Opinion polls on health care reform keep piling up, and most of them show the public's deep ambivalence, if not rejection, of the House and Senate bills on the table. But a new survey of residents in key battleground congressional districts found that support for reform can go way up if people are asked their opinion of specific proposals that might either save money or improve care.
The poll, sponsored by a pro-reform coalition of business and labor unions called America's Agenda, sought out likely voters in Congressional districts where represenatives are could face tough opposition in the next election, as well as those represented by conservative Democrats, often called "Blue Dog" Democrats. It found that only 36% of these moderate-to-conservative voters favor current reform proposals (28% strongly), with 38% opposed (30% strongly) and 26% undecided.
But then the pollsters asked voters if they would support a reform bill that required that teams of doctors and nurses work together to coordinate all of patient's health care needs, particularly for those with chronic diseases. Under that scenario, 57% of voters in Blue Dog
districts and 70% of voters in swing Republican districts would be in favor of a health care reform.
It's a bit of a trick question, since neither the House and Senate bills include any meaningful incentives to encourage such coordinated care, often referred to as the patient centered medical home. Though the concept holds great favor among health care experts, the current fee-for-service payment structure, which rewards doctors for the quantity of services rendered, works against the medical home. There is also the lack of widespread implementation of electronic health records that are almost a necessity for coordinated care. Add in the fact that 83% of primary care practitioners are not tied into a network of care givers--in fact, half are in single-doctor practices--and coordinated care appears a long way off.
Still, the survey does show that people might show greater support for a reform bill that focused on improving care and making the system more cost-efficient, rather than just figuring out how to cover the uninsured. While such proposals as mandating that citizens buy insurance without providing a public financed option, or taxing high-coverage "Cadillac" plans, typically poll very low, reform proposals that improve care, even if it means dramatic changes in the existing delivery system, are usually quite popular. "People are saying I can support reform. They really do want the reform agenda to focus on care improvement and chronic care and team care," says George Halvorson, CEO of managed care provider Kaiser Permanente. Kaiser is one of the nation's largest practitioners of coordinated care, and a member of America's Agenda.
Congress doesn't seem to be listening, however, since the current bills do little to reduce costs and nothing to change the delivery system, other than fund a few pilot projects. A Rasmussen Reports poll released this week found that just 38% of American voters favor the Democratic health care plan against 56% who are opposed. A Robert Wood Johnson poll was more positive, but did point out that Americans are pretty conflicted over what health care reform would mean for them:
Asked how the health care overhaul would affect their own access to medical care, 57 percent said it would stay the same. Similarly, 61 percent said their personal financial situation would stay about the same. Among those who do expect a change, 28 percent said they thought their access to care would get worse, while 15 percent said they thought it would improve. On finances, 27 percent said they thought the health care bill would make them worse off financially, while 12 percent expected an improvement.
Meanwhile, here are the results of five other polls on health care reform released in the last week:
• Fox - Favor 35% Oppose 51%
• Quinnipiac - Favor 35% Oppose 51%
• CBS News - Favor 40% Oppose 45%
• CNN - Favor 46% Oppose 49%
• PPP - Favor 40% Oppose 52%
(Source: pollster.com. Polls taken November 13 to 18)
Congress might want to take another look at the medical home model if it wants to win support.
On Capitol Hill, it's almost like open season on the Federal Reserve: Lawmakers are threatening to diminish its regulatory powers, lay bare its books, and let the government pick more of the top officials now named by boards dominated by bankers and corporate executives. Critics worry the proposals could drive down the dollar and undermine confidence in the U.S. as an economic bastion if they pass.
For the last decade or so, energy companies have much-reduced the risk they face in the oil patch through the use of 3D technology. Rather than blindly drilling underground on the basis of little more than sonic data transferred into lines on long sheets of paper, the companies have been able to project 3D images of a subterranean reservoir onto a screen, snap on some fancy glasses, and figuratively walk through an oilfield, picking precisely where to drill.
Now the companies responsible for this technology are branching out. Companies like Norway's Cyviz, Belgium's Barco and Canada's Christie Digital are marketing 3-D "media walls" to militaries, to pharmaceutical companies, to aerospace companies, and more. Pharmaceutical researchers based in offices around the world can simultaneously, for instance, make a close examination of the molecular structure of a virus, and figure out strategies for attacking it. The companies are hot competitors in Washington, D.C., at the moment, vying for the business of government agencies.
I asked Washington-based Cyviz executive Jeff Eisenhard to talk about the technology.
Health care and solar power seem to be worlds apart. Yet the massive health care bill could cast a pall on renewable energy.
How? The link is an obscure tax provision in the House version of the health care bill, explains tax attorney Jerome Breed, a partner at Bryan Cave LLP. The provision actually has nothing to do with health care either—its purpose is to raise revenue.
The provision centers around the idea of “economic substance.” It puts into legislation the idea that a transaction (such as putting solar panels on a business) has to have some economic substance (i.e. an economic return) to be eligible for a tax credit. In the case of solar panels, the federal government offers a tax credit of 30% of the cost of systems business owners or investors install. But what if the return is mostly in the tax credit—so that the owener or investor really doesn't get any other economic benefit? “It’s not clear if, when you take away the effect of the credit, there has been a meaningful change in their economic position,” explains Breed. So if an economic substance requirement passed, the owner or investor would no longer be eligible for the tax credit.
Renwables power isn’t the only industry that could get hit by this provision. The economic substance doctrine would also make it harder to use the low income housing tax credit, the credit for rehabbing historical buildings, and others, says Breed.
Why is the provision in the bill at all? It’s a revenue raiser. The House expects to get about $5.4 billion, mostly from penalties levied from transactions that don’t meet the economic substance test. The provision is also supposed to discourage people from entering into transactions that don’t result in economic substance, thus preventing tax money for being used for dubious purposes.
Clearly, some sort of provision disallowing dubious transactions is needed. Otherwise, “there could be fraud,” says Breed. “Someone could claim tax credit for building 1000 solar panels in the desert that don’t exist, or could claim that the panels cost $1 million when they only cost $100,000. So it’s appropriate to protect against that type of transaction.”
The worry is, though, that a blanket prohibition against transactions without economic substance will also knock out many legitimate transactions. Tax lawyers have been meeting with the Joint Committee on Taxation to push for a compromise position, so far without success.
The U.S. union workforce is increasingly female, Asian or Latino, and more highly educated, according to a study released today by the non-profit Center for Economic and Policy Research in Washington, D.C.
The report, “The Changing Face of Labor, 1983-2008," chronicles the demographic shift that’s taken place over the past 25 years among union members. It underscores that new forces will continue to shape the political agendas of labor unions, which played a key role in get-out-the-vote operations in Presidential elections.
“The view that the typical union worker is a white male manufacturing worker may have been correct a quarter of a century ago, but it’s not an
accurate description of those in today's labor movement,” said John Schmitt, senior economist at CEPR and an author of the report. “The unionized workforce is changing with the country.”
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