Paper Examines U.S. Health Care Financing; NEJM Perspective Discusses Massachusetts Health Insurance Law; Poll Gauges Effect of Economic Downturn on U.S. Adults

• "Financing the U.S. Health System: Issues and Options for Change," Better Health Care Together: The paper examines the implications of different options to finance the U.S. health care system, including proposals to continue current financing and redirecting health care spending to more effective uses, eliminating high-income tax cuts, changing the current tax exclusion for health benefits, a "pay-or-play" model and a value-added tax. The paper also examines the effects of these proposals on individuals, employers and the health care system (Seshamani et al., "Financing the U.S. Health System: Issues and Options for Change," June 2008).
  
  A webcast of a Better Health Care Together forum to discuss financing the U.S. health care system is available online at health08.org.
  
  
• "Health Care Reform in Massachusetts -- Expanding Coverage, Escalating Costs," New England Journal of Medicine: In the perspective, Robert Steinbrook, an NEJM national correspondent, discusses coverage expansions under the Massachusetts health insurance law and potential challenges facing the state. Steinbrook writes that there "are still many difficulties with access to primary care" and covering the remaining uninsured. He adds that "Massachusetts has made some strides, and given sufficient resources, more can be done," such as helping the remaining uninsured obtain coverage, expanding employer-sponsored coverage, and improving options for low-income working adults and others who received hardship exemptions. Steinbrook says improvements can continue as long as the public supports the law and the state and federal government are willing to continue funding "the ever-increasing bill" (Steinbrook, NEJM, 6/26).
  
  
• Kaiser Health Tracking Poll: Election 2008, Kaiser Family Foundation: The latest poll finds that the economic downturn continues to create serious financial problems for most U.S. residents. According to the poll, 59% of adults reported having a "serious problem" with at least one of seven major financial issues, including one in four adults who cited paying for health care as a serious problem. With gas prices topping $4 per gallon nationally, people are most likely to cite paying for gas as a serious problem (43%), followed by getting a good-paying job or a raise (27%) and paying for health care costs (25%). Other problems rank lower: paying for food (19%), dealing with credit card or other personal debt (16%), losing money in the stock market (15%) and paying their rent or mortgage (14%). In thinking about health care costs, voters are more troubled by their personal costs than by national health spending. Nearly half (47%) say they are most worried about increases in what the average American pays out-of-pocket for health care and for insurance. In comparison, two in 10 (19%) say they are most concerned about increases in how much the U.S. as a whole spends on health care. Smaller shares cite increases in spending on public health insurance programs (14%) or increases in what employers pay for their workers' health insurance (10%). The poll looks at the idea of moving away from the employer-sponsored health insurance system -- a concept promoted by some policy leaders from across the political spectrum. The poll, which is available online, is part of a broader effort by the Kaiser Family Foundation to provide a central hub for resources and information about health policy issues in the 2008 election. More information is available online at www.health08.org (Kaiser Family Foundation release, 6/25).