Our Health Policy Matters

There's a simple reason why (after more than a decade) Donald Trump and the Republicans have no plan to replace Obamacare. I'll explain in a few minutes. But first, some background. When the Affordable Care Act (or Obamacare) was passed in 2010, it was an effort to expand health care coverage to a lot of people who needed it, while controlling their costs. It had certain key provisions, not the least of which were that people couldn't be denied coverage for pre-existing conditions, that all chronic diseases needed to be covered fairly, and lifetime coverage caps had to be lifted. The problem was that if you left matters to insurers to set insurance premiums based on what this would cost, the price of insurance would rise dramatically. So the government took a look at three different programs and ultimately put them together into one system. For people whose income was so low that they couldn't afford any real cost-sharing, the government expanded Medicaid. For elders...

I started writing Our Health Policy Matters three and a half years ago, right after the 2010 mid-term elections. Since then, I have written about two policy areas about which I am passionate – public health and mental health.  As I explain below, I am about to change my professional focus.  And while I will be speaking about one more than the other in the future, for me these two areas are related. Let me explain why. Mental health and public health are first and foremost about wellness.  They are about identifying risk factors for disease and eliminating or mitigating them. Many of the same environmental risk factors contribute to poor health, especially poor mental health.  These include poverty, violence, abuse, and neglect.  When we address or mitigate these risk factors, we improve our nation’s health and mental health together. We often place the burden of responsibility for maintaining one’s health squarely on the shoulders of individ...

I started writing Our Health Policy Matters three and a half years ago, right after the 2010 mid-term elections. Since then, I have written about two policy areas about which I am passionate – public health and mental health.  As I explain below, I am about to change my professional focus.  And while I will be speaking about one more than the other in the future, for me these two areas are related. Let me explain why. Mental health and public health are first and foremost about wellness.  They are about identifying risk factors for disease and eliminating or mitigating them. Many of the same environmental risk factors contribute to poor health, especially poor mental health.  These include poverty, violence, abuse, and neglect.  When we address or mitigate these risk factors, we improve our nation’s health and mental health together. We often place the burden of responsibility for maintaining one’s health squarely on the shoulders of individ...

I never ate yogurt, avocadoes, or tofu until I was in my twenties.  When I first went to the dentist as an eight year old, I had twelve cavities.  And the Connecticut River smelled like raw sewage when I was a kid – because it was filled with raw sewage. This is Public Health Week; the theme is “return on investment.”  The good news – spending on public health  (as a percentage of all health spending) has doubled in the last fifty years.  The bad news, this is still less than 3 percent of our national health budget. Despite that meager investment, the return has been big.  Here are my top ten public health initiatives ever – or at least in my lifetime. 10. From Twinkies to Tofu.  Nutrition education has come a long way in the last fifty years. Twinkies, snowballs, chocolate cupcakes, and sugary cereals “fortified” with vitamins were staples of my youth.  We knew so little about nutrition in those days.  I never ate yogurt....

I never ate yogurt, avocadoes, or tofu until I was in my twenties.  When I first went to the dentist as an eight year old, I had twelve cavities.  And the Connecticut River smelled like raw sewage when I was a kid – because it was filled with raw sewage. This is Public Health Week; the theme is “return on investment.”  The good news – spending on public health  (as a percentage of all health spending) has doubled in the last fifty years.  The bad news, this is still less than 3 percent of our national health budget. Despite that meager investment, the return has been big.  Here are my top ten public health initiatives ever – or at least in my lifetime. 10. From Twinkies to Tofu.  Nutrition education has come a long way in the last fifty years. Twinkies, snowballs, chocolate cupcakes, and sugary cereals “fortified” with vitamins were staples of my youth.  We knew so little about nutrition in those days.  I never ate yogurt....

“I will keep them from harm and injustice.” “I will prevent disease whenever I can, for prevention is preferable to cure.” - Classic and modern versions of the Hippocratic Oath , from MedicineNet.Com Senator Tom Coburn of Oklahoma is a physician.  He’s familiar with the Hippocratic Oath, and has used it to explain his opposition to health care reform. Last November, Senator Coburn famously termed a $15 billion appropriation for public health and prevention a “slush fund.”  That’s because it was paying for community tobacco control programs, immunization activities, and addiction disorder prevention and treatment services around the country.  For information on sources, see note below “Prevention is about focusing on an individual patient,” he commented, apparently forgetting everything he learned about epidemiology at the University of Oklahoma’s College of Medicine and at least some of the words of the Hippocratic Oath. Public health is the ba...

“I will keep them from harm and injustice.” “I will prevent disease whenever I can, for prevention is preferable to cure.” - Classic and modern versions of the Hippocratic Oath , from MedicineNet.Com Senator Tom Coburn of Oklahoma is a physician.  He’s familiar with the Hippocratic Oath, and has used it to explain his opposition to health care reform. Last November, Senator Coburn famously termed a $15 billion appropriation for public health and prevention a “slush fund.”  That’s because it was paying for community tobacco control programs, immunization activities, and addiction disorder prevention and treatment services around the country.  For information on sources, see note below “Prevention is about focusing on an individual patient,” he commented, apparently forgetting everything he learned about epidemiology at the University of Oklahoma’s College of Medicine and at least some of the words of the Hippocratic Oath. Public health is the ba...

In arguing last week for the “contraception exception,” did Catholic Bishops – whose compassion for human beings is generally second to no one’s – really mean to open the door to those who would deny people access to other needed prevention services? To recap, the Obama Administration announced that birth control had to be a part of employer-based health insurance plans.  Contraception is considered preventive health, and the Affordable Care Act mandates this and many other prevention services be offered free of charge. The Catholic Bishops objected strongly.  They are morally opposed to birth control, and argued that, as an employer, the Church should not be compelled to pay for prevention services it deems immoral. The Obama Administration then announced a compromise.  No religious institution would be required to pay for contraception services in its health insurance plan, but insurers would still have to cover the services for women who wanted them. ...

In arguing last week for the “contraception exception,” did Catholic Bishops – whose compassion for human beings is generally second to no one’s – really mean to open the door to those who would deny people access to other needed prevention services? To recap, the Obama Administration announced that birth control had to be a part of employer-based health insurance plans.  Contraception is considered preventive health, and the Affordable Care Act mandates this and many other prevention services be offered free of charge. The Catholic Bishops objected strongly.  They are morally opposed to birth control, and argued that, as an employer, the Church should not be compelled to pay for prevention services it deems immoral. The Obama Administration then announced a compromise.  No religious institution would be required to pay for contraception services in its health insurance plan, but insurers would still have to cover the services for women who wanted them. ...

With the Iowa caucuses finally behind us, the Presidential campaign of 2012 now begins in earnest, and will dominate our news and lives for the next year.   I predict we will hear words like "Obamacare," “Romneycare,” “government takeover,” and “individual mandate” (usually in sentences following the word “repeal”) until we can’t stand it anymore. If this is to be our fate in the New Year, then perhaps we can take some comfort in knowing that the debate probably won’t make a dime’s worth of difference about where most of us get our health care over the next few years or how we pay for it. This is because the 2010 Affordable Care Act and the individual mandate were not really health reform .   They were efforts to preserve health insurance as we know it, by getting more people who can afford it to purchase private insurance, and more who cannot onto the Medicaid public insurance program. So maybe we should take a minute between caucuses, primaries, and the general...

With the Iowa caucuses finally behind us, the Presidential campaign of 2012 now begins in earnest, and will dominate our news and lives for the next year.   I predict we will hear words like "Obamacare," “Romneycare,” “government takeover,” and “individual mandate” (usually in sentences following the word “repeal”) until we can’t stand it anymore. If this is to be our fate in the New Year, then perhaps we can take some comfort in knowing that the debate probably won’t make a dime’s worth of difference about where most of us get our health care over the next few years or how we pay for it. This is because the 2010 Affordable Care Act and the individual mandate were not really health reform .   They were efforts to preserve health insurance as we know it, by getting more people who can afford it to purchase private insurance, and more who cannot onto the Medicaid public insurance program. So maybe we should take a minute between caucuses, primaries, and the general...

Except for summertime humidity, the Florida and Connecticut “climates” don’t have a lot in common.  For example, Connecticut has one of the best climates for health and health care, while Florida’s is in the bottom half.  On the other hand, Florida has one of the best business tax climates, while Connecticut’s is near the rear. Their political climates are also polar opposites.  Florida’s governor is a Republican, and its Legislature is overwhelmingly Republican.  Connecticut’s governor is a Democrat, and its legislature is overwhelmingly Democratic. And the difference in their policy climates is reflected in the way they handled their 2011 budget crises.  Connecticut raised taxes and cut spending, while Florida just cut spending.  As a result, Connecticut’s budget now balanced.  Florida, meanwhile, extended its crisis by another year.  And its Governor has just proposed cutting $2 billion from health services alone in his proposed...

Except for summertime humidity, the Florida and Connecticut “climates” don’t have a lot in common.  For example, Connecticut has one of the best climates for health and health care, while Florida’s is in the bottom half.  On the other hand, Florida has one of the best business tax climates, while Connecticut’s is near the rear. Their political climates are also polar opposites.  Florida’s governor is a Republican, and its Legislature is overwhelmingly Republican.  Connecticut’s governor is a Democrat, and its legislature is overwhelmingly Democratic. And the difference in their policy climates is reflected in the way they handled their 2011 budget crises.  Connecticut raised taxes and cut spending, while Florida just cut spending.  As a result, Connecticut’s budget now balanced.  Florida, meanwhile, extended its crisis by another year.  And its Governor has just proposed cutting $2 billion from health services alone in his proposed...