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Monthly Archives: January 2010

Health Reform = Job Creation

A new report from the Center for American Progress, co-authored by David Cutler and Neeraj Sood, finds that health care reform has enormous potential to create more jobs in this country. You’ll have to read the report if you want all the details, but the basics are these:

  • Employers pay a substantial amount for employees’ health insurance premiums
  • If health reform reduces premiums, employers can increase salaries or hire more employees

Those basic assumptions, when combined with a sizable amount of historical and projected data point to the conclusion that the health care reform currently being considered by Congress has the potential to:

  • Create 250,000 new jobs under fairly conservative estimates
  • Create 400,000 new jobs using less conservative estimates

Either way, the point is this: Health care reform does more than reform the health care system. It also takes the brakes off of an economy that has been grinding to an inevitable halt.

 
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Posted by on January 29, 2010 in Uncategorized

 

Health Care and Automotive Repair

A couple of weeks ago, an article appeared in the New York Times on the subject of health care reform–with a Colorado-centric focus. The article was written by Robert Pear, who’s as good as they come in the world of health care journalism. As he usually does, Pear nails the policy details, but his opening made me chuckle. He cites Donny Sefer, the manager of an auto repair shop in Denver as being disillusioned with health care reform. Apparently, Sefer wanted Congress to figure out the underlying problem of rising health care costs and do something to fix it. That’s sensible. But Sefer’s also quoted saying “I am an automotive diagnostician. We look for the root cause of problems. If we treat the symptoms, the problem always comes back. With health care, we are not treating the root cause: Why does it cost so much?”

It was the question he posed at the end that I wanted to turn back on him. “Mr. Sefer, why does automotive care cost so much?” It’s a rhetorical question. The answer is that, with the possible exception of urban areas with efficient public transportation systems, we are dependent on our automobiles. Consequently, it’s a problem when they cease to work as they should. Mechanics possess the skills to get them working again in short order. We don’t know if what they did was actually anywhere near as complicated as the price we are willing to pay might suggest. Many of us would happily pay a couple of hundred bucks to our local mechanic if they told us “Well, the problem was your flim-flam valve was glopped up, so we had to adjust the tension on the thingamabob belt and replace your do-hickey regulator.” As long as she’s running again, we’re happy. Now for those of you who know what an idle air control motor is, maybe you drive a harder bargain, but that’s not typical.

Our lack of information as consumers puts us at a pretty big disadvantage when we need something important to us to be restored to working order. And that’s cars, folks. The principles at work in the mechanic-car owner relationship are only exacerbated in the context of health care. The reason why is obvious: Worst-case scenario, you can’t go down to the dealership and pick up another you. If things are serious enough–say it feels like there’s an elephant sitting on your chest–you’ll be pretty quick to agree to just about anything without even taken cost into consideration. It’s the “shopping” equivalent of going “all in.” There’s no other purchasing decision I can think of that works like that.

So, I was surprised that Mr. Seyfer, a mechanic, would wonder why health care costs are so high. He’s in as good a position as anyone to understand the precise forces at work. We need more information as consumers, for a start. Of course, that’s just for a start. There’s much else that has to happen to get prices, and thus, costs, brought under control, but I just wanted to knock down the analogy that Robert Pear set up so nicely for me.

 
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Posted by on January 28, 2010 in Uncategorized

 

SOTU Wrap-Up

The State of the Union address just concluded. I have to say that I thought it was sobering, balanced, and one of the best SOTUs I’ve ever witnessed. But I’m a health care guy, so where did Obama fall on that topic? A new type of word cloud (with frequencies shown in parentheses) shows that health reform–while stressed–took a big backseat to the economy and job creation. The President’s key point, however, that we must persevere, is one I wholeheartedly second.

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Posted by on January 28, 2010 in Uncategorized

 

Chapel Hill Resident Guest of Michelle Obama Tonight

The State of the Union is being delivered tonight, and up in the First Lady’s box to watch President Obama deliver the address will be one of Chapel Hill’s own, Ping Fu. Here’s her biography as released by the White House Press Office. Congrats, Ping!

Ping Fu (Chapel Hill, NC)

Ping Fu co-founded Geomagic, a company which pioneers technologies that fundamentally change the way products are designed, engineered and manufactured around the world from automobiles to medical devices. Geomagic, under her leadership, has been an active participant in the SBA’s Small Business Innovation Research (SBIR) program. Fu has led Geomagic to deliver broad-based economic impact to the US economy with tangible results – the company tripled its customer base and employment while achieving high growth and profitability. As such, the NSF awarded Geomagic the prestigious Tibbetts Award for exemplifying the very best in SBIR.

Fu has more than 25 years of software industry experience in database, internet technology, and visual computing. Before Geomagic, she was the Director of Visualization at the National Center for Supercomputing Applications and is also, actively involved in promoting entrepreneurship and women in mathematics and sciences.

 
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Posted by on January 27, 2010 in Uncategorized

 

Dear Senate, Please Read This

Some of the biggest names in the world of health reform–people who know what they’re talking about–just sent this letter out to the Senate leadership last night. It mirrors one they sent to the House just a few days ago.

“Dear Senators Reid, Baucus, and Harkin:

For nearly three-quarters of a century, Presidents and Congressional
leaders have tried to enact legislation that would make health care
accessible to Americans. Although pieces of this dream have been
realized–health care for the elderly, the disabled, and children in
low-income families–universal coverage itself has proved beyond
reach.

We are now on the cusp of realizing this goal. Both houses of Congress
have adopted legislation that would provide health coverage to tens of
millions of Americans, begin to control health care costs that
seriously threaten our economy, and improve the quality of health care
for every American. These bills are imperfect. Yet they represent a
huge step forward in creating a more humane, effective, and
sustainable health care system for every American.

We have come further than we have ever come before. While the House
and Senate bills differ on specific points, they are built on the same
framework and common elements–eliminating health status underwriting
and insurance abuses, creating functioning insurance markets, offering
affordability credits to those who cannot afford health insurance,
requiring that all Americans act responsibly and purchase health
insurance if they are able to do so, expanding Medicaid to cover all
poor Americans, reforming Medicare payment to encourage quality and
control costs, strengthening the primary care workforce, and
encouraging prevention and wellness.

Key differences between the bills, such as the scope of the tax on
high-cost plans and the allocation of premium subsidies, should be
repaired through the reconciliation process. Key elements of this
repair enjoy broad support in both houses. Other discrepancies between
the House and Senate bills can be addressed through other means.

Last Friday, we urged the House to adopt the Senate-passed bill along
with improvements that can be immediately achieved through
reconciliation. We urge the Senate to join the House in this effort,
and we urge the President to sign both bills.

With the loss of Edward Kennedy’s Senate seat, Democrats no longer
enjoy a filibuster-proof Senate majority, though they still enjoy the
largest Senate majority any party has achieved in the past generation.
The loss of this one vote does not require Congress or the President
to abandon Senator Kennedy’s life work of health care reform. A year
of political infighting, misleading debates about death panels and
socialized medicine, and sheer inaction has left Americans exhausted,
confused, and disgruntled. Americans are also bearing the severe
consequences of deep recession and unemployment. Still, a majority of
Americans support health reform, and all Americans need it.

If Congress abandons this effort at this critical moment, that will
leave millions more Americans to become uninsured in the coming years
as health care becomes ever less affordable. Abandoning health care
reform–the signature political issue of this administration–would
send a message that Democrats are incapable of governing and lead to
massive losses in the 2010 election, possibly even in 2012. Such a
retreat would also abandon the chance to achieve reforms that millions
of Americans across the political spectrum desperately need in these
difficult times. Now is the moment for calm and resolute leadership,
pressing on toward the goal now within sight.

Some have proposed dividing the bill or starting anew with
negotiations to produce a less comprehensive bill. From the
perspective of both politics and policy, we do not believe this is a
feasible option. We doubt that the American public would welcome more
months of partisan wrangling and debate. We doubt that the final
product would match what has already been achieved. Indeed we doubt
that any bill would reach the President’s desk should congressional
leaders pursue this misguided course.

We, the signatories of this letter, come from a variety of different
perspectives. Some of us are long-standing advocates of progressive
causes. Some of us are nonpartisan or identify as political
moderates.

From these differing perspectives, we agree on one thing: the current
choice is clear. The Senate must work with the House in agreeing on
legislation that is acceptable to both houses of Congress insofar as
this is possible within the reconciliation process and then both
houses must adopt the final reconciliation legislation.

Sincerely,
Henry Aaron, Brookings
Ronald Andersen, UCLA
Gerard Anderson, Johns Hopkins
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia University
Anna Burger, Secretary-Treasurers, SEIU
David Cutler, Harvard University
Stephen Davidson, Boston University
Linda Degutis, Yale University
Judy Feder, Georgetown University
Eric Feldman, University of Pennsylvania
Brian R. Flay, Oregon State University
David Grande, University of Pennsylvania
Thomas Greaney, Saint Louis University
Colleen Grogan, University of Chicago
Jonathan Gruber, MIT
Jacob Hacker, Yale University
Mark Hall, Wake Forest University
Jill Horwitz, University of Michigan
Jim House, University of Michigan
Peter Jacobson, University of Michigan
Timothy Stoltzfus Jost, Washington and Lee (organizer)
Theodore Joyce, CUNY
George Kaplan, University of Michigan
Jerome Karabel, University of California, Berkeley
Mark A.R. Kleiman, UCLA
Paula Lantz, Univesity of Michigan
Theodore Marmor, Yale University
Lynda Martin-McCormick, NSCLC
Michael Millenson, Northwestern University
James Morone, Brown University
Paul Nathanson, NSCLC
Len Nichols, New America Foundation
Jon Oberlander, University of North Carolina
Mark A. Peterson, UCLA
Harold Pollack, University of Chicago (organizer)
Karen Pollitz, Georgetown University
Daniel Polsky, University of Pennsylvania
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas, Austin
Theda Skocpol, Harvard University
Donald H. Taylor, Duke University
William Terry, Brigham and Women’s Hospital
James A. Tulsky, Duke University
Alexander C. Wagenaar, University of Florida
Joseph White, Case Western Reserve University
Celia Wcislo, 1199-United Healthcare Workers East, SEIU”

 
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Posted by on January 27, 2010 in Uncategorized

 

The Truth Behind Serving Sizes

First, a humorous take on the subject by one of my favorites, Brian Regan:

Jokes.com
Brian Regan – Serving Size
comedians.comedycentral.com
http://media.mtvnservices.com/mgid:cms:item:comedycentral.com:191272
Joke of the Day Stand-Up Comedy Free Online Games

Then, a link to the truth behind how food serving sizes are actually determined. It’s probably a lot more complicated and ridiculous than you’d think.

 
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Posted by on January 27, 2010 in Uncategorized

 

Chart Wars!

This is absolutely fantastic…

That being said, you should give these health care charts a look.

 
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Posted by on January 26, 2010 in Uncategorized

 

What Color Are You? What Color Is Your State?

By now, we’re all accustomed to the readily applied labels of red states and blue states. In fact, pretty much since the closely contested 2000 Presidential election, most of us can easily envision the map of the United States broken out into the two colors. The west coast and the the northeast are blue (i.e., liberal) states, while the rest of the country tends to consist of red (i.e., conservative) states. Of course, if we break things down further, we see that even within red states, the large cities tend to be blue. There are patterns to all of this. There are powerful stereotypes of red and blue voters, too, and the book Red State, Blue State, Rich State, Poor State by Andrew Gelman uncovers it all.

Gelman is a professor of statistics and political science at Columbia University, and he recently sent me a review copy of the revised edition of his book. I finished it a couple of weeks ago, and am just now finding the time to get a quick review up on the blog.

If you watch Fox News, or take in the fervor surrounding “everywoman” Sarah Palin, you’ll get the sense that the Republicans are the party of the common people–the hardworking, salt-of-the-earth, Walmart shopping, God-fearing, gun-toting backbone of America. You might also get the sense that the Democrats are well-educated, wealthy, Volvo-driving, Starbucks-sipping, atheistic elites who are out of touch with mainstream America. When you then consider that the Republicans’ policy positions–especially their economic ones–typically favor not the average citizen, but the very well off, and that the Democrats’ policy positions–again, especially their economic ones–typically favor redistribution to aid the less-well-off, you find a paradox. It’s only a paradox, though, because the image you have of Republicans and Democrats is wrong.

As Gelman shows using a wealth of data, high-income individuals are more likely to vote Republican than Democrat–no matter where they live or anything else about them (like their race, religious beliefs, etc.). The reality is that this effect of income level on voting preference matters less in states that are wealthier on average than it does in states that are less wealthy. That’s the central finding of Gelman’s work. Of course, he walks through a variety of other arguments and controls for a variety of other factors, finding some (e.g., race and religion) fairly important, and others (e.g., income inequality) less so. The book goes a long way in explaining the partisan divide in this country–and as someone who hails from the ultra-conservative deep south, but has morphed into more of a left-leaning moderate over time–I’ve got to say every story Gelman tells made sense to me. You should pick up a copy and give it a read. It’s full of great graphs, which will make that easy for you. Plus, you might be pretty surprised to find out how easily you can be put in a box on the basis of just a few relevant factors. I know I was.

 
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Posted by on January 25, 2010 in Uncategorized

 

Massachusetts Goes Purple….Now What?

Congratulations are in order for Scott Brown, who won the special election in Massachusetts and really upset the health reform apple cart. It’s ironic, because Brown opposes the national health reform efforts that practically mirror the state health reform in Massachusetts that he voted for and continues to support. There is commentary aplenty about what exactly it means that a Republican was able to claim a seat held by Ted Kennedy for nearly half a century, in America’s bluest state. Said state is now, I think it’s fair to say, purple. Does this mean the “people have spoken” or that this was “a referendum on health reform” or that “Democrats are out of touch with the American people?” Maybe. Of course, for any of those sweeping statements to be true, we’d have to agree that the people of Massachusetts adequately represent a cross-section of America and that Martha Coakley did everything right in her campaign. I don’t think either of those things is true. And I don’t really care.

The media’s gone on the offensive, hyping Brown’s victory as the death of health reform and searching in Nancy Pelosi’s public comments for what could be evidence of the coffin’s final nail. I and others think it’s all incredibly overblown. The better question is what do the Democrats do now? And as is being widely reported, there are several options.

First, as I previously wrote, the House could vote for the bill the Senate passed on Christmas Eve. This is probably the best option left, substantively, and it’s happened before. The problem with that is, the House bill is much more progressive than the Senate bill, and despite what some people might accuse the party of, there are some Democrats who refuse to compromise any further. So, it doesn’t look like this is going to happen, and Pelosi’s comments seem to be bearing that out.

There’s also the idea of doing things through the reconciliation process, which looks like a possibility. Congressional Democrats might even decide to break the bill up into smaller pieces and pass some of the key reforms that are easily communicated to–and strongly supported by–the public. Then they could build on that. Hooray for incrementalism. (Although some people think such a strategy will never work.)

If you need to buy some time to figure out a strategy, maybe you bring up banking reform to divert people’s attention from health care reform for the moment by focusing on something that all people (save bankers) should–theoretically–support. Or maybe the process should just go forward, forcing the Republicans, who will inevitably vote against the bill, spending all their time explaining why the country doesn’t need insurance reform. If they can pick up a lot of seats in 2010 with that platform, perhaps they deserve to win.

But not so fast. Health reform has suffered a setback, but it is not yet dead. Now is the time for politicians to find creative solutions to the problem. Plenty of people will complain about more compromising–as it has been so one-sided until now–but just letting health reform die is no better. The Democrats have a real chance to lead here and they must. In fact, that’s just what a group of nationally-known health policy experts (including my dissertation committee chair) had to say in a recent letter to Congressional leadership. They urge the House to pass the Senate bill and make subsequent compromises through the reconciliation process. I like their approach and would have signed-on, too, if I were considered enough of an expert to be asked. Here’s what they wrote:

Congresswoman Nancy Pelosi
Speaker of the House of Representatives
235 Cannon House Office Building
Washington, DC 20515

Congressman Charles Rangel
Committee on Ways & Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington D.C. 20515

Congressman Henry A. Waxman
Committee on Energy and Commerce
2204 Rayburn House Office Building
Washington, D.C. 20515

Congressman George Miller
Committee on Education and Labor
2205 Rayburn House Office Building
Washington, DC 20515

Dear Speaker Pelosi and Chairmen Rangel, Waxman, and Miller:

For nearly three-quarters of a century, Presidents and Congressional
leaders have tried to enact legislation that would make health care
accessible to Americans. Although pieces of this dream have been
realized—health care for the elderly, the disabled, and children in
low-income families—universal coverage itself has proved beyond
reach.

We are now on the cusp of realizing this goal. Both houses of Congress
have adopted legislation that would provide health coverage to tens of
millions of Americans, begin to control health care costs that
seriously threaten our economy, and improve the quality of health care
for every American. These bills are imperfect. Yet they represent a
huge step forward in creating a more humane, effective, and
sustainable health care system for every American.

We have come further than we have ever come before. Only two steps
remain. The House must adopt the Senate bill, and the President must
sign it.

While the House and Senate bills differ on specific points, they are
built on the same framework and common elements—eliminating health
status underwriting and insurance abuses, creating functioning
insurance markets, offering affordability credits to those who cannot
afford health insurance, requiring that all Americans act responsibly
and purchase health insurance if they are able to do so, expanding
Medicaid to cover all poor Americans, reforming Medicare payment to
encourage quality and control costs, strengthening the primary care
workforce, and encouraging prevention and wellness.

Some differences between the bills, such as the scope of the tax on
high-cost plans and the allocation of premium subsidies, should be
repaired through the reconciliation process. Key elements of this
repair enjoy broad support in both houses. Other limitations of the
Senate bill can be addressed through other means.

The Senate bill accomplishes most of what both houses of Congress set
out to do; it would largely realize the goals many Americans across
the political spectrum espouse in achieving near universal coverage
and real delivery reform.

With the loss of Edward Kennedy’s Senate seat, Democrats no longer
enjoy a filibuster-proof Senate majority, though they still enjoy the
largest Senate majority any party has achieved in the past
generation. The loss of this one vote does not require Congress or
the President to abandon Senator Kennedy’s life work of health care
reform. A year of political infighting, misleading debates about death
panels and socialized medicine, and sheer inaction has left Americans
exhausted, confused, and disgruntled. Americans are also bearing the
severe consequences of deep recession and unemployment. Still, a
majority of Americans support the elements of the Senate bill.

The House of Representatives faces a stark choice. It can enact the
Senate bill, and realize the century-old dream of health care reform.
By doing so, it can achieve a historic milestone while freeing itself
to address other national problems such as joblessness and mortgage
foreclosure that affect millions of Americans. Differences between
the House and Senate bill can be negotiated through the reconciliation
process.

Alternatively, Congress can abandon this effort at this critical
moment, leaving millions more Americans to become uninsured in the
coming years as health care becomes ever less affordable. Abandoning
health care reform—the signature political issue of this administration
—would send a message that Democrats are incapable of governing and
lead to massive losses in the 2010 election, possibly even in 2012.
Such a retreat would also abandon the chance to achieve reforms that
millions of Americans across the political spectrum desperately need
in these difficult times. Now is the moment for calm and resolute
leadership, pressing on toward the goal now within sight.

Some have proposed dividing the bill or starting anew with
negotiations to produce a less comprehensive bill. From the
perspective of both politics and policy, we do not believe this is a
feasible option. We doubt that the American public would welcome more
months of partisan wrangling and debate. We doubt that the final
product would match what has already been achieved. Indeed we doubt
that any bill would reach the President’s desk should congressional
leaders pursue this misguided course.

We, the signatories of this letter, come from a variety of different
perspectives. Some of us are long-standing advocates of progressive
causes. Some of us are nonpartisan or identify as political
moderates.

From these differing perspectives, we agree on one thing: the current
choice is clear. Pass the Senate bill, and improve it through
reconciliation.

Sincerely,

Henry J. Aaron, The Brookings Institution
Gerard Anderson, Johns Hopkins University
Ronald Anderson, UCLA
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia University
Anna Burger, SEIU
David Cutler, Harvard University
Linda C. Degutis, Yale University
Eric Feldman, University of Pennsylvania
Thomas Fisher, University of Chicago
Brian R. Flay, Oregon State University
David Grande, University of Pennsylvania
Thomas Greaney, St. Louis University
Colleen Grogan, University of Chicago
Jon Gruber, MIT
Mark A. Hall, Wake Forest University
Jacob S. Hacker, Yale University
Jill Horwitz, University of Michigan
James S. House, University of Michigan
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University (organizer)
Theodore Joyce, CUNY
George A. Kaplan, University of Michigan
Jerome Karabel, University of California at Berkeley
Mark A.R.. Kleiman, UCLA
Paula M. Lantz, University of Michigan
Simon Lazarus, NSCLC
Arleen A. Leibowitz, UCLA
Theodore Marmor, Yale University
Lynda Martin-McCormick, NSCLC
Michael L. Millenson, Northwestern University.
James A. Morone, Brown University
Jonathan Oberlander, University of North Carolina at Chapel Hill
Karen Pollitz, Georgetown University
Harold Pollack, University of Chicago (organizer)
Daniel Polsky, University of Pennsylvania
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Theda Skocpol, Harvard University
Paul Starr, Princeton University
William Terry, Brigham and Women’s Hospital
James A. Tulsky, Duke University
Alexander C. Wagenaar, University of Florida, Temple University
Joseph White, Case Western Reserve University
Celia Wcislo, 1199-United Healthcare Workers East, SEIU

(Institutional affiliations listed for identification only).

cc. Senator Harry Reid
President Barack Obama

 
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Posted by on January 22, 2010 in Uncategorized

 

What Does Health Reform Mean For Me?

I ran a piece similar to this one a week ago, but it looks like concrete examples are the new way of communicating health reform to the public in a way that people can–hopefully–understand. So, today, I bring you more of that kind of “stuff” that explains what health reform will mean for you. Provided, of course, that you fall neatly into one of the categories that are used as examples.

As always, the staff of the Kaiser Health News does a great job of presenting non-partisan information. Their write up is a good place to start. Next, there’s a look at what families can actually afford as laid out by The New Republic’s Jonathan Cohn. And finally, Uwe Reinhardt answers the question that many of you are asking–why should we all pay one premium based on where we live (community rating) rather than individual premiums based upon our health history and personal habits and risk factors (experience rating)?

As an aside, here’s a copy of a memo sent to all Democratic Senators from Mark Mellman, head of the Mellman Group–a public opinion research consulting group–explaining who does and who doesn’t support health reform and how to get more support. I think I’d like a job like his.

 
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Posted by on January 22, 2010 in Uncategorized

 
 
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