Category Archives: Health Reform

Most Republicans Think the U.S. Health Care System is the Best in the World. Democrats Disagree

Source: Harvard School of Public Health

A recent survey by the Harvard School of Public Health (HSPH) and Harris Interactive, as part of their ongoing series, Debating Health: Election 2008, finds that Americans are generally split on the issue of whether the United States has the best health care system in the world (45% believe the U.S. has the best system; 39% believe other countries have better systems; 15% don’t know or refused to answer) and that there is a significant divide along party lines. Nearly seven-in-ten Republicans (68%) believe the U.S. health care system is the best in the world, compared to just three in ten (32%) Democrats and four in ten (40%) Independents who feel the same way.

This poll was conducted during a period of debate over the comparative merits of the U.S. health care system and the health care systems in other countries. President Bush and other prominent political figures have claimed that the U.S. has the best system in the world. At the same time, the World Health Organization and other organizations have ranked the U.S. below many other countries in their comparisons, while Michael Moore presented a similarly negative assessment of the U.S. health system in a popular format with his film Sicko.

So how might this issue impact how Americans vote in the upcoming presidential election? When asked if they would be more likely to support or oppose a presidential candidate who advocates making the U.S. health care system more like health systems in other countries, specifically Canada, France, and Great Britain, only one in five (19%) Republicans say they would be more likely to support such a candidate. This is compared to more than half (56%) of Democrats and more than a third of Independents (37%) who say they would be more likely to support such a candidate.

Americans’ views on the U.S. health care system (Word; 340 KB)

The Administration’s Medicaid Regulations: State-By-State Impacts

Source: U.S. House of Representatives, Committee on Oversight and Government Reform, March 2008

From the press release:
Although Medicaid is the largest health care program operated by the states, the Administration has failed to provide any estimates of the state-specific impacts of its regulations. After several unsuccessful attempts by the Committee to obtain these important state estimates from CMS, the Committee requested an analysis from Medicaid State Directors on the impact of the CMS regulations on their state.

The report finds that the state estimates of the fiscal impact of the CMS regulations are significantly higher than the $15 billion impact projected by the Administration for next five years. States estimated that the regulations would reduce federal payments to them by nearly $50 billion over the next five years, more than three times the Administration’s estimate.

The large discrepancy between the state estimates and the CMS estimates is evidence that the regulations are likely to have a much larger fiscal and programmatic impact on state Medicaid programs and state budgets than people realize.

Summaries of State Responses
Interactive Map
Response from Center for Medicaid and State Operations

Presidential Candidates’ Key Proposals on Health Care and Climate Will Require WTO Modifications, Overreach of WTO Highlighted by Potential Conflicts with Candidates’ Non-Trade Proposals

Source: Todd Tucker and Mary Bottari, Public Citizen, Global Trade Watch, February 2008

From the press release:
Public Citizen today identified changes needed to World Trade Organization (WTO) rules and the investment provisions of the North American Free Trade Agreement (NAFTA) to implement a dozen of the presidential candidates’ key health and climate policy proposals.

The changes were detailed in a report, “Presidential Candidates’ Key Proposals on Health Care and Climate Will Require WTO Modifications, Overreach of WTO Highlighted by Potential Conflicts with Candidates’ Non-Trade Proposals.”

Although they have nothing to do with trade, key health care cost containment proposals on the creation of health insurance risk pooling mechanisms, reduction of pharmaceutical prices and electronic medical record-keeping, a proposal to expand coverage by requiring large employers to provide health insurance and a proposal to establish tax credits for small employers as an incentive to provide health insurance fall within WTO jurisdiction. In addition, proposals that address climate policy, such as increasing Corporate Average Fuel Efficiency (CAFE) standards, banning incandescent light bulbs, establishing new regulation of coal-fired electric plants and establishing national renewable portfolio standards (RPS), green procurement proposals and green industry subsidies come under the jurisdiction of existing U.S. WTO commitments.

Poll Finds Americans Split by Political Party Over Whether Socialized Medicine Better or Worse Than Current System

Source: Harvard School of Public Health, Press release, February 14, 2008

During the course of the presidential nomination campaign, some candidates’ health care plans have been described as ‘socialized medicine’. Historically, the phrase socialized medicine has been used to attack health reform proposals in the U.S. However, a new poll by the Harvard Opinion Research Program at the Harvard School of Public Health (HSPH) and Harris Interactive finds that Americans are split on whether a socialized medical system would be better or worse than the current system. Among those who say they have at least some understanding of the phrase (82%), a plurality (45%) says such a system would be better while 39 percent say it would be worse. Twelve percent say they do not know and four percent say about the same.

The poll shows striking differences by party identification. Seventy percent of Republicans say that socialized medicine would be worse than our current system. The same percentage of Democrats (70%) say that a socialized medical system would be better than our current system. Independents are more evenly split with 43% saying socialized medicine would be better and 38% worse.
Americans’ Views on Socialized Medicine

What Public Employee Health Plans Can Do To Improve Health Care Quality: Examples From The States

Source: Aaron McKethan, Terry Savela, and Wesley Joines, The Lewin Group, January 2008

In recent years, health system stakeholders have experimented with a wide range of efforts to stimulate quality improvement, often combined with efforts to contain costs. In this report, the authors explore strategies that public and private purchasers are using to improve care quality, focusing specifically on the role that states play as employers providing health benefits for public employees and retirees. Examples of innovations used by state public employee health plans include: promoting provider adherence to clinical guidelines and best practices, publicly disseminating provider performance information, implementing performance-based incentives, developing coordinated care interventions, and taking part in multi-payer quality collaborations. This report can be used by public employee health plans and other large purchasers making strategic decisions about how to develop or coordinate quality improvement initiatives.

New Reports Show Aggressive Efforts by States To Expand Coverage, but Indicate Economy and New Rules May Compromise Progress

Source: Kaiser Family Foundation Commission on Medicaid and the Uninsured, January 28, 2008

From press release:
New reports released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) describe aggressive efforts by states in the past year and a half to expand coverage to low-income children and their families, but the actions may be curtailed as a deteriorating economic climate and new limits on federal assistance take effect.

A downturn in the economy, the federal failure to reauthorize the State Children’s Health Insurance Program (SCHIP) and new federal rules affecting Medicaid and SCHIP eligibility all suggest that the recent period of aggressive expansion of coverage by states may be over. This is the conclusion based on a series of new studies by the KCMU, including a 50-state survey of eligibility and enrollment rules in Medicaid and SCHIP for children and families, interviews with Medicaid directors in ten states representing all regions of the country, and recent studies of enrollment in Medicaid and SCHIP.

Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles
Current Issues in Medicaid: A Mid-FY2008 Update Based on a Discussion with Leading Medicaid Directors
SCHIP Enrollment in June 2007: An Update on Current Enrollment and SCHIP Policy Directions
Medicaid Enrollment in 50 States: December 2006 Update
State Children’s Health Insurance Program (SCHIP): Reauthorization History

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