Health Reform Passes. Now, The Real Work Begins.

Well, as I'm sure you're well aware, Health Reform has passed both Houses of Congress. The House of Representatives passed their version on November 7th, 2009 with a vote of 220-215. The Senate passed their version of the health care bill on December 24th, 2009 with a clear 60-39 party-line vote. A clear victory for health-reform advocates (and a nice Christmas gift for those advocates whom celebrate the holiday), the battle is far from over.

Step 1 of the battle was passing the bill. Step 2 now is compromising the two forms and agreeing on the bill's provisions, which is no small task. A number of provisions will be hammered out: 1) national versus state health exchanges (no more public option), 2) definition of, and possible taxing of, "Cadillac" health plans, and 3) how to pay for this health care overhaul. Democrats are focusing on some provisions appealing to all consumers, such as: 1) the cutoff age for children to be on their parents' health plan moved to 26, 2) eliminated co-payments for preventive services, and 3) no more denying coverage to children under the age of 18 with preexisting conditions. However, that doesn't mean Republicans are done fighting. As stated by Minority Leader Mitch McConnell (R-KY), "My colleagues [Republicans] and I will work to stop this bill from becoming law."

I think Adam Zyglis' (from the Buffalo News) Charlie Brown cartoon (above) says it all for our next steps. How far will the compromises go and what will our final version of health care reform look like? Will it be enough?

5 Months Until Health Reform?

I took a quick look today at Kaiser Health News (KHN), the new nonprofit news organization devoted to health care policy and politics.  They just rolled out today, June 1st, 2009.  I added a quick link in my bookmarks also.  KHN will be a great, high-quality resource for stories on things like health reform, health care costs, insurance, aging, health IT, and quality and delivery of care issues.  I urge you to take a look.

Regarding the title of this post, "5 Months Until Health Reform?," an interview was done with White House health care czar, Nancy-Ann DeParle and she estimates that Obama will have a health reform bill on his desk by Thanksgiving.   DaPerle is asked about her thoughts on financing, and the answere appear unclear, although she does state her opinion that health reform will not be funded primarily with taxes and that a scaled back version of health reform (e.g. scaling uninsured number to half) is not an option right now.  Full reform is the focus.  Also see the KHN article, "Big, Small or Nothing At All? Three Scenarios For Health Reform."  

What are your thoughts on health reform?  What about Kaiser's new health news, KHN?

You can view the press releases for KHN here:  11-19-2008 and today's roll-out 6-1-2009.

Obama & Health Care: Most Likely Outcomes

Obama has some hefty challenges awaiting him in the White House for sure.  The rough economy and war overseas will have to be immediate priorities in January.  Health care reform is also in that list of top priorities.  Last week, Johns Hopkins School of Public Health (JHSPH) held their 4th event in the Universal Healthcare Series, "Moving Toward Universal Healthcare:  Alternative approaches to reform in the US."  Harvard's Dr. David Himmelstein was among the speakers, whom pointedly noted that we've had plenty of opportunities for reform, which have failed (think Clinton's 1992 effort and many multiple state attempts).  He pointed out that now is our opportunity for reform.  

In today's issue of The Lancet, Nellie Bristol discusses Obama's plans for our country and the world's health (Obama's plans for US and global health care).   Many project the following are most probable and feasible Obama's immediate administration:  reversal of Bush's ban on stem cell research, expansion of State Children's Health Insurance Program (SCHIP), reversal in "Mexico City policy" (aka global gag rule), and the establishment of a comparative effectiveness group (similar to UK's National Institute for Health & Clinical Excellence).  

To expand on probable immediate actions, Obama is likely to remove some of the restrictions Bush placed on stem cell research (to only use existing stem-cell lines).  Secondly, SCHIP was vetoed by Bush last year after approval from both houses of Congress.  Most likely coverage will be expanded by $35 billion to $60 billion (paid by cigarette taxes).  Children make up 20% of the US uninsured population (Kaiser Foundation).  Expansion of SCHIP appears likely.  Next, the Mexico City policy (global gag policy) requires NGOs to agree to neither "perform nor actively promote abortion as a method of family planning in other nations."  It was enacted by Reagan in 1984, overturned by Clinton, and put back into place by Bush.   Finally, the comparative effectiveness group would look at evidence-based medicine and the Medicare system for physician reimbursements to give guidelines for clinical practice.  

What will be the long-term results though?  Will we move away from employer-based health insurance?  Will we cover all Americans?  Will we have better preventive care and can we improve health outcomes with new policy reform?  How much will we spend on global health, when the US needs the health improvement also?  

It's certainly an interesting time to be near Washington DC and in the field of Health Policy & Management.  Be sure to advocate and put full pressure on local representatives to push for health care reform (there is also currently a $1m media campaign targeted at newly elected officials to "keep their promises" for health care reform).  

If we don't reform US health care now, (when) will we?