Our Health Policy Matters

The Affordable Care Act has finally had its days in court this week. And commentators who were certain on Monday that the Supreme Court would uphold the individual mandate were just as certain on Tuesday that it would not.  Perhaps they have some special insight into the thinking of the Justices. I don’t.  I’ll just wait for the decision.  In the meantime, I’m wondering not how each of us thinks the Court will rule, but how we hope it will rule. The answer isn’t so simple, because we divide into – and often move among – three competing minority camps about health reform in general: The Affordable Care Act represents the best compromise for insuring more people while preserving most of our current public/private payer system. Expanding reform to a single payer system like those favored by other developed nations would be better.  Replacing ACA with a private market-based system is at least worth a try. If we’re as uncertain as polls cited by the Kaiser Family F

How will the Supreme Court respond to an argument next week that might lead to the disintegration of health care in America? In recent years, we have been making slow policy progress in better coordinating and integrating primary and specialty care, and health and mental health care.  Two milestones were the passage of the federal Mental Health Parity Act in 2008 and the Affordable Care Act provisions in 2010 that prohibit insurance discrimination against people with pre-existing conditions, both in coverage and in cost. These are opening more primary care doors to people with mental illnesses.  80% of all mental health problems are first seen in a primary care office.  And it now pays for a primary care clinician to screen for mental health problems.  According to one recent projection completed by the Mental Health Association of Palm Beach County (available on request from that organization), a primary care practitioner can generate in excess of $100,000 in insuranc

Here is a cautionary tale about the risk of downplaying the importance of environmental health. A year ago, Fukushima City was a bustling city with a population of 290,000.  Its people were going about their business the day the earthquake and tsunami hit northern Japan, triggering the biggest environmental disaster most will ever experience. At first, the trains stopped running because of damage to the railways, and most of the city’s water stopped running because of ruptures in water mains. Over the next several days, a silent toxin began to spread along with word of the natural disaster.  The Fukushima nuclear power plants, 39 miles southeast of the city, began melting down, releasing radioactive particles into the air and water.  Although Fukushima remained outside the quarantined evacuation zone stretching twelve miles out from the nuclear facility, waves of radioactive cesium dust escaped the zone, flying on the winds toward the city.  As it rained and snowed,

Does a stronger safety net mean a healthier community?  Apparently so, according to recent research. It’s a well-known fact that the United States spends 16% of its GDP on health, far more than any other country in the developed world. It’s also a well-known fact that all of our health spending doesn’t give us an edge in life expectancy or a number of other indicators of the overall health of the population.  One of the reasons for this is that we spend so little on public health, compared to health care. But there may be another reason, too.  We spend too little on welfare and social services.  To put this into context, it is important to remember – with a nod to the late George Carlin – that “welfare” wasn’t always one of the “seven dirty words” no politician could utter in public.  (The others today are “liberal,” “tax” and “increase” used in the same sentence, and “bigger,” “government,” and “spending,” also used in the same sentence.) When I was a membe