Today, a group of progressive think tanks released their response to the deficit: Investing In America's Economy: A Budget Blueprint for Economic Recovery and Fiscal Responsibility. As Naomi indicates below, the report represents a collaborative effort by Demos, the Economic Policy Institute (EPI) and The Century Foundation (TCF). Here, I’m focusing on how we can rein in health care spending, but I urge you to read the entire report. It makes it clear that we don’t need the austerity budget that the conservative Peterson-Pew Commission proposes. Instead, we should be focusing on jobs and growth.

Commenting on “Investing in America’s Economy” over at Think Progress, Matt Yglesias highlights a major theme: “No Cost Shifting.” He quotes the report: “Policies that simply shift costs from the federal government to individuals and families may improve the government’s balance sheet but may worsen the condition of many Americans, leaving the overall economy no better off.”

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The Century Foundation in a collaborative effort with Demos and the Economic Policy Institute has produced a new report entitled: “Investing in America’s Economy: A Budget Blueprint for Economic Recovery and Fiscal Responsibility.” The blueprint prioritizes a strong economic recovery because widespread job creation and robust economic growth are essential to successful deficit reduction. The report also singles out health care costs as one of the prime drivers of growth in our national debt, and with contribution by Maggie Mahar, proposes a variety of policies that will reduce the growth of these costs. According to the blueprint report, these changes would not only help reduce the deficit, but could also improve the quality of care and reduce costs for businesses and families.

Over the past two weeks, Bob Wachter, Associate Chairman of the Department of Medicine at the University of California, San Francisco, has published two provocative posts on hospital errors and patient safety on The Health Care Blog (THCB) (www.thehealthcareblog.com)

The first post, which appeared on November 22, focuses on  a breakthrough article in the New England Journal of Medicine, a candid  report of a case in which Dr. David Ring, a prominent Harvard hand specialist at the Massachusetts General Hospital (MGH),  performed the wrong operation on a 65-year-old woman. She needed a trigger finger release, but received a carpal tunnel release, an entirely different operation. In the November 11 issue of the NEJM, Ring described his own error, with safety expert Gregg Meyer providing commentary. http://prod.nejm.org/doi/full/10.1056/NEJMcpc1007085   

“This was a breakthrough for the Journal,” Wachter notes, “the first time in its storied 86-year history that the Case Records of the MGH published such a report. But it was not the first opportunity the NEJM had to publish such a piece… that occurred a decade earlier. The story of the path from then to now reflects the evolution of the patient safety movement. It’s a story I know well since it involved one of the lowest points in my professional life”

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Summary: Below, I write about Palliative Care: Transforming the Care of Serious Illness (Jossey-Bass, 2010), an outstanding collection of essays edited by Diane E. Meier, Stephen L. Isaacs and Robert G. Hughes. In this post I also focus on a a Dartmouth Atlas report, released just last week, spotlighting geographic variations in access to hospice care.  

Often, hospice and palliative care are confused. They are alike in that both hospice and palliative care emphasize  relieving suffering and improving the quality of the patient’s life. But while hospice care is designed for those who are clearly dying, palliative care provides comfort and pain relief for anyone who is seriously ill, regardless of their prognosis—whether a cancer patient who hopes to go into  remission, or a patient who is expected to live for years with a chronic disease such as heart failure or Alzheimer’s.

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Rep. Jan Schakowsky (D-IL) is a member of the President’s bi-partisan commission on deficit reduction, but she’s not happy with the proposals put forward by the commission’s Co-Chairs, Erskine Bowles and Alan Simpson. They would reduce the deficit by cutting Social Security, Medicare, Medicaid, and health care for the military.

“Social Security is not part of the deficit problem,” Schakowsky declares. “To take it out on the elderly, who have an average income of $18,000  [including social security, pensions, investment income]  . . .  I think that is, frankly, immoral,” she adds. “The average benefit is $14,000 a year. Nobody’s getting rich.”

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Senators Scott Brown (R-MA) and Ron Wyden (D-OR) have introduced a bill that would let states apply in 2014 for waivers to allow them to get federal funding for health reform schemes that opt out of such integral provisions of the Affordable Care Act as the individual mandate, the employer penalty for not providing coverage, and minimum standards for a basic health insurance policy. Currently, states may only apply for such waivers in 2017—three years after the insurance exchanges and other major provisions of the legislation have been set in motion.

In theory, this bill, dubbed the "Empowering States to Innovate Act", could allow Vermont, for example, to set up the single-payer system that both the governor-elect and Senator Bernard Sanders support. It could also allow Tennessee to receive federal funding for a free-market, consumer-driven system that focuses on health savings accounts and catastrophic coverage, a plan advocated by some leaders in that state. There are important caveats included in the bill, according to Wyden: States will only be granted waivers if their plans will result in the same number of residents having affordable coverage as would occur under the ACA's mandates and subsidies. Also, the insurance coverage must be “at least as comprehensive as provided under federal law,” and the plan must not add to the federal deficit.

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Maggie's recent absence from this blog has been due to a health problem, but she is on the mend and will be back to blogging right after Thanksgiving.

Let’s say you’ve enrolled in a new health insurance plan and need to find an internist who participates. How do you decide which doctor to choose? My (long deceased) grandmother made her choices by using the following criteria: She looked for a male doctor with a Jewish-sounding last name who graduated from an American medical school—preferably one located in New York City. Nowadays her narrow (and culturally biased) criteria would have excluded some of the most esteemed practitioners around.

If you are like most people, you don’t depend on your grandmother’s advice to find a physician, but rather ask friends, colleagues or other doctors for recommendations. But taking one person’s experience with an internist or surgeon as a signal that he or she is “really good” is still far from the optimal way to choose a practitioner.

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As I read the report that the Peterson-Pew Commission on Budget Reform released yesterday,  two recommendations caught my attention:

“A permanent freeze on payments to [all] Medicare physicians

“Increase Medicare retirement age to 67”

The first proposal offers a crude solution to a problem that the Affordable Care Act addresses in a far more intelligent way, giving the Secretary of Health and Human Services the discretion to raise payments for “undervalued services” and lower payments for “overvalued services.”  The truth is that Medicare underpays many doctors, particularly primary care physicians, geriatricians, palliative care specialists and general surgeons. This is one reason why we have a serious shortage in these areas. At the same time, the Medicare Payment Advisory Commission has pointed out that we over-pay for certain services, and because they are so lucrative, they tend to be done too often. Past experience shows that when fees were trimmed for certain imaging services, volume leveled off.

As for lifting the Medicare retirement age to 67, does the Commission realize how many uninsured 62–year-olds are hanging on, counting the days and months until they turn 65?  Gathering the votes to pass the second proposal would mean going up against every lobby that protects older Americans.

The Draft of the Co-Chair’s Proposal

Late yesterday afternoon, I saw a much more detailed document–the “Draft Co-chair’s Proposal” for addressing the deficit.    The authors begin by touting the Commission’s report as a “sensible, real plan” that “requires shared sacrifice.”  But as I began reading the section on healthcare, it didn’t take too long to figure out who would be making the sacrifices:  sick seniors and doctors are expected to offer themselves up.  The health care corporations that feed at the trough of an extravagant health care system are barely asked to contribute.  Indeed, the Peterson-Pew report calls for slashing taxes for corporations from 36 percent to 25 percent.

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Texas is thinking of abandoning Medicaid, reports the New York Times, reprinting a story from the Texas Tribune, a colorful piece that omits one central fact about Medicaid expansion under the Affordable Care Act (ACA).

Apparently the state’s conservatives are unhappy that reform legislation will open Medicaid’s doors to millions of Texas. Today, in the Lone Star state, parents qualify for Medicaid only if their family income is below $5,720. The legislation would set a new national standard for Medicaid eligibility at about $28,000—or $33,000 for a family.

“Dropping out of Medicaid is worth considering,” State Senator Jane Nelson, who heads the state’s Senate Public Health Committee, told the Tribune. “Currently, the Texas program costs $40 billion for a period of two years, with the federal government paying 60 percent of the bill,” but “as a result of federal health care changes, millions of additional Texans will be eligible for Medicaid. I want to know whether our current Medicaid enrollees, and there certainly could be millions more by 2014, could be served more cost efficiently and see better outcomes in a state run program.” 

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