August 12, 2011
10:49 am
The Republican presidential candidates who participated in last night’s Iowa debate put on quite an interesting, as well as entertaining, show. With political analysts pointing out that this weekend’s Ames straw poll could winnow the field, the gloves came off as the eight candidates fought to maintain a critical mass of voter support.
Anyone who turned on the debate, though, to learn the candidates’ visions for healthcare in the United States would have come away disappointed.
We learned, to no one’s surprise, that the GOP presidential contenders have a steadfast dislike for the Affordable Care Act that President Obama signed into law last year. Most of the candidates also believe that the individual health insurance mandate contained in the ACA is unconstitutional.
It was also clear that, as long as former Massachusetts Governor Mitt Romney is the frontrunner, he will be criticized for what rival Tim Pawlenty calls “Obamneycare.”
But future GOP debates need to do more than reaffirm what the White House aspirants are against. There are indeed widespread concerns about the current health reform law, including questions over affordability, healthcare quality and whether an unprecedented expansion of Medicaid is the best approach for reducing the uninsured population. Those who would take Mr. Obama’s place need to spell out for us how they would do things differently. The questions they need to answer include:
• Do you support eliminating pre-existing conditions as a barrier to health coverage? And, if so, how do you achieve that without an individual mandate to ensure that consumers don’t wait until they’re sick or injured to purchase health insurance?
• How do you slow down the growth in healthcare costs without undermine healthcare quality, access or innovation?
• How do you address the question of Medicare sustainability?
• What are your answers to the projected workforce shortages in healthcare? How do we ensure enough medical professionals to treat a growing patient population?
• With the CDC calling for a huge escalation in the number of Americans with diabetes, how do you propose to address the rise in chronic disease cases that are driving healthcare costs?
With these questions and many others, there’s an important health policy debate to be had among the Republican presidential contenders. It just hasn’t happened yet.
April 15, 2011
11:55 am
It’s worth noting that, in the same week that President Obama cited the Independent Payment Advisory Board (IPAB) as a key tool in cutting future Medicare costs, a House Democrat known for her expertise on healthcare issues went public with her belief that IPAB is a bad idea that should be repealed.
In fact, Representative Allyson Schwartz (D-PA), co-chair of the New Dems Health Care Task Force, said she would support Representative Phil Roe’s legislation to do away with IPAB. She’s not the first member of her Democratic caucus in the House to do so. Fellow Democratic Representatives Shelley Berkley (D-NV), Michael Capuano (D-MA) and Larry Kissell (D-NC) have already cosponsored the bill.
IPAB was created by the Affordable Care Act. The board would have the power to make Medicare spending reduction recommendations if program expenditures exceeded the per capita gross national product plus one percent. If Congress didn’t vote down the IPAB recommendations, they would automatically take effect. In President Obama’s deficit reduction proposal, he would give IPAB even greater authority, lowering the spending threshold at which the board’s powers would kick in.
Schwartz’s reasons for opposing IPAB are good ones. First, it transfers decisionmaking over healthcare policy from members of Congress to an unelected commission, placing an unwanted layer of bureaucracy between patients, healthcare providers and their elected representatives. In Schwartz’s words, it would “undermine our (Congress’s) ability to represent the needs of seniors and disabled in our communities.”
She also said that she “cannot condone the implementation of a flawed policy that will risk beneficiary access to care.”
That, I believe, is the greatest knock against the IPAB concept, as it’s drawn up in the health reform law. Rather than develop innovative ways to deliver high quality, cost effective care to Medicare beneficiaries, IPAB is simply about chopping spending levels downward. At a time in which likely physician shortages are on the horizon, it makes little sense to “fix” Medicare by cutting payments. As Alex Valadka, a neurosurgeon, said in National Journal, “Doctors cannot continue to ably treat Medicare patients if they are constantly wondering whether or not the money will be there to reimburse them.”
Yes, we do need to take steps to place Medicare on a sustainable course, but as Congresswoman Schwartz and others so ably point out, IPAB is the wrong tool to pursue that objective.
April 14, 2011
8:01 am
Sure, the topical thing to do in this space today would be to comment on the President’s deficit reduction speech and the contrast between the Obama budget plan and the one put forward by Congressman Paul Ryan (R-WI).
But there will be plenty of time to do that. This debate over our nation’s priorities and how best to reduce the debt will be going on for months to come.
Instead, I wanted to share an item that caught my eye because I found it fascinating that it took someone other than a political or economics journalist to put the current budget wars into a proper perspective. Mark Bittman, the food columnist for The New York Times Magazine, pointed out in an online commentary this week that, by the year 2030, the cost of treating heart disease in the United States will escalate to $800 billion. And incidences of diabetes, according to the Centers for Disease Control and Prevention, are projected to reach a point at which every other American will have either Type 1 or Type 2 diabetes, which will cause cumulative treatment costs to rise to $500 billion.
So that’s over $1 trillion in future costs connected to just two chronic diseases. By comparison, the recent congressional budget fight that almost resulted in the federal government shutting down was over a small fraction of that, $38 billion.
Bittman’s point is that many of our healthcare costs – and, subsequently, costs to taxpayers because of the number of Americans receiving care through Medicare or Medicaid – can be addressed through better diet. He’s right, but the point is bigger and broader than that.
It is going to be impossible to get a grip on future healthcare costs unless our nation makes wellness and disease prevention an urgent priority. Today, the treatment of chronic disease is responsible for 75 cents of every healthcare dollar we spend in this country. And if projections are correct on the significant increases in heart disease, diabetes, pulmonary illness and various cancers, huge budgetary outlays in both the public and private sectors are going to be unavoidable simply to treat a less healthy populace.
Many employers and communities have made tremendous progress in developing incentive programs to encourage individuals to live healthier lifestyles and seek diagnostic tests and preventive care. We need to take these success stories and expand them so they can benefit a nation.
Now, I don’t expect the upcoming budget debates to focus on how we can get more Americans to quit smoking, eat healthier, get exercise and see their doctor for regular exams and blood tests, but if we don’t give wellness and prevention at least as much attention as, say, appropriations for public radio, then aren’t we missing the point?
April 06, 2011
2:48 pm
Before we get too far along in the week, I didn’t want to miss the opportunity to highlight an article by Robert Pear of the New York Times that appeared in the newspaper’s Monday edition. Mr. Pear went to Louisiana to see firsthand the scope, or lack thereof, of healthcare services available to Medicaid patients. If you’re concerned about the ability of our healthcare system to adequately serve at least 15 million new Medicaid beneficiaries as a result of health reform, this article won’t alleviate your worries.
The thrust of the Pear article is that states are making cuts in their Medicaid programs in order to balance their budget, and that these cuts are making it more difficult for patients to get the services they need, particularly if they need to see a specialist of some kind.
This is not a new problem, though, but an exacerbation of an already-existing one. There were already a significant number of physicians that do not see Medicaid patients because of the program’s comparatively small provider payments, lower than Medicare and substantially lower than private insurance plans.
For his story, Mr. Pear interviewed a woman in Opelousas, LA because of three herniated discs in her neck that require surgery. She can’t, however, find a surgeon that will take her because she is a Medicaid patient. Holding up her Medicaid card, she said, “It’s a useless piece of plastic. I can’t find an orthopedic surgeon or a pain management doctor who will accept Medicaid.”
The new health reform law allows states to cut their Medicaid budget, but they can’t touch eligibility for the program. That means cuts are going to come either through further reductions in provider payments or by limiting the scope of services beneficiaries can receive.
A critical goal of health reform is to make certain that all Americans have access to quality healthcare. The Medicaid issue is one that remains to be addressed if this objective is to be met.
March 24, 2011
1:19 pm
There has been much ado made this week over the one year anniversary of the passage of the Affordable Care Act. And, just as was the case a year ago, controversy continues to rage over health reform. Polls show the public continues to be divided on the issue and Congress is in a partisan deadlock over what the next steps should be in, depending on your point of view, ACA implementation, repeal or defunding.
This post isn’t about the controversy or the debate.
Instead, I want to call attention to one of the indisputably positive provisions of the health reform measure. This week, the Center for Medicare and Medicaid Innovation (CMMI), created through the Affordable Care Act, launched its new website. It’s more than just an informational site. In fact, it’s a portal through which all participants in the healthcare system can submit ideas on how to improve U.S. healthcare to improve both quality and cost-effectiveness. That’s the purpose of CMMI — to test new ideas aimed at providing better patient care in a more sustainable way. It’s one of the aspects of health reform that, I believe, should be preserved and utilized to the fullest extent.
In fact, members of the Healthcare Leadership Council have already provided several examples of practices, tools and technologies that are, in fact, addressing both the quality and affordability of care. We provided these to CMS administrator Don Berwick in the form of our HLC Value Compendium. We’re working on an expanded volume of that compendium now with more metrics-supported case studies, as well as a Wellness Compendium with information on how HLC member companies and organizations are promoting better health and preventing disease.
The controversy over health reform will undoubtedly continue to rage on for some time. Let’s just keep the quest for ideas on how to improve our healthcare system outside of the firing zone.
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