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
There was some buzz this week that the AHCA, as passed by the House, might actually run afoul of Senate budgetary rules that would invalidate the bill. Potentially, this could mean having to revise and re-pass the bill in the House, separately from any process going on in the senate. The potential issues appear to stem from requirements that laws not add to the deficit. I have seen some skepticism that this potential scenario would actually play out; Vox.com offered an explainer.
“Depending on what the CBO says, the House might have to change the American Health Care Act and pass it again or even start over, according to Bloomberg…Experts have wondered if the House bill would work under the Senate’s rules, which are supposed to restrict a bill considered under “budget reconciliation” to make sure it affects only federal spending and revenue. If those strict conditions are met, then the Senate can advance a bill with just 50 votes. Republicans are using that process because otherwise Democrats could block the legislation.”
Continue reading Health Policy Updates: May 20 2017
This week Republicans made some amendments to the AHCA before continuing it along its legislative course to passage. Including work requirements for Medicaid recipients and large tax cuts for high-income Americans, these changes seem oriented more towards placating hard-Right opponents such as the Freedom Caucus rather than fixing the many problems with the bill that health policy wonks – both left and right – have been pointing out.
“These aren’t changes that address the core problems the GOP health care bill will create for voters, insurers, or states; instead, it’s legislation that tries to solve some of the problems the bill creates for conservative legislators….None of these provisions meaningfully change the underlying legislation, nor any of its flaws. These are mostly tweaks meant to win over hardcore conservatives and Congress members from New York.”
Ultimately, however, these efforts were not effective in winning enough support among Republican members of Congress. Rather than see the bill go down in defeat, Speaker Ryan pulled the bill from the House floor on Friday before any vote took place. The consensus is that this means efforts to repeal the ACA *currently* dead.
“Then, the Friday vote was abruptly canceled, as Republicans failed to whip enough votes for the bill. And so, Ryan concluded, Obamacare remains the law of the land.”
Continue reading Health Policy Updates: March 25 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
Beautiful infographics on global trends in life expectancy, disease burden, and child and maternal mortality. It is truly striking how much improvement we have made over the last 50 years, and continue make. Continue reading Health Policy Updates: January 1 2017