It would create a mechanism for states to request federal funds after establishing their own health insurance programs…. It would, for the first time, create a system under which a Medicare-for-all program could be rolled out on a state-by-state basis. In California’s case, it would make coverage available to the roughly 7 million people now lacking health insurance.

“This is a huge deal,” said Jamie Court, president of Consumer Watchdog, a Santa Monica advocacy group. “This is a lifeline for people who want to create a Medicare system at the state level.”

The bill could warm the hearts of liberals who expressed frustration with the Affordable Care Act’s more moderate approach of building on the existing health care system and should also satisfy GOP presidential candidate Mitt Romney. The former Massachusetts governor has sought to differentiate his 2006 health reform from Obamacare by rejecting a federal prescription for reform and promising to “pursue policies that give each state the power to craft a health care reform plan that is best for its own citizens.”

The ACA creates state flexibility by granting waivers to states that meet certain coverage standards and a bipartisan group of lawmakers has offered legislation expanding the provision by allowing states with innovative health care solutions to opt out of certain provisions beginning in 2014. Romney, meanwhile, has pledged to build on the ACA’s flexibility and grant states to the ability to opt out of the law entirely.

McDermott’s measure would go even further and encourage states to repurpose federal funds to build a universal single-payer health system of their own. If Republicans are truly interested in states rights, they will back it in mass.

-Zachary Bernstein

High U.S. spending on health care does not seem to be explained by either greater supply or higher utilization of health care services. There were 2.4 physicians per 100,000 population in the U.S. in 2009, fewer than in all the countries in the study except Japan. The U.S. also had the fewest doctor consultations (3.9 per capita) of any country except Sweden. Relative to the other countries in the study, the U.S also had few hospital beds, short lengths of stay for acute care, and few hospital discharges per 1,000 population. On the other hand, U.S. hospital stays were far more expensive than those in other countries—more than $18,000 per discharge. By comparison, the cost per discharge in Canada was about $13,000, while in Sweden, Australia, New Zealand, France, and Germany it was less than $10,000.

“It is a common assumption that Americans get more health care services than people in other countries, but in fact we do not go to the doctor or the hospital as often,” said Squires. “The higher prices we pay for health care and perhaps our greater use of expensive technology are the more likely explanations for high health spending in the U.S. Unfortunately, we do not seem to get better quality for this higher spending.”

Prescription drugs were also found to be far more expensive in the United States than several other countries, and Americans used expensive technology like CT or MRI scans more frequently. According to the researchers, meanwhile, while the U.S. had the best survival rates for breast and colorectal cancer, the survival rate for cervical cancer was below average. The rate of asthma-related deaths among people aged 5 to 39 was also high, as were amputations for people with diabetes.

This chart details how much the United States spends on health care per capita compared to other developed nations:

This one compares survival rates for three types of cancer:

Previous studies have cast doubt on the effectiveness of more expensive treatments. Meanwhile, the health care reform law encourages physicians to focus on quality rather than quantity of care in an effort to bring down health care costs.

-Zachary Bernstein

But now, he’s brushing off the criticism by insisting that “he was actually taking advantage of the law in Massachusetts that allows children to remain on their parents’ insurance plan until age 24.” “You can do that in Massachusetts, I voted for that,” Brown said. “For (Warren) to call me a hypocrite as to how Gail and I provide for our family, it’s sad,” Brown said, referring to his wife, Gail Huff.

Brown may have taken advantage of Massachusetts reform while serving in the Bay State, but as a senator, he’s benefiting from the ACA’s most popular provision.

According to the Office of Personnel Management’s (OPM) website, Brown’s congressional health care plan (the Federal Employees Health Benefits Plan) is regulated by federal law, not state legislation — “The FEHB Program is a Federal program and preempts state law requirements,” the site says — and the program allows dependents to stay on their parents’ insurance plans until age 26 as a result of Obamacare:

An official at OPM confirmed to ThinkProgress that “As long as the parent has a self-and-family enrollment, dependent children are covered under that enrollment until they reach age 26, as a result of passage of the ACA. Before the ACA, the dependent age was by FEHB law up to age 22.”

The Brown campaign did not return multiple requests for comment.

-Zachary Bernstein

But yesterday, this Tea Party champion and great opponent of Obamacare admitted something astonishing: his 23 year old daughter is one of the 2.5 million young Americans who are benefiting from a regulation that allows young people to stay on their parents’ health care plan until age 26:

“Of course I do,’’ the Massachusetts Republican told the Globe. Brown is insuring his daughter Ayla, a professional singer who is 23 years old, under a widely popular provision of the law requiring that family plans cover children up to age 26.

Brown said the extended use of his congressional coverage is not inconsistent with his criticism of the federal law, enacted over his objection after he won a special election in 2010, because the same coverage could be required by individual states.

Brown is responding to charges of hypocrisy by claiming that “he still wants to repeal the law” because it is inferior to the measure enacted by then-governor Mitt Romney in 2006. “I’ve said right from the beginning, that if there are things that we like, we should take advantage of them and bring them back here to Massachusetts,” the senator said.

Brown has a history of denying to others the benefits he himself enjoys. After all, his first campaign for the senate was predicated on the notion that Massachusetts has enacted successful health reform and should not have to pay for a national effort to expand coverage and lower health care costs. Now he’s displaying this very same selfishness with the ACA, telling voters that while his daughter can stay on her parents’ health plan, their children should go out and pay for their own health insurance.

For instance, there’s no evidence that doctors can diagnose ovarian cancer with a pelvic exam in women showing no symptoms. A clinical trial found that doctors were unable to identify any cancers in test subjects by pelvic exams alone, and the National Cancer Institute no longer recommends the tests for postmenopausal women. [...]

The scientific basis for much of the traditional well-woman ob-gyn annual check-up is so slim that “the routine pelvic examination may be an example of more service leading to worse outcomes,” Dr. Carolyn Westhoff, an ob-gyn at Columbia University, wrote in the Journal of Women’s Health last year.

So why are doctors so adamant about the additional testing? Drug and medical device companies fund most continuing medical education, which is primarily how doctors learn about new science, and these industries are not interested in limiting care, Shannon Brownlee, a health policy expert at the New America Foundation, explains to Menicmer. Under the existing fee-for-service health reimbursement system, doctors are also paid for every additional procedure — regardless of whether it actually improves patient care.

Delinking pelvic exams from women’s birth control prescriptions underscores the importance of health research in guiding health care decisions. The Affordable Care Act invests in comparative effectiveness research to help determine the most cost-effective course of treatment, and it also begins to recalibrate the system so we stop paying doctors for unnecessary care and instead reimburse them for treatments that only bolster patient outcomes.

(AP Photo/J. Scott Applewhite)

This Sunday, during an appearance on CNN’s State of the Union with Candy Crowley, Speaker of the House John Boehner (R-OH) was asked about the House Republicans’ plan to avoid an increase in student loan interest rates by taking money from a health care fund that particularly benefits women. The Prevention and Public Health Fund, created by the Affordable Care Act, provides states and communities with funds for “promoting wellness, preventing disease, and protecting against public health emergencies.”

But Boehner, noting that the Obama administration had earlier agreed to take some money out of the account to pay for the payroll tax cut extension, claimed that none of the money in the account benefits women. He told Crowley:

CROWLEY: We have [House Democratic Leader] Nancy Pelosi out there saying, well, they want to protect the big oil companies because they want to pay for the student loan interest rates by closing loopholes in the oil industry and we want to protect women’s health. We want to prevent breast cancer and cervical cancer and that’s what this fund is for.

BOEHNER: That is just nonsense. There’s no women’s health issue here.

CROWLEY: It’s a preventive fund, isn’t it?

BOEHNER: I’ll guarantee you they’ve not spent a dime out of this fund dealing with anything to do with women’s health.

Watch the video:

Boehner’s statement is absolutely false. The fund has already been used to provide health care workforce development and public health initiatives to combat diseases like obesity, diabetes and HIV/AIDS. It will soon invest millions more in cancer screenings, immunizations, and detection of birth defects — benefits with particularly benefit women. Already, $17 million from the fund has gone to grants in Boehner’s own state of Ohio to provide community prevention, clinical prevention, public health infrastructure and training, and research and data collection.

Rather than protect student loan rates by ending special corporate tax breaks for hugely profitable oil companies, Boehner is asking Americans to choose between enabling students to afford college and investing in preventative care for women and children.

Adults with pre-existing conditions spend $1,504 to $4,844 more per year annually on health care, and most — 88 to 89 percent — live in areas of the country “without insurance protections similar to the Affordable Care Act provisions, which will become effective in 2014.”

Interestingly, 48 percent of respondents — including 46 percent of Republicans — said they “support the Medicare program we have now, where people can choose the government run program or a plan from a private health insurance company.” Just 13 percent — and 26 percent of Republicans — would favor “a Medicare program solely run by private insurance companies.” The other results:

– 53 percent were opposed to raising taxes

– 60 percent opposed “increasing co-pays and deductibles so that out-of-pocket costs will increase”

– 72 percent support cutting the price Medicare pays for prescription drugs

– 57 percent are in favor of having people with higher incomes pay more for their Medicare benefits than people with lower incomes

– 54 percent support the proposal that doctors and hospitals be paid “based on quality and results, rather than the volume of care provided”

Currently, over 15 percent of the federal budget goes toward funding Medicare, and that number is expected to increase to roughly 18 percent by 2020.

– Fatima Najiy

-Zachary Bernstein

But Boehner’s proposal would finance the $5.9 billion cost of maintaining the 3.4 percent interest rate for one year by repealing the Affordable Care Act’s Prevention & Public Health Fund, financing that’s designed to help states and communities fight chronic conditions like heart disease, cancer, stroke, and diabetes, and ultimately reduce health care costs. During a press conference yesterday, Boehner characterized the Fund as an affront to small businesses:

Today I’m pleased to announce that on Friday the House will vote on a bill to extend the current interest rate on federal student loans for one year. We will pay for this by taking money from one of the slush funds in the president’s health care law. [...]

“Listen, the rising cost of tuition is a serious one for students. I know this issue well. It took me seven years to work my way through college, working every job I could get my hands on. And what Washington shouldn’t be doing is exploiting the challenges that young Americans face for political gain. And it shouldn’t be sticking small businesses with a health care law that’s…making it more difficult for them to hire workers.”

In reality, the Fund is an essential tool to help re-orient the American health care system towards prevention of chronic conditions, which are “responsible for 7 of 10 deaths among Americans each year and account for 75 percent of the nation’s health spending.” The Fund will “invest $12.5 billion over the next ten years (FY2013-FY2022) in effective programs proven to prevent disease and injury.” Republicans have long considered prevention a key offset, however, scoffing at its investments as wasteful spending, or as one Republican Senate aide described it, a “slush fund for jungle gyms.” Boehner’s proposal would eliminate the Fund and rescind all unobligated balances, including money being spent this year.

Yet the GOP had supported increased federal funding for prevention before Obama embraced it, even attempting to take credit for it as a Republican idea:

- Sen. Jon Kyl (R-AZ) took to the Senate floor and proclaimed that “one of the things we did in the health care legislation was to provide a lot of different incentives for preventive care, for screening to try to help people avoid illnesses on the theory that it would be a lot cheaper if we didn’t do a lot of treatment that was unnecessary.” [7/12/2010]

- Sen. Chuck Grassley (R-IA) said the law’s emphasis on preventive care is good “because it costs less to keep people well than to treat them when they’re sick.” [10/18/2010]

- Sen. Mitch McConnell (R-KY): “Congress should be able to work together on our practical ideas that the American people support, such as reforming our medical liability laws to discourage junk lawsuits…encouraging wellness and prevention programs that have proved to be effective in cutting costs and improving care.” [8/26/2010]

- Sen. Saxby Chambliss (R-GA): “I am an original cosponsor of S. 1099, the “Patients’ Choice Act,” …. The legislation would make health care coverage accessible and affordable for all Americans through private insurance coverage, while also promoting prevention and wellness which can improve lives and lower long-term medical costs. [7/19/2009]

Sen. Lamar Alexander (R-TN) has also proposed to offset lower loan rates by requiring individuals or families who receive subsidies within the exchanges to “pay back a greater share of any excess subsidies,” while legislation offered by Senate Majority Leader Harry Reid (D-NV) would pay for the lower interest rates by requiring “shareholders in S-corporations — typically small-sized businesses — to pay payroll taxes from which they’re now exempt.” House Democrats have proposed “ending unwarranted tax subsidies to big oil and gas companies” to finance the measure.

Congress has already cut $5 billion from the Fund to pay for legislation to “renew a payroll tax cut that benefits 160 million workers, as well as extending benefits to millions of unemployed Americans.” As a result, the fund was supposed to reach $2 billion in fiscal years 2015 under current law, but now “won’t hit the $2 billion mark until fiscal 2022.”

ROMNEY: With Obamacare fully installed, government will come to control half the economy, and we will have effectively ceased to be a free enterprise society. This President is putting us on a path where our lives will be ruled by bureaucrats and boards, commissions and czars. He’s asking us to accept that Washington knows best – and can provide all.

The charge is particularly disingenuous because Romney almost certainly knows that government is already heavily invested in health care and that the Affordable Care Act — much like his own reforms in Massachusetts — doesn’t dramatically expand its reach. Instead, it builds on the existing public/private partnership, in which public health already comprises more than 40 percent of the nation’s health care spending:

As the Congressional Budget Office (CBO) concluded, after the law’s initial boost of coverage expansion in the first decade (as the uninsured enter the health care system), “the increases and decreases in the federal budgetary commitment to health care stemming from this legislation would roughly balance out, so that there would be no significant change in that commitment.” By 2014, private sector growth is projected to accelerate — thanks to health care reform — but even then, “private health insurance is anticipated to account for roughly 31 percent of national health spending, or about the same share as was expected without enactment of the Affordable Care Act,” actuaries at the Center for Medicare and Medicaid estimate. “For 2011–13, government outlays (averaging 5.2 percent growth) are projected to roughly maintain a 45-percent share of total health spending.” The public/private balance, in other words, remains the same.

Remember that Romney sold his 2006 Massachusetts reforms by arguing that the state could take the the tax dollars it’s already spending on uncompensated care and — together with additional federal funding approved by the Bush administration — expand and subsidize private coverage for the uninsured. The Affordable Care Act does something very similar, while also raising additional revenue to pay for the law and reduce the federal deficit. So if using tax-payer dollars to provide care to the uninsured constitutes “government control,” then Romney himself could be considered a fan of the so-called nanny state.

Kelly, who is running to fill Gabby Gifford’s vacated seat — made the remarks while meeting with voters at the La Cholla Country Club yesterday. A senior citizen asked the candidate about his philosophical approach to health care and whether “health care is a right or a privilege?” Kelly hemmed and hawed before conceding that he believes health care “is a privilege to some extent.” He went on to say that health care is one of those “privileges you earn.”

VOTER: Do you think that health care is a right or a privilege?

KELLY: My belief system is this. The health care for anybody but especially for our nation. The highest quality and lowest cost can only be delivered without the government. What I believe is that all things we drive, we do, health care, anything, is a privilege to some extent. Life, liberty, and the pursuit of happiness, those are inalienable rights endowed by your creator. If you’re claiming a right, if you’re going to say anything’s a right, if you’re going to say you have a right to a cell phone, then who has the responsibility to pay for it? That’s what I believe.

VOTER: So you’d put health care as a privilege then?

KELLY: Absolutely, absolutely. I believe that all things we have are. But they’re privileges you earn.

Watch it:

Whether or not you agree with Kelly’s belief that health care is just a privilege, it is still a reality that far too many Americans die each year because they can’t afford access to the health care they need or receive uncompensated care that is financed by those who have insurance. Since everyone is bound to fall ill — and some may suffer an unexpected medical setback, as the Giffords tragedy illustrated — a system in which 50 million Americans are uninsured is an inefficient and quite expansive waste of tax payer dollars and resources.

In its 2011 National Healthcare Disparities Report, the Agency for Healthcare Research and Quality (AHRQ) at the Department of Health and Human Services has finally called out these disparities. AHRQ publishes this report every year to help policymakers understand and address the impact of racial, socioeconomic, and other differences on various populations.

The report focuses on priority populations such as racial and ethnic minorities, lower-income people, and people with disabilities—and, for the first time, it also includes the LGBT population as a priority population.

While the report discusses the disproportionate impact of HIV and AIDS on gay and bisexual men and other men who have sex with men, its strongest focus is on the disparities in health status and health care access that transgender people experience.

Drawing on data from Injustice at Every Turn: A Report of the National Transgender Discrimination Survey conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, the report emphasizes the enormous burden of discrimination, prejudice, and poor health that the transgender population bears.

According to the report, “transgender and gender non-conforming people bear the brunt of social and economic marginalization due to their gender identity…. Too often, policymakers, service providers, the media, and society at large have dismissed or discounted the needs of transgender and gender non-conforming people in their communities, and a paucity of hard data on the scope of antitransgender discrimination has hampered the struggle for basic fairness.”

The disparities cited in the report include low rates of insurance coverage among transgender people, obstructed access to urgent and routine medical care, and refusals of treatment from providers. The report notes that almost 50 percent of transgender respondents have postponed medically necessary care for financial reasons or because they were afraid of encountering discrimination from providers.

And all of these disparities were higher for transgender people of color: for example, 31 percent of Black transgender respondents were uninsured, compared with 17 percent of white respondents.

The inclusion of LGBT health disparities in the National Healthcare Disparities Report reflects ongoing efforts by the Department of Health and Human Services to develop LGBT health care metrics and to build a body of data on LGBT population health. In particular, the department is developing sexual orientation and gender identity measures that will be included on federally supported surveys such as the National Health Interview Survey starting in 2013.

Data are crucial to identifying, tracking, and addressing the health disparities that prevent LGBT people, particularly transgender people, from accessing the health insurance and health care services they need to keep themselves and their families healthy. It is vital that the department continue to make progress on these sexual orientation and gender identity data collection efforts.

It is also critical that research bodies such as the National Institutes of Health (NIH) support further investigation into LGBT health disparities. The 2011 Institute of Medicine report on LGBT health recommended that NIH develop a research agenda designed to advance knowledge and understanding of LGBT health. A year later, NIH has yet to respond to that recommendation with a plan for next steps on building this research agenda. It also remains unclear whether NIH will consider the LGBT population in the methodology for designating health disparity populations that it is currently revising.

Under the Obama Administration, much progress in identifying LGBT health disparities has been made. But much work remains to be done, particularly when it comes to taking action to address these disparities. And ultimately, the National Healthcare Disparities Report finds that efforts to address the disparities affecting other priority populations are also making little headway—further underlining the importance of a sustained focus on health equity and an investment in reducing health disparities across the board.

The Agency for Healthcare Research and Quality has taken an enormous step forward in prioritizing LGBT disparities and drawing attention to the burden of poor-quality care and obstructed access to treatment that so many disadvantaged communities face. Others should not hesitate to follow.

Zeke Emanuel — a senior fellow at the Center for American Progress — addressed the Doctors For America’s 2012 National Leader Conference Monday morning and urged physicians to remain engaged in the nation’s health care debate. Emanuel predicted that the Affordable Care Act will succeed in expanding coverage and slowing the growth of health care spending by 2020, but stressed that the biggest changes will occur in how health care providers deliver services to patients — an area which doctors must lead in shaping, he maintained.

Health care systems around the country are already moving away from the existing fee-for-service reimbursment system and coordinating care in a way that improves efficiency and care quality. These successes contain valuable lessons for the kind of delivery reforms the ACA hopes to foster and offer a glimpse into the system of the future. Emanuel explained what those changes will look like, relying on the real-world experiences of Group Health of Puget Sound in Washington state:

1) “It doesn’t look like lone doctors working alone. It looks like health care teams of doctors working with nurses, working with public health professionals.” Specialized groups of providers are better equiped to provide personalized care to patients with multiple chronic conditions, who consume two-thirds of the health care dollars.

2)”You don’t wait for the patient to come to you. You have active outreach to patients.” Providers track their pateints’ physiological indicators and call them to ensure that they’re complying with medication and other interventions.

3) “You have electronic health records so you can track patients over time … so that you can track physician, nurse and other quality performance in your group.”

4) “You also don’t treat patients individually. You have team huddles, you have team plans. You standardize care for patients.”

5) “You also create specialized clinics for chronic problems, have the best people you have doing that over and over.”

The results have been impressive. Sine adopting the changes, Group Health experienced a six percent drop in readmissions, a six percent decrease in length of stay, decreases in physician visits, but a dramatic increase in telephone calls and email communications. Most remarkably, the new system saved $1.50 for every $1.00 invested in the re-engering process over a 21-month period.

Providers also experienced a boost in morale “because the health staff finally felt like they were practicing the medicine they were trained to and not just doctor reimbursment,” Emanuel stressed.

That’s the future providers can look forward to. And now, they have to work to make sure it becomes a reality.

-Zachary Bernstein