Our Health Policy Matters

I wrote a column in January entitled A Dime’s Worth of Difference in 2012 . The central premise of the column was that this year’s health policy debate would fall short of what we needed.  It would instead resonate with the words “Obamacare,” “Romneycare,” “government takeover,” and “individual mandate.”  That is exactly what we got – and then some. But we needed something more. We needed an honest debate about: the future of Medicare for our elders; the importance of Medicaid to people with chronic conditions; the growing mental health needs of our population – including our returning veterans; the essential role of public health in our lives, no matter what our socioeconomic status; the fact that health and social assistance providers are the real job creators in our 21 st century economy, and must play a key role in our recovery from recession. What we experienced instead was a tsunami of concern for our more selfish instincts – that we should

When Senator George McGovern, who died this past weekend, decided to run for President, he did so as a World War II hero who opposed the Vietnam War.  A respected South Dakota senator, he helped galvanize anti-war sentiment among young people and ride it to the Democratic Party’s nomination in the summer of 1972. His election prospects that year were as remote as Senator Goldwater’s had been just eight years earlier.  From opposite ends of the philosophical spectrum, there was much to admire about both of them.  But they were also both too removed from the center of the political spectrum to be electable in the moderate America of those times. As a vocal McGovern supporter back in 1972, I have long wondered how he felt about the one thing I admired least about his political career – the moment when he let fear about mental illness alter the course of our public policy history. There is an excellent and recent brief story about this on the National Public Radio websi

Former U.S. Congressman Patrick Kennedy was in South Florida last week pushing the radical idea that all people, including those with mental illness, are created equal. What makes this idea radical in 2012 is that we continue to discriminate against the 6% of Americans who have serious mental illnesses.  Patrick Kennedy understands this, and is devoting his life after Congress to fighting on their behalf. It is a fight that affects him personally, as it does the one-fifth of all children and the one-fourth of all adults with a diagnosable mental illness each year. Discrimination against people with mental illness takes on many forms – arrests for loitering, incarceration instead of treatment, and perhaps most commonly in the unequal coverage by insurers for mental health conditions. This last form of discrimination was supposed to have ended with the passage of the Mental Health Parity and Addiction Equity Act of 2008.  But the federal “rule” implementing this law h

If you care about Medicare, then who lost last week’s Presidential debate?  Perhaps we all did. That’s because both candidates favored some cuts in the Medicare program.  And cuts translate into a real impact on real people. But no cuts could mean something even worse - unsustainable levels of spending in the Medicare program. The question is what’s the lesser evil – a cut in payments to providers or a cut in benefits to individuals?  That’s the choice President Obama and Governor Romney gave us. President Obama favored cuts in payments to providers.  Governor Romney favored cuts in benefits to individuals.  The difference in their positions became clear as Romney pressed his point about the $716 billion in “cuts” that Obama supported in the Affordable Care Act. The “cuts” Obama favored actually fell into two categories that are built into the law – provider rate reductions and cuts to private insurers offering Medicare Advantage plans.  The provider rate redu

There was a fascinating news report out of Arizona this past week that embracing the ACA Medicaid expansion will result in $8 billion in new federal dollars flowing into the state over four years – in return for an investment of $1.5 billion from the state. That looks pretty good on the surface, and the 435,000 people who will become insured as a result are a nice bonus. What many people don’t recall is that Arizona was the last state to enroll in the Medicaid program.  So a report such as this from a state whose embrace of Medicaid was a long time coming is especially noteworthy. After seeing numbers like that, I can’t help but wonder what might happen if the state decides not to expand Medicaid.  Its residents could lose a lot of money in return. This is what Florida is facing. We can calculate just how much money every resident of Florida will lose by reviewing what Florida Attorney General Pam Bondi wrote to the Supreme Court this past January: Florida

Here is a question I’d love to see candidates answer before the election. Source: NY Times Does the continuing activity around the implementation of the Affordable Care Act signal the collapse of American capitalism – at least as it pertains to health and health care? The myth of American capitalism is so powerful that I imagine they won’t touch this one with a ten foot pole – or even a ten-foot long poll!  In the politics of our $2.6 trillion healthcare economy, however, capitalism takes a back seat. The recent activities of the Connecticut health exchange board explain why capitalism in health care is about as relevant as a Democratic voter in Utah.  Connecticut is one of the dozen or so states embracing ACA, and is making an impressive effort to implement its health insurance exchange on time in 2014.  By contrast, more than half the states have yet to even declare their intentions, even though the deadline for doing so is mid-November. According to a recen