Our Health Policy Matters

A single health policy issue will decide who controls Congress after the 2014 election.  Here’s why. You may have noticed the relative dearth of partisanship emanating from Washington over the past couple of months.  Congress approved a budget with little fanfare and passed a debt ceiling increase with no hint of strings attached. There is a reason for this newfound spirit of bipartisanship, and it is not what you think.  Congress isn’t suddenly taking to heart its relentlessly low approval ratings in 2013.  And it hasn’t just become aware of how unproductive it has been. Barring an unforeseen catastrophe like 9/11, Katrina, or Sandy, it’s just that members of Congress already know which issue will swing the upcoming election.  And they are not interested in muddying the waters at this relatively late date.  The Democrats know that they have an advantage in the improving economy, their stand on women’s issues, and their strong support among minorities. T

I was asked recently why I didn’t actively seek out a specialized school setting many years ago in which to educate my son. My son has a serious mental illness, one which first manifested when he was a child.  I’ve written about this before in Health Affairs and will write about it again in a book scheduled for publication later this year. The argument is this.  If you put children with a special condition – such as serious mental illness – into a classroom with other children with the same condition, then you can adjust your educational services to meet the needs of those children all at the same time – and you will get better outcomes. That’s essentially how our health care delivery system has often been built, too.  Through most of the twentieth century, people with mental illnesses were treated in one set of hospitals (usually state hospitals). And people with most physical conditions were treated in a different set of hospitals. I wrote “most” above becau

Obamacare will insure 2 million fewer people in 2014 than previously reported.  That number is in a new report just released by the Congressional Budget Office (CBO). That may come as a surprise to you.  But it isn’t the biggest surprise in the report for me.  I’ll explain why later.  First, let’s review the new numbers. Last May, the CBO estimated that seven million people would sign up for insurance through exchanges this year.  That number is not a surprise – it has been reported widely in the media. It also estimated that nine million previously uninsured people would be enrolled in Medicaid or CHIP.  In other words, a total of 16 million people would obtain coverage this year through Obamacare. But last week, CBO released updated estimates .  It now says that only 6 million will sign up through the exchanges this year, and only 8 million will enroll in Medicaid or CHIP.  Because some of the people who would have signed up are already insured, that means

It is never easy to absorb unpleasant information. And when I was a policymaker, if someone told me that my decisions were going to cost innocent people their lives, then I usually chalked it up either to hyper-sensationalism or hyperbole.  After all, would passing a small increase in a business tax really force an employer to imperil workers by cutting corners on safety?  Would gun registration really leave a homeowner defenseless in the case of a break-in? Would cutting back welfare a few dollars actually result in a choice between eating or heating in the winter? In most instances, it was hard to see the direct connection. But the more I learned about health issues, the more I understood that there really were some decisions that were a matter of life and death.  These were the issues that taught me humility.  These were the issues that taught me that I needed to set aside my political ideology and embrace both theology and hard data whenever they stared me in