Health Affairs Blog

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background-color: #CCCCCC;"> <small> <small><small> September 3rd, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_1');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_1')" onmouseover="javascript:LayerSwitch('authormenu_1')">Chris Fleming</a></strong> <div class="authormenu" id="authormenu_1" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Chris Fleming</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=11','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=11" title="Chris Fleming's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F09%2F03%2Fhealth-affairs-briefing-bending-the-cost-curve-in-health-spending%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>For decades, the United States and other nations have sought to tame the long-term growth of health spending. Even as resources devoted to health care grow, they remain poorly distributed, and much of the health care purchased is of questionable value. As the Obama Administration and Congress tackle health reform, expanding health coverage to millions of uninsured Americans while simultaneously “bending the cost curve” are co-equal goals. </p> <p> The September-October 2009 edition of <em>Health Affairs</em>, titled “Bending the Cost Curve,” delves deeply into this issue. The journal will bring together key administration officials, lawmakers, and leading health policy experts, including Aetna Chairman and CEO Ronald A. Williams and Commonwealth Fund President Karen Davis, to discuss it at a September 9th <em>Health Affairs</em> briefing.</p> <p>Among the topics to be explored:</p> <p>• Can reforms in the health care delivery system, changes in payment policies, or other measures restrain the rate of growth in health care costs?<br/> • How might such policy choices affect the quality of care Americans receive and the growth of medical knowledge?<br/> • What has already worked, and what might work, to take costs out of the system? What ought to be top areas of focus for policymakers, health care providers, payers, and patients going forward?</p> <p>Larry Wheeler, <em>Health Affairs</em> Senior Editor, will offer live updates from the event on Twitter at #HACostCurve. The briefing and <em>Health Affairs</em> issue are supported by grants from Aetna, the Aetna Foundation, and the Commonwealth Fund. A preliminary agenda is below.</p> <p>Here are the details:</p> <p>WHEN: Wednesday, September 9, 2009<br/> 8:30 a.m. – 12:30 p.m.</p> <p>WHERE: Capital Hilton Hotel<br/> 1001 16th St., NW (northeast corner of 16th and K), Washington, D.C.<br/> Presidential Ballroom, Mezzanine<br/> Metro: Farragut North (Red Line); Farragut West (Blue & Orange Lines)<br/> <br/> RSVP: <a href="https://web.archive.org/web/20090904104202/http://www.burnesscommunications.com/new/new_rsvp.htm?doc_id=997023" target="_self">RSVP for this event online here</a>.</p> <p><strong>Bending the Cost Curve<br/> </strong>Agenda<br/> Wednesday, September 9, 2009</p> <p>8:30 am – 8:40 am: <strong>Welcome and Introductions</strong></p> <p>Susan Dentzer, Editor-in-Chief, Health Affairs</p> <p>8:40 am – 8:45 am: <strong>Brief remarks</strong></p> <p> Ronald A. Williams, Chairman and CEO, Aetna Inc. </p> <p>8:45 am – 9:45 am: <strong>Administration & Congressional Panel</strong></p> <p>Speakers TBA</p> <p>9:45 am – 10:45 am: <strong>Overview Panel: The Challenge of Rapidly Rising Health Spending and the Forces Driving It</strong></p> <p>Michael Chernew, PhD, Harvard Medical School</p> <p>Paul Ginsburg, PhD, Center for Studying Health System Change</p> <p>Henry Aaron, PhD, The Brookings Institution</p> <p>Joseph Newhouse, PhD, Harvard University</p> <p>Audience Q&A</p> <p>Break – 10:45 am – 11:00 am</p> <p>11:00 am – 11:45 am: <strong>Specific Issues in Reining in Health Costs</strong></p> <p>Strengthening Payers’ Hands and Dealing with Prices:<br/> Bruce Vladeck, PhD, Nexera Consulting</p> <p>Overhauling Medicare Governance:<br/> Mai Pham, MD, Center for Studying Health System Change</p> <p>Payment Reform Options:<br/> Harold D. Miller, Network for Regional Healthcare Improvement<br/> Karen Davis, PhD, President, The Commonwealth Fund</p> <p>11:45 am – 12:15 pm: <strong>Challenges Ahead</strong> </p> <p>Eliminating Fraud:<br/> Lewis Morris, Office of the Inspector General, U.S. Dept. of Health & Human Services</p> <p>Care of the Seriously Ill:<br/> John Rowe, MD, Mailman School of Public Health,<br/> Columbia University</p> <p>12:15 pm – 12:30 pm: Audience Q&A</p> <p>12:30 pm Adjourn – Box lunches will be available.</p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/coverage/" title="View all posts in Coverage" rel="category tag">Coverage</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-care-costs/" title="View all posts in Health Care Costs" rel="category tag">Health Care Costs</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/medicare/" title="View all posts in Medicare" rel="category tag">Medicare</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/03/health-affairs-briefing-bending-the-cost-curve-in-health-spending/#respond" title="Comment on <em>Health Affairs</em> Briefing: Bending The Cost Curve In Health Spending">Post a Comment</a> <strong>|</strong> <a href="" title="Trackbacks on <em>Health Affairs</em> Briefing: Bending The Cost Curve In Health Spending"></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1982" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/03/health-affairs-briefing-bending-the-cost-curve-in-health-spending/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1967"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/01/health-reform-proposals-top-ha-blog-most-read/" rel="bookmark" title="Permanent Link to Health Reform Proposals Top HA Blog Most-Read"> Health Reform Proposals Top HA Blog Most-Read </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> September 1st, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_2');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_2')" onmouseover="javascript:LayerSwitch('authormenu_2')">Jane Hiebert-White</a></strong> <div class="authormenu" id="authormenu_2" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Jane Hiebert-White</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=15','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=15" title="Jane Hiebert-White's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F09%2F01%2Fhealth-reform-proposals-top-ha-blog-most-read%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Health reform proposals and an examination of what’s working to control health care costs dominated the most-read posts on <em>Health Affairs</em> Blog in August. Additional commenting is always welcome.</p> <ol> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/24/a-modest-proposal-on-payment-reform/">A Modest Proposal On Payment Reform</a><br/> by Uwe Reinhardt</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/28/low-cost-high-quality-care-in-america/">Low-Cost Health Quality Care In America</a><br/> by John Iglehart</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/obesity-spending-estimated-at-147-billion-annually/">Obesity Spending Estimated at 147 Billion Annually</a><br/> by Chris Fleming</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/">Building A Health Marketplace That Works</a><br/> by Alain C. Enthoven</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/">Moving From Volume Driven Medicine Toward Accountable Care</a><br/> by Aaron McKethan and Mark McClellan</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/17/the-accountable-care-organization-not-ready-for-prime-time/">The Accountable Care Organization: Not Ready For Prime Time</a><br/> by Jeff Goldsmith</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/12/what-people-don%e2%80%99t-know-about-health-insurance-exchanges/">What People Don’t Know About Health Insurance Exchanges</a><br/> by Peter Lee and John Grgurina</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/24/all-payer-rate-setting-a-response-to-a-modest-proposal-from-uwe-reinhardt/">All Payer Rate Setting: A Response To A Modest Proposal From Uwe Reinhardt</a><br/> by Paul B. Ginsburg</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/health-affairs-briefing-fact-versus-fiction-in-health-reform/"><em>Health Affairs</em> Briefing On Key Issues in Health Reform: Fact Versus Fiction In Health Reform</a><br/> by Chris Fleming</li> <li><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-a-tireless-legislator-and-courageous-man/">Senator Edward Kennedy: A Tireless Legislator And Courageous Man</a><br/> by David Blumenthal</li> </ol> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/blog/" title="View all posts in Blog" rel="category tag">Blog</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/cost/" title="View all posts in Cost" rel="category tag">Cost</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/payment/" title="View all posts in Payment" rel="category tag">Payment</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/01/health-reform-proposals-top-ha-blog-most-read/#respond" title="Comment on Health Reform Proposals Top HA Blog Most-Read">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/01/health-reform-proposals-top-ha-blog-most-read/#trackbacks" title="Trackbacks on Health Reform Proposals Top HA Blog Most-Read">1 Trackback</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1967" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/01/health-reform-proposals-top-ha-blog-most-read/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1955"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/01/fact-or-fiction-the-role-of-government-in-health-care/" rel="bookmark" title="Permanent Link to Fact Or Fiction: The Role Of Government In Health Care"> Fact Or Fiction: The Role Of Government In Health Care </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> September 1st, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_3');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/JKI.jpg"><strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_3')" onmouseover="javascript:LayerSwitch('authormenu_3')">John Iglehart</a></strong> <div class="authormenu" id="authormenu_3" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">John Iglehart</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=6','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=6" title="John Iglehart's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F09%2F01%2Ffact-or-fiction-the-role-of-government-in-health-care%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>The traditional summer break that provides members of Congress a respite from their official duties instead, in some areas, turned into a raucous, sometimes angry series of town hall meetings focused on the ambitious health care reform proposals of Democrats. The meetings have given reform opponents and advocates an opportunity to voice their opinions, although some of their exchanges have shed more heat than light on the issues, placing legislators in uncomfortable positions. Nevertheless, their impact has reverberated throughout the country because of extensive media coverage transmitted by television, newspapers, and countless bloggers. Much of the dialogue — which has often been contentious — has focused on whether the Democratic plans would transform health care into a government-controlled enterprise and, if so, what its implications might be.<br/> <br/> To focus attention on the role of government should a reform plan become law — as well as the potential impact of slowing Medicare spending growth and proposed new Medicare reimbursements for advance-care planning — <em>Health Affairs</em> sponsored a briefing on August 20 at the National Press Club, titled “<a href="https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/issue_briefings/2009_08_20_fact_vs_fiction/2009_08_20_fact_vs_fiction.php" target="_self">Fact vs. Fiction: Key Issues in Health Reform</a>.” The first panel — health economist Len Nichols of the New America Foundation and Gail Wilensky of Project HOPE — addressed the question: “What exactly is the federal government’s role in U.S. health care and health financing currently, and how might this change under health reform?” Nichols, a Democrat, was an active participant in the reform pursuits of the administration of Bill Clinton; Wilensky, a Republican, served in key health policy posts for President George H.W. Bush. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/01/fact-or-fiction-the-role-of-government-in-health-care/#more-1955" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/coverage/" title="View all posts in Coverage" rel="category tag">Coverage</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/medicare/" title="View all posts in Medicare" rel="category tag">Medicare</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/spending/" title="View all posts in Spending" rel="category tag">Spending</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/01/fact-or-fiction-the-role-of-government-in-health-care/#respond" title="Comment on Fact Or Fiction: The Role Of Government In Health Care">Post a Comment</a> <strong>|</strong> <a href="" title="Trackbacks on Fact Or Fiction: The Role Of Government In Health Care"></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1955" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/01/fact-or-fiction-the-role-of-government-in-health-care/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1942"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/28/trade-rules-limit-availability-of-generics/" rel="bookmark" title="Permanent Link to Trade Rules Limit Availability Of Generics"> Trade Rules Limit Availability Of Generics </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 28th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_4');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_4')" onmouseover="javascript:LayerSwitch('authormenu_4')">Chris Fleming</a></strong> <div class="authormenu" id="authormenu_4" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Chris Fleming</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=11','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=11" title="Chris Fleming's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F28%2Ftrade-rules-limit-availability-of-generics%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>In a recent <a href="Trade rules limit availability of generics" target="_self"><em>Health Affairs</em> Web Exclusive</a>, researchers document for the first time that trade rules reduce access to generic drugs in a low-income country. Using recent Ministry of Health data, they report that in Guatemala, some generics have been withdrawn from the market while others have been denied entry altogether due to intellectual property rules contained in the Central American Free Trade Agreement. As a result, the cash-strapped Guatemalan public sector must purchase higher priced brand-name drugs to fight diseases such as diabetes and HIV/AIDS, say Ellen Shaffer and Joseph Brenner, co-directors of the Center for Policy Analysis on Trade and Health.</p> <p>The authors point specifically to CAFTA’s “data exclusivity” rules which provide brand-name drugs monopoly protection which, on top of existing patent protections, further contribute to higher prices. Generic drugmakers typically rely on the clinical trial data already generated by brand-name manufacturers to demonstrate the safety and efficacy of their products. But CAFTA prohibits generic drug manufacturers from using the brand-name clinical trial data for a fixed period of years, sometimes even after the brand-name drug is no longer under patent. Because of these rules, Guatemalans end up paying for brand-name drugs at costs up to hundreds of times higher than generics that were once available or that could be manufactured were it not for CAFTA rules. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/28/trade-rules-limit-availability-of-generics/#more-1942" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/global-health/" title="View all posts in Global Health" rel="category tag">Global Health</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/pharma/" title="View all posts in Pharma" rel="category tag">Pharma</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/28/trade-rules-limit-availability-of-generics/#respond" title="Comment on Trade Rules Limit Availability Of Generics">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/28/trade-rules-limit-availability-of-generics/#trackbacks" title="Trackbacks on Trade Rules Limit Availability Of Generics">1 Trackback</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1942" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/28/trade-rules-limit-availability-of-generics/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1933"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/health-affairs-briefing-fact-versus-fiction-in-health-reform/" rel="bookmark" title="Permanent Link to <em>Health Affairs</em> Briefing: Fact Versus Fiction In Health Reform"> <em>Health Affairs</em> Briefing: Fact Versus Fiction In Health Reform </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 27th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_5');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_5')" onmouseover="javascript:LayerSwitch('authormenu_5')">Chris Fleming</a></strong> <div class="authormenu" id="authormenu_5" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Chris Fleming</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=11','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=11" title="Chris Fleming's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F27%2Fhealth-affairs-briefing-fact-versus-fiction-in-health-reform%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>What exactly is the U.S. government’s role in health care and how might it change under health reform? What are the implications of slowing the rate of growth in Medicare spending and what would the impact be on beneficiaries? How do the issues involved in end-of-life care really look to the people and providers who live it?</p> <p>These issues were discussed at a <em>Health Affairs</em> briefing titled “Fact Versus Fiction: Key Issues in Health Reform,” held August 20 at the National Press Club. <a href="https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/issue_briefings/2009_08_20_fact_vs_fiction/2009_08_20_fact_vs_fiction.php" target="_self">Video and audio of the briefing and speaker presentations</a> are available on the <em>Health Affairs</em> Web site, as is a special <a href="https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_10.pdf" target="_self">Health Policy Brief</a> examining the issues discussed at the briefing.</p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/end-of-life-care/" title="View all posts in End-of-Life Care" rel="category tag">End-of-Life Care</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/medicare/" title="View all posts in Medicare" rel="category tag">Medicare</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/politics/" title="View all posts in Politics" rel="category tag">Politics</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/spending/" title="View all posts in Spending" rel="category tag">Spending</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/health-affairs-briefing-fact-versus-fiction-in-health-reform/#respond" title="Comment on <em>Health Affairs</em> Briefing: Fact Versus Fiction In Health Reform">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/health-affairs-briefing-fact-versus-fiction-in-health-reform/#trackbacks" title="Trackbacks on <em>Health Affairs</em> Briefing: Fact Versus Fiction In Health Reform">2 Trackbacks</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1933" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/health-affairs-briefing-fact-versus-fiction-in-health-reform/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1830"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/19/health-affairs-briefing-to-be-covered-on-twitter/" rel="bookmark" title="Permanent Link to <em>Health Affairs</em> Briefing To Be Covered On Twitter"> <em>Health Affairs</em> Briefing To Be Covered On Twitter </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 19th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_6');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_6')" onmouseover="javascript:LayerSwitch('authormenu_6')">Chris Fleming</a></strong> <div class="authormenu" id="authormenu_6" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Chris Fleming</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=11','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=11" title="Chris Fleming's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F19%2Fhealth-affairs-briefing-to-be-covered-on-twitter%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Tomorrow’s <em>Health Affairs</em> briefing, “Fact <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/16/health-affairs-briefing-on-key-issues-in-health-reform-fact-versus-fiction/" target="_self">Versus Fiction: Key Issues In Health Reform</a>,” will be covered live on <a href="https://web.archive.org/web/20090904104202/http://twitter.com/" target="_self">Twitter</a>. Posts from <em>Health Affairs</em> deputy editor Sarah Dine will appear in real time on the Twitter “channel” #healthreform with important points and content from the event.</p> <p>You can follow the discussion on Twitter by searching on “#healthreform.” If you have a Twitter account, you can join the discussion and post to the channel by appending “#healthreform” to your messages. If you don’t have a Twitter account, you can register for one <a href="https://web.archive.org/web/20090904104202/http://twitter.com/" target="_self">here</a>.</p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/end-of-life-care/" title="View all posts in End-of-Life Care" rel="category tag">End-of-Life Care</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-care-costs/" title="View all posts in Health Care Costs" rel="category tag">Health Care Costs</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/medicare/" title="View all posts in Medicare" rel="category tag">Medicare</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/personal-experience/" title="View all posts in Personal Experience" rel="category tag">Personal Experience</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/19/health-affairs-briefing-to-be-covered-on-twitter/#respond" title="Comment on <em>Health Affairs</em> Briefing To Be Covered On Twitter">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/19/health-affairs-briefing-to-be-covered-on-twitter/#trackbacks" title="Trackbacks on <em>Health Affairs</em> Briefing To Be Covered On Twitter">1 Trackback</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1830" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/19/health-affairs-briefing-to-be-covered-on-twitter/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1822"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/19/nurse-shortage-payment-reform-lead-ha-blog-top-10/" rel="bookmark" title="Permanent Link to Nurse Shortage, Payment Reform Lead <em>HA</em> Blog Top 10"> Nurse Shortage, Payment Reform Lead <em>HA</em> Blog Top 10 </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 19th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_7');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_7')" onmouseover="javascript:LayerSwitch('authormenu_7')">Chris Fleming</a></strong> <div class="authormenu" id="authormenu_7" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Chris Fleming</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=11','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=11" title="Chris Fleming's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F19%2Fnurse-shortage-payment-reform-lead-ha-blog-top-10%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>A post on the short-term easing of the nurse shortage and Uwe Reinhardt’s ”Modest Proposal On Payment Reform” top the <em>Health Affairs</em> Blog most-read list for July. The list also includes several posts addressing the ongoing health reform debate. Additional comment is always welcome. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/19/nurse-shortage-payment-reform-lead-ha-blog-top-10/#more-1822" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/blog/" title="View all posts in Blog" rel="category tag">Blog</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/nurses/" title="View all posts in Nurses" rel="category tag">Nurses</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/payment/" title="View all posts in Payment" rel="category tag">Payment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/19/nurse-shortage-payment-reform-lead-ha-blog-top-10/#respond" title="Comment on Nurse Shortage, Payment Reform Lead <em>HA</em> Blog Top 10">Post a Comment</a> <strong>|</strong> <a href="" title="Trackbacks on Nurse Shortage, Payment Reform Lead <em>HA</em> Blog Top 10"></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1822" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/19/nurse-shortage-payment-reform-lead-ha-blog-top-10/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1761"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/16/health-affairs-briefing-on-key-issues-in-health-reform-fact-versus-fiction/" rel="bookmark" title="Permanent Link to <em>Health Affairs</em> Briefing On Key Issues In Health Reform: Fact Versus Fiction"> <em>Health Affairs</em> Briefing On Key Issues In Health Reform: Fact Versus Fiction </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 16th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_8');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_8')" onmouseover="javascript:LayerSwitch('authormenu_8')">Chris Fleming</a></strong> <div class="authormenu" id="authormenu_8" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Chris Fleming</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=11','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=11" title="Chris Fleming's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F16%2Fhealth-affairs-briefing-on-key-issues-in-health-reform-fact-versus-fiction%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Reforming the way health care is paid for and delivered in the United States is serious business. It deserves an equally serious discussion<br/> rising above partisanship and hot air. </p> <p>Join <em>Health Affairs</em>, the nation’s leading health policy journal,<br/> for a special conference on Key Issues in Health Reform: Fact vs. Fiction.</p> <p>WHEN: Thursday August 20, 2009 – 8:30 am to 12:00 pm<br/> WHERE: National Press Club, Washington DC</p> <p>TOPICS TO BE DISCUSSED:</p> <ul> <li>What exactly is the U.S. government’s role in health care and how might it change under health reform?</li> <li>What are the implications of slowing the rate of growth in Medicare spending and what would the impact be on beneficiaries?</li> <li>End of Life Health Care: How the issues really look to the people and providers who live it.</li> </ul> <p>SPEAKERS TO INCLUDE: </p> <ul> <li>Welcoming remarks from former Surgeon Generals C. Everett Koop and Richard Carmona</li> <li>Len Nichols, Director, Health Policy Program, New America Foundation</li> <li>Gail Wilensky, Senior Fellow, Project HOPE and former head of HCFA</li> <li>C. Eugene Steuerle, Vice President, Peter G. Peterson Foundation</li> <li>Christine Cassel, MD, President, American Board of Internal Medicine</li> <li>Diane E. Meier, MD, Director, Center to Advance Palliative Care, Mount Sinai School of Medicine</li> <li>Darrell Kirch, M.D., Persident and Chief Executive Officer, Association of American Medical Colleges</li> <li>Joshi Maulik, President, Health Research and Educational Trust, and Senior Vice President of Research, American Hospital Association</li> <li>Jerald Winakur, MD, University of Texas Health Science Center/San Antonio, Noted Author of “What Are We Going To Do With Dad,” <em>Health Affairs</em> Narrative Matters essay, and <em>Memory Lessons: A Doctor’s Story</em> (Hyperion Books)</li> </ul> <p><a href="https://web.archive.org/web/20090904104202/http://www.burnesscommunications.com/new/new_show.htm?doc_id=1001373" target="_self">RSVP online here</a>. For questions, contact Debbie Boylan, <a href="https://web.archive.org/web/20090904104202/mailto:dboylan@projecthope.org">dboylan@projecthope.org</a>.</p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/end-of-life-care/" title="View all posts in End-of-Life Care" rel="category tag">End-of-Life Care</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/insurance/" title="View all posts in Insurance" rel="category tag">Insurance</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/medicare/" title="View all posts in Medicare" rel="category tag">Medicare</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/personal-experience/" title="View all posts in Personal Experience" rel="category tag">Personal Experience</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/quality/" title="View all posts in Quality" rel="category tag">Quality</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/16/health-affairs-briefing-on-key-issues-in-health-reform-fact-versus-fiction/#comments" title="Comment on <em>Health Affairs</em> Briefing On Key Issues In Health Reform: Fact Versus Fiction">1 Comment</a> <strong>|</strong> <script language="javascript"> menu.push('commentermenu_1'); </script> <a href="javascript:ToggleLayers('commentermenu_1')" onmouseover="javascript:LayerSwitch('commentermenu_1')"> Show Commenters</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/16/health-affairs-briefing-on-key-issues-in-health-reform-fact-versus-fiction/#trackbacks" title="Trackbacks on <em>Health Affairs</em> Briefing On Key Issues In Health Reform: Fact Versus Fiction">2 Trackbacks</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1761" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/16/health-affairs-briefing-on-key-issues-in-health-reform-fact-versus-fiction/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_1" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/16/health-affairs-briefing-on-key-issues-in-health-reform-fact-versus-fiction/#comment-29794" title="View Michael D. Miller, MD's Comments">Michael D. Miller, MD (1 Comment)</a></td></tr> </table> </div> </span> </div> <div class="post" id="post-1713"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/06/summertime-surveillance-from-polio-to-flu/" rel="bookmark" title="Permanent Link to Summertime Surveillance: From Polio To Flu"> Summertime Surveillance: From Polio To Flu </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 6th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_9');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_9')" onmouseover="javascript:LayerSwitch('authormenu_9')">Sarah Dine</a></strong> <div class="authormenu" id="authormenu_9" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Sarah Dine</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=563','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=563" title="Sarah Dine's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F06%2Fsummertime-surveillance-from-polio-to-flu%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Several recent stories have reminded us that perhaps the most looming health crisis is not the political debate about health reform but the pandemic swine flu H1N1. The dreaded phone call has not come from a pollster or the local political party urging you to call your representative, but from a summer camp or overseas program telling you that your child is sick or their program has been shut down. Thousands of American children this summer have either had the flu, been exposed to flu, or had their summers disrupted as day camps, sleep-away camps, special-needs camps, and overseas and domestic programs for middle and high school age children either never opened, shut down in the middle of a session, or sent children home and some into quarantine. </p> <p>While the <em><a href="https://web.archive.org/web/20090904104202/http://www.nytimes.com/2009/07/28/health/28flu.html?_r=2" target="_self">New York Times</a></em> featured a story about flu, quarantine, and American students overseas, programs in the U.S. that attract students from overseas including China, such as one at <a href="https://web.archive.org/web/20090904104202/http://http//www.cumberlink.com/articles/2009/07/09/news/local/doc4a55c79d6539e294248357.txt" target="_self">Johns Hopkins</a>, also had to figure out how to send children back to their home countries, where they might face quarantine and also deal with myriad airline rules about flu exposure, quarantine, and unaccompanied minors on airplanes. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/06/summertime-surveillance-from-polio-to-flu/#more-1713" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/public-health/" title="View all posts in Public Health" rel="category tag">Public Health</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/06/summertime-surveillance-from-polio-to-flu/#comments" title="Comment on Summertime Surveillance: From Polio To Flu">2 Comments</a> <strong>|</strong> <script language="javascript"> menu.push('commentermenu_2'); </script> <a href="javascript:ToggleLayers('commentermenu_2')" onmouseover="javascript:LayerSwitch('commentermenu_2')"> Show Commenters</a> <strong>|</strong> <a href="" title="Trackbacks on Summertime Surveillance: From Polio To Flu"></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1713" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/06/summertime-surveillance-from-polio-to-flu/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_2" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/06/summertime-surveillance-from-polio-to-flu/#comment-29679" title="View Annie Cardi's Comments">Annie Cardi (1 Comment)</a></td></tr> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/06/summertime-surveillance-from-polio-to-flu/#comment-30819" title="View kervin's Comments">kervin (1 Comment)</a></td></tr> </table> </div> </span> </div> <div class="post" id="post-1682"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/obesity-spending-estimated-at-147-billion-annually/" rel="bookmark" title="Permanent Link to Obesity Spending Estimated At $147 Billion Annually"> Obesity Spending Estimated At $147 Billion Annually </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> July 29th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_10');</script> <table><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_10')" onmouseover="javascript:LayerSwitch('authormenu_10')">Chris Fleming</a></strong> <div class="authormenu" id="authormenu_10" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Chris Fleming</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=11','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=11" title="Chris Fleming's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F07%2F29%2Fobesity-spending-estimated-at-147-billion-annually%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Medical spending on conditions associated with obesity has doubled in the past decade and is estimated to have reached an annual rate of $147 billion in 2008, say researchers in <a href="https://web.archive.org/web/20090904104202/http://content.healthaffairs.org/cgi/content/short/hlthaff.28.5.w822" target="_self">a new study</a> published July 27 on the <em>Health Affairs</em> Web site. The study was presented at the U.S. Centers for Disease Control and Prevention’s “<a href="https://web.archive.org/web/20090904104202/http://www.cdc.gov/media/pressrel/2009/a090727.htm">Weight of the Nation</a>” conference in Washington, where the <a href="https://web.archive.org/web/20090904104202/http://www.cdc.gov/media/pressrel/2009/r090727.htm" target="_self">CDC issued 24 new recommendations </a>on how communities can fight back. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/obesity-spending-estimated-at-147-billion-annually/#more-1682" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/chronic-care/" title="View all posts in Chronic Care" rel="category tag">Chronic Care</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/prevention/" title="View all posts in Prevention" rel="category tag">Prevention</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/public-health/" title="View all posts in Public Health" rel="category tag">Public Health</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/spending/" title="View all posts in Spending" rel="category tag">Spending</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/obesity-spending-estimated-at-147-billion-annually/#respond" title="Comment on Obesity Spending Estimated At $147 Billion Annually">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/obesity-spending-estimated-at-147-billion-annually/#trackbacks" title="Trackbacks on Obesity Spending Estimated At $147 Billion Annually">1 Trackback</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1682" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/obesity-spending-estimated-at-147-billion-annually/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_2" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="navigation"></div> </div></td> <td width="1%" align="right" valign="top" style="background: url('/web/20090904104202im_/http://healthaffairs.org/images/vertical.gif') repeat-y; background-position: center;"></td> <td width="47%" align="left" valign="top" bordercolor="#000000"> <table width="100%"> <tr><td align="left" valign="top"><div id="content" class="rightnarrow"> <img src="/web/20090904104202im_/http://healthaffairs.org/images/Voices.gif" alt="Contributing Voices" width="250" height="32"><br> <div class="post" id="post-1869"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/02/unstable-ground-the-need-for-better-data-to-make-better-health-care-policy/" rel="bookmark" title="Permanent Link to Unstable Ground: The Need for Better Data to Make Better Health Care Policy"> Unstable Ground: The Need for Better Data to Make Better Health Care Policy </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> September 2nd, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_11');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/OGrady.jpg"><strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_11')" onmouseover="javascript:LayerSwitch('authormenu_11')">Michael O’Grady</a></strong> <div class="authormenu" id="authormenu_11" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Michael O’Grady</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=2168','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=2168" title="Michael O’Grady's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F09%2F02%2Funstable-ground-the-need-for-better-data-to-make-better-health-care-policy%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Imagine the following. You are the senior White House health policy adviser, and you’ve been told to brief the president and his cabinet officials about the number of Americans who lack health insurance. The president turns to you, and you say: “Mr. President. The government has four different national surveys that count the uninsured. Unfortunately, each survey has different estimates that range from 18.9 million to 45 million. Each one measures things distinctly, and we’re not sure which, if any, of them is correct.”</p> <p>That was the situation facing Doug Badger, then the White House health policy adviser, in the middle of 2004. Following passage of the Medicare Modernization Act, the Bush administration was contemplating new polices for dealing with the uninsured. Health and Human Services Secretary Tommy Thompson was pushing hard to follow up on the success of the Medicare prescription drug benefit with a new initiative for the uninsured that would go beyond the tax-credit approach that was then administration policy. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/02/unstable-ground-the-need-for-better-data-to-make-better-health-care-policy/#more-1869" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/coverage/" title="View all posts in Coverage" rel="category tag">Coverage</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/insurance/" title="View all posts in Insurance" rel="category tag">Insurance</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/politics/" title="View all posts in Politics" rel="category tag">Politics</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/02/unstable-ground-the-need-for-better-data-to-make-better-health-care-policy/#comments" title="Comment on Unstable Ground: The Need for Better Data to Make Better Health Care Policy">1 Comment</a> <strong>|</strong> <script language="javascript"> menu.push('commentermenu_3'); </script> <a href="javascript:ToggleLayers('commentermenu_3')" onmouseover="javascript:LayerSwitch('commentermenu_3')"> Show Commenters</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/02/unstable-ground-the-need-for-better-data-to-make-better-health-care-policy/#trackbacks" title="Trackbacks on Unstable Ground: The Need for Better Data to Make Better Health Care Policy">2 Trackbacks</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1869" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/02/unstable-ground-the-need-for-better-data-to-make-better-health-care-policy/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_3" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/09/02/unstable-ground-the-need-for-better-data-to-make-better-health-care-policy/#comment-30825" title="View sweisgrau's Comments">sweisgrau (1 Comment)</a></td></tr> </table> </div> </span> </div> <div class="post" id="post-1889"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-a-tireless-legislator-and-courageous-man/" rel="bookmark" title="Permanent Link to Senator Edward Kennedy: A Tireless Legislator And Courageous Man"> Senator Edward Kennedy: A Tireless Legislator And Courageous Man </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 27th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_12');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/DBlumenthal.jpg"><strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_12')" onmouseover="javascript:LayerSwitch('authormenu_12')">David Blumenthal</a></strong> <div class="authormenu" id="authormenu_12" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">David Blumenthal</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=2173','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=2173" title="David Blumenthal's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F27%2Fsenator-edward-kennedy-a-tireless-legislator-and-courageous-man%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Editor’s Note: <em>During his 47 years in the Senate, the late Senator Edward Kennedy of Massachusetts was a lion of U.S. health care and health policy. We at</em> Health Affairs<em>, along with much of the rest of America, grieve at his passing. We recently asked Democratic and Republican politicians, policy experts, and former Senate staff to write for us about the senator’s many contributions. We now publish several of these on the </em>Health Affairs<em> Blog, including the piece by David Blumenthal below, and will also issue Web Exclusive versions for the archives in the weeks to come.</em></p> <p><em> – Susan Dentzer, Editor-in-Chief</em></p> <p>When I learned of Senator Edward M. Kennedy’s death, I shared with millions around the world a deep sense of personal and professional loss. Inevitably, the personal dominated. Here was a man, great and flawed, mythical and mortal, who could operate with equal comfort on the world stage and in personal relationships. He affected the history of nations and of countless unheralded individuals who passed through the powerful force field that he projected. I was lucky to be one of those individuals. </p> <p>I was not an intimate of Ted Kennedy. He was, at heart, a boisterous, expansive Boston Irish politician. I was a Jewish physician-academic. But he found a place for me, like so many others of every background and persuasion, in his huge circle of well-wishers, loyalists, admirers, and yes, friends. In the end, no one had greater influence on my professional life or taught me more about my work, about health policy and politics, and about greatness. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-a-tireless-legislator-and-courageous-man/#more-1889" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/insurance/" title="View all posts in Insurance" rel="category tag">Insurance</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/politics/" title="View all posts in Politics" rel="category tag">Politics</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-a-tireless-legislator-and-courageous-man/#comments" title="Comment on Senator Edward Kennedy: A Tireless Legislator And Courageous Man">1 Comment</a> <strong>|</strong> <script language="javascript"> menu.push('commentermenu_4'); </script> <a href="javascript:ToggleLayers('commentermenu_4')" onmouseover="javascript:LayerSwitch('commentermenu_4')"> Show Commenters</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-a-tireless-legislator-and-courageous-man/#trackbacks" title="Trackbacks on Senator Edward Kennedy: A Tireless Legislator And Courageous Man">2 Trackbacks</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1889" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-a-tireless-legislator-and-courageous-man/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_4" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-a-tireless-legislator-and-courageous-man/#comment-30291" title="View tinkerr's Comments">tinkerr (1 Comment)</a></td></tr> </table> </div> </span> </div> <div class="post" id="post-1882"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-architect-of-reform-builder-of-compromise/" rel="bookmark" title="Permanent Link to Senator Edward Kennedy: Architect Of Reform, Builder Of Compromise"> Senator Edward Kennedy: Architect Of Reform, Builder Of Compromise </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 27th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_13');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/Nexon.jpg"><strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_13')" onmouseover="javascript:LayerSwitch('authormenu_13')">David Nexon</a></strong> <div class="authormenu" id="authormenu_13" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">David Nexon</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=2172','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=2172" title="David Nexon's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F27%2Fsenator-edward-kennedy-architect-of-reform-builder-of-compromise%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Editor’s Note: <em>During his 47 years in the Senate, the late Senator Edward Kennedy of Massachusetts was a lion of U.S. health care and health policy. We at </em>Health Affairs<em>, along with much of the rest of America, grieve at his passing. We recently asked Democratic and Republican politicians, policy experts, and former Senate staff to write for us about the senator’s many contributions. We now publish several of these on the</em> Health Affairs <em>Blog, including the piece by David Nexon below, and will also issue Web Exclusive versions for the archives in the weeks to come.</em></p> <p><em> – Susan Dentzer, Editor-in-Chief</em></p> <p>Senator Edward Kennedy was the indispensable senator in health care, as in so many other areas of national policy. His influence extended across the broad range of health policy, from the National Institutes of Health to community health centers to the Food and Drug Administration to Medicare and Medicaid. And, of course, his influence encompassed the continuing struggle to guarantee quality, affordable health care for every American.</p> <p>I had the extraordinary good fortune to work with Senator Kennedy from 1983 to 2005 as his senior health policy adviser and as his chief of the health policy staff on the Senate Health, Education, Labor, and Pensions (HELP) Committee. In this perspective I discuss the Kennedy approach to health policy making and briefly present two case studies illustrating that approach. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-architect-of-reform-builder-of-compromise/#more-1882" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/insurance/" title="View all posts in Insurance" rel="category tag">Insurance</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/medicare/" title="View all posts in Medicare" rel="category tag">Medicare</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/pharma/" title="View all posts in Pharma" rel="category tag">Pharma</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/politics/" title="View all posts in Politics" rel="category tag">Politics</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-architect-of-reform-builder-of-compromise/#comments" title="Comment on Senator Edward Kennedy: Architect Of Reform, Builder Of Compromise">1 Comment</a> <strong>|</strong> <script language="javascript"> menu.push('commentermenu_5'); </script> <a href="javascript:ToggleLayers('commentermenu_5')" onmouseover="javascript:LayerSwitch('commentermenu_5')"> Show Commenters</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-architect-of-reform-builder-of-compromise/#trackbacks" title="Trackbacks on Senator Edward Kennedy: Architect Of Reform, Builder Of Compromise">1 Trackback</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1882" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-architect-of-reform-builder-of-compromise/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_5" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-architect-of-reform-builder-of-compromise/#comment-30306" title="View Ellen R. Shaffer's Comments">Ellen R. Shaffer (1 Comment)</a></td></tr> </table> </div> </span> </div> <div class="post" id="post-1874"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-and-american-health-care-policy-an-appraisal/" rel="bookmark" title="Permanent Link to Senator Edward Kennedy And American Health Care Policy: An Appraisal"> Senator Edward Kennedy And American Health Care Policy: An Appraisal </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 27th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_14');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/Marmor.jpg"><strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_14')" onmouseover="javascript:LayerSwitch('authormenu_14')">Theodore Marmor</a></strong> <div class="authormenu" id="authormenu_14" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Theodore Marmor</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=1386','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=1386" title="Theodore Marmor's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F27%2Fsenator-edward-kennedy-and-american-health-care-policy-an-appraisal%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Editor’s Note: <em>During his 47 years in the Senate, the late Senator Edward Kennedy of Massachusetts was a lion of U.S. health care and health policy. We at</em> Health Affairs<em>, along with much of the rest of America, grieve at his passing. We recently asked Democratic and Republican politicians, policy experts, and former Senate staff to write for us about the senator’s many contributions. We now publish several of these on the</em> Health Affairs<em> Blog, including the piece by Theodore Marmor below, and will also issue Web Exclusive versions for the archives in the weeks to come.</em></p> <p><em> – Susan Dentzer, Editor-in-Chief</em></p> <p>Senator Edward Kennedy’s passing, a central question for me as a scholar is simple to state, but complicated to answer. Would American medical care — its practices and its policies — be very different had the senator taken up a business career like his father rather than a political career like his brothers</p> <p>In one respect the answer seems straightforward. Neither Senator Kennedy nor anyone else has pulled off the major “overhaul” that has been a constant topic of political discussion since at least the early 1960s. We are in 2009 debating about almost exactly the same topics that Senator Kennedy addressed in his 1972 book, <em>In Critical Condition</em>. The costs then were skyrocketing, to use a phrase common to 2009. The financial barriers to care were one major object of the 1972 book’s reform agenda, with attention to areas of poor quality, inadequate supply of services, and vastly complicated insurance packages that left too many in fear of bankruptcy from being sick or injured. It is no surprise that when former Senator Tom Daschle set out to write his reform plan for a Democratic president who might emerge in 2009, he used the title <em>Critical</em>. It is noteworthy that none of the commentary on the 2008 Daschle book that I came across in writing a review of it mentioned the Kennedy forerunner, itself a sign of how hard it is to maintain an accurate historical perspective on a reform process that has now stretched over at least the decades since Medicare and Medicaid were enacted in 1965.</p> <p>It would be a mistake, however, to treat wholesale health reform as the standard for evaluation. American political institutions are designed constitutionally to make large-scale reform in any sphere difficult. And, if no one — from presidents on down — has been able to meet that test, there are still other appropriate benchmarks by which to judge the role of a health policy leader. One is that leader’s role in setting the agenda and framing the debate over the reform of American medical care. Another is whether a leader like Senator Kennedy made a smaller but significant difference in policy and whether, in slightly different circumstances, he might have made a major difference. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-and-american-health-care-policy-an-appraisal/#more-1874" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/children/" title="View all posts in Children" rel="category tag">Children</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/medicare/" title="View all posts in Medicare" rel="category tag">Medicare</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/pharma/" title="View all posts in Pharma" rel="category tag">Pharma</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/politics/" title="View all posts in Politics" rel="category tag">Politics</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-and-american-health-care-policy-an-appraisal/#respond" title="Comment on Senator Edward Kennedy And American Health Care Policy: An Appraisal">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-and-american-health-care-policy-an-appraisal/#trackbacks" title="Trackbacks on Senator Edward Kennedy And American Health Care Policy: An Appraisal">6 Trackbacks</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1874" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/27/senator-edward-kennedy-and-american-health-care-policy-an-appraisal/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_5" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1838"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/" rel="bookmark" title="Permanent Link to Moving From Volume-Driven Medicine Toward Accountable Care"> Moving From Volume-Driven Medicine Toward Accountable Care </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 20th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_15');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/McKethan.jpg"></td><td> </td><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/McClellan.jpg"></td></tr><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_15')" onmouseover="javascript:LayerSwitch('authormenu_15')">Aaron McKethan</a></strong> <div class="authormenu" id="authormenu_15" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Aaron McKethan</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=2153','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=2153" title="Aaron McKethan's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td><td width="30" align="center"> and </td><td> <script language="javascript">menu.push('authormenu_16');</script> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_16')" onmouseover="javascript:LayerSwitch('authormenu_16')">Mark McClellan</a></strong> <div class="authormenu" id="authormenu_16" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Mark McClellan</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=2154','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=2154" title="Mark McClellan's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F20%2Fmoving-from-volume-driven-medicine-toward-accountable-care%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Editor’s Note: <em>The post below argues that accountable care organizations (ACOs) represent a critical step away from volume-driven health care payment and toward better health and better care at lower cost. In addition to Aaron McKethan and Mark McClellan of the Engelberg Center for Health Reform at the Brookings Institution (pictures and bios above), the post is coauthored by Elliott Fisher and Jonathan Skinner of Dartmouth College. Fisher is Director of the Center for Population Health at The Dartmouth Institute for Health Policy and Clinical Practice and Professor of Medicine and of Community and Family Medicine at Dartmouth Medical School. Skinner is the John Sloan Dickey Third Century Professor of Economics at Dartmouth College; he is also a professor at the Dartmouth Institute for Health Policy and Clinical Practice, and a professor of Community and Family Medicine at Dartmouth Medical School.</em></p> <p><em>This post responds to <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/17/the-accountable-care-organization-not-ready-for-prime-time/" target="_self">a post by Jeff Goldsmith</a> which argues that ACOs are “not ready for prime time.”</em></p> <p>Accountable care organizations (ACOs) are provider collaborations that integrate groups of physicians, hospitals, and other providers around the ability to receive shared-savings bonuses by achieving measured quality targets and demonstrating real reductions in overall spending growth for a defined population of patients. ACOs can be organized in a number of provider configurations with different payer participants. They can also feature different payment incentives ranging from “one-sided” shared savings within a fee-for-service environment, to a range of limited or substantial capitation arrangements with quality bonuses.</p> <p>Unlike traditional pay-for-performance (P4P) programs, which often add to total costs by paying out incremental financial bonuses in exchange for meeting certain benchmarks on process measures, ACOs place a much greater emphasis on measuring and rewarding results at the level of a population of patients – not at the level of particular services or episodes that may or may not add up to higher-value care.</p> <p>In the current health care reform environment, ACOs are being considered as an element of reform to achieve urgently needed improvements in the quality and cost of health care. According to the Congressional Budget Office (CBO), ACOs can produce savings for Medicare ; indeed, many payers, including the Centers for Medicare and Medicaid Services (CMS), are currently implementing ACO-type payment reforms. As Jeff Goldsmith notes, it is important to identify any problems and issues with these reforms to ensure that current efforts build on past experience. On behalf of the Brookings/Dartmouth ACO Collaborative, which is designed to support providers in implementing ACO reforms, we also use this opportunity to correct some misperceptions of how ACOs work and highlight how they are designed to overcome challenges in previous payment reform efforts. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/#more-1838" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/hospitals/" title="View all posts in Hospitals" rel="category tag">Hospitals</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/physicians/" title="View all posts in Physicians" rel="category tag">Physicians</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/quality/" title="View all posts in Quality" rel="category tag">Quality</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/spending/" title="View all posts in Spending" rel="category tag">Spending</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/#comments" title="Comment on Moving From Volume-Driven Medicine Toward Accountable Care">3 Comments</a> <strong>|</strong> <script language="javascript"> menu.push('commentermenu_6'); </script> <a href="javascript:ToggleLayers('commentermenu_6')" onmouseover="javascript:LayerSwitch('commentermenu_6')"> Show Commenters</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/#trackbacks" title="Trackbacks on Moving From Volume-Driven Medicine Toward Accountable Care">7 Trackbacks</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1838" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_6" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/#comment-29848" title="View acavale's Comments">acavale (1 Comment)</a></td></tr> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/#comment-30338" title="View Nate Kaufman's Comments">Nate Kaufman (1 Comment)</a></td></tr> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/#comment-30201" title="View Maria Todd MHA, PhD's Comments">Maria Todd MHA, PhD (1 Comment)</a></td></tr> </table> </div> </span> </div> <div class="post" id="post-1754"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/18/affordable-access-for-modest-income-workers-eligible-for-group-coverage/" rel="bookmark" title="Permanent Link to Affordable Access For Modest-Income Workers Eligible For Group Coverage"> Affordable Access For Modest-Income Workers Eligible For Group Coverage </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 18th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_17');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/Curtis.jpg"></td><td> </td><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/Neuschler.jpg"></td></tr><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_17')" onmouseover="javascript:LayerSwitch('authormenu_17')">Rick Curtis</a></strong> <div class="authormenu" id="authormenu_17" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Rick Curtis</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=1003','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=1003" title="Rick Curtis's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td><td width="30" align="center"> and </td><td> <script language="javascript">menu.push('authormenu_18');</script> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_18')" onmouseover="javascript:LayerSwitch('authormenu_18')">Ed Neuschler</a></strong> <div class="authormenu" id="authormenu_18" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Ed Neuschler</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=1004','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=1004" title="Ed Neuschler's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F18%2Faffordable-access-for-modest-income-workers-eligible-for-group-coverage%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p><strong>The Problem. </strong>The treatment of lower-income workers and families eligible for employer coverage is a difficult challenge for health reform. Many of these workers struggle to afford their rising contribution requirements. Recent <a href="https://web.archive.org/web/20090904104202/http://www.kff.org/uninsured/7840.cfm">survey findings</a> indicate that 38 percent of workers eligible for employer coverage and with incomes under 200% of the federal poverty level (FPL) decline to participate, and over 20 percent remain uninsured.</p> <p>But subsidy policies that would invite a shift from employer- to federally financed coverage would be very costly. According to the Census Bureau, of all non-elderly people with employer coverage, 47 percent have incomes under 400% FPL, the income threshold for premium-credit subsidies available through the Exchange under the Senate HELP and House Energy and Commerce Committee bills. Almost 30% have incomes under 300% FPL, the subsidy level reportedly being considered by the Senate Finance Committee.</p> <p>Of people in the Committees’ core (common) Exchange subsidy eligibility range of 150% to 300% FPL, 38 million had employer coverage—2.5 times the 15 million who were uninsured.</p> <p>To avoid a costly shift from employer to public financing, Committee-approved plans establish a “firewall” blocking subsidized coverage in the Exchange unless the worker’s share of employer plan premiums exceeds 12.5% (Senate HELP Committee) or 12% (House) of family income. But those amounts would deny access to reasonably affordable coverage to many lower-income workers. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/18/affordable-access-for-modest-income-workers-eligible-for-group-coverage/#more-1754" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/access/" title="View all posts in Access" rel="category tag">Access</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/cost/" title="View all posts in Cost" rel="category tag">Cost</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/insurance/" title="View all posts in Insurance" rel="category tag">Insurance</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/18/affordable-access-for-modest-income-workers-eligible-for-group-coverage/#respond" title="Comment on Affordable Access For Modest-Income Workers Eligible For Group Coverage">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/18/affordable-access-for-modest-income-workers-eligible-for-group-coverage/#trackbacks" title="Trackbacks on Affordable Access For Modest-Income Workers Eligible For Group Coverage">1 Trackback</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1754" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/18/affordable-access-for-modest-income-workers-eligible-for-group-coverage/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_6" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1724"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/17/the-accountable-care-organization-not-ready-for-prime-time/" rel="bookmark" title="Permanent Link to The Accountable Care Organization: Not Ready For Prime Time"> The Accountable Care Organization: Not Ready For Prime Time </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 17th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_19');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/Goldsmith.jpg"><strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_19')" onmouseover="javascript:LayerSwitch('authormenu_19')">Jeff Goldsmith</a></strong> <div class="authormenu" id="authormenu_19" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Jeff Goldsmith</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=567','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=567" title="Jeff Goldsmith's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F17%2Fthe-accountable-care-organization-not-ready-for-prime-time%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Editor’s Note: <em>In the post below, Jeff Goldsmith argues that the concept of accountable care organizations (ACOs) is “not ready for prime time.” <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care/" target="_self">In a response</a>, Aaron McKethan, Mark McClellan, Elliott Fisher, and Jonathan Skinner state that ACOs represent a critical step away from volume-based health care payment and toward better health and better care at lower cost.</em></p> <p>Everyone from President Obama to Rush Limbaugh seems to agree on one thing about health reform: the vital importance of containing health costs. Policymakers seem finally to have learned that merely reducing Medicare’s unit payments to hospitals and doctors backfires. It increases “moral hazard”–driven volumes and further shifts costs from public programs onto drowning businesses and cash-strapped households. So an intensive search is on for policy alternatives for saving money.</p> <p>There were lots of cost containment ideas bandied about during the presidential campaign: disease management, medical homes, the electronic health record, prevention and wellness, bundling provider payments, “consumer empowerment.” Many are cropping up in health reform legislation. All these ideas suffer from a common problem: it’s depressing how little credible evidence there is that any of them actually save money.</p> <p>In this yawning policy vacuum, people, including congresspeople, are flocking to what seems like a bright idea that originated the Dartmouth health policy factory- the accountable care organization (ACO). The ACO grew out of the important Wennberg/Fisher work on market variation in health cost, and the idea has been studied and developed by the Dartmouth group and others, notably researchers at the Brookings Institution’s Engelberg Center for Health Care Reform. It was built on what is (to my consulting colleagues, anyway) a stunningly obvious discovery: Medicare spending for physician services tends to cluster around hospital service areas. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/17/the-accountable-care-organization-not-ready-for-prime-time/#more-1724" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/hospitals/" title="View all posts in Hospitals" rel="category tag">Hospitals</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/physicians/" title="View all posts in Physicians" rel="category tag">Physicians</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/quality/" title="View all posts in Quality" rel="category tag">Quality</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/spending/" title="View all posts in Spending" rel="category tag">Spending</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/17/the-accountable-care-organization-not-ready-for-prime-time/#respond" title="Comment on The Accountable Care Organization: Not Ready For Prime Time">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/17/the-accountable-care-organization-not-ready-for-prime-time/#trackbacks" title="Trackbacks on The Accountable Care Organization: Not Ready For Prime Time">3 Trackbacks</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1724" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/17/the-accountable-care-organization-not-ready-for-prime-time/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_6" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1727"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/12/what-people-don%e2%80%99t-know-about-health-insurance-exchanges/" rel="bookmark" title="Permanent Link to What People Don’t Know About Health Insurance Exchanges"> What People Don’t Know About Health Insurance Exchanges </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> August 12th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_20');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/PLee.jpg"></td><td> </td><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/Grgurina.jpg"></td></tr><tr><td> <strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_20')" onmouseover="javascript:LayerSwitch('authormenu_20')">Peter Lee</a></strong> <div class="authormenu" id="authormenu_20" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Peter Lee</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=2142','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=2142" title="Peter Lee's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td><td width="30" align="center"> and </td><td> <script language="javascript">menu.push('authormenu_21');</script> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_21')" onmouseover="javascript:LayerSwitch('authormenu_21')">John Grgurina</a></strong> <div class="authormenu" id="authormenu_21" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">John Grgurina</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=2141','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=2141" title="John Grgurina's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F08%2F12%2Fwhat-people-don%25e2%2580%2599t-know-about-health-insurance-exchanges%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>Editor’s Note: <em>For more on health insurance exchanges and health reform, see</em> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/" target="_self">Building A Health Marketplace That Works</a><em> by Alain Enthoven.</em></p> <p>Much of the heat so far in the debate over how health care reform will expand coverage to uninsured Americans has been about whether or not there should be a public plan option. That has overshadowed one of the most important issues – how to design effective health insurance exchanges to meet the needs of small employers and individuals. </p> <p>Both houses of Congress have now proposed frameworks for expanding coverage that rely on exchanges. A health insurance exchange is simply a structured marketplace where people can choose among health plan options. The exchange offers information to help people make informed choices, and it provides administrative services such as simplified processing of enrollment, subsidies, and premium payment. This can be of great value to small employers and individuals who don’t have access to employer-sponsored group plans.</p> <p>Plenty of academic experts have written about the ideal design of an exchange, but we bring a unique, real-world perspective. We know why exchanges have and haven’t worked based on our experience running one of the largest voluntary health insurance exchanges in the country, PacAdvantage, which served over 10,000 small employers in California from 1993 to 2006, at its peak providing insurance for 150,000 enrollees. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/12/what-people-don%e2%80%99t-know-about-health-insurance-exchanges/#more-1727" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/consumers/" title="View all posts in Consumers" rel="category tag">Consumers</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/insurance/" title="View all posts in Insurance" rel="category tag">Insurance</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/politics/" title="View all posts in Politics" rel="category tag">Politics</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/12/what-people-don%e2%80%99t-know-about-health-insurance-exchanges/#respond" title="Comment on What People Don’t Know About Health Insurance Exchanges">Post a Comment</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/12/what-people-don%e2%80%99t-know-about-health-insurance-exchanges/#trackbacks" title="Trackbacks on What People Don’t Know About Health Insurance Exchanges">1 Trackback</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1727" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/08/12/what-people-don%e2%80%99t-know-about-health-insurance-exchanges/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_6" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> </table> </div> </span> </div> <div class="post" id="post-1704"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/" rel="bookmark" title="Permanent Link to Building A Health Marketplace That Works"> Building A Health Marketplace That Works </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> July 31st, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_22');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/Alain.jpg"><strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_22')" onmouseover="javascript:LayerSwitch('authormenu_22')">Alain C. Enthoven</a></strong> <div class="authormenu" id="authormenu_22" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Alain C. Enthoven</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=287','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=287" title="Alain C. Enthoven's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F07%2F31%2Fbuilding-a-health-marketplace-that-works%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>In the debate about health reform, many issues are getting an inordinate amount of attention, but one is not getting the detailed consideration it deserves. How it is finally resolved is likely to be one of the key factors of the ultimate plan’s success or failure. That issue is the design of the <em>health insurance exchange.</em></p> <p>An exchange is a managed marketplace in which individuals can choose among a variety of health plans. Why do we need an exchange? An exchange would help to remedy serious deficiencies in the current health care system:</p> <p>• <strong>Lack of consumer choice.</strong> Most employees are offered only one insurance option. Health insurers usually don’t allow small employers to offer competing plans, due to high administrative costs and concerns about adverse selection; as a result, the employer is forced to accept a “one-size-fits-all” plan for her/his employees. This is usually an expensive “fee-for-service” plan that rewards doctors for volume of services but not quality of care. The lack of choice for employees also means that there is no effective competition among insurers at the consumer level. This market blocks the growth of efficient integrated financing and delivery systems, which are not good candidates for the role of an employer’s sole plan. <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/#more-1704" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/competition/" title="View all posts in Competition" rel="category tag">Competition</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/consumers/" title="View all posts in Consumers" rel="category tag">Consumers</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/insurance/" title="View all posts in Insurance" rel="category tag">Insurance</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/#comments" title="Comment on Building A Health Marketplace That Works">5 Comments</a> <strong>|</strong> <script language="javascript"> menu.push('commentermenu_7'); </script> <a href="javascript:ToggleLayers('commentermenu_7')" onmouseover="javascript:LayerSwitch('commentermenu_7')"> Show Commenters</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/#trackbacks" title="Trackbacks on Building A Health Marketplace That Works">4 Trackbacks</a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1704" onclick="email_popup(this.href); return false" title="EMail This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/email/images/email.gif" alt="E-Mail This Post/Page"/></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/print/" title="Print This Post"><img src="https://web.archive.org/web/20090904104202im_/http://healthaffairs.org/blog/wp-content/plugins/print/images/print.gif" alt="Print This Post/Page"/></a> <br> <span style="position: relative; left: 0pt; z-index: 10;" class="authorname"> <div class="authormenu" id="commentermenu_7" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/#comment-29666" title="View bett martinez's Comments">bett martinez (1 Comment)</a></td></tr> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/#comment-29684" title="View acavale's Comments">acavale (1 Comment)</a></td></tr> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/#comment-30150" title="View Bob Stone's Comments">Bob Stone (1 Comment)</a></td></tr> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/#comment-29674" title="View Bill Stapleton's Comments">Bill Stapleton (1 Comment)</a></td></tr> <tr><td class="authormenu_link"><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/31/building-a-health-marketplace-that-works/#comment-29807" title="View James Mhyre's Comments">James Mhyre (1 Comment)</a></td></tr> </table> </div> </span> </div> <div class="post" id="post-1687"> <h2><a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/parsing-public-plan-proposals/" rel="bookmark" title="Permanent Link to Parsing Public Plan Proposals"> Parsing Public Plan Proposals </a></h2> <hr size="7" style="color: #CCCCCC; background-color: #CCCCCC;"> <small> <small><small> July 29th, 2009 </small></small> </small> <br> <div class="authorname"> <script language="javascript">menu.push('authormenu_23');</script> <table><tr><td> <img src="/web/20090904104202im_/http://healthaffairs.org/blog/author_images/pdmzq.jpg"><strong class="authorname">by</strong> <span style="position: relative; left: 0;" class="authorname"> <strong><a href="javascript:ToggleLayers('authormenu_23')" onmouseover="javascript:LayerSwitch('authormenu_23')">Peter McMenamin</a></strong> <div class="authormenu" id="authormenu_23" style="visibility: hidden"> <table cellpadding="4" cellspacing="1" border="0"> <tr><td class="authormenu_head">Peter McMenamin</td></tr> <tr><td class="authormenu_link"><a href="javascript:popUp('https://web.archive.org/web/20090904104202/http://www.healthaffairs.org/blog/user_bio.php?author_id=2008','authorbio','400','300')"> View Author Bio</a></td></tr> <tr><td class="authormenu_link"><a href="?feed=rss2&author=2008" title="Peter McMenamin's RSS Feed"> <img src="https://web.archive.org/web/20090904104202im_/http://www.healthaffairs.org/images/rss.gif" border="0"></a></td></tr> </table> </div> </span> </td></tr></table> </div> <div class="entry"> <div class="tweetmeme_button" style="float: right; margin-left: 10px;"><iframe src="https://web.archive.org/web/20090904104202if_/http://api.tweetmeme.com/button.js?url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F07%2F29%2Fparsing-public-plan-proposals%2F&style=normal" height="61" width="50" frameborder="0" scrolling="no"></iframe></div><p>The “public plan” is today’s ultimate Rorschach test; different observers may see very different perspectives. Particularly when the advocates leave loose ends, their opponents weave those untied threads as they will. Nobody’s on firm ground so no concrete debate is possible. Lots of smoke, hardly any light. </p> <p>It seems that there are some simpler clarifying questions that could be addressed to get the proponents to demonstrate that they do have specific ideas on how to get there (wherever <em>there </em>is) from here. Proponents should be expected to provide practical demonstrations of how a public plan could work in a real world. </p> <p>At a minimum there are four questions that need to be answered:</p> <p>1. What will be the financial obligations of those covered by policies obtained through the public plan?<br/> 2. What will be the locus or locuses of competition between the public plan and private plans?<br/> 3. Will there be sufficient providers to willingly (or not) provide services under the public plan? and<br/> 4. Will there be administrative (or other) savings? <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/parsing-public-plan-proposals/#more-1687" class="more-link">Read the rest of this entry »</a></p> </div> <p align="left" class="postmetadata">Posted in <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/all-categories/" title="View all posts in All Categories" rel="category tag">All Categories</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/health-reform/" title="View all posts in Health Reform" rel="category tag">Health Reform</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/medicare/" title="View all posts in Medicare" rel="category tag">Medicare</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/physicians/" title="View all posts in Physicians" rel="category tag">Physicians</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/policy/" title="View all posts in Policy" rel="category tag">Policy</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/politics/" title="View all posts in Politics" rel="category tag">Politics</a>, <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/category/spending/" title="View all posts in Spending" rel="category tag">Spending</a> <strong>|</strong> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/2009/07/29/parsing-public-plan-proposals/#respond" title="Comment on Parsing Public Plan Proposals">Post a Comment</a> <strong>|</strong> <a href="" title="Trackbacks on Parsing Public Plan Proposals"></a> <a href="https://web.archive.org/web/20090904104202/http://healthaffairs.org/blog/wp-content/plugins/email/wp-email-popup.php?p=1687" onclick="email_popup(this.href); 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