What would it take to make the US health care system the best in the world? We already spend more money (by far) on health care than any other country, but our results are middling (see the figure below). Recent thoughts on what the US might do in order to translate our huge financial investment in health into better results, in the NEJM.
“The first challenge the U.S. health care system must confront is lack of access to health care…Affordable and comprehensive insurance coverage is fundamental. If people are uninsured, some delay seeking care, some of those end up with serious health problems, and some of them die.
The second challenge is the relative underinvestment in primary care in the United States as compared with other countries…In contrast to the United States, a higher percentage of these countries’ professional workforce is dedicated to primary care than to specialty care, and they enable delivery of a wider range of services at first contact…” Continue reading Health Policy Updates: August 19 2017
As of Tuesday, the Senate voted to open debate on a bill which, 24 hours prior, its members did not know the contents of.
“…there are at least four different draft health care bills floating around right now…The lack of clarity is part of a larger lack of direction for Senate Republicans’ six-month health care effort…Throughout this process, Republicans have struggled to articulate what exactly they want to achieve — aside from delivering on a seven-year campaign promise to repeal and replace Obamacare.”
Votes on the BCRA and then “full” Obamacare repeal followed shortly thereafter, and were both defeated by slim margins. Attention then turned to the so-called “skinny repeal,” which would leave the ACA/Obamacare’s Medicaid expansion intact and get rid of only the individual and employer mandates to have health insurance. Finally, even skinny repeal went down in a vote early Friday morning, with John McCain breaking party ranks (and joining Sens. Collins and Murkowski) to become the decisive “no” vote, in a dramatic fashion on the Senate floor – video here.
It remains to be seen whether the ACA repeal effort is truly dead this time, or will continue to rise from its own ashes.
Continue reading Health Policy Updates: July 29 2017
With the AHCA’s passage of the House, the Senate remains a serious hurdle. Some members have made it clear that the senate will start from scratch, and not base any of their health care reform plans on the House AHCA bill. How this will move forward, and play out in a hypothetical future reconciliation process, is yet to be seen.
“On the Senate side, where several Republicans have long been deeply skeptical of the House effort, the bill is expected to undergo sweeping changes that might leave it unrecognizable — perhaps stripping away some of the provisions that helped earn the support of hard-right House members and ultimately secure its passage.”
Continue reading Health Policy Updates: May 14 2017
It hasn’t been a good week for Obamacare. More insurers are pulling out, and the Trump Administration seems to be split on whether it wants the exchanges to die now or hang around a little longer to provide for a smooth transition.
“The administration’s zigzags haven’t placated worried insurers, who see another year of red ink from enrollees that are older and sicker than they had expected. Congress’ paralysis on repeal and replacement translates into precisely the kind of uncertainly that makes risk-averse insurers want to run for cover. And Trump’s executive order, signed just hours after his inauguration, unnerved the health plans with its call for government agencies to abolish as much of the law as possible through administrative action. That fueled fears that his administration won’t enforce the individual mandate requiring most Americans to get coverage.”
Continue reading Health Policy Updates: February 18 2017
The big news of the week was some apparent waffling on the part of Congressional Republicans on the Obamacare repeal plan. What had once seemed like a sure thing has run into some road bumps as members consider the difficulty in coming up with a viable replacement.
Sarah Kliff reports here.
“The Republican Party is fracturing around Obamacare in ways we haven’t seen before. This is happening for a simple reason: It’s really, really hard to end health insurance benefits for 20 million Americans, especially when you don’t have a plan for what comes next. I still think repeal is the most likely outcome of this debate — it just doesn’t seen nearly as certain possibility as it did a month ago.”
Continue reading Health Policy Updates: January 15 2017