Cost

Two years ago, Massachusetts produced an impressive example of bi-partisan health reform when a Republican governor, Mitt Romney, agreed to cover all citizens and a Democratic legislature agreed to operate within a private market system.

Michael Tanner of the Cato Institute pointed out that health care costs are out control and spending, projected to rise from about 17 to 20 percent of GDP in less than a decade, is unsustainable. We agree. No health reform proposal will be sustainable without serious efforts to reduce costs and improve quality.

Determined to have a constructive voice in the growing national dialogue on health reform, the National Federation of Independent Business (NFIB), the nation's largest small business association, launched its new health care campaign—Solutions Start Here: When Healthcare is Fixed for Small Business its Fixed for America.

The Mayo Clinic held a health reform conference this week -- New America's Health Policy director Len Nichols was there and he'll post about it momentarily. But Mayo also released a survey about what the public is thinking about health care. The Health Blog at the Wall Street Journal summed it up, but here are a few interesting snippets:

Another doctor is weighing in on the chaotic—and costly—way we take care of patients.

We read Senator Tom Coburn's (R-OK) piece in the New York Sun yesterday. While we applaud Senator Coburn’s commitment to reforming our struggling health system and his bill, S.

We flew in a bunch of survivors from the California health wars the other day to share their perspective with Washington policymakers gearing up for possible national health reform next year. As we all know, a carefully crafted bipartisan compromise between the Republican Gov. Arnold Schwarzenegger and the Democratic Assembly passed that chamber by a healthy 46-31 margin last December only to fizzle a month later in the state Senate Health Committee. The seven to one "no" vote was the legislative equivalent of blunt trauma to the head. Yet we were struck by the optimistic tone of our panelists. They built powerful coalitions against difficult odds around an ambitious hybrid public-private health coverage plan. Their ability to bring stakeholders together was an important lesson as we try to prepare bipartisan, cross-sector ground for national reform next year. And instead of retreating to lick their wounds, they are thinking about how to keep cooperating in the future. One possible target: the much-publicized "rescissions" in which insurers have retroactively cancelled policies after an insured person gets sick and starts costing them money.

The Kettering Foundation, along with Public Agenda and the National Issues Forum Institute, held what they billed as a novel experiment in public thinking about health care and the environment this week. We attended the health care event -- a half-hour film of focus groups around the country of ordinary people talking about the trade-offs of health reform, followed by a panel discussion by nine experts in public opinion or public policy (but not necessarily in health policy). They plan on holding more discussions across the country in the coming months.

We certainly laud dialogue on health care -- particularly recognition upfront that it involves tough choices and tradeoffs. One of the pitfalls of previous reform efforts, we think, is that people were asked if they wanted to improve the system but not immediately confronted with all the implications of that choice -- and then they backed off in a panic.

How far would you drive for a dentist appointment? If you’re lucky enough to have dental insurance, your answer might be in minutes, but if you’re poor and uninsured in Wisconsin, you might travel up to 250 miles to get to one of Greg Nycz’s community health clinic.

When Boston-based Fidelity Investments began calculating retirees' likely health costs in 2002, the figure was a pretty hefty $160,000 in savings for a couple. Just six years later, the necessary nest egg has swelled to $225,000. And this is for the segment of our population covered by Medicare as well as a new prescription drug benefit enacted after this annual survey began. [slideshow]Many experts believe the out-of-pocket expenses for the elderly will continue rising unless we come up with an effective national strategy of cost containment.