Health Reform

The Patient Protection and Affordable Care Act established a new public-private entity for comparative effectiveness research: the Patient-Centered Outcomes Research Institute. The institute is charged with identifying priorities, establishing an agenda, and carrying out comparative effectiveness research. The political process through which the institute was formalized greatly influenced its scope and charge, including the organization’s goals, its unique private-public composition, and its funding.

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.

Few things are more inconsistent than Americans’ attitude toward death. They want their doctors to “do everything” to keep them alive -- and they want to die peacefully and quietly, preferably at home. But unless there’s a way to blend "House" and "Forrest Gump" (think Sally Field’s deathbed scene), something is wrong with this picture. For frail, disabled, aging, or dying Americans, health care reform may offer a new image, in ways that were obscured or distorted during much of the political debate.

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.

We’ve written before about the issue of hospital readmissions, but we just wanted to point to an excellent post this week by Anne-Marie J. Audet, M.D., MSc., the VP of Health System Quality and Efficiency at over at the Commonwealth Fund. Audet points out the deficiencies surrounding rehospitalization rate reporting -- though we have solid rehospitalization studies looking at Medicare patients only, these studies are limited in scope and cannot give us an accurate picture of the health system as a whole. She calls for a standardized national measure for reporting rehospitalizations and improved data systems to make sure reporting is timely. Audet writes:

Several national reports published…feature rehospitalization rates, and some have tracked rates over time. Yet, two problems persist: each group has adopted a different definition of rehospitalization, which makes comparisons and benchmarking across states, regions, and hospitals impossible, and most reports are based on data that are more than two years old.

Several of us from New America spent some time at the Agency for Healthcare Research and Quality’s big annual conference this week, its first since health care reform with all its potential for primary care was enacted. It’s a bit hard to sum up (keynote speaker Atul Gawande called it being "in the trenches with the data") so I’ll jump off from the opening plenary -- "21st Century Health Care: What Does it Mean to Achieve Success in Quality, Value, and Access to Care."

AHRQ director Carolyn Clancy (we had a chance to talk to her this summer here) moderated, and the panelists were Maulik Joshi, president of the Health Research & Educational Trust and senior vice president for Research at the American Hospital Association, James Mold, professor and director of research in the Department of Family and Preventive Medicine at the University of Oklahoma College of Medicine and Debra Ness, president, National Partnership for Women and Families (and the fact that Ness was there, keeping the focus on what patients/consumers/families want, was itself telling).

The discussion started with the observation that "patient-centeredness" is a bit of a Rorschach test, but panelists agreed (more or less) that people want coordinated care from someone who knows them, and can treat the whole person, not just an organ or a condition. They want to be engaged, and share in the decision-making. And getting there is tough.

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.

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.

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.