Category Archives: Health Reform

Health Care in the 2008 Presidential Primaries

Source: Robert J. Blendon, Drew E. Altman, Claudia Deane, John M. Benson, Mollyann Brodie, and Tami Buhr, New England Journal of Medicine, Vol. 358 no. 4, January 24, 2008

For the first time since 1928, neither the Democratic nor the Republican party has an incumbent president or vice president among the candidates in its field, so both primaries are particularly open to all challengers and very competitive. In this article, we report findings from public opinion polls that assessed how health care issues might affect voters’ choices in the 2008 presidential primaries.

This article examines the role of health care in the 2008 presidential primary elections in two ways. First, it draws on data from multiple opinion surveys to better understand how Republicans and Democrats differ in their values, beliefs, and attitudes with regard to health care and health care policy. Second, it focuses particularly on voters who say they are going to participate in the early Democratic and Republican primaries and caucuses, looking at differences in their health care preferences and the extent to which the health care issue is affecting their vote.

Finally, we explore how the differences in views and desires concerning health care among Republicans and Democrats are reflected in the kinds of proposals being put forward by the major candidates, and we assess the ways in which these divisions might affect the general-election campaign.
See also:
The Amazing Noncollapsing U.S. Health Care System — Is Reform Finally at Hand?

National Survey on Public’s Health Care Reform Views: Americans Favor Keeping Employer Role in Paying for Health Insurance; Believe Covering All Should Be Shared Responsibility of Employers, Individuals, and Government

Source: Commonwealth Fund, January 15, 2008

Eighty-one percent of Americans believe that in order to help reach the goal of health insurance for all, employers should either provide health insurance to their workers or contribute to the cost of their coverage, according to survey data released today by The Commonwealth Fund. Nearly nine of 10 (88%) Democrats, nearly three-quarters (73%) of Republicans, and nearly four of five (79%) Independents would support such an employer “play or pay” requirement.

In addition, the survey, conducted between June and October of 2007, found that a wide majority of Democratic (67%), Republican (66%), and Independent (70%) voters believe that health insurance costs should be shared by individuals, employers and the government. Further, a majority of the public was strongly or somewhat in favor of requiring individuals to have health insurance coverage–with government help for those who cannot afford it. Sixty-eight percent of Americans favor such a proposal, with 80 percent of Democrats in support, and more than half of Republicans (52%) and two-thirds of Independents (68%) in favor, according to a report on the survey findings, The Public’s Views on Health Care Reform in the 2008 Presidential Election.
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Related Articles:
Envisioning the Future: The 2008 Presidential Candidates’ Health Care Reform Proposals
Sara R. Collins and Jennifer L. Kriss, Commonwealth Fund, January 2008

Do Individual Mandates Matter?

Source: Linda J. Blumberg, John Holahan, Urban Institute, January 29, 2008

In this brief we conclude that, absent a single payer system, it is not possible to achieve universal coverage without an individual mandate. The evidence is strong that voluntary measures alone would leave large numbers of people uninsured. Voluntary measures would tend to enroll disproportionate numbers of individuals with higher cost health problems, creating high premiums and instability in the insurance pools in which they are enrolled, unless further significant government subsidization is provided. The government would also have difficulty redirecting current spending on the uninsured to offset some of the cost associated with a new program without universal coverage.

Pathways To Coverage: The Changing Roles Of Public And Private Sources

Source: Jessica P. Vistnes and Barbara S. Schone, Health Affairs, Vol. 27 no. 1, 2008
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Using data from the Medical Expenditure Panel Surveys for 1997 and 2005, spanning the eight-year period after enactment of the State Children’s Health Insurance Program (SCHIP), we examine whether the composition of insurance coverage has changed for working families. Public coverage has played an increasingly important role for working families with children. For families without access to job-based insurance, roughly two-thirds of single-parent and over half of two-parent families with children had at least one family member covered by public insurance in 2005. Among families with access to job-based insurance, nearly half of minority single-parent families had at least one family member with public coverage.

Leading the Way? Maine’s Initial Experience in Expanding Coverage Through Dirigo Health Reforms

Source: Debra J. Lipson, James M. Verdier, and Lynn Quincy, Mathematica Policy Research, Inc., December 2007

In this evaluation of Maine’s health reform plan, researchers examine interim indicators of progress after two years of program implementation. Since enacting comprehensive health care reform in 2003, the effort has helped expand coverage for low- and moderate-income individuals. Yet by late 2006, the initiatives had enrolled less than 10 percent of previously uninsured residents.

Researchers identify both the successes and challenges of the program. They also consider how Maine’s experiences could serve as a lesson for other states which are exploring initiatives to expand access and provide affordable insurance.

Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending

Source: The Commonwealth Fund

U.S. health spending is projected to increase from 16 percent of GDP in 2006 to 20 percent in 2016–from $2 trillion to $4 trillion. Meanwhile, the number of uninsured Americans continues to rise. In this report prepared for The Commonwealth Fund Commission on a High Performance Health System, the authors examine 15 federal policy options that have the potential to lower health spending relative to projected trends. They include policies that would: produce and use better information for health care decision-making, promote health and enhance disease prevention, align financial incentives with quality and efficiency, and correct price signals in health care markets. Combining policies would capture the synergistic benefits of individual changes. If implemented along with universal health insurance, a combination of selected options could save $1.5 trillion in national health expenditures over 10 years, while also improving value in terms of access, quality, and health care outcomes.

The Health Care for America Plan

Source: New Labor Forum, Fall 2007
By Jacob Hacker

America’s $2.2-trillion-a-year medical complex is enormously wasteful, ill-targeted, inefficient, and unfair. The best medical care is extremely good, but the Rube Goldberg system through which that care is financed is extremely bad–and crumbling. One out of three non-elderly Americans spend some time without health insurance every two years, and the majority of those remain uninsured for more than nine months. Meanwhile, runaway health costs have become an increasingly grave threat, not just to the security of family finances, but also to corporate America’s bottom line. The United States spends much more as a share of its economy on health care than any other nation, and yet all this spending has failed to buy Americans the one thing that health insurance is supposed to provide: health security.

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries

Source: Annals of Internal Medicine

From press release (American College of Physicians):
In a new evidence-based paper, the American College of Physicians (ACP) analyzes health care in the United States and 12 other industrialized countries and identifies lessons that could be applied to the particular political and social culture of the United States to achieve a high performing health care system, including achieving universal health insurance coverage for all Americans.

In the paper, “Achieving a High Performance Health Care System with Universal Access: What the USA Can Learn from Other Countries,” published on the Web site of ACP’s flagship journal, Annals of Internal Medicine, ACP notes that spending on health care in the United States is the highest in the world and has been rising at a faster pace than spending in the rest of the economy. Yet an estimated 47 million Americans – nearly 16 percent of the population – lack health insurance protection. Even among those with health insurance coverage, wide variations exist in terms of cost, utilization, quality, and access to health care services.

A Roadmap to Health Insurance for All: Principles for Reform

Source: Commonwealth Fund

From press release:
Health insurance reform plans that build on a mix of private and public health insurance, where costs are shared among government, employers, and enrollees would have great potential to move the system to high performance and would be the most practical to implement according to a new report released today by The Commonwealth Fund Commission on a High Performance Health System. Commissioners are a diverse group of leading health policy experts from government, private industry, health care delivery organizations, academia, and professional associations.

Affordable, comprehensive health insurance coverage for all Americans is essential to achieving a high performance health system, say the report authors, because coverage helps to ensure access to essential preventive services; improve overall health; cut down on inefficiencies like duplicate medical tests; reduce administrative costs; and eliminate costly uncompensated care for uninsured and underinsured families.

However, the way coverage reform plans are designed will be critical to their success and ability to offer all participants access to high-quality, efficient, and equitable health care, according to the analysis, A Roadmap to Health Insurance for All: Principles for Reform, prepared for the Commission by Sara Collins, Assistant Vice President at The Commonwealth Fund and colleagues. The report is the first of three major policy reports the Commission will issue this Fall.

Full Report (PDF; 487 KB)

Presidential Politics and the Resurgence of Health Care Reform

Source: New England Journal of Medicine

The 2008 presidential election will not resolve the debate over health care reform, but the results will go a long way toward determining the future of U.S. health policy. It would be a mistake, however, to read the candidates’ plans too literally. A plan offered during the primaries usually looks different in key respects from the plan that a newly elected president takes to Congress, to say nothing of any legislation that Congress actually passes. Still, it is clear that there is a wide partisan gap on health care reform that reflects ideological divisions over the roles that government and market forces should play in the health care system. And the further U.S. health policy moves from incrementalism, the more that partisan divide is likely to be exposed.