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A Reader’s Guide to Health Reform

Doctor with patient; AFP/Getty
Many people have written to us in the past several weeks saying they can’t stand to hear another word about the political sausage-making process behind health reform. What they ARE eager to learn more about is how the legislation will actually change things for them, their families, their employers – with answers about costs, limitations, and unintended consequences.

With that in mind, we’ve constructed a brief Reader’s Guide to Health Reform that includes a few of the more interesting pieces we’ve come across out of the millions of words written over the past 14 months. In some cases, these might be stories that you overlooked before. Or they may be articles you wanted to set aside to read but never did.

First, let’s start with the question of what you need to know.

There are good roundups of what the House passed last night and the myriad of ways it may affect you or your employer. Here are just two of many guides that spell out the details with real numbers: the first from Kaiser Health News and the second from The Washington Post. The Wall Street Journal also offers a list of suggestions to consumers on how to prepare for the reform changes.

Next, the question of what ails the U.S. health care system.

There have been a number of pieces attempting to diagnose the troubles in the American health care system, to explore smaller state experiments under way around the country, and to examine how the existing problems and attempted solutions might affect the legislation.

Most recently, for example, Kevin Sacks of the New York Times showed how the arcane matters of Medicaid payments translate into real-life problems that patients face in finding a doctor. Last year, the NewsHour’s health correspondent Betty Ann Bowser looked at the benefits and problems Massachusetts has encountered since enacting universal coverage, including a doctor shortage (there’s more here).

On locally-based efforts, the NewsHour’s Spencer Michels reported from San Francisco on the city’s initiative to extend coverage to its more than 60,000 uninsured residents. And the NYT’s Gardiner Harris looked at lessons that could be learned from Hawaii’s lesser-known experience.

And then there were the issues of coverage and costs.

Throughout the debate, the focus shifted periodically from coverage to costs to discrimination. On the question of coverage and insurance discrimination, Time’s Karen Tumulty drew major attention last year for her powerful cover piece titled “The Health Care Crisis Hits Home,” which chronicled the battles her brother encountered over the years as he dealt with a form of autism.

Perhaps no writer was more quoted throughout this debate than surgeon and New Yorker writer Dr. Atul Gawande, whose work was cited by President Obama and too many others to count when it came to questions of cost disparities and coverage. Back in June 2009, Gawande wrote a story about how two border towns in Texas of similar size and location, McAllen and El Paso, cost Medicare very different amounts of money. The article triggered plenty of discussion about whether there was waste, inefficiency, and a simple lack of standards in Medicare. And it generated debate over how to interpret that data, which Gawande responded to here.

Dr. Gawande also wrote a provocative essay early on arguing that it was important for a country to pass health reform, however imperfect, and realize that the program would evolve over time as it has in Europe and elsewhere. And our own Betty Ann Bowser sat down with Dr. Gawande to explore his idea of creating a checklist for doctors and hospitals to improve the quality of care and reduce deaths.

Costs dominated much of the talk throughout the year, particularly the idea of “bending the cost curve” – and there were sharp pieces written on all sides of that question. Most recently, former CBO director Douglas Holtz-Eakin and former adviser to Sen. John McCain wrote a withering attack.

And Ruth Marcus – who was favorably disposed to support health reform – said she didn’t have much faith in the CBO estimates either. But The New Republic’s Jonathan Cohen argued it was fiscally responsible. And David Leonhardt noted that while the bill was imperfect and not as courageous as he would like, it would begin to implement some changes to help bend the cost curve.

To take a look at what some places have done to improve the quality of care and reduce costs, Betty Ann and NewsHour health unit producer Bridget DeSimone traveled around the country to look at early adopters — health systems that have already made some of the changes that legislators and health policy analysts are now advocating.
Geisinger Hospital System in Pennsylvania has created a “90-day warranty” program on some surgical procedures. The Billings Clinic in Montana is aiming to reduce costs and improve quality by integrating patients’ care in doctor visits, surgery and hospital care. Judy Woodruff spoke with the CEO of the Cleveland Clinic, one of the largest practitioners of that kind of integrated care, about his ideas for keeping costs down. And in Grand Junction, Colo., reforms implemented in the 1980s mean that the majority of doctors work together to offer coordinated care, resulting in some of the lowest medical costs in the country — 30 percent below the national average for Medicare.

And there were also comparisons to health care systems abroad.

We explored international comparisons on our program. Betty Ann talked to reporter T.R. Reid about his book on what the United States might learn from other countries’ health care systems. And the NewsHour’s global health team traveled to the Netherlands to see how a massive health care overhaul that that country undertook four years ago has worked out.

And the developments continue on Capitol Hill and beyond.

In the last several weeks, two developments took center stage – the hike in insurance premiums in California and elsewhere; and the battle over abortion. Slate’s Timothy Noah struck back hard at the insurers and health consultant Robert Laszewski tried to put Wellpoint’s 39 percent insurance hike in a different perspective.

In the meantime, NPR’s Julie Rovner – who tried to alert everyone to the simmering troubles of the abortion fight for months – looked at what the bill did and did not do when it comes to using taxpayer money to provide abortion coverage.

Finally, one last duo of links — and that’s to a pair of stories released the other day on how health reform went from death’s door to passage inside of two months. It’s a story that shows off House Speaker Nancy Pelosi’s tough spine, captured here and here.

Once the bill is signed, you can expect to see plenty more pieces on the NewsHour and elsewhere about its implementation and the legal challenges ahead, including one right here. But maybe we can all take a breath before we start bookmarking those.