Health Care Reform 2009

Implementing Evidence-Based Health Policy in Washington State

Gary M. Franklin, M.D., M.P.H., and Brian R. Budenholzer, M.D.

The Obama administration’s infusion of stimulus funds into enhanced comparative-effectiveness research (CER) is in keeping with the conclusion of a recent Commonwealth Fund report that, of the top 15 ways of bringing health care costs under control, CER promises the greatest short- and long-term savings.¹ (more…)

Massachusetts Health Care Reform — Near-Universal Coverage at What Cost?

Joel S. Weissman, Ph.D., and JudyAnn Bigby, M.D.

Massachusetts has long been known for its academic medical centers, biomedical research, high-quality health care, and perhaps not unrelatedly, high health care costs. (more…)

Health Care Reform in Perspective

Arnold M. Epstein, M.D., Henry J. Aaron, Ph.D, Katherine Baicker, Ph.D, Jacob S. Hacker, Ph.D, and Mark V. Pauly, Ph.D

President Barack Obama has placed U.S. health care reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills — three in the House of Representatives and two in the Senate — that proponents believe will move the country in the direction of universal coverage, a fairer insurance system, and slower escalation of health care costs. (more…)

Primary Care and Accountable Care — Two Essential Elements of Delivery-System Reform

Diane R. Rittenhouse, M.D., M.P.H., Stephen M. Shortell, Ph.D., M.P.H., M.B.A., and Elliott S. Fisher, M.D., M.P.H.

With discussions about U.S. health care reform focused heavily on insurance reforms, relatively little attention has been paid to the delivery-system reforms that will be required to improve the quality and coordination of health care and slow the growth of spending. (more…)

Lost in Transmission — FDA Drug Information That Never Reaches Clinicians

Lisa M. Schwartz, M.D., and Steven Woloshin, M.D.

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. (more…)

Comparative Effectiveness — Thinking beyond Medication A versus Medication B

Kevin G. Volpp, M.D., Ph.D., and Anup Das

The American Recovery and Reinvestment Act of 2009 (ARRA), the stimulus package signed into law by President Barack Obama on February 17, 2009, directs $1.1 billion to support “the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies, including through efforts that . . . (more…)

Communal Responsibility for Health Care — The Example of Benefit Assessment in Germany

Peter T. Sawicki, M.D., Ph.D.

Many German observers are bewildered over the U.S. health care reform debate. Most Europeans see affordable health insurance for everyone as a fundamental element of a stable and prosperous society — an element founded on the principle of communal responsibility. Like the United States, Germany is a wealthy, democratic society with strong nongovernmental community institutions.¹ (more…)

Baucus’s Bill and the Long Road to Reform

John K. Iglehart

In an effort to attract Republican support, Senator Max Baucus (D-MT), chair of the Senate Finance Committee, stripped his health care reform proposal of some of its most contentious elements — the creation of a public insurance option, the imposition of an employer mandate, and the provision of physician payments for counseling Medicare beneficiaries about end-of-life care. (more…)

Poor Substitutes — Why Cooperatives and Triggers Can’t Achieve the Goals of a Public Option

Jacob S. Hacker, Ph.D.

According to a recent survey, a majority of U.S. physicians support health care reform that includes a new national public health insurance plan, which would compete with private plans.¹ Polls have shown that a substantial majority of Americans support the public option as well.  (more…)

Medicaid and National Health Care Reform

Sara Rosenbaum, J.D.

Defined by a history of both achievement and controversy, Medicaid has once again become central to the U.S. health policy debate, this time figuring as a key to national health care reform. Since its creation, Medicaid has repeatedly been called on to compensate for the shortcomings of a market-based health insurance system that excludes the poor and the sick. (more…)

Use of Electronic Health Records in U.S. Hospitals

Ashish K. Jha, M.D., M.P.H., Catherine M. DesRoches, Dr.Ph., Eric G. Campbell, Ph.D., Karen Donelan, Sc.D., Sowmya R. Rao, Ph.D., Timothy G. Ferris, M.D., M.P.H., Alexandra Shields, Ph.D., Sara Rosenbaum, J.D., and David Blumenthal, M.D., M.P.P.

This national survey showed that less than 2% of U.S. hospitals have a comprehensive system of electronic health records across all clinical units. (more…)

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Compromises and Controversies — Moving Forward on Reform

John K. Iglehart

Accelerating progress toward the Democrats’ goal of enacting health care reform legislation, House Speaker Nancy Pelosi (D-CA) unveiled a bill on October 29 that would establish a mandate for most legal U.S. residents to obtain health insurance. The bill would extend coverage to some 36 million people, and according to the Congressional Budget Office (CBO),¹ its net costs ($894 billion over 10 years) would be fully paid for — largely through an income-tax surcharge on high-income persons and a reduction in the growth of Medicare’s payment rates for most services, except those provided by physicians. (more…)