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  • Pulling It Together: The “R” Word Is Back

    Perspective

    Longer ago than I care to admit, I got my start in health policy at M.I.T. when I wrote a book about health care regulation. The book was about a long forgotten attempt to rationalize the health care system through an elaborate health planning program set up in the seventies under the National Health Planning and Resources Development Act. It established a system of federal, state and regional planning bodies to control health care costs by limiting the supply of…

  • Pulling It Together: Keeping the Health Reform Coalition Together

    Perspective

    We could be headed for a new schism in the debate about health reform. Not the familiar gulf between advocates of the market and government, or the predictable one between deficit hawks and spenders, but a new one that crosses traditional partisan and ideological lines between advocates of long-term reform of the health care delivery system, and immediate help for the uninsured and insured struggling with health care costs.  This new rift is most likely to develop if tight money and a crowded agenda…

  • Pulling It Together: What Do We Want Health Insurance To Be?

    Perspective

    Trends in the health insurance marketplace show substantial growth in high deductible health plans, especially among smaller firms, where 35% of workers are now covered by plans with a deductible of $1,000 or more. That's according to our recently released employer health benefits survey, which we have been conducting now for ten years. The majority of these plans are simply high deductible health plans; only a minority are so-called "consumer driven" plans with savings accounts.…

  • Pulling It Together: A Recovery Raises Expectations Too

    Perspective

    New Orleans is a city still struggling with the aftermath of Katrina and the levee breaks. The people of New Orleans feel that the nation and the federal government have largely forgotten them. Those are the results of our 2008 survey of the people of New Orleans, the second in a series we are doing to track progress in the recovery from the perspective of the residents of the city themselves. As the head of a…

  • Pulling It Together: Moving Away From Employer Based Coverage: Don’t Forget Public Opinion

    Perspective

    One of the underlying big issues in the unfolding health reform debate is whether most Americans should continue to get insurance through work where they get it today, or purchase it themselves in the individual private health insurance marketplace. Senator McCain promotes moving to individual insurance and having individuals rather than employers make coverage decisions, as has President Bush.  But this is not only a conservative idea.  Many on the liberal side -- such as…

  • Pulling It Together: Perspectives on State Health Reform

    Perspective

    This Pulling It Together column is the fourth in my new series. All four so far have dealt with different dimensions of health reform. This time I write about one of my favorite topics, the states. As a former head of an umbrella health and social services agency in a big state responsible for about a third of a state budget and workforce, I have a deep appreciation for state government. It's a level of…

  • Pulling It Together: Health IN the Economy

    Perspective

    I am writing this Pulling It Together column about this one chart and its potential interpretations and implications. Source: Key Findings: Kaiser Health Tracking Poll: Election 2008 -- April 2008, Kaiser Family Foundation, April 2008. This chart from our most recent tracking poll shows the economy rising as a political issue and health care falling, with Iraq in the middle. Findings from other polling groups will show the same thing for as long as the economy…

  • Pulling It Together: Critical Path To Health Reform: Conclusion

    Perspective

    Finally, it bears mentioning for organizations like Kaiser that do research and analysis and are committed to public education on complex health policy issues, that the kinds of activities that will be most useful will vary depending on what stage we are at on the "critical path." At this early stage, education about the problems and the issues is critically important to establish the facts and dispel myths. What are the public's concerns and experiences…

  • Pulling It Together: Critical Path To Health Reform: Stage Three

    Perspective

    If there is a debate in the new Congress in 2009 about comprehensive health reform legislation, a major question is: Will there be an appetite for a bipartisan, centrist deal? No matter who is in the White House or what the margins are in the Senate, it is very unlikely that the deep divisions about how to reform our health care system between left and right will have been transformed enough to support passage of legislation…

  • Pulling It Together: Critical Path To Health Reform: Stage Two

    Perspective

    Will the new president make health a top early priority and exercise real leadership on the issue? One of the big lessons of the health reform debate of the early nineties is that the Congress needs to be fully engaged in the process early on. Nevertheless, for health reform legislation to stand a chance, a new President will have to make it an early and top priority and exercise real leadership. Given the history of…