Health Populi

Friday, January 16, 2009

Prospects for health reform - the economy both drives and splits consensus


The economy, the economy, and the economy -- and a dash of Iraq and health care -- are on American citizens' minds when it comes to what they want President Obama to address when he takes office.

Kaiser Family Foundation (KFF) and the Harvard School of Public Health (HSPH) have come together once again -- as they've done since 1992 -- to gauge Americans' interest in health as a priority for the President and Congress.

In this poll, conducted in December 2008, health is seen by people as integral to the economy. The chart illustrates that 30% of people had a serious problem getting a good-paying job or a raise in pay; 29% reported a serious problem losing money in the stock market, 27% paying for gas; and 25% paying for health care and health insurance.


This last problem, paying medical bills, is a growing problem. When KFF/HSPH first polled Americans in March 1992, 21% said they or someone in their family had a problem paying medical bills. Since then, 18 years later, 32% of Americans said they are having problems paying medical bills. That's 1 in 3 citizens. Drew Altman points out that that 1/3 will go up before it begins to fall given the nation's economic downturn in 2009.

The ripple effects on health, Altman says, are significant: 47% of Americans said that they have sacrificed on their health care in some way: for example, skipping recommended medical tests, delaying seeking care or postponing a prescription refill. Thus, health has become a pocketbook issue, not simply a 'medical' issue, for Americans, as the table illustrates.

You can view the webcast here.


Health Populi's Hot Points: Drew
Altman introduced this webcast with the Clint Eastwood construct, The Good, the Bad, and the Ugly. There is a whole lot of good which are forces that optimists would see as a perfect storm for health reform ASAP: Obama has made health reform a top priority; leaders in Congress, such as Senators Kennedy and Wyden, are already crafting reform plans; the public is very concerned about health as a kitchen-table issue; key interest groups, including strange bedfellows like Labor and Big Business, are playing nice with each other on health reform broadly brushed.

There seems, then, to be a window of opportunity..."if leaders move fast," Altman warns.

That's where The Bad comes into play. The health reform naysayers see that there are serious partisan divides on health reform priorities, such as ensuring universal care and how to contain costs (such as prescription drug prices). More Democrats are more concerned about the economy than Republicans, who put terrorism and Iraq higher on the priorities list; broadly speaking, the Dems are more about the "butter" and the Republicans more about the "guns" in the guns v. butter economics paradigm.

And then, there is the tiny issue of how to pay for health reform with the prospect of a $1 trillion deficit and a public hardly enthusiastic about raising taxes (at least on those with household incomes below $250K).



The Ugly? Well, that's letting the window of opportunity close on this unprecedented moment where a majority of ducks seem to be in a row to support significant health reform.

A majority of Americans make the connection between the macroeconomy and health care. Popular elements on which to base reform include building on the existing employer-based system, expanding coverage to children and veterans, and making sure unemployed people have access to coverage.

In this post-Lehman and -Madoff era where regulation was seen as de minimis, more regulation is now seen as a good thing--over drug costs, health care costs, and insurance companies.

The Ugly issues have to do with tax preferences, individual mandates (that is, forcing citizens to buy into or accept health insurance) and employer mandates (especially among smaller businesses and those is low-margin industries).

If stakeholders keep in mind, front-and-center, that health care is the #1 driver of long-term debt in the U.S., we can get to "yes" on health reform in this very tight window of opportunity. 61% of Americans think we can; President Obama will no doubt say, "Yes, We Can."

posted by Jane Sarasohn-Kahn at 5:15 AM

1 Comments:

  • A Need To Reformulate

    The following are facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled:
    The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.
    However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses. Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago. Most is spent with medical institutions, as far as health expenditures are concerned. One third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.
    We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.
    Our children.
    Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.
    About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported. Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system. The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA, according to others.
    Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.
    Health Care must be the priority immediately by the new administration and congress. Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S. Yet considering the hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system, health policy analysts should not be greatly concerned on the steakholders who may be affected by this reform of our health care system that is desperately needed. Tom Daschle leads this Transition’s Health Policy Team. And we also have Ed Kennedy, the committee chair and a prolific legislator. So if the right people have been selected for this reforming team, the urgency and priority regarding our nation’s health care needs should be rather overt to the country’s citizens.
    Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported, which should be addressed as well.
    It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. This specialty makes nearly 100 thousand less in income compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system. PCPs manage the chronically ill patients, who would benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them. Nearly have of the population has at least one chronic illness- with many of those having more than one of these types of illnesses. A good portion of these very ill patients have numerous illnesses that are chronic, and this is responsible for well over 50 percent of the entire Medicare budget.
    The shortage of primary care physicians is due to numerous variables, such as administrative hassles that are quite vexing for these doctors, along with ever increasing patient loads complicated by the progressively increasing cost to provide care for their patients. Many PCPs are retiring early, and most medical school graduates do not strive to become this specialty for obvious reasons. In fact, the number entering family practice residencies has decreased by half over the past decade or so. PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers.
    Yet if primary care physicians were increased in number with the populations they serve and are dedicated to their welfare. Studies have shown that mortality rates would decrease due to increased patient outcomes if this increase were to occur. This specialty would also optimize preventative care more for their patients. Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the ideal continuity in health care these PCPs provide if they are numbered correctly to treat and restore others. Also, the quality improves, as well as the outcomes for their patients. Most importantly, the quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase in the years to come. The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.
    Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system. Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers. These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.
    Health 2.0, a new healthcare social networking innovation, is informing patients about their symptoms and potential if not possessing various disease states- largely based on the testimonies of other people on various websites. This may be an example of how so many others rely now on health concerns from those who likely are not medical specialists, instead of becoming a participant, if not victim, of the U.S. Health Care System.
    Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today, which is why the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially. It should be and likely will be funded by a combination of payroll taxes and general tax revenue:
    Access- citizens do not have the right or ability to make use of this system as we should.
    Efficiency- this system strives on creating much waste and expense as it possibly can.
    Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
    Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.
    http://www.mckinsey.com/mgi/publications/US_healthcare/index.asp
    Dan Abshear

    By Anonymous Anonymous, At January 17, 2009 11:34 AM  

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