Health Affairs

A recent spate of commentaries on the continuing health spending moderation raise an important policy question:  If the cost curve is well and truly bent, why are we investing so much of our policy energy on bending it further, when the more pressing problem is the declining percentage of Americans that can afford our health... Read the rest of this entry »

The Medicare Payment Advisory Commission (MedPAC) is the closest thing Congress has to adult supervision on important health policy questions. The Commission commands bipartisan respect both for its record of sound policy advice and for its leadership. With its October recommendations, MedPac attempted to solve the sustainable growth rate (SGR) physician payment formula budget crisis... Read the rest of this entry »

Other than the egg-laying exercise surrounding the ACO regulations, 2011 was a quiet year among Washington health policy experts until June 6 when McKinsey released the results of a survey of employer plans under the Affordable Care Act. The McKinsey study found that roughly 30 percent of employers were considering dropping their employee insurance coverage... Read the rest of this entry »

In the ten months since the passage of health reform, health care managers, particularly those in hospitals and health systems, have struggled to make sense of an onslaught of change in Medicare policy.  The response has been depressing:  an accelerating wave of merger and acquisition activity, both horizontal hospital mergers and an accelerating concentration of... Read the rest of this entry »

Of all the ghosts that haunt the Medicare program, none has been noisier, scarier or rattled more chains than the Medicare Sustainable Growth Rate (SGR) problem.   SGR has required Congress to reset physician payment policy almost every year for the last decade to avoid gutting Medicare physician compensation, a recurring reminder of how difficult Medicare... Read the rest of this entry »

Last fall, David Blumenthal and James Morone published a timely history of the presidential handling of health reform from Franklin Roosevelt onward, called The Heart of Power (see my review in Health Affairs). At the end of the book, they offered eight rules for presidential management of health reform distilled from the experience of the past... Read the rest of this entry »

Tim Jost’s thoughtful analysis of the state of health reform concluded that the only practical means of accomplishing health reform is to find a short parliamentary path to some melded version of the two bills that passed the respective Houses. In a comment in response to Jost’s Post, I argued that even if the bills were... Read the rest of this entry »

No single government report more reliably generates editorials on the nation’s healthcare “crisis” than the annual CMS actuary’s report on US health spending. I’ve long suspected that a lot of these editorials, like obituaries, are written in advance, so that the editorialist can simply fill in the new numbers.  A two-decade long accumulation of these editorials... Read the rest of this entry »

Last week, the Congressional Budget Office weighed in on the biggest economic imponderable in the health care debate:  how private health insurance premiums will behave under health reform. Building on its December 2008 CBO health insurance market analysis,  CBO forecast largely benign effects from health reform’s private market reforms and subsidies on the vast majority... Read the rest of this entry »

As Senate and House Committee versions of health reform move toward unified legislation and floor votes, the most complex political challenge is how to resolve the “public option” controversy.  While one would have thought weightier issues such as the shape of Medicare reform, the taxation required to support coverage subsidies, or the presence or absence... Read the rest of this entry »

Editor’s Note: In the post below, Jeff Goldsmith argues that the concept of accountable care organizations (ACOs) is “not ready for prime time.” In a response, Aaron McKethan, Mark McClellan, Elliott Fisher, and Jonathan Skinner state that ACOs represent a critical step away from volume-based health care payment and toward better health and better care at lower cost.... Read the rest of this entry »

One of the most controversial parts of the Obama health reform campaign platform was its pledge to create a new Medicare-like public health insurance offering that would “compete” with existing private insurance plans, and put pressure on them and on providers to hold down costs. It would do this mainly by using Medicare-like pricing leverage... Read the rest of this entry »

Since the release of the president’s budget in February, the national health reform policy process has entered its “underground” phase. While we wait for details to emerge from secret meetings on Capitol Hill, the president’s financing plan for health reform is in increasing difficulty. We should take President Obama at his word that he is... Read the rest of this entry »

When President Obama announced Peter Orszag as his choice for director of the Office of Management and Budget, many in the health care community ran for Google. Orszag, an intense and studious 40-year-old economist, who headed the Congressional Budget Office during 2007 and 2008, has emerged as a forceful advocate of controlling entitlement spending and... Read the rest of this entry »

When Tom Daschle, President-elect Barack Obama’s designate for Secretary of Health and Human Services, published a book earlier this year titled Critical: What We Can Do about the Healthcare Crisis, I saw the favorable reviews and made a mental note to buy and read it. After Obama’s announced choice of Daschle for HHS secretary, this... Read the rest of this entry »

Barack Obama won the presidency campaigning on a promise substantially to expand health coverage. His ability to achieve this promise rested on the capacity to raise and spend about $1.6 trillion over ten years to subsidize private coverage for individuals and small businesses that could not otherwise afford to buy it themselves, as well as... Read the rest of this entry »

Two statistical “events” catalyze a lot of health reform debate every year: the Census Bureau’s annual estimate of those without health insurance, and the Centers for Medicare and Medicaid Services (CMS) actuary’s estimate of the percentage of gross domestic product (GDP) devoted to health care. We can argue about whether these are the two most... Read the rest of this entry »

Having reviewed the latest report on national health spending in 2006 (Health Affairs, Jan/Feb 2008) from the Centers for Medicare and Medicaid Services (CMS) and Paul Ginsburg’s commentary (“Don’t Break out the Champagne: Continued Slowing of Health Spending Growth Unlikely to Last”), I want to offer a dissenting view. Though I do not have the... Read the rest of this entry »

What we’ve read in recent headlines was: 47 million Americans lack health insurance! Back on page 5, President Bush and Congress fight over reauthorizing the Children’s Health Insurance Program (SCHIP), which augments Medicaid coverage for children (and expires at the end of September). Looking at the data that produced the headlines makes it clearer how hard health reform is... Read the rest of this entry »

Elliott Fisher and colleagues in their provocative paper published online December 5 validated an approach to quantifying the clinical and economic performance of physician communities clustered statistically around hospitals. Fisher describes the so-called extended hospital medical staff as “hospital-associated multispecialty group practices” or “virtual organizations.” While some physician markets do indeed function as “communities,” with... Read the rest of this entry »