Our Health Policy Matters

There are bad reviews and then there are bad reviews.  But it would be difficult to imagine some worse headlines than the ones Obamacare has received during the past month. My favorite for over-the-top headline?  How about this gem from the National Journal: “ Why Obamacare May Be Obama’s Katrina, Iraq .” That’s right.  An initiative to insure millions of Americans has been equated with the most frightening American natural and man-made disasters of the 21 st century.  In a world in which we have come to expect tight plotlines, heroic successes, and quick and satisfying endings, I imagine that a blockbuster like Obamacare was never going appeal to critics. The Obamacare story is being reported this month as if it were a classic disaster movie, with millions of people about to be left out in the cold to fend for themselves in a chaotic healthcare system as Obamacare exchanges crash and burn around them. But that’s not close to reality. This we...

There are bad reviews and then there are bad reviews.  But it would be difficult to imagine some worse headlines than the ones Obamacare has received during the past month. My favorite for over-the-top headline?  How about this gem from the National Journal: “ Why Obamacare May Be Obama’s Katrina, Iraq .” That’s right.  An initiative to insure millions of Americans has been equated with the most frightening American natural and man-made disasters of the 21 st century.  In a world in which we have come to expect tight plotlines, heroic successes, and quick and satisfying endings, I imagine that a blockbuster like Obamacare was never going appeal to critics. The Obamacare story is being reported this month as if it were a classic disaster movie, with millions of people about to be left out in the cold to fend for themselves in a chaotic healthcare system as Obamacare exchanges crash and burn around them. But that’s not close to reality. This we...

A relatively modest Medicare proposal put forward by President Obama in his 2014 budget may help to rekindle the debate about how we pay for long term care services in the coming years.  But where will we draw the line about our own responsibilities and those of the government? This is because the President’s proposal is simple and easy to understand, and it will affect nearly all of us sooner or later. He has asked for a $100 Medicare co-pay, starting in 2017, for five or more home care visits that are not preceded by a stay in an institution, according to a story this week in Kaiser Health News .  KHN added that “home care is one of the few areas in Medicare that does not have cost sharing.” So should it? While there is cost-sharing throughout most of the Medicare program – hospital deductibles, nursing home benefits, drug payments, and physician co-pays, for example – home health care has always been something of a special case. A century ago, home c...

A relatively modest Medicare proposal put forward by President Obama in his 2014 budget may help to rekindle the debate about how we pay for long term care services in the coming years.  But where will we draw the line about our own responsibilities and those of the government? This is because the President’s proposal is simple and easy to understand, and it will affect nearly all of us sooner or later. He has asked for a $100 Medicare co-pay, starting in 2017, for five or more home care visits that are not preceded by a stay in an institution, according to a story this week in Kaiser Health News .  KHN added that “home care is one of the few areas in Medicare that does not have cost sharing.” So should it? While there is cost-sharing throughout most of the Medicare program – hospital deductibles, nursing home benefits, drug payments, and physician co-pays, for example – home health care has always been something of a special case. A century ago, home c...

An accurate but off-the-mark news headline this week proclaimed that health care costs for people insured in the private sector rose twice as fast as inflation in 2010.  But it didn’t mention that health insurance premium prices rose six times as fast. The Health Care Cost and Utilization Report, 2010 was released by the Health Care Cost Institute (HCCI).  It was based on claims data for 33 million people – one fifth of those with employer-based health insurance. The bottom line: the consumer price index rose by only 1.6% in 2010, but health care spending was up by 3.3% for the same year. The report summarized that “prices increased across all categories of service, with outpatient services experiencing the fastest growth.”  This is bad news for Americans with private health insurance already fed up with low and flat salaries and the high price of health.  The cost of health care now absorbs over one-sixth of our entire gross domestic product, an...

An accurate but off-the-mark news headline this week proclaimed that health care costs for people insured in the private sector rose twice as fast as inflation in 2010.  But it didn’t mention that health insurance premium prices rose six times as fast. The Health Care Cost and Utilization Report, 2010 was released by the Health Care Cost Institute (HCCI).  It was based on claims data for 33 million people – one fifth of those with employer-based health insurance. The bottom line: the consumer price index rose by only 1.6% in 2010, but health care spending was up by 3.3% for the same year. The report summarized that “prices increased across all categories of service, with outpatient services experiencing the fastest growth.”  This is bad news for Americans with private health insurance already fed up with low and flat salaries and the high price of health.  The cost of health care now absorbs over one-sixth of our entire gross domestic product, an...

“I will keep them from harm and injustice.” “I will prevent disease whenever I can, for prevention is preferable to cure.” - Classic and modern versions of the Hippocratic Oath , from MedicineNet.Com Senator Tom Coburn of Oklahoma is a physician.  He’s familiar with the Hippocratic Oath, and has used it to explain his opposition to health care reform. Last November, Senator Coburn famously termed a $15 billion appropriation for public health and prevention a “slush fund.”  That’s because it was paying for community tobacco control programs, immunization activities, and addiction disorder prevention and treatment services around the country.  For information on sources, see note below “Prevention is about focusing on an individual patient,” he commented, apparently forgetting everything he learned about epidemiology at the University of Oklahoma’s College of Medicine and at least some of the words of the Hippocratic Oath. Public health is the ba...

“I will keep them from harm and injustice.” “I will prevent disease whenever I can, for prevention is preferable to cure.” - Classic and modern versions of the Hippocratic Oath , from MedicineNet.Com Senator Tom Coburn of Oklahoma is a physician.  He’s familiar with the Hippocratic Oath, and has used it to explain his opposition to health care reform. Last November, Senator Coburn famously termed a $15 billion appropriation for public health and prevention a “slush fund.”  That’s because it was paying for community tobacco control programs, immunization activities, and addiction disorder prevention and treatment services around the country.  For information on sources, see note below “Prevention is about focusing on an individual patient,” he commented, apparently forgetting everything he learned about epidemiology at the University of Oklahoma’s College of Medicine and at least some of the words of the Hippocratic Oath. Public health is the ba...

Implementing health reform in the states is a governmental responsibility.   But Kaiser Health News reported this week that states are turning to foundations to help them with the costs of implementing these reforms.   Financing governmental duties has not traditionally been the role of a foundation.   Governmental programs should be implemented efficiently, but asking foundations to pay for this implementation is drawing dollars away from the most important work of foundations. This important work involves investing resources in promising initiatives that aren’t yet “government ready.”   Foundations are uniquely equipped to provide seed funding to experimental and innovative programs before they are ready for governmental action. On the other hand, funding governmental obligations leads to two unintended consequences.   First, it relieves governments of their obligation to justify to the public the expenditures they need to make to implement their prog...

Implementing health reform in the states is a governmental responsibility.   But Kaiser Health News reported this week that states are turning to foundations to help them with the costs of implementing these reforms.   Financing governmental duties has not traditionally been the role of a foundation.   Governmental programs should be implemented efficiently, but asking foundations to pay for this implementation is drawing dollars away from the most important work of foundations. This important work involves investing resources in promising initiatives that aren’t yet “government ready.”   Foundations are uniquely equipped to provide seed funding to experimental and innovative programs before they are ready for governmental action. On the other hand, funding governmental obligations leads to two unintended consequences.   First, it relieves governments of their obligation to justify to the public the expenditures they need to make to implement their prog...