Our Health Policy Matters

Now that the ACA decision is behind us, what’s on the horizon in the world of public health, mental health, and health policy? The truth is that ACA was essentially neutral with respect to prevention and public health.  3% of our nation’s health funding went to these services last year, and 3% will continue to go to these services with or without ACA. That won’t stop the assault on public health.  Federal, state, and local governments have all cut public health services in recent years and, unless we have a public health crisis, may well cut further. And Chief Justice Roberts took a swipe at public health programs in his majority decision, when he wrote on page 22 and 23: “To consider a different example in the health care market, many Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance…. The failure of that group to have a healthy diet increases health care costs, to a grea...

Now that the ACA decision is behind us, what’s on the horizon in the world of public health, mental health, and health policy? The truth is that ACA was essentially neutral with respect to prevention and public health.  3% of our nation’s health funding went to these services last year, and 3% will continue to go to these services with or without ACA. That won’t stop the assault on public health.  Federal, state, and local governments have all cut public health services in recent years and, unless we have a public health crisis, may well cut further. And Chief Justice Roberts took a swipe at public health programs in his majority decision, when he wrote on page 22 and 23: “To consider a different example in the health care market, many Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance…. The failure of that group to have a healthy diet increases health care costs, to a grea...

“States and private markets, not the federal government, hold the key to improving our health care system.” Those are the words of Presidential candidate Mitt Romney, as he articulates his health reform vision on his campaign web site . U.S. health care costs are around $2.5 trillion. This money buys a lot of care, and pays a lot of salaries.  One out of every six workers in America relies on the health care industry for a paycheck.  Romney thinks that’s too big a cost for care. “At its core of this debate,” he writes (jarringly inarticulately for an official campaign web site), “is the question of what creates better patient outcomes and more efficiency: free enterprise and consumer-driven markets, or government management and regulation?” I realize that he wants us to answer “free enterprise and consumer-driven markets.” But in this case, that doesn’t happen to be true. The reasons why we have even a semblance of an affordable health care s...

“States and private markets, not the federal government, hold the key to improving our health care system.” Those are the words of Presidential candidate Mitt Romney, as he articulates his health reform vision on his campaign web site . U.S. health care costs are around $2.5 trillion. This money buys a lot of care, and pays a lot of salaries.  One out of every six workers in America relies on the health care industry for a paycheck.  Romney thinks that’s too big a cost for care. “At its core of this debate,” he writes (jarringly inarticulately for an official campaign web site), “is the question of what creates better patient outcomes and more efficiency: free enterprise and consumer-driven markets, or government management and regulation?” I realize that he wants us to answer “free enterprise and consumer-driven markets.” But in this case, that doesn’t happen to be true. The reasons why we have even a semblance of an affordable health care s...

The recent heavy-handed action by Blue Cross and Blue Shield of Florida (BCBSFL) to terminate and amend all of its contracts with mental health providers brings to light a well-kept national health care financing secret. It is an American myth that we rely on private insurance companies to finance our healthcare delivery system.   America’s privately-financed private health insurance companies pay so small a share of the nation’s healthcare bill today that they could vanish tomorrow and we would barely notice anything but the cheering. Insurance companies have been marginalizing themselves by years of short-sighted actions against both providers and patients. They are well on the way to becoming little more than bundles of administrative costs and profits. And it may already be too late for them to do anything about it.  According to the Centers for Medicare and Medicaid Services (CMS), our total U.S. health care expenditures in 2009 were just under $2.5 trillion...

The recent heavy-handed action by Blue Cross and Blue Shield of Florida (BCBSFL) to terminate and amend all of its contracts with mental health providers brings to light a well-kept national health care financing secret. It is an American myth that we rely on private insurance companies to finance our healthcare delivery system.   America’s privately-financed private health insurance companies pay so small a share of the nation’s healthcare bill today that they could vanish tomorrow and we would barely notice anything but the cheering. Insurance companies have been marginalizing themselves by years of short-sighted actions against both providers and patients. They are well on the way to becoming little more than bundles of administrative costs and profits. And it may already be too late for them to do anything about it.  According to the Centers for Medicare and Medicaid Services (CMS), our total U.S. health care expenditures in 2009 were just under $2.5 trillion...

According to a recent report in Health Affairs , health spending in the United States is projected to rise by 5.8% per year over the next decade. source: CT OPM Rising health care costs are a problem that must be brought under control.  One approach is to do what Florida's doing.  It is forcing state employees into a single HMO, removing all competition from the market while praying that the HMO won't be motivated by making a profit.  Another is to look at what the State of Connecticut is doing. It is betting over $100 million that its employees and retirees will respond to a different kind of “individual mandate” from the one under fire in the Affordable Care Act.   Connecticut has decided to give financial incentives to employees and retirees to manage their health.   It will also penalize financially those who do not.   State workers overwhelmingly voted to accept the new deal earlier this month.   If the plan works, then it may sign...

According to a recent report in Health Affairs , health spending in the United States is projected to rise by 5.8% per year over the next decade. source: CT OPM Rising health care costs are a problem that must be brought under control.  One approach is to do what Florida's doing.  It is forcing state employees into a single HMO, removing all competition from the market while praying that the HMO won't be motivated by making a profit.  Another is to look at what the State of Connecticut is doing. It is betting over $100 million that its employees and retirees will respond to a different kind of “individual mandate” from the one under fire in the Affordable Care Act.   Connecticut has decided to give financial incentives to employees and retirees to manage their health.   It will also penalize financially those who do not.   State workers overwhelmingly voted to accept the new deal earlier this month.   If the plan works, then it may sign...

In a recent column, I wrote about the importance of public health spending in reducing the death rate.   What other public policy strategies also lead to a healthier state? Chart shows positve healthy state rank relationship to health spending, negative to business tax climate.   There are quite a few.   I compared several other state rankings with the most recent state health rankings published earlier this year. These included health care spending per capita, per enrollee Medicaid spending, Medicaid spending for people with disabilities, Medicaid spending on children, and state mental health agency spending.   I also looked at rankings in per capita income, household income, the percentage of people with private health insurance, and business tax climate.   It turns out that a higher state ranking in eight of the nine areas is related to a higher state health ranking.   In only one area – business tax climate – did a higher ranking predict a lower...

In a recent column, I wrote about the importance of public health spending in reducing the death rate.   What other public policy strategies also lead to a healthier state? Chart shows positve healthy state rank relationship to health spending, negative to business tax climate.   There are quite a few.   I compared several other state rankings with the most recent state health rankings published earlier this year. These included health care spending per capita, per enrollee Medicaid spending, Medicaid spending for people with disabilities, Medicaid spending on children, and state mental health agency spending.   I also looked at rankings in per capita income, household income, the percentage of people with private health insurance, and business tax climate.   It turns out that a higher state ranking in eight of the nine areas is related to a higher state health ranking.   In only one area – business tax climate – did a higher ranking predict a lo...