The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Health Care Reform 2009: Even More Required Reading

Posted by Alan on August 11, 2009

Welcome to the third edition of health care reform 2009’s required reading list. (The previous editions were Health Care Reform 2009: Required Reading and Health Care Reform 2009: More Required Reading). What I try to do in these cleverly titled posts is to pull together the articles and web sties offering meaningful insights into the current health care debate. I don’t always agree with the authors facts, reasoning or conclusion, but having them available can be a useful guide to what people are saying and thinking.

  1. If folks are going to argue over what’s in the House Energy and Commerce Committee’s legislation (the “America’s Affordable Health Choices Act“) we might as well all read the darn thing. And the various press releases, summaries and white papers associated with it. The Committee’s site has it all and more.
  2. When the Congressional Budget Office talks people listen. (To be precise, when the CBO writes, people read — especially lawmakers, public policy wonks, the media and the political groups seeking to sway the outcome of the health care reform debate). One of their most read pronouncements concerned the impact of a government-run health plan to compete with private carriers or through a health insurance exchange under the Energy and Commerce Committee’s bill. The CBO concluded enrollment in a public plan or exchanges would be relatively modest — by 2016 they project “nearly 3 million Americans who would be covered under an employment-based plan under current law … would choose instead to obtain coverage in the exchanges because the employer’s offer would be deemed unaffordable and they would therefore be eligible to receive subsidies via an exchange…”  When part-time workers are added in, the CBO estimates that the private carriers would lose approximately 9 million people to the exchange by 2016. Estimating that a public plan would offer premiums approximately 10 percent lower than typical private plans offered in the exchange,  the CBO concludes the public plan would have a “limited effect on the the proposal’s net budgetary impact,” implying enrollment would be modest. The CBOreport is a thorough analysis well worth an investment of time.
  3. When it comes to polling, trends often matter as much as the actual numbers. The Kaiser Family Foundation has been tracking the public’s attitude toward health care reform since March 2007.  Their July 29th Public Opinion on Health Care Issues finds a majority of Americans continue to believe “it is more important than ever to take on health care reform now.” While the percentage has declined since October 2008 from 62 percent to 56 percent, that’s still a striking result given the rhetoric surrounding the debate. Of course, it all depends on who you talk to: roughly 70 percent of Democrats believe this is the time for health care reform while approximately 60 percent of Republicans state “we cannot afford to take on healthcare reform right now.” Independents split 54 percent-to-42 percent in favor of moving forward with change now.
  4. Just because you see it on television doesn’t mean it’s true. Partisans on the left, right and middle have a tendency to misstate the facts., a project of the Annenberg Public Policy Center is an excellent source for the real scoop. They take on liberals and conservatives with equal fervor, for instance, debunking the euthanasia claims of the right and challenging President Barack Obama’s claim that health insurance companies are raking in “record profits.” 
  5. During the presidential campaign, one of Obama campaign’s most potent weapons was a site called “Fight the Smears.” It allowed the campaign to quickly respond to and debunk unfounded rumors. The White House is launching a similar site, called “Reality Check” to counter attacks on the president’s health care goals. The justifications are not surprisingly skewed to the Administration’s positions, but as a single source for President Obama’s positions on controversial issues it’s a great resource.
  6. Keeping the health plans straight without a program is nearly impossible. Even with a program it’s darn tough. The National Association of Health Underwriters offers a useful comparison between the Senate Health, Education, Labor and Pensions Committee legislation and the House of Representative’s legislation (HR 3200). In fact, NAHU has a wide range of useful legislative information of particular interest to health insurance brokers. (If you’re a broker and not a member of NAHU, now is the time to join. No other organization is as engaged or effective at representing the perspective of professional insurance brokers.) The Kaiser Family Foundation ahs a great tool for comparing various health care reform proposals as well.
  7. Health care reform is critical importance to state governments. They simply cannot afford the burden of increasing medical costs for programs like Medicaid (Medi-Cal in California). California Arnold Schwarzenegger made this point very clear in a letter to Congressional leaders urging them to pass health care reform, but warning against pushing the financial burden onto state governments. It’s an aspect of health care reform that is not receiving a great deal of attention, but is of critical importance. The letter does an excellent job of explaining the issue. 

Of course the most important document to read is the Senate Finance Committee’s compromise proposal. Unfortunately, it doesn’t exist yet, although there are plenty of stories on what it is likely to contain. Until it sees the light of day, however, reports on its provisions are merely conjecture, trial balloons or both. In the meantime, these sites and publications should provide some pleasant summer reading.


11 Responses to “Health Care Reform 2009: Even More Required Reading”

  1. Bart said

    This blog seems to provide thoughtful and referenced reports and inferences, the likes of which should inform every person who makes health care policy/practice decisions and every individual subject to the consequences of these decisions.

    Health care (either staying well or receiving care for being ‘not well’), is immensely personal and vitally important to every individual. In this country, the aggregate effects of individual ‘entitlement’ to good health and an almost infinite value placed on health (combined with politicians who promise it and payers who use money from many healthy people to pay for one ‘ill’ person), make for a ‘feed-forward’ mechanism for a combustible increase in money invested in ‘health’ (about 15% of average individual contribution to the GDP…more any other nation).

    Given this dynamic and framework, since being ‘healthy’ is ultimately the primary goal of essentially everyone, how do you stop health care from absorbing money until it squeezes resources required for anything else? Theoretically, if left unattended, our health care expenses will consume income, trumping luxuries like homes, cars, recreation, (competition in the global market…), etc. It may be as much a cultural phenomenon as an economic one. E.g., what is the value of health?

    Given the integral role of health (and thus the health-related economy) in every citizens life, and the incalculable ramifications of gross attempts to regulate this economy, there can be no simple solution. So, how does ‘it’ get done? When one sets out to ‘solve the health care problem’, what is it that one is trying to solve? Is the solution a change in attitude, culture, a cap on money spent, other?


  2. JimK said

    Very Good Site. Just one question. Is there a reason that the Wyden-Bennett, Healthy Americans Act, was not included on the Healthcare Comparison Download?

    • Alan said

      A very good question. I wrote about that legislation over a year ago, but I guess because it’s not being marked up by any of the committee’s it’s no longer being considered part of the mix. There are several elements from it that are in the Senate HELP bill and I’m confident even more of it will be in the Senate Finance Committee. But the bill itself seems to be dormant, to be kind.

  3. Nosedoc said

    Liability reform is the key to eliminating defensive medicine practices. Unfortunately, this topic is anathema to the Democrats. Here is an excellent article on the topic:

  4. I am not sure what should be done, but I know something needs to be done. Maybe one of the easier solutions is to take away the write off Drug Companies get for advertising so we can get rid of all the ads on TV.
    Sparky Flavored Coffee Drinker

  5. Alan, thanks for compiling all these resources of information in one place. I think a lot of the fear and apprehension over health care reform is due to a lack of information the public feels they can trust.

    • Dave Wood said

      The nation is equally divided, Obama has gone way to the left and the American people are now getting scared. People want to LOVE this guy, we want him to succeed.

      But as the American people finally pay attention to the details of this complex and fragmented issue, they are wanting to know why they should support giving more authority to a federal govt. that just oversaw and encouraged the subprime housing debacle, that got us into an unnecessary war in Iraq, that cannot even manage to evacuate an American city with 3 days notice of a hurricane, that just bought two car companys, and is so full of waste, ineffectiveness, and dysfunction. WHY WHY WHY!

      Even my sandle wearing bleeding heart liberal sister claims she would rather a local authority run health care than the federal govt.

      Have you EVER seen any real accountability in this congress? Sure we see majoritys change every decade or so. But really, did any congressman ever get taken to task on their support for fredy mac and fannie maes decision to INCREASE its purchases of sub prime loans, which fueled the debacle?

      How many Americans will have more stress and anxiety, more divorces, more suicides, more heart attacks because of this recession, which is entirely caused by govt. incopetence at all levels?

      Obama care is too heavy on reducing the uninsured, and is too light on cutting costs.

      Would it be an improvement? YES, but not by much. And when you consider the cost of all this debt, it may be the beginning of the end of American dominance of the world economy as Asia finances our spending, our medicare costs, our new Obama care costs, and that will only transfer power and standard of living to the financiers of our massive debt. So perhaps Obama care will be a giant step backward over time. Who knows.

  6. Meg McComb said

    Alan, what would we do without you?!

  7. Rick said

    Alan, thanks for this excellent Blog!

  8. Alison said

    “Pleasant Summer Reading” – writer AND comedian.

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