Original links are included though some may have expired.

In This Issue:

1.) Whither State Health Care Reform?
2.) An Ounce of Information is Worth a Pound of Cure
3.) Taking the Federal Budget Off Autopilot

1.) Whither State Health Care Reform?

Ever since California backed down from health care reform in the face of a $4 billion deficit, the direction of state-based reform has been unclear. Some states have faltered while others are just getting going. But the November elections will be clarifying. Here are some important developments in a few key states:

Minnesota: The Democratic legislature is on the verge of passing a substantial health care reform, but Republican Governor Tim Pawlenty has balked. According to The (Minneapolis) Star-Tribune, the governor supported the taskforce work that led to legislation but is unwilling to buck Republican legislators who don't support the legislation. That's a big disappointment as a diverse group of "hospitals, insurers, unions, physician groups and patient organizations have worked to craft major changes in how health care is financed and delivered in Minnesota." The reforms include Massachusetts-style reforms like an individual mandate, a health insurance exchange, and sliding scale subsidies for coverage plus cost-reducing measures like a medical home for coordinating care, pay for performance, and a cost-effective, evidence-based set of benefits. Should reform fail, it will surely be an issue in the fall election.

Colorado: Following the release of the Blue Ribbon Commission's report on reform, a bipartisan group of legislators have introduced legislation building on its recommendations. According to the lead sponsor, Sen. Bob Hagedorn (D), the legislation envisions a two-year process that might include a voter referendum on the financing if other funding sources were insufficient. The reforms include an individual mandate, sliding scale subsidies, insurance reforms that mirror a health insurance exchange, pay for performance, mandatory health information technology, and incentives for healthy behavior. Gov. Ritter (D) hasn't embraced this bill and instead has recommended short-term steps until its clear what the federal government does next year, according to The Denver Post.

Pennsylvania: Following on Gov. Ed Rendell's Rx for Pennsylvania to cover all state residents, Democrats in the Pa. House of Representatives have passed one part of the governor's approach: coverage for low- and moderate-income adults through either an employer or a government program. It would be funded through premiums paid by participants, federal Medicaid funds, tobacco settlement money, and phasing out medical malpractice insurance subsidies to physicians, according The Philadelphia Inquirer. Although Democratic House leaders scaled back the governors proposal, Republicans who control the Senate have not spoken favorably about it. If the bill does indeed die in the Senate, then Pennsylvania voters will have a clear choice in November.

For more information:

"Huge Health Care Bill Spikes a Nasty Fever,"
By Patricia Lopez & Warren Wolfe, The (Minneapolis) Star-Tribune, March 25, 2008:
http://www.startribune.com/politics/state/17001796.html

Health Care Transformation Task Force, Minnesota Department of Health:
http://www.health.state.mn.us/divs/hpsc/hep/transform/

"Health Coverage Gets New Push,"
By Tim Hoover, The Denver Post, March 28, 2008:
http://www.denverpost.com/search/ci_8723239 "Centennial Care Choices,"
Sen Bob Hagedorn, Colorado State Senate, 2008 Regular Session, SB08-217:
http://www.leg.state.co.us/clics/clics2008a/
csl.nsf/fsbillcont/6EC2CF1AE2736DD98725741100632986
?Open&file=217_01.pdf

"Pa. House Passes Health-Insurance Bill,"
By Mark Scolforo, The Philadelphia Inquirer, March 18, 2008:
http://www.philly.com/philly/news/
20080318_Pa__House_passes_health-insurance_bill.html

"Health Coverage for All: States Lead the Way,"
By Katie Donohue and David Kendall, PPI, October 16, 2007:
http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=111
&subsecid=137&contentid=254475

2.) An Ounce of Information is Worth a Pound of Cure

One of the pioneers in the field of health information policy, Josh Seidman, executive director of the Center for Information Therapy, has been advocating for better use of patient information in the prevention and treatment of disease and injuries. In less than a decade, the nation has gone from a dearth of health information to an overwhelming amount. Visits to websites for health information are now more common than doctor visits in the United States, but patients would still prefer to receive information directly from doctors about their specific situation, according to Seidman.

The disconnect between patients and doctors is both a challenge and an opportunity. In a new white paper, Seidman along with Karen Sepucha at Harvard Medical School writes:

Change is coming to medicine, and the question is how to take advantage of the democratization of information and harness its potential to improve the quality of health care ... The way information is created, exchanged, and shared is compounding exponentially, raising the importance of new tools to sort, search, organize and synthesize it. Methods to deliver the right information to the right patient at the right time are critical.

Seidman envisions the delivery of information as a prescription given by a doctor. It would offer tailored support for patients as they care for themselves, or in other words, information therapy. For example, a doctor who has just told a patient that she has diabetes could follow-up the visit with an email with links to information about managing diabetes. The patient will be much better equipped to process the information at home with the support of loved ones. Today, that process happens with haphazard web searches without any feedback going back to a physician or a nurse about whether the patient has found reliable information and has begun to master the disease.

With information technology and electronic health records, the cost of delivering information therapy would be minimal. Large health plans like Kaiser Permanente are already using their new information systems in this way. It's cheaper and better to connect patients who have chronic diseases like diabetes with support for self-care than it is to deliver costly care like amputations later on because the patient couldn't take care of herself.

Organizing and delivering reliable information through mass personalization needs to be part of any health care reform effort to end the mad scramble over burgeoning costs and increases in chronic diseases.

For more information:

"Navigating a Changing Health Care System: How Consumers, Clinicians and Policymakers Can Make Sense of Shared Decision Making and Information Therapy,"
By Joshua Seidman and Karen Sepucha, Center for Information Therapy, March 19, 2008:
http://www.ixcenter.org/publications/whitepapers.cfm

3.) Taking the Federal Budget Off Autopilot

With the federal cash crunch from baby boomer retirement drawing near, a politically diverse group of policy and budget experts, including PPI President Will Marshall, have proposed to change the budget decision process to force Congress to make choices about the federal entitlement programs, which include Social Security, Medicare, and Medicaid. Congress would have to set long-term budget goals over perhaps 30 years and make adjustments every five years. Currently, the entitlements run on budgetary autopilot and spending goes up every year regardless of whether Congress acts.

The automatic increases in entitlement spending provide a high degree of stability for older Americans and others who depend on them. But it also lets Congress off the hook for making budgetary trade-offs. As a result, the entitlements already consume 42 percent of the budget. At current growth rates, Medicare and Medicaid alone will consume the same portion of the nation's economy in 40 years as the entire federal government does today.

This budget reform proposal would force Congress to deal with the fiscal reality of the entitlements issue. The five-year review periods would have to include a trigger involving automatic benefits cuts and tax increases if Congress failed to take other action to balance the long-term budget.

The proposal report developed under the auspices of the Brookings-Heritage Fiscal Seminar also does a good job of restating the enormity of the challenge ahead. No single solution, including: faster economic growth, European level taxation, benefit cuts, or program efficiencies, can solve the problem alone. Perhaps only the problem of global warming can make the nation's fiscal challenges look manageable, but like global warming, the entitlement problem will take multiple initiatives to solve.

For more information:

"Taking Back Our Fiscal Future,"
Brookings-Heritage Fiscal Seminar, March 31, 2008:
http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=125
&subsecid=162&contentid=254604

Newsletter compiled and written by David B. Kendall, PPI's senior fellow for health policy.