Health Care Lawyers & Attorneys : Schottenstein Zox & Dunn Law Firm : Strategic Planning, Managed Care, Insurance : Columbus, Cleveland, Cincinnati, Central Ohio

In the heat of a Presidential Campaign, especially one of this historical importance, it is not surprising that political commentators focus on the differences between the candidates' views.  But when it comes to health care reform, especially now that the economy will make it harder for the victor to fix the financial part of the problem, it might make sense to consider what Democratic candidate Barack Obama and Republican candidate John McCain can agree to.

At a recent  Washington, D.C. program, Peter Leibold, Executive Vice President/CEO of the American Health Lawyers Association, identified 10 areas of agreement among the candidates when seeking solutions to the problems of cost control and increased quality:

1.   Governmentally supported pooling mechanisms for catastrophic illness

2.   Payment mechanisms that encourage quality of care

3.   Support for information technology use by health care providers

4.   Promoting coordinated care and disease management

5.   Increased funding for research and public health

6.   Provider cost transparency

7.   Promoting healthy lifestyles

8.  Allowing re-importation of drugs and quicker release of generics

9.   Portable health insurance

10. Greater attention to treatment of cancer and autism

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This may well be the strangest Presidential Election Campaign in U.S. history, but excuse me, what happened to any meaningful discussion of health care reform?  Obviously, the economy and energy issues have caused health care to drop below the radar screen (see Modern Healthcare, Sept. 8, 2008, page 9), but how can this really be an election about "change" if we sweep health care under the rug?  Neither of the major candidates gave any prominence to this issue in his acceptance speech.  Does that mean we have to wait another four years to begin an honest discussion about something as vital as the health and well being of our citizenry?

While others may be tuned into the Gaffe of the Day, it is worth studying what the candidates (or more accurately their campaigns) have said about health policy reform.  This entry and the next two will focus on three aspects of reform:  1) cost, 2) quality and 3) fairness.  Let's begin with cost.

Barack Obama proposes to lower costs by modernizing the U.S. Health Care System. John McCain proposes to lower costs by restoring control of the system to patients and their families.

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Politics aside, can anyone explain how a federal program only 43 years old came to be insolvent?  When Congress enacted the Medicare Act in 1965, the program was estimated to have an annual cost of under $10 billion for quite some time.  Indeed, contributions from Part A payroll taxes and premiums for Part B were designed to create a surplus that would be held in trust for use in the future when revenues might not cover costs.  In 2007, Medicare required an infusion of $178 billion of general revenues just to pay its current bills.  How can we have gotten so far off track?

"The Facts About Medicare," an article that appeared in the July/August 2008 issue of Contingencies, the journal of the American Academy of Actuaries, attempts to answer this question. Six factors are blamed for what might be the greatest forecasting error in history.  First, the Medicare population grew much faster than expected because of a marked increase in life expectancies (which means the program worked!).  Second, new benefits and new covered populations have been continuously added since the inception of the program, the most recent being Part D prescription drug benefits.  Third, medical costs have grown faster than wages  during the same period, both because of price inflation and the addition of new medical technologies (we can do much more today than we were able to do in 1965).  Fourth, the percentage of the program's cost shouldered by consumers has steadily fallen since inception.

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It is well known that the American health care crisis has reached epic proportions, but a recent report from the Families USA Foundation finds the problem particularly acute in cities.  While the media tend to give most of their focus to the funding roles of state and federal governments, as well as employers and individuals, they often overlook the burden shouldered by city governments.  All of the cities participating in the Families USA survey state that they have seen an increase in the demand for services at safety net clinics over the past year.  Most cities are also seeing crowding in hospital ERs and growing demand for mental health, substance abuse and social services.  None of this should be a surprise given that more than 93 percent of Americans live in metropolitan areas.  However, unlike state and federal governments, municipalities rarely have the funding mechanisms to keep up with the rising cost of providing health care services to their citizens, not to mention indirect costs such as those associated with absenteeism in city schools.  Urban health care providers know this all too well.  Not only have urban ERs become a substitute for a functioning primary care system in many cities, but the closing of a growing number of inner-city hospitals has compounded the problem for those still in business. Continue Reading...

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