Category Archives: health care reform

some people still don’t have health insurance, and it still matters

Excellent piece on life down in the trenches, as told by a primary care doctor, Jonathan Han, who practices in rural Pennsylvania and whom I consider a good friend. Every day in his office Dr. Han sees patients who come to medical attention only after having developed advanced disease, including incurable cancers, because they lack health insurance. Another convincing argument for why we can’t afford to roll back last year’s health care reforms.

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continuing ed

I’m home after three days of continuing medical education at the Cleveland Clinic. For me being back in the lecture hall feels totally numbing — you’re bombarded with eight hours of Power Point slides daily — yet in hindsight I’m feeling recharged about my day job.

Perhaps the most striking lesson lay beyond the classroom door. One morning I visited a farmer’s market on the Clinic grounds, which is more of an anomaly than you might think; hospitals are far more likely to sell McDonald’s burgers than radishes by the bunch.

Turns out the farmer’s market is one small facet of a massive wellness push at the Clinic that focuses on weight and stress reduction, quitting smoking, and smart nutrition. Of course you already knew this stuff was good for you; the issue is committing to doing it.

At the Clinic a formal program to engage employees in their own health enabled the collective to lose 144,000 pounds in 2009. One man lost 30 pounds in eighteen months simply by deciding to take stairs instead of the elevator. As a result, while health care expenditures were on the rise everywhere else in the last two years, employee health care costs at the Clinic dropped 8%. Bending the cost curve, as the lingo goes.

In the months and years to come I’m betting we’ll hear more about like-minded efforts to promote wellness — much more. And not just because it saves money, but because we’re all starting to wake up to how unsustainably we live. A recent New York Times story about paying patients to take their medications would be a case in point.

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major health care bill passes

Today the U.S. House of Representatives passed a sweeping health care bill that will bring health insurance to more than 30 million people who presently go without. The legislation will also protect those with insurance from being denied coverage because they are — wait for it — sick. Think that’s too awful to be true? Read about this young Baltimore family.

I admit I wasn’t confident this day would ever come. But here we are, and Republicans are already threatening to use the bill as a weapon in the upcoming midterm elections. We’ll see.

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let me know when it’s over

I’m happy to report that health care reform looks much less dead than it did two months ago. At this very moment, Speaker of the House Nancy Pelosi is wrestling up support for this weekend’s big vote — that’s right, a vote on the Senate health care bill that passed back in December. Today comes the welcome news that the bill will (somehow) reduce the deficit, or so says the Congressional Budget Office.

These reforms won’t fix everything wrong with health care. Not by a long stretch. But it will bring health insurance to millions of people who didn’t have it before. At the risk of beating a dead horse, we need that. Desperately.

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mostly dead

Tuesday’s special election in Massachusetts immediately and dramatically reshaped the political landscape in Washington D.C, and it’s no longer clear whether the health care bill, which proposes to insure thirty million more Americans, will survive.

Rumors of the demise of health care reform caused insurance company stocks to rise on Wednesday. But weirdly, this year’s push for universal coverage might have been the best long-term growth opportunity for insurance companies. The New York Times reports that insurance companies are steadily losing customers as employers lay off workers and scale back or do away with health insurance coverage altogether. Universal coverage would have brought a significant infusion of new business.

Of course, that’s only true sans public option.

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all eyes on massachusetts

The future of the health care bill may hang on today’s special election in Massachusetts, to fill the late Sen. Ted Kennedy’s seat. Should Republican Scott Brown defeat Democrat Martha Coakley, Democrats would lose their filibuster-proof 60 votes in the U.S. Senate. A Republican win may discourage other Democrats in tight re-election races from voting for health care reform. Eyes are peeled.

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health care reform approaches

Separate health care bills were finally approved in both the House and Senate during Christmas week. The two pieces of legislation will need to be reconciled in a joint House-Senate conference, so nothing’s final, but the end result will almost certainly bring the security of health insurance to tens of millions more Americans.

One thing is already clear: the reforms won’t be perfect. They’ll be incredibly expensive, and though both bills are said to be deficit-neutral, efforts to clamp down on rising costs come mainly in the form of pilot programs, dozens of them. To secure adequate votes for the initial bills, our elected officials engaged in unsavory horse-trading, most notably over public funding for abortion, and you can bet on more of the same before it’s all said and done. But we ought not let perfection be the enemy of the possible. Denying millions of Americans health insurance is not an acceptable way to control costs, and as our present experience suggests, it doesn’t work.

These bills are a good start, but the need for reform doesn’t end here. The health care experience even for those who are insured can be very challenging, and we’ll discuss that further in the months to come.

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Health care bills are slowly making their way through both chambers of Congress. Last night the House passed a $1.1 trillion bill that would insure an additional 35 million Americans. Importantly, the bill makes it illegal for insurance companies to deny health insurance to those with pre-existing conditions, or to cancel your policy if you develop an expensive disease.

The House bill also calls for a ‘public option’, or government-sponsored health plan available for individual purchase. This isn’t thought likely to survive a Senate vote.

While I was being interviewed on XM Satellite’s Book Radio last week, a caller expressed dismay at the proposed level of government intervention in health care. I sympathized with his point of view. While writing House of Hope and Fear I learned that Seattle’s public hospital, Harborview, remained financially healthy in spite of very little government funding. How? Partly because the hospital needs to compete for business with every other hospital in town. Public hospitals operating primarily on the dole don’t do nearly as well.

But the free market isn’t a cure-all. Private sector success has increasingly come from excluding sick people from needed health care. Nearly one in six Americans is now inadequately insured, or not insured at all, and the problem is only growing worse. No doubt health care reform will be expensive. But doing nothing could cost even more. We pay for universal health care now, and in the priciest way possible — through our Emergency Rooms. This year’s health care bills won’t solve all of our problems, but they look to be a reasonable start.


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what obama wants

During last night’s speech, President Obama finally proposed a few concrete ideas for health care reform:

-Insurance companies could no longer exclude certain individuals from obtaining coverage; lifetime maximums would become illegal.

-Small businesses and other uninsured individuals could obtain insurance at reasonable cost through co-ops or exchanges.

-Individuals would be required to obtain health insurance or face a penalty. Businesses would be required to provide insurance for employees or pay a fee.

-A public insurance option could be used to spur competition in markets dominated by a few insurers, but is not a requirement for the final bill.

-There would be a cap on health care spending. Excessive spending would trigger automatic Medicare cuts.

-The $900 billion price tag would be paid for by savings gleaned from reducing waste in the current health care system. The final bill would be deficit neutral.

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the speech

President Obama gives his big health care speech tonight. Be there.

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