We are happy to announce that the authors of Primary Care Breakfast Club published a perspective piece in the New England Journal of Medicine on September 6, 2012. Our piece, titled "The Developing Vision of Primary Care", has received a lot of feedback from all sides. If you are interested in continuing the conversation, feel free to leave a comment.
To read the piece, visit the following link: http://www.nejm.org/doi/full/10.1056/NEJMp1204487
We hope you enjoy and would love to hear your feedback!
Showing posts with label ACA. Show all posts
Showing posts with label ACA. Show all posts
Saturday, October 27, 2012
Monday, March 26, 2012
Supreme Court to Start Hearings on Health Reform Today
Today, the Supreme Court will begin hearings regarding the constitutionality of parts of the Affordable Care Act (ACA). The Supreme Court will hear six hours of oral arguments over the course of the next few days looking at three issues. First, they are looking at the legality of the individual mandate. Second, they will decide if this part of the law can be severed from the rest of the ACA. And three, they will hear about the constitutionality of Medicaid expansion.
Titles I and II of the ACA will reduce the number of uninsured citizens in our country through two mechanisms: required insurance by everyone and by expanding Medicaid.
Title I is the divisive individual mandate whereas every person in this country is required by law to purchase health insurance or else they face a fine. This is similar to car insurance requirements. The individual mandate, which is historically a Republican policy idea, has been controversial since the bill was passed. Economist argue that by requiring everyone to buy insurance this will broaden the risk pool thereby protecting us all financially. Additionally, by requiring health insurance, it will reduce moral hazard such that people will not seek out coverage only when they are sick or injured.
Title II expands Medicaid to cover everyone who is under 133% of the federal poverty line. It is estimated that the Medicaid expansion will result in half of the newly insured 32 million Americans.
An important aspect of the Supreme Court hearings is whether or not the ACA can stand without Titles I and/or Title II. The ACA has already benefited millions of Americans. Young adults, who make up the second largest group of uninsured Americans, are already covered. Women's health insurance premiums have been reduced equal to their male counterparts. Provisions regarding prescription drug coverage have already saved our elderly population $32 billion. Children and adults are no longer denied coverage because they have a pre-existing condition. And most importantly, as a country we have come together to reach out to our most vulnerable populations.
The hearings this week and the subsequent ruling, which is expected to come out later this spring, will be historic and will significantly impact the lives of all Americans. For the sake of our country's health and economy, I hope to see the legislation held up.
Wednesday, February 1, 2012
Public vs. Market
I am taking a class at Harvard School of Public Health this term called "Health Care Issues: Public vs. Market." It is a cumbersome title, but defines the topic and scope of the course well. Essentially it applies the debate between free markets and government intervention to the Affordable Care Act (ACA). Our first policy memo (which kind of blends into an essay in my case) was about our personal thoughts on the public vs. market debate. Are there times when government intervention in health care is necessary and if so, when and how? I offer up a few suggestions.
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We are at a significant turning point in the history of healthcare in this country. With the passage of the Affordable Care Act (ACA)in 2010 and the upcoming elections in November 2012 the debate about marketsand government in health care is intense. In this memo I will explain thebenefits of competitive markets and then explain why the health care market differs. I will finish with a discussion of the ACA and how it addresses theseissues.
Competitive markets have been the foundation of an Americaneconomy that is the largest in the world. Competition for profit spursinnovation, contains prices, and gives the consumer choice. Innovationresults when companies consistently push the envelope with new technologies,products, and production processes in an effort to expand their market share andmaximize profits. Competition alsoworks to keep prices for consumers low. Companies search for new, moreeconomical methods of production and reduce inefficiencies in their businessmodels. Southwest Airlines, for example, has repeatedly reduced operatingcosts by eliminating “frills” and shortening turnaround time between flights inorder to keep their prices competitive. Lastly, markets give the consumerchoice. In truly competitive markets, many businesses provide the same orslightly variable products from which the consumer can choose.
Health care differs from perfect markets in several ways, however. First, many view health care as a human right and believe access tohealth care should not be based on employment status or ability to pay. Second, health care is an unpredictable need and often catastrophicallyexpensive. An insurance market is a viable solution. The twoclassic problems in the health insurance market, however, are moral hazard andadverse selection. Moral hazard is the principle that after obtaininginsurance, patients will seek care they do not need, because it is free at the“point of sale.” Adverse selectionis the principle that patients know more about their state of health thaninsurance companies and therefore will buy insurance only when they need it. This leads to the third pitfall of a competitive health care market. Competitive markets assume perfectinformation. The informationasymmetry in health care is undeniable and unavoidable, both between insurancecompanies and patients (adverse selection) and between patients and theirproviders. Patients often do not know their medical needs and rely on theprovider (i.e. physician, hospital, etc) for advice, often in times ofemergency and stress. These issuescannot be addressed in a competitive market for health care and thus requiregovernment intervention.
The ACA contains solutions to many of these challenges that makesense. First, the ACA provides access for an estimated 32 of the 50million people in the US for whom the current system was failing, increasing equityin a way the market cannot. Previously, affordable health insurance was availableonly through Medicare, Medicaid, and employer-sponsored insurance, incentivizedthrough tax subsidies to companies who provide insurance for their employees. Second, companies were not mandated toprovide insurance to employees, nor individuals to carry it. This created equity and adverseselection issues, especially for the individual market. The ACA now implements a mandate with subsidiesfor persons unable to afford to buy insurance on their own. Third, the ACA places an emphasis onquality and transparency. Regulatingquality measures gives consumers more information and power to make rationaldecisions about where they will seek care. The insurance exchanges promote transparency whenindividuals are choosing a coverage plan. These are important interventions to improve information symmetry.
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MEMORANDUM
To: Speaker of the House
From: Jason Kroening-Roche
Re: Public vs. Market in Health Care Reform
Date: January 30, 2012
To: Speaker of the House
From: Jason Kroening-Roche
Re: Public vs. Market in Health Care Reform
Date: January 30, 2012
We are at a significant turning point in the history of healthcare in this country. With the passage of the Affordable Care Act (ACA)in 2010 and the upcoming elections in November 2012 the debate about marketsand government in health care is intense. In this memo I will explain thebenefits of competitive markets and then explain why the health care market differs. I will finish with a discussion of the ACA and how it addresses theseissues.
Competitive markets have been the foundation of an Americaneconomy that is the largest in the world. Competition for profit spursinnovation, contains prices, and gives the consumer choice. Innovationresults when companies consistently push the envelope with new technologies,products, and production processes in an effort to expand their market share andmaximize profits. Competition alsoworks to keep prices for consumers low. Companies search for new, moreeconomical methods of production and reduce inefficiencies in their businessmodels. Southwest Airlines, for example, has repeatedly reduced operatingcosts by eliminating “frills” and shortening turnaround time between flights inorder to keep their prices competitive. Lastly, markets give the consumerchoice. In truly competitive markets, many businesses provide the same orslightly variable products from which the consumer can choose.
Health care differs from perfect markets in several ways, however. First, many view health care as a human right and believe access tohealth care should not be based on employment status or ability to pay. Second, health care is an unpredictable need and often catastrophicallyexpensive. An insurance market is a viable solution. The twoclassic problems in the health insurance market, however, are moral hazard andadverse selection. Moral hazard is the principle that after obtaininginsurance, patients will seek care they do not need, because it is free at the“point of sale.” Adverse selectionis the principle that patients know more about their state of health thaninsurance companies and therefore will buy insurance only when they need it. This leads to the third pitfall of a competitive health care market. Competitive markets assume perfectinformation. The informationasymmetry in health care is undeniable and unavoidable, both between insurancecompanies and patients (adverse selection) and between patients and theirproviders. Patients often do not know their medical needs and rely on theprovider (i.e. physician, hospital, etc) for advice, often in times ofemergency and stress. These issuescannot be addressed in a competitive market for health care and thus requiregovernment intervention.
The ACA contains solutions to many of these challenges that makesense. First, the ACA provides access for an estimated 32 of the 50million people in the US for whom the current system was failing, increasing equityin a way the market cannot. Previously, affordable health insurance was availableonly through Medicare, Medicaid, and employer-sponsored insurance, incentivizedthrough tax subsidies to companies who provide insurance for their employees. Second, companies were not mandated toprovide insurance to employees, nor individuals to carry it. This created equity and adverseselection issues, especially for the individual market. The ACA now implements a mandate with subsidiesfor persons unable to afford to buy insurance on their own. Third, the ACA places an emphasis onquality and transparency. Regulatingquality measures gives consumers more information and power to make rationaldecisions about where they will seek care. The insurance exchanges promote transparency whenindividuals are choosing a coverage plan. These are important interventions to improve information symmetry.
Inconclusion, markets have been extremely successful in this country. However, the health care market needsgovernment intervention to correct market failures and there are many models toachieve this. Working within thecurrent system, however, the ACA does a good job ensuring greater access andequity, mitigating adverse selection, and protecting consumers from informationasymmetry. I recommend it for yoursupport.
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