Health Affairs

In a recent Health Affairs post comparing the House Republican budget and the Senate Democratic budget, Uwe Reinhart says the contrast could not be more stark:

At least the American people now have before them the visions the two parties have for our country, especially in regard to health policy.

What are those visions? The Democratic vision he says, is that people “should have access [to health care] on roughly equal terms.” The Republican vision, by contrast, “signals to millions of low-income Americans without health insurance that they are on their own in health care.”

A Republican vision for health care? Unfortunately, there isn’t one.

On January 4, my Pew colleagues and I applauded President Obama and the U.S. Food and Drug Administration (FDA) for releasing two sets of draft rules central to implementing the FDA Food Safety Modernization Act (FSMA), the first major update to our food safety laws in more than 70 years. The law signals a long-overdue shift in FDA’s food safety strategy. Instead of reacting to an outbreak after it occurs, the agency will focus on preventing illnesses before they happen. This emphasis on prevention should help strengthen food safety and reduce foodborne illnesses, which strike about 48 million Americans and are responsible for more than $77 billion in health-related costs each year.

The administration has taken an important step, but it must do more. Important draft regulations focused on the safety of imported foods are still awaiting release. These rules, which include the creation of a new Foreign Supplier Verification Program, are especially important since about two-thirds of fruits and vegetables and 80 percent of seafood consumed in the United States come from abroad. Overall, imports account for as much as 15 percent of all food consumed in U.S. households—and that figure is growing about 10 percent annually.

It has been a long time since I have done a round-up of posts on other philanthropy blogs that have caught my eye, so today is the day! Other topics covered below include social determinants of health (specifically, housing), “tasksharing” in global health, and charities’ use of data. I love having the opportunity to peruse the... Read the rest of this entry »

Time travel, both backward and forward, continues to be a favorite theme in popular culture. If we could travel back just 60 years or so, we would see a vastly different health care system, one geared to provide acute care, not chronic care, and one offering what today would be seen as rudimentary treatments. No one in 2012 would expect a surgeon to use techniques from that era or a doctor to prescribe medications long surpassed by more effective drugs. Yet one important area of health care and long-term care services and supports clings to outmoded terms and measures.

Welcome to the hidden world of family caregivers — broadly defined as the spouses, adult children, other family members, partners, friends and neighbors who provide or manage most of the care of the growing number of noninstitutionalized people with chronic illnesses and disabilities. As our recently released AARP Public Policy Institute and United Hospital Fund report (available here and here) puts it:

Family caregivers have traditionally provided assistance with bathing, dressing, eating, and household tasks such as shopping and managing finances. While these remain critically important to the well-being of care recipients, the role of family caregivers has dramatically expanded to include performing medical/nursing tasks of the kind and complexity once provided only in hospitals.

These tasks include managing multiple medications, not just pills but injections and infusions; wound care; operating medical equipment like feeding tubes, dialysis machines, and mechanical ventilators; and using electronic monitors and other devices.

Just four years ago, only two people in the world had their genome sequenced:  James D. Watson (co-discoverer of the structure of DNA) and J. Craig Venter (former President of the firm that mounted a private-sector rival to the Human Genome Project).  There are now many thousands of such people.  At genome meetings, scientists are... Read the rest of this entry »

On May 9th, William Nickerson, Senior Judge in the Southern Maryland Federal District Court, issued a 15 page ruling against the six Augusta, GA primary care physician plaintiffs who challenged HHS’ and CMS’ longstanding relationship with the American Medical Association’s Relative Value Scale Update Committee (RUC). The opinion did not weigh the substance of the... Read the rest of this entry »

A posting on the Health Affairs blog earlier this year by Carol Levine asked the pointed question: “The year of the family caregiver- in what country?”  In it, she compared the “Year of the Family Caregiver” in the U.S. to the recent elections in Canada, where politicians were competing to see who could provide a... Read the rest of this entry »

Should everyone be required to have health insurance? The short answer is no. There is nothing that can be achieved with a mandate to buy health insurance that cannot be better achieved by a carefully designed system of tax subsidies. Beyond that, a requirement that everyone obtain insurance (as the new health reform law dictates)... Read the rest of this entry »

Reducing Medicare Part D drug prices requires careful tools, not simply the power to negotiate

I live in Texas. Right now, the only health insurance I can buy is insurance regulated under Texas law. But if bills before Congress (most notably, one sponsored by Arizona Republican Congressman John Shadegg), are enacted, I would be able to buy insurance regulated, say, by the laws of Virginia, or the laws of Delaware,... Read the rest of this entry »

We offer a practical solution to the issues that Jack Wennberg and Shannon Brownlee raised in their November 17th blog, “The Battle Over Rewarding Efficient Providers.”  We combine our experience in areas of law and patient care, respectively. American health care is in real peril of being swamped by surging costs.  President Barack Obama’s budget... Read the rest of this entry »

As Congress and the Administration debate health care reform, it is instructive to look at the Massachusetts model, now in its third year. Health Affairs today released a study of workers in the Bay State who were interviewed in fall 2008 about their employer-sponsored health care coverage, following up on similar surveys in 2006 and... Read the rest of this entry »

One of the most controversial parts of the Obama health reform campaign platform was its pledge to create a new Medicare-like public health insurance offering that would “compete” with existing private insurance plans, and put pressure on them and on providers to hold down costs. It would do this mainly by using Medicare-like pricing leverage... Read the rest of this entry »

A public-private alliance known as the Commercial Aviation Safety Team (CAST) has greatly improved aviation safety. A similar alliance among health care stakeholders could reduce medication and device errors and wrong-site surgeries, renowned patient safety expert Peter Pronovost and coauthors say in an article published April 7 on the Health Affairs Web site. Pronovost is a... Read the rest of this entry »

The most-read posts on Health Affairs Blog this January included much health reform advice to the Obama Administration and calls to action on health IT and rebuilding primary care. Additional commenting is always welcome. Top 20 Health Affairs Journal Articles For 2008 by Jane Hiebert-White Complete The Work On Health Information Technology by David Brailer... Read the rest of this entry »

Americans need and deserve health information technology (IT). As the chairman and CEO of Verizon Communications Inc. and the only business representative on a federal commission to develop a strategy for health care IT standards, I have spent considerable time over the past several years promoting this technological necessity.   In addition, Verizon helped found an... Read the rest of this entry »

Just when it looked as if the debate over the State Children’s Health Insurance Program (SCHIP) couldn’t get any more agonizing, some of the same folks who brought us the devastating RAND 55 percent study four years ago are back with the dismal news that children, on average, receive recommended treatment in only 46.5 percent... Read the rest of this entry »

Policy debates about reauthorizing and expanding the State Children’s Health Insurance Program (SCHIP) and its related Medicaid programs for kids are about providing access for poor kids to health insurance. School-based health care is about reaching kids where they spend half or more of each weekday. The larger issue in creating high-quality health care accessible... Read the rest of this entry »

Community rating, once the hallmark of health insurance in the United States, has been in accelerated decline since the 1980s. For the past few years, a fundamentally opposite notion of insurance, that of individual health savings accounts has been all the rage. The concept of consumer-driven health care–making consumers more aware of the actual costs... Read the rest of this entry »

Elliott Fisher and colleagues in their provocative paper published online December 5 validated an approach to quantifying the clinical and economic performance of physician communities clustered statistically around hospitals. Fisher describes the so-called extended hospital medical staff as “hospital-associated multispecialty group practices” or “virtual organizations.” While some physician markets do indeed function as “communities,” with... Read the rest of this entry »