The Senate Health, Education, Labor, and Pensions Committee commenced mark-up for the tenth day yesterday. Most amendments were Republican-sponsored and didn’t gather enough votes to pass. However, there was one small victory in an amendment put forward by Barbara Mikulski (D-MD), co-sponsored by Tom Harkin and Chris Dodd (who unfortunately was absent from mark-up yesterday because he was attending his sister’s funeral. Our thoughts are with the Dodd family). The amendment established funding for community women’s health centers. There was some discussion – John McCain (R-AZ) was upset about the lack of Congressional Budget Office scoring on the amendment, and Orrin Hatch (R-UT) and Bob Casey (D-PA) were both concerned about the broadness of the bill and the possible inclusion of abortion coverage. Hatch inquired about whether Mikluski would be willing to change her amendment to explicitly exclude abortion, and she said, politely, she was not willing to do that.
In other reform news, taxing benefits looks like it won’t happen, and tax increases for the wealthy look like they might happen. The issue, of course, is still financing this bill. The group of Blue Dog conservative Democrats in the House of Representatives have voiced concerns over financing, so the House Tri-Committee bill will not be released today, but hopefully on Monday of next week. And out of all of this rubbish is the reality that the timetable for health care is slipping (some say due to explicitly obstructionist Republican members of these committees).
An article from The American Prospect from a few days ago addressed the inequities in continuous health care coverage for women. Since women have fewer opportunities for employer-provided health insurance, straight women often depend on their partner’s health insurance to cover them. This makes women much more vulnerable to losing their health insurance due to relationship or family issues that disrupt the relationship that provides them coverage. Dana Goldstein makes the case in this article that “[women who experienced health disruptions] had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of the cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.”
This highlights the importance of providing women with health insurance that they choose, on their terms, and controlled by them. Women need self-determinations in all areas of life, and health insurance is an important piece of the puzzle.
Yesterday the New England Journal of Medicine released an article written by Michael Porter that outlines the solution to health care reform. He breaks it up into a series of steps before and after reform.
In the face of a significant aging population in this country and the development of new medical technologies, Porter makes the case for an increased value-based system of health provision where “the central focus [is] increasing value for patients – the health outcomes achieved per dollar spent”. He states that “achieving and maintaining good health is inherently less costly than dealing with poor health” and that the two goals should be universal coverage and a complete restructuring of the care delivery system. His suggestions for doing this are as follows:
1. Changing the basis of health insurance competition: companies should do well when they take care of their patients. This seams obvious, but right now insurance companies benefit when they provide lots of care, not necessarily the best care. Porter also suggests the removal of things like gender and age ratings and discrimination against individuals with preexisting conditions. In addition, health plans should be required to report the outcomes of health care they cover. All of these things point back to the basic premise of a value-based system.
2. Porter asserts that employers should be kept in the system because they depend on the performance of their employees, so they are interested in keeping them healthy.
3. Fix the burden that has been put on individuals who have no access to employer-based coverage.
4. Porter makes the case for larger pools that will spread out costs.
5. Financial support for individuals of lower-incomes will help them get health insurance and therefore stay healthy.
6. Everyone should be required to purchase health insurance so as to spread out the costs and everyone is included.
Porter also emphasizes the importance of measuring and disseminating health outcomes so everyone knows which health providers offer the best care. Preventive services are essential to the change in attitude about health care. Consumers need to be encouraged to address health concerns before they become health emergencies. A better reimbursement system would benefit everyone, as would electronic medical records that help measure outcomes.
Check out the full article here, and let us know what you think!
The “global gag rule” otherwise known as the Mexico City Policy was a rule first instated by President Ronald Regan in the 1980s that restricted federal funds given to non-governmental organizations that were somehow tied to abortion care. This meant that any organization that offered abortions, information on abortions, or referrals for abortions in any country (regardless of the legality of abortion in that country) could not receive federal USAID funding. It was kept by President George HW Bush, rescinded by President Clinton, reinstated by President George W Bush, and rescinded for a second time by President Barack Obama. So since obviously this little rule doesn’t go away for very long, members of the US Senate moved yesterday to permanently remove it from appropriations bills by stating that no organization should be barred from receiving funding because they provide legal, medically appropriate care. This is excellent news, and very well might happen! Take a look at the article from RH Reality Check.
Though it feel sometimes like health care reform is a lost cause, that all things are doom and gloom, it’s nice to hear some elected officials speak out in support of what their constituents want. This article from the Daily Kos talks about the leadership and membership of the Congressional Progressive Caucus. They have stated their support for the public health insurance option and their dismay at the Olympia Snowe (R-ME) proposed trigger option. These statements were in response to Obama’s chief of staff Rahm Emanuel and the comments he’s made recently about the trigger option being a compromise the White House is considering.