http://views.washingtonpost.com/healthcarerx/panelists/ 15 Views on America's health care reform debate from our panel of experts at Health Care Rx. en Copyright 2010 Fri, 02 Apr 2010 08:31:19 -0500 http://www.movabletype.org/?v=4.2-en http://blogs.law.harvard.edu/tech/rss Regardless of where you fall on the political spectrum, one thing is true: these are historic times. The singular issue of health has dominated the national political landscape for just over a year in unprecedented fashion--revealing our hopes and fears and testing our resolve. We can debate whether its high ranking on the national agenda was motivated by financial concerns (the rising costs of health care) or a moral obligation (health care as a right not a privilege)--but the essential point is that America is speaking about health. And all during a time of worldwide economic turmoil and uncertainty. History shows that during economic hardship, governments (local, state and federal) have chosen to dismiss health as a "side issue" or eliminate health services altogether, forgetting the direct link between health and economic stability. So credit must be given to President Obama, for without his tenacious leadership in keeping the nation http://views.washingtonpost.com/healthcarerx/panelists/2010/04/true-health-reform.html http://views.washingtonpost.com/healthcarerx/panelists/2010/04/true-health-reform.html Fri, 02 Apr 2010 08:31:19 -0500 It's been a wild ride over the past two years: first the campaign, then the stimulus debate, and finally passage of health reform. As I've written elsewhere, this has been the ride of a lifetime for me personally. This is probably the most significant thing I have ever done. A long list of delayed projects and papers awaits me. Our charge is to describe the implications of this complex new law. I would say that the implications are somewhat indeterminate. Libertarian legal scholar Richard Epstein complains that a 2,500-page bill will require a 20,000 page rule book to implement it. I agree, though I am less bothered by this fact of modern life than Richard is. One page per $130 million of economic activity doesn't seem excessive to me. I am gratified that this bill establishes -albeit imperfectly--the principle of near-universal health insurance coverage. I am gratified that this bill http://views.washingtonpost.com/healthcarerx/panelists/2010/04/one-wild-ride-ends-another-begins.html http://views.washingtonpost.com/healthcarerx/panelists/2010/04/one-wild-ride-ends-another-begins.html Thu, 01 Apr 2010 17:13:16 -0500 I am an optimist by choice - not by nature. I arise each day and metaphorically cloak myself in a robe of 'learned optimism.' But I have to tell you that it's sure been difficult for me to remain optimistic in the face of the partisan political rancor that marked the final chapters of the health care reform legislative process. So much so, I found that my muse had left me after my last washingtonpost.com posting in November. I'm back for the final weigh-in. Now that the bill has passed, we've been left to figure out the ramifications of the myriad disparate pieces described in more than 2,400 pages. It's a mixed bag to be sure. As a Family Physician I feel that the bill offers some important validation for the critical role of Primary Care in the health care delivery system of the future. As a vendor of population http://views.washingtonpost.com/healthcarerx/panelists/2010/04/epilogue.html http://views.washingtonpost.com/healthcarerx/panelists/2010/04/epilogue.html Thu, 01 Apr 2010 00:25:59 -0500 Unlike so many, I find myself being more impressed each time I delve into the new law. This is, ultimately, a piece of legislation that WILL achieve many stated and even unstated objectives: 1. It will extend the Medicare Part A trust fund for just long enough to allow BOTH sides to discuss meaningful reforms to make it truly sustainable. 2. It provides a real commitment to our nation's poor; and strengthens Medicaid at the same time. Here, too, there are opportunities for additional reforms, but this makes clear what our priorities are; and, importantly, demonstrates our national humanity and compassion for those less fortunate. 3. It dramatically reforms our understanding of and right to health insurance. We have never had a federal definition of health insurance and this begins that discussion in a meaningful way. 4. It is financially sustainable, as long as our elected officials do not undo http://views.washingtonpost.com/healthcarerx/panelists/2010/03/not-perfect-but-what-legislation-ever-is.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/not-perfect-but-what-legislation-ever-is.html Employer health plans Wed, 31 Mar 2010 15:25:51 -0500 "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are life, liberty and the pursuit of Happiness." These famed words written on parchment in 1776 became more tangible with the passage of the recent health-care law. In expanding coverage to 32 million Americans we approached a more equitable union where all citizens have the opportunity to achieve the fullness of life. Quite obviously, it will not solve all of the complexities of the American health system, but it does represent a credible start and investment in our collective future. Flawed as it may be, the current law narrows the health and well-being gap between the insured and uninsured. While it is not possible to legislate good health, rather, it is possible to legislate good health policy, and recent legislation, if it has http://views.washingtonpost.com/healthcarerx/panelists/2010/03/we-hold-these-truths-to-be-self-evident.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/we-hold-these-truths-to-be-self-evident.html Wed, 31 Mar 2010 11:00:05 -0500 For small business, the new health-care law begins a long struggle against cost increases, uncertainty and perverse incentives (see timeline here). Traditionally, small business produces over two-thirds of America's new jobs, but this bill jeopardizes that role. Premium increases will dominate the near-term horizon. Insurers will no longer be constrained by an impending Congressional vote. Some insurers will see their days as numbered and will hike premiums before exiting the market. Surviving insurers will face fewer competitors and may increase their margins before the law limits their ability to do so. Millions of people will begin gaining insurance, with no commensurate increase in the number of doctors and other providers; this will push medical fees upwards, and insurers will have to cover the increases. The small-group market is always more vulnerable to rate increases, and this market will not change substantially until 2014. Premium hikes won't be limited to small http://views.washingtonpost.com/healthcarerx/panelists/2010/03/not-an-ending-only-a-beginning.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/not-an-ending-only-a-beginning.html Wed, 31 Mar 2010 10:30:57 -0500 Despite the rhetoric, threats and backlash over health-care reform, the final legislation is going to make America a kinder and healthier place. For those of us who advocate for a universal system, it may not go far enough or fast enough, but the new health-care bill is a vehicle that is moving health care in the right direction. The bill addresses areas of greatest need and ensures access for all Americans by providing support and options so families and individuals can purchase much needed insurance. It keeps employers involved and makes provisions for small business. It addresses the high cost of Medicare and reduces the gap in coverage for seniors needing drugs. It was a brilliant move to link affordability of education with affordability of health insurance. By Including legislation that cuts the cost of lending and financial aid for students the American people may come to see the benefit http://views.washingtonpost.com/healthcarerx/panelists/2010/03/power-to-the-people.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/power-to-the-people.html Wed, 31 Mar 2010 09:53:00 -0500 The mainstream reform debate has been primarily focused on access -- the millions of Americans who don't have insurance. We heard heartbreaking story after heartbreaking story day after day for nearly a year. And this bill tackles that enormous problem! But there are the other big problems -- skyrocketing costs, misaligned incentives, inferior and inconsistent care, and so on -- all stemming from the fact that our health delivery model has remained what is essentially an acute, episodic care business model from the 19th century; a traditional fee-for-service model based on patients visiting hospitals and physicians' offices when they're sick. We have a system that hasn't evolved to keep up with the way our nation's health has changed -- toward chronic care. Nor has it progressed to use health data in an effective way to drive better decision-making and improved methods. It's not set up to enable the kind of http://views.washingtonpost.com/healthcarerx/panelists/2010/03/the-first-mile-of-the-marathon-to-real-reform.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/the-first-mile-of-the-marathon-to-real-reform.html Tue, 30 Mar 2010 21:28:17 -0500 Is the health care overhaul perfect? Absolutely not. From some angles, the work is just beginning. We have legislation now, but that legislation has to be put into policy. Patient advocacy groups will have a particularly important role in helping shape new offices and agencies like the Health Insurance Exchanges and the National Prevention, Health Promotion and Public Health Council. We've seen the sausage-making that went into the bill. Equally important is the execution that will take place outside the spotlight. But the reason many in the cancer community are elated are the tangible benefits right around the corner and the elimination of the worst of the dirty tricks practiced by insurers. Cancer survivors like me will no longer have to swallow the discrimination that so many of us face today. When I was diagnosed with cancer three times at the age of 19, I found out the hard way http://views.washingtonpost.com/healthcarerx/panelists/2010/03/goodbye-dirty-tricks.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/goodbye-dirty-tricks.html Tue, 30 Mar 2010 18:19:37 -0500 We're all Atlas's now, charged with taking on the mantle of health reform implementation. Whether we're health citizens, providers, payers, plans, suppliers to the industry or government agencies, our roles in health and health care will evolve over the coming months and years. The heavy lifting will come in the forms of new payment mechanisms, for some involving bearing more tax burdens, and for others sorting out the logistics of buying and paying for new health plans. More lifting will be required for better understanding and acting on our responsibility as health citizens, to become more informed and smarter about accessing, buying and consuming health services. For Washington and the states, being Atlas means moving ahead in new ways, designing and promulgating new models for incentivising health-care delivery for providers and utilization among health citizens. Quickly moving toward patient-centered medical homes and electronic health record adoption will drive better outcomes http://views.washingtonpost.com/healthcarerx/panelists/2010/03/the-heavy-lifting-of-implementation-begins.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/the-heavy-lifting-of-implementation-begins.html Tue, 30 Mar 2010 08:57:35 -0500 There is no such thing as a perfect piece of legislation, especially on an issue as contentious as health care. This legislation had many positive components and it creates not only major insurance market reform, but transformational payment, delivery, access and quality reform. There are many good pieces in the legislation on prevention, long-term care and on addressing some issues with the senior citizens prescription drug program. All that being said, I am deeply concerned that we have created a larger health insurance system prior to fixing what is broken in the current system. Because many of the fixes in terms of quality, delivery and payment reform depend on future actions by regulators and cabinet agencies, it is too tempting for special interests to fight to preserve what's wrong with our system. In a personal blog I posted today on www.mikecritelli.com, I used the example of a New York Times http://views.washingtonpost.com/healthcarerx/panelists/2010/03/final-reflections-on-health-insurance-reform-law.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/final-reflections-on-health-insurance-reform-law.html Tue, 30 Mar 2010 06:24:07 -0500 As a doctor and business executive I have seen every aspect of the U.S. health-care system over the past 25 years. I applaud the success in breaking down doors like never before. It is unfortunate that this law could potentially could crush the nation's economy and burden our children with further debt and poor access to quality health care. Is that reform? While nobody will deny that coverage for the uninsured is critical, that insurance companies need to be held more accountable and that we can not afford to increase our deficit, we have not effectively accomplished any of that. Coverage is not synonymous with care. While we have put in place the means for providing coverage we have not addressed the issue of how quality care will be maintained and who will measure it. If it were so easy, employers would have done it successfully years ago. The average http://views.washingtonpost.com/healthcarerx/panelists/2010/03/history-has-been-made-and.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/history-has-been-made-and.html Mon, 29 Mar 2010 14:33:26 -0500 We at Cardinal Health applaud the effort to tackle such an extraordinarily complex, technical and personal issue of health care, and we believe Congress has taken an important step in improving access to and affordability of health coverage for millions of Americans, particularly those most vulnerable. As more than 30 million new patients come into the system -- a system already under stress -- we are eager to continue to do our part to make health care more cost-effective. This is just the beginning of the reform process - a great deal of work will now be done in the regulatory arena as the specifics of reform are outlined. In addition, while the law creates several demonstration projects to better align payment systems with clinical outcomes and value, more needs to be done in this area. We would also like to see additional attention paid to wellness, personal responsibility for http://views.washingtonpost.com/healthcarerx/panelists/2010/03/just-the-beginning.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/just-the-beginning.html Mon, 29 Mar 2010 13:56:19 -0500 For decades, our outmoded, profit-driven health-care system has been one of America's biggest drivers of inequality. The lack of adequate, affordable care has perpetuated other economic and social disparities among poor people, people of color and people on the edges of society. This bill is a remarkable -- though not yet sufficient -- step toward creating a nation where the amount of money in your wallet does not determine your worthiness to receive health care. More than 32 million Americans will get insurance under this plan. Billions will go toward subsidies for poor families. Small businesses will get help to provide care to their employees and pull some of the weight of the yoke health-care cost from their shoulders. And, most important, it starts us on a path to truly national and universal coverage. While this is the most important health policy passed in generations, it must only be just http://views.washingtonpost.com/healthcarerx/panelists/2010/03/a-powerful-start----but-only-a-start.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/a-powerful-start----but-only-a-start.html Mon, 29 Mar 2010 13:17:00 -0500 When I was in ninth grade, I returned home after a particularly inspiring world history class and announced to my mother that I wanted to be Secretary of State when I grew up. Far from being excited, she was worried. Politics, in her mind, was a corrupting profession that was more about self interest than service. It's no secret that many people in the United States share her view. They have watched in frustration as the promises of politicians have faded into the status quo. They've watched with resignation as moneyed interests have rendered their opinions inconsequential. For most of the year, the health-care debate did not inspire many to feel differently about politicians or the political process. But in the closing days, a different strain of passion emerged in the debate, most clearly from the President himself. It was the moral argument for health reform. The moral argument for http://views.washingtonpost.com/healthcarerx/panelists/2010/03/moral-courage.html http://views.washingtonpost.com/healthcarerx/panelists/2010/03/moral-courage.html Doctors Thu, 25 Mar 2010 18:34:31 -0500