It’s just one more interesting twist in the never-ending health reform saga.

On the one hand, a recent poll shows that public support for health reform is sagging – down from 50 percent to 43 percent – as the mid-term elections approach.

On the other hand, folks – and by “folks” we also mean state governments and about 2,000 employers – are already lined up to apply for some of the benefits of the health reform legislation. And why wouldn’t they want the benefits?

But then there’s the other other hand … the hand where many of the same folks opening wide for the subsidies are actually suing the federal government to overturn the health care overhaul as unconstitutional.

Three hands? Doesn’t really faze us. We think it just sort of goes back to what we’ve been saying all along: that we think many folks will oppose the health reform legislation until they know specifically what’s in it for them.

Ultimately, we do think most folks will find something in the reform specifically for them. The question is whether they’ll find that something BEFORE the mid-term elections or whether they’ll be voting to keep benefits out of their own hands.

Back in the spring and summer of last year, the debate about health reform exploded over an issue that was not, in my estimation, worthy of a firecracker-sized pop. The issue was advanced care planning consultations, and looking back now, it seems to me the most odd point of contention that could have been raised with regard to the proposed health reform legislation.

Someone's mother, possibly a 'death panel.'

Health reform’s critics warned that the advanced planning provision would create “death panels,” and proceeded to use the term to terrify the public for months. The threat? That power-hungry bureaucrats, given enough power through health reform, would  send representatives to the elderly and terminally ill and coerce them to not only have consultations about their end-of-life planning options, but to encourage them to undergo cheaper alternatives – all to cut health care costs.

That issue died last summer when Republicans demanded it be ripped out of the legislation (despite the fact that some of them had supported the idea several years earlier). But this week, the issue was resurrected for me with the publication of this really great article from The New Yorker. In reading it, I was struck by a sense of loss over a huge missed opportunity to do something both immensely helpful to families facing end-of-life planning decisions and because the article makes it clear that there really are potential cost savings to be realized from this provision.

Gasp now. To advise the terminally ill on how to have a more comfortable, more meaningful, more peaceful death could result in cost savings? As noted by the article’s author, a surgeon at Brigham and Women’s Hospital, patients who understood their end-of-life options didn’t have to be coerced to accept less expensive treatments as their illnesses progressed. The palliative-care solutions (which were more about comfort and less about trying every curative treatment until the moment death occurs) actually required fewer hospital services.

In 2005, I took over care of my 92-year-old grandmother as she began “winding down.” During the year and a half or so that I cared for her, the very best advice I received was from my mother. My mother worked in a nursing home for decades and now works in hospice care. I can say without any hesitation that she does what she does because she truly cares for her patients and wants to make them comfortable in their “golden years” and at “the end.”

Long before my grandmother actually died, my mother reminded me that my grandmother had lived a full and beautiful life – and that because my grandmother  had no cancer, no emphysema, no debilitating disease, she was going to slowly wither away. Eventually, her body would begin shutting down, and when it did, I should carefully consider, as my grandmother’s medical power of attorney, whether to fight that process.

If I did fight the inevitable, grandmother’s natural process of dying would become a process that would likely involve a feeding tube, possibly a ventilator and God knows what else. Instead  of being with my conscious grandmother – and being able to hear her final thoughts and wishes – I might well be sitting next to an intubated, unconscious shell of that person. She may have already left, unable to say goodbye because she was in a coma.

Ultimately, I heeded my mother’s advice, and my grandmother did gradually wither away – and I made her as comfortable as I possibly could, following my mother’s suggestions for palliative care.

And so it amuses me to think that my mother was my “death panel.” Mom’s advanced care consultation felt nothing like any “death panel.” If anything, it was a “life-affirming” panel. She was my advisor during a time that could have been a lot more sad, confusing and ultimately filled with the stress that comes with agonizing decisions about how we want to be treated and how the people who we care for want to be treated.

Sometimes, people want to try every possible treatment and fight until the bitter end. Sometimes, they want to stop fighting and use their remaining time to celebrate life in a peaceful, pain-free setting. Patients should always choose which option feels right to them, but they first need to know that both options are there.

The “death panel” provision didn’t make it into the passed health reform legislation, sadly. It saddens me because here’s the thing: not everyone will have someone as experienced and thoughtful as my mom when the time for difficult decisions approaches.

So – death panel or no death panel – thanks, Mom.

We know it’s stating the obvious to say that the health insurance industry was not pleased by the outcome of the battle over health reform that concluded in March.

Health insurers are getting ready for Round Two of the epic health reform fight.

But this article on Bloomberg shows just how bad the battle went, according to industry execs, whose ideas now include jettisoning Karen Ignani from her position as head of the trade group America’s Health Insurance Plans. According to Bloomberg, AHIP’s performance in the battle earned worse than a “thumbs-down.” (One observer says the for-profits got “spanked a little bit,” while Cigna CEO David Cordani gave the effort a big, fat F.)

Now, Bloomberg reveals, the insurers are scrambling. Senior government relations staff from five major health insurers have been meeting for at least two months to come up with a strategy for responding to the new law and influencing how it will be implemented.

Possible industry targets? They’ll certainly include insurance regulators who will interpret medical loss ratios set by the new law, and state officials who now have the ability to deny unreasonable – and in some cases “jaw-dropping” – premium hikes. Health care pundit Robert Laszewski says that insurers are also hoping the face of Congress will get a little redder in the upcoming elections.

Naturally, the strategy also includes figuring how much of a “war chest” to build for Round 2 – and it looks like it’s going to be a bloody second round. A source for Bloomberg put that number at $20 million.

New health reform rules will make it easier for consumers to appeal claim denials by insurers.

When you start talking about the recently passed health reform legislation, there’s a good chance you’re headed for an argument. But it’s hard to see how anyone – other than health insurance companies – could argue against the consumer protection provisions announced by the Obama Administration yesterday.

Anyone who’s fought it out with an insurance carrier over denial of a claim – and anyone who’s ever prayed they wouldn’t have to fight that fight – will breathe a sigh of relief over the regulations, which give patients a process to appeal health plan decisions in every state. “No” from an insurer may not ultimately mean “no.”

More importantly, the regulations ensure that a patient’s care has to be covered for the duration of an appeal.

But that’s not all. The latest provisions of the health reform legislation also provide funding for a Consumer Assistance Program that actually aids consumers in appealing health plan decisions. That – and the CAP will also steer consumers away from trouble in the first place by helping them choose from a range of coverage options that meet their individual needs before they buy.

You might say these new rules are just what the patient ordered.

Everything you always wanted to know about health reform*

Say what you will about the recently passed health reform legislation – good or bad – but you can’t say that its supporters are withholding information about what’s ahead.

With mid-term elections around the corner, the Obama Administration is readying a Lollapalooza of a dog-and-pony show to highlight its accomplishments to date – and the Patient Protection and Affordable Care Act is center stage. The Administration is using every trick in the PR and marketing book to make sure consumers know exactly what they can expect from this year’s landmark health reform legislation.

Opponents of the legislation are considering whether its provisions could provide ammunition for a major Congressional seat grab this fall. But judging by the steady barrage of news releases and an extensive health reform Web site, the Administration believes that every new provision announced only increases the value of its stock.

The Web site is filled with a mountain of information, but the piece we think will matter most to folks confused about the legislation is What’s Changing and When. It’s a timeline that shows what’s been implemented since passage of the ACA, and when the rest of the provisions are due to take effect.

For consumers, it provides an easy-to-read answer to the questions, “How will the legislation affect me personally?” and “What’s in that mammoth bill anyway?” (For the Administration, it’s a great way to answer the question, “What have you done for me lately?”)

Of course, there’s a lot more to the site, including enough videos to schedule a film festival, pages detailing each of the provisions, and a section, drably titled Information for You that provides more detail about how the legislation affects Families with Children, Individuals, People with Disabilities, Seniors, Young Adults and Employers.

For folks who don’t think visiting the site will satisfy their craving for health reform news, the Administration has also set up nifty features that push the latest press releases and speeches to readers through e-mail updates and, naturally, Twitter posts.

For months Americans have been saying that the architects of health reform have a lot of explaining to do. We think it’s safe to say that their wish has been granted.

Risk pool business isn't risky for the uninsured.

Tomorrow, many states will start taking applications for insurance coverage through the temporary high-risk insurance pools established through this year’s historic health reform legislation. As the Associated Press points out, it’s a “huge investment” by the federal government.

It’s no secret that many critics believe the pools are a huge mistake. Though the funding for the states was set at $5 billion, the legislation still didn’t fund the program adequately. As The New York Times points out, the funds will only adequately fund coverage for 200,000 to 400,000 people, “or fewer than 10 percent of those denied health insurance because of pre-existing medical conditions.”

Some skittish states are opting out of the program, letting the federal government take the responsibility of running the pools through a private nonprofit entity. Other states are doing what they can, knowing that for many folks, the high-risk pools are the only option for coverage until 2014, when insurers will be prohibited from denying coverage based on a pre-existing condition.

We applaud those states.

Critics can say what they want about risk pools, but we’ve known for years that risk pools are not “risky business.” They have, in fact, often been the only business for folks who are uninsurable. Risk pool enrollment is certainly not limited to low-income Americans. As this site has pointed out, sometimes you just can’t get coverage because carriers have denied coverage – or the cost is just too high.

If you don’t know someone who’s gotten their health coverage through a risk pool, you might just ask an acquaintance or two. I have both a close friend and a family member who turned to risk pools as a last resort. In both cases, a risk pool meant the difference between life and death.

The risk pools aren’t perfect. The federal program is open only to those with pre-existing conditions who can prove they’ve been uninsured for at least six months. And historically, premiums in the pools have been painfully high.

We know there’s still room for improvement – and the need for additional funding. And eventually, we hope there’s no need for risk pools in our health care system. But for now, we’re thrilled to see hundreds of thousands of lives improved by the measure.

Pollster: Health reform NOT uniformly despised. (We paraphrase.)

If you listen to John Boehner, health reform is not only completely abhorrent to the critics who pummeled it for months on end, but it’s now also uniformly despised by everyone, everywhere.

In reality, health reform is probably viewed negatively (ranging from “completely loathed” to “not really certain what it will do”) by about half of Americans and favorably (ranging from “fantastic but still not far-reaching enough” to “not really certain what it will do”) by the other half.

But it’s definitely not uniformly despised, judging by the looks of this nifty chart from Pollster. If anything, the chart shows that people are liking health reform more and more as its provisions take effect.

Since the very beginning, we’ve thought a huge chunk of the American public was squarely on the fence: wanting some kind of health reform but fearing that too much health reform would take our stinking economy even deeper into the abyss. But the public was also on the fence because the provisions just weren’t explained very well, or maybe not simply enough, or perhaps explained way too much (in an information overload kind of way).

We predict the black arrow will continue to swing upward as folks start to appreciate the provisions of the bill – and after fear of the unknown dissipates (as we know more about the unknowns of the legislation).

But the bottom line here is that the direction of the red line says pretty clearly: health reform is being hated less.

We're NOT #1 in health care performance, but we ARE tops in terms of per capita health care spending. Yay?

Like Avis, the United States is apparently not Number One – not in health care performance at least – when compared against a bunch of other countries. And they’re countries that repeatedly got a really bad rap during the health care debate as being examples of poor quality, inefficiency, and – worst of all – rotten access.

When critics of health reform plans forecast the future of the U.S. system under Democrat-crafted reforms, they pointed to Canada, where “socialized medicine” apparently means almost certain death for everyone who’s subjected to it.

Canadians – including the guy who dashed off a hot-and-bothered reply to my post yesterday – should be saying “nyah nyah” today, after The Commonwealth Fund’s report pegged the U.S. as dead last in the category of “Long, Healthy, Productive Lives.” (Not just healthy and productive, but also long. Pretty specific.)

The U.S., it turns out, was not tops in any category (in a good way) – though, as the Avis line goes, we do appear to be trying harder. (The U.S. had the highest health expenditure by far – $7,290 per capita – of the seven countries studied, and nearly double that of Canada.)

Uhhh … good for us???

Photo: edalisse

President Obama likes his health reform legislation. Go figure.

And today, he also gave consumers more reasons to like the legislation – namely a bunch of consumer protections the administration is calling the “patient bill of rights.”

How about reversing course? The POTUS said – in a nutshell – “Let’s not and say we didn’t.”

Happy 90-Day Birthday, Patient Protection and Affordable Care Act!

What has health reform done for me lately?

Seriously. Ask, “What have you done for me lately?”

Do it today – submit your questions about health reform progress to About.com. Maybe if you ask nicely, Katherine Sebelius will actually answer your question during a live event streamed tomorrow at 3 p.m. (Eastern) at Whitehouse.gov/live.

Questions that probably WON’T get answers:

• “Why are you trying to kill Grandma?”
• “Could you please not touch my Medicare?”
• “How will we keep the greedy Canadians from stealing our free health care?”
• “Is there any way we can get the animals in the Gulf covered under a catastrophic plan?”

Just sayin’.