Health Politics

If we want to improve quality and control costs in our health care system, we need verifiable, reliable information about what works and what doesn’t. Comparative effectiveness research (CER), which compares two or more medical treatments, tests, or interventions to see which one works better for patients, is the key to figuring this out.

The journal Health Affairs themed its October issue around the “new era” of comparative effectiveness research. The health reform law advances CER by establishing the Patient-Centered Outcomes Research Institute (PCORI), a public-private entity that will establish research priorities, set the agenda, and provide for research to be carried out. The GAO recently announced the members of the PCORI Board of Governors. (The GAO is home to the Comptroller General, who was in charge of board appointments).

One of the most unfortunate side effects of the way the right demonized health reform through the "death panel" fiction was that it made people, particularly older people, genuinely afraid that health reform would harm them, maybe even hasten their deaths. In truth, health reform holds the potential -- if we implement it well and build on it wisely -- to give people more choices about where and how they age and die, give them more opportunity for them to ensure that the treatment and services they get as they enter their final years is the treatment they want.

Joe Mathews of NBC’s PropZero (and a New America Foundation Senior Fellow) wrote that “The Meg Whitman housekeeper story is the most interesting political story in California this week. It isn’t the most important.”

Instead, Joe tips Governor Schwarzenegger’s recent signing of two important pieces of legislation creating a health benefit exchange in California -- the first established in the US since the passage of the Affordable Care Act this past spring.

We agree. These bills are both symbolically and substantively important. As Schwarzenegger stressed in a ceremonial signing at the California Endowment headquarters in Los Angeles on Friday, the backing of a moderate Republican governor for the exchanges gives a leg up to the wider goal of implementation. Moreover, Schwarzenegger signed the bills in the face of spirited business opposition led by Anthem Blue Cross and the California Chamber of Commerce, which contended (wrongly, in our view) that the new exchanges would create an unaccountable new branch of government and gain undue authority over insurers.

The latest Health Wonk Review is up over at the Healthcare Talent Transformation blog. Review host Peggy Salvatore's theme is something she believes is even more headline-worthy than the recent six month anniversary of comprehensive health reform...Aliens! That's right, the United Nations just appointed our first ambassador for extraterrestrial contact. In the spirit of "take me to your leader," Salvatore runs down the list of terrestrial leaders in health -- from Texas legislators to doctors to economists to the HHS, and more. Check it out! (It includes Joanne Kenen's post on whether Atul Gawande made it safe for us to all talk about end of life care again -- what it means to care for a patient when there is no cure for a patient.)

Today in the Wall Street Journal, Karl Rove asserts that aggregate polling clearly shows “an army of opposition” to health reform and to Democrats in midterm elections. He claims that:

• 40 percent of Americans approve of the health reform law, while 50 percent oppose it.
• “Strong Disapproval” outnumbers “Strong Support” two-to-one.

I say not so fast! And not because I specifically disagree with the numerical accuracy of the figures Karl Rove puts forward.  What I disagree with is the wisdom of using polling averages to make such definitive statements on an issue as complex as health reform. Politically useful? Absolutely. Polling numbers are a great tool for supporting an argument (and they get used frequently on both sides of the political aisle) -- but polling numbers, especially polling averages, aren't as straightforward as they seem. Careful examination of the polling used (pollster.com) reveals a lot of nuance in the numbers and the language surrounding health care polling that aren't immediately apparent in top-line takeaways -- so readers should be at least a little bit wary when presented with "averages."

Pollster.com’s most recent “Health Care Plan: Favor/Oppose” graph shows opposition at 49.6 percent vs. support at 39.9 percent. At first glance, it would appear that Rove’s number check out (at least as of Sept. 19, the most recent update). But looking at the constituent polls should provoke some questions.

Gov. Arnold Schwarzenegger is deciding whether to sign legislation that would create the "California Health Benefit Exchange," a key piece of federal health care reform. This is the perfect time, therefore, to clear the air about what the exchange will and won't do. A clear-eyed account of the facts about the exchange shows it to be the exact kind of moderate solution that the governor has pushed for throughout his tenure, one that combines a concern for the public good with the power of the private market.

Health Policy Program Director Kavita Patel published an op-ed today in CNN, exploring the prospects of "repeal and replace" and the new health  insurance consumer protections :

When President Barack Obama signed the Affordable Care Act into law, it was clear he would face an uphill battle defending the law and communicating its benefits to the American public.

In the months leading to passage, we heard cries of rationing, death panels and blatant mischaracterization of what is in the bill.

Since passage, the cries have shifted from rationing to repeal. Efforts to repeal the law have been highlighted by the self-proclaimed "Young Guns" of the GOP...President Obama should not be fazed by this or any other calls for repeal. He should do the job he was elected to do and protect patients' interests, but he will need to face a confused public...

Read the full article here.

It’s time for some straight talk about plans to “repeal” health care reform.

Republicans might engage in some budgetary maneuvers in an attempt to “defund” the health reform law but they are extremely unlikely to rollback enormously popular provisions such as the ban on pre-existing conditions exclusions or the small business tax credits.  They will, of course, push for many significant changes.  Democrats, however, know that they too will have to make changes. Health reform is and always will be a process, not a destination.

The legislation passed in March was one historic part of that process, but building a higher quality, lower cost health system will take at least a generation and will require everyone’s attention and effort.

This continues our series of posts on the various constitutional challenges to the individual mandate, by Tony Cardona, an attorney who is doing some work with New America's health policy program. Read his post about federal authority and taxation here.

“The Congress shall have Power . . . To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution . . .” (U.S. Const., Art. 1, sec. 8, cl. 18)

In their required Contracts courses, first year law students learn “the four corners rule.” It simply means that the language inside the four corners of the contracted document will be the primary source for resolving a dispute. When our Founding Fathers drafted the Constitution, they created a contract with every generation of Americans. The Supreme Court, the interpreters of this contract, look within the four corners of the Constitution to decides whether a federal law -- such as the individual mandate to purchase health insurance -- exceeds the contract’s scope.  A federal action -- such as regulating the health insurance market -- doesn’t have to be mentioned specifically in the Constitution, but it does have to relate to a power enumerated in the Constitution.