A Good Idea and Bad Leadership--A Way Out of the Entitlement Crisis Meets Partisan Politics

Tuesday, October 30, 2007
I call your attention to a column this morning by the Washington Post's David Broder.He tells us that there will be an important Senate hearing tomorrow on the issue of Social Security and Medicare entitlement costs.It seems that two Senators, one a Republican and one a Democrat, are trying to create a bipartisan task force that would have the power to fast track a solution to this huge emerging

Bush Ups the Budget Pressure--Shows No Sign of Compromising on SCHIP

President Bush just made a statement on the SCHIP bill and the upcoming 2008 budget votes. Standing in front of the White House with the Republican leaders behind him, he blasted the Democratic Congress, the recent SCHIP bill passed by the House, and rumored efforts on the part of Democratic leaders to couple defense and Iraq spending bills with domestic budget bills.The bottom line is that the

House SCHIP Vote Fails to Attract Veto-Proof Majority

Friday, October 26, 2007
Yesterday evening, the House passed a slightly modified version of the SCHIP bill President Bush vetoed last week, this time by a vote of 267-142. That is still likely at least 7 votes short of the two-thirds needed to overturn the expected Bush veto.The bill now goes to the Senate.It is possible that both sides will try to work out a compromise--but not likely.Expect the Senate to pass it, Bush

Poll Shows Democratic Presidential Candidates Attracting Independents and Moderates With Their Health Reform Plans

Thursday, October 25, 2007
I was struck by this conclusion in today's Los Angeles Times regarding their recent voter survey:"In one of the most politically significant results, the poll finds that independents and moderates were generally lining up with Democrats in the healthcare debate."The survey also suggested an explanation for the emerging alignment: Independents were most likely to complain about "job lock" -- the

Discussions Regarding Scheduled Physician Fee Cuts and Possible Reductions in Medicare Advantage Payments Getting Serious

As the year winds down, the Congress must deal with the scheduled January 2008 9.9% Medicare physicians fee cut. Both Democrats and Republicans want to fix it.To fix the physician fee cut, proposed cuts to Medicare Advantage have been on the table.Senate Finance Chair Max Baucus (D-MT) has been working on a package that would cost $25 to $30 billion and fix the physician fee problem not only for

New Study Shows Lower Costs in Consumer-Driven Plans--But the Findings Won't Settle the Debate Over Just How Effective C-D Plans Are

Wednesday, October 24, 2007
HealthPartners, a highly regarded not-for-profit Minnesota health plan, has issued an important report on its consumer-driven care book of business. It includes Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs).Their findings include:After adjusting for "illness burden," HealthPartners found that heath care costs were 4.4% lower for members in a consumer-driven plan compared

Democrats Pushing to Vote on New SCHIP Bill This Week--Bush Starting to Give

Democratic attempts to modify the SCHIP bill just enough to pick off the seven more Republicans they need are intensifying.The House failed to override Bush's veto by 13 votes last week.Yesterday, Bush's lead person on the SCHIP issue, HHS Secretary Leavitt, said the administration is now willing to consider covering kids up to 300% of poverty--they had said they would not go above 200%. Leavitt

The Fight Over SCHIP Tells Us This Budget Season is Going To Be One Big Food Fight--Medicare Payments to HMOs and Physicians Are in the Middle of It

Tuesday, October 23, 2007
Now that the House has failed to overturn President Bush's veto of the SCHIP bill by just 13 votes, Democrats are looking to tweak the $35 billion expansion of SCHIP just enough to get the extra Republican votes they need to get their bill passed.The House Democratic leadership is now in discussions with Republican House members who voted with their President last week and who might be persuaded

A Detailed Analysis of Rudy Giuliani's Health Care Plan

Thursday, October 18, 2007
A Detailed Analysis of Rudy Giuliani's Health Care PlanRudy Giuliani's health care reform plan generally follows the Republican health care reform template that places the emphasis on making the health care market more effective in controlling health care costs and thereby enabling more people to be covered.Giuliani would remodel the income tax system to help people buy coverage and encourage

Health Wonk Review is Up

Jason Shafrin is hosting this edition of "Health Wonk Review" over at the "Healthcare Economist."

SCHIP Veto Override Fails in the House--Now What?

As expected, the SCHIP veto override effort in the House failed by a vote of 273-156--thirteen short of the two-thirds necessary.Now what?First, SCHIP will not expire. A continuing resolution funds the program at current levels until mid-November and that can likely be extended indefinitely. However, at current levels hundreds of thousands of kids will eventually fall off the program.The

Why Bush is So Ready to Use the Veto Now When He Never Did When Republicans Were "Spending Like Drunken Sailors"

This from an article in today's Washington Post stood out for me:"President Bush declared yesterday that he remains 'relevant' despite his political troubles, and he derided Democrats for running a do-nothing Congress that has failed to address critical domestic, economic and security issues in the nine months since they took control of Capitol Hill."Back on August 2nd, I did a post, Why Is

Kaiser Family Foundation Creates a Great Tool to Compare Presidential Candidate's Health Care Plans

Tuesday, October 16, 2007
The Kaiser Family Foundation interactive comparison tool for the presidential candidates' health care plans can be found here.You can find my evaluation of each candidate's plan in the index on the right side of this blog.

The CED Health Reform Plan Gets It Right Until They Have to Make the Tough Decision

The Committee for Economic Development (CED) has released its report, "Quality, Affordable Care for All."A few days ago I asked a number of questions about just how far the CED would go toward creating a better health care system.While I think the group has made a number of very valuable suggestions, when it comes to cost containment they don't offer more than the long list of incremental and

Upcoming "Common Good" Forum: Health Courts, Administrative Compensation & Patient Safety: Research, Policy & Practice

For years we have debated reforming the medical malpractice system. But, most of that debate has focused on capping a system most people believe just doesn't work when it comes to improving the quality of our medical care. To me, that has always begged the question, Why cap a system that is fundamentally flawed?Common Good has been doing good work on that more fundamental question and will have

Committee for Economic Development (CED) to Release Its Health Plan This Week--The Questions to Ask Them

David Broder gave us a preview of the Committee for Economic Development's (CED) upcoming health care reform plan. With the likes of Alain Enthoven and "a high powered business group" involved, we all need to pay attention.Key points the report will make according to David's column:Business can no longer afford afford to pay for health care.Five years ago the group laid out a strategy for

Health 2.0 and the Promise of Market-Based Health Care Reform

Monday, October 15, 2007
"The ONLY policy-based reform approach that makes real sense is for the leaders of non-health care business to come together around a change agenda. They could use their collective strength to overwhelm the health industry’s objections, and drive disciplines and tools – standards, information technologyinfrastructure, evidence-based best practices, transparency and decision-support, and

SCHIP Veto Override Vote on Thursday--The Ragged Line Between Those Who Need Assistance and Those Who Don't

The House is scheduled to vote on overriding President Bush's veto of the State Children's Health Insurance Program (SCHIP) expansion.As I said last week, I believe the Democrats will come up about ten votes short in their attempt to override. I would be surprised, but not shocked, if they can find the two-thirds necessary to override the President.One of the arguments opponents of the SCHIP

When It Comes To Drug Prices the Europeans Are Better Health Care Capitalists Than We Are!

Friday, October 12, 2007
Sometimes I think the government-run European health care systems do a better job of using market tools to control their drug prices than we do in the U.S. market.For example, some government-run systems in Europe, France for example, are not afraid to take a drug off their official formulary if they don't get a competitive price.In January, the Democratic House passed a bill requiring Medicare

Cavalcade of Risk--Recent Posts From the World of Risk Management

Wednesday, October 10, 2007
Today, it's my turn to host the "Cavalcade of Risk." Every two weeks the Cavalcade offers insights into efforts to manage risk.Having spent substantial time at a main line property and casualty company, when I hear the term "risk management" my thoughts go to the things that corporate insurance managers do to limit their "loss costs."The popular notion of individual responsibility, and the

Aetna to Provide Managed Care Services to the British National Health Service--Say What?

Monday, October 8, 2007
Aetna has been approved by the British National Health Service (NHS) as one of the suppliers who can provide local Primary Care Trust (PCT) managers "a wide range of support, ranging from specific tasks such as designing medical management programs, also known as demand management, to comprehensive contracting and procurement of services."Where's Michael Moore? He needs to do an addendum to "

Means Testing for Medicare--It's Unavoidable If Politically Problematic

Friday, October 5, 2007
Means testing is politically problematic but necessary and probably unavoidable if we are to shore-up Medicare.The Bush administration is pushing a proposal to begin means testing on the new Medicare Part D drug benefit. They would increase deductibles and premiums on single seniors with incomes over $82,000 a year and couples with incomes over $164,000 a year.We already have a means test on

An Important and Disciplined Review of the Health Care Marketplace--The Latest Site Visit Report From 12 Markets

Thursday, October 4, 2007
Good health care market intelligence is hard to come by. Information tends to come in the form of detailed and narrow, often backward looking, surveys that give us little texture for what key players are thinking. Or, at the other extreme, market information is often based on a relatively few almost random anecdotal impressions by "experts" as they do their work in the market.The highly respected

Health Wonk Review is Up

Jane-Hiebert-White has the latest Health Wonk Review up over at the Health Affairs blog.This sample of some of the best recent posts in the health blog world not surprisingly has lots to say about the SCHIP debate and other timely health reform issues.I wonder what 1993 would have been like if we'd had the blog world?

SCHIP Supporters Are At Least Ten Votes Short to Override a Bush Veto

The Democrats are now going to take two weeks to try to change some minds before they attempt to override the Bush veto of the SCHIP bill--scheduling a vote for October 18th. If nothing else they will continue to hammer on the President and his Republican supporters over what is turning out to be a very unpopular stand by the President.The Senate approved the SCHIP compromise by a vote of 67-29.

Now That The UAW Is On The Hot Seat to Manage Its Retiree Health Costs Will Their View of Health Care Management Change?

Wednesday, October 3, 2007
Brian Klepper joins us again today this time with an astute analysis of the UAW/GM deal. Now that the UAW owns their GM retiree plan will they look at health care management differently?The Hot Seatby Brian KlepperI agree with Bob that the GM-UAW deal is a turning point for American health care. In a stroke – OK, it was a 456 page stroke – GM agreed to turn over as much as $35 billion, about 70

Reforming Our Health Care Financing System Won't Mean Anything if Americans Don't Start Taking Better Care of Themselves

Tuesday, October 2, 2007
Ken Thorpe, along with associates David Howard and Katya Galactionova, of Emory University has expanded on his earlier work on chronic disease in the U.S. and its impact on our health care costs in a web article for the journal Health Affairs. He compares chronic disease in the U.S. and Europe and looks at the difference as a means to help explain our higher health care costs.As all of the

The Country's Political Center is Shifting and With it the Health Care Reform Debate

Monday, October 1, 2007
I always thought it was shortsighted for the Republicans to avoid comprehensive health care reform in the six years they controlled the White House and the Congress (2001-2006). Instead they just added $8 trillion in unfunded liability (Part D) to a Medicare system they've been telling us from the beginning is unsustainable as it is.Eventually the political pendulum swings to the other side.