Our Health Policy Matters

I celebrate my birthday today.   As I enter my 59 th year on earth, I wonder who, besides my creator, I should thank.   Public health professionals are a good place to start. If I had been born just 50 years sooner, my life expectancy would have been 47 years.   But life expectancy grew by almost 30 years in the 20 th century. In the last ten years, the age-adjusted death rate in the United States has decreased by another 16%.   I can expect to live as many as 20 years longer than my parents did.   source: CDC, 2011 So what’s making the difference? The Centers for Disease Control and Prevention (CDC) has some answers. CDC recently released its top ten public health achievements of the last ten years, and there are some surprising accomplishments on the list. Not a single one got a headline.   In fact, the release of entire list was overshadowed by the media attention given to the humorous hook a CDC blogger used the same week to educate people about preparing for natural d

In my last column, I described Florida’s new Medicaid managed care and previewed a few of its implications. In this column, I look closely at seven problems in the law.   First, Medicaid recipients will be asked to pay $10 per month to participate in the program, and $100 for each non-emergency use of a hospital emergency room.   This will increase Medicaid costs, not lower them.   Charging even $10 a month for Medicaid encourages people to avoid enrolling in the program until they get sick. What they don’t get is preventive care, so their care costs more.   Half of all emergency room visits are “non-emergency,” but the patient doesn’t know this until after he or she gets the diagnosis.   For example, chest pain is sometimes indigestion, but other times, a heart attack. You don’t want someone who might be having a health crisis to delay receiving care because they don’t have $100.   If they do and guess wrong, their care will only cost the state more. Second, Medicaid recipients

Florida’s Medicaid reform law, which takes effect on July 1, mandates the enrollment of most of Florida’s 3 million Medicaid recipients into managed care programs.   It has been called transformational, but it probably won’t deliver on its promise. There is a lot to write about, so I’m devoting two columns to the subject – and publishing them both this week, instead of one this week and one next week.   This column focuses on the details of the new program.   It explains how first year cost savings are unrelated to managed care, why families of nursing home residents in particular should be worried, and how a new profit motive has been built into the Medicaid program.   My next column will focus on seven policy problems built into the new law.     While managed care got the headline, the first-year savings in the legislation come from a 5% provider rate cut, not from managed care.   Medicaid will still be a $20 billion+ program.   It will still consume nearly a third of the state

There were more than a few sighs of relief when Florida House and Senate members came to an agreement on health and human budgets this week. There was also some welcome news.   But not everyone is happy, and there will still be plenty of pain to go around.   People like me won’t feel it, but millions of others will. First, let’s get to the good news.   After weeks of uncertainty, funding for adult mental health services will not be eliminated or cut.   Senate and House leaders, led by Rep. Denise Grimsley, came to the conclusion that asking people with mental illness to shoulder this much more pain this year was just too much.   This is a tremendous relief to everyone affected by mental illness.   Though we may not be able to quantify “things that don’t happen,” we know that legislators saved many people from harm, and prevented scores of crises down the road. The Medicaid “medically needy” and “aged and disabled” programs in Florida also remain intact.   If they had been eliminated, o