Amidst the avalanche of conversation about health policy during the long 2012 presidential process, one event, the September 11 2011 Republican Presidential Primary debate, stands out to me:
CNN moderator Wolf Blitzer's hypothetical question about whether an uninsured 30-year-old working man in coma should be treated prompted one of the most boisterous moments of audience participation in the CNN/Tea Party Express.
"What he should do is whatever he wants to do and assume responsibility for himself," Paul responded, adding, "That's what freedom is all about, taking your own risk. This whole idea that you have to compare and take care of everybody."
The audience erupted into cheers, cutting off the Congressman's sentence.
After a pause, Blitzer followed up by asking "Congressman, are you saying that society should just let him die," to which a small number of audience members shouted "Yeah!"
Par for the course for libertarian Ron Paul. What struck me was Mitt Romney standing speechless with the others. He could not lift a rhetorical pinky in the young man's behalf because it would set him apart from his competitors by looking compassionate.
Fast forward to Mitt Romney's September 23, 2012 CBS news interview:
If our upcoming elections were about addressing big issues and finding real solutions, then the conversation about Medicare and Medicaid would focus on a group known as the "dual eligibles." They are among the most expensive population to care for in the world, and a lot is happening now to improve care and lower costs for these folks. In figuring out how to do this as well as possible, Massachusetts is way out in front, thanks to a group you've never heard of called the Commonwealth Care Alliance (CCA).
First, what's a dual eligible? It's 9 million individuals enrolled in both Medicare and Medicaid at the same time. Duals are in Medicare because of age or disability, and in Medicaid because of low income. Medicare covers what Medicare covers, and Medicaid covers everything else. Duals are much sicker and more chronically ill than most other groups, and much more expensive. For example, about 15% of everyone on Medicaid is also on Medicare, and about 40% of all Medicaid spending pays for their care. For the most part, duals' care is uncoordinated, wasteful, and even harmful. Most Medicaid enrollees living in nursing homes are duals.
For folks who pay attention to fixing the U.S. medical care system, it's got to be a confusing time. So many developments trending is so many directions. How does one make sense of it, and what does it all mean? Let's dive in for a bit.
First, an important shift in how we pay for health care in the U.S. began this month as the federal government started financially penalizing hospitals with excessively high rates of hospital readmissions and hospital acquired infections for Medicare patients. New Jersey is a state with among the highest proportion of hospitals facing these penalties, and here's a story about how hospitals there are addressing the challenge.
This shift is important. We are moving beyond fee-for-service by which we pay providers for how much they do. We are also moving beyond "pay for performance" where we reward providers for doing process steps such as screenings and other tests. We are moving, slowly and surely, toward "paying for outcomes," a potentially game-changing stage if the current efforts aimed at readmissions and infections are seen as just the first steps.FULL ENTRY
"Value" is a dicey word because we each value different things. This is especially true in relation to health insurance. Some people value insurance based on the price of premiums, and some people want to consider the required level of cost sharing in the form of copays, deductible, and coinsurance; some care mostly about choice of provider and others care more about the scope of services covered.
A new report from U.S. News and World Report takes a crack at answering this thorny question by closely evaluating near 6,000 health insurance plans across the U.S. that sell "non-group" coverage to individuals and families. Click here for the summary of the report and click here for access to the full report.
Bless USNWR, they also evaluated the value of plans state by state. We already know that Massachusetts has among the highest health insurance premiums in the nation. Surprise, surprise, though, U.S. News and World Reports concludes that Massachusetts health insurance plans "consistently offered broad coverage and protection against a potential flood of medical bills..."
Here are some more details, including their state by state map:FULL ENTRY
I just returned from a week long training program in South Africa (SA) with some colleagues from the Harvard School of Public Health. We were there for the launch of collaboration with health professional schools in Pretoria and East London to train up-and-coming officials in the South African health system to meet the challenges in this dynamic and complex system. While there, I also got a look at that nation's efforts to achieve national health insurance for its 50 million residents.
I arrived thinking they might have some things to learn from the U.S. health reform experience, and left convinced we have some things to learn from South Africa. Here are some thoughts, mostly written on the 16-hour plane ride back home:
Some quick reactions on the health care debates in tonight's first presidential debate:
Tough for both when stats and debating points are flying everywhere fast and furious.
Massachusetts: The big winner from tonight's debate regarding health policy may be the Massachusetts health reform program. Here's a point about health that both O and R agree on -- Massachusetts health reform is good and it working well. I'm sure that makes ObamaCare and RomneyCare opponents choke -- nice to have it agreed on by both candidates for president.
Romney added: "What we did in Massachusetts is a model for nation -- state by state. Whisking aside the 10th amendment is not the answer." The US Supreme Court weighed in on constitutional violations, and the ACA stands tall. RomneyCare works only because the federal government pays the lion's share of the tab.