Failth-based Health Reform Initiatives

Picked this one up from the Kaiser Daily Health Policy Report, and thought I'd pass along:

Faith-based groups Faithful America and Cover All Families have launched a campaign on Christian radio stations advocating for health care reform, the Wall Street Journal's "Washington Wire" reports. The ads, titled "Abundant Life," feature a voice saying, "All Americans should be able to get the care they need for their families, when they need it. God desires abundant life for all people. It's time we step up, ask our politicians to move the debate forward, so we can get the reform we desperately need." The campaign also urges listeners to contact their congressional representatives about health care reform. The ads are running in seven states -- Arkansas, Colorado, Florida, Indiana, Louisiana, Missouri and Nebraska -- which have "representatives and senators who may well determine the fate of health reform," according to CAF (Mundy, "Washington Wire," Wall Street Journal, 5/21).

Those of you reform-minded liberals may have some unlikely allies in your fight. Keep this in mind.

Do Your Eyes & Ears a Favor...

Today, I had the absolute pleasure of listening to the Senate Committee on Health, Education, Labor, and Pensions' Executive Hearing on Delivery Reform: The Roles of Primary and Specialty Care in Innovative New Delivery Models.

The recorded webcast is available here, and the entire 126 minutes is well worth the watch.

Proposals to Provide Affordable Coverage to All Americans: A Synopsis

I've finally managed to work my way through the Senate Finance Committee's paper on policy options to expand coverage. This is, as Ezra Klein notes, the guidebook that the Committee will use when building its bill. For our purposes, I've highlighted 20 of what I feel to be the key proposals on the table:

1. Merge the individual and small group markets, so as to better distribute risk
2. Grandfather current coverage plans available, so that citizens may keep their current coverage if they so choose
3. Create one or more national insurance exchange(s)
4. Mandate health insurers offer a bare minimum of four standard coverage options: high, medium, low, and lowest
5. Provide tax credits and assist with continuation of COBRA coverage for low income tax individuals and certain small employers
6. Establish a public plan (either Medicare-like, TPA, or state-run)
7. Expand Medicaid access and coverage (e.g. income eligibility up to 150% FPL, elimination of face-to-face interview entry requirements, include drug coverage as a mandatory benefit, expand Medicaid coverage in U.S. territories)
8. Increase CHIP income eligibility to 275% FPL
9. Change the Federal Medicaid Assistance Percentage (FMAP) formula to more efficiently distribute funds to needier states
10. Establish at CMS an Office of Coordination for Dually Eligible Beneficiaries, to more effectively manage the disproportionate use of care
11. Reduce or phase-out the Medicare Disability Waiting Period
12. Temporary Medicare Buy-In for individuals aged 55-64.
13. Establish an individual mandate, effective 1/1/2013 (at the latest)
14. Perhaps establish an employer mandate -- not yet definitive
15. Encourage development of a personalized prevention plan and routine wellness visit for all Medicare beneficiaries
16. Remove or limit Medicare & Medicaid beneficiary cost sharing for all preventive services (e.g. no copayment or deductible)
17. Establish additional grants to states for the prevention of chronic disease and encouragement of healthy lifestyles
18. Employer wellness credits
19. Bolster Medicaid HCBS (Home & Community Based Services) program and shift focus away from institutional LTC
20. Establish new requirements for data collection and public reporting

Those are the big ones.

Obama on Comparative Effectiveness

A few weeks ago, during his interview with David Leonhardt of the NY Times, President Obama provided perhaps the most eloquent words I've yet heard on the Comparative Effectiveness controversy. The full interview is available here , but I've provided an excerpt for our purposes:

You have suggested that health care is now the No. 1 legislative priority. It seems to me this is only a small generalization — to say that the way the medical system works now is, people go to the doctor; the doctor tells them what treatments they need; they get those treatments, regardless of cost or, frankly, regardless of whether they’re effective. I wonder if you could talk to people about how going to the doctor will be different in the future; how they will experience medical care differently on the other side of health care reform.

THE PRESIDENT: First of all, I do think consumers have gotten more active in their own treatments in a way that’s very useful. And I think that should continue to be encouraged, to the extent that we can provide consumers with more information about their own well-being — that, I think, can be helpful.

I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.

And so, in that sense, there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.

And right now we’re footing the bill for a lot of things that don’t make people healthier.

THE PRESIDENT: That don’t make people healthier. So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies (9) as a way of reining in costs, that’s not an attempt to micromanage the doctor-patient relationship. It is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.

Won’t that be hard, because of the trust that people put in their doctors, just as you said? Won’t people say, Wait a second, my doctor is telling me to take the red pill, and the government is saving money by saying take the blue —

THE PRESIDENT: Let me put it this way: I actually think that most doctors want to do right by their patients. And if they’ve got good information, I think they will act on that good information.

Now, there are distortions in the system, everything from the drug salesmen and junkets to how reimbursements occur. Some of those things government has control over; some of those things are just more embedded in our medical culture. But the doctors I know — both ones who treat me as well as friends of mine — I think take their job very seriously and are thinking in terms of what’s best for the patient. They operate within particular incentive structures, like anybody else, and particular habits, like anybody else.

And so if it turns out that doctors in Florida are spending 25 percent more on treating their patients as doctors in Minnesota, and the doctors in Minnesota are getting outcomes that are just as good — then us going down to Florida and pointing out that this is how folks in Minnesota are doing it and they seem to be getting pretty good outcomes, and are there particular reasons why you’re doing what you’re doing? — I think that conversation will ultimately yield some significant savings and some significant benefits.

And there you have it.