Health Care Experts

Troublesome Directions

Mon, 16 Nov 2009 12:30:00 GMT

Updated at 12:45 p.m. on Nov 19.

What concerns you most about the direction that health care reform proposals are taking in Congress? A few that have drawn particular scrutiny:

• Financing and taxes
• Affordability to individuals
• The overall price tag
• Cost to businesses
• Medicare cuts
• Reductions in payments to medical providers
• Medicaid and other government program expansions
• Scope of provisions to bend the cost curve

Information about the plan released by Senate Democrats:
• Summary Of Senate's Health Care Reform Bill [PDF]
• Timeline For Implementation Of Senate Bill [PDF]

Robert Greenstein responded to Troublesome Directions on November 20, 2009 03:38 PM

Mon, 16 Nov 2009 12:30:00 GMT

Bill Marks Good First Step The Senate should now move without delay to consider this landmark legislation, which would represent a dramatic improvement over the current health insurance system. The new Senate health bill marks a major step toward comprehensive, fiscally responsible health reform. It would extend health insurance coverage to 31 million Americans who lack it, reduce the budget deficit, and put long-term downward pressure on health care costs. The bill would reduce deficits by an estimated $130 billion over the 2010-2019 period and by about one-quarter of one percent of GDP in the decade thereafter, according to the...

Marilyn Werber Serafini responded to Troublesome Directions on November 20, 2009 08:51 AM

Mon, 16 Nov 2009 12:30:00 GMT

Baucus Praises Senate Bill Too many parents struggle to pay for health insurance and also try to save for college, too many employers are forced to drop health coverage because they simply can’t afford the premium... This is the moment to change that. Sen. Max Baucus, chairman of the Senate Finance Committee, released this statement after the Sen. Reid unveiled the Senate Democratic bill: The CBO score we received today illustrates the Senate health reform legislation is a balanced, fiscally-responsible package that will deliver the real reform that American families, businesses and the economy need. The Senate bill is fully...

Ron Pollack responded to Troublesome Directions on November 20, 2009 08:44 AM

Mon, 16 Nov 2009 12:30:00 GMT

Senate Meets Pocketbook Test For America's families, the key assessment about health insurance reform will be a personal pocketbook test, namely: Will the legislation result in needed financial relief for families struggling to pay for health coverage and care? The newly announced Senate bill scores high marks on the personal pocketbook test-making health insurance much more affordable for hard-working middle-class American families. Through tax-credit subsidies made available for plans in a newly created marketplace, the Senate bill limits a family of four with income under about $88,000 a year from spending more than 9.8 percent of the family's budget on...

Jason Rosenbaum responded to Troublesome Directions on November 19, 2009 03:33 PM

Mon, 16 Nov 2009 12:30:00 GMT

Time To Move Forward & Vote This bill is not perfect... However, the fact that Majority Leader Harry Reid did the right thing and listened to the American people by including things like a public health insurance option and a tax credit level that goes a long way towards making health care affordable means that this bill deserves a debate and a fair, majority up-or-down vote. The Senate bill looks very much like the House health care bill. It ends insurance company abuses like denying care for those with pre-existing conditions and it sets benefit standards to make sure the...

Drew Altman responded to Troublesome Directions on November 19, 2009 01:42 PM

Mon, 16 Nov 2009 12:30:00 GMT

Deductibles Will Come Into Play The fact that the Senate bill has been completed with a financing mechanism in place, a low CBO score and forecast that it will reduce the deficit even beyond the initial ten year period adds momentum to the prospects for Democratic backed health reform legislation. Since both the Senate and House bills now contain income-related financing measures the outlines of a deal between the two bodies on the all important question of financing health reform may be coming into view. One prediction I will make is that as the process moves forward there will be a much...

Andy Stern responded to Troublesome Directions on November 19, 2009 10:55 AM

Mon, 16 Nov 2009 12:30:00 GMT

Senate Can Deliver Results This is the Senate's opportunity to stand up and say 'Enough!' No more scare tactics. No more kowtowing to conservative obstructionism. No more politics as usual. No more hesitation. For close to a century, Presidents and congressional leaders have debated ways to fix our healthcare system. A system that leaves too many hardworking families struggling to get by or facing economic ruin. Each go round, politics, special interests and scare tactics said we can't. "We can't change. We can't make our country better. We just can't." Not this time. Just eleven days ago, the United States...

Marilyn Werber Serafini responded to Troublesome Directions on November 19, 2009 10:29 AM

Mon, 16 Nov 2009 12:30:00 GMT

Does The Senate Bill Move In The Right Direction? Senate Democrats yesterday unveiled their health reform bill, which looked much like the bills already approved by committees of jurisdiction, and which cost $849 billion. The bill is paid for in part through Medicare cuts, according to CongressDaily, including an increase in the Medicare payroll tax for individuals making $200,000 or more, and a tax on high-cost insurance plans. The Medicare payroll tax would bring in $54 billion and the Cadillac tax would raise $149 billion in revenue. Senate Minority Leader Mitch McConnell , R-Ky., called the bill another “trillion dollar experiment,”...

Newt Gingrich responded to Troublesome Directions on November 18, 2009 11:27 AM

Mon, 16 Nov 2009 12:30:00 GMT

Slow Down And Stop Spending Without a doubt, the time has come to reform our healthcare system. But the direction reform proposals have taken over the past 10 months have been alarming. Today, I signed a letter, along with dozens of other national leaders, lawmakers, and former administration officials, calling on President Obama, Speaker Pelosi and Leader Reid to abandon current healthcare legislation and instead seek sound, bipartisan solutions that increase quality, lower costs and don’t break the bank. Read the letter. Dear President Obama, Speaker Pelosi, and Leader Reid: There is no doubt that improving healthcare for all Americans...

Darrell G. Kirch, M.D. responded to Troublesome Directions on November 17, 2009 03:22 PM

Mon, 16 Nov 2009 12:30:00 GMT

More Insured, Not Enough Doctors? Will there be a doctor in the house when I need one? There are three issues that worry Americans about health care: Will there be a doctor in the house when I need one? Will I be able to pay the bill? And will the system and its people care for me? While answers to the second question—access to insurance-- are now coming into sharper focus, the issues of whether we will have enough doctors and whether we will achieve the kind of reform that results in well-coordinated, patient-centered systems of integrated care, are still largely unsettled....

Karen Davis responded to Troublesome Directions on November 17, 2009 09:33 AM

Mon, 16 Nov 2009 12:30:00 GMT

Why The Health Reform Bill Will Contain Costs Updated at 10:07 a.m. on Nov. 17. Late last week, the Centers for Medicare and Medicaid (CMS) Office of the Actuary (OACT) released a report projecting that total national health expenditures (NHE) would increase by $289 billion under the historic health care reform act recently passed by the U.S. House of Representatives out of the $35 trillion otherwise expected to be spent over the period from 2010-2019. Several commentators have seized on this estimate as evidence that, contrary to the claims of its supporters, the bill will raise costs and allow the...

John C. Goodman responded to Troublesome Directions on November 16, 2009 12:22 PM

Mon, 16 Nov 2009 12:30:00 GMT

Stopping Innovation Costs will be higher. Quality will be lower. Access to care will probably be worse. We will have created new entitlements that we cannot afford. But bad as all this is, the worst feature of the reforms is more subtle: We will likely make it impossible for entrepreneurs to develop real solutions to our problems without going off shore....

Joseph Antos responded to Troublesome Directions on November 16, 2009 07:33 AM

Mon, 16 Nov 2009 12:30:00 GMT

Cutting Costs Means Getting Smarter If health reform is enacted this year (or next), one thing is certain. The final bill will do little to change the fundamental economic incentives that drive health spending. This is disappointing but not surprising given the political forces at work. Although politicians argue that we need to bend the cost curve down, reform proposals will increase total health spending—confirmed by CMS actuaries, even assuming Medicare fee cuts that are unlikely to be implemented fully. For the most part, health reform will expand the current inefficient health system, hoping that another layer of regulation will...

Stuart Butler responded to Troublesome Directions on November 16, 2009 07:30 AM

Mon, 16 Nov 2009 12:30:00 GMT

Bills Will Only Increases Costs We’d better be nice to the Chinese, who hold much of our debt. There are several reasons why many of us who for years have supported health reform and coverage expansion are now so concerned about the direction the bills are taking. Here are just a few: Congress is taking a “big bang” approach rather than reforming in stages. The US health care economy is larger than the entire economy of Britain. Trying to fix something that large in one bill is impossible to get right. The bills bend total spending up, not down, and...

How Much Fraud?

Mon, 09 Nov 2009 13:41:00 GMT

Editor's Note: This week, former House Speaker and founder of the Center for Health Transformation Newt Gingrich is providing the question and serving as guest host for the blog.

The U.S. health care system wastes between $505 billion and $850 billion every year -- 22 percent, or approximately $200 billion, of which is fraudulent Medicare claims, kickbacks and other scams -- according to an October Thompson Reuters report. A few weeks ago, "60 Minutes" estimated that Medicare fraud costs U.S. taxpayers about $60 billion a year and has become among the most profitable crimes in America today, with increasing participation by organized crime.

I remember a 2005 New York Times article that revealed that New York's Medicaid program had become so massively complex and so lightly policed that it was easily exploited by a new breed of criminals. Stories like a dentist who billed 991 procedures in one day and one Buffalo school official who sent 4,434 students to speech therapy in a single day without talking to them or reviewing their records never cease to amaze. James Mehmet, the former chief inspector, estimated that up to 40 percent of all claims were questionable.

This New York Times story was the spark that eventually led to our book Stop Paying The Crooks. It provides an in-depth look at the fraud, waste and abuse crippling the U.S. health care system and offers solutions designed to end it. We believe it totals at least $100 billion each year in Medicare and Medicaid alone.

Unfortunately, current draft legislation does nothing proactive to eliminate fraud, waste and abuse in our health care system. Congressional Budget Office projections put savings at less than 1 percent of what they could be. We need real solutions that would dramatically reduce health care fraud so that savings could serve as a major pay-for for health information technology and covering the uninsured.

Questions:

• Reuters estimates $200 billion and 60 Minutes says $60 billion in annual Medicare fraud. We at CHT believe it is at least $100 billion in yearly Medicare and Medicaid fraud. Are these figures reasonable? If not, how much fraud do you think is actually out there?

• Are the anti-fraud efforts contained in the leading Senate and House bills likely to produce significant savings?

• What sort of provisions should be contained in order to maximize savings?

-- Newt Gingrich

What The Bills Would Do

John Iglehart wrote a primer on the issue over the summer in the New England Journal of Medicine ("Finding Money for Health Care Reform -- Rooting Out Waste, Fraud, and Abuse").

Here's how the major health reform bills propose to tackle fraud, according to the Kaiser Family Foundation.

• The Senate HELP bill would establish an integrity coordinating council; a fraud, waste and abuse commission; and two federal positions to oversee and coordinate oversight of health care fraud, waste and abuse in public and private coverage.

• The House committees approved bills that would allow provider screening, enhanced oversight periods and enrollment moratoria in areas at elevated risk of fraud in all public programs; they would also require Medicare and Medicaid providers and suppliers to establish compliance programs.

• The Senate Finance Committee bill calls for intensive screening of providers, the development of a database to capture and share data across federal and state programs, increased penalties for submitting false claims, and an increase in funding for anti-fraud activities.

Newt Gingrich responded to How Much Fraud? on November 13, 2009 04:05 PM

Mon, 09 Nov 2009 13:41:00 GMT

Congress Needs To Get Serious Updated at 11:18 a.m. on Nov. 18. These responses are a good indication of why fraud in Medicare and Medicaid has festered for decades and now reaches into the tens of billions of dollars annually. It largely goes unacknowledged and/or is dismissed in favor of discussing other issues. For example, the mention of tax evasion is completely unrelated to a health care blog (But on that topic, it is worth noting that tax evasion is highest in high-tax jurisdictions both domestically and internationally so lower, flatter taxes would go a long way toward ameliorating tax...

Marilyn Werber Serafini responded to How Much Fraud? on November 10, 2009 11:39 AM

Mon, 09 Nov 2009 13:41:00 GMT

Only Enforcement Can Stop Fraud As long as the system is run by people there will be fraud. Joe Luchok, a communications consultant who has worked on health care issues for organizations including the March of Dimes and the now defunct Health Insurance Association of America, argues that health information technology might offer limited improvement, but that the biggest help would come from increased enforcement. Here’s what he has to say: “Health care fraud will be very difficult to stop. We may be able to control some of it but stopping it is a daunting task. The system is so large...

Uwe Reinhardt responded to How Much Fraud? on November 10, 2009 11:22 AM

Mon, 09 Nov 2009 13:41:00 GMT

Fraud Difficult To Pin Down I believe fraud and waste are triggered by both public and private defined-benefit health insurance contract. We talk more about fraud in Medicare and Medicaid because these programs are at least semi-transparent. Two features of Mr. Gingrich’s set-up stem stand out. First, he does not offer a concise definition of fraud. Second, whatever he may mean by it, he seems to believe it occurs only or mainly in the public Medicare and Medicare programs. Defined-benefit health insurance contracts, whether they are public or private, are among the most complicated contingency financial contracts....

Marilyn Werber Serafini responded to How Much Fraud? on November 10, 2009 10:20 AM

Mon, 09 Nov 2009 13:41:00 GMT

Look To Biometrics Scott Kimmel, founder of Biometric Technologies, Inc., argues that fraud prevention is all about health information technology, and he offers here an explanation of biometrics as one possible solution. “Perhaps Mickey Mouse is the answer to eliminating health care, Medicare and Medicaid fraud. The Disney theme parks have 45 million visitors who enter their parks every year by placing their finger on a biometric device. The same technology can and should be used to eliminate health care fraud. Blue Cross states that at least 75% of health care fraud is committed by the provider and 18% by...

Henry J. Aaron responded to How Much Fraud? on November 9, 2009 09:47 AM

Mon, 09 Nov 2009 13:41:00 GMT

Time To Get Serious It would be refreshing if Mr. Gingrich would be as vocal in supporting staffing and funding adequate to root out tax fraud as he is on behalf of likely-ineffective technological ‘fixes’ to detect health care fraud Fraud on Medicare is a crime. Rooting it out should be a high priority—a much higher priority than it is today. That takes money to support enforcement agencies—the HHS Inspector General, the FBI, and others. Even with the meager resources now available to it, the HHS Inspector General currently identifies billions of dollars of fraud each year. No call...

John C. Goodman responded to How Much Fraud? on November 9, 2009 09:21 AM

Mon, 09 Nov 2009 13:41:00 GMT

Empower Patients To Cut Fraud The biggest waste of resources is not the result of fraud. It is the result of over consumption of care. Too many doctor visits, too many tests, too many procedures -- all because health care to the patient is free and because providers derive income from these services. The answer is to empower patients, give them control over more of the health care dollars, and allow them to pay the full cost of the services they receive. This in turn, will cause providers to compete on price and compete in other ways that will lower...

The Affordability Factor

Mon, 02 Nov 2009 12:48:00 GMT

Health insurers woke up policymakers and the public with claims that health reform bills on the table would increase insurance premiums -- not decrease them.

When it comes to affordability for individuals, what is most important to remember as members of Congress move forward with reform legislation? Are premium subsidies set properly at about 400 percent of the federal poverty level? How far up the income scale should Medicaid reach? What percentage of income should a person be required to spend on health care before they qualify for an exemption?

Karen Davis responded to The Affordability Factor on November 3, 2009 12:18 PM

Mon, 02 Nov 2009 12:48:00 GMT

Resolving Affordability Inequalities Reaching consensus on what constitutes affordability and committing the necessary funds to achieve it are crucial in securing access to essential care for all Under all of the bills now before Congress, new insurance market regulation requiring individual and small business health plans cover everyone and charge the same premium regardless of health status will do a great deal to increase affordability, especially for people with major health concerns. The bills differ, however, on the levels of coverage and assistance offered. The latest version of the House bill, like the HELP bill, would expand Medicaid eligibility up...

John Rother responded to The Affordability Factor on November 2, 2009 10:26 AM

Mon, 02 Nov 2009 12:48:00 GMT

An Ongoing Issue Affordability for healthcare insurance is a function of three elements: premium cost, cost sharing, and scope of covered services. Ideally, no one should be required to pay more than 10% of their incomes for total health costs, but the ceiling of $900b on the net cost of a health bill makes this an impossible standard to meet. While the House bill would greatly lower the cost for many people in the individual and small group markets, it would still impose costs above 10% for moderate and middle income individuals and families -- roughly those between 300 and...

Sen. Ron Wyden, D-Ore. responded to The Affordability Factor on November 2, 2009 07:52 AM

Mon, 02 Nov 2009 12:48:00 GMT

Low Cost Comes From Competition Reformers have much more to do when it comes to making health care more affordable for Americans. Three points stand-out in my mind: 1. Writing in Time magazine (10/26), Kate Pickert points out that during the ongoing open enrollment season millions of Americans with employer based health coverage are going to find themselves paying more for less. Pickert points out that the percentage of workers with significant deductibles has more than doubled in the last three years while surveys indicate that 40% of workers will pay higher premiums next year in addition to facing...

Ron Pollack responded to The Affordability Factor on November 2, 2009 07:49 AM

Mon, 02 Nov 2009 12:48:00 GMT

The "Pocketbook Test" America's families cannot fathom the difference between $800 billion, $1 trillion, or some similar figure In Washington, much of the discussion about affordability focuses on the gross costs of health insurance reform to the federal government: Specifically, should the gross federal costs be limited to $800 billion over ten years, $900 billion, $1 trillion, or some other figure. (The net costs will actually be zero or less since the gross costs will be fully paid for through the elimination of health system waste and new revenues.) Around the country, however, America's families cannot fathom the difference between...

Drew Altman responded to The Affordability Factor on November 2, 2009 07:48 AM

Mon, 02 Nov 2009 12:48:00 GMT

Real-Life Affordability Debate Will Come Lately the health reform debate has been "all public option all the time". The ideologically oriented debate about the public option has diverted attention from the meat and potatoes consumer issues in health reform. There is no doubt that policies offered to people in the exchanges will be better than what they could get in the broken non-group insurance market. But, depending on how details of the legislation are resolved, questions are likely to be raised about whether policies will be affordable for people who now will be required to have them as a...

Public Plan Opt-Out

Mon, 26 Oct 2009 12:07:00 GMT

Are there any downsides to creating a national public health insurance option and allowing states to opt out? Would it do any good?

Senate Democratic leaders seem intrigued with the idea. CongressDaily on Friday quoted Sen. Charles Schumer, D-N.Y., as saying, "Liberals live with it. Moderates live with it. It's in the middle."

But what about the policy implications? While such a proposal could potentially get enough votes to pass Congress, would a public option really lower costs if only some states offered it? How many would opt out, and why?

Len Nichols responded to Public Plan Opt-Out on October 29, 2009 10:53 AM

Mon, 26 Oct 2009 12:07:00 GMT

The public plan debate marches on this week as we discuss whether or not states should be allowed to “opt-out” of the public health insurance plan. Allowing states to choose not to provide the public health insurance plan as an option in their markets has its virtues. It establishes the infrastructure necessary to create a public health insurance plan nationwide, but it also makes the decision ultimately a state judgment. This may be a safer way to go for those who worry about government expansion. While we do not know the details of what kind of public plan...

Denis Cortese, M.D. responded to Public Plan Opt-Out on October 28, 2009 03:26 PM

Mon, 26 Oct 2009 12:07:00 GMT

The downsides associated with whether or not states opt in or out pales in comparison to the potential downsides associated with a public option that is not well thought out. Creating a government-run, price-controlled, Medicare-like public plan would be disastrous to the country regardless of who does or does not participate. Many years of experience with Medicare has shown that, despite across-the-board cuts in reimbursement, costs have continued to spiral out of control drawing the country closer to financial ruin. Effective insurance reform should include mandating that individuals purchase insurance through employers, on the individual market, through cooperatives or through private insurance...

Jason Rosenbaum responded to Public Plan Opt-Out on October 27, 2009 05:51 PM

Mon, 26 Oct 2009 12:07:00 GMT

Harry Reid stood up for America yesterday. He put a public health insurance option in the Senate bill, the merged version of the two health care bills passed out of committee that will now go to the Senate floor for debate, amendments, and passage. This is a huge victory. Putting the public health insurance option in the Senate bill that goes to the floor makes it much harder to remove later. Opponents will need 60 votes to amend the Senate bill, meaning a high bar will have to be cleared to take out or change the public health insurance option....

James P. Gelfand responded to Public Plan Opt-Out on October 27, 2009 04:06 PM

Mon, 26 Oct 2009 12:07:00 GMT

Texas Governor Rick Perry last night made some important comments on Fox Business Network about this. Essentially, "opt out" is not a real "opt out", unless you enjoy taxing citizens and businesses in your state to pay for a program that only operates in other states. I echo the sentiments of Mike Cannon below. Further, consider the implications of punting this to the states. Right now a cabal of far leftist groups have vowed to spend nearly $100 million pushing a public option. On the federal level, this won't go that far, because they have powerful opponents (like the business...

Karen Ignagni responded to Public Plan Opt-Out on October 27, 2009 04:01 PM

Mon, 26 Oct 2009 12:07:00 GMT

A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality. The American people want health care reform that will reduce costs and this plan doesn’t do that. The divisive debate about a government-run plan is a roadblock to reform. It’s time we focus instead on broad-based reforms that will ensure the affordability and sustainability of our health care system...

Michael F. Cannon responded to Public Plan Opt-Out on October 26, 2009 10:11 AM

Mon, 26 Oct 2009 12:07:00 GMT

President Barack Obama and his congressional allies want to create yet another government-run health insurance program (call it Fannie Med) to cover yet another segment of the American public (the non-elderly non-poor). The whole idea that Fannie Med would be an “option” is a ruse. Like the three “public options” we’ve already got – Medicare, Medicaid, and the State Children’s Health Insurance Program – Fannie Med would drag down the quality of care for publicly and privately insured patients alike. Yet despite offering an inferior product, Fannie Med would still drive private insurers out of business because it would...

Sec. Mike Leavitt responded to Public Plan Opt-Out on October 26, 2009 08:15 AM

Mon, 26 Oct 2009 12:07:00 GMT

Updated at 10:10 a.m. on Oct. 26. Advocates for a public health-care plan continue to look for a way to give political cover to moderates while advancing their goal of implementing a government-run health-care system. Their latest proposal is to create a federally controlled public plan that states can opt out of if they so choose. The public plan is pitched as if it would simply encourage competition and provide another choice for consumers. But a government-run plan is not just another plan, offering just another choice. It is designed to undercut private insurance. A government-run plan is dangerous for...

Paul B. Ginsburg responded to Public Plan Opt-Out on October 26, 2009 08:07 AM

Mon, 26 Oct 2009 12:07:00 GMT

Updated at 9:51 a.m. on Oct. 26. State opt out is appealing to some because political cultures vary across states, thus potentially permitting compromise on what is mostly an ideological issue. What the implications are beyond ideology depends heavily on what type of public option we are talking about. If it is the version where the public plan pays hospitals and physicians at Medicare rates, an extensive pattern of distortions could result. How Medicare rates compare with those negotiated by private insurers varies to a very large degree across geographic areas and also within a geographic area. One result could...

Defining Universal Coverage

Mon, 19 Oct 2009 12:30:00 GMT

How should Congress define universal coverage? The Senate Finance Committee bill is estimated to cover 94 percent of the population. Massachusetts has covered 97 percent of its population through its health reform, although it had a relatively low level of uninsured to begin with.

What is the best way to define universal coverage, and what are the most important factors that could keep the nation from getting there? How many of the uninsured should be covered under health reform?

Michael F. Cannon responded to Defining Universal Coverage on October 21, 2009 11:13 AM

Mon, 19 Oct 2009 12:30:00 GMT

I cannot disagree with Uwe Reinhardt's response to me. But his response bears clarification and emphasis. Improving "population health" generally means "helping people live longer." To paraphrase, Uwe then writes: If helping people live longer were our objective in health reform, we could do better than universal coverage. But health reform is not (solely or primarily) about helping people live longer. It is (also or primarily) about other things, like relieving the anxiety of the uninsured. I applaud Uwe for acknowledging a reality that most advocates of universal coverage avoid: that universal coverage is not solely or primarily about improving health. Will Uwe go...

John C. Goodman responded to Defining Universal Coverage on October 21, 2009 09:52 AM

Mon, 19 Oct 2009 12:30:00 GMT

This is an anecdote I have at my blog. It’s what they call “universal coverage” in Massachusetts: I get my health care through MassHealth [Medicaid in Massachusetts] and I went through 20 names before I finally found a doctor who would see me. I wasn’t going through the Yellow Pages. I was going down a list that MassHealth gave me!...

Uwe Reinhardt responded to Defining Universal Coverage on October 19, 2009 05:31 PM

Mon, 19 Oct 2009 12:30:00 GMT

Michael Cannon invites us to reflect on his throught-provoking statement, and so I shall. It has been known for many years that, at the aggregate level, the use of health care as we define it is only one of numerous factors that drive the average health status of populations (what we call "population health"). In fact, in health-production-function work or other research on the drivers of population health status, health care per say is only a minor player. Education, nutrition and environment rank higher. So it is true that if "population health" were our objective in health reform, we would...

Uwe Reinhardt responded to Defining Universal Coverage on October 19, 2009 05:16 PM

Mon, 19 Oct 2009 12:30:00 GMT

Let me state how touched I am by John Goodman's candor and modesty. All of us, I am sure, will from time to time encounter situations or statement that push uas beyond our intellectual capacity. Usually, at meetings, we remain quiet about it, lest someone discover our intellectual limitations. How refreshing then that John openly admits them, for all of us to see. Uwe ...

Michael F. Cannon responded to Defining Universal Coverage on October 19, 2009 11:36 AM

Mon, 19 Oct 2009 12:30:00 GMT

The more important question is: should Congress even try to achieve universal coverage? If the goal is to improve health, then the answer is clearly no. Ironically, even though universal coverage is presumably about helping the sick, the Democrats’ pursuit of universal coverage demonstrates not how much, but how little they care about their neighbors’ health. Economists Helen Levy and David Meltzer explain, in a book published by the Urban Institute, “There is no evidence at this time that money aimed at improving health would be better spent on expanding insurance coverage than on…other possibilities,” such as clinics, hypertension...

Ron Pollack responded to Defining Universal Coverage on October 19, 2009 10:00 AM

Mon, 19 Oct 2009 12:30:00 GMT

We should make every effort to secure health coverage for all Americans. However, instead of playing a numbers game of what percentage of the American public needs to have health insurance for it to be considered universal health coverage, we should focus on the key measures that need to be taken by Congress to move us towards the universal goal. At least two sets of improvements to the pending bills should receive top-priority attention. First, we need to ensure that the Medicaid expansions for America's lowest-income people and families -- currently proposed under all pending bills to rise to 133 percent of the...

John C. Goodman responded to Defining Universal Coverage on October 19, 2009 09:24 AM

Mon, 19 Oct 2009 12:30:00 GMT

I've read Uve's comment several times and cannot make sense of it. But then the question we are answering is sort of nonsensical. Universal coverage has not been the goal since the Democratic Primary contest ended -- some time last August. Now there is only one goal: pass a bill....

Uwe Reinhardt responded to Defining Universal Coverage on October 19, 2009 08:48 AM

Mon, 19 Oct 2009 12:30:00 GMT

It's funny how we all talk about it as if we knew what it was; but operationalizing it is quite a challenge. The definition has at least two distinct dimensions: (a) the benefit package that is considered minimally adequate and (b) the fraction of discretionary income (disposable income minus estimated minima spending on food, housing, utilities, etc.) that is absorbed by health spending on that minimum package (out-of-pocket spending on it plus premiums paid). So we would count as "uninsured" anyone who has less than that minimum package or spends mor than the normative percentage of discretionary inome on it or is characterized...