Thanks Joe for this nasty attack of realism. It is obvious that the price
of Bush's socialism in bailing out the "freedom loving" bankers is that US
health policy wonks will be kept in business for many a year yet as you
inch towards civilisation! No doubt like the Brits you will reinforce the
drive towards "quality" with further financial incentives. Is there really
robust evidence that Premier for US hospitals has worked? We are calling
this CQUIN (commissioning for quality and innovation)or following the
GP-Quality Outcomes Framework in 2004, a QOF for hospitals. AS a sad old
econ I like the notion of pay for performance but like the author of the
second editorial in this week's New England journal (writing about
incentivising drug research for orphan drugs) I think targeting has to be
careful and coupled with robust evaluation. CQUIN together with patient
reported outcome measures (PROMs_) from 4/2009 for 4 elective surgical
procedures will keep us Brit health policy wonks entertained! Good riddence
to the bushman and let's be realistic about what this splendidly refreshing
son of a goat herder can do! Best wishes Alan
On Nov 6 2008, Adam Oliver wrote:
>>From Joe (White):
>
>-----Original Message-----
>From: Joe White [mailto:[log in to unmask]]
>Sent: 06 November 2008 14:20
>To: Oliver,AJ
>Cc: 'Jon Oberlander'
>Subject: FW: FW: Obama
>
>Hi Adam,
>
>For some reason I can't reply to the network list. But I can't help
>commenting... Share if you wish.
>
>There is nowhere near enough money politically available. Dems are already
>talking about incremental measures. And, I'm afraid, they probably should.
>
>By "politically available," I mean not only that the economy is cratering,
>with extremely unpleasant effects on revenues and on other obligations, but
>that Obama's campaign commitments and the nature of his governing coalition
>also set constraints.
>
> People are talking about a trillion dollar deficit. Unimaginable and, in
> some ways, a measurement error. A lot of it will involve advancing funds
> to financial institutions and maybe to households, in ways that might
> eventually be paid back. But it won't be paid back for a while, and the
> government will have to borrow to get the money to lend, and it will face
> those long-term interest expenses as well. Therefore there is good
> reason, at least from their perspective, for budget moderates to get
> nervous about further obligations such as, say, an extra $100 billion+
> for health care. (For why it's $100 billion, see the Commonwealth Fund's
> report on a sensible plan).
>
> Collecting some of the money from new mandates on employers won't help
> much because extra charges on payroll are not the most attractive policy
> during a recession. Particularly not large extra charges.
>
>Obama has already promised middle-class tax cuts. I'm not sure how much
>reality there is to these promises, but presumably he has to do SOMETHING.
>Clinton promised cuts, didn't provide them, and lost control of Congress
>(for that and other reasons) in the immediately subsequent election.
>
> I have assumed (nobody has been very clear about the numbers) that a
> portion of Obama's "cuts" are in addition to extending the tax provisions
> that are currently due to expire at the end of 2010 (Obama's tax
> "increases" on higher incomes essentially consist of allowing the
> reductions that the Republicans enacted in 2001 and 2003, which are
> already scheduled to expire in 2010, to expire as scheduled). In
> addition, the Dems have to fix something called the Alternative Minimum
> Tax, which keeps getting postponed and, if underlying law is ever allowed
> to function, will suddenly zap about 20 million extra upper-middle-income
> taxpayers with significant tax increases.
>
> So, relative to the current formal estimates from the Congressional
> Budget Office, which show all those Bush tax cuts expiring in 2010, and
> so the budget getting into much better shape (well, that was before the
> financial crisis), Obama will have to come in and (a) extend virtually
> all the Bush tax cuts for people with incomes below $200,000 per year (he
> may have some wiggle room on capital gains taxes, but there aren't going
> to be many capital gains revenues for a while anyway, it appears...); (b)
> pay for some extra cuts for those people, so as to keep campaign
> promises; (c) fix the Alternative Minimum Tax. Meanwhile, the estimates
> also assume most spending only keeps pace with inflation, which means
> there is huge pent-up demand for programs such as medical research. And
> then there is the cost of his energy initiatives, which he has said will
> be his top priority; and of whatever is done to rescue the auto industry,
> and lord knows what else.
>
>Bottom line: there is something in the range of $300 billion in hits to the
>budget bottom line on top of the bailout and stimulus already enacted and
>the direct effects of an economic slump. Meanwhile probably 20% of the
>Democrats in the House are "blue dogs" who really worry about the deficit.
>And even liberal economists, though they see the need to spend now, keep
>talking about the looming "crisis" from an aging society. Which is a dumb
>argument, but totally conventional wisdom nonetheless.
>
> So I just don't see where Obama gets the votes for a major expansion,
> given all the stuff he is going to have to get the Blue Dogs to swallow
> next year.
>
> I have to suspect that most new federal health care dollars will go
> towards subsidies to states to continue their existing Medicaid programs
> (since the states will face much more severe budgetary conditions than
> the federal government does, because the states have balanced budget
> rules, and their governors will ask Blue Dog legislators for relief). It
> looks like the Democratic leadership in the House has already begun
> thinking about combining that with some sort of expansion of the
> guarantee for children. That will be difficult in various ways. The main
> problem is distributional. If the Feds say, for example, "we will pay 80%
> of the cost of health insurance for children for any state that
> guarantees coverage up to 300% of the federal poverty level," that will
> be a much greater increase of spending for states that are currently
> furthest below that level. The states that are currently close to 300%
> may complain that they are getting less new subsidy than the lower-level
> states. While the lower-level states may complain that they are being
> forced to spend more new money than the higher-level states! And,
> assuming a deal can be cut that can pass the Senate (where state
> financial interests are reflected most directly), it still will require
> extra federal spending. But I do think the Dems will attempt something of
> the sort, and any spending they can assert is related to economic growth
> (medical research to grow the economy???). I can't see much prospect for
> a program of the scale that liberals (including me), or indeed anyone
> with a proper notion of elementary human decency, would desire.
>
>Sorry,
>Joe White
>
>
>
>-----Original Message-----
>From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On
>Behalf Of Calum Paton
>Sent: Thursday, November 06, 2008 8:21 AM
>To: [log in to unmask]
>Subject: Re: FW: Obama
>
>> Adam/Monika, thanks for keeping me entertained.....this conversation
>gets more like what you'd have found a couple of centuries ago in a
>'salon' every day (a compliment, by the way)....!
>
>And good luck to Obama.
>
>If he can get a real national health reform thru Congress and into law,
>he'll do what no President has done since (arguably) LBJ with M/M, which
>itself was of course only a half-way house....
>
>let's hope he only 'reaches out' as far as he needs to (ie not to the
>diehards....... and 'neocons', who are of course nothing of the
>sort...they're neo-liberals using democracy-lite as a justifying ideology,
>in coalition with the descendants of those who overthrew democracy
>(Mossadeq in Iran, 1953) and helped 'grow' the Taliban to overthrow the
>moderste government in Afghanistan which happ[ened to be (re-)installed by
>the USSR .....the USSR had invaded at the end of the '70s after a split
>Politburo (see Gorby's memoirs)to overthrow a 'rogue communist' - H. Amin
>- who had supplanted the original 'revolution', which had overthrown the
>ex-king's shady cousin Daoud, who had overthrown the King......
>
>the real 'neo-cons' were ex-Marxists who missed out the middle in turning
>to the Right, as they renounced the USSR (and Daniel Bell, for example -
>he of 'The End of Ideology' fame - a sort of ne-con fellow traveller,
>summed it up well when I said, 'I am a socialist in economics, a liberal
>in politics and a conservative in culture'
>
>I hope Barack knows all this.........!
>
>Adam, isn't all this more fun than health economics?
>
>best Calum
>
>Dear Members,
>>
>> Monika sends the following brief message...(although I doubt that anyone
>> outside France has thought that there has been a French pretender since
>> the end of the 18th Century, at least).
>>
>> -----Original Message-----
>> From: Monika STEFFEN [mailto:[log in to unmask]]
>> Sent: 05 November 2008 18:46
>> To: Oliver,AJ
>> Subject: Re: Obama
>>
>> Dear Oliver and AAHPN members,
>> as I cannot come in for a coffee, it's not so much because of
>> distance (1.500 km bird's fly) but because there is a strike again,
>> today in France; this time it is the railway system, which would it
>> make problematique to get to the next international airport or to
>> join the Eurostar, if the latter is running at all.
>>
>> So let me just give you a short account of French reactions: EVERYONE
>> I met here seems absolutely happy to have Obama as the strongest, at
>> least most important man of the World. "As this title cannot be hold
>> anymore by a French pretender, De Gaulle being dead and Sarko not
>> quite eligible, it then should be, as an alternative to a Son of the
>> Grand Nation, at least a very handsome man, dynamic, smart and
>> elegant just as like Obama!", that was the conclusion of our
>> secretaries, after collective delibaration on the subject over an
>> expresso.
>> "Le Monde", the most legitimate opinion maker of the Grand Nation,
>> and the Left Intellectual media leader, titled warmest felicitates
>> with great headlines to great this achievement. This evening's issue
>> will be entirely on OOBAAMAA.
>>
>> In the street people all smiled (which is unusual) this morning, and
>> talked to each other (even more unusual) in public transport and
>> shops, very spontanouly knowing that everone else had the same
>> opinion, to say something like: "Oh it was such a wonderful night" or
>> "Now we will come back to normal, in Irak as well as at Wall Street".
>> Or "Oh my God, now I will be able to sleep again, it was so
>> stressing, I drank a whole bottle of Champain last night, alone with
>> Obama!".
>> An old lady said that she had been "waiting for this since three
>> months, and that she had actually lit up candles last night, since
>> she was not allowed to vote but wanted to help destiny fulfill its
>> task and to do it well" as she explained.
>>
>> And personnally, I am just happy and hopeful, and conscious that a
>> big turn in history is beginning; he will not have the time to
>> actually do it all, 4 and even 8 years is not enough, but he will be
>> the one who puts the train on the truck and in the right direction;
>> conscious also that he is at danger to be assassinated (I guess the
>> risk at 1 to 4). Hopefully the security staff will be well directed,
>> and that the experts learned from Kennedy and the World Trade Center.
>> That is actually my main thinking, that he will not be assassinated.
>>
>> A strange witness is on this political science institute, where
>> nothing happened at all, at least so far, not even from the side of
>> the students; but that is France : nothing happened either when the
>> Berlin wall broke down, no-one even talked about it. Therefore, the
>> secretaries collective deliberation, with its stylish
>> expresso-cafee-ceremony, as strange the "sexy-worded-judgement" may
>> sound to well educated British ears, is a most expressive witness of
>> the French normal average citizen being VERY content with this
>> election, and an excellent sign that the entire French nation is
>> behind .... OBAMA ! So far I have not heart one single words that
>> would not have been enthousiastic.
>>
>>
>> Monika (Steffen)
>>
>>
>>
>>>Dear AAHPN members,
>>>
>>>Just a quick note to congratulate our American cousins on their
>>>collective common sense last night. You never know - this might even
>>>facilitate our attempts at encouraging greater Anglo-American health
>>>policy learning.
>>>
>>>If any of you are in London and want to meet for coffee or something,
>>>let me know.
>>>
>>>All best wishes,
>>>Adam
>>>
>>>Please access the attached hyperlink for an important electronic
>>>communications disclaimer:
>>>http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
>>
>>
>> Monika STEFFEN
>> Directeur de recherche au CNRS,
>> Présidente de la Commission Scientifique de l'IEP de Grenoble
>> PACTE (UMR 5194),
>> Institut d'Etudes Politiques
>> Grenoble University
>> BP 48
>> 38O4O GRENOBLE/France
>> Tel. direct: +33 (0) 476 82 60 71
>> Secretary: +33 (0) 476 82 60 42
>> FAX: +33 (0) 476 82 60 98 (... 82 60 70)
>> e-mail: [log in to unmask]
>>
>>
>> Please access the attached hyperlink for an important electronic
>> communications disclaimer:
>> http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
>>
>
>
>
> Please access the attached hyperlink for an important electronic
> communications disclaimer:
> http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
>
>
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