Health Care Reform's Bleeding Kansas

The fight over state children's health insurance plans (S-CHIP) has become the bleeding Kansas of the coming war over health insurance reform. All the papers this morning are reporting the Bush administration's Friday night "sacking of Lawrence" that severely restricted the number of poor kids that state programs can cover. As this New York Times story notes, the 1997 law creating the program specifically stated that S-CHIP programs can't be designed to substitute for private insurance. Sounds suspiciously like the 2003 drug benefit, which put insurance companies in charge of administration. The new rules sent out to state administrators late Friday would, among its crueler provisions, impose a one-year waiting period for children in near-poor families without insurance. Will the liberals in Congress who passed the S-CHIP expansion bills in July have a Pottawatomie Massacre up their sleeves when they return from their August break? . . .

Whom Do You Trust?

New York Attorney General Andrew Cuomo, acting in concert with that state's doctors, is challenging Cigna and Aetna for their physician quality rankings, an effort by the health insurance giants to steer families away from lower-ranked docs. Cuomo alleges its more about costs than quality since insurers having an obvious conflict of interest. They'd prefer patients go to low-cost providers, his spokesman says in a story in this morning's Wall Street Journal.

This raises an important issue. Measuring quality, not paying for errors, and rewarding doctors and hospitals that follow clinical practice guidelines are the "evidence-based" building blocks of any pay-for-performance scheme. But when insurance companies or Medicare interpret the evidence and set the quality standards, they have a conflict of interest if they also pay the bills. Great Britain has its National Institute of Clinical Effectiveness set medical practice standards for its single-payer system. It would be interesting to know what safeguards that country has set up to ensure its independence. . .

Some Seniors Still Lack Drug Coverage

The number of seniors without prescription drug coverage is down to eight percent from about a third before the 2003 drug benefit passed, according to a new survey published in Health Affairs. But one in five seniors still put off buying some drugs because of high co-pays. John Rother of the AARP tells the Los Angeles Times "that's pretty positive for most beneficiaries," but Tricia Neuman of the Kaiser Family Foundation says "there is still work to be done in making medications more affordable for seniors."