Our Health Policy Matters

Last week, I shared four of the top policy stories of the year that told us something about how health policy has been trending over the past decade or more.  This week, I’m offering four more to close out the year that tell us a little about where health policy is going in the future. 4.  Connecticut Employees Choose Health .  Back in the early days of managed care, when HMOs were not yet a four-letter word and they emphasized wellness as much as health care cost containment, they proved to be popular with members.  In August, the State of Connecticut revived the concept, giving its employees the choice of a lower cost health insurance plan that emphasized wellness or their traditional comprehensive plan.  It expected 50% to choose the new wellness plan.  But the state got a big surprise.  When the dust settled in October, 97% had opted for the wellness plan.  This will cost the state much more in the first year, but will also produce more than the $100 million in health care co

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 vi

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 new budget. But for two states wit

If there were an award given for the worst health policy exaggeration of 2011, it might well go to Newt Gingrich, Mitt Romney, Rick Perry, and a chorus of others who call the Affordable Care Act “a government takeover of health care.” They make this charge to capture votes from a constituency that fears what life would be like if we had “socialized medicine.”  The problem with the rhetoric is this.  It isn't true.  If you look at who pays the bill, the United States already has socialized medicine. We just get less for our money than practically anyone else in the world. According new data from the Organisation for Economic Cooperation and Development (OECD) , no other country spends close to what our government alone does on health care.  Right now, the total government share of our annual per capita health care bill is around $6,000, or over 70% of the total .  Norway is next most expensive, but its total per capita bill is $5,352.  The government share is $4

It costs an average of $6,000 per person per year in federal, state, and local taxes to cover the government’s share of our national health care bill. The three levels of government pay about 71%, or roughly $1.8 trillion, of our nation’s annual health expenditures.  It is no wonder that most rational people want policymakers to do more to bring these costs under control. Policy leaders talk all the time about controlling health care expenditures.   This would help. But if we actually want to reduce costs significantly, we have to invest in prevention and public health.  This is a position I’ve pushed in the past.  All it takes to understand why is to recognize that prevention and public health have been responsible for half of our increased life expectancy during the past century while absorbing less than 5% of our overall health spending. This is old health policy news.  So why aren’t policymakers doing more in prevention? The answer may boil down to two word

Some states do a much worse job than others of keeping their residents healthy and providing for high-quality, affordable health care when their residents need it.  People usually live shorter, less healthy lives in these states than they might if they lived elsewhere. In my last column, I described a new States for Your Health ranking, and examined the states that finished near the top. This week, I want to look first at why Florida, ranked first in one of the seven indicators – per capita Medicare spending on non-institution-based services – only finished 30 th overall. Florida’s doesn’t invest enough in public health and prevention.  It is 36 th among the states in the 2011 Kids Count rankings, and 37 th in the 2011 Healthy State rankings.  Children in poor environments for their health are more likely to develop both physical and mental illnesses as they age.  Obesity, cancers, heart diseases, and mental illnesses are all expensive, and can cut decades from life

When the Supreme Court reviews the constitutionality of the Affordable Care Act next year, it will do so against the backdrop of both a national sentiment for government to do more in the area of health and significant inequalities in access to health and health care based solely on the states in which people live.   A new poll released last week by the Robert Wood Johnson Foundation and the Harvard School of Public Health found that 52% of Americans want government to put more resources into health.   Only 41% gave high grades to our health care system, and only 33% gave our public health system high grades. We would all like a more effective health and health care system.  But a better national delivery system would make a much bigger difference in some states than in others. This week, Our Health Policy Matters unveils a new ranking of the states that reflects which states invest most effectively in our health and health care.  It was created by combining

Nearly 2.1 million veterans received mental health care from the Veterans Administration between 2006 and 2010.   According to a Government Accountability Office report released in October , 1.2 million veterans received mental health treatment in 2010 alone. Almost 30% of the 7.2 million veterans who received treatment from the VA received mental health treatment.  So did 38% of Iraq and Afghanistan (“OEF/OIF”) veterans.  Many more probably needed it.  The GAO report shows how pervasive mental illness is among veterans, and how co-occurring mental illnesses overwhelm both veterans and their service delivery system. Younger veterans and reservists are especially affected. We now have over 22 million living American veterans, but only 4 million served during World War II or the Korean War.  Seven million served during the Vietnam War, and almost 6 million are OEF/OIF veterans.  OEF/OIF veterans accounted for 12% of all those receiving VA mental health services in

Obesity is a disease, just like cancer, heart disease, mental illness, and addiction.  That’s the message of experts at a recent  Future of Medicine summit on the subject. And there are missing pieces in the way states with some of the largest concentrations of obese residents, like Florida, Connecticut, Texas, California, New York, and New Jersey, approach the epidemic. As recently as 25 years ago, obesity was uncommon in America .  Most states didn’t even collect data on it, and not a single state reported obesity in more than 15% of its population.  Connecticut and Florida both reported rates under 10%. The CDC map at that link shows what has happened since.  Every state in the country quickly grew bigger.  By 2010, in 12 states, including Connecticut, between 20% and 25% of the population was obese.  In 24 states, including Florida, between 25% and 30% of the population was obese.  In the remaining 12 states, including Texas, over 30% of the population was ob

Herman Cain’s ascendant Presidential campaign brings into focus the limited health policy thinking that has dominated the campaign so far.   Here are our current major health policy challenges: Reversing the trend toward lower investments in the public health and prevention activities that have accounted for half of our increased longevity in the last century;   Assuring fair coverage of the chronic conditions, including mental illness, cardiovascular disease, and cancers, that affect 60% of our population; Giving even the uninsured 16% of our population access to high quality, comprehensive, integrated primary, specialty, and hospital care; and Figuring out how best to pay for all this. Despite the urgency of these challenges, the current health policy debate can be condensed into a four word sound bite – “Repeal Obamacare Individual Mandate.” Here are the specifics of what the candidates have been talking about the past couple of weeks. Mitt Romney