Health and Wealth, part 3

To follow up on the prior two parts of this series on the status of our health system and terms of the debate, here are additional voices and links to studies and information related to healthcare in the US. Let’s start with the March 5, 2009 press briefing by Press Secretary Robert Gibbs.

Q Yes, Robert. I wanted to follow up on a couple of points the President made today. One of his comments was that those who seek to block any reform at any cost will not prevail this time around in the health care debate. Could you explain who he’s talking about there? Who does he mean when he says, those who are trying to block reform at any cost?

MR. GIBBS: Well, I think that many times health care reform has been tried, and many times health care reform has failed, based on any number of things.

Sometimes it’s — it’s special interests. But what we have to do and what the President believes strongly is that we can — we cannot wait for health care reform any longer; that we have to do all that we can. And I think today’s event was an important start in that process. I think many people have written today in stories about a number of people that opposed health care reform 15 years ago, 15 or so years ago, were in a room today with others that wanted health care reform working together to try to come to a solution. The President wanted to get stakeholders involved from differing viewpoints, representing different constituencies, into the same room to begin this process, understanding that there are shared goals, but there may be differences as to how to achieve them. I think that’s why this process — the beginning of this process was so important.

Q You’ve said that the goal is to have this done by the end of the year. I understand that as a goal, but can you explain why, given the history and the complexity to this, why that’s feasible, how that’s feasible?

MR. GIBBS: Well, again, I think it’s feasible largely because we can’t wait for it to happen. The problem has only gotten more intense over the past few years. Getting sick eats into people’s retirements. It’s eating into the federal budget. It affects millions of families that are watching the cost of their health care skyrocket. And he believes that all the stakeholders are poised and ready to act, and I think that’s why today was an important first step in ensuring that that process moves forward.

It’s ambitious, but as the President has said and as we’ve noted, that for quite some time we’ve — we’ve run up huge deficits, we’ve spent money we didn’t have, and didn’t get anything for it. This President has decided that we’re going to make tough choices and invest in health care and education and energy independence in order to ensure sustained long-term economic growth. And one of the only ways we’re going to do that is to deal with the health care problem.

And now, more of the studies pouring out on issues related to health care in the US.

1. From Families USA, Americans at Risk: One In Three Uninsured

This analysis found that 86.7 million people – one out of every three Americans under the age of 65 – was uninsured for some period of time during 2007 and 2008. These Americans have had to pay for medical care out of their own pockets, or they have had to delay needed care altogether.

Who are these uninsured Americans? No one is protected from the risk of uninsurance. People in all age groups, of every race and ethnicity, and across all income ranges are affected. While most of us have health insurance through our jobs, four out of five uninsured Americans are from working families. Many of these working families are at great risk today as more and more workers get laid off and lose their ability to retain health coverage.

The overwhelming majority of the uninsured had jobs. The rest were unable to work for various reasons.

Four out of five individuals (79.2 percent) who went without health insurance during 2007-2008 were from working families: 69.7 percent were in families with a worker who was employed full-time, and 9.5 percent were in families with a worker who was employed part-time.
. . .
Of the people who were uninsured during 2007-2008, only 16.2 percent were not in the labor force – because they were either disabled, chronically ill, family caregivers, or not looking for employment for other reasons.

2. A new report from the Centers for Medicare & Medicaid Services, Health Spending Through 2018: Recession Effects Add Uncertainty To The Outlook (Feb. 24, 2009) found that this year’s growth in health care spending is expected to be higher than GDP.

The health share of GDP is anticipated to rise rapidly from 16.2 percent in 2007 to 17.6 percent in 2009, largely as a result of the recession, and then climb to 20.3 percent by 2018. Public payers are expected to become the largest source of funding for health care in 2016 and are projected to pay for more than half of all national health spending in 2018.

3. Commonwealth Fund Commission on a High Performance Health System, The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies that Pave the Way

This report from the Commonwealth Fund Commission on a High Performance Health System offers recommendations for a comprehensive set of insurance, payment, and system reforms that could guarantee affordable coverage for all by 2012, improve health outcomes, and slow health spending growth by $3 trillion by 2020 – if enacted now to start in 2010. Central to the Commission’s strategy is establishing a national insurance exchange that offers a choice of private plans and a new public plan, with reforms to make coverage affordable, ensure access, and lower administrative costs. Building on this foundation, the report recommends policies to change the way the nation pays for care, invest in information systems to improve quality and safety, and promote health. By stimulating competition and delivery system changes aimed at providing more effective and efficient care, the policies could yield higher value and substantial savings for families, businesses, and the public sector.
. . .
The nation’s health and economic security are at risk: rising costs are putting pressure on families, businesses, and governments, and sharp increases in the number of uninsured and underinsured are leaving millions without access to care or essential financial protection when sick. The U.S. health care system is already the most expensive in the world, by far, and total health spending is projected to double by 2020—rising from a projected $2.6 trillion in 2009 to $5.2 trillion by 2020 to consume 21 percent of the nation’s economic resources (gross domestic product). To achieve more affordable coverage and ensure access for everyone in the country, we must change the way health care is delivered and the way we pay for care. We must focus on value. Despite having centers of excellence, our health care system falls short. It fails to produce the outcomes and care it could, wastes resources, often fails to provide the right care at the right time, and delivers unacceptably wide variations in quality and safety. Unless we move to a high performance delivery system and improve the value of care that is delivered, efforts to expand coverage will be difficult, if not impossible, to sustain over time.

4. Testimony of Cathy Schoen, Insurance Design Matters: Underinsured Trends, Health and Financial Risks, and Principles for Reform U.S. Senate Health, Education, Labor and Pensions Committee, February 24, 2009

Central to the Commission’s strategic recommendations is the creation of a national insurance exchange that offers a choice of private plans and a new public plan, with associated insurance market reforms and provisions to make coverage affordable.

Insurance recommendations include:

* Establish a health insurance exchange that offers an enhanced choice of private plans and a new public plan. This new public plan would offer comprehensive benefits with incentives for disease prevention and payment methods that reward results. It would build on Medicare’s claims administrative structure and national provider networks. The exchange and new public plan would be open to all, including large employers.

* Require individuals to have coverage and employers to offer coverage or contribute to a trust fund for insurance, sharing responsibility to pay for insurance for all.

* Provide income-related premium assistance to make coverage affordable.

* Expand eligibility for and improve payment under Medicaid and CHIP to improve affordability and access. Eliminate Medicare’s two-year waiting period for the disabled.

* Set a minimum benefit standard to ensure access and adequate protection from the financial burden of obtaining needed health care.

* Reform health insurance markets to improve insurance efficiency, access, and affordability by prohibiting premium variation based on health and guaranteeing offer and renewal of coverage to all regardless of health status.

Building on this foundation, an integrated set of polices would change the way the nation pays for care and would invest in system reforms and health initiatives. Payment reforms include: enhanced value for primary care and new payment methods to support better care coordination and management of chronic disease (often called “patient centered medical home”); moving away from fee-for-service to more “bundled” payment for care; and correcting price signals to align payment levels with more efficient care. Together, the set of payment reforms aims to reward efficiency (high quality and prudent use of resources) and penalize waste and ineffective care by stimulating and supporting a more effective and efficient delivery system. System reforms include investing in and expanding effective use of health information technology (HIT) and networks (HIT with information exchanges), providing better information on comparativeness effectiveness and using this information to guide benefit and pricing policies, and all-population data with benchmarks of top performance.

5. Finally, testimony and related documents may be found here.

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