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 »

The State Children’s Health Insurance Program was supposed to be the MVP of various health care policy initiatives in 2007. SCHIP reauthorization, featured widely in conferences, at meetings, and on the Health Affairs Blog, had broad, bipartisan support uniting very strange bedfellows of all political stripes. Nonetheless, two bills for reauthorization were vetoed, and a modest extension keeps the program running for another day.

The original SCHIP bill represented a triumph of bipartisanship led by Sens. Orrin Hatch (R-UT) and Ted Kennedy (D-MA) after years of dispiriting controversies over the Clinton health reforms and budget fights in Congress. Along with several other health care initiatives of the 1990s, it was a hardy offshoot from the failure of comprehensive reforms pushed by the Clinton administration in the early 1990s. Any program with that kind of support and history is tough to keep down. The congressional election in Illinois’ 14th district on March 8 bears witness to phoenix-like qualities of SCHIP.

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Like a recurring illness, stalemate looms again over the prospects for settling the issue of payment levels to private plans in Medicare, which now exceed the average per beneficiary cost of traditional fee-for-service Medicare by 13 percent, according to the Medicare Payment Advisory Commission. MedPAC recommends eliminating the differential, which funds extra benefits for private-plan enrollees. House Ways and Means Health Subcommittee chair Pete Stark (D-CA) and most other Democrats agree.

But as always in health care, one guy’s costs are another guy’s revenues. The excess payments are catnip to the plenipotent insurance lobby. Rural Senators Max Baucus (D-MT) and Charles Grassley (R-IA) opposed sharp cuts last year from their insurmountable position atop the Senate Finance Committee, dutifully protecting the interests of constituents who benefit from the Medicare Advantage program’s largesse. Likewise, the NAACP supports the current scheme, which also subsidizes low-income minority beneficiaries. And President Bush has vowed to veto any significant reduction.

In the midst of this partisan impasse, amazingly, a disinterested policy debate broke out last week with the publication of Bob Berenson’s compromise proposal in Health Affairs [1-week free access]. In recognition of Berenson’s stature in the policy community, MedPAC chair Glenn Hackbarth paid him the compliment of a public response in a March 10 interview with CQ HealthBeat’s John Reichard.

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