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Be Not Afraid

Thu, 11 Mar 2010 00:00:00 -0800

The New England Journal of Medicine - By Len M. Nichols, Ph.D. - Mar. 11 (Opinion) - Aside from the stunningly effective misinformation campaign, the substantive issue that has stalled health care reform is economic: Can we afford this new promise to ourselves, now?

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Learning from Failure in Health Care Reform

Thu, 25 Oct 2007 06:34:01 -0700

The New England Journal of Medicine - By Jonathan Oberlander, Ph.D. - Oct. 25 (Opinion) - Since 1994, inaction and incrementalism have governed U.S. health policy, with the predictable result that both health care spending and the number of uninsured Americans have reached record levels. Indeed, worsening conditions in the health care system have triggered renewed interest in comprehensive health care reform. Signs of change in the health care debate are everywhere -- in the formation of coalitions by business and labor groups to pursue reform, the launching of advertising campaigns by the American Cancer Society and the American Medical Association to highlight the plight of the uninsured, the pursuit of ambitious plans by states such as Massachusetts to expand insurance coverage, and the unveiling of an array of health care reform plans by candidates in the Democratic and Republican presidential primaries. Health care reform is even the subject of an attention-grabbing movie, Michael Moore's Sicko. It is thus tempting to believe that the moment for reform has finally arrived and that we stand on the verge of historic change. Yet before reform advocates get too exuberant, they would do well to remember what happened the last time health care reform topped the national agenda. In the early 1990s, reformers also believed that the conditions were ripe for change1; then, as now, soaring health care costs and growth of the uninsured population fueled public dissatisfaction (see table). When President Bill Clinton took office in 1993 with Democratic majorities in the Senate and House of Representatives, the country appeared inexorably headed toward health care reform. But just a year after its introduction in September 1993, the Clinton Health Security Act (see box) was dead in Congress. What happened to the Clinton plan, and what lessons can today's reformers learn from its failure?

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Health Care for All?

Thu, 20 Sep 2007 10:45:27 -0700

The New England Journal of Medicine - By M. Gregg Bloche, M.D., J.D. - Sep. 20 (Opinion) - In the summer of 1793, as Prussian and Hapsburg armies closed in on Paris, French leaders issued an unprecedented decree, ordering all unmarried men 18 to 25 years of age to take up arms, married men to make arms, women to sew tents and uniforms, and old men to "excite the courage of the warriors" and "preach the hatred of kings." France thereby transformed warfare from the business of professionals to the work of a whole nation.1 Historian and legal scholar Philip Bobbitt suggests that we owe our national social-insurance systems to this reinvention of war.1 In exchange for widespread sacrifice, citizens began looking to the state to secure their welfare. Over the next century and a half, advances in firepower and mobility made mass participation more vital -- and wartime sacrifice more horrific. Bismarck gets credit for forging a compact to ensure that citizens called on to risk everything had their needs met in return. After sending a vast conscript army to take Paris in 1870, he moved to secure the welfare of German citizens by creating the first national system of social insurance and medical coverage. World War I brought a new level of ferocity -- and global progress toward national health insurance.

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The Battle over SCHIP

Thu, 06 Sep 2007 09:05:59 -0700

The New England Journal of Medicine - By John K. Iglehart - Sep. 06 (Special Report) - Reauthorization of the State Children's Health Insurance Program (SCHIP), which was considered a routine matter until recently because of the program's success in expanding coverage to children of the working poor, has become embroiled in a larger struggle over ideologies that divide the political parties. The immediate battle to reauthorize SCHIP, for which the legal mandate expires on September 30, will resume this fall as Democrats, who command the House and Senate by slender margins, seek to stand up to President Bush, who has said he would veto the SCHIP bills approved by the two chambers because they authorize too much spending and go "too far in federalizing health care." In the last days before Congress broke for its summer respite, the Senate defied Bush's threatened veto and underscored the bipartisan popularity of SCHIP by reauthorizing the program for 5 years on a vote of 68 to 31. House Democrats approved a more expansive version by a vote of 225 to 204, but only 5 Republicans supported it. Because the House-approved bill would also repeal an impending reduction in Medicare payments to physicians, broaden prevention benefits to Medicare beneficiaries, and increase support for selected hospitals (as well as eliminate the higher Medicare payments to private plans, as compared with fee for service), it attracted the support of the American Medical Association and allied physician organizations, as well as the formidable elderly lobby (AARP). This support adds muscle to the efforts of Democrats to overcome the administration's opposition but also complicates the process.

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Use of Health Services by Previously Uninsured Medicare Beneficiaries

Thu, 12 Jul 2007 19:20:39 -0700

The New England Journal of Medicine - By J. Michael McWilliams, M.D., Ellen Meara, Ph.D., Alan M. Zaslavsky, Ph.D., John Z. Ayanian, M.D., M.P.P. - Jul. 12 (Special Report) - Previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured.

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