The biggest question for some of us Americans who live beyond the beltway is whether there will be health care reform at all. A month into Obama's presidency, we have no secretary of HHS, no head of the Center for Medicare and Medicaid Services, no head of the FDA, no surgeon general, no open indication of movement on the health care reform front. Congress has passed a SCHIP refunding bill that it had long been ready to pass anyway. The Stimulus bill contains a subsidy for COBRA health insurance continuation for the unemployed, money for healthcare IT, and temporary increased federal funding for Medicaid. A provision in the House bill that would have extended Medicaid to the unemployed without income or asset limits disappeared in the Senate bill. Continuation coverage is so expensive (84% of the cost of average unemployment benefits according to a recent Families USA study), that even at a 65% subsidy, it will be unaffordable to the poor. There is little here to indicate an aggressive agenda for extending health care coverage.
The most interesting aspect of the stimulus debate concerned the provision on "comparative effectiveness research." It has long been a given in the American healthcare debate pretty much across the spectrum that we needed more information on the comparative effectiveness of health care interventions. The only opponents have been drug and device companies who would just as soon not have anyone know that their products are less effective than the products of other companies. The Senate, however, changed "comparative effectiveness" to "comparative clinical effectiveness,"and with one voice suddenly started talking about how the real agenda of comparative effectiveness research was to allow the government to ration care by denying care to people who need it because it is costly, like the evil European socialist countries do. The conference bill dropped "clincal" but there is language in the conference committee report claiming that this research is not supposed to support rationing.
I am wondering at this point, 1) Does Obama still care about health care reform, and if so, why isn't getting an HHS secretary committed to reform at the top of his agenda, and 2) have the Republicans already seen health care reform as a battle worth waging for political gain, once again arguing that most Americans are ok with their current insurance and any change will make things worse. I hate to be a pessimist, but pessimists have a pretty good track record on health care reform in the U.S.
Tim Jost
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From: Anglo-American Health Policy Network [[log in to unmask]] On Behalf Of Calum Paton [[log in to unmask]]
Sent: Tuesday, February 17, 2009 7:59 AM
To: [log in to unmask]
Subject: Re: Medicaid and NHI - NEJM piece
Hi Adam,
Seems to me that getting universal coverage in the USA has a 'Catch 22'
problem - you need NHI because the system is an 'un-rationalised' mess (ie
NHI should involve system redesign), but you can't get NHI because the
system is not rationalised (ie NHI is said to be 'unaffordable.')
President Carter, for example, said you had to have cost-containment first.
But without the fiscal pressue of NHI, there was no (adequate)
cost-containment.
So suerly now is the time to have a universal system - and then sort out the
inflationary pressures which result by changing the delivery and provider
incentives. If 'spend now, control inflation later' is good enough for the
whole economy (US and UK), surely it's ok to slip in health coverage!
The US institutions were designed -in part - to eschew the 'tyranny of the
majority.' That meant that (in domestic policy) they protect the tyranny of
lots of minorities! Paradoxically of course, when the majority is
reactionary, they protect some residual welfare wedges too.
And re Anna's point - does the federal programme need to avoid (in the UK
lingo) 'post-code lotteries' (or rather post-code discrepancies - they may
not be by chance!)...... which in US terms are substantial inter-state
differences?
Why not? Many major federal programmes do.
Best Calum
CALUM R PATON
Professor of Health Policy
School of Public Policy and Professional Practice
CBA1.054
Keele University
Keele, Staffordshire ST5 5BG, U.K.
Tel: +44 (0) 1782 734867
Email: [log in to unmask]
See: Calum Paton, New Labour's State of Health: Political Economy, Public
Policy and the NHS, Ashgate, 2006
See Calum Paton, 'The NHS after 10 years of New Labour', in Martin Powell
(Ed.), Modernizing the Welfare State: The Blair Legacy, Policy Press, 2008
See Calum Paton, 'Blair and the NHS: Resistible Force Meets Moveable
Object?', in Terrence Casey (Ed.), The Blair Years, Palgrave (Macmillan),
2009
Visit the International Journal of Health Planning and Management online at:
www.interscience.wiley.com/journal/hpm
----- Original Message -----
From: "Adam Oliver" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 16, 2009 9:44 PM
Subject: Medicaid and NHI - NEJM piece
Hi
Attached is a short piece by Michael Sparer on the possibility of expanding
Medicaid to achieve universal insurance. Michael would appreciate your
comments - his email address is [log in to unmask]
All best,
Adam
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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