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In inside circles of the health reform debate there has been criticism of the President for not weighing in earlier and publicly on the details of health reform legislation. Does he want the Senate's approach to employer obligations, or the approach taken in the House? What form of public option does he want: a robust one, a trigger, an opt-in, an opt-out, or none at all? What level of premiums and cost sharing is he…
For as long as I have been in the field, there have been two dominant schools of thought about how to control health care costs. One school, The Regulators, believed that the best way to slow increasing costs was to control the total resources going into the health care system: putting limits on the supply of medical professionals, technology and facilities; setting payment rates; or putting enough purchasing power in the hands of government to…
When I was a graduate student at MIT my adviser Jeffrey Pressman was a great political scientist who had just written the seminal book on program implementation. It was called, simply enough, Implementation, with a subhead that read: "how great expectations in Washington are dashed" (OK, we political scientists study politics too much and are a little cynical at times). The book literally created a new subfield in political science focusing on program implementation. This…
For many years now the news media has served as the public's number one source of information on important issues like health reform. People rely on the news media to help them wade through claims and counter claims, understand how policy options will affect them and come to judgment on complex issues. In some cases the broader news media has performed admirably in explaining the sometimes overwhelming complexities of health reform, particularly in recent weeks…
This week we put out our annual benchmark survey of employer health coverage and costs. Two numbers jumped off the pages. The first number was the average cost of a family health insurance policy in 2009: $13,375. To put that number in context, if you are an employer, you can hire an employee at the minimum wage for about $15,000 per year. If you are a consumer, you can rent an average two-bedroom apartment nationwide…
No, this is not about “death panels.” The town hall meetings. The media coverage of the town hall meetings. Media polls about how the American people feel about the town hall meetings. And even the media myth busting and fact checking about the most extreme claims made at the town hall meetings and the Administration's daily efforts to set the record straight. All these things have focused attention on a few hot button issues that…
It’s no secret that the response to the HIV epidemic domestically has not kept pace with the response to the global epidemic. And in an earlier column called America Has Gone Quiet on HIV/AIDS I wrote about the growing complacency towards the domestic epidemic revealed in our recent survey of the American people. Last Friday, we released a new study with the National Alliance of State and Territorial AIDS Directors that documents the level of…
Way back in the eighties when I was Human Services Commissioner in New Jersey, I established something called the Garden State Health Plan (GSHP). It was the first — and I think the only — federally qualified state-run HMO for Medicaid beneficiaries. One goal of the GSHP was to reallocate the Medicaid dollar, giving more to primary care physicians who at the time were paid $9 for a general office visit, and a little less…
Last week we learned that health reform could cost the federal government at least a trillion dollars over ten years, and that it will be really difficult to forge bipartisan agreement on legislation and keep major interest groups on board. This obviously brought more angst to the deliberations, several Republicans seized the moment to criticize the Democrats' plans, and the press was all over it, with many commentators declaring health reform in dire straits. But…
The health reform legislation currently being crafted on Capitol Hill is undeniably complex. To oversimplify slightly it can be boiled down into four parts: coverage (subsidies for private coverage and Medicaid expansions); delivery and payment reforms; insurance market reforms and regulations; and prevention, with each broad category containing a range of specific policy proposals and ideas. There’s been a lot of discussion so far about coverage expansions and how to pay for them, as well…
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