The Netherlands, which combines mandatory universal health insurance with competition among private health insurers, has been frequently cited as a possible model for reform in the United States. You can read Wynand van de Ven and Frederik Schut’s examination of the Dutch experience (free access until May 27) in the May/June issue of Health Affairs, a thematic volume on health reform that was published May 13. Read the rest of this entry »

By proposing to move away from the employer-based health care system to one emphasizing the individual market, Sen. John McCain (AZ), the presumptive Republican presidential nominee, has set the stage for health care to become part of a major debate about government and the marketplace during this year’s election, Robert Blendon said May 5.

Blendon, a professor of health policy and political analysis at Harvard University and director of the Harvard Program on Public Opinion and Health and Social Policy, spoke during a conference call moderated by Health Affairs editor-in-chief Susan Dentzer on the role of health reform in the presidential election. Other participants included Robert Laszewski, the president of Health Policy and Strategy Associates Inc. and the author of the widely respected blog Health Care Policy and Marketplace Review; and Julie Rovner, a health policy correspondent for National Public Radio and a contributing editor for National Journal’s CongressDaily. Health Affairs organized the call in connection with the publication of its May/June issue, a thematic issue on health reform. Click here for the full transcript of the call. Read the rest of this entry »

What role will the issue of health care reform play in the 2008 presidential election? How would the candidates control rising health costs and cover the uninsured, and how will the economic downturn affect efforts to expand access? Would the candidates’ reform proposals fix the health system’s flaws? What lessons can be drawn from previous health care reform efforts?

Join representatives from the Clinton, Obama and McCain presidential campaigns to tackle these and other questions at a Tuesday, May 13 briefing highlighting the May/June issue of Health Affairs, which focuses on health reform. Susan Dentzer, the journal’s Editor-in-Chief, will moderate the briefing, which will take place from 8:45 AM until noon at the Willard Hotel. Leading political pollsters Celinda Lake and Bill McInturff will discuss the prospects for health reform. Congressional Budget Office Director Peter Orszag and Jason Furman of the Brookings Institution will examine the potential of different strategies, from tax credits to individual mandates, to reduce costs and improve quality and access. Read the rest of this entry »

UnitedHealth Group officials may have been laying protective cover for themselves when they attributed poor first-quarter earnings to a sagging economy last week. But that doesn’t mean it isn’t also true, as United said, that business is bad because the company’s products are getting too expensive for a growing number of workers and companies. Coming within weeks of similar announcements by WellPoint and Aetna, United’s bad news represents a conundrum for any candidate who wants to talk about expanding coverage in 2009 — and most of them do. Read the rest of this entry »

In interviews with Health Affairs, government ministers in Germany and the Netherlands talk up market-oriented refinements to their universal health insurance systems for the future. But the news from Europe isn’t all happy: an unsettling survey in the United Kingdom finds that some physicians believe that the market will unravel the government-owned and -operated National Health Service (NHS) in the next decade.

The online poll of more than 500 general practitioners (GPs) conducted by Pulse, which describes itself as “UK’s leading medical weekly,” found that 84% believed that the NHS would not exist “as we know it” in ten years’ time and that only one-third believe that the NHS will be free at the point of use in the same amount of time. Read the rest of this entry »

It’s been nearly five years since the President’s New Freedom Commission on Mental Health issued its final report. The report affirmed the possibility of recovery and the effectiveness of available treatments for many conditions. But it also warned that many patients never find their way to care and that providers are often unaware of therapies that have proved their worth.

The commission also marshaled evidence of the crucial importance of ancillary services like supported housing and employment and income-support programs for the severely ill. But it candidly acknowledged that management of these services is in most cases hopelessly fragmented among siloed government departments with no collaborative traditions. Read the rest of this entry »

Because the most glaring geographic variations in health care use have been observed in specialty and end-of-life care, policymakers have had trouble coming to terms with the work of John Wennberg and his Dartmouth colleagues. The questions the Dartmouth researchers raise about spending and quality are too disruptive, too threatening. Specialty and end-of-life care are too sensitive for the blunt instruments of policy to address.

But with publication today of the latest edition of the Dartmouth Atlas, focused on chronic care, Wennberg and company carry their analysis to the most fundamental, everyday questions about the organization and delivery of care. The new Atlas joins the battle for health system improvement on a level that everyone can understand. It engages with questions that have immediate meaning for Congress, consumers, and many medical professionals and throws its weight behind policy proposals that already have widespread support. Wennberg is no longer a lonely voice crying out in the wilderness. Read the rest of this entry »

Health Affairs and its publisher Project HOPE are pleased to announce that Susan Dentzer will become the journal’s new editor-in-chief on May 1, 2008.

Dentzer, one of the nation’s most respected health policy journalists, is currently an on-air correspondent for The NewsHour with Jim Lehrer on the Public Broadcasting Service. She heads The NewsHour’s health unit, which she helped create in 1998, and appears frequently on other programs such as Nightline and The McLaughlin Group. Her nearly three decades of journalistic experience span both broadcast and print media and include service as the chief economics correspondent at U.S. News & World Report and a senior business writer at Newsweek.

Dentzer has spoken on health care and other policy issues to a wide array of governmental, professional, and educational groups, and she has moderated panel discussions on key policy questions for organizations such as the AARP and the BlueCross BlueShield Association. She was selected through a process led by Health Affairs Founding Editor John Iglehart and will succeed Jamie Robinson, who is returning to his previous position as the Kaiser Permanente Distinguished Professor of Health Economics at the University of California, Berkeley, School of Public Health. Read the rest of this entry »

As Jacob, one of the three Old Testament patriarchs, flees from his brother Esau, he stops for the night at Bethel, where he dreams of a ladder going from earth to heaven with the angels of God ascending and descending the ladder (Genesis 28:11-19). There is extensive biblical commentary on this dream and particularly on why the angels are first ascending and then descending.

However, as anyone who follows the research on economic mobility and social determinants of health knows, you are always better off ascending the ladder rather than descending it. The spiritual “Jacob’s Ladder” also used the imagery of the ladder to symbolize the climb out of slavery and into freedom. Read the rest of this entry »

A lot of pipe dreams have been stoked by the seductive notion of “aligning incentives” — a catchphrase of the managed care era that promised better quality and lower costs in one magical bubble. But the divergent interests of patients, payers, and providers are in reality more likely to collide than align, a circumstance that has consigned most of this well-intentioned abstraction to the recycling bin.

In recent years, this journal has documented an increasingly competitive medical marketplace. While cheered by market fundamentalists, this wave of entrepreneurial enthusiasm has problematic implications for the critical issues of fragmentation of care and perverse incentives to overtreat. The most troubling of these has been the deepening of fault lines between hospitals and physicians. Read the rest of this entry »