Tom Miller of the American Enterprise Institute is engaging a conversation about rechanneling health policy to focus on better health.
“U.S. health policy was (and remains) pathological: We are neurotic, and we insist on making government psychotic,” he writes in “Doing Better, Still Feeling Worse.”
Health spending is astronomically high yet Americans’ longevity is declining. We spend more but get worse outcomes.
Tom focuses on a 50-year-old study by political scientist Aaron Wildavsky who found that the health system’s clinical care affects only about 10% of the usual measures of health—mortality, morbidity, functionality, longevity. The number is only slightly higher today, according to recent studies.
Many of the most important factors in our health—nutrition, lifestyle, genetics, social conditions, income—are mostly outside the medical profession’s tools.
We can’t just keep pouring more money into our health sector and expect different outcomes.
Here is a link to the event that Tom hosted at AEI on Wednesday with a very enlightening conversation about the data and suggested solutions. It’s worth your time. “Are We Looking for Health Care Competition in All the Wrong Places?”
Bob Graboyes has been writing in Substack about this issue as well: “When Healthcare Spending Isn’t about Healthcare: And why price controls and insurance overhaul may not make much difference.”
He concludes: “Perhaps reforms would best be aimed at improving the quality of care and finding more efficient ways of treating patients. That might not reduce spending, but it just might make us healthier and happier.”
Health policy guru and Wharton professor emeritus Mark Pauly and colleagues argue that there is a market solution to the problems of high-cost care. Their Health Affairs paper focuses on the remarkable CAR T cell therapy cures that reprogram a patient’s own genes.
“The genetic treatments we looked at seemed to be cost effective even at very high prices because they avoided so much future bad health with a one-time treatment,” Mark explains. “Our paper says that private insurance can handle this by doing what it does best—converting an enormous cost for a few treated patients into a small increase in premium for many people at risk.”
This also is worth your time: “Is employment group insurance financing of expensive gene therapies threatened in the United States?”
And in a welcome surprise, Bob Moffit of Heritage alerted us that the famous center-left economist Alain Enthoven of Stanford gave a glowing review to Medicare Modernization: Harnessing the Power of Consumer Choice and Market Competition.
“This book, with chapters by leading authorities, explains how and why a new model, based on informed cost-conscious consumer choice among competing private health plans is the most promising — indeed the only practical — solution to the problem of soaring health care costs,” Enthoven writes for Health Affairs in “A New Prescription for What Ails Medicare.”
“Put simply, it points to a solution based on getting the incentives right, for consumers to seek and choose care, and providers to deliver value for money.
“Indeed, the importance of this book extends beyond Medicare and points to the kind of health care financing and delivery system that will yield affordability and the best value for money for the American people in general.”
Wow! Enthoven is a highly respected academic in liberal circles. Maybe there is hope for a new generation of health reform after all based upon consumer choice, aligned incentives, and market competition. (Here is my review of the book for Forbes, “Saving Medicare.”)
Americans have more than $100 billion saved in their Health Savings Accounts. Dean Clancy of Americans for Prosperity writes today in The Hill that lower-income people on Obamacare plans should have “the option to redirect their subsidies — commonly referred to as cost-sharing reductions (CSRs) — into an HSA. Currently, CSRs go to the insurance companies. So instead of disappearing into the health care abyss, this proposal would put that money directly into the hands of low-income patients.”
“Let Lower-Income Earners Keep Their Obamacare Cash”
Bill Smith of the Pioneer Institute has a new paper out explaining how protecting patents helps to protect patients. “Pioneer Study: Study Finds Patent Protections Fuel Biopharma Innovation that Helps Patients”
And join Bill for Pioneer’s in-person briefing about his new 340B web tool that allows users to search state legislative districts for 340B pharmacies, hospitals and clinics. Users can also see the levels of charity care spending by individual 340B hospitals for the last decade. This transparency is important to make sure the program is serving the low-income patients it was designed to help.
When: November 7th at noon
Where: 101 Constitution Avenue NW, Washington, D.C., 3rd floor. Lunch will be served. Briefing will also be available via Zoom.
To register: Send a message to wsmith@pioneerinstitute.org
Finally, several of you responded to my newsletter last week about former Speaker Kevin McCarthy, quite strongly disagreeing with my take. I argued that he had set up a refreshingly inclusive policymaking process and had attempted to revert to regular order for appropriations bills.
But one said, “When some is hired to do a job and they purposely ignore their job description, there are consequences and its getting fired.” We can argue about whether a small number of members actually thwarted his ability to do that. But it’s clear that those of you who felt strongly enough to write me back are glad to see him gone.
I can only wonder if the vote had been taken a week later, after the horrors in Israel, if having stability in the American government might have prevailed. We now have a new mess in trying to find a new Speaker.
