Category Archives: Health Reform

Health Care Opinion Leaders’ Views on the Presidential Candidates’ Health Reform Plans

Source: Katherine K. Shea, Sara R. Collins, and Karen Davis, Commonwealth Fund, January 2008

From the overview:
The 13th Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey asked a diverse group of experts for their perspective on the health care reform proposals of the 2008 presidential candidates. Survey participants strongly support reform proposals that applied a mixed private-public market approach. Additional favored policy strategies for reform include a requirement for individuals to obtain health insurance, new private market regulations, and a requirement for employers to provide coverage or contribute to a coverage fund. Alternatively, respondents think proposals that focus on tax incentives to purchase individual private health insurance are not an effective method for controlling the rising costs of health care or achieving universal coverage. Health care opinion leaders call for the next president to simultaneously address universal coverage and quality, efficiency, and cost containment policies to move our health care system toward high performance.

Related commentaries:
Reform Is No ‘Either-Or’: We Must Fix the Payment System Along with Access
Darrell Kirch, M.D, president and chief executive officer of the Association of American Medical Colleges
Tough Choices Ahead: Candidates Ignore Pain of Needed Cuts to Health Costs
Dallas L. Salisbury, president and CEO of the Employee Benefit Research Institute and a member of The Commonwealth Fund Commission on a High Performance Health System

Related resources:
Data Brief
Chartpack
Tables
Methodology

Knowing What Works in Health Care: A Roadmap for the Nation

Source: Jill Eden, Ben Wheatley, Barbara McNeil, and Harold Sox, Institute of Medicine/National Academies Press, 2008
(scroll down)

From press release:
Solutions to some of the nation’s most pressing health problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. Spending on ineffective care contributes to rising health costs and insurance premiums. Variations in how health care providers treat the same conditions reflect uncertainty and disagreement about what the standards for clinical practice should be. Patients and insurers cannot always be confident that health professionals are delivering the most effective care.

A new report from the Institute of Medicine offers a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise, and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. This program would also be responsible for developing and promoting rigorous standards for clinical practice guidelines, which could help minimize the use of questionable services and target services to the patients most likely to benefit, said the committee that wrote the report.
Report Brief
Report Summary

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
(subscription required)

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.