>
> Joe White's comments seem right (ie seem to be on the same track as mine
yesterday!! joke).
Just a thought....Charles, given your comments, should you be the Edward
M. Kennedy Professor....... (another joke...I know this discussion group
has its sensitive moments!!)....admittedly, Teddy has been a great
pragmatist in the latter part of his career, so I know the answer; ok,
ok!!
as ever Calum
> ________________________________
>
> From: Joe White [mailto:[log in to unmask]]
> Sent: Wed 07/01/2009 5:08 PM
> To: Oliver,AJ
> Subject: FW: Reform
>
>
>
> Hi Adam,
>
> Nobody ever knows what the public thinks "major reform" means.
>
> But I would disagree with Professor Normand. It depends a lot on what
> you're trying to change, and on the consequences of disruption.
>
> When the United States implemented its Medicare program that was certainly
> major reform. Yet it went fairly smoothly. It went smoothly in part
> because the reform was designed to change as little as possible at the
> operational ground level. This also meant it did not control costs
> immediately. But costs weren't controlled before, either. The goal of
> reform was to get people insured, and it worked quite well, quite quickly.
>
> Professor Normand's rule is roughly right for "reorganization," such as
> creating the U.S. Department of Homeland Security. But, for example,
> putting all of the uninsured into Medicare would be much less complicated.
> It's an add-on, not a change-over. Creating a regulatory structure to
> transform the private insurance market would be more difficult. But it is
> highly unlikely to make things worse for the first three years, simply
> because the status quo is so egregiously bad. What could the consequence
> of
> reform be? That some people slip through the cracks and don't get
> insured?
> That insurers overcharge some people? Get away with risk-rating? Get away
> with cherry picking? Those wouldn't exactly be changes.
>
> Where Professor Normand's concerns apply most clearly is delivery reform.
> Delivery is a lot more complicated than finance. It involves many more
> activities. They are much harder for outsiders to observe and so to
> manage
> (for example, it's easy to monitor what is charged for a service; much
> harder to monitor the course of care). It is much harder to decide what
> activities are appropriate (As an operating matter even though economists
> won't agree in theory, it's easy to decide whether a fee is appropriate:
> you
> set the fee and if they charge more that's inappropriate). The activities
> interrelate in much more complicated ways. They are entrenched in
> organizational structures in much more complicated ways. And, by the way,
> we don't have good data about better ways to deliver care, while we have
> compelling evidence about how financing can be done better than it is done
> in the United States. For all these reasons, if reform means delivery
> reform, Professor Normand could be right. Increments could be the way to
> go. But reform of insurance, and even some cost controls (e.g. reasonable
> fee restraints) are much easier and less complicated.
>
> Cheers,
> Joe White
>
>
>
> -----Original Message-----
> From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
> On
> Behalf Of Charles Normand
> Sent: Wednesday, January 07, 2009 4:34 AM
> To: [log in to unmask]
> Subject: Re: Reform
>
> Adam
>
> I am not sure either what major reform is meant in this context, but my
> fear
> is always that the effect of major reform is to make so many changes so
> fast
> that the whole system takes years to recover. The three year rule is that
> it takes at least this long for the system to be no worse than it was
> before
> the changes began. In some cases this makes things so much worse that a
> need
> is perceived for another major reform. If the new team has an ounce of
> sense between them they will opt for a Norwegian style of problem solving
> rather than system reform - the main difference is that this is based on a
> clear understanding of the usefulness of each element of change and almost
> no fanfare.
>
> Charles Normand
> Edward Kennedy Professor of Health Policy & Management
> University of Dublin
> Trinity College
> 3-4 Foster Place
> Dublin 2
> +353 1 896 3075
> -----Original Message-----
> From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
> On
> Behalf Of Adam Oliver
> Sent: 22 December 2008 19:09
> To: [log in to unmask]
> Subject: Reform
>
> Fyi, although can someone tell me what 'major reform' is? I have no idea -
> good job no-one rings me to ask these types of questions. I suspect for
> most
> people it means "I want cheaper health care coverage for me, now", or "I
> want the Government to do obviously good things so long as I don't have to
> pay for it.". But perhaps I'm being too cynical.
>
>
> OBAMA: Majority Supports Major Reforms to Health Care System
>
>
> A majority of U.S. adults believe that President-elect Barack Obama should
> make major reforms to the health care system, according to a recent
> Washington Post-ABC News Poll, the Post
> <https://exchange.lse.ac.uk/exchweb/bin/redir.asp?URL=http://www.washingtonp
> ost.com/wp-dyn/content/article/2008/12/20/AR2008122001498.html> reports
> (Cohen/Agiesta, Washington Post, 12/21). The poll, conducted by telephone
> between Dec. 11 and Dec. 14, included responses from a random sample of
> 1,003 adults. The poll has a margin of error of plus or minus three
> percentage points. Seventy-seven percent of adults believe that Obama
> should
> make major reforms to the health care system, compared with 20% who
> believe
> that he should not, the poll found. According to the poll, among adults
> who
> believe that Obama should make major reforms to the health care system,
> 51%
> believe that he should seek to make such changes immediately after he
> takes
> office, and 26% believe that he should wait until later in his presidency.
> Sixty-eight percent of adults believe that Obama will have the ability to
> make major reforms to the health care system, compared with 28% who
> believe
> that he will not have the ability, the poll found. Almost three-fourths of
> adults believe that Obama should increase federal funds for health
> insurance
> for children, compared with 23% who believe that he should not, according
> to
> the poll. Among adults who believe that Obama should increase federal
> funds
> for health insurance for children, half believe that he should address the
> issue immediately, compared with 24% who believe that he should wait,
> according to the poll. In addition, 52% percent of adults believe that
> Obama
> should increase federal funds for embryonic stem cell research, compared
> with 42% who believe that he should not, the poll found (Washington Post
> graphic
> <https://exchange.lse.ac.uk/exchweb/bin/redir.asp?URL=http://www.washingtonp
> ost.com/wp-dyn/content/story/2008/12/21/ST2008122100258.html> , 12/21).
>
>
>
> 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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