A social inequality icon in São Paulo, Brazil's biggest city: The Paraisópolis Favela and the luxury buildings

Wealth Inequality is a Vital Public Health Issue

Every day, 10,000 people die because of a lack of health care. Yes, every day. That’s over 3.5 million people annually. This shocking statistic comes from a report released last month by Oxfam.

The primary topic of Oxfam’s report was not global mortality rates or health coverage. Rather it was about global wealth and income inequality. Oxfam’s title for the press release containing this information was “Billionaire fortunes grew by $2.5 billion a day last year as poorest saw their wealth fall.” Read More

The Problem With Doctors Communicating via Robot is Attitudes About Technology, Not Poorly Communicating Doctors

By Evan Selinger and Arthur Caplan

Perhaps you’ve seen the debate? A physician used video chat technology to inform a hospitalized Ernest Quintana and his family that he would be dying sooner than they expected. After he passed away, they objected to how the news was delivered. Over at Slate, Joel Zivot an anesthesiologist and ICU physician, responded to the uproar with an essay titled, “In Defense of Telling Patients They’re Dying Via Robot.” Read More

Protesters hold up signs that read "everyone deserves healthcare"

The Future of Health Care? How States are Trailblazing Medicaid Buy-In Programs

States can be laboratories of health reform.

Massachusetts and Oregon expanded insurance coverage during previous periods of federal inaction, and with solutions unlikely to come from a politically divided Washington D.C., how will states tackle the problem of health insurance becoming increasingly unaffordable and unattainable for many families?

Is there a role for the government to play a greater role in making health insurance affordable and accessible? As public support for action on health care grows, what options are available to states now?

I spoke to former Petrie-Flom Student Fellow and Medicaid policy scholar Emma Sandoe about states that have begun to explore Medicaid Buy-In policies, which allow people to purchase government backed health insurance or Medicaid-like plans. Read More

ONC’s Proposed Rule is a Breakthrough in Patient Empowerment

By Adrian Gropper

Imagine solving wicked problems of patient matching, consent, and a patient-centered longitudinal health record while also enabling a world of new healthcare services for patients and physicians to use. The long-awaited Notice of Proposed Rulemaking (NPRM) on information blocking from the Office of the National Coordinator for Health Information Technology (ONC) promises nothing less. 

Having data automatically follow the patient is a laudable goal but difficult for reasons of privacy, security, and institutional workflow. The privacy issues are clear if you use surveillance as the mechanism to follow the patient. Do patients know they’re under surveillance? By whom? Is there one surveillance agency or are there dozens in real-world practice? Can a patient choose who does the surveillance and which health encounters, including behavioral health, social relationships, location, and finance are excluded from the surveillance? Read More

Healthcare Already Taking Center Stage in 2020 Democratic Primary Race

With Massachusetts senator Elizabeth Warren (D-MA) announcing that she was forming a Presidential exploratory committee, I suppose that means the 2020 Democratic Primary is off to the races. Joining her are some lower profile candidates, including John Delaney (former MD congressman), Richard Ojeda (WV state senator and former congressional candidate), Tulsi Gabbard (HI congresswoman), Julian Castro (former secretary of HUD). And within the last week, senators Kirsten Gillibrand (D-NY) and Kamala Harris (D-CA) put their hats in the ring.

While many issues are likely to play prominent roles in this campaign — immigration, taxes, inequality, housing, universal pre-k, college affordability, environment/climate change — healthcare is likely to play an outsized role after Democrats found it to be a winning issue in 2018.  Read More

A protester holds a sign with a quote that reads: "Pf all the forms of inequality injustice in health care is the most shocking and inhumane."

We Shouldn’t Be Focusing on Whether Healthcare Is a Right

The call for “Medicare for All” has grown louder and its cadence more frequent. Even President Obama has expressed support for it. Increasingly, as policymakers and stakeholders debate the path forward for healthcare in the U.S., a familiar invocation of human rights language can be heard.

The sentiment that “healthcare is a right” — rather, that it should be a right — has many layers. Its complexity is more accurately captured as “health(care) is a (human) right”. These parens make my head spin, too. They also suggest that Medicare for All is at best a piecemeal solution to the causes of poor health in the U.S. Read More

millennial man at home sick with scarf and thermometer talking on the phone

The Millennial Need for Speed in Healthcare

According to a recent Kaiser Family Foundation (KFF) poll, shockingly large swaths of Americans have reported that they don’t have a primary care provider.

The July 2018 report found that 45 percent of 18-29 year olds, as well as 28 and 18 percent of 30-49 and 50-64 year olds, respectively, also lack designated primary care.

Kaiser Health News (KHN) explained that the price transparency, convenience, and speed of alternatives to office-based primary care physician (PCP) visits appear to be some of the preferences driving these patterns. Retail clinics, urgent care centers, and telemedicine websites satisfy many of these preferences, and are therefore appealing alternatives to scheduled appointments with a PCP. For example, extended hours and shorter wait times at increasingly widespread retail clinics have attracted young patients who want to avoid the hassle and wait times involved in scheduling and attending a traditional doctors office.

A 2015 PNC Healthcare survey similarly found that millennials saw their PCP significantly less (61 percent) than baby boomers and seniors (80 and 85 percent, respectively). The study emphasized the effects of technology on millennials’ trends in healthcare acquisition, such as higher utilization of online reviews to shop for doctors (such as Yelp). It also found that millennials are much more likely to prefer retail and acute care clinics, and are more likely to postpone treatment due to high costs than older generations.

Read More

Short-Term Limited Duration Insurance Can Now Be Less Short-Term

Short-term, limited-duration insurance was designed as a temporary gap-filler while a person transitions from one kind of health insurance to a different plan or coverage. In 2016, recognizing its serious limitations, an Obama Administration rule mandated that coverage of short-term, limited-duration insurance be limited to three months, including any period of renewal.

But due to a final rule in August 2018 from the Trump Administration, short-term, limited-duration insurance coverage contracts can now last as long as one day short of a year, and can last as long as three years with renewals or extensions. The Trump Administration explained in its final rule that it selected this standard to promote access to choices of health coverage and to individual health insurance coverage. The rule also acknowledged this kind of insurance may not be the most appropriate or affordable for everyone. As of Tuesday, October 2, insurers can sell these “skimpy” plans for the extended duration.

Read More

image showing a line of voting booths, with legs showing

Medicaid Expansion Goes to the Polls

With the 2018 midterm elections fast approaching, there are key some voter propositions with important health implications.

Most notably, this November, voters in three conservative states — Idaho (Proposition 2), Utah (Proposition 3), and Nebraska (Initiative 427) — will be deciding on whether to expand Medicaid. In addition, voters in Montana will decide whether to permanently extend their state’s Medicaid expansion. This is coming at the heels of the closely watched November 2017 referendum where Mainers decisively supported Medicaid expansion 59 percent  to 41 percent.

Read More

The cost of drug monopolies in the United States

By James Love

The United States, like other countries, uses the grant of legal monopolies as the incentive to reward successful R&D investments. The legal mechanisms are varied, and include most importantly patents on medical inventions, but also a variety of regulatory exclusivities in a patchwork of programs that address (for example) delays in regulatory approval, testing for pediatric patients, development of treatments for rare diseases, rights in test data used to provide new drugs and vaccines, and the development of new antibiotic drugs.

Each of these legal mechanisms that are used to block competition can be evaluated separately, but it is also useful to look at the big picture, and ask – what is the cost of the drug monopolies in the United States?

Read More