Investing in children is an investment in the future

In a conference call today, the Commonwealth Fund discussed a new report which ranks all 50 states and the District of Colombia on key measures of how each state’s health care systems are working for children. The report, to be released tomorrow, assesses states on 13 measures on their health care, quality care, health care costs, health care equity and the potential to lead long healthy lives.

The Commonwealth Fund is a private foundation that supports independent issues on health care research, and try to get proper information to policy makers to make policy decisions according to the needs of the people. Unlike adult health care, children’s health care relies heavily on federal and states funding not private insurance. According to the report Michigan has the lowest amount of uninsured children at five percent, whereas Texas has 20 percent of uninsured children. Edward Schor, vice president for child development and preventative care at the Commonwealth Fund, said that if every state had only five percent of children uninsured, there wold be 4.6 million more insured children cutting the amount of uninsured children in half.

The main purpose of the report, according to Karen David, president of the Commonwealth Fund, is to help individual states better their health policies for children. States can learn from each other and should model their own policies after successful states, because investing in children’s health is an investment in the future, said Schor.

There is a wide variation across the states, and the report is intended to bring attention to high performance, not as an ideal of what would be desirable but to show what is feasible and what has been achieved by others, said David. In general the south ranked poorly, and Iowa and Vermont led in overall performance. More information and a state by state ranking can be seen at www.commonwealthfund.org.

Medicare putting seniors at risk; leaving them vulnerable/

This morning there was a full committee hearing on Medicare improvements titled "Seniors at Risk: Improving Medicare for Our Most Vulnerable," focusing on Medicare Part D's Low Income Subsidy. Ranking Member Senator Gordon Smith (R-OR) and others were on hand to hear testimony.

After a brief introduction of the Medicare program and part D's low income subsidy, testimony was heard from multiple people including representatives from the AARP, Georgetown University Health Policy Institute, and SHIBA, The Senior Health Insurance Benefits Assistance.

Perhaps the most interesting testimony came from Judy Korynasz, a beneficiary witness and caregiver for her mother whom does not qualify for low income subsidy due to personal assets. Mrs. Korynasz has medicare along with her husband, in addition to her mother Charlotte Wachdorf, as noted above. Mrs. Wachdorf has chronic obstructive pulmonary disease, diabetes, congestive heart failure, chronic anemia, and many other illnesses. She has to take many medications, use a walker, and is restricted to using oxygen. Unfortunately, paying for this health care uses a significant amount of her money, even with the help of Medicare. Due to the confusing wording of the program, some seniors are being confused as to which program is the best for them. In the meantime, seniors are paying outrageous costs for health care, which is a clear indication that the program needs to strengthen. Though the program has helped some, it could help more.

U.S. health care system: “most expensive, crazy structure in the world”

The New America Foundation (NAF) held a discussion on "Employer Health Costs in a Global Economy: A Competitive Disadvantage for U.S. Firms," with opening remarks by Sen. Debbie Stabenow (D-Mich.). She said the U.S. is losing jobs because of the structure of health insurance and the inability to lower costs. She said the U.S. has the most expensive and crazy structure in the world for health insurance, and that this creates a competitive disadvantage. Stabenow, and other senators, are working on the Healthy Americans Act to address these problems.

Len Nichols, director of the Health Policy Program at NAF, said health care costs are going up, and that firms are pushing health care costs into wages while unions push back. He said the hourly cost of health benefits for the manufacturing trade in the United States in 2005 was $2.38, compared to $0.86 in Canada. He said that the driving factors for this difference are the increase in employers’ cost share and an inefficient health system. He feels “the employer role is good health policy and good economic policy,” and suggests extending “the advantages of the employer system for all Americans.”

Charles Kolb, president of the Committee for Economic Development (CED), said the employers’ role in financing health care needs to change. He said the U.S. is outspending and yet under performing in health care, and that to compete in the international economy the country needs a healthy workforce. He said the employer sponsored system is not sustainable, for reasons including high costs, low efficiency, and the fact it leaves people out. He and CED suggest creating independent regional “exchanges” to provide “a single point of entry for each individual to choose among competing private health plans.”

Andrew Webber, president and CEO of the National Business Coalition on Health, had a different point of view, which he said was less “gloomy.” He agrees that U.S. employers pay more than the rest of the world, that employers can’t shift costs, and that the business community can’t raise prices because of global competitiveness, but he is not ready to “throw in the towel” on the employer based system. He believes that if the employer community got together and was serious and aggressive, they can fight for transparency, better performance, higher quality, and more efficient costs for health insurance. He said he is not ready to pass health care over to consumers to fight for on there own.

Gerald Shea, assistant to the president of government at the AFL-CIO, said he provided the workers’ perspective to the discussion. He said employers want to be involved and provide health care, but that the system can’t continue in this way. He said from the unions’ point of view, workers are accepting lower wages to maintain the same health care benefits, since people can not do without health care. He said group purchasing is the key to having the power to control costs.

Nursing shortage could hinder health care reform

Nursing Economics held a discussion at the National Press Club to discuss the plight of the current nursing shortage and its impact on the availability and effectiveness of health care. The presenters released a report called “Nursing Trends: 2007: Key facts about a changing workforce” complete with graphs showing results of surveys and statistics relevant to the shortage.


Peter Buerhaus, RN, professor of Nursing, and Director said that the shortage of registered nurses began in 1998 and has continued to be the longest lasting shortage on record. He said the number of registered nurses continues to grow, but at a rate that is too slow to meet demand. Citing that less than one percent of American men and Latinos are RNs, Buerhaus said that an increase in RNs from those demographics would help alleviate the shortage.

Beth Ulrich, RN and Senior Vice President, surveyed nurses about presidential candidates’ positions on health care and nursing and found that while Sen. Hillary Clinton (D-NY) received the highest endorsement, 31 percent of participants did not believe any candidate had an adequate reform plan.

Karen Donelan, Senior Scientist in Health Policy, surveyed public perception of the nursing field and found that the public views registered nurses in extremely high favor, second only to teachers. She said responses also showed that the public believes physicians are overpaid and nurses are underpaid, and that this contributes to the shortage of registered nurses.

Super Tuesday in a drowning nation

By Ellen Ratner

Twenty-four hour campaigning, 7,000 person rallies, political ads filling every TV and radio spot, political pundits spewing their latest guesstimates … overall, there is a lot of noise and promises, but no one is dealing with two of the biggest issues facing America – debt and health care crises.

In fairness, Ron Paul has attempted to elevate the debt crisis to the national scene, but he has been sidelined. And yes, the Democrats are talking about health care for all, and even Mitt Romney is touting his Massachusetts health care plan, but neither party is taking a hard look at the facts with debt or health care.

According to Demos and the Center for Responsible Lending, credit card debt has almost tripled since 1989 and risen 31 percent in the last three years. Many people are using credit cards as safety nets instead of relying on savings. Low and middle-income households have an average $8,650 in credit-card debt. Most people with this amount of debt have carried it for more than one year. Almost half of all card debtors have used their credit cards to pay for automobile repair. Not just paying the minimums, most people in this study paid $700 last month and are making a median payment of $300 per month. This kind of debt for so many Americans is clearly unsustainable.

On the health care front, the issue has been focused on the ability of people to purchase health insurance policies. Mitt Romney worked with the Democrats in his state to fine people who did not buy health insurance policies and to underwrite part of the costs for people who could not afford it. Hillary Clinton and Barack Obama each have plans to get the majority of Americans to be able to purchase health insurance. None of the candidates are discussing the real problem – the cost of health care, whether it is paid by insurance or the government, is going to rise astronomically. Insurance is not going to pay these rising costs because they will go broke doing so. Health care is now almost 17 percent of our GDP, up from 13 percent in 2000, and it is rising about a percentage point a year.

You do not have to be a Nobel laureate in economics to know that these numbers are unsustainable – health care will not be affordable to individuals or taxpayers as it takes a larger and larger chunk out of our overall economy.
Even though the candidates don't want to address these problems, there are solutions. First, on the credit crisis, we can provide real incentives for people to save by providing some kind of matching program in the same way that we are giving out treasury checks in the stimulus program. Congress can support legislation that would provide a tax break to those who save. Second, start making some deals with the credit card companies in the form of tax savings if they stop handing out easy credit and start reducing the monthly interest rates for people with high debt.

In addition, Demos and the Center for Responsible Lending recommend that credit card companies be required to disclose the overall cost of minimum payments and require meaningful underwriting standards so that credit card limits are not pushed beyond what they know can be paid for by the consumer.
With health care taking such a bite out of our GDP, the only solution is to turn the rising health technology costs into a plus on our national balance sheet. Other countries recognize our expertise. Johns Hopkins and the Cleveland Clinic are going to be managing hospitals in the United Arab Emirates. With our advances in equipment and other technology, there is no reason why we can't pay for our increasing health care bill by supporting research and exporting it. We have given tax breaks to tobacco companies to export their products, why not the same for health care innovators and providers?

The above are just a few solutions to major economic problems but nary a word from the major presidential hopefuls. You have to dig deep on their websites to find any in-depth thinking and forget about policy specifics. They are convinced that the American people don't want to hear anything but sound bites. If you don't believe that, watch one of the debates. They simply respond to one generality with another unless it's about "who" said or did "what" "when," and then the exchange becomes so sophomoric, as it did with Sen. McCain attacking Romney last week, that the other candidates have to redirect the focus to real issues when moderator Anderson Cooper lost control.

President Bush is no different than the candidates. He prefers to fly in the stratosphere on issues versus rolling up his sleeves and addressing root causes. He signed an executive order to put together a panel on increasing financial literacy for the greater population; that is great, but it hardly helps people caught in the vise now. Americans aren't dumb; they want real talk about real solutions. Too bad Super Tuesday won't move the candidates to enter into the discussion.