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Demystifying Medicine One Week at a Time

Game Changer.

Well, 2016 is off and running. Though the markets seem in peril due to China’s economic cooling, the health care arena in the U.S continues to burn like a hot stove.

For one thing, a now-unified Republican Congress passed the 62nd or so attempted repeal of ObamaCare, which the President unsurprisingly vetoed. The new year will likely decide the fate of the Affordable Care Act — and whether it continues its evolution and improvement in providing coverage to more Americans and helping control health care costs, or whether it is substantially rolled back.

Whatever your position on the law, here are some incontestable facts about it:

  • marmotsdhThe law has survived two (2) different Supreme Court challenges.
  • More than 20 million Americans previously without insurance coverage now have it.
  • The percentage of uninsured Americans is the lowest since the government began tracking the statistic in 1972. [Percentages were much higher in the early 1960s before the passage of Medicare and Medicaid in 1965.]
  • Millions more are eligible to gain insurance through the law’s mechanisms, provided those people elect to sign up rather than pay a tax penalty.

But here’s what I find really interesting:

More than just a coverage law, the Affordable Care Act is also a health care delivery law. Parts of the statute are directed at improving how health care is delivered and how our menu(s) of options are developed and prioritized. Fundamentally, it’s reasonable to ask: If the U.S. spends the most in health care (both per capita and in aggregate), and our outcomes are worse than other nations (in measures like life expectancy, infant mortality, etc.), shouldn’t we seriously reconsider how we prioritize our health care spending?

CMS, the federal agency that administers Medicare and Medicaid announced this week its first ever pilot initiative to fund programs addressing social determinants of health: housing, food security, utilities, transportation. [Other key determinants not covered under this pilot are education and employment.]

This is a game changer because it’s the first time the biggest driver of health care services and innovation is directly attempting to address issues that undergird our collective poor health attainment. Rather than just continuing to pour money into “sick care” (i.e. where most of the spending in health care occurs), this initiative provides dollars “upstream” to see if together we can find ways to prevent both major and chronic illnesses.

Couple new initiatives like this with ongoing efforts to reform medical education, and one gets hopeful that we can change health care to become smarter, more compassionate, and achieve better results.

1 Comment

  1. “Millions more are eligible to gain insurance through the law’s mechanisms, provided those people elect to sign up rather than pay a tax penalty.”

    … Everyone has always been “eligible” for health insurance if they sign up for it and pay for it. But now thanks to ACA, they get to pay even more money for worse coverage than they would’ve gotten previously. Or they’re fined (I mean, they pay a “tax penalty”). So… hooray.

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