It's Expensive, Yes, But What is the Cost of Doing Nothing?

Coffee Brown, University of New Mexico, Talk Radio News Service

Dr. Peter Orszag, previously the Director of the Congressional Budget Office, currently the Director of the President's Office of Management and Budget, told the Senate Committee on Finance that the cost of doing nothing about healthcare reform would be fiscal crisis, decreased take-home pay, 46 million uninsured Americans, and an increasing burden on state governments which is already cutting into other services, such as increased tuition costs for college.
"Do you know of anyone in either party who wants to do nothing?" Sen. Chuck Grassley (R-Iowa) asked.
Orszag replied, "No, Sir. That's why I am confident that we can get healthcare reform passed this year."
Grassley said there was not yet any conflict between Republicans and Democrats about healthcare reform, but that that was partly because the president's budget, while "bold", was "not very detailed."

Still, $634 Billion is a lot of money.

Sen. Max Baucus (D - Mont.) said, "Would healthcare reform now lead to substantial savings?"
"Yes," answered Orzack.
"Should we accept short term deficit spending to achieve that?" asked Baucus.
Orzack replied, "The president's budget for healthcare reform is designed to be deficit neutral for the first 5-10 years, then we should begin to see savings. If we could cut one percent per year from medical cost growth, we could realize savings of 20 percent of GDP in 50 years. For forty years, medical costs have risen 2 to 2.5 percent faster than inflation."

The hearing, at which Orszag was the sole witness, turned from general costs to specific strategies.

Baucus asked, "Can we incentivize consumers to be more cost effective?"
"25 percent of beneficiaries use 85 percent of the cost. That's the group to target," Orszag replied.
"Would costs come down if everyone were covered? And how could we do that?" Baucus asked.
According to Orszag, we need to reduce consumer costs, reduce complexity, and encourage enrollment. We can encourage enrollment by subsidies, mandates, and automatic enrollment with an opt-out choice. Social norms need to change, so that people would be as shocked if you had no health insurance, as they now are if you don't buckle your seatbelt. the key to that is massive public awareness campaigns, he finished.

Grassley said he was concerned that Medicare Advantage might be cut too sharply under the new budget. Physicians might opt out of Medicare if reimbursement is too low.
Orszag said that Medicare Advantage was targeted because it paid substantially more than basic Medicare.

Expansion of the public sector would place new pressures on the private sector.

"Would a public plan undermine Obama's promise that people who prefer to can stay with their current plan? Would Obama support a plan that would 'crowd' 18 million people off private plans onto public?" Grassley wondered.

Sen. Maria Cantwell (D - Wash.) was also concerned about proposed cuts: "We've found medical homes, home care, and Medicare Advantage to be cost effective, but they face cuts under the new budget."
"Evidence strongly favors integrated care...Long term health care is in the budget...Competitive bidding should reflect local costs," Orszag replied.
He pointed out later, however, that the budget office had found that home care typically had much higher profit margins than other sectors of healthcare, and had been targeted for that reason.

Public funding means public accountability.

Orrin Hatch (R - Utah) said, "A Federal Reserve-style medical board would be a disaster, leave standards of care to the specialty boards. Keep these decisions in the private sector. We should not be be setting prices."
"Those problems are common to all the models. Both public and private systems must change," Orszag said.

Sen. Baucus closed the meeting by pointing out that time is of the essence, and the Senate must move quickly.
"We have our sleeves rolled up; we're ready to go," said Orszag.

Nursing in Critical Condition

Coffee Brown, University of New Mexico, for Talk Radio News Service

Susan Reinhard, of AARP’s Public Policy Institute helped found the new Champion Nursing Coalition in response a critical and worsening shortage. Thousands of qualified prospective students are being turned away from nursing programs for lack of enrollment capacity, she said. At the same time, she continued, there will be a deficit of 500,000 to a million nurses by 2025.

John Lumpkin, MD, MPH, of the Robert Wood Johnson Foundation described a few of the many roles nurses fill, clinical, social, chronic care, and administrative. He called the shortage unprecedented.

There is some good news, however, according to Nancy LeaMond Ex. VP at AARP. Agency for Healthcare Research and Quality (AHRQ) polls show overwhelming positive ratings and public support for the profession. AHRQ is a federal agency tasked with studies of healthcare improvement.

Citing Institute of Medicine Studies, Nancy Reller, representing Consumers Advancing Patient Safety, said that understaffing of nurses is associated with worse outcomes.

Jerald Newberry, for the National Education Association, said that asthma, obesity, and diabetes are so common in elementary schools that every one of them should have a nurse, but that many do not.

The panel recommends that funds be used to expand nursing programs, which would require about twice as many instructors as now. As it stands, about half of current instructors are expected to retire over the next decade.

It's Not So Much What You Spend As What You Know

Coffee Brown, University of New Mexico, for Talk Radio News Service

Several programs based on knowledge and teaching, rather than intensive funding, have proven effective in test communities, according to Wayne H. Giles, MD, MS, of the Centers for Disease Control (CDC).

The CDC has promoted programs like giving flu shots at voting sites, inspecting the homes of the elderly for trip-and-fall hazards, and educating patients to ask the right questions at clinic visits.

Substantial gains resulted in markers like the percentage of at-risk individuals getting flu shots, safer homes, and better blood sugars.

Giles noted that it's not enough to tell communities they need safe places for people to walk and exercise; action plans, "step by step cookbooks," are available online free through the CDC (http://apps.nccd.cdc.gov/DACH_CHAPS/Default/LinksResourceType.aspx?topic=7) and HHS(http://www.communityhealth.hhs.gov/homepage.aspx?j=1). These resources have proven effective and are intended for use by communities all over the country looking for low cost ways to improve the health of their members, Giles told the National Advisory Committee On Rural Health and Human Services.

A Futuristic Grid and Fossil Gas are Energy’s New Pillars

Coffee Brown University of New Mexico, for Talk Radio News Service

During two energy conferences in Washington, DC, Secretary of Energy Dr. Steven Chu said that a new, expanded, robust, and smart electric grid is the big ticket item for his department in the just-signed stimulus bill (American Recovery and Reinvestment Act).

We are moving away, he said from locally produced power in pursuit of alternative energies, such as wind and solar, which are favored by geography in sparsely populated areas. As energy is produced in a fluctuating pattern due to local weather, and then sent farther away, a computerized grid which can direct, even out, monitor and store power will be needed. This coordination will extend even to homes, where fluctuations in use or peak draws can be managed to limit brown- and black-outs. he described circadian pricing, rewarding users who shift usage away from peak hours, and buy-back credits for homes which actually produce power as examples of smart distribution at the home level.

Chu noted that the new grid could be a target, so robust design was a security priority.
While wind power is as high as 20 percent in some areas, it is only three percent of overall production, and will need to mature and expand over a decade or more to compete on a cost-per-kilowatt basis.

Chu has made a priority of streamlining funding of shovel-ready projects, which were facing delays of up to two years for approval.

At the second conference, chaired by Senate Majority Leader Harry Reid, and attended by entrepreneur and hedge fund manager T.Boone Pickens, the question of new regulatory agencies came up, as power distribution became less regional and more interconnected. Reid said that he thought it could be handled administratively.

Pickens said that there are vast reserves of natural gas at several fields in the U.S., far more than would be needed to bridge the gap to non-carbon pumping energy production. Trucks, he said, can never run on batteries but can easily be converted from gasoline to natural gas, which is 30 percent cleaner and would create many American jobs and businesses.

Chu concluded by saying that carbon capture and climate change are important topics that will be addressed in later stages of the program.

House Republicans Contend That H.R.2 is Not Bipartisan, Democrats Disagree

Coffee Brown, University of New Mexico, for Talk Radio News Service



In Wednesday's statements prior to voting, Republicans led by Pete Sessions (R-TX) complained that they had been effectively shut out of any debate over the provisions of H.R. 2: Children's Health Insurance Program Reauthorization Act of 2009. They said the 40 percent of House members who were Republicans and the 12 percent who are freshmen (Note: this appears to double count 22 out of 54 freshmen), were not included in the drafting of the bill’s provisions.

Democrats, led by Jared Polis (D-CO) countered that the original bill was co-sponsored by Republicans and the extension was passed twice with overwhelming bipartisan support already, only to be vetoed by then-president Bush. Since there are no substantive changes, they said, this bill is bipartisan.
Republicans stated that they want to pass an extension of the existing bill, but not an expansion.
The current version, they feel, invites fraud by removing the proof-of-citizenship requirement. It expands coverage to families with much higher incomes than before, up to 80 thousand dollars, by raising the qualifying threshold from twice the poverty level to three times that, and by waiving some forms of income from consideration. This, in turn means that the four million new enrollees will include about 2.4 million who are actually privately ensured now. S-CHIP should not compete with private insurance because public healthcare pays only 30-50 percent of market, making providers reluctant to see such patients, thereby reducing access and lowering quality.

Several states are using S-CHIP to cover adults, they added. The net effect, according to Steven King (R-IA), will be to raise the true cost from the projected $3.85 Billion to over $15 billion. Cigarette taxes are not going to be nearly enough to pay for that, especially if smoking rates continue to fall.
Sessions reminded Democrats of their own criteria for the bill, saying, "This is neither cost effective nor common sense."
Democrats said caring for children should be the nation's first priority. They pointed out that children born here are citizens regardless of their parents' status, and children have no say in their own socioeconomic circumstances.
Healthcare dollars are cost effective, they said, because they ensure healthy workers and help reduce the high costs of under-managed chronic disease and of avoidable emergency department visits. The younger we begin preventive care, the greater the return on the investment. Healthcare also generates high quality, lasting jobs.
In the words of Alan Grayson (D-FL), "Choose life."

The measure passed, with 30 Republican votes, 183 to 89.