A story in today’s New York Times begins: “For years, health policy experts have said health care spending is much higher in New York City and Boston because doctors and hospitals there provide more services, practicing medicine in a more intensive way. But new government data show that Medicare costs per patient in those cities are slightly below the national average when the numbers are adjusted for the cost of living and other factors.”

The Times goes on to explain that President Obama “says that the nation could save huge sums if all doctors and hospitals were as efficient as those in lower-cost states like Iowa, Minnesota, Washington and Wisconsin. Lawmakers from those states have reached an agreement with House Democratic leaders that would increase federal Medicare payments to health providers in their states. Higher-cost states, which could see their Medicare payments reduced, are fighting back.”

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Here’s what we have been waiting for and waiting for and waiting for  –Senate Finance Chairman Max Baucus’ outline for “bipartisan health care reform.” You’ll find the 18-page document here.

Keep in mind this is still a work-in progress. But I couldn’t help but notice a gift to the for-profit insurance companies near the very top of the document:

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Over at Jon Cohn’s TNR blog, The Treatment, Harold Pollack a, professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment points to a major piece of misinformation in today’s New York Times.

In an interview, a reporter asked: Would any of the plans under discussion on Capital Hill reduce the rate of medical bankruptcies?"

The single-payer advocate responded: "Only the single-payer plan sponsored by Representative John Conyers, Jr. and Senator Bernie Sanders. The others pretty clearly do little or nothing for medical bankruptcy.”

As Pollack points out, this simply isn’t true—the House bill caps how much money a family of four earning $55,000 a year can spend out-of pocket on health care at $368 a month–even if they were in an auto accident and ran up $300,000 worth of medical bills. (Their monthly medical premium would be capped at $322 a month)  See his full explanation here.

More reporters need to read the House bill and explain what is in it to their readers. Otherwise, people will continue to repeat lies like this one until everyone believes them. (Let me be clear: I am not suggesting that the single-payer advocate deliberately lied. My guess is that he just hasn’t read the House bill carefully, and is relying on what other single-payer advocates have told him.)

Pollack ends his post: “I don’t blame single-payer advocates for pushing their own bill, HR676. Still, I am baffled by the apparent hostility with which some single-payer advocates regard current health care reforms. I am also baffled by the apparent equanimity with which some regard the prospect of these measures [the House bill and the Senate HELP bill)  going down to defeat—a defeat that would badly damage the Obama presidency. Pollack links to this interview.

Addressing the single-payer advocates, Pollack writes: “Wake up guys. We need the  help.” Do they really want to see Obama become a one-term president?

September is Sickle Cell Disease Awareness Month and it would be hard to find a disease that could benefit more from a boost in public attention. Yes, advocates still organize walks through city streets to raise money and support for this, the nation’s most common inherited blood disorder. And over the years the post office has issued special stamps to help Americans remember that there are 72,000 or more people living with this debilitating disease.

Yet, despite the fact that some 2 million Americans, or 1 in 12 African Americans, carry the sickle cell trait and 2,000 babies are born each year with the disease, public and private funding for research, clinical trials and social programs has remained consistently low. Pharmaceutical companies have introduced no new drugs to treat sickle cell disease and the pipeline remains dry. Patients, mostly minorities and recent immigrants, face steep hurdles to receiving care. These obstacles include institutionalized racism, lack of insurance, language barriers and serious under-treatment of pain.

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Michael Millenson, the president of Health Quality Advisors LLC, is the author of an excellent book Demanding Medical Excellence: Doctors and Accountability in the Information Age. Earlier in his career, Millenson  was a Pulitzer Prize-nominated reporter for the Chicago Tribune. Recently Millenson put his investigative skills to work to explore the two sides of Betsy McCaughey: “Good Betsy and Bad Betsy” for Matthew Holt’s The Health Care Blog (THCB)  http://www.thehealthcareblog.com/the_health_care_blog/2009/09/betsy-mccaugheys-infected-advocacy.html   Enjoy.

Health Wonk Review spotlights the best healthcare posts of the past two weeks. The most recent edition calls attention to Joe Paduda’s two-part post on Managed Care Matters.  Part 1 is titled, “Your Life Without Healthcare Reform.” (See http://www.joepaduda.com/archives/001615.html

Paduda begins by observing that reports from consulting firms Segal and Aon reveal that health benefit costs will jump more than ten percent next year—and that this “shows exactly what we’re in for if reform efforts fail.

“And by 'reform'” Paduda adds, “I mean reform with strong cost controls.”

I would add that, for the past 10 years, the amount that private insurers have been spending on health care has been levitating by roughly 8% a year. If we continue on the current track, this means that in nine years, healthcare costs—and your premiums—will double.

“But when something can no longer continue, it won't,” says Paduda. “When enough Americans lose their coverage, when cost-shifting gets to the point where those left with insurance are paying thousands in premiums to cover those without, when local taxes to pay for teachers' and police benefits get so high that folks are losing their houses, when Medicare finally goes insolvent, when hospitals are collapsing due to the cost of indigent care, when big pharma and device companies are no longer making the gazillions they so richly deserve, then, and only then, will the screaming hordes at Town Hall meetings decide that any health care coverage is better than none.

“While the opponents of reform may well win this battle,” he concludes, “in the long run they will lose the war.”   

I agree, and like Joe, I can only hope it doesn’t come to that. If it does, by then health care inflation will have driven a spike into the heart of the economy. If that sounds like an overstatement, keep in mind that White House budget director has told us that climbing health care costs represent “the single greatest threat to the U.S. economy.”

In part 2 of Paduda’s post, “Your Life Without Healthcare Reform,” he sketches what a future without reform holds. Here are just a few details (for links to his evidence, go to the post here: http://www.joepaduda.com/archives/001616.html

n  178,000 small business jobs will be lost by 2018 as a result of health care costs

n  If employee contributions stay at their current level (about 30% of premiums),  workers will be paying $9000 per year, or $750 per month, towards their health coverage – not including deductible, copays, coinsurance, and services not covered

n  More Americans will have to rely on the kindness of others for their health care. Because 65 million of us will be without health insurance.

“Unlike the distortions, misrepresentations, and outright lies being spread by McCaughey, Limbaugh, Palin et al, this is the real deal,” Paduda writes.  “So fight against reform if you wish, but don't complain later when you can't afford insurance, your employer can't afford insurance, your taxes are going up to pay for teachers' benefits, and our economy is sinking under the weight of health care costs.”

Kudos to Paduda, who understands what is at stake here.

To explore many other excellent health care posts included in the newest Health Wonk Review, check out the Lucidius Report http://lucidicus.org/editorials.php?nav=20090903a  which is hosting Health Wonk Review this time around.

The Congressional Budget Office (CBO) has warned that progressive proposals for reforming health care will add to the deficit that looms over our economy. But when you stop to think about it, just how likely is it that CBO can accurately predict the cost of health care reform—and the savings that it will generate– over a ten year period?  Virtually any economic predictions that attempt to go out ten years are, at best, guesstimates. Few  investors  would attempt to project a single company’s earnings out over ten years: how can one “score” the effect of very complicated legislation on a $2.6 trillion industry?

"The CBO’s track record in predicting the effects of health legislation is abysmal,” observes Bruce Vladeck, the man who ran Medicare while serving as administrator of the Health Care Financing Administration from 1993 to 2997.  “Over the last two decades, the CBO has routinely overestimated the costs of expanded government health care benefits,” Vladeck adds, “and underestimated the savings from program changes designed to reduce expenditures.”

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If you take a look at the history of left-wing politics in America, you’ll find that left-wingers always seem to be spoiling for a fight—with each other.

This summer, many on the left have decided to attack the very president who so many championed not nine months ago.  Let me be clear: I, too, could find fault with what the President has done, and hasn’t done, during his first eight months in office. In particular, I’m sorry to see a troop build-up in Afghanistan, and would be much happier if many more U.S. soldiers were coming home.

But military strategy is not my area of expertise.  Health care is, and when it comes to reform, this president has accomplished more in eight months than any president in the past 44 years.

Yet, the left, like the right, continues to spread misinformation about President Obama’s efforts at healthcare reform. For example, today Allison Kilkenny co-host of Citizen Radio, the alternative political radio show published this piece on AlterNet alleging that the president has “betrayed the progressives who got him elected” :

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Healthcare –and healthcare reform—is complicated, in part because so much of what we think we know about American medicine turns out to be untrue. For instance, one would assume that more expensive care would be better. But the Dartmouth research has taught us that isn’t the case. Most people also assume that for-profit insurers are making a fat profit; after all, look at how high insurance premiums are! 

But as Rick Newman points out in the most recent issue of U.S. News & World Report , “blaming insurance firms for runaway healthcare costs is a weak argument, because the insurance industry isn't all that profitable to start with."

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I still recall Ted Kennedy’s speech at the 1980 Democratic convention. It remains the finest, most inspiring political oration that I have ever heard. This is in part because Kennedy was speaking from a position of defeat. He had just lost the Democratic nomination to Jimmy Carter. And yet this was a full-hearted, rousing speech delivered by a man who realized that in the battle ahead, the issues at stake were far, far more important than his own loss. Intuitively, he knew that the country had reached a turning point.

Many people are talking about that speech today. Instead of substituting my prose for Kennedy’s, I have decided to quote high points from that speech for the many readers who either didn’t hear it– or don’t remember it in all of its richness. This was a speech written long before slippery political strategists had learned to “frame” ideas as bumper-stickers. In its eloquence, it shows great respect for the English language, for ideas, and for its audience. And, I think, it reminds health care reformers that this is not a time to “yield.”

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