Also missing: better ways to pay doctors and hospitals
posted 6-23-2009 7:50 p.m.; updated 7-13-2009 4:41 p.m.

 
In my last post, I began a list of what’s missing so far from health care reform efforts:

• enough primary care doctors, primary care nurse practitioners and hospital nurses
• more practitioners and resources in the right places
• better funding mechanisms for practitioner and hospital malpractice insurance
• a national medical malpractice arbitration system to settle most claims, similar to no-fault workers' compensation
• functional, properly financed metro and regional trauma networks
• better physician practice organization
• needed data collection and analysis on a large scale
• a federal privacy czar at cabinet level to monitor and police the privacy and security of consumers' medical, financial and other data and punish offending database owners and other violators

The last entry addressed the first four points. Since then, I’ve come up with two more missing pieces:

• better ways of paying health care practitioners
• better ways of paying hospitals

You’ll notice I didn’t include nursing homes or intermediate care facilities; that’s an entirely separate discussion and a mammoth Gordian knot of its own. Let’s leave that for another time.

By ‘better ways’ I mean mechanisms for paying health care providers that provide reasonable compensation for them without bankrupting the rest of us. But there’s more to it than that.

Fixing health care reform: too many missing pieces now, but we can build on parts that work
posted 5-12-2009 2:17 p.m.

 
There are those who liken tinkering around the edges of health care reform (which is all Congress and the president have attempted, so far) to fixing a leaky faucet or unclogging a drain in New Orleans while Hurricane Katrina approaches: there’s a much bigger picture that needs to be addressed. I agree with that last part, but to me the health care system is more of a Rube-Goldberg machine or a potential This Old House project: it began long ago with a very small core and was slowly cobbled together over time to do more and more but performs in a costly, roundabout, less than effective way — yet our attempts to improve it have only resulted in more things cobbled on, without rethinking the entire design.

With the rising clamor for a public health insurance plan as an alternative mechanism for covering everyone, it’s time to think about whether or not we have the pieces of the delivery system in place to make a public health plan effective. I don’t think we do. However, we do have pieces that are useful now and would be good to incorporate into any reformed delivery system. We have to retain those parts while we figure out what our care system needs to look like, which will determine what our reform plan must look like.

Sebelius, DeParle will have their work cut out for them
posted 3-2-2008 7:46 p.m.

&nbspbr>The Obama Administration today announced the nominations of its top two health care officials. In appointing two different people for those positions, the administration wisely reversed itself. Each of the nominees will have more than enough to do, once they are approved.

Earlier today, Kansas Gov. Kathleen Sebelius(D) accepted the nomination for Secretary of Health and Human Services, replacing former senator Thomas A. Daschle, who withdrew from consideration last month after his tax problems and position as a lobbyist complicated matters for the Obama Administration. Also, Nancy-Ann DeParle was named director of the White House Office for Health Reform. DeParle headed the Health Care Financing Administration, which oversaw Medicare and Medicaid, during the Clinton Administration. She was also a Clinton era health care adviser at HHS and at the White House Office of Management and Budget.

Health insurance is a big deal, Mr. Obama, so take a little time to get it right
posted 2-24-2008 8:22 a.m.

 
The problem with most backroom deals in politics is that they’re completed in everything short of a vote before the public even knows about them. Average Americans like you and me have no opportunity to influence the result, yet often we’re the ones most affected – sometimes most adversely affected – by the result. Such a backroom deal on health insurance reform is afoot right now, led by none other than Ted Kennedy. And President Obama appears to have signed off on it. I'm betting it's what he presents tonight in his address to the nation.

Senator Kennedy has long wanted health care reform and championed that cause, even for a time favoring a single payor plan not unlike Medicare. That he should be talking to stakeholders is not the concern. He wants to accomplish something lasting on health care before he dies. But national health insurance, or even something close to it, is a far cry from what’s on the table now – and what is under discussion is more a full-employment plan for the insurance industry with you and me footing the bill than what most Americans want.

Health reform debates during the Obama Administration’s first week
posted 1-28-2009 3:50 p.m.

 
In a week in which 10,000 jobs were lost in a single day, with more losses to come in the months ahead, the weak health care spending measures meant to cover more children and unemployed are already virtually moot. Unless Congress snaps to and suddenly realizes its gross underfunding, the monies intended to expand coverage won’t even give the states enough to maintain status quo. And the states aren’t waiting: they’re already cutting back.

There is a solution, but the Democrats would have to be uncommonly brave to take it on. And they’d have to push aside all but a mere handful of moderate conservative Republicans to get it done. The economic disaster is of great enough proportions to justify it; but that doesn’t mean the majority in the House and Senate will work up the nerve and twist enough moderate arms to get it done. And they're in too big of a hurry, as is the President.

A workforce for today and tomorrow
posted 1-15-2009 3:03 a.m.

 
President Obama is saying all the right things about rebuilding not just the physical infrastructure of the nation, but also the workforce infrastructure, in that he thinks there's plenty of opportunity to create new jobs by encouraging the proliferation of newer, greener industries. He's right, as far as that goes — but who's going to be the innovators of those industries if not scientists and engineers, those folks we need but don't have enough of? Not only do we not respect those people we call geeks, we don't graduate enough of them for this future workforce.

Mr. Obama's got to do a lot of fast talking and faster planning to solve this situation before he can convince Congress — because Congress is way behind on this issue. And the Republicans don't even want to discuss it, because of what the funding consequences have to be in order to bring about the goal of more scientists and engineers. Better science and math education in grade and high schools is barely a start: it's college programs that really make the difference and will produce results sooner.