Our Health Policy Matters

Fifty years ago, we already knew that there were environmental causes of chronic conditions like mental illness.   Had we taken them on as an American nation-building project with the zeal with which we have approached nation-building overseas, we would be a healthier country today.   Will we do any better in the next half-century? I’ve recently been reading a book written in 1969 about the 1968 Presidential campaign, called An American Melodrama .   It is a very long book about a very short political campaign by today’s standards. Bobby Kennedy, for example, didn’t announce for the Presidency until March, and George Wallace – who won several southern states as a third-party candidate – didn’t pick his running mate until October.   Political scientists will find many parallels from that time to today.   One example: former Governor Romney was the early favorite for the Republican nomination.   (He never made it to the starting gate.) It was a campaign and a time repeatedly rocked b

For over thirty years, states have tried and failed to contain Medicaid costs. And if they continue to do what they’ve always done, then “more flexibility” through block grants – code words for cutting people and benefits from the programs – isn’t going to help.   This is because the strategies they have used don’t work.   I wrote a few weeks ago about problems with some of the specifics of Florida’s Medicaid reform bill this year.   In this column, I want to add a more global perspective.   source: US DHHS, 2007 Between 1980 and 2004, total personal health care expenditures in the United States increased by 726%.   Total Medicaid expenditures increased by 1,028%.   That’s a pretty compelling opening argument against the four common “cost containment” strategies -- cutting provider rates; reducing the number of people eligible; eliminating chronic disease detection, prevention, and management services; and making recipients pay for services. These strategies have two thi

On a sultry June morning in our national’s capital last Friday, I visited the Vietnam Veterans Memorial .   Scores of people moved silently along the Wall, viewing the names of the men and women who died in that war.   Some stopped and took pictures.   One group of men about my age surrounded one name for a photo.   Two young women posed in front of another, perhaps a grandfather or great uncle they never got to meet. It is always an incredibly moving experience to visit the Wall.   It treats each of the people it memorializes with respect. There is no rank among those honored.   Officer or enlisted, rich or poor, each is given equal space and weight. It is a form of acknowledgement and respect for which many veterans still fight. Brave Vietnam veterans returned from Southeast Asia to educate our nation about the effects of war and violence. I didn’t know anything about Post Traumatic Stress Disorder when I entered the Connecticut Legislature in the late 1970s.   I had only vag

Implementing health reform in the states is a governmental responsibility.   But Kaiser Health News reported this week that states are turning to foundations to help them with the costs of implementing these reforms.   Financing governmental duties has not traditionally been the role of a foundation.   Governmental programs should be implemented efficiently, but asking foundations to pay for this implementation is drawing dollars away from the most important work of foundations. This important work involves investing resources in promising initiatives that aren’t yet “government ready.”   Foundations are uniquely equipped to provide seed funding to experimental and innovative programs before they are ready for governmental action. On the other hand, funding governmental obligations leads to two unintended consequences.   First, it relieves governments of their obligation to justify to the public the expenditures they need to make to implement their programs.   This always seems to

New!! Can't remember exactly where you got a data reference from Our Health Policy Matters? Check out the new Data Source Links page for a complete list of past hyperlinks used in all Our Health Policy Matters columns. A growing number of highway billboards encourage people to use hospital emergency rooms.   The ones in my area advertise pre-registration to avoid lines or shorter waiting times. These billboards clearly aren’t targeted to people riding in the backs of ambulances, who generally aren’t ER comparison-shopping.   They’re for potential ER users who are in a position to make a choice.   That’s the “non-urgent” crowd. The irony is that these billboards are proliferating just as state policymakers impose new charges to discourage non-urgent ER use. Two examples from recent weeks:   Florida’s Legislature voted to impose a $100 charge on non-urgent emergency room visits by the Medicaid population.   Connecticut decided to impose a new $35 charge on state employees do