Health Care.

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The front group “Get Health Reform Right,” funded by the insurance industry, sent out their first “grassroots” email today. Here’s what it says:

The healthcare reform debate is heating up in Washington and we all have a stake in the outcome.   Draft health reform legislation in the House of Representatives is now under consideration.  While this draft legislation takes some of the critical steps needed to transform our healthcare system and expand coverage, it also takes a huge leap in the wrong direction by creating a new government-run health plan.

We all agree that it is critically important to enact comprehensive healthcare reform this year, but legislation that includes a government-run health plan will actually undermine the goals of reform and have devastating consequences on our healthcare system.  Take action now and tell Congress to get health reform right.

More government bureaucracy will only create more problems, not solve the ones we have.  A new government health plan would use its built-in advantages to eventually take over the entire health insurance market, forcing out private plans and limiting consumers’ choices.  Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan.  This is not the answer for improving our healthcare system.  Instead, Congress should build on the current employer-sponsored healthcare system that is already working for more than 160 million Americans.  Tell Congress to build on healthcare that’s working for most until it works for all.

Thank you for making your voice heard on this important issue.  With so much riding on healthcare reform, Congress needs to get health reform right for America.

Now, given that it’s the insurance industry sending this message, I’m going to rewrite it so you can see what they really mean:

The healthcare reform debate is heating up in Washington and our profits have a stake in the outcome.   Draft health reform legislation in the House of Representatives is now under consideration.  While this draft legislation takes some of the critical steps needed to transform our healthcare system and expand coverage, it also forces us to compete and actually provide health insurance, or lose money. We don’t like that.

We keep saying that it is critically important to enact comprehensive healthcare reform this year, but we’re really worried that our CEOs won’t be able to take that 2nd vacation this year if our profits get cut a couple percentage points. So we’re going to tell people that offering them a choice of a public health insurance option somehow will cause them to lose health care. It’s not true, but it sure is scary! And if we scare them enough, maybe they’ll complain to their Members of Congress!

If we actually had to compete, we couldn’t pay our CEOs billions, and we would have to stop denying care for prexisting conditions. That would be a big problem – for us. And of course, though we’ve argued for years that government is so incompetent that it can’t do anything, we’re going to pretend that we’re so vulnerable that we can’t compete with government. Yes, we know this doesn’t make sense, but we’re going to say it anyway. If we make it sound scary enough, people might not realize they would love to choose to dump us if they could, and that most of them (76%) support giving us a bit of competition.

We hate competition, and so we’re against health reform. And we’re trying to scare you so you are, too.

Boo!

I don’t expect anything better from the industry – they lie about everything else, why not lie about being grassroots.

Update: The Education and Labor Committee sends along this fact-check of the insurance industry’s lies:

1. Government plan would use its built-in advantages to eventually take over the entire health insurance market, forcing out private plans and limiting consumers’ choices.

The public health insurance option would be just one choice for consumers and families in a menu of private health insurance options called the national health insurance exchange. The public health insurance option would be required to follow the same rules as private insurers (level playing field). And, the public health insurance option would self-sustaining through premiums, not government subsidies.

If we are serious about real competition to help control costs, and most Americans agree, a public health insurance option must be one of many choices consumers will have. As studies have shown, many Americans have little or no choices in health plans in their region.

2. Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan.

No one will be forced into the public health option. If an employer drops their insurance coverage for their employees, those workers would have a choice of any plan in the health insurance exchange, including a public insurance option. In addition, the employer would then have to pay an 8 percent penalty, based on their payroll, for not covering its employees in order to assist low and moderate income employees to obtain insurance coverage that is right for them.

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Some text for the HELP Committee’s public health insurance option leaked last night. The language includes:

–HHS-based plan: The community health insurance option would be run by HHS. The government would pay for the first three months of claims as a way to capitalize it; this would be a loan to be repaid over time. For the first two years and longer if necessary, the option would also qualify for “risk corridor protections” which offset or reclaim excessive losses and gains which could result during the start-up period (identical to those in Medicare Part D). Subsequently, its premiums would be set to make it self sufficient. This would make the health insurance option quickly available in all areas of the country.

–Plays by the same rules: The option would be one of the Gateway choices. It would follow the same rules as private plans for defining benefits, protecting consumers, and setting premiums that are fair and based on local costs. The only difference between this option and others is that the Secretary would set the reserve requirements for this plan rather than states.

–Provider payments and participation:

• Negotiated rates within limits: The payment rates paid by the option would be no more than the local average private rates – but could be less. The Secretary would negotiate these rates.

• Input from Advisory Councils: Each State would create a Council of provider and consumers to recommend strategies for quality improvement and affordability. States would share in the savings that result.

• Purely voluntary: Health care providers would have the choice of participating in this plan; there would be no obligation to do so.

Why It Will Make Health Care Affordable:

–Pooled purchasing power: This health insurance option can pool the purchasing power of its enrollees nationwide to leverage lower prices to compete with private plans. Similar negotiation power has been used by states to get drug rebates in Medicaid beyond the statutory minimum. It has been used by large businesses to drive delivery system change. This negotiation would be backed by a ceiling of paying no more than average local rates.

–Flexibility and incentives to innovate: Unlike administered pricing, the negotiation for payment rates gives the Secretary the ability to quickly and aggressively promote payment policies that promote quality and best practices. In addition, the State Advisory Councils would tailor delivery system reform for the plan, with a financial bonus for success.

–Lower administrative overhead: The community health insurance option would not need to raise premiums to support shareholder profits, extensive marketing, and extra risk reserves required by require to protect enrollees from plan insolvency or mismanagement of funds.

This fulfills the broad requirements for a public option: Available everywhere and on day one, and accountable to Congress and the voters, as well as rate flexibility. Of course, things are still very much in flux and these details could all change, for better or for worse. But so far, so good.

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Chris Bowers has been keeping track of the answers you all have gotten from the Senate over the last few weeks. For those just joining the campaign, we, along with Chris at OpenLeft and Democracy for America, are asking Senators to answer for questions on the public health insurance option:

• Do you support a public healthcare option as part of reform?
• Do you support a public healthcare option that is ready on day one?
• Do you support a public healthcare option that is national, available everywhere, and accountable to our government?
• Do you support a public healthcare option that has the clout to establish rates with providers and big drug companies?

The answers are starting to trickle in, and we’re going to publish them all this week. But we want to make sure we’ve gotten all the responses so our count is accurate. So, if you’ve gotten a response from your Senator, click here to report it.

Of course, if you haven’t gotten an answer yet, keep asking. As Chris says (and I concur), if there’s one thing he’s learned from blogging, it’s that you have to keep asking Senators over and over until you get the answer you want. So, click here to email you Senator.

And of course, tell your friends about this campaign, so we can turn up the pressure.

Stay tuned for the answers!

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NEWS

Dianne Feinstein: Criticism From Left On Health Care “Doesn’t Move Me One Whit” – Greg Sargent

Senator Dianne Feinstein has already taken a hammering from Dems and health care reform advocates for casting doubts on the prospects of President Obama’s health care reform efforts. MoveOn, for instance, aired an ad against her in California, demanding she show some leadership and fight harder to get the president’s reform plan passed.

Obama Steers Health Debate Out of Capital – New York Times

With Democrats deeply divided over health legislation, President Obama is trying to enlist the nation’s governors and his own army of grass-roots supporters in a bid to increase pressure on lawmakers without getting himself mired in the messy battle playing out on Capitol Hill.

AP Interview: Snowe seeks bipartisan health bill – Associated Press

Sen. Olympia Snowe, a key figure in shaping federal health care legislation, said Monday that a government-run plan that would take effect if the private insurance market fails to deliver affordable coverage could bridge the partisan divide that threatens to derail President Barack Obama’s efforts to reform the system.

Dems warn GOP not to overreach in health care – Associated Press

Mainstream Democrats close to Barack Obama are warning Republicans about insisting on too many changes to the president’s health care overhaul, saying the Democratic-controlled Congress will move ahead without GOP input if they do.

OPINION

Designing the Health Insurance Exchanges – Ezra Klein

I’ve said before that the Health Insurance Exchange is arguably the most important element of health-care reform. And I’m worried about it. Just like there’s a strong and weak version of the public plan, there’s a strong and weak version of the exchange. It’s been hard to get people to care about the exchanges. So maybe this will help: The Health Insurance Exchange is where the public plan will live. And if the exchange doesn’t survive, or thrive, then neither will the public plan.

Tom Daschle: ‘I Can’t Think Of A Tool That More Effectively Controls Costs Than A Public Option’ – Think Progress

Over at ThinkProgress, Faiz Shakir reports that “in an emailed statement to Bloomberg News, Health and Human Services Secretary Kathleen Sebelius said she’s open to the idea of dropping a public health insurance option in favor of a medical-insurance cooperative,” even if the proposed co-operative is a mosaic of state-based programs.

Health Care’s #1 Enemy - Media Matters

Betsy McCaughey is at it again – spreading misinformation about health care reform and helping to prevent millions of Americans from gaining access to basic health care services.

Senate Finance Committee Health Care Influence Cluster: The Democrats - Paul Blumenthal

Last week, I took a look at the circle of former staffers turned health care lobbyists that surround Senate Finance Committee Chair Max Baucus. The Senate Finance Committee is one of the two central committees in the Senate charged with formulating health care reform legislation. Knowing the connections to the health care lobby of all committee members provides us with a glimpse into who may have access to shape the forthcoming legislation. In continuing with mapping Baucus’ connections, below you’ll find a map of all the committee Democrats and their connections, through former staffers turned health care lobbyists, to various health care lobbies.

Debating the Public Option – The American Prospect

In “The Perils of the Public Plan,” Paul Starr warns that a public-insurance option could turn into exactly the opposite of what progressives want. Here he discusses the problems with the Prospect’s two other co-founders, Robert Kuttner and Robert Reich.

Taxing Employer Health Benefits: The Poison Pill That Would Kill Health Care Reform – Jimmy Hoffa

Congress is finally beginning to grapple with a way to give all U.S. citizens access to affordable health insurance. Unions support universal coverage like a large majority of Americans.

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As usual:

This won’t come as the slightest surprise to those versed in health care policy issues. But I fear it’s only barely permeated the health care reform debate in the country, certainly in Washington. And that’s this: the opposition to a so-called ‘public option’ comes almost entirely from insurance companies who have developed monopolies or near monopolies in particular geographic areas. And they don’t want competition.

Note, I’m not saying more competition. I’m saying any competition at all. As Zack Roth explains in this new piece 94% of the health care insurance market is now under monopoly or near-monopoly conditions — the official term of art is ‘highly concentrated’. In other words, there’s no mystery why insurance costs keep going up even as the suck quotient rises precipitously. Because in most areas there’s little or no actual competition.

That’s exactly right. As President Obama pointed out last week, the arguments used by the industry and by conservatives are illogical at best and dishonest at worst:

If private insurers say that the marketplace provides the best quality health care; if they tell us that they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.

They’re not against the public plan because it would be bad for you and me, they just don’t want the competition. Pretty self-serving, no?

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As Health Care for America Now’s report on affordability issues in the health system shows, Americans in every state face exploding health care costs. That’s one reason why strong majorities of Americans, in poll after poll, say they want a strong public option.

Americans all over the country are speaking out, but the past week has seen major pressure on elected officials from out West. Reform advocates demonstrated in Las Vegas this weekend. Last week, California Senator Dianne Feinstein faced strong pushback from grassroots groups in response to her skepticism that the Senate will support a public option.

The Western state where grassroots pressure is most likely to move a skeptical Democrat, though, is Washington. A local outlet, The Columbian, says Washington’s congressional delegation “has muscle to flex over health care”:

Washington’s top elected officials — Gov. Chris Gregoire and Sens. Patty Murray and Maria Cantwell — have key roles in the national debate.

Gregoire was among five governors who met with President Obama Wednesday to discuss the states’ perspective on health care reform. She said later that she advocated “a hard look” at a government-run plan, but suggested that it could be run by the individual states — with the federal government footing the bill.

Cantwell and Murray serve on the two committees that are writing the Senate bill. Both will be in the state this week to talk health care with constituents.

Though Rep. Brian Baird does not serve on any House health care committee, he has a long-standing interest in the issue. In 2007, he introduced legislation that would de-link health coverage from employment and provide private health insurance coverage for every uninsured American.

All have offered measured support for creation of a government-run “public option” that would compete with private insurance plans, by far the most contentious issue in the health care debate.

Both Cantwell and Baird have come under fire from advocates of a public option for failing to take a stronger stand.

One example of the fire directed at Sen. Cantwell by Washingtonians is this piece in Seattle’s The Stranger, bluntly titled “What’s Up with Maria Cantwell?” Author Eli Sanders writes,

Seattle congressman Jim McDermott supports it. Washington senator Patty Murray wants it. So does President Barack Obama. So does the often conservative Seattle Times editorial page. So do 72 percent of Americans, according to a recent poll. So what’s going on with Washington’s junior senator, Maria Cantwell? Why doesn’t she want Congress to include a public option—a new government-run health-care plan that will be available to everyone and will compete with private insurance companies to bring down costs—in its health-care-reform package?

“I don’t think that’s something we can get through the United States Senate,” Cantwell told KUOW on June 22. It’s an odd bit of circular logic: Because Cantwell can’t yet count enough votes to pass the public option, she won’t add her vote in favor of the public option—which, of course, makes it even harder to find enough votes to pass the public option.

Sanders goes on to share his frustration – and the frustration of a Washington small business owner he interviewed – at Cantwell’s lack of clarity on her positions regarding a public plan or various proposed compromises.

For one more Washingtonian voice on health reform, I looked up the Seattle Times editorial that Sanders references. This line stood out to me:

After so many false starts and clever ads from opponents of health-care reform, the public is serious about change. Politicians notice.

Judging from the diversity and seriousness of the voices in Washington pushing for meaningful reform, if Cantwell hasn’t yet noticed the hunger Washingtonians have for real change then she will soon. With nearly three-quarters of a million people in Washington uninsured, nearly one in ten unemployed, and health premiums rising over five times faster than median earnings in the state, it’s clear Cantwell’s constituents are suffering under the current system. With Murray and others in Washington’s delegation on board for real reform, it’s also clear that Cantwell will have plenty of company if she joins the ranks of reformers. Here’s hoping she’ll put a finger to the wind and feel the change that’s taking place in Washington, in the West, and across the entire United States.

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Just so we’re clear, we know Republicans aren’t going to vote for health reform that actually does anything right?

Via the New York Times:

Representative John A. Boehner of Ohio, the House Republican leader, said he was unaware of any House Republican inclined to support the Democrats’ proposed legislation.

Asked how many Senate Republicans could sign on to developing Democratic plans, Senator Richard M. Burr of North Carolina, author of a Republican alternative, said: “I think right now, none. Zero.”

So, the question becomes, how far are you willing to push this “bipartisanship” thing? Will you go for bipartisanship at the expense of getting a bill that does what President Obama and the American people want it to do – lower costs, make health care affordable, and increase coverage?

Because it’s possible to get, say, one or two Republican votes in the Senate, but that might not even be enough to satisfy Republicans:

Hoping to lessen the divide, a handful of senators from the two parties who sit on the Finance Committee have been meeting privately, trying to find some consensus. But they left for the weeklong Fourth of July recess without any firm agreement, though they pledged to keep trying. Even a senator at the center of those talks among four Republicans and three Democrats, Charles E. Grassley of Iowa, the senior Republican on the committee, indicated a reluctance to back any legislation unless it was constructed to attract more than a handful of Republicans.

“This is not going to be a bipartisan bill with just three or four Republicans,” Mr. Grassley said. “This is a bill that gets broad bipartisan support or it is not going to be a bipartisan bill.”

Now you tell me: What kind of bill do you think more than a few Republican Senators would vote for? Do you think it would do any good? Do you think it would be anything but the status quo? Do you think it would lower your costs instead of bailing out the insurance industry with taxpayer dollars?

If I had to guess, any bill Senate Republicans support would do nothing for the American people. The health care crisis is too great – bipartisanship isn’t worth the price we’d pay.

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NEWS

Little Hope for G.O.P. to Support Health Bill – New York Times

Congressional Republicans are finding much to dislike in Democratic health care proposals, illustrating the immense difficulty Democrats face in fashioning an overhaul that can attract enough Republican support to be portrayed as bipartisan.

Unions demand public plan in healthcare bill - The Hill

A horde of union members gathered on Capitol Hill on Thursday demanding that a government-backed insurance program be included in healthcare reform legislation.

President Obama to host town hall on healthcare reform – Examiner

In another move that further underscores the importance his administration (and most Americans) attaches to the issue of our broken healthcare system, President Obama will on Wednesday host a town hall on healthcare reform in Annandale, Virginia. In the video (below) courtesy of the White House blog, the POTUS asks Americans to submit their questions via YouTube, a continuation of his policy of interacting personally with the people as a means of gauging their pulse on this most crucial of national issues.

Axelrod, Grassley Spar Over Bipartisan Health Care – Huffington Post

One of Barack Obama’s chief advisers and one of the key Republicans in the Senate jousted on Sunday over what constitutes bipartisanship when it comes to health care legislation.

OPINION

E.J. DIONNE: Obama and the stone tablets: Compromise should not not be allowed to gut health care plan - Washington Post

EVERY general studies the mistakes of the last war, and President Obama’s style has been much influenced by the difficulties of Bill Clinton’s presidency.

Insurance Company Schemes - New York Times

Congressional committees heard a lot this month about the devious schemes used by health insurance companies to drop or shortchange sick patients. It was a damning portrait — and one Americans know from painful personal experience — of an industry that all too often puts profits ahead of patients.

The Public Option Is Important. But How Important? - The New Republic

Speaking on Thursday before thousands of activists gathered on Capitol Hill, former Governor Howard Dean made clear his litmus test for health reform: “We expect change,” he told the crowd, “We want a public health insurance option now.”

Eric Cantor Fails to Explain GOP Health Care Plan on Morning Joe – Crooks and Liars

Eric Cantor is asked by MSNBC’s Dylan Ratigan to explain just what the GOP’s plan is for health care reform, and again, Cantor fails to give any details as to just what their plan is, other than saying no to a public option and offering consumers more “choice”. Even Ratigan points out at the end of the interview that Cantor didn’t answer his question.

Does The White House Have a Secret Strategy for Health Reform? – Ezra Klein

As Paul Krugman writes today, it’s a bit tricky to say exactly what the White House’s bottom line is on health care — or even if it has one. “The only thing that’s non-negotiable is success,” Rahm Emmanuel likes to say. And a lot of things can be defined as success.

WaPo Turns Into Healthcare Insurance Industry Advocate By Skewing Coverage – Crooks and Liars

So I’m skimming my bookmarked sites for post ideas and on CongressMatters (which, if you don’t read regularly, you should), David Waldman blogged about this ridiculously slanted article in today’s Washington Post.

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In the spirit of shared responsibility, Wal-Mart, the nation’s largest employer, joined SEIU and the Center for American Progress to support an employer mandate to provide coverage if it is coupled with steps guaranteed to slow the rate of health care cost growth.

The letter to President Obama states clearly, "We are for shared responsibility…We are for an employer mandate which is fair and broad in its coverage." It also recognizes the varying ability of employers to contribute by saying, "Not every business can make the same contribution, but everyone must make some contribution."

Wal-Mart, SEIU, and CAP emphasize that "guaranteeing cost containment is essential," and express their support for one proposal to ensure savings put forth by the Bipartisan Policy Center to "implement pre-specified targets for spending growth and enact a ‘trigger’ mechanism that automatically enforces reductions." A similar idea to "hold providers accountable to cost and quality standards at a specified date" was proposed by Health CEOs for Health Reform.

More on this announcement later. But for now it is encouraging to see Wal-Mart not only talking the talk, but walking the walk on shared responsibility for our health care goals.

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Not a lot of aspects of U.S. health care still have the power to stun me, but when I first heard the statistics on U.S. hospital readmissions I was, well, stunned. I wrote about readmissions in today’s Washington Post (in a collaboration with the new Kaiser Health News.) Readmissions is a pretty sprawling topic, but I think the reason it interested me so much is because it’s a nexus of so much of what’s wrong with our health care system. Errors of omission and commission. A system so complex and fragmented that we lose track of what the patient needs. Financial penalties (in some although not all cases) for hospitals that try to make things better.

For a Medicare patient who has been hospitalized, about one in five are rehospitalized in 30 days, one in three within 90 days. Within a year, two-thirds are either rehospitalized, or dead. For younger patients, the figures are better but not great. After all, don’t we all have friends and family who have gotten out of the hospital and headed right back in again a week, two weeks, a month later?

Not every rehospitalization is unnecessary; people who have excellent care can still have setbacks. Diseases can and do progress. But a lot of these hospitalizations (some experts argue a majority of them) result from patients falling into one crack after another in our chronic care system.

Dozens if not hundreds of projects and initiatives are underway to reduce high readmissions rates. A few lessons have already emerged. For instance, Stephen Jencks, one of the experts I interviewed (he worked for Medicare for a long time and now consults for IHI) told me that one of the biggest factors is whether a patient sees his or her own physician outside the hospital quickly. (Finding out how many don’t or can’t get an appointment is another stunner). The quality of personal communication is also crucial. The Iowa "Teach Back" program I wrote about sounds so simple, but it actually takes careful effort over several days. The nurses make sure the patient understands what medicine he needs to take when he goes home from the hospital. Easier said than done. Patients who are groggy from their drugs, anxious because they are sick and in the hospital, in too much pain to concentrate or suffering from dementia or short-term memory deficits aren’t going to understand complex directions. (Take the little orange pill four times a day on an empty stomach, take the big blue pill three times a day on a full stomach, take the pink pill as needed for pain, take the red pill before the pain starts, avoid grapefruit with the square white pill but have some yogurt to coat your stomach before the oblong white pill, take the little green one to help you sleep but don’t take the big green one at night because it will keep you up…Add about a dozen more instructions for an elderly person with several chronic diseases, and call me in the morning). Teach Back is more complex than it sounds at first blush (and it can sound plenty daunting to nurses who are already overburdened by staffing shortages).

Relationships and self-care both seem to matter. The patients at Inova’s Heartlink call in their health status, and they have to pay attention to their own bodies—their weight, their breathing, swelling in their limbs. (A relative can take this on if the patient is not well enough or not cognitively able to handle it). But the HeartLink nurse is keeping track. If someone doesn’t call in, she notices and she’ll check in. Some telephone-based disease management programs have not worked well. The Virginia program I wrote about is new, so their data is still quite preliminary and anecdotal. But it’s also very encouraging. It’s phone monitoring, but it’s phone monitoring with a heart. The HeartLink nurse knows most of the patients in person, or she develops ongoing relationships over the phone. She isn’t just a detached voice from out of town. Most of the HeartLink patients are treated by a small cardiology group that works closely with the high quality community hospital. Technically it isn’t an "integrated" system, but the relationships—between doctor, nurse, patient and hospital—appear to work.

One last thought. As regular readers of this blog know, I’ve done a lot of writing on end of life and palliative care. Sometimes we send patients back to the hospital even though they might not really want to be there if their doctor had an honest conversation with them about the severity and likely course of their condition. At some point, even well-managed chronic diseases can become terminal diseases. Instead of going through the revolving door, back into ERs and ICUs, sometimes it is time, as nurse Honora Fowler noted, to have a conversation about palliative care or hospice. It can be hard. But the alternative can be harder.

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Remember that $1.1 billion in the economic stimulus package (aka the American Recovery and Reinvestment Act) dedicated to comparative effectiveness research? Though many of us have had a lot on our minds lately with health care on the Hill, others have stayed focused on how to best use those stimulus funds. This week, the Federal Coordinating Council for Comparative Effectiveness Research, an independent advisory committee, released recommendations.

Comparative effectiveness research provides insight into the best treatments based on real world data. The Council’s goal is to create a solid foundation of research that both patients and clinicians could use to inform their treatment decisions.

Health care is a large, diverse field, so the Council also had to come up with a framework for prioritizing research areas. To be considered, a research topic has to meet certain criteria:

• Does it fit with the definition of CER?
• Is it going to provide useful information to patients, clinicians, and stakeholders?
• Does it respond to the needs expressed by patients, clinicians, and stakeholders?
• Is it feasible to research? (Can we actually produce something valuable in a reasonable amount of time?)

High priority CER research topics had:

• a large potential impact (looking into health conditions that are particularly widespread, burdensome, or costly)
• high variability or uncertainty in clinical practice
• the potential to positively effect diverse and/or large populations (priority populations include racial and ethnic minorities, persons with disabilities, persons with multiple chronic conditions (including co-existing mental illness), the elderly, and children)
• the potential to lay a strong foundation and get the ball rolling on future research
• the potential to affect areas that other organizations are unlikely to address

According to the report, "the primary investment for this funding should be data infrastructure. Data infrastructure could include linking current data sources to enable answering CER questions, development of distributed electronic data networks and patient registries, and partnerships with the private sector."

The Council’s recommendations are directed specifically at the Office of the Secretary of HHS. The Council expects the Agency for Healthcare Research and Quality (AHRQ), which received $300 million of the $1.1 billion, and the National Institutes of Health (NIH), which received $400 million, to fill in the gaps in translating and distributing the findings of CER to the right places. Thus "dissemination and translation of CER findings, priority populations, and priority types of interventions" are a secondary priority for CER investment.

The Council prioritized transparency and public input in their recommendations; they held numerous public listening sessions, collected feedback through their website, and heard testimony from doctors, patients, and stakeholders.

The full report is available here.

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Politico’s Pulse has the scoop on what it describes as a draft of the Senate HELP committee’s proposal for a public health insurance option. Likening the plan to the "level playing field" option proposed by Senator Chuck Schumer, Pulse says, "it won’t be as liberal as the House, but it will be a strong alternative to the coop plan that is the emerging idea in the Finance Committee."

The details, as of now:

• Structure: The "community health insurance option," would be run by HHS. After the initial start up, which would allow for some risk adjusting to account for excess gains or losses, the plan would run self-sufficiently off its own premiums. The plan would be one option in the so-called Gateways, or insurance market exchanges, proposed in the HELP legislation. It would be subject to the same rules as private plans and set premiums "that are fair and based on local costs."
• Payment Rate: The HHS Secretary will negotiate payment rates that will be "no more than the local average private rates" but could be less. Provider participation is voluntary and State Advisory councils made up of consumers and providers will be set up to recommend strategies for improving quality and affordability.
• Potential Value: As structured, the community health insurance option would help make health care more affordable by pooling purchasing power, giving HHS more flexibility to promote payment policies that can drive quality improvements and best practices, and lowering the administrative overhead.

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A new message coming from the anti-health reform chorus is telling older Americans that they have a lot to lose under comprehensive health reform. For instance, Senate Minority Leader Mitch McConnell took to the airwaves on Sunday to proclaim, “When you get to the question of paying for [health reform], it appears as if they want to pay for it on the backs of seniors through Medicare cuts.” It’s not surprising, then, that recent polls have found some seniors more nervous about health care reform.

Older Americans, age 65 and up, are the only segment of the U.S. population that has coverage for all under Medicare. Nobody is talking about taking it away from them; some of the changes to Medicare contemplated in reform plans are actually designed to change incentives so that they get more appropriate care for their multiple chronic diseases. The status quo is also failing millions of older Americans, age 50-64, and reform proposals would lend an urgently needed hand to that segment of the population, which is vulnerable, often-overlooked, and growing. “They are uninsured people ages 50 to 64 who are caught in a frightening twilight zone of health care—old enough to be facing more medical problems but too young for Medicare,” Patricia Barry wrote recently in AARP Bulletin Today. “And this is the age when chronic health conditions such as diabetes and heart problems most often begin to show up.”

Because insurance companies often refuse to cover individuals with pre-existing conditions—and charge much higher premiums to those they do accept—Americans in this age bracket without employer-sponsored insurance often have tremendous difficulty obtaining affordable coverage. The problem is only getting worse as the economic downtown forces many middle-aged workers into early retirement.

More than 7 million adults aged 50 to 64 were uninsured in 2007, a 36 percent increase over 2000 levels, according to an AARP analysis. Nearly one in six individuals applying for individual insurance are rejected at age 50. The number rises to one in four at age 60.

Insurance market reforms that require insurers to take all comers regardless of preexisting conditions and ban them from setting premiums based on personal medical history will help Americans 50 to 64 years old get the health care they need. These changes will also save the federal government money down the road since patients will be healthier when they become eligible for Medicare.

AARP The Magazine has an instructive piece in its current issue debunking eight other health care reform myths that might be particularly scary for older people. First and foremost: “Health reform won’t benefit people like me, who have insurance.”

Just because you have health insurance today doesn’t mean you’ll have it tomorrow. According to the National Coalition on Healthcare, nearly 266,000 companies dropped their employees’ health care coverage from 2000 to 2005. "People with insurance have a tremendous stake, because their insurance is at risk," says Judy Feder, a professor of public policy at Georgetown University and a senior fellow at the Center for American Progress…

Comparing health reform to buying an Energy Star appliance—pay a little now to save a lot later—the article also cites a recent Commonwealth Fund study that estimated that “health care reform will cost roughly $600 billion to implement but by 2020 could save us approximately $3 trillion.”

What’s more, the recent deal the White House brokered with the pharmaceutical industry will save America’s seniors billions in out-of-pocket payments for prescription drugs.

The truth is that all of us—young and old—stand to gain a great deal as Congress moves to overhaul our nation’s ailing health care system. Failing to act is what should worry us the most.

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Business Week takes a look at the medical home model, and finds that, lo and behold,  primary care docs can provide high quality coordinated care and boost their income to boot.

Improving patient centered primary care—which means care coordination, prevention, wellness and management of chronic conditions—is a key theme of national health reform, supported across ideological lines. A medical home can take various forms. It can be a large group practice or a solo one like Dr. Peter B. Anderson’s in Newport News, Virginia, profiled by Catherine Arnst in the Business Week story. (Or this doctor profiled last year in the Washington Post, a slightly different model). As Cathy writes:

The "home" is the office of a primary-care doctor where patients would go for most of their medical needs. The general practitioner would oversee everything from flu shots to chronic disease management to weight loss, and coordinate care with nurses, pharmacists, and specialists. A 2004 study estimated that if every patient had such a home, the resulting efficiencies might reduce U.S. health-care costs by 5.6%, a savings of $67 billion a year.

She described how Anderson and his team of four nurses (three fulltime and one parttime) take plenty of time to counsel patients about things like weight control, nutrition and smoking. People with chronic conditions get frequent checkups to keep their illnesses under control. And because of the way the doctor and nurses divide and coordinate care, and their successful incorporation of electronic medical records, they see more patients a day than doctors typically do. Abderson’s practice sees 30 to 35 patients a day, compared with 20 to 25 for a more typical primary care doctor.

There’s a lot of support in Washington for paying primary care doctors more, and shifting the incentives in the system to improve care coordination and prevention.  Anderson, 56, has actually made the medical home model work for him and his patients even in the current system, where the incentives are for more specialty care and procedures, and the results are often fragmentation and overutilization.

 Before he switched to the medical home model five years ago, he worked 50 to 60 hours a week and wasn’t able to pay his bills. Now, he’s working fewer hours, seeing more patients, making more money and "delivering the best care I’ve ever done."

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Over at The Washington Post’s Daily Dose, Ceci Connolly has another excellent Monday morning update, laying out the state of play for health reform.

Connolly notes that with Congress out, "the White House is filling the health-care space with a series of events—in person and over the Internet—to keep the spotlight on the president’s top domestic priority."

First, there was the national health care day of service, this past Saturday. Today, at 5 pm, Nancy-Ann DeParle, Director of the White House Office of Health Reform, will host a live-streamed, online discussion of health care reform. (Check the White House’s Facebook page for more). Secretary of HHS Kathleen Sebelius will talk health care on MSNBC’s Dr. Nancy at noon.

On Wednesday, the President will host another town-hall discussion in Annendale, VA, with Americans able to submit questions online via YouTube and Twitter (hash tag: #WHHCQ). See the president’s message below:

Finally, Vice President Joe Biden sent out an email this morning touting Health Care Stories for America. Designed by Obama’s political arm, Organizing for America, the site has collected hundreds of thousands of stories of how the health care crisis has affected Americans personally (You can submit your story here). In another example of social networking meets social change, visitors to the site can share stories through the usual channels (Facebook, Digg, Delicious, etc.) and vote to amplify the particularly moving stories, increasing the chance others will see it.

Particularly neat is the ability to type in a location and find stories from the surrounding area. It’s important to put a human face on a debate that can devolve into complicated minutiae. Like Brian, whose father had to take on a second job to provide health insurance for his family of six, or Linda who avoids going to the doctor because she can’t afford the high costs that remain her responsibility under her high-deductible plan . As Vice President Biden writes, "For folks who don’t yet understand why health care reform is such an urgent priority, these stories make the case far better than any statistics ever could."

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Despite ADA regulations regarding accessibility of public buildings, people with disabilities often face barriers to accessing healthcare that are not addressed by the law, including a lack of appropriate staff training and accessible equipment. A report in Friday’s Boston Globe indicates that two nationally known, Harvard-affiliated area hospitals – Massachusetts …

[This is a content summary only. Click the headline to visit Our Bodies, Our Blog for the full post, links, other content and more!]

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Woman Shackled During Labor Sues State: A former inmate at the Washington Corrections Center for Women who was shackled while in labor is suing the state of Washington for violating her constitutional rights. Read the full complaint here (pdf).

The Seattle-based women’s rights organization Legal Voice filed the federal lawsuit last …

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It would seem likely.

In May 2009 at “The Machinery Behind Healthcare Reform: How the HIT Lobby is Pushing Experimental and Unsafe Technology on Unconsented Patients and Clinicians” I wrote:

… I can add that if this initiative [the U.S. multibillion dollar ARRA push towards national healthcare IT by 2014] blows up as it has in the UK, then the only triumph will be the financial triumph of the trade group and its apparatchiks. The losers will be the administration, patients, clinicians, and everyone else in the healthcare system.

The UK situation is much worse than I thought. The UK’s NPfIT in the NHS was suspected to have been doomed from the start, but proceeded anyway; see “16 key points in Gateway Reviews on NHS IT scheme” and the secretive Gateway Reviews themselves upon which the preceding article was based, released under UK Freedom Of Information laws. From ComputerWeekly.com author Tony Collins on Gateway Reviews:

… Gateway reviews are mini-audits at critical stages in projects. The reports in question gave a red, amber or green status at each stage to help the project’s senior responsible owner decide whether to move to the next phase.

The government’s policy on Gateway reviews is to keep them confidential. All copies of a review are shredded, with the supporting material, to ensure only two reports remain – one for the Treasury’s Office of Government Commerce (OGC) and the other for the project’s senior responsible owner.

Highlights of the secretive health IT program reviews, now made public:

• the NPfIT was probably doomed from the start, in Spring 2002. As one Gateway Review put it, many dedicated people were working hard on building the components for a car that hadn’t been designed. To some extent that’s still true today.

• people didn’t really know what they were doing in the first critical months in 2002

• the initial plan was for new IT – not for changes to the way people work. So the preoccupation was with IT and not patients. It was hoped that new IT would drive change. But that rarely if ever succeeds.

• that the costs and complexity were initially underestimated – by about £7bn – because nobody had an understanding of what was needed.

• that speed was unduly important. One gateway review suggested that key staff didn’t have time to take action on recommendations or learn lessons.

• the programme as a whole, according to one Gateway Review, was not assessed against a list of Common Causes of Failure, as published by the National Audit Office. Only individual projects were assessed against the list.

How many of these findings apply in the U.S. Health IT program in 2009?

Finally, about the aforementioned May 2009 post, Matthew Holt of the Healthcare Blog wrote that I had “gone loopy”, i.e., crazy (see footnote to the above-linked May 2009 post). The Chairman of CCHIT Mark Leavitt wrote that concerns about health IT are expressed by “fearmongers” and should be “laughed off.”

These cavalier attitudes are a major part of what has gone wrong in HIT, as well as our society more generally.

Not to draw a specific comparison with these individuals, but our society is crumbling, and it’s in no small part due to clowns in leadership roles, rather than as performers in Ringling Bros. and Barnum and Bailey’s Greatest Show on Earth.

According to Matthew Holt and Mark Leavitt, Health IT concerns are a laughing matter, expressed by crazy people.

I (and many like minded colleagues) don’t find healthcare information technology issues a laughing matter, however.

– SS

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