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Health Access Weblog
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Clicking around...
Friday, June 27, 2008
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Taking consumer representation seriously...
Thursday, June 12, 2008
Good Health Wonk Review just published at the Health Affairs Blog, including our post on budget cuts being a big threat to health reform. Lots of good posts. The Health Affairs Blog had a previous post of note, "Who Speaks for the Health Care Consumer?" Ron Cunningham quickly debunks the mis-used term of "consumer-directed health care," asking "When did consumers ever stand up and demand that they be allowed to pay more when they are sick?"Taking the question seriously, he reports that "Unresolved questions about the meaning of consumer engagement in the health sphere surfaced Monday in a lively conversation among health services researchers at the AcademyHealth Annual Research Meeting in Washington." Here's a provocative paragraph: Panelist Shoshanna Sofaer of the City University of New York bluntly described the term “consumer empowerment” as an oxymoron, because of the implication that if power could be bestowed on a consumer, it could equally well be taken away. In general, Sofaer said, as matters now stand, “consumers have no voice” in the workings of the health system. Her view was seconded by Ed Mendoza of the California Office of the Patient Advocate, who suggested that consumers have little or nothing in common with powerful “stakeholder” groups. Inviting consumer representatives or advocates to participate in a stakeholder collaborative could amount to little more than tokenism. True consumer activism is more likely to begin with a negative reaction to what incumbent stakeholders are doing, Mendoza said. It's absolutely true that there's lots of task forces, commissions, and decision making bodies in the health care world and in state and federal government where there is a token consumer representation (although you'd be surprised at how many decision-making entities don't even make that effort.) Placing a random "consumer" or two on a board may introduce some good questions and thoughts to a discussion, but is of limited use: they are often outnumbered, but often don't come to the table to with the information, political savvy, or political power to make a difference. Sofaer is right: consumer empowerment needs to be done by the consumers, not the government. As a consumer advocacy coalition, we don't believe that we are "empowered" by government officials, but by the organizations and individual members and constitituencies. So Health Access California seeks to provide real consumer representation on board and commissions and the like. First of all, we work to build political power to represent consumers, as a stakeholder of equal or greater standing than the traditional "stakeholders" in the process. We work to build the biggest and broadest coalition of organizations that represent consumers to advocate for policy changes that would help their community. Health Access and other organizations not only then come with power and standing, but with accountability, that they are actually representating a constituency, albeit a very broad one. (And for the record, we are organized for the positive goal of quality, affordable health care for all; we do often have a "negative reaction" to industry practices, but that's because of the industry practices... we'd rather be focused on our positive agenda.) And then there's expertise. For example, Health Access is lucky to have Elizabeth Abbott direct our administrative advocacy, working to represent us at various agencies, and on various board and commissions. She often is the only (or one of a few) consumer advocates on a panel--but she has the backing of Health Access and our collective knowledge and resources, as well as her own experience running Medicaid and Medicare for CMS at their Regional Administrator until recently. This gives her the ability to ask the right questions, the savvy to sniff out when something sound wrong, and the ability to make a stand when necessary, and to ensure that people listen. So consumer representation and engagement can be mere tokenism, but it doesn't have to be be, if the representatives come with their own expertise, accountability, and organizational resources and power.Finally, there's just the numbers: why is it acceptable to have lots of boards and commissions with the goal of benefitting consumers, and consumers only have a seat or two, or are outnumbdered 10-1? There's much more work to do to have our health system be truly "consumer directed," in the original and true meaning of that term. One more thing: I sometimes dislike when decision-makers just call us "the advocates," because that description robs us of our central role, as consumer representatives: we aren't just advocating for advocating's sake: we are representating consumers, who are, in our estimation, the point of this whole health care enterprise in the first place. Labels: HealthAccessCommunity, OtherBlogs
posted by Anthony Wright |
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11:46 PM
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Healthy blogging...
Sunday, June 01, 2008
Those interested in health policy should be subscribed to the news summary that the Kaiser Family Foundation puts out on a daily basis. Now, those summaries will often include a health policy blog roundup, which will be another way to keep up-to-date. Here's several gold nuggets they found from panning the blogosphere about McCain's health plan: Joe Paduda of Managed Care Matters examines presumptive Republican presidential nominee Sen. John McCain's (Ariz.) health care plan and whether it could increase the number of uninsured residents by destabilizing the employer-based health care system. Robert Laszewski of Health Care Policy and Marketplace Review builds off of Paduda's post to argue that McCain's market-based plan reforms might work well for some voters, as long as advisers present certain changes carefully. Bob Vineyard of Insure Blog reacts to a Slate article and discusses McCain's proposal to allow individuals to purchase insurance across state lines. Peter Harbage from the Wonk Room Blog discusses a new Center for American Progress Action Fund paper about McCain's health care plan and administrative costs. Really good stuff there. Don't forget the biweekly Health Wonk Review, which this week is hosted by Hank Stern at InsureBlog. We are listed in there with over a dozen interesting posts from around the web. Finally, for those who prefer to read offline, our state-based colleagues at the Connecticut Health Policy Project have a blog of interest, CT Health Notes Blog, and have a recommended booklist for your summer reading. Labels: OtherBlogs, OtherStates, PresidentialCandidates
posted by Anthony Wright |
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1:10 AM
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The new/renewed conversation on health reform...
Friday, May 23, 2008
“When you come to a fork in the road, take it,” said Yogi Berra. It’s a lesson that health reformers can take to heart after reading the May issue of The American Prospect, which has a special section on “the path to universal health care.” The articles reflect heated debates, some spanning decades, on the preferred type of health reform; the best strategies and messaging; whether to pursue reform at the state or federal level; and how prevention can be a cornerstone for reform. My sense is we need all of the above: multiple efforts on different tracks and different venues—to meet this challenge. There’s agreement on a couple of things, including the absolute urgency for reform. Many people are uninsured, or concerned their coverage won’t be there for them when they need it. Lack of adequate health coverage has direct health and financial consequences. The uninsured—and underinsured—live sicker, die younger, and are one emergency away from financial ruin. A couple of the articles debate the kind of health reform to pursue and point out issues with experiments like the Massachusetts reform and Medicare. I was privileged to contribute an article on some of the lessons learned from the debate in California, and about how we can be ready for the next round.
We have a new window of opportunity in 2009 to confront these issues, with a new President and new Congress. While California had a health reform effort stall recently, there is enough support and momentum that the window for comprehensive reform will re-open at the state level as well, with new legislative leaders and a Governor who still wants to pursue big reform in his last two years. In California we have an opportunity to pursue state reform, to both bolster and shape federal efforts, alongside our own direct pursuit of a national solution. So will we be ready? Yes, if we learn lessons from our multiple-year experience in California, and help educate our friends around the nation. We Californians have much to tell: no other state has had such a robust discussion of health reforms in the past five years. Our legislature has advanced multiple reforms—expansions of job-based coverage, universal children’s coverage, a single-payer system, and a comprehensive “shared responsibility” approach—and all these ideas are still on the table. To be ready, we need to lay the foundation this year. Proposed budget cuts would take us backwards in terms of access to health care. The budget—and current programs like Medi-Cal and Healthy Families--are the foundation on which health expansions will be built. While shoring up the budget with new revenues, we can also pass other policy reforms that are building blocks toward universal coverage.
Most of all, we need to plan and prepare for the next stage of the great health debate—as previewed in The American Prospect. We have a real opportunity in the next year or two and we need to take it. (Cross-posted at Bob's Blog, as a guest post on the new and renewed conversation on health reform, at the website of The California Endowment, an important funder for the Health Access Foundation and many key health programs and organizations in our state.)Labels: InTheNews, OtherBlogs, Uninsured, YearOfReform
posted by Anthony Wright |
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12:11 PM
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More on high risk highjinks...
Saturday, May 17, 2008
Our post on the state of California's high-risk pool, MRMIP, has gotten web attention by the new Health Wonk Review, hosted at the Healthcare Economist this week, and by multimedia globetrotting journalist Sarah Arnquist at The Health Care Blog, on a post about people so desperate for coverage--and yet denied in in the individual market--that they'll marry in order to get good group coverage. Again, the focus here is the key. Consumer advocates are actively working to improve the sorry state of the individual market--Health Access has a bill, SB1522(Steinberg), to better standardize the market, so that people have a better sense of what they are getting. AB1945 (De La Torre) has provisions to place oversight over any rescissions, and in fact to standardize the underwriting procedures of insurers, such as the dreaded questionnaire. And then there's AB2 (Dymally) to improve the high-risk pool for those who are denied because of pre-existing conditions. While all these reforms are needed in the individual market, a preferred solution is to avoid these problems altogether by having people come together in groups (whether through employers, public programs, or large purchasing pools) to get coverage. In contrast to the Obama, Clinton, Edwards, Hacker, Kuehl, and Nunez/Schwarzenegger plans, the McCain plan actively works to shift people from group coverage into the individual market, and that's the fatal flaw. McCain may offer some support of state "high-risk" pools as a way to "solve" the problem--a worthy effort by itself--but the very nature of his proposal makes the problem that needs to be solve--people facing denials for "pre-existing conditions"--much worse, and his solution doesn't begin to undo the damage. Labels: Insurers, OtherBlogs, PresidentialCandidates
posted by Anthony Wright |
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8:46 AM
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More on McCain...
Thursday, May 01, 2008
There's a new May Day edition of the Health Wonk Review up at the Medical Humanities blog. While they spotlight our post on McCain's health "plan," I want to recommend Jonathan Cohn at the New Republic for his analysis, as well as a discussion on Time.com's Curious Capitalist and Swampland, which has lots of links as well. Basically, the nicest things I've heard about the McCain plan is it won't do any harm because it really isn't a fleshed out plan, and it doesn't have a chance in Congress. However, the majority think it's a radical shift--and not in a good way. One debate started in Time.com's Swampland here, which quotes health policy expert Robert Blendon. McCain's--which has some of the features of a plan proposed by George Bush in 2007, which didn't go anywhere in Congress*--actually envisions an entirely new system in which individuals would shop for their own health care coverage, presumably getting a better deal thanks to vastly more competition in the marketplace. "He proposes a vision for the future that doesn't exist -- yet," Blendon says. "His argument is I'm going to change how this thing works. ... In some sense, he has the largest scale what you would call 'reform' of all the candidates." On the other hand, the assumption underlying the Obama and Clinton plans is the opposite, says Blendon, that "the worst thing that can happen to people is to be by themselves trying to negotiate for insurance. ... The solution is protecting people from being out there by themselves" by pooling them together, either through the workplace or in newly created purchasing cooperatives.
A commentator agrees, and succinctly lays out the three main reasons why not to shift people to the individual market: 1. Individuals have less bargaining power and sophistication than employers.
2. Negative selection.
3. Greater frictional costs from advertising to individuals, etc. Pretty good, although they are linked. Because the individual has so little power against a big insurer, individuals usually get charged more expensive rates, and insurers profit more from the individual market. Since they lack purchasing power, they also can excluded on a case-by-case basis (as opposed to group coverage, where part of the deal is to take the entire group). And finally, the administrative and marketing costs are far more example when the company is managing and selling the plans one-at-a-time, as opposed to a group. Individual buying coverage are simply not getting the same bang for their buck as those in the group market. Why Bush, McCain, and others would want to take coverage in that direction is beyond me. Labels: OtherBlogs, PresidentialCandidates
posted by Anthony Wright |
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11:26 PM
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High-risk health reform...
Tuesday, April 29, 2008
John McCain is getting beaten by a woman, and it's not Hillary Clinton. It's Elizabeth Edwards. In unveiling his health care plan, McCain seems super-focused on the fact that many more people could be denied coverage because of "pre-existing conditions," as he seeks to shift people from employer-based coverage to the individual insurance market, with some assistance from a tax credit. Elizabeth Edwards pointedly has challenged McCain, saying that an American with her or his health history would be denied under McCain's plan in the individual insurance market. (To be fair, the Los Angeles Times made this point earlier.) She's absolutely right. And because of this, McCain has a liability. He even has a "myth and facts" section of his website designed to counter exactly one, and only one, myth: "MYTH: Some Claim That Under John McCain's Plan, Those With Pre-Existing Conditions Would Be Denied Insurance. FACT: John McCain Supported The Health Insurance Portability And Accountability Act In 1996 That Took The Important Step Of Providing Some Protection Against Exclusion Of Pre-Existing Conditions. FACT: Nothing In John McCain's Plan Changes The Fact That If You Are Employed And Insured You Will Build Protection Against The Cost Of Any Pre-Existing Condition. FACT: As President, John McCain Would Work With Governors To Find The Solutions Necessary To Ensure Those With Pre-Existing Conditions Are Able To Easily Access Care."
The multiple "facts" don't really the answer the charge. The "myth" is a factual statement. Where do those those with "pre-existing conditions" go under the McCain plan? Some will get left behind. In the new twist to the slim pickings already on his website, McCain would now have states figure out how to solve the issue of the "uninsurables." . The New York Times coverage by Michael Cooper and Kevin Sack focus on this aspect. Bob Laszewski from Health Care Policy and Marketplace Review thinks McCain has opened a major liability for himself. I think the Democratic rivals made good responses but didn't quite capture the central critique of this plan in their responses. * Some of what they say is a criticism of what is *not* in McCain's plan, which indicates it lacks a certain ambition, but doesn't really say why the proposal is still not an improvement from the status quo. (Frankly, it doesn't take much.) * Clinton appropriately criticizes state high-risk pools (and her statement--"virtually all high-risk pools today have waiting lists, high premiums, and scaled-back benefits"--is a dead-on description for California's MRMIP, Managed Risk Medical Insurance Program, which now has a waiting list, is underfunded, has high premiums and a $75,000 benefit cap.) * But in our current system, the state high-risk pools are an essential lifeline to coverage for many. The problem is not the high-risk pool itself, but the major people who are denied in the individual market, that the high-risk pool provides some comfort. * The real issue is not the high-risk pools in the state as a solution, but that his plan seeeks to make the problem much bigger. The more he accomplishes his goal of moving people from group coverage (like that of their employer) to individual coverage, the more he creates the problem that he seeks to solve. Here in California, Health Access California supports AB2 (Dymally) and other efforts to improve and better fund our high-risk pool, so more people, denied for pre-existing conditions, can at least get some coverage. We were more pleased to support AB x1 1, the negotiated reform between the Governor and the Speaker, that included not only guaranteed issue--so no insurers could deny for health status--but it would expanded group coverage enough that there was a net decrease in the number of people having to get individual coverage. This was important, because the individual market is fundamentally a place where the individual has little market power against the big insurers, as opposed to when they at least have the purchasing power of a group. McCain would place more people in the individual market. So the criticism isn't that McCain relies on state-based high-risk pools, it's that he would increase the need for them in the first place.Labels: Insurers, InTheNews, OtherBlogs, PresidentialCandidates
posted by Anthony Wright |
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11:42 PM
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Working on both fronts...
Friday, April 25, 2008
Lots of hub-bub in health circles about an article in the Capitol weekly publication The Hill, suggesting health reform isn't a certainty in 2009 at the federal level. There's lots of pushback and clarification as a result. Either way, it suggests that reformers and advocates, while continuing to push for national health reform, should *not* sit on their hands at the state level. We have a window of opportunity in 2009-10 at *both* the federal and state levels, with a new President and Congress, and here in California with new legislative leaders and a Governor interested in prioritizing health care. We need to work on both, in simultaneous and complementary ways. Labels: Federal, OtherBlogs, YearOfReform
posted by Anthony Wright |
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5:50 PM
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Now that's straight talk, to the President...
Merrill Goozner has an amusing anecdote about a medical legend who got to give advice on health policy to President Bush, directly and publicly. Labels: OtherBlogs
posted by Anthony Wright |
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2:51 AM
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From the World Health Care Congress...
Wednesday, April 23, 2008
Just wanted to spotlight some of the blog posts and reports from the World Health Care Congress, now at the World Health Care Blog.Joe Paduda of Managed Care Matters has an excellent report, especially his commentary on the presentations by the presidential campaigns, as well as other panels. ChangeNow4Health also has notes from that panel. Notes are also taken by jenmccabegorman and ajfortin on Twitter. With the Pennsylvania primary just past us, Richard Eskow at the Sentinel Effect has more opinion about the presidential plans. Here's my basic gist: the Clinton and Obama plans are very similar, and very good. There's an important difference about the individual mandate, but it's one of emphasis, rather than actual implementation. But both plans are far from what McCain has put on the table, which simply isn't serious, and would actually do harm. Labels: InTheNews, OtherBlogs, PresidentialCandidates
posted by Anthony Wright |
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12:50 AM
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On top of student loans...
Sunday, April 20, 2008
We are coming close to high school and college graduations, so it's a good time to spotlight this post by Henry Stern on InsureBlog on student insurance. The young are the most likely to be uninsured, and what is offered to them isn't a very good value. The post spotlights a very typical student policy that will leave some students will have significant medical debt even before graduation. Labels: MedicalDebt, OtherBlogs, Underinsurance, YoungAndUninsured
posted by Anthony Wright |
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2:38 PM
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Drug cost-sharing and other wonkery...
Thursday, April 17, 2008
Maggie Mahar and Niko Karvounis at Health Beat host this week's Health Wonk Review. In addition to a better-than-the-original summary of our post on ER overcrowding, the blog hightlights lots of good issues and posts. There's lots of commentary (some compiled by Brass and Ivory) on the recent New York Times article by Gina Kolata (reprinted in the Sacramento Bee and elsewhere) about the astonishing co-payments and cost-sharing for a new "tier 4" class of prescription drugs. Here's the Wonk summary and links on this issue: "...many insurers are now insisting that patients suffering from diseases such as MS, Hepatitis C and some cancers pay a percentage of the cost of super-expensive drugs.
Normally patients are asked to pay a flat fee of $10, $20, or $30, depending on whether an insurer classifies a drug as tier 1, tier 2 or tier 3. But now patients are forced to pay 20 percent to over 30 percent of the cost of “tier 4” drugs that can cost $100,000 a year—or more. Emrich presents the full range of responses coming from MS Bloggers, Health Policy Wonks, and Medical Professionals.
While some think that “Patients have been shielded from costs far too long, subsequently leading to an entitlement mentality,” others sympathize with MS bloggers like Jeri who writes: “I am terrified about what will happen when this Fingolimod trial ends and I no longer get my medication for free. I strongly believe that the medicine is the reason for this long period of remission that I am enjoying, and the health care system is putting a price on that for me. I know it will be out of my reach once it has gone to market and I am forced to pay for it."
Meanwhile, at the Sentinel Effect, Richard Eskow quotes a surprising industry response from Robert Zirkelbach of America’s Health Insurance Plans: "When plan designs are no longer made to change behavior, but simply to transfer high-cost items back to the insured party, that’s risk transfer and not benefit design. As a result, the insurance concept is being subtly modified - and arguably undermined." [Note: this, from an interview by American Prospects’s Ezra Klein.] Lisa ends by tipping her hat to Merrill Goozner of GoozNews, re-printing Goozner’s post on tier 4 in its entirety.
At Colorado Health Insurance Insider, blogger Louise offers her own very sharp take on tier 4 drugs, and offers her solution for keeping costs down without imposing an unfair burden on a smallgroup of very sick patients. Her concluding paragraph deserves to be reprinted in full: “Charging insured [patients] slightly higher prices for common drugs - the ones that are prescribed to millions of Americans - and not having to charge dramatically higher prices for the rarely prescribed, expensive drugs would be a better way of spreading the rising cost of prescriptions out over the whole population, instead of dumping it at the feet of those who are already battling against some of the nastiest illnesses around.” Amen to that.
Finally, for Health Beat's take on Tier 4, check out Maggie's last post, where she asks “Who Sets the Price at $100,000” and, does anyone happen to know, “Are These Drugs Effective?”
Labels: Drugs, InTheNews, OtherBlogs
posted by Anthony Wright |
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3:01 AM
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Wonks R Us...
Friday, April 04, 2008
Brian Klepper at The Health Care Blog hosts the new version of Health Wonk Review. It's well worth checking out, even if it didn't includes two Health Access California posts, one on balance billing by me, and another on Senator Clinton's health plan by Hanh. The whole thing is worth the read, but here's other posts of note: * Jane Sarasohn-Kahn reviews new health consumerism data at Health Populi, showing little enrollment in so-called "consumer directed" health plans. As Klepper summarizes: "The enrollees in these plans tend not to be born-again uninsureds, but the healthy and wealthy. And still, a lack of information that can provide decision support to these enrollees remains a problem." * Bob Laszewski at Health Policy and Marketplace Review reports on a General Accounting Office (GAO) review of the individual health coverage market and state high risk pools, and the implications for McCain's health plan. * Health disparities are the focus of a post InsureBlog, on a Harvard study, suggesting the need for translation services. * The Medical Humanities blog's Daniel Goldberg responds to a NY Times article citing continuing evidence that wealthier people have fewer health problems than poor people. * Maggie Mahar, writing at HealthBeat, describes how " the different sensibilities inherent in America’s social class structure are a major obstacle to meaningful political reform." * Colorado Health Insurance Insider, reviews data showing that a high percentage (59%) of American physicians support a national health insurance program.Labels: OtherBlogs
posted by Anthony Wright |
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12:07 AM
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Looking back, looking forward...
Thursday, March 20, 2008
Steve Wiegand of the Sacramento Bee brings us a fascinating blast from the past, explaining some of the details with Gov. Earl Warren's attempt at health care reform many decades ago. The question is whether the current Republican Governor's second attempt at health reform (he says he's committed) will be more successful... Lots of posts about state and national health reform in this week's Health Wonk Review, hosted by Joe Paduda at Managed Care Matters. It nicely spotlights our recent post asking what's wrong with the restaurants... Ground zero in health care reform (at least one of the 'zeros') is San Francisco, perhaps the largest political entity in this country to legislate universal coverage. Anthony Wright finds the most vocal opposition to Healthy San Francisco came not from insurers, or pharma, or physicians or neocons, but restaurants. From his desk, it looks like the restaurant's opposition may be backfiring, as some patrons are happy to pay a surcharge to cover their server's health benefits. I've always said that given the raw numbers, Los Angeles was the ground zero in the uninsured crisis in the nation--so maybe it's appropriate California offer a ground zero in the solution--hopefully Sacramento will re-establish it's claim to that mantle as well. Other interesting posts noted include: * a series on the state of America's health system by Tom Lynch (a four-part post: One, Two, Three and Four), trying to answer the question is our system is the best in the world... * a Colorado look at a proposal to allow out-of-state plans to offer coverage by Louise Norris--she notes all the problems with such a proposal in terms of undermining state consumer protections and markets; and while these consumer protections are national, I think there's a role for the states in insurance regulation; * and Jason Shifrin on a minimum benefits requirement for health insurance--an issue we are trying to tackle with SB1522 (Steinberg), which we believe strikes the right balance, allowing lots of choice and variation that is in the insurance market right now, but have some standardization to prevent the "junk" insurance plans that really don't provide even catatrophic coverage, and allow for apples-to-apples comparisons for consumers. Labels: Insurers, OtherBlogs, SanFrancisco, YearOfReform
posted by Anthony Wright |
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3:11 PM
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Wonkery and other links...
Thursday, March 13, 2008
I would be remiss in not linking to the new Health Wonk Review, at Workers Comp Insider. Lots of interesting posts. It pointed me to an Deloitte survey of the attitude "health care consumers" done for corporations and their marketing, but with policy implications: suggesting support for broad health reform, with two-thirds willing to support mandates, and with a majority even willing to consider taxes. As Health Populi reported, they even defined some categories of consumers, based on their frequency of using the system, knowledge, compliance with treatments, focus on cost or quality, and other factors: * Content & compliant, 29% of Americans * Sick & savvy, 24% * Online & onboard, 8% * Shop & save, 2% * Out & about, 9% * Casual & cautious, 28% of the population. Two other posts I would like to highlight: Ezra Klein promises a post that is his wonkiest yet, using charts to compare health plans with the goal of system integration. And Health Care Policy and Marketplace Review reports welcome news that several House Democrats have requested the Goverment Accountability Office (GAO) to report on the state of the individual market. This was prompted, in part, by the rescission controversy in California. It's a much needed investigation. Labels: OtherBlogs
posted by Anthony Wright |
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12:12 AM
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Cost containment bullets...
Tuesday, February 26, 2008
In the holy grail of cost containment, I've always thought that there isn't one "silver bullet," but there is a list of policy reforms (here's the Health Access one-pager) that can each bring down health costs somewhat, but that taken together, the savings over the long term could be significant. Some of these reforms are ingrained in comprehensive health reforms: the negotiating power of large purchasing pools, the global budgeting of a single-payer system, or just the preventative aspect of getting everybody insured, and the reduction of the "hidden tax" of having the uninsured. Other elements, such as rate regulation, information technology, transparency of cost and quality, or encouragement of "best practices", are proposals that can be stand-alone, or part of broader reforms. Joe Paduda at Managed Care Matters seems to have a similar philosophy on cost containment, and a similar list. In his post, he also goes through each idea, how Obama and Clinton fare in their proposals, how effective he thinks each strategy would be. It's a pretty good and fair assessment, even if I might quibble on details. There are real cost containment elements in the Obama and Clinton plans: none are silver bullets, but together they can make a real difference. Labels: CostContainment, OtherBlogs, PresidentialCandidates
posted by Anthony Wright |
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12:57 AM
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Wonking and blogging...
Thursday, February 21, 2008
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Reactions...
Tuesday, January 29, 2008
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Wonkery...
Monday, January 28, 2008
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West Coast Wonkery...
Saturday, January 12, 2008
There's a new Health Wonk Review at the always interesting Health Care Policy and Marketplace Review. And I don't just say that because Bob Laszewski included our post on the presidential candidates' health plans, and said, "if you are following California reform, you need to keep an eye on this site." After all, readers of this blog already know that. There's just so many interesting posts, I could fill this blog with responses, especially since so many of the issues are California-centric. This includes: * Brian Klepper's critique of the current reform proposal in California (which was cross-posted to The Health Care Blog, where I responded); * A take by the Colorado Health Insurance Insider on the recission controversy in California, (which bizarrely suggests more underwriting, rather than just getting rid of the practice); * A HealthBlawg post on the ERISA lawsuit in San Franscisco (which had to be updated for the most recent, positive decision by the Appeals Court); and * A couple of posts (on InsureBlog and HealthBeat) on the Nataline Sarkisyan situation, the complicated and tragic issue of a 17-year old denied for a liver transplant by Cigna, who died just after hours public pressure was succesful in getting an approval. Happy reading! Labels: OtherBlogs
posted by Anthony Wright |
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12:07 AM
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Continuning coverage of the ballot...
Saturday, December 29, 2007
There's a decent amount of coverage today on the initiative being filed with the Attorney General, by Michael Rothfeld in the Los Angeles Times, Tom Chorneau in the San Francisco Chronicle, Aurelio Rojas in the Sacramento Bee, and Laura Kurtzman at the AP. They include different descriptions of the content of the initiative, as well as some political tidbits: one suggests that the campaign consultants will include Steve Schmidt (of the Governor's team) and Gale Kaufman (from the Speaker's side). Blog coveage includes KQED Capitol Notes and the Alan Katz Health Care Reform Blog, which provides a little more on the timetable. With the initiative filed yesterday, Attorney General Jerry Brown has until February 15th to release a Title and Summary; The window to collect signatures will be between whenever the title and summary is released, and April 21st, when signatures need to be turned into the county registrars. Labels: OtherBlogs, YearOfReform
posted by Anthony Wright |
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3:20 PM
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Arnold should ask for a recount...
Wednesday, December 19, 2007
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More on (individual) mandates...
Tuesday, December 11, 2007
In the national debate about mandates, many are making mountains out of molehills. To recap from earlier posts on this blog: Even though their plans are incredibly similar, Clinton and Edwards are making a big deal that Obama's plan doesn't include one element, an individual mandate, even though he has said repeatedly that he would consider including an individual mandate later. Obama says he wants universal coverage and would accept a mandate, but first wants to focus on making coverage available and affordable. Clinton and Edwards say they will make coverage available and affordable (through largely the same mechanisms), and then place a mandate to ensure everyone is in the system. I am in agreement with Robert Laszewski at the Health Policy and Marketplace Review, in his analysis when he says: "So, when the day is done, I don't see much real difference here." Some, fairly progressive health policy folks, including those who support single-payer, criticize Obama for not including a mandate. This includes Jonathan Cohn at The New Republic, and Maggie Mahar of HealthBeat, in perhaps the best of the recent articles, who quotes Princeton professor Paul Starr. “The secret power of the mandate is that it is as much a mandate on government as it is on individuals. It is a mandate on government to make coverage available and affordable. For it would be patently unacceptable to demand that people have coverage and then provide no practical way for many people to get it.”
Having the mandate as a challenge to policymakers to make coverage available and affordable is a good thing--unless the policymakers don't meet the challenge. Governor Schwarzenegger clearly came to the health reform conversation out of a belief in an individual mandate, and as a result he did some--but not all--of the things that a mandate would require. For example, his original plan only had subsidies that were limited to folks up to 250% of the federal poverty level. Leave it to Ron Brownstein of the National Journal (formerly of the LA Times) to cut through some of the clutter. He appropriately finds the geneology of the individual mandate and recognizes the critique from both sides of the aisle (including yours truly), but he also identifies that the issue is not ideological, but practical: Although Republicans raise mostly ideological objections to an individual mandate, Democrats express more-concrete concerns. For liberals, notes Anthony Wright, a California health care advocate, the key issue is whether the government subsidies are sufficient to ensure that uninsured families can afford the coverage that a mandate compels them to buy...
It is on this front that Hillary Clinton faces the toughest questions today. She responds to concerns about the mandate's affordability by noting that her plan (like Edwards's) would cap the share of income that individuals must contribute to premiums, with government subsidies covering the rest. But, wary of providing a target for opponents, her campaign won't say what that cap will be. Although Clinton has promised generous funding for the public subsidies, it's difficult to see how uninsured families can judge her proposal without knowing even roughly how much of their income it would require them to contribute to buying insurance. The mandate muddle masks the real question: how much actual help does the health plan provide people? I would much rather that the candidates were competing on the level of subsidies they were providing low- and middle-income Americans, on how much they were going to use group purchasing power to bargain down the cost of coverage and drugs, etc. That's what we should use to rate one proposal superior to another. That's how any California health reform plan should be evaluated. People want coverage: the question is what does any plan do to help them get the coverage they want and need--and whether that is sufficient for specific populations. Labels: IndividualMandate, InTheNews, OtherBlogs, PresidentialCandidates, Schwarzenegger, YearOfReform
posted by Anthony Wright |
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How others make it work....
Wednesday, November 28, 2007
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Geek love...
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