Friday, March 27, 2009

Dispatches From The Health-Care Wars

Psst. Wanna hot stock tip?

Invest in companies that make walkers used by women suffering from osteoporosis -- and there are millions of them -- because business is gonna go through the roof if a certain trend continues in the face of a crappy economy.

That trend is away from elective surgery, including knee and hip replacements for women with bone fragility and fracture problems that typically are covered by private health insurance with high deductibles.

The problem is being exacerbated by the precipitous decline of bone-strengthening Vitamin D in people's bodies, probably because they are indoors more and use more high-protection sunscreen.

Barack Obama soft-pedaled health-care reform during the presidential campaign. This is because it was one less thing to be attacked about ("he's a socialist!") and bringing the waste, fraud and discriminatory practices under control that are eating away at the system would take years and billions of dollars ("he's a socialist!").

Reform was not going to be on the table in the opening months of an Obama presidency if most of his advisors had their way, but a key player insisted that it be front and center.

Not only did health-care reform crash and burn in the early weeks of Bill Clinton's first term, but voters seemed to punish him for ClintonCare, his wife's shoot-the-moon initiative, in mid-term elections the following year.

But that was then and now is now, you say. Well, not so fast. Polls taken in 1993 and more recently show -- surprisingly, in my view -- that the basic contours of public opinion remain unchanged. What has changed is the political environment.

The taxes paid by American workers keep those massive government health-care programs running, but according to a new study nearly one in five of them are uninsured, a significant increase from fewer than one in seven when Hillary Clinton was making a hash of things.

In the 1990s, there were eight states with 20 percent or more of the working age population uninsured. Now there are 14, yet workers continue to foot the bill for covering others through Medicare, which insures the elderly, although government provides little direct assistance to help cover workers themselves.

Tucked away in the stimulus bill is $1.1 billion for something called "comparative effectiveness research" in health care, which in essence is an effort to look at different treatments and see which ones work better or work just as well for less money.

Seems simple, right? Wrong.

This is because the last time it came up -- yup, during the ClintonCare debacle -- it was decried as an invasion of privacy and worse.

Not too worry
. At least not too much.

The jury is still very much out on Commonwealth Connector, Massachusetts' bold initiative to provide health insurance for all that is often cited as a model for national reform.

On the one hand, fewer than 3 percent of Bay State residents are now uninsured, the lowest rate in the U.S., while on the other hand the gains to date will be unsustainable if costs, notably reimbursement rates for hospitals and doctors, are reined in.

Three views of the plan here, here and here.

Did I say that one goal of true reform is to bring discriminatory practices under control? Yup.

The health insurance industry has offered for the first time to curb its practice of charging higher premiums to people with a history of medical problems, a potentially significant shift in the reform debate, but there is a very big string attached: The practice will continue if not all Americans are required to get coverage.


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