Category Archives: health care reform


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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the week in review

Yesterday, driving through Seattle’s Eastside, we spotted a minivan with this scrawled across the rear window: “No Government Health Care!” And that’s fairly civil when compared to the general tone that has infected health care reform efforts of late. Extremists have ignited rumors about government- sponsored “death panels” and are showing up at town hall meetings packing heat. People are comparing the government’s efforts to expand health care benefits with Nazism.

The level of confusion and misinformation truly amazes me. For one thing, it’s about forty years too late for no government health care; the government insurance programs Medicare and Medicaid now cover about 1 in 3 Americans. The question is how to manage the unsustainable growth of these programs; Medicare may go bankrupt in the next dozen years without serious intervention.

And we desperately need serious public dialogue on end-of-life care, not sound bites about ‘death panels’. Most of the patients I take care of — and believe me, they’re not all liberals — desire dignity and comfort at the end of life and not the intensive, life-prolonging efforts that are the current default. The latter are incredibly expensive, generally futile, and not very pretty to watch. That’s why you’ll often hear providers describe such efforts as ‘floggings’.

As for Nazi health care, Robert Proctor’s Nazi War on Cancer (Princeton University Press, 2000) describes Hitler’s efforts to provide superior health care in the service of a superior race. If parallels can be drawn to our current situation, I’m not entirely sure how.

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how do they do that?

In today’s New York Times, Dr. Atul Gawande says we can learn from U.S. communities that deliver high-quality, lower-cost health care. Gawande and colleagues identified communities that rank among the top 25% for quality of care and in the bottom 25% for cost, and they invited health care leaders from ten of these communities to convene in the ‘other’ Washington to discuss what they are doing right.

prov pavillion

One of those communities was nearby Everett, Wash., which includes 362-bed Providence-Everett Hospital, a multi-specialty physician group called The Everett Clinic, and the Premera Blue Cross insurance plan.

Turns out the ten communities have a few things in common. Their health care organizations are largely non-profit. Typically the needs of patients come before commercial concerns. More and more, the organizations are collecting data to measure and improve on their own performance. There is a strong primary care presence in the communities, which leaders identified as critical to efficiency. The result is a blend of collaboration and competition among various physician practices, hospitals, and insurers.

And patient satisfaction is very high in these settings.

Especially telling, I thought, was a comment from the Everett contingent: “We are doing less worse than the rest of the U.S.” Maybe something else that puts these folks at the top of the heap is their recognition that there is always room to improve.

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are you represented?

According to the Center for Responsive Politics, the twenty organizations that spent the most on health care lobbying in the first half of 2009 were:

U.S. Chamber of Commerce ($26.2 million), Exxon ($13.6), Pharmaceutical Research & Manufacturer’s Assoc. ($13.1), Chevron ($12.8), General Electric ($12.3), Pfizer ($11.7), National Assoc of Realtors ($9.6), Blue Cross/Blue Shield ($9.5), AARP ($9.4), Verizon ($9.3), ConocoPhillips ($9.3), American Hospital Assoc ($8.5), American Medical Assoc ($8.5), AT&T ($8.2), B.P. ($7.6), Altria Group ($7.5), Business Roudtable ($7.3), Eli Lilly ($7.0), National Cable & Telecom Assoc ($6.9), and Lockheed Martin ($6.8).

Are these people who represent you and your interests? If not, it’s time to get informed and get involved!

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health care reform is delayed

It’s been a tumultuous few weeks in the world of health care reform. The House and Senate have been working to hammer out bills that increase health insurance coverage while lowering health care costs, and we’ve become stuck on the question of how to pay for all this reform.

On the table are a variety of funding proposals — the millionaire tax, the tax on couples earning more than $350,000 per year, an employer tax on those already providing health insurance for workers. None are terribly popular. Then there are those who believe cost savings can be found by “decreasing inefficiencies” and “reducing waste.” The White House in particular wants to see large-scale effectiveness studies, so we’re only paying for treatments that actually work — worthwhile in concept, but many years from becoming a reality.

So we’re now hearing the inevitable comparisons between the legislative process and sausage-making, and pundits seem eager to declare the death of this massive undertaking.

Last night President Obama held a prime-time news conference to urge patience with health care reform efforts, which Senate Majority Leader Harry Reid has said will continue beyond the Congress’ August recess and into fall. Health care reform is so complex — yet so critical — that more time sounds like a good thing.

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