President Obama Remarks over South Korea Sinking Ferry and the Affordable Care Act. – Video

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President Obama Remarks over South Korea Sinking Ferry and the Affordable Care Act.
Republicans #39;were wrong #39; about Obamacare Presidential News Conference April 17, 2014 President Obama makes remarks about the sinking of a ferry off South Korea #39;s coast and enrollment in the...

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President Obama Remarks over South Korea Sinking Ferry and the Affordable Care Act. - Video

Dems want health care for all no matter the cost

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With little fanfare, Vermont is preparing to become the first state to implement a single-payer, government-run health-care system. The Vermont plan, if implemented, would abolish private health insurance in the state and replace it with a taxpayer-funded system under which the state government directly pays doctors and hospitals.

Of course the state is having a bit of trouble figuring out how to pay for the programs estimated $2 billion price tag, considering that the entire state governments operating budget is currently just $2.7 billion. Currently under consideration is an increase in the state sales tax from 6.9% to 29%.

At the same time, opponents of ObamaCare have often suggested the massive health-care program is really a stalking horse for such a government-run system. ObamaCares fans have sometimes suggested the same. Senate Majority Leader Harry Reid (D-Nev.) has said that the health-care law is as step in the right direction toward abolishing private health insurance.

But a single-payer system or at least government-run health care may already be a reality in far more ways than most Americans realize.

Already the government directly pays for more than half of every dollar spent on health care in this country. This compares to just 13 cents directly paid by the individual purchasing or consuming the health care. (Virtually all of the remaining 37% is paid for through insurance, much of which is also subsidized, directly or indirectly, by the government).

In fact, consumers in many countries that we associate with socialized medicine, such as France, actually pay more out of pocket for their health care than do Americans.

Medicare is the single biggest government health care program. At a cost of $612 billion this year, the massive insurance program for seniors alone accounts for one-fifth of all US health care spending. Medicaid pays an additional 15%. Altogether, there are at least a dozen government programs to provide or pay for health care.

In 2012, nearly 41% of New Yorkers receive health care through one or another government program, Medicaid in particular. According to the Kaiser Family Foundation, roughly 23% of New Yorkers are on Medicaid. By comparison, just 15% of Connecticut residents and 12% of New Jerseyans are on Medicaid.

Medicare is the second-largest health-care payer in New York, providing coverage for 12% of residents, slightly below the 14% in Connecticut and New Jersey.

But Medicares influence extends well beyond the number of enrollees. Because the program is the 800-pound gorilla in terms of paying for health care, it establishes the standards that private insurers use to set reimbursement rates for doctors and hospitals. Thus, directly or indirectly, the government is already involved in setting health-care prices.

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Dems want health care for all no matter the cost

Peter Orszag: Burwell's big chance to control health care costs

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In the past several months, health care costs outside Medicare may have accelerated, even as Medicare spending growth remains remarkably low. This is why Sylvia Mathews Burwell (who is a friend of mine) has the opportunity to be a transformational secretary of Health and Human Services.

If over the next three years she can take the bold steps needed to reinforce better value in health care, she will drastically alter prospects for everything from the federal budget to state and local priorities (including education) and the take-home pay of Americas workers.

After several years of very slow growth, total health care spending picked up in the fourth quarter of 2013, data from the Bureau of Economic Analysis show. This has led some commentators to declare an end to the era of slower health-cost increases, which has lasted for the past several years. Yet Medicare spending growth is still low, even through last month. Indeed, in the first half of this fiscal year, nominal Medicare spending was only 0.6 percent higher than in the corresponding period a year earlier.

The combined acceleration in total health care spending (which should be expected to pick up as the economy continues to recover) and continued low growth in Medicare highlights why leadership is needed from Health and Human Services. If the secretary provides a clear glide path for shifting away from fee-for-service payments, then low health-cost increases will be much more likely.

Perhaps the most important thing Burwell could do is to declare a specific goal for payment reform I favor aiming to have 75 percent of Medicare costs paid in some way other than fee-for-service by 2020 and then lay out a timetable for how to get there. Such clarity is crucial because health care providers already anticipate a shift toward value-based payment mechanisms and are poised to respond, but the timing is unclear, as is exactly which new payment model will prevail. This ambiguity impedes strategic planning and action.

With a better sense of how they will be paid for value rather than quantity, providers could do much to limit cost growth as demonstrated by the results from the many new payment systems (such as the Alternative Quality Contract in Massachusetts) currently being tested. Lower cost growth, in turn, would have multiple benefits, as a series of papers presented at the Brookings Institution recently illustrates.

Two of these reports examined what would happen if health care costs grow at the same rate as income per person, or 2.5 percentage points faster. Economists Alan Auerbach of Berkeley and William Gale and Benjamin Harris of Brookings found that, under the lower-growth scenario, stabilizing the federal debt between now and 2040 would require tax and spending changes amounting to 1.3 percent of gross domestic product a challenge, but a manageable one.

Under the higher health-spending scenario, in contrast, immediate tax increases or spending cuts equal to a whopping 4 percent of GDP would be needed to stabilize debt as a share of the economy through 2040. Over longer periods, the differences are even greater; under the more rapid spending scenario, no plausible traditional tax increases or spending reductions would be sufficient to stabilize our fiscal trajectory.

As for state and local governments, the low-growth scenario is unlikely to pose particularly difficult decisions, Donald Boyd, a fellow at the Rockefeller Institute of Government, found. But high growth would impose severe stress: Over the next two decades, state and local governments would have to either cut all nonhealth spending by 20 percent or increase taxes to a level 20 percent higher than they have been in 70 years, as a share of GDP.

Clearly, much is riding on whether we can improve value and maintain low cost growth in health care. Sylvia Burwell, an inspired choice to be the next secretary of Health and Human Services, has the opportunity to boldly lead the system toward a brighter future in which our dollars buy better health care, not just more of it.

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Peter Orszag: Burwell's big chance to control health care costs

CU system resets health care with $63M personalized medicine division

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Research assistant Natalie Thomas pulls a slice of a cancerous tumor for analysis at the Anschutz Medical Campus. (Andy Cross, The Denver Post)

Ellen Smith received a death sentence for her advanced lung cancer five years ago, but it was commuted by a revolution in human genetics, drug therapies and clinical approaches unfolding at the University of Colorado Hospital.

The advances have saved her life, by her reckoning, four times.

The accelerating speed of DNA sequencing, drug development and data analysis has led UCHealth, the University of Colorado Medical School and Children's Hospital Colorado to join in an effort to fundamentally change the way they care for patients.

The partnership will invest more than $63 million over the next five years to create a new division, adding clinicians, genetic counselors, researchers and advanced practice nurses and also expanding a DNA bank and advanced data warehouse. It's called the Center for Personalized Medicine and Biomedical Informatics.

The pioneering field of personalized medicine uses molecular analysis to determine a patient's predisposition to developing certain diseases and to deliver tailored medical treatment.

"There is no doubt in my mind that this will change how we treat disease, how we teach our students, how physicians work, how we raise our kids and how we conduct public health policy," Dr. David Schwartz, chair of the CU Department of Medicine, said of the center.

The DNA bank, Schwartz said, probably will require a year of discussion with physicians, academicians, lawyers, ethicists and patient advocates about what it really means to secure patients' genetic blueprints and how they should be used.

While the center will be based on the Anschutz Medical Campus in Aurora, it will serve UCHealth's five hospitals and Children's Hospital. The DNA bank would sequence and analyze samples from around the region.

The benefits of personalized medicine have been evident for several years in cancer treatment, said Dr. Dan Theodorescu, director of the CU Cancer Center. It's why the center's survival rates are significantly better for certain types of cancers than the average national outcomes, he said. The new center will bring these kinds of lifesaving therapies to all disease fronts while providing more laboratory and analytical power to evaluate cancer DNA, he said.

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CU system resets health care with $63M personalized medicine division