street Journal, 12/4). The proposal also calls for a national health plan for small businesses that would provide "essential services," such as primary and emergency care (Freking, AP/San Francisco Chronicle, 12/3). The plans would be portable and would not be subject to minimum coverage requirements imposed by states. The group also supports expanding Medicaid and SCHIP (Levey, Los Angeles Times, 12/4).
AHIP President and CEO Karen Ignagni said, "We need to move forward with health care reform, and it needs to be comprehensive and it needs to include quality improvement, value improvement, cost containment and access" (Washington Times, 12/4). Ignagni said, "The process is just beginning," adding, "I think the American people want the problem solved" (Wall Street Journal, 12/4). James Roosevelt, president and CEO of Tufts Health Plan, said, "We have laid out a workable, realistic path to universal coverage ... We want to make sure no one falls through the cracks of our health care system because of age, health status or income" (Wangsness, Boston Globe, 12/4). Comments
Anthony Coley, a spokesperson for Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.), said, "There's a spirit of optimism about our work to ensure quality, affordable health care for all Americans -- and today's announcement adds to that optimism," adding, "The insurance industry has advanced serious proposals that deserve serious analysis and consideration" (Edney, CongressDaily, 12/3). An aide to Senate Finance Committee Chair Max Baucus (D-Mont.) said the senator "is very glad to see the insurance industry come to the table to participate and looks forward to what he hopes will be constructive discussions," adding, "This proposal certainly adds to the momentum for everyone to come together and work to achieve comprehensive health care reform" (Washington Times, 12/4).
Richard Kirsch, national campaign manager for Health Care For America Now, said, "Of course, there's nothing in the industry's plan that would limit their multimillion dollar CEO salaries or require companies to spend the lion's share of health insurance premiums on providing health care instead of on administrative costs, fat cat salaries, and skyrocketing profits" (AP/San Francisco Chronicle, 12/3). He added, "The health insurance industry's vision of health care reform lets them keep charging whatever they want and increase their profits while sticking families and taxpayers with high costs" (Los Angeles Times, 12/4).
 The proposal is available online.
Health Care Marketplace
UAW Agrees To Allow Big Three Automakers To Delay Contributions to VEBA, Make Other Concessions
[Dec 04, 2008]
United Auto Workers on Wednesday after a meeting with union representatives from the Big Three automakers agreed to allow the companies to delay contributions to a fund that will provide health benefits to union retirees and make other concessions to help the companies obtain $34 billion in financial assistance from the federal government, the Kansas City Star reports (Heaster, Kansas City Star, 12/3). Under contracts negotiated last year, the automakers agreed to contribute about $56.5 billion to the voluntary employees' beneficiary association, which UAW will manage. The VEBA, which will take effect in 2010 and remain operational for 80 years, will reduce retiree health benefit liabilities for the automakers by about $100 billion.
General Motors and Chrysler both proposed to delay their scheduled contributions to the VEBA as part of requests for financial assistance that they presented to Congress on Tuesday (Kaiser Daily Health Policy Report, 12/3). GM has agreed to contribute $7 billion to the VEBA in early 2010 (Silke Carty, USA Today, 12/4).
UAW President Ron Gettelfinger said that the union would consider additional changes to contracts with the automakers, such as reductions in health or other benefits. Such changes would require approval from UAW members, he said (Vlasic/Bunkley, New York Times, 12/3).
CEOs from GM, Chrysler and Ford plan to appear before House and Senate committees on Thursday and Friday to discuss their requests for financial assistance (AP/Winston-Salem Journal, 12/4). Jim Manley, a spokesperson for Senate Majority Leader Harry Reid (D-Nev.), said that Reid "remains committed to figuring out a way to help the auto companies avoid bankruptcy and prevent millions of Americans from losing their jobs." However, he added that "without the support of Senate Republicans and President Bush," legislation to help the automakers will not pass (Schatz, CQ Today, 12/3). White House Press Secretary Dana Perino said, "Let us have a chance to look" at the requests from the automakers, and "let's see what support it can get on Capitol Hill" (Sanchez, CongressDaily, 12/3). Opinion Piece
"The real solution to the high health care costs that burden American employers -- not just automakers -- is establishing a universal, national health care system," Gettelfinger writes in a Boston Globe opinion piece. "Thankfully, we finally have a Congress and a President-elect who are committed to real health care reform," adding, "In our negotiations with the domestic automakers in 2007, however, our members realized that we could not wait for the government to act," according to Gettelfinger.
UAW "took action ourselves, by establishing" a VEBA, "which will assume responsibility for retiree health care, removing this cost from the company's books once and for all," Gettelfinger writes. He adds, "Like many American families, we've sacrificed wage increases to pay for our health care" (Gettelfinger, Boston Globe, 12/4). Broadcast Coverage
 CBS' "Early Show" on Wednesday reported on the concessions made by UAW. The segment includes comments from Gettelfinger (Roberts, "Early Show," CBS, 12/3).
- CNN's "The Situation Room" on Wednesday reported on the concessions made by UAW. The segment includes comments from Gettelfinger and a UAW local representative (Baldwin, "The Situation Room," CNN, 12/3). A transcript is available online.
- NBC's "Nightly News" on Wednesday reported on the concessions made by UAW (Cohn, "Nightly News," NBC, 12/3).
- NPR's "All Things Considered" on Wednesday reported on the concessions made by UAW. The segment includes comments from Gettelfinger (Dwyer, "All Things Considered," NPR, 12/3).
Insurer Conseco Transfers Many Long-Term Care Policies to Trust
[Dec 04, 2008]
Insurer Conseco has transferred many of its long-term care policies to Senior Health Insurance of Pennsylvania, a new state-supervised, not-for-profit trust, a move that will affect more than 140,000 Conseco beneficiaries, the Wall Street Journal reports. Conseco officials said the transfer was made so the company could concentrate on its core business. According to the Journal, the policies lowered company earnings because they were under-priced and needed continuing capital infusions to meet the long-term needs of policyholders. The trust will pay claims from a pool of funds transferred from Conseco, including $175 million in capital.
Pennsylvania Insurance Department Commissioner Joel Ario said, "There were no good choices here, only bad ones and worse ones." He said Conseco has put more than $900 million into Conseco Senior Health Insurance and its corporate board denied more money. "The likely result would have been either substantial rate increases or insolvency," he added.
Frank Darras, a California attorney who represents policy owners in disputes with insurers, said the transfer is "unfounded, unfair and unprecedented." He said, "The trust can't survive. It is on the ventilator right now." Insurance-rating firm A.M. Best said the trust might have to raise rates and reduce benefits because it has no access to additional capital.
Experts said that if the trust becomes insolvent, state guaranty agencies would be required to pay out claims, but limits set by state law would apply. Possible Precedent
Critics of Conseco's transfer say it might set a precedent for other struggling insurance companies. According to the Journal, the transfer "comes at a time of growing concerns about whether many long-term care policies will pay off when needed, or will require drastic premium increases." The Journal reports that about eight million U.S. residents hold long-term care policies, mostly people in their 50s and 60s, in order to gain protection against "claims that may not occur for decades."
According to the Journal, the problem is compounded by the recession, because insurance companies are having difficulty raising funds through their investments to meet the reserve and capital demands of state regulators (McQueen, Wall Street Journal, 12/3).
Philadelphia Inquirer Series Examines Rise in Insurance Premiums for Early Retirees
[Dec 04, 2008]
The Philadelphia Inquirer on Thursday, as part of its series titled "Falling Through: Casualties of the Health Insurance Crisis," profiled a 62-year-old retired Pennsylvania woman who recently discovered that her Independence Blue Cross group HMO premiums will increase by more than 45%, from $6,384 to $9,336, in January 2009. The woman, who lives on a fixed income, is concerned about paying for living expenses while compensating for the increased premiums. The woman might be able to find less costly premiums through an individual insurance plan, provided she is in good health, according to Mark Pauly, a health policy expert at the University of Pennsylvania's Wharton School. However, the woman is reluctant to leave her plan because she is secure in it, regardless of her health, until she becomes eligible for Medicare. According to the Inquirer, although health coverage for people ages 55 to 64 "can be expensive," the age group is the most likely to be insured. In addition, only four million, or about 9%, of the 45 million U.S. residents without health insurance in 2007 were people ages 55 to 64, according to the Foundation (Vitez, Philadelphia Inquirer, 12/4).
Medicaid
CMS Issues Medicaid Rule Intended To Give States More Flexibility in Designing Programs
[Dec 04, 2008]
CMS on Wednesday published a final Medicaid rule that gives states the option of offering Medicaid coverage that is equal in value to one of four "benchmark" plans, CQ HealthBeat reports. Benchmark plans include the standard Blue Cross/Blue Shield PPO service benefit plan under the Federal Employees Health Benefit Plan, state employee health coverage or coverage approved by the HHS secretary. The final rule also grants states the ability to pay a portion of an employee premium so that the worker could afford employer coverage, CMS said. Acting CMS Administrator Kerry Weems said, "This new rule recognizes that states are in the best position to design plans that provide Medicaid beneficiaries better health care for the same or even lower cost" (CQ HealthBeat, 12/3).
Florida's Medicaid Options Hotline Backlogged, Threatens Beneficiaries' Access to Care, Group Says
[Dec 04, 2008]
The hotline Florida Medicaid beneficiaries must call to switch health plans continues to be understaffed and consistently busy, according to the consumer advocacy group Florida CHAIN, the Florida Health News reports. CHAIN in a release said that because of the problems, "many beneficiaries are facing a disruption of essential care." According to CHAIN, the state Agency for Health Care Administration, which oversees Medicaid, has known about the problem since the state began using a new vendor four months ago but has failed to adequately address the problems.
The group called on AHCA Secretary Holly Benson to suspend automatic enrollment of Medicaid beneficiaries into HMOs until the problems are resolved; prioritize enrollment for beneficiaries who face the greatest barriers to care; and establish an online enrollment process to allow beneficiaries "to bypass the log-jammed phone system." EDS, which operates the Medicaid information systems and the hotline, said it would look into the problems (Florida Health News, 12/2).
Prescription Drugs
FDA To Post Public Health Advisories, Consumer Updates, Safety Information on Dedicated WebMD Web Page
[Dec 04, 2008]
FDA and WebMD on Wednesday announced an agreement that will allow the agency to post public health advisories, consumer updates and safety information on food, medications and cosmetic products on a dedicated WebMD Web page, CongressDaily reports (CongressDaily, 12/3). Under the agreement, FDA will post the information on a dedicated Web page separate from the main WebMD site that includes no advertisements. The Web page also will feature FDA user polls. In exchange, FDA will publish consumer updates in a bimonthly print magazine produced by WebMD. Neither FDA nor WebMD will receive payments under the agreement, agency spokesperson Scott McFarland said.
The information currently appears on the FDA Web site, but the dedicated WebMD page will allow more consumers to access the information, according to agency Commissioner Andrew von Eschenbach. WebMD has nearly 50 million unique users monthly, and about nine million individuals read the magazine, he said.
Von Eschenbach said, "Whether it's the issue of an outbreak of a food illness or a concern over a contaminated product or the availability of a new innovative solution to a disease process, I think we're looking at a multiplex way of trying to get that information to the public and this is one more of these opportunities" (Kim, CQ HealthBeat, 12/3). He added, "This is an important step forward in our effort to form partnerships to help bring timely safety alerts and other public health information to a wider audience in the most effective and convenient way" (Corbett Dooren, Dow Jones, 12/3).
NBC's "Nightly News" on Wednesday reported on the agreement (Williams, "Nightly News," NBC, 12/3).
Advocacy Group Prescription Project Asks FDA To Review Direct-to-Consumer Ad Regulations for Medical Devices
[Dec 04, 2008]
Direct-to-consumer advertisements for several medical devices on the video Web site YouTube violate federal regulations because they do not include required warnings and disclosures about potential risks, according to the consumer watchdog group Prescription Project, the AP/Los Angeles Times reports. On Wednesday, the group petitioned FDA to update its advertising rules to specifically address Internet marketing (Perrone, AP/Los Angeles Times, 12/3).
In its complaint to FDA, the group cited ads for the drug-coated stent Xience V, manufactured by Abbott Laboratories; the Prestige Cervical Disc, a spinal implant manufactured by Medtronic; and the Cormet hip-surfacing system, manufactured by Stryker (Rockoff, Wall Street Journal, 12/4). The group said that the ads tout the benefits of the products but they do not inform consumers about the potential risks with using them (AP/Los Angeles Times, 12/3). The Prescription Project also asked FDA to urge the device makers to remove the ads from YouTube.
Allan Coukell, director of policy for the group, in a statement said, "The videos raise serious questions about whether drug and device companies are using the Internet to skirt laws that safeguard consumers" (Moore, Minneapolis Star Tribune, 12/3). "We'd argue that on the Internet, real estate is not limited, so there's much more room to give a full statement of risks," he added (Snowbeck, St. Paul Pioneer Press, 12/3).
Federal regulations that require pharmaceutical and medical device manufacturers to ensure product advertisements include information about possible side effects apply across all media platforms, including the Internet, according to an FDA spokesperson. The spokesperson declined to comment on the Prescription Project's complaint. Comments
A spokesperson for YouTube in a statement said that videos that are placed on the Web site "must comply with local laws and regulations, as well as our own policies," adding that the video-sharing service regularly reviews its guidelines and collaborates with the videos' producers and government agencies "to keep them current and effective" (Wall Street Journal, 12/4).
In a statement issued on Wednesday, Abbott said that the company's "practice is to comply with all regulatory requirements and to provide patients and consumers with accurate and complete product information," adding, "All Abbott's Xience V videos on YouTube were posted in July 2008 with prominent links to the 'Brief Summary of Instructions for Use,' which details the product's risk and safety information." The Illinois-based company noted, "To avoid any problems in the future, we will embed safety and risk information in the videos moving forward" (Japsen, Chicago Tribune, 12/3).
Chuck Grothaus, a spokesperson for Medtronic, said he has asked VNR-1 Communications, the Texas-based advertising firm that produced its YouTube ad, to remove the video on Wednesday (St. Paul Pioneer Press, 12/3). In a statement, the company also said, "Any additional video produced by, or on behalf of, Medtronic that does not comply will be addressed immediately" (AP/Los Angeles Times, 12/3). A spokesperson for Michigan-based Stryker declined to comment (Minneapolis Star Tribune, 12/3).
The ads and petitions are available online.
State Watch
California Superior Court Judge Upholds State Regulations Against 'Balance Billing'
[Dec 04, 2008]
Sacramento, Calif., Superior Court Judge Michael Kenny on Tuesday upheld the regulations issued by the state Department of Managed Health Care that seek to protect patients from "balance billing," a practice often used by hospitals in reimbursement disputes with health insurers, the Sacramento Bee reports.
Balance billing most often occurs when patients with health insurance receive emergency care at out-of-network hospitals. In such cases, out-of-network hospitals or physicians often seek the balance of the cost of services not covered by health insurers -- in some cases thousands of dollars -- directly from patients.
The state DMHC on Oct. 15 finalized regulations that deemed balance billing an unfair practice. In response, the California Medical Association and the California Hospital Association filed a lawsuit that sought to block the regulations, which the groups said could undermine current agreements between health insurers and hospitals.
The groups likely will appeal the decision issued on Tuesday (Calvan, Sacramento Bee, 12/4). Wall Street Journal Examines Issue
The Wall Street Journal on Thursday examined the "nasty surprise" of balance billing. "It's not clear how much balance billing occurs in the U.S., but the practice appears to be widespread," according to the Journal. In response, a "growing number of state regulators" -- such as those in California, Illinois and New York -- have begun "moving to crack down on balance billing," the Journal reports.
"Physician groups say doctors have the right to refuse to sign up with insurers' networks, and regulators shouldn't bar doctors who don't participate in health plans from billing insured patients" as "insurers' payments to out-of-network health providers are often unfairly small," according to the Journal. In addition, health insurers maintain that "they shouldn't be forced to pay whatever fee out-of-network health care providers demand" and "defend how they calculate payments they make to out-of-network" providers, a process that often uses a "database of medical claims price information," the Journal reports (Wilde Mathews, Wall Street Journal, 12/4).
Colorado Health Programs Likely To Be Affected by Declines in Cigarette Tax Revenue
[Dec 04, 2008]
A decline in smoking rates in Colorado has led to a decline in cigarette tax revenue that is used in part to fund state health insurance programs, the Denver Rocky Mountain News reports. In 2004, the state increased the cigarette tax by 64 cents per pack with the goal of using the revenue for health care and tobacco education. The tax generated $169.6 million in the first year, but revenue has fallen for two straight years and budget forecasts show the revenue is expected to decline to $135.5 million in fiscal year 2012 -- a 20% drop before accounting for inflation. The purchase of cigarettes across state lines, over the Internet and on the black market also is contributing to lower cigarette tax revenue.
State legislators say that they anticipated the decline in revenues and that most of the new money was allocated in yearly grants that can be reduced without much impact. However, 46% of the cigarette tax revenue is used to expand enrollment in public health insurance programs, such as Medicaid and SCHIP. State Sen. Betty Boyd (D) said, "That's a problem if the funds aren't there, because you can't provide services if you don't have money. In the end, if we lose enough money, less kids will get services." She added, "If the money falls off, that's good news and bad news. And I think we celebrate the good news and hope that a dropoff in smoking reduces the cost of health care."
Smoking rates in the state have declined in two of the past three years and smoking rates among teenagers already are below the 2010 goal set by a national coalition of health care professionals.
The state Department of Health Care Policy and Financing, which oversees Medicaid and SCHIP, currently has a reserve of $91.4 million but expects it will be completely depleted by July 2012 if it continues to provide services at the current level. The law also specifies percentages of revenue that must go toward programs such as public health insurance, community clinics and anti-smoking programs, which prevent the state from cutting smoking cessation program grants while keeping the same amount of money in place for Medicaid and SCHIP as revenue declines, according to the Rocky Mountain News.
Sen. John Morse (D-Colo.) said the state could reduce the income eligibility level to reduce costs but that would reverse years of expanding eligibility (Sealover, Denver Rocky Mountain News, 12/3).
Opinion
Letter to the Editor Says Medicare Advantage Plans Should Accept 'Level Playing Field'
[Dec 04, 2008]
"It is only fair to recoup" higher payments to Medicare Advantage plans because they "are a drain on the Medicare Trust Fund," House Ways and Means Subcommittee on Health Chair Pete Stark (D-Calif.) writes in a letter to the editor in the New York Times. The letter is in response to a Nov. 29 Times editorial about MA plans.
Stark writes that about "80% of the Medicare beneficiaries ... pay higher premiums to subsidize those who enroll in private Advantage plans," but "private Medicare Advantage plans do not always provide more care than traditional fee-for-service." Stark continues that many MA plans "charge far more than traditional Medicare for important items like hospitalizations, home health care, durable medical equipment and chemotherapy."
According to Stark, "when private plans came to Medicare, they said they could provide better care for less money and happily accepted 95% of the fee-for-service payment rate." He concludes, "All we now ask is that they compete on a 100% level playing field. Isn't that fair competition?" (Stark, New York Times, 12/4).
Editorials, Opinion Pieces Address Issues Related to Health Care Overhaul
[Dec 04, 2008]
Summaries of several recent editorials and opinion pieces that address issues related to health care reform appear below. Editorials
- Boston Globe: Recent support from the health insurance industry for guaranteed health insurance for all U.S. residents in combination with an enforceable requirement that all residents obtain coverage "could bring the country closer to universal health care" and "lead to a debate in which insurers are not working to sabotage agreement," a Globe editorial states. According to the editorial, President-elect Barack Obama, who has proposed a health care plan that does not include such a requirement, should "be open" to the proposal from the health insurance industry. The editorial concludes that the "Obama administration should seize the opportunity the insurance industry is presenting and finally get the nation to yes on universal health coverage" (Boston Globe, 12/4).
- USA Today: "Any serious attempt to rein in spending" must target national security and "big benefit programs," such as Medicare and Medicaid, which, when combined, account for 77% of the federal budget, a USA Today editorial states. According to the editorial, the decision by Obama to nominate as the new director of the White House Office of Management and Budget Peter Orszag, who as director of the Congressional Budget Office has "built a reputation for thinking seriously about how to restrain rising health care costs," was "heartening." The editorial states, "Washington is awash with lists of potential budget cuts, and everyone knows where they are," adding, "What's needed is the political will to aim at the elephants, not just at the flies" (USA Today, 12/4).
Opinion Pieces
- Marie Cocco, Denver Post: The proposal by Obama to use the "compromised" employer-sponsored health insurance system "as the basis for health insurance revision is folly," syndicated columnist Cocco writes in a Post opinion piece. "Tightening regulation of the insurance industry and creating a new, government-based plan to make coverage available to those who cannot afford to buy it from private insurers -- the essence of Obama's campaign proposal -- would only add another layer of complexity and, eventually, cost," Cocco writes. In addition, she writes, "Only a single, government-financed system can eliminate the administrative waste, unfairness and economic burden of our current health insurance scheme," concluding, "Timidity is no longer an option" (Cocco, Denver Post, 12/3).
- Jonathan Gruber, New York Times: Health care reform "is good for our economy," Gruber, a professor of economics at Massachusetts Institute of Technology and a Massachusetts Health Insurance Connector Authority board member, writes in a Times opinion piece. One of the "most effective ways to" promote spending is to "give states money to enroll more people in Medicaid" and SCHIP, a move that would "free up state money" for public works projects, "spending that could create jobs," Gruber writes. "Expanded insurance coverage would also drive demand for high-paying, rewarding jobs in health service" and "stimulate more consumer spending, as previously uninsured families would no longer need to save every extra penny to cover a medical emergency," according to Gruber. He writes that "rather than sit back and lick our wounds, we must move toward healing them," adding that "health care reform that features universal insurance coverage is an important place to start" (Gruber, New York Times, 12/4).
- Robert Bixby, Washington Post: "Although this year's budget deficit, likely to top $1 trillion, can be largely explained by temporary factors, shortfalls of this size will become routine and ultimately unsustainable if nothing is done to close the projected gap between government revenue and spending on federal health care and retirement benefits," Bixby, executive director of the Concord Coalition, writes in a Post opinion piece. An analysis conducted in 2007 by the Department of Treasury "found that promised Medicare benefits over the next 75 years will exceed dedicated revenue and premiums by $34.1 trillion in net present value," he writes, adding, "The longer this situation persists, the bigger the bailout that future taxpayers will be left to finance" (Bixby, Washington Post, 12/4).
- Sebastian Mallaby, Washington Post: "The growth of U.S. government" needed to help end the current economic recession "need not be an economic disaster," and government "can be rendered more efficient by cutting out unneeded spending" in Medicare and other entitlement programs, Post columnist Mallaby writes. According to Mallaby, entitlement program spending "must be revisited" because a "government that faces legitimate pressure to grow can't afford big retirement benefits for people who are too young or too wealthy to need them." The federal government cannot "tolerate a situation in which, after adjusting for variation in demographics and labor costs, some states spend twice as much on health benefits per retiree as other states find adequate," Mallaby writes. He adds that "to get away with big government, you must have smart government" (Mallaby, Washington Post, 12/4).
Recent Releases in Health Policy
Papers Examine Potential Challenges for Obama Administration, Congress; Perspectives Examine Expected Demand for Home-Based Health Care Services, Recommendations for Medical Residents
[Dec 04, 2008]
- "Doctors, Dollars & Quality," Health Affairs: The Web-exclusive package includes a series of papers and perspectives that examine the relationship of several factors -- the supply of physicians, the composition of the physician work force, the quality of health care and overall health spending -- that could pose challenges to the incoming Obama administration and new Congress in their efforts to overhaul the U.S health care system (Health Affairs release, 12/4).
- "Home Delivery -- Bringing Primary Care to the Housebound Elderly," New England Journal of Medicine: In the perspective, Susan Okie, a national correspondent for NEJM, discusses how the demand for home-delivered primary care for the elderly is expected to increase over the next 20 years. According to Okie, meeting the medical needs of an aging population likely will "require increasing reliance on midlevel providers (nurse practitioners and physician's assistants), as well as the use of multidisciplinary teams" of practitioners, who will be able to visit "patients in rest homes, assisted living facilities and nursing homes, as well as at home and in a medical office" (Okie, NEJM, 12/4).
- "Revisiting Duty-Hour Limits -- IOM Recommendations for Patient Safety and Resident Education," NEJM: In the perspective, John Iglehart, a national correspondent for NEJM, discusses the recent recommendations by an Institute of Medicine panel that aim to improve patient safety by alleviating fatigue among medical residents, providing greater supervision of residents and improve the process for transferring responsibility for patients between shifts, among other measures (Iglehart, NEJM, 12/3).
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EDITORIAL STAFF:
Jill Braden
Balderas, managing
editor, kaisernetwork.org
Allison Czapp, editor, Kaiser Daily Health Policy Report
Beth Liu, senior web writer, kaisernetwork.org
Kate Steadman, web writer, kaisernetwork.org
Simone Vozzolo, senior web producer, HealthCast
Amanda Wolfe, editor-in-chief, Kaiser Daily Reports
Francis Ying, web producer, HealthCast
Hayes Edwards, Julia Moss, Santosh Rao, Matt Wayt, Sherkiya Wedgeworth, Stephanie Woodrow, staff writers, Kaiser Daily Health Policy Report
Amy Moczynski, Michael Pogachar, copy editors, Kaiser Daily Reports
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Larry Levitt, editor-in-chief, kaisernetwork.org; vice president, Kaiser Family Foundation
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