President-elect Donald Trump is making good on his promise to repeal and replace Obamacare by appointing Tom Price as Secretary of Health and Human Services (HHS) and Seema Verma as administrator for the Centers for Medicare and Medicaid Services (CMS). There is trouble coming.
Under our medical-industrial complex, decisions regarding location of facilities such as emergency departments are frequently based on business considerations of the market rather than on what would be optimal for the community. This NBER paper demonstrates that such decisions can be a matter of life or death. If closure of an emergency department results in more than a ten minute delay in access to the next closest hospital, mortality for an acute myocardial infarction is increased.
Republicans repeatedly voted for repeal of the Affordable Care Act (ACA) knowing that the severe adverse consequences would be prevented by serial vetoes by President Obama. They also filed a lawsuit – House v. Burwell – to prevent the payment of cost-sharing subsidies for exchange plans since the funds were never authorized by Congress. But since, to their surprise, a judge has ruled in favor of the Republicans, they are concerned about being blamed for the ensuing disaster if the judge’s decision were to be upheld.
The Centers for Medicare and Medicaid Services (CMS) has been leading the charge to paying for quality instead of quantity, as if that will be the answer to our concerns about the high cost of health care. This report on CMS’s hospital quality star ratings reveals that the ratings are not only invalid, but they are potentially harmful because of the misinformation disseminated about the hospitals’ quality status.
Quoting Professor Gerald Kominski: “No option should be ruled out quickly because it appears too difficult or politically impossible.”
In designing the Affordable Care Act, special attention was given to be sure that children were well covered by our system of public and private programs. Yet over 20 million children still have access barriers to essential health care services.
The Affordable Care Act (ACA) is now essentially fully implemented. So how are we doing? According to a new Commonwealth Fund study, “adults in the United States remain more likely to go without needed health care because of costs compared to adults in other high-income countries.” Although ACA brought some improvements, they are grossly inadequate by international standards.
May this book become the bible of “our revolution.”
Health care reform is once again on the national political agenda. It is time for action. The suggestions offered should provide guidance on how each of us can become personally involved.
Much of the interview is cloaked in uncertainty since we do not know yet precisely what Donald Trump, working with Congress, will do. But the discussion to date raises great concerns.
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