James Pethokoukis

Politics and policy from inside Washington

What Americans really want in healthcare reform

August 19, 2009

This is a great analysis of healthcare polling by Humphrey Taylor, head of The Harris Poll (via The Health Care Blog):

However, if you study all the polls, as opposed to cherry picking them as many politicians do, a  clear picture of public opinion emerges:

  1. Most people are unhappy with the current health care system and favor reform.  They want to have a system that gives them affordable access to quality care for the rest of their lives.  International surveys show that Americans are more dissatisfied with the U.S. health care system than are people in all, or almost all, other developed countries.
  2. Most people think that some kind of government intervention is needed to fix the system, to expand coverage, and to contain costs.  However, support for government intervention does not, in most case, translate into support for a “government-run” system.  (Though what people understand by that phrase is far from clear.)
  3. While most people believe that fundamental changes are needed in our health care system, only a minority wants to completely rebuild it.  Most people favor building on the present system and the bits of it that seem to work well.
  4. There is substantial support for health care reform not only among the public but from large majorities of almost all major interest groups.  Only small minorities of doctors, employers or insurers think that the system works pretty well now.  However, they also have different interests and tend to see very different problems and support or oppose different proposals.
  5. Most people are at least reasonably satisfied with their own health insurance (if they have it) and with the quality of care that they receive.  However, that does not mean that they like the system.  Most people believe that the costs are too high and that everyone should be covered.
  6. More people think that both the total cost and the out-of-pocket costs of care are too high, but their perceptions of why this is so are different from those of most health economists.  They often blame greedy insurers and pharmaceutical companies and think there is a lot of fraud and abuse.  But they are less likely to focus on over-utilization, the impact of fee-for-service incentives and the relatively (compared to other countries) high price of medical services.
  7. Few people seem to worry much about the unfunded liability for Medicare that economists tell us is a huge problem.
  8. Proposals that people believe will take away the health insurance they have now, or force them to change doctors, that “ration” care, or prevent them from getting the treatments they think they need are deeply unpopular.
  9. There is no consensus on the appropriate roles of the government, employers and individuals.  Half of the population thinks that health insurance and health care should be “an entitlement paid for by taxes,” while a third believes that it should be like other products and services, where you get what you can pay for.
  10. Republicans and Democrats are highly polarized on many aspects of reform.  Most Democrats think that this is a very important issue and focus on expanding coverage and limiting out-of-pocket costs.  They tend to favor an expanded role for government.  Most Republicans focus on cost containment and oppose a bigger role for government.  Democrats are much more likely than Republicans to think that health care is a “right.”
  11. There are many things that many people do not want.  They do not want to pay much higher taxes and out-of-pocket costs.  They don’t want to damage the economy or increase unemployment.  They dislike the idea of rationing and oppose anything that they think might reduce the quality of their care or limit their choices.
  12. Most people do not think or talk about the issues that are the focus of much debate among policy wonks, think-tanks, and legislators.  They rarely mention health information technology, comparative effectiveness reviews, a health information exchange, reimbursement reform, pay-for-performance, quality measures, or outcomes research.  When asked about these issues, the public’s replies vary dramatically, depending on whether the language used is that of the proponents or opponents of proposals.  For example, a new agency to provide information on which treatments work better or worse sounds pretty good – but not if it is used to deny care that a doctor or patient wants.
  13. Most people do not seem to see a conflict between giving patients every test and treatment they and their doctors  want, however expensive, and containing costs.
Me: I think this shows that the White House has done a poor job educating people on this issue. Nor have Americans done a good job educating themselves, which is inexcusable in the Internet Age. For his part, Taylor thinks the issue is just too complex. Maybe, then, we need simpler solutions.

Comments

…hows about this….we just leave it the way it is…or else December 21st 2012 will be in the future History books…mah’ok?

Posted by A little Bird | Report as abusive
 

Of course Obama didn’t educate the base that put him in the WH, it is difficult to educate the uneducated Democrat as they vote like there Mom and Dad, “Just becuase….”.

The typical Democrat is so spun up on one issue(environment, gay rights, this color person, that color person, women’s rights as opposed to the unborn’s rights, etc.) that they oppose logic because their emotions get in the way.

Healthcare is no different-take it to the extreme with the Public Option, screw the 75% that are happy.

Here is an idea:

1.) Catastrophic for the 16M(not 45M)
2.) Portability
3.) No discrimination based upon pre-existing conditions
4.) Tort Reform to keep the ambulance chasers in check.

This is easy, but it is a powergrab by Obama and his lackies.

There’s northing worse then a Harvard narcissist who thinks the government is in a better place to administer our healthcare system then the current system. Take a look a Soc. Sec., Post Office, US Dept of Educ, etc. All failures…….why would government run healthcare be succesful I ask?

Posted by P. Britt | Report as abusive
 

THIS OLD WORLD ORDER OF ABUSE AND NEGLECT OF OUR POORER AMERICANS NEEDS ENLIGHTENED POLITICAL MINDS AND HEARTS TO VIEW GOD DIFFERENTLY THEN $$$.

THERE ARE NOT MANY MORE DISTRACTIONS LEFT WHICH ARE AVAILABLE FOR OUR WEALTHY ELITE AMERICANS TO HIDE BEHIND IN NOT TAKING PROPER CARE OF ALL OUR AMERICANS IN A HUMANE FASHION !!!

AMERICAN IVORY TOWER U.S.CONGRESSIONAL LEADERS OF THE FREE WORLD HAVE PASSED FEDERAL LEGISLATION IN WASHINGTON DC TO SPEND 50 BILLION AMERICAN TAX $$$ ON THE INTERNATIONAL FIGHT AGAINST AIDS OVER THE NEXT FIVE YEARS WHILE THEIR OWN AMERICAN CITIZENS ARE BEING TOLD BY THIS SAME U.S.CONGRESS THAT NATIONAL HEALTH CARE AND PROPER LEGAL REPRESENTATION FOR MIDDLE CLASS AND WORKING POOR CITIZENS IS UNAFFORDABLE.

*** WEALTHY ELITE AMERICANS (WHO ARE ONLY 1% OF OUR USA POPULATION) SADLY ALSO CONTROL HOW OUR U.S.CONGRESS SPENDS THEIR BUDGET TRILLION$ AND HAVE OBVIOUSLY FOUND MORE WORTHY INTERNATIONAL CITIZENS THEN OUR OWN DESPERATE AND NEEDY POOR TO ASSIST !!!
~Poorer Americans Nationwide only get 400 million $$$ per year for legal representation allocated them by CONGRESS~

Middle Class and Working Poor Americans are unable to afford proper legal representation in their Civil, Criminal and Family Courts of law all across America causing tremendous hardships nationwide,but these great minds and callous hearts in our American Congress have found others Worldwide more needy then their own citizens who are being falsely incarcerated,wrongfuly executed,losing their homes or apartments,losing child custody or visitation with their children etc…

Not being afforded proper legal representation by our U.S. Congress has created a total breakdown of the American judicial system for our poorer Americans because the our U.S. Courts punish all of us little people if we are not assisted with proprer legal counsel.it is a known fact that our average Middle Class and Working Poor Americans without proper legal representation in all of our American Courts of law lose their legal cases to the better financed who are able to afford lawyers.

Lawyers For Poor Americans is now actively in the hunt for International Countries and Leaders Worldwide to help raise 5 Billion Dollar$ for our slighted poorer Americans who have had their own American Congress turn their backs on their desperate needs in not affording them proper legal representation.

Troy Davis and Mumia Abu – Jamal are 2 perfect examples of American citizens who never had proper legal representation afforded them by our U.S. Congressional Leaders Of The Free World in their initial criminal trials in (Georgia and Pennsylvania) who might very well have to pay the ultimate price of possibly being completely innocent and falsely executed in the near future.

This is the first of many www International pleas by Lawyers For Poor Americans for other leaders and countries to help raise the needed monie$ to correct these blatant injustices that have been inflicted on poorer Americans for the last few decades.

Lawyers For Poor Americans has many other written articles that can be viewed with any www search engine by our name or our telephone number.

Lawyers For Poor Americans is a www lobby group of volunteers that sing out about the decades old neglect,abuse and injustices being inflicted on our poorer Americans that have become Crimes Against Humanity issues for the International World Court to investigate.

lawyersforpooreramericans@yahoo.com
(424-247-2013)

Posted by LAWYERS FOR POOR AMERICANS | Report as abusive
 

An excellent summary of my fellow Americans opinion of reform – “We want more for less with no hassle.”

Ya think? But that isn’t a basis for revamping the current system.

The issue is what are we trying to fix and why. The current proposals are sausage making at its worst.

If we want to provide coverage for uninsured Americans – provide tax breaks for the deductibility of premiums across the board.

If we want to provide choice, options and comptetion – allow variability and flexibility in the market place (how a public optin that requres certain coverage, mandates mirror coverage in the priv sector and sets prices = choice and competition is beyond me)

If we are concerend about individuals exhausting limits –allow for the issuance of “excess” catastrophic coverage that has a lengthy term and a non cancellation clause.

If we are concerned about availability – allow carriers to groups individuals, portability at a cost.

If we are concerned about health care supply – spend money to increase the size of medical schools or build more – then (subsidize the cost of medical school – not through loans – just lower the cost at state schools) – more doctors will mean more available and a lower delivery cost.

These are simple fixes and i am sure there are others that do not require revamping an entire system ( but not have it go into effect until 2013) – all of this can be done now.

If we want single payer – then pass it (and no exceptioons for the congress and executive branch) and see what happens at the next election.

Posted by John Adams | Report as abusive
 

To the fellow from Lawyers for Poorer Americans, you are absolutely right that the wealthiest 1% have influence: we pay 40% of all personal income taxes (2007 IRS data)! And the wealthiest 5% pay 60%! I absolutely expect to be heard and respected. You want to be heard? Pay some bills. Until then, stay in your seat.

Posted by Phillip Ley | Report as abusive
 

To the post of Phillip Ley.
Top 1 percent are worth about 40% of total net worth. Bottom 80 percent only 15%
How did you get there genius?

Posted by MM | Report as abusive
 

I think you nailed it. Make it simple. Fix what is broken. Make a specific list, for example:

A primary problem with American healthcare today is the system’s failure to make the continuous improvement of healthcare safety, quality, and efficiency a top priority. Consider the following:
• The number of deaths caused by medical treatment, usually due to physician mistakes and negative drug effects, are between 80,000[1] and 250,000.[2] These deaths were caused by unnecessary surgeries, medication errors, infections, and negative effects of drugs. This means the U.S. ranks 15th out of 19 countries in deaths potentially preventable with excellent medical care.[2a,2b]
• An average of 44 errors in a 300-bed hospital per day has been reported.[2c] The total cost of medical mistakes, including medical costs and lost production, totals $17 to 29 billion a year.[2d]
• There is a problem of “practice variation,” in which different healthcare providers, even major academic medical centers, treat similar patients in vastly different ways and for significantly different costs. This research shows that more care and higher spending are not associated with better outcomes, and may, in fact, result in worse outcomes. A patient could be hospitalized for nine days in one part of the country and three in another for the same diagnosis, and those differences would have no impact on outcomes. No other industry handles the same situation in so many different ways when these differences don’t yield better results, and even result in worse outcomes. In other words, more expensive care isn’t necessarily better care.[2e,2f]
• The total Medicare debt as of 2004 was $29.2 trillion, and future generations will add another $32.5 trillion to this obligation, which is 62 percent of all future federal income tax receipts, and will require over 90 percent of projected federal income tax revenues by 2075.[2g]
• One-third of patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results—the highest rate of any of the six nations surveyed.[3]
• Overall, patients receive only 55 percent of recommended steps for top-quality care.[4]
• Studies of autopsies reveal that 20 percent of the time doctors seriously misdiagnose fatal illnesses, so millions of patients are treated for the wrong disease.[5]
• America has one of the highest mental illness rates in the world, with fewer than half ever receiving treatment.[6] Of those receiving treatment, correct care is rendered only half the time.[7]
• The total cost of medical mistakes, including medical costs and lost production, totals $17 to 29 billion a year.[8]
• At least 30 percent of all direct health care outlays are the result of poor quality care, consisting primarily of overuse, misuse, and waste,[9] with $2 billion being spent annually in excess medical costs alone.[10]
• Our government’s annual bill for healthcare spending significantly exceeds that of other nations.[11,12] The nation’s tab for health care could hit $3.6 trillion by 2014, or nearly 19% of the entire U.S. economy[13] and more than $4 trillion by 2015 with one of every five dollars being spent on healthcare.[14] These higher costs, however, don’t imply higher quality, as a lack of best practices results in wide variations in care across regions and hospitals.[15] In other words, more expensive care isn’t necessarily better care.[16]
• Forty-five million Americans are uninsured, premiums for healthcare coverage rise continuously, and there is a widening rift as people lacking employer-based and Medicare coverage suffer increasingly worse care quality and access.[17,18,18a]
• Only half of adults receive preventive and screening tests according to guidelines for their age and sex.[18b]
• Even wealthy Americans are concerned that healthcare costs will ultimately consume a major portion of their financial assets and 47 percent surveyed say health and wellness is their No. 1 financial concern.[19]
• Many people have chronic illnesses that are exceedingly expensive and complex treat because multiple problems accompany them. They are often a function of how people lead their lives, which points to a failure in prevention.[20]
• A national survey found that 55% of Americans were dissatisfied with the quality of health care in 2004, up from 44% in 2000.[21]
• Over 44 [now up to 47] million people in the United States lack access to primary healthcare,[21a] is essential for improving outcomes and controlling costs by being patients’ first point of contact with the healthcare system, as well as their main source of preventive and essential care. Compared to other industrialized countries, the U.S. is among the least likely to have extensive clinical information systems or quality-based payment incentives, the least likely to provide access to after-hours care, and the most likely to report that their patients often have difficulty paying for care.[21b]
• The U.S. has the second worst infant mortality rate in modern world.[21c]
• Only half of adults receive preventive and screening tests according to guidelines for their age and sex.[21d]
• Mental healthcare is not a priority despite evidence that up to half of all visits to primary care physicians are actually mental health related.[22]
• Other evidence shows that mental healthcare decreases medical utilization and costs considerably[23,24,25] and results in total cost savings.[26] Despite this, the U.S. mental health system is fragmented and in disarray[27] and many people’s mental health needs are unaddressed.[28]
• Nearly 40 percent of physicians have manipulated insurance reimbursement in order to give their patients needed care by exaggerating patients’ symptoms to allow for longer hospital stays, and changing patients’ diagnoses for billing purposes.[29]
• Providers are growing so frustrated with the reimbursement rates that receive from health plans that they are starting to sever ties with those plans. The low rates have an additional negative effect: They force providers to increase patient rosters, resulting in shorter office visits, longer waits, and growing dissatisfaction among patients.[30]
• Aging baby boomers are in for a rude awakening. The healthcare costs for promised medical benefits to retiring public employees — and estimated $1 trillion — have not been budgeted and is a looming disaster. According to one consultant, “If anybody understands it, they’ll freak out.”[31]

Information like this makes a clear and convincing case that the quality of American healthcare has much to be desired. It also shows that the fiscal strategies of the past have failed to curb costs, and may have actually lowered quality in the process.

There are many reasons for these healthcare quality problems and for why past strategies have been not worked, including consumers’ ignorance; wide care cost variations that are not associated with care effectiveness; provider compensation models that do not reward quality; the difficulty in assessing the performance of given provider; insufficient use of clinical knowledge driving evidence-based decisions; a focus on efficiency without adequate focus effectiveness;[32] as well as misdirected approaches to competition.[33]

Nevertheless, U.S. healthcare has great potential to do great things,[33a] but many of our policies and practices are blocking realization of that potential.

While it is widely accepted that information technology is an essential part of the solution, few providers use clinical information systems to (a) support providers in making diagnostic and treatment decisions by coupling patient problems with evidence-based knowledge; (b) manage and assess the execution of plans of care; and (c) collect and share outcomes data[34] and lessons learned. The dominant trend in every realm of science is the increasing value and usage of computers[35], yet healthcare lags far behind as clinical decisions are made largely without the aid of computer software.[36] The U.S., in fact, lags as much as a dozen years behind other industrialized countries in the adoption of health information technology.[37]

We contend that the only solutions able to improve healthcare effectiveness and control costs, and sustain these benefits, must focus on obtaining and using clinical knowledge to increase the quality and efficiency of care, including well-care (prevention of illness and self-management of chronic conditions), sick-care (treatment of illness and dysfunction), and emergency-care. This involves cooperation between all stakeholders who use effective and economical information systems to develop and implement evidence-based knowledge to support decisions about how best to prevent health problems and treat them cost-effectively. Such solutions would overcome devastating effect of today’s healthcare “knowledge void.”

Footnotes and References:

[1] NCQA (2004). NCQA Report Finds Major Gains In Health Care Quality, But Only For 1/4th of The System. Available at http://www.ncqa.org/Communications/News/ sohc2004.htm
[2] Starfield B. (2000). Journal American Medical Association; 284(4):483-5
[2a] The Commonwealth Fund (Sep 20, 2006). New National Scorecard: U.S. Health Care System Gets Poor Scores on Quality, Access, Efficiency, and Equity. Available at http://www.cmwf.org/newsroom/newsroom_sh ow.htm?doc_id=403809
[2b] Fox, M. (Sep 20, 2006). U.S. spends most but gets mediocre health care. Reuters. Available at http://go.reuters.com/newsArticle.jhtml; jsessionid=3DKJLHCUJP0M0CRBAE0CFFA?type= healthNews&storyID=13548835&pageNumber=0
[2c] Barker et al. (2002). Medication Errors Observed in 36 Health Care Facilities. Arch Intern Med; 162:1897-1903.
[2d] Kohn L, ed, Corrigan J, ed, Donaldson M, ed. (1999). To err is human: building a safer health system. Institute of Medicine. Washington, DC: National Academy Press.
[2e] Dartmouth Researchers Say Rising Health Care Costs Don’t Necessarily Buy Better Health. Health Affairs, February 7, 2006. Available at http://www.healthaffairs.org/press/janfe b0605.htm
[2f] Bender, M. W. and Van Kuiken, S. J. (2005) IT remedies for US health care: An interview with WellPoint’s Leonard Schaeffer. Available at http://www.mckinseyquarterly.com/article _abstract.aspx?ar=1696&L2=12&L3=63
[2g] Senior Journal News (Feb. 18, 2005). Medicare Will Consume Almost All Income Taxes by 2075: Trustee for Social Security, Medicare testifies before Senate Budget Committee. Available at http://www.seniorjournal.com/NEWS/Medica re/5-02-18AllTaxes.htm
[3] Consumer Affairs.Com (2005). U.S. Health Care Most Expensive & Most Error Prone. Available at http://www.consumeraffairs.com/news04/20 05/medical_errors.html
[4] Asch, S.M., et al. (2006). Who Is at Greatest Risk for Receiving Poor-Quality Health Care? New England Journal of Medicine; 354(11):1147-1156. http://content.nejm.org/cgi/reprint/354/ 11/1147.pdf
[5] Leonhardt, D. (February 22, 2006). Why Doctors So Often Get It Wrong. New York Times. Available at http://www.nytimes.com/2006/02/22/busine ss/22leonhardt.html?_r=1&oref=slogin
[6] Washington Post; June 7, 2005; Page A03. Available at http://www.washingtonpost.com/wp-dyn/con tent/article/2005/06/06/AR2005060601651. html
[7] NCQA (2004). NCQA Report Finds Major Gains In Health Care Quality, But Only For 1/4th of The System. Available at http://www.ncqa.org/Communications/News/ sohc2004.htm
[8] Kohn L, ed, Corrigan J, ed, Donaldson M, ed. (1999). To err is human: building a safer health system. Institute of Medicine. Washington, DC: National Academy Press; 1999
[9] Midwest Business Group on Health, with Juran Institute and Severyn Group. (April 2003). Reducing the Costs of Poor-Quality Health Care through Responsible Purchasing Leadership. Available at http://www.mbgh.org/templates/UserFiles/ Documents/CostofPoorQualityReport.pdf .
[10] NCQA (2004). NCQA Report Finds Major Gains In Health Care Quality, But Only For 1/4th of The System. Available at http://www.ncqa.org/Communications/News/ sohc2004.htm
[11] The New England Journal of Medicine. (1999). 340:48, 70-76
[12] Consumer Affairs.Com (2005). U.S. Health Care Most Expensive & Most Error Prone. Available at http://www.consumeraffairs.com/news04/20 05/medical_errors.html
[13] USA Today. (2/24/05). Healthcare in U.S. Most Expensive Per Capita in Industrialized World. Available at http://thereitis.org/displayarticle908.h tml
[14] New York Times (February 22, 2006). Analysts: Health Care Costs to Keep Rising. Available at http://www.nytimes.com/aponline/national  /AP-Health-Care-Costs.html?_r=1&oref=sl ogin
[15] Bender, M. W. and Van Kuiken, S. J. (2005) IT remedies for US health care: An interview with WellPoint’s Leonard Schaeffer. Available at http://www.mckinseyquarterly.com/article _abstract.aspx?ar=1696&L2=12&L3=63
[16] Dartmouth Researchers Say Rising Health Care Costs Don’t Necessarily Buy Better Health. Health Affairs, February 7, 2006. Available at http://www.healthaffairs.org/press/janfe b0605.htm
[17] Hurley, R.E., et al. (2005) A Widening Rift In Access And Quality: Growing Evidence Of Economic Disparities. Health Affairs. Available at http://content.healthaffairs.org/cgi/con tent/abstract/hlthaff.w5.566v1
[18] Book, E. L. (2005). Health Insurance Trends Are Contributing To Growing Health Care Inequality, Health Affairs Web Exclusive. Available at http://content.healthaffairs.org/cgi/con tent/abstract/hlthaff.w5.577v1
[18a] Overview of the Uninsured in the United States: An analysis of the 2005 Current Population Survey. The Assistant Secretary for Planning and Evaluation (ASPE) issue brief. Available at http://aspe.hhs.gov/health/reports/05/un insured-cps/index.htm
[18b] The Commonwealth Fund (Sep. 20, 2006). New National Scorecard: U.S. Health Care System Gets Poor Scores on Quality, Access, Efficiency, and Equity. Available at http://www.cmwf.org/newsroom/newsroom_sh ow.htm?doc_id=403809
[19] Poll: Wealthy Floridians fear health care costs. (1/24/06). The Business Journal of Jacksonville. Available at http://www.bizjournals.com/jacksonville/ stories/2006/01/23/daily17.html
[20] Bender, M. W. and Van Kuiken, S. J. (2005) IT remedies for US health care: An interview with WellPoint’s Leonard Schaeffer. Available at http://www.mckinseyquarterly.com/article _abstract.aspx?ar=1696&L2=12&L3=63
[21] The Kaiser Family Foundation/Agency for Healthcare Research and Quality/Harvard School of Public Health. National Survey on Consumers’ Experiences With Patient Safety and Quality Information. Washington, DC: Henry J. Kaiser Family Foundation; 2004. Publication No. 7209.
[21a] U.S. Dept. of Health and Human Services. Primary Health Care. Available at http://www.ask.hrsa.gov/Primary.cfm
[21b] Schoen, C., et al. (2006). On the Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries. Health Affairs; 25: w555-w571. Available at http://content.healthaffairs.org/cgi/con tent/abstract/hlthaff.25.w555?key=3YyH7y DwrJSoc&keytype=ref&siteid=healthaff
[21c] Green, J. (May 10, 2006). U.S. has second worst newborn death rate in modern world, report says. CNN Health. Available at http://www.cnn.com/2006/HEALTH/parenting  /05/08/mothers.index/
[21d]The Commonwealth Fund (Sep. 20, 2006). New National Scorecard: U.S. Health Care System Gets Poor Scores on Quality, Access, Efficiency, and Equity. Available at http://www.cmwf.org/newsroom/newsroom_sh ow.htm?doc_id=403809
[22] Pautler, T. (1991). A Cost-Effective Mind-Body Approach to Psychosomatic Disorders. In Anchor. K. N. (Ed.), Handbook of Medical Psychotherapy: Cost-Effective Strategies in Mental Health. New York: Hogrefe & Huber.
[23] Cummings, N. (1993). Somatization: When Physical Symptoms Have No Medical Cause. In Coleman, D. & Gurin, J. (Eds.), Mind Body Medicine. New York: Consumers Union.
[24] Friedman, R., Myers, P., Sobel, D., Caudill, M. & Benson, H. (1995). Behavioral Medicine, Clinical Health Psychology, and Cost Offset. Health Psychology;14(6) 509-518.
[25] VandenBos, G. R. (1993). U.S. Mental Health Policy: Proactive Evolution in the Midst of Healthcare Reform. American Psychologist’48, 287.
[26] APA Online. Medical Cost Offset. Available at http://www.apa.org/practice/offset3.html
[27] President’s New Freedom Commission on Mental Health. (2003) Available at http://www.mentalhealthcommission.gov/re ports/reports.htm
[28] CMHR. (2005).16 National Organizations Cite Crisis in Mental Health System, Release Roadmap for Reform. Available at http://www.mhreform.org/news/7-27-05repo rtrelease.htm
[29] Wynia, M.K., et al. (2000). Physician Manipulation of Reimbursement Rules for Patients. JAMA; 283:1858-1865.
[30] New York Times. (12/4/05) Large Medical Practice Drops an Insurer
[31] New York Times. (12/11/05) The Next Retirement Time Bomb
[32] Newhouse, J.P. (July/Aug 2002) Why Is There a Quality Chasm? Health Affairs;13(25). Available at http://www.medscape.com/viewarticle/4397 98
[33] M. E. and Teisberg, E. O. (Jun 1, 2004). Redefining Competition in Health Care. Harvard Business Online. Available at http://www.hospicepharmacia.com/images/s upporting/redefiningcompetition.pdf
[33a] Associated Press (April 19, 2006). Officials: U.S. Deaths See Largest Drop in 60 Years. Available at http://www.foxnews.com/story/0,2933,1922 89,00.html
[34] Outcome measurements assess the consequences of care. They reflect a patient health status, functional status, quality of life, physiologic parameters, and levels of satisfaction and well-being. Outcomes are used to measure how a person responded to specific treatment interventions.
[35] Working Group on Biomedical Computing, Advisory Committee to the Director

 

Did they ask people if they would like a pony? I bet they would!

Posted by RM | Report as abusive
 

$2.241 Trillion – what we collectively spent on health care in 2007 as a nation.
$1.035 Trillion – was the government portion of the health care spending in 2007.
$900 billion – what a UK-style National Health Service for America would cost per year (providing medical, dental, and vision care to all Americans).

The government portion of annual health care spending is more than enough, all by itself, to full fund a US version of Britain’s National Health Service. This is a system that is the root cause of such undesirable things as Britain’s greater longevity and lower infant mortality, than in the US.

Posted by AC | Report as abusive
 

Equation !

$1.042trillion (cost of reform) + $245bn (cost to reflect annual pay raise of docs) = $1.287bn (actual cost of reform).

$583bn (the revenue package) + $80bn (doughnut hole) + $155bn (savings from hospitals) + $167bn (ending subsidies for insurers) + $277bn (ending medical fraud, a minimum of 3%) = $1.257trillion + the reduced tax on the wealthiest = why not ? (except for magic pill, an outcome-based payment reform & IT effects and so forth)

In relation with medical fraud, please visit http://www.npr.org/templates/story/story .php?storyId=111967435, you will be stunned ! Thankfully, in May 2009, the Obama administration announced a new task force made up of officials from the Department of Justice and the Department of Health and Human Services to work on health care fraud.

Thank You !

Posted by hsr0601 | Report as abusive
 

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