A Tale of Twin Cities

In addition to all of the televised political activities this week in the Twin Cities, there also were a number of serious policy discussions taking place. I spoke at several of them, including forums on health care organized by Congressional Quarterly and the Hubert H. Humphrey Institute of Public Affairs. More on those in a minute.

But first, I attended a breakfast hosted by PhRMA at the Science Museum in St. Paul featuring Emmy Award-winning talk show host Montel Williams, who spoke about the pain and daily challenges of his 20-year struggle with multiple sclerosis.

He, along with actor Joey Pantoliano, praised the Partnership for Prescription Assistance. This program provides a single point of access to hundreds of patient assistance programs, including more than 180 offered by pharmaceutical companies. These programs make low-cost or free drugs available to five million people who need help purchasing medicines.

Williams said it is only because of pharmaceuticals that he is able to continue to live a productive life, and it was moving when he asked those who work for the pharmaceutical companies to raise their hands so we could applaud and offer rare thanks for the work they do in making these medicines available.

He and Pantoliano travel widely, including to Denver last week, to bring attention to PPARx so people with fewer resources than they can also have access to these life-saving medicines.

And about my events:


  • I spoke on a health care panel that culminated a full week of presentations about politics and policy hosted by the University of Minnesota's Hubert H. Humphrey Institute of Public Affairs.


    Sen. Bob Bennett (R-UT) was the keynote for our session, explaining the Wyden-Bennett Healthy Americans Act and his support for the important changes in tax policy that are needed to usher our health sector into the 21st century.


    He said he and Sen. Wyden are teaming up because both of them are passionately committed to modernizing our health sector, and both of them are willing to compromise to make legislation happen.


    I said I see at least three areas in the bill that may need to be the starting point for compromise because I believe they will be political lightening rods: 1) An individual mandate, which leads to a government definition of acceptable insurance and which, as defined in the bill, will be prohibitively expensive; 2) the requirement that premiums be community-rated, with younger people forced to subsidize their older and often more affluent parents and grandparents; 3) and the requirement that employers pay a percentage of premiums in the form of a new tax.


    I had to leave to catch a flight before the session ended. I will, of course, follow up on these discussions.


  • Congressional Quarterly hosted an event sponsored by Together Rx Access to discuss "Strategies for Giving Uninsured Americans Access." I was on a panel with Merrill Matthews of the Institute for Policy Innovation and Jim Frogue of the Center for Health Transformation.


    We discussed the multi-faceted and complex problem of the uninsured and offered suggestions and strategies, ranging from state-based reforms to private-sector innovations and the need for federal initiatives.



I was fortunate to be in the convention hall Wednesday night when Alaska Gov. Sarah Palin spoke. One of the more touching moments was her description of her "perfectly beautiful baby boy named Trig," who was born in April with Down syndrome.

"Children with special needs inspire a special love," she said, promising that the families of special-needs children "will have a friend and advocate in the White House." You could see from the emotional response in the audience how many people and families are touched by special needs children.

Our family is among them. Our dear niece, Katie Turner, was born with Down's nearly 31 years ago to my husband's brother, Bob and his devoted wife, Doris. The last of four children, Katie was the joy of the family. She loved life more than anyone I have ever met, and her birthday every September 21 was a multi-event celebration.

Country music, theater, the Food Network, and the color pink were just some of her passions. She had a job she loved and the most active social calendar of anyone I know. Her family hosted a formal dinner for her 30th birthday last year where she was celebrated by the family and friends who adored her.

Katie died this April after her life-long struggles with a weak heart led to a series of heart attacks, leaving us with only the memories of the joy and love and sweetness she brought to us. The church at her memorial service was full and, without anyone having planned in advance, most of the women wore something pink to honor Katie's memory.

Her family made so many sacrifices for Katie, but she gave so much back to everyone. And she was gentle and kind to the end, whispering to her father on her deathbed, "I'm so sorry for my poor health."

Dear Katie. How much we loved you and miss your sweet presence in our lives. What a blessing you were to all of us.

Grace-Marie Turner

Recent News Articles and Studies

Better Care at Lower Cost for Every American
What You Don't Hear About Health Care
Michelle Obama Is Right About Avoiding the ER
Here's One Way to Cut Health Care Costs, Improve Quality
State Health Care Reform: Retargeting Medicaid Hospital Payments to Expand Health Insurance Coverage
Covering the Uninsured: Springing a Leak in the "Cost Shifting Hydraulic"
The Voice of Small Business: Tax Code Should Treat All Health Insurance Purchases Equally
Health Care's New Entrepreneurs
State-Run Medicine Kills Innovation


Better Care at Lower Cost for Every American
Sen. John McCain
Contingencies, Sep/Oct 08

Fundamental health care reform must begin with restoring control to individuals and their families as health care consumers and patients and making them the central focus of our health care system, writes Sen. John McCain. His plan would replace the tax exclusion for employment-based health insurance with a refundable tax credit in the fixed amount of $2,500 for individuals or $5,000 for families — regardless of the source of that coverage, regardless of how one purchases it, and regardless of one's income. McCain's plan would also allow individuals to purchase health insurance across state lines. Nationwide insurance markets that ensure broad and
vigorous competition will wring out excess costs, overhead, and bloated executive compensation.

While it still needs more fleshing out, McCain's health care plan actually goes a long way toward addressing the most egregious problems with the system, writes Philip Klein in The American Spectator. It is important for conservatives to point out that far from having a free market, America is a nation whose health care system is suffering from ham-handed government intrusions. Conservatives have to master liberal arguments for increasing the role of government and be prepared to offer intelligent criticisms that go beyond merely screaming "socialized medicine." And finally, conservatives have to demonstrate how freeing up the market could reduce costs and improve health care outcomes.

What You Don't Hear About Health Care
Sally C. Pipes, Pacific Research Institute
Republican-American, 09/03/08

Health care reform will be front-and-center in the presidential debates. Pipes discusses five topics that you'll likely hear about many times between now and November, including prescription drug importation, government-sponsored comparative-effectiveness research, and the health care systems of Canada and Europe.

Michelle Obama Is Right About Avoiding the ER
Scott Gottlieb, American Enterprise Institute
The Wall Street Journal, 09/02/08

At the University of Chicago Medical Center, Michelle Obama worked to expand a program that encouraged uninsured patients to visit local health clinics in lieu of the hospital emergency room. While she has been criticized for this, Gottlieb writes that the success of these community health clinics is supported by plenty of clinical data proving that patients are helped by the continuity of care that they offer. Also, medical expenses for community health centers run about 40% lower than for patients seen in emergency rooms, saving the country an estimated $17.6 billion a year. The real challenge, Gottlieb says, will be in allowing these clinics to survive under the health reform proposals of an Obama administration.


Here's One Way to Cut Health Care Costs, Improve Quality
Gov. Sarah Palin
Anchorage Daily News, 02/25/08

In a commentary published earlier this year, Republican vice presidential nominee and Alaska Governor Sarah Palin describes her state's proposal to repeal its Certificate of Need (CON) program. After more than 30 years of such programs, the National Conference of State Legislatures has found there is no solid proof that the state-sponsored CON programs have actually controlled health care costs. In 2004, the Federal Trade Commission and the Department of Justice both asserted that these programs actually contribute to rising prices because they inhibit competitive markets. Repealing Alaska's current CON program will not only reduce the cost of health care, it will also improve access to health care, allow more competition and improve quality of care for patients, Palin wrote.

Not surprisingly, the health care providers that benefit from the absence of competition are much more enamored of the status quo than the governor, writes The American Spectator. And, for the time being, they have successfully thwarted the governor's reform effort. An aggressive lobbying campaign by the Alaska Hospital and Nursing Home Association prevented Palin's legislative allies from garnering enough votes to pass the measure during this year's session.

State Health Care Reform: Retargeting Medicaid Hospital Payments to Expand Health Insurance Coverage
Christopher J. Meyer
The Heritage Foundation, 08/29/08

Public safety-net hospitals are critical to health care access in America, but the current policy of propping up public hospitals with supplemental payments creates a two-tiered health care system that diminishes individuals' freedom to choose the best health care at an affordable price, writes Meyer. State officials should enable their residents, including low-income individuals and families, to access superior private health insurance coverage instead of depending on substandard public programs or obtaining routine care in hospital emergency rooms. By transferring Medicaid dollars to help poorer individuals and families access solid private coverage, thereby reducing overcrowding in America's emergency rooms, innovative state officials can begin to change the broader health care system in America.


Covering the Uninsured: Springing a Leak in the "Cost Shifting Hydraulic"
Thomas Miller, American Enterprise Institute
Health Affairs Blog, 09/04/08

Miller responds to a study by Jack Hadley et al, which finds that cost shifting is financing a relatively small amount of uncompensated care and has only a very small impact on the level of private insurance premiums. The bottom line is that the cost shifting argument for covering the uninsured is the weakest of several arguments for insurance coverage expansion, even though it allows non-profit hospitals, less-efficient private insurers, and public health program appropriators to try to shift the blame to someone else while hoping to increase their market share and incoming revenue streams, writes Miller. Hadley and colleagues also make new estimates for the total increase in health spending — approximately $122 billion more — under universal coverage. Miller cautions that the authors too conveniently assume that provider payment rates, administrative costs, and the generosity of coverage would stay largely the same under universal coverage. Perhaps they should have provided some alternative estimates for likely costs under even the less-than-universal-coverage health plan of Sen. Obama. The range of first-year costs stretch from the optimistic, low-end in-house estimates by his advisers of at least $65 billion, to a more recent, fully-loaded one by health economist Roger Feldman at a staggering annual cost of $452 billion.

NCPA's Devon Herrick provides a brief analysis of the Census Bureau numbers on the uninsured.


The Voice of Small Business: Tax Code Should Treat All Health Insurance Purchases Equally
Todd Stottlemyer
National Federation of Independent Business, 09/02/08

Stottlemyer, president and CEO of the NFIB, provides a concise description of the tax treatment of health insurance. The federal governme
nt is providing more than $200 billion in taxpayer money to lock the purchase of health insurance into your job, he writes. This connection between the workplace and health care benefits creates unique challenges for America's small businesses and the self-employed by driving up the costs in the small-group and individual insurance markets. A more open and competitive market for health insurance would encourage smarter health care consumption. By including the right balance of tax incentives with such a proposal, the next president and Congress could create a system that would offer new incentives for individuals to shop for health insurance. The right solution also could provide the self-employed with equal health care incentives and end the disparity in the tax treatment of health insurance for the self-employed.


Health Care's New Entrepreneurs
Paul Howard, Manhattan Institute
City Journal, Summer 2008

Entrepreneurs are finding ways to bring innovative, consumer-oriented health care to market — simplifying medical decisions, reinvigorating primary care, and lowering health care costs, writes Howard. From health insurance to DNA-driven medicine, American health care is experiencing a revolution that promises to improve quality, lower costs, and empower people to control their own health care. To unleash the full promise of these new technologies and business models, policymakers should deregulate the market for medical products and services while liberating consumer demand. In short, from HSAs to DNA, we'll be matching the right treatment to the right patient at the right price, and we'll be restoring patients to the center of medical decisions — which is where they belong.


State-Run Medicine Kills Innovation
Peter Pitts, Center for Medicine in the Public Interest
The Press-Enterprise, 09/23/08

Pharmaceutical companies from around the world have been scaling back clinical research in the United Kingdom, largely because of government parsimony, writes Pitts. The main culprit is Britain's National Institute for Health and Clinical Excellence, the government agency responsible for comparing the effectiveness of different treatment options. When the National Health Service decides not to cover a drug, it hinders the ability of drug companies to recoup research and development expenses. NHS practices also make British patients less-than-appealing subjects for clinical trials. Most patients in the U.K. aren't currently receiving the highest-quality medical treatment, so clinical trials that compare the average British patient with a patient taking an experimental drug simply don't yield much useful information. America should avoid the mistakes of the U.K. and make sure we keep the interests — and hopes — of patients first in our pursuit of health care reform, writes Pitts.

Upcoming Events

Building a Healthy Oregon
Oregon Health Forum Town Hall Forums
September 8-18, 2008

Overhauling Health Care Delivery
Health Affairs Event
Wednesday, September 10, 2008, 9:00 a.m. – 11:00 a.m.
Washington, DC

The Future of Medicare Advantage
The Heritage Foundation Event
Wednesday, September 10, 2008, 11:00 a.m.
Washington, DC

State Policy Network 16th Annual Meeting
State Policy Network Event
September 10-12, 2008
Scottsdale, AZ

Great Debate Health Care in the Next Administration: Obama vs. McCain
Harvard School of Public Health and The New England Journal of Medicine Event
Friday, September 12, 2008, 3:00 p.m. – 5:00 p.m.
Boston, MA
For more information, please contact Linda McDonald at 617-432-5522 or mcdonald@hsph.harvard.edu.

Southwest Conference on Health Care Reform
Mayo Clinic Health Policy Center and Arizona State University Event
Tuesday, September 16, 2008, 8:30 a.m. – 4:00 p.m.
Tempe, AZ

Innovative Employer Caregiving Programs
Centers for Medicare and Medicaid Services Broadcast
Wednesday, September 17, 2008, 1:00 p.m. – 2:00 p.m. ET

Connecting Caregivers to Medicare Resources
Centers for Medicare and Medicaid Services Webcast
Thursday, September 18, 2008, 12:00 p.m. ET

Industry Support for Continuing Education of Healthcare Professionals
Center for Medicine in the Public Interest Event
Monday, September 22, 2008, 8:00 a.m. – 12:30 p.m.
Washington, DC
For more information, please contact Mario Coluccio at 212-417-9169 or mario.coluccio@cmpi.org.

The National Congress on Health Reform
September 22-24, 2008
Washington, DC
Grace-Marie Turner will give a presentation on consumer-driven health care on Tuesday, September 23.


Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org.

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The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.