Persistent Barriers to Reform of the American
Health Care System
A Colloquy
national health care experts followed by a series of structured conversations among panelists, and between panelists and the audience. Questions will be encouraged, and follow-up questions and comments will be permitted under guidelines intended to keep the discussion focused and moving along. We hope to have a free-ranging and candid discussion of the technical, cultural and political barriers to further health care reform in the United States.
Participants:
• Moderator: Philip Caper, MD, Health Policy columnist, Bangor Daily News, Board member, Physicians for a National Health Program, and Maine AllCare.
• Theodore Marmor, Professor Emeritus of Public Policy and Management & Professor Emeritus of Political Science, Yale School of Management
• Marcia Angell, Senior Lecturer in Social Medicine, Harvard Medical School and former Editor in Chief, The New England Journal of Medicine
• Merton Bernstein, Walter D. Coles Professor of Law Emeritus, Washington University of Law
• Donald Berwick, Former Administrator, Centers for Medicare and Medicaid Services (CMS)
• Laurence Seidman, Chaplin Tyler Professor of Economics, University of Delaware
• Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute (AEI)
• Joseph White, Luxenberg Family Professor of Public Policy and Director of the Center for Policy Studies, Case Western Reserve University
• John McDonough, Professor of Public Health Practice in the Department of Health Policy & Management, Harvard School of Public Health
http://www.nasi.org/events/170/interest-groups#HealthPolicy
New Analysis Challenges Arguments for Repealing Tax on Medical Devices
WASHINGTON — A tax on medical devices, imposed by the Affordable Care Act, has become a prime target for Republicans, some Democrats and a small army of lobbyists for the industry. But a new report from the Congressional Research Service challenges economic arguments that are being made to justify repealing the tax.
Critics of the tax say it is destroying jobs and encouraging manufacturers to move operations overseas. Repealing it is a priority for Republicans on Capitol Hill.
But in its report, the Congressional Research Service, a nonpartisan arm of Congress, said that many of the concerns were unfounded.
The effects on jobs, research and company profits are “relatively modest,” the report said. As a result of the tax, it estimates, 47 to 1,200 workers could lose their jobs. They account for one one-hundredth to two-tenths of 1 percent of jobs in the industry.
“These relatively modest effects occur partly because the tax is relatively small,” the report said.
In addition, it said, “innovation and research would be minimally affected.”
The tax, which took effect in 2013, is equal to 2.3 percent of the sale price of a medical device and is expected to raise $29 billion over 10 years. It applies to products like X-ray machines, magnetic resonance imaging scanners, pacemakers, artificial hearts and artificial hip and knee joints.
Most of the tax will be passed on in the form of higher prices, the report said, but “the effect on the price of health care will most likely be negligible because of the small size of the tax and small share of health care spending attributable to medical devices.”http://www.nytimes.com/2015/01/14/us/tax-has-modest-effects-on-medical-device-makers-report-says.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region®ion=bottom-well&WT.nav=bottom-well
The Costs of Stinginess in Medicaid
JAN. 13, 2015
How much money does Arkansas save by offering stingier Medicaid than Vermont?
It looks like a straightforward calculation. Arkansas makes it tougher for children to qualify for Medicaid than Vermont does, and it spends much less on each beneficiary. Even though Arkansas’s poverty rate is double Vermont’s, Medicaid’s costs in Arkansas in 2012, the most recent year for which figures are available, were $600 less per resident than in Vermont.
But there is a price to pay for such parsimony. Children in Arkansas get fewer regular checkups at the doctor and dentist. More adults forgo care because of the expense. More Arkansans are overweight and have diabetes. More are disabled. They die younger.
This is not to pick specifically on Arkansas or to extol the virtues of Vermont. The contrast between these two disparate states frames a broader debate about the purpose of the American government. With a new Republican majority in Congress looking to further the cause of low taxes and less spending, it is easy to forget that tightfisted government imposes very real costs. That we can’t easily measure them doesn’t mean they don’t exist.
Over the last couple of years, voters have been spared the bitter partisan brawl over taxes and spending that scarred President Obama’s first term in office.
Having gained hefty spending cuts — notably through the process known as sequestration — Republicans concentrated on other goals, like sinking the Affordable Care Act. Content to have raised some taxes on the wealthiest Americans, the president, too, turned his attention elsewhere.
But the fundamental partisan conflict never went away. When the new session of Congress opened last week, Republicans put the fight squarely back on the table.
First they got rid of Douglas Elmendorf — a well-respected economist who, though a Democratic appointee, was widely considered a nonideological shooter — as the head of the nonpartisan Congressional Budget Office.
Next they proposed changing the rules governing how the budget office conducts its economic analysis of legislation in a fashion that many experts believe could ease the way for Republicans’ ambitious tax-cutting agenda.
Republicans’ underlying assumption is that tax cuts amount to a tonic for economic growth, encouraging investment and toil. Many analyses by the budget office, they argue, misjudge the effect of tax cuts on the budget by underestimating their role as economic stimulus.
They are not entirely wrong. Most economists agree that cutting taxes is likely to deliver some increase to growth. But it is substantially weaker than what Republicans often claim.
At the same time, the implicit proposition underlying the Republican case is that public spending amounts at best to money down the drain and, more often, to an albatross around the economy’s neck, discouraging work among beneficiaries of government largess.
The evidence for that is even weaker. Under such assumptions, the return to Vermont’s additional Medicaid spending would shrivel to nothing. That is, pretty much, how the budget office scores Medicaid spending today. That truly misjudges the role of government in the long-term health of the American economy.
“Of course there are positive returns to spending on health, education, nutrition,” said William Gale, a tax expert at the Brookings Institution. “They are saving a lot of money and generating revenues. The macro effects are big relative to the expenditures.”
A study published this week about the long-term impact of changes in Medicaid eligibility, by Amanda Kowalski of Yale University, and David Brown and Ithai Z. Lurie from the Treasury Department’s Office of Tax Analysis, underscores just how costly scrimping on Medicaid can be.http://www.nytimes.com/2015/01/14/business/economy/the-costs-of-stinginess-in-medicaid.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region®ion=bottom-well&WT.nav=bottom-well
New Obamacare enrollments in California top 217,000
CHAD TERHUNE
California's health insurance exchange said 217,146 people have newly signed up for Obamacare coverage after nearly two months of open enrollment.
The Covered California exchange said Tuesday the number of applications slowed during the holidays, but it remains confident of reaching its 2015 goal for health-law enrollment.
During the initial rollout of the Affordable Care Act, 1.2 million people had purchased a private health plan through Covered California.
State officials are trying to hold on to those existing policyholders and add about 500,000 more to finish open enrollment Feb. 15 with 1.7 million consumers.
Peter Lee, Covered California's executive director, declined again Tuesday to release figures on renewals even though the federal insurance marketplace has done so for weeks.
Lee said the state exchange is awaiting more data on how many people actually paid to renew coverage.
"Things look very strong on renewals," Lee said. "We are quite confident we will hit or beat the new enrollment goal."
http://www.latimes.com/business/healthcare/la-fi-obamacare-california-enrollment-20150113-story.htmlMaine's Franklin County Beats the Odds in Combating Chronic Disease
By PATTY WIGHT • 17 HOURS AGO
FARMINGTON, Maine - An article published today in the Journal of the American Medical Association highlights the unique efforts to combat cardiovascular disease in Franklin County, Maine.
Beginning in the 1970's, several initiatives sought to reduce what is still the number one cause of death in the U.S. And the authors of the report say the data show those efforts have successfully improved the odds in this rural county.
Franklin County isn't the type of place you expect to see this type of success. It's a low-income, aging population.
"Most epidemiologists would agree, poor people and poor populations have poor health," says Dr. Burgess Record. Dr. Record is a physician who helped implement Franklin County's Cardiovascular Health Program. He's also the lead author of the JAMA report.
Record says back in the late 1970's, several health advocates wondered if they could reverse expected outcomes for patients in Franklin County. They set a goal to prevent cardiovascular disease, and enlisted the help of hundreds of volunteer nurses.
Sandy Record, who is married to Burgess Record, worked for 32 years as nurse manager of the Franklin Cardiovascular Health Program.
"Where they lived, where they worked, where they played," she says. "To schools, to work sites, to communities. And had one-on-one with each individual over a long period of time, and so there became that trusting relationship."
Nurses took blood pressure and referred patients to physicians. They helped community members improve their diets, quit smoking, and exercise. Record remembers one physician who shared walking maps created by the program with patients.
"He had a book, and when he'd see patients, 'So - where do you live? Oh - there? You're not walking? Here - here's your safe map. Go back and tell me how many times you've walked this route," she recalls. "It was incredible. That simple little project made a big-time difference for these people."
Franklin County's multiple, overlapping interventions,- along with the integration of public health with primary care - is what made the program unique, and successful, according to the JAMA study.
Health insurance paperwork wastes $375 billion
By Dan Mangan
CNBC.com, Jan. 13, 2015
CNBC.com, Jan. 13, 2015
And you thought your bills were out of control.
The United States health-care system wastes an estimated $375 billion annually in billing and insurance-related paperwork that could be saved if the nation moved from a "multipayer" health coverage system to a "single-payer" system run by the government, a new study says.
That dollar figure, tied to getting people, insurance companies and governments to pay for health-care services provided, equals almost 15 percent of total national health-care spending.
"We all sort of suspected there was quite a big number, but when we came down to the actual figure it was certainly revealing," said Aliya Jiwani, health policy researcher and lead author of the report, which was published by the journal BMC Health Services Research.
Jiwani said that while "the administrative costs have been an issue" in the health-care world for years, "the fixes that have been put in place have only aggravated the issue."
In fact, the paper notes that "administrative costs as a percentage of total care health care spending more than doubled from 1980 to 2010."
The authors of the paper write that the savings from eliminating trillions of dollars in administrative waste over the years "could cover all of the uninsured" people currently in the U.S. if a single-payer system were adopted. They estimate the cost of covering all of the roughly 40 million Americans still lacking health insurance would be equal to just about half of the $375 billion in projected savings.
The balance of those savings, they write, could "upgrade coverage for the tens of millions who are under-insured."
While the paper identified a very big number of wasted dollars, it remains a big question of whether that could lead to a single-payer system anytime soon.
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