Public policy attacks on public health and mental health, intrusions
in doctor/patient privacy, the continuing fight over the Affordable Care Act, and
our collective loss of faith in private health insurance were among the top
health policy story lines of 2011.
This year, eight stories make my short list. Not all of these stories made big headlines
during the year. But they have had, or
will have, an outsized impact on our lives.
I’ll begin the countdown this week with four that capture and
continue some of the major trends of the recent past. Next
week, I’ll offer four more that hint at where health policy may go in the
future.
8. The Shooting of
a Congresswoman. In January, the
first big health policy story of the year was about violence and mental illness
– the horrible wounding of a member of Congress, and the murder of several
people around her. As the media struggled
to make sense of this, it raised once again the relationship between mental
illness and violence. What it failed to
do was to report that, while this particular shooter seemed mentally
imbalanced, most perpetrators of violence are not, and many victims of violence
either already have mental illness, or will develop it as a result.
The continuing trend –
Our jails are our nation’s largest mental health institutions, and will remain
so until we invest more in prevention and treatment of mental illness.
7. The End of the
Iraq War. The War in Iraq may have
ended this month, but its health effects will be with us and our veterans for
many years to come. A GAO report released in October
got little mainstream media attention, but was blunt in its description of the
effects of this war and others on veterans’ mental health. The 2.1 million unique veterans who received
mental health treatment in the five year period between 2006 and 2010 represented
over 30% of the veterans who received any type of health care. The fastest-growing groups of veterans
receiving mental health treatment during this period were the 213,000 Iraq and
Afghanistan veterans with mental health needs.
And 38% of all Iraq/Afghanistan veterans who received health care during
that time required mental health care.
The continuing trend –
So long as we remain at war, veterans’ health and mental health services will
need to be expanded significantly throughout the foreseeable future, and, as
taxpayers, we will need to pay for them.
6. The Death of
the CLASS Act. What does it say when
the first major provision of health reform to be killed off in a bipartisan way
was the one provision that had enjoyed bipartisan support for a
generation? There are at least two
things about long term care most of us don’t want to face. The first is that most of us will need it
someday. The second is that practically
none of us can afford it on our own. Rather than coming up with a meaningful
public/private partnership to pay for it after almost thirty years of trying, the
Administration and Congress quietly killed CLASS in October, choosing once
again to keep the current, broken system in place. This is the one where we first impoverish
people when they get old and sick, and then let government pay the whole bill.
The continuing trend –
Medicaid will remain the default payer for long term care. Costs will continue to skyrocket, we’ll all
continue to complain, and long term care insurance won’t gain a greater
foothold in the market any time soon.
5. Low PCIP
Enrollment Numbers. The most
compelling evidence in 2011 that we may have finally lost our faith in private
insurance was found in the late summer reports of the low enrollment in the
Pre-Existing Condition Insurance Program (PCIP). This is a program that eligible uninsured
people were supposed to embrace, because it pretty much guaranteed that it
would pay out far more for their health care than it collected in premiums,
saving each of them lots of money. But
when only
30,000 of the 4 million eligible people enrolled as of July, most of the
rest seemed to be saying that they would rather take their chances on permanent
financial ruin than insurance. Or that they
were already so impoverished by illness that they no longer had anything to
lose.
The continuing trend –
If the health insurance industry cannot restore our trust, even the people who
need it most will opt out, relying only on safety net government funding.
Next week: The final Our Health
Policy Matters column of the year looks at four more big stories of the year,
and their implications for the future.
Comments
Post a Comment