Massachusetts’ Health Reform Plan: Miracle or Muddle?

June 30, 2009

Grace-Marie Turner and Tara Persico. Massachusetts’ Health Reform Plan: Miracle or Muddle? Galen Institute, 06/26/09.

Interest in the Massachusetts health reform plan remains high as observers at the federal and state levels monitor its progress toward achieving universal health insurance coverage and controlling rising health costs. Many of the features of the Massachusetts plan are contained in legislation under consideration in Congress, including a bill offered by Massachusetts Sen. Edward Kennedy’s Health, Education, Labor, and Pensions Committee. Therefore, it is worth assessing the experience with the Bay State’s reform initiative so far for lessons that may be useful for federal lawmakers.

When the state’s reform plan was enacted in 2006, then-Massachusetts Gov. Mitt Romney was hailed for achieving what no other political leader has been able to accomplish: Developing a broad health reform plan with strong bipartisan support. By enacting sweeping health reform legislation, Massachusetts sought to be the first state in the nation to have all of its citizens covered by health insurance.

Since then, state officials, including Gov. Deval Patrick, as well as many others in the health sector and business community, continue to advance the reform experiment. But implementation continues to pose many challenges — both in access and costs — and observers are cautious about the outcome.

For example, more than half of those newly enrolled in health coverage in Massachusetts are in free or heavily subsidized plans, causing significant budget pressures for the state. Rising costs for health coverage and health care pose the biggest challenge to the success of the reform effort. And physician and medical workforce shortages have been exacerbated, with half of the state’s internists and family physicians closing their practices to new patients.

Architects of the plan are confident it will succeed. Jon Kingsdale, head of the Commonwealth Health Insurance Connector Authority, and others implementing the plan say support remains strong among political leaders and the business community. Gov. Deval Patrick cites 439,000 newly insured residents in the state as evidence of its success. But major problems remain, and duplicating the Massachusetts experiment would be a significant challenge for any other state, much less the federal government.

Massachusetts’ reform initiatives that are being considered by Congress include an individual mandate, employer play-or-pay mandate, a national health insurance exchange, strict regulation of private health insurance, expansion of Medicaid, and establishing a government-mandated health benefits package. Before proceeding to implement this experiment on a nationwide scale, it would be wise to learn more about how the reform plan in this sophisticated, highly-motivated state is developing. [Full Text] [Summary]

14th Annual Wall Street Comes to Washington Conference

June 29, 2009

14th Annual Wall Street Comes to Washington Conference
Sponsor: Center for Studying Health System Change
Date: Wednesday, July 8, 2009
Time: 9:00 a.m. – 12:00 p.m.
Location: Washington, DC

ABC News | Prescription for America: Obama Interview

June 27, 2009

On June 24, President Obama held a forum at the White House, where he discussed the pressing need for health care reform, and fielded questions and concerns from some of the 164 audience members. The audience represented a diverse array of health care stakeholders — including doctors, nurses, insurance company executives, small business owners, as well as patients from across the country.  [Full Interview] [ABC News Webcast of Prescription for America].

Urban Institute | Is the Public Plan Option a Necessary Part of Health Reform?

June 27, 2009

John Holahan and Linda J. Blumberg. Is the Public Plan Option a Necessary Part of Health Reform? Urban Institute, Health Policy Center, June 26, 2009. [Full Report (pdf)]

This paper makes the argument that a public plan is important to health reform because it will contribute to cost containment, primarily by addressing problems caused by increased concentration in insurance and hospital markets. We describe how the public plan might be structured, how many people might be expected to enroll, and how much money the public plan might save. We discuss the most frequent arguments that are made in opposition to the public plan. We conclude that the private insurance industry would survive at about the same size but be more efficient and more effective in controlling health care spending.

MedPAC Report to the Congress: Improving Incentives in the Medicare Program

June 24, 2009

Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Improving Incentives in the Medicare Program. June 2009. [NewsRelease] [Fact Sheet] [Full Report]

MedPAC’s report focuses on how incentives in the Medicare payment systems could be changed to strengthen the Medicare program and promote quality care for Medicare beneficiaries. “To achieve better care coordination and efficiency, Medicare must change the way it pays health care providers,” said Glenn Hackbarth, chair of the Commission. “Current incentives reward volume instead
of value and costly care instead of efficient, effective care. When providers don’t work together, quality suffers and costs increase—which benefits neither the patient nor the Medicare program.”

Book | Ethical Issues in Governing Biobanks: Global Perspectives

June 24, 2009

nBernice Elger, Nikola Biller-Andorno, Alexandre Mauron, and Alexander M. Capron. Ethical Issues in Governing Biobanks: Global Perspectives. Farnham, UK, Ashgate Publishing, 2008. ISBN-13: 978-0-7546-7255-5 257 pp, $114.95.

Reviewed byThomas A. Faunce, LLB, BMed, PhD, Medical School and College of Law, Australian National University, Canberra, Australia, in JAMA. 2009;301(24):2596-2597.

Many nations are now establishing large population-based biobanks and associated human genetic research databases that combine genetic information derived from biological samples with personal data about environment, medical history, lifestyle, or genealogy. Notable examples in addition to the pioneering Icelandic Health Sector Database Project are the Karolinska Institutet (Sweden), CARTaGENE (Canada), National Heart, Lung, and Blood Institute (National Institutes of Health, United States), KORA-GEN (Germany), the Western Australian Genome Health Project (Australia), and the Centre for Integrated Genomic Medical Research (United Kingdom). There have been few texts dedicated to the regulatory issues posed by biobanks. The most obvious comparitor is Biobanks Governance in Comparative Perspective (2008, Routledge), edited by Herbert Gottweis and Alan Petersen, which focuses more on issues associated with establishing biobanks in particular countries in Europe, the United States, and Australia. [Full Text of Review]

JAMA | States Explore Shared Decision Making

June 24, 2009

Bridget M. Kuehn. States Explore Shared Decision Making. JAMA. 2009;301(24):2539-2541.

Health officials in Washington State are probing whether more actively involving patients in decision making will help improve patient care and satisfaction and perhaps lower costs associated with certain elective medical procedures.

In 2007, the state passed legislation that officially recognized shared decision making as a high standard of informed consent. The law also required a demonstration project, which is now under way, to gauge the effects of this model of informed consent for treating patients with “preference-sensitive conditions” that have multiple options for care. The project includes such conditions as osteoarthritis of the knee or hip, low back pain, abnormal uterine bleeding, fibroids, benign prostatic hyperplasia, chronic stable angina, early-stage breast cancer, and breast reconstruction after mastectomy. [More]

NBER | Abortion and Crime: A Review

June 23, 2009

Theodore J. Joyce. Abortion and Crime: A Review. NBER Working Paper No. 15098, June 2009. [Full Text]

Ten years have passed since John Donohue and Steven Levitt initially proposed that legalized abortion played a major role in the dramatic decline in crime during the 1990s. Criminologists largely dismiss the association because simple plots of age-specific crime rates are inconsistent with a large cohort affect following the legalization of abortion. Economists, on the other hand, have corrected mistakes in the original analyses, added new data, offered alternative tests and tried to replicate the association in other countries. Donohue and Levitt have responded to each challenge with more data and additional regressions. Making sense of the dueling econometrics has proven difficult for even the most seasoned empiricists. In this paper I review the evidence. I argue that the most straightforward test given available data involves age-specific arrest and homicide rates regressed on lagged abortion rates in the 1970s or indicators of abortion legalization in 1970 and 1973. Such models provide little support for the Donohue and Levitt hypothesis in either the US or the United Kingdom.

NBER | Risk-Based Pricing and Risk-Reducing Effort: Does the Private Insurance Market Reduce Environmental Accidents?

June 23, 2009

Haitao Yin, Howard Kunreuther, and Matthew White. Risk-Based Pricing and Risk-Reducing Effort: Does the Private Insurance Market Reduce Environmental Accidents? NBER Working Paper No. 15100, June 2009. [Full Text]

[Note: this paper does not relate directly to health policy, but may provide some useful evidence regarding the performance of public vs. private health plans]. This paper examines whether risk-based pricing promotes risk-reducing effort. Such mechanisms are common in private insurance markets, but are rarely incorporated in government assurance programs. We analyze accidental underground fuel tank leaks–a source of environmental damage to water supplies–over a fourteen-year period, using disaggregate (facility-level) data and policy variation in financing the cleanup of tank leaks over time. The data suggest that eliminating a state-level government assurance program and switching to private insurance markets to finance cleanups reduced the frequency of costly underground fuel tank leaks by more than 20 percent. This corresponds to more than 3,000 avoided fuel-tank release accidents over eight years in one state alone, a benefit in avoided cleanup costs and environmental harm exceeding $400 million. These benefits arise because private insurers mitigate moral hazard by providing financial incentives for tank owners to close or replace leak-prone tanks prior to costly accidents.

via Risk-B Risk-Reducing Effort: Does the Private Insurance Market Reduce Environmental Accidents?.

NBER | Obesity, Self-esteem and Wages

June 23, 2009

Naci H. Mocan and Erdal Tekin. Obesity, Self-esteem and Wages. NBER Working Paper No. 15101, June 2009. [Full Text]

Obesity is associated with serious health problems, and it can generate adverse economic outcomes. We analyze a nationally-representative sample of young American adults to investigate the interplay between obesity, wages and self-esteem. Wages can be impacted directly by obesity, and they can be influenced by obesity indirectly through the channel of obesity to self-esteem to wages. We find that female wages are directly influenced by body weight, and self-esteem has an impact on wages in case of whites. Being overweight or obese has a negative impact on the self-esteem of females and of black males. The results suggest that obesity has the most significant impact on white women’s wages.