Health Care Affordability: Iron Triangle Or Iron Curtain?

“The high cost of health insurance and health care services now affects not only the uninsured but also middle-class Americans with employment-based health insurance (ESI), enrollees in the Affordable Care Act exchanges, and Medicare beneficiaries. A popular concept in health policy discussions is the “iron triangle”: here, here, here, here, and here. These authors posit that it is impossible to increase access and quality of care while simultaneously reducing spending. That idea warrants further scrutiny. [..] evidence suggests that failure to improve affordability is primarily due not to a mathematical “iron triangle” constraint, but an “iron curtain” of stakeholders who are aware of promising alternatives but oppose their … Read More

Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake

“The perpetual diet wars between factions promoting low-carbohydrate, keto, paleo, high-protein, low-fat, plant-based, vegan, and a seemingly endless list of other diets have led to substantial public confusion and mistrust in nutrition science. While debate rages about the relative merits and demerits of various so-called healthy diets, less attention is paid to the fact that otherwise diverse diet recommendations often share a common piece of advice: avoid ultra-processed foods. [..] The rise in obesity and type 2 diabetes prevalence occurred in parallel with an increasingly industrialized food system characterized by large-scale production of high-yield, inexpensive, agricultural “inputs” (primarily corn, soy, … Read More

The New Hospital at Home Movement: Opportunity or Threat for Patient Care?

Select Key Findings Policy Issues Debating the Future: Does H@H Save Costs and Improve Patient Care? “[..] Recent studies of cost savings from H@H programs range from 20 percent (Reese 2021) to 40 percent (Brigham and Women’s Hospital in Boston, Levine et al. 2020). But these findings are not generalizable as they are based entirely on single case studies of highly structured programs involving small samples of very carefully selected patients. For example, the study of Brigham and Women’s program examined 91 adults who were admitted to the hospital’s ED and randomly assigned to the hospital vs home for treatment. [..] While … Read More

Can Employer-sponsored Insurance Be Saved? A Review of Policy Options: Price Regulation

“[..] spending on hospital care makes up the largest single component of personal health care spending, an estimated 39 percent of the total in 2023, compared to 24 percent for physician and clinical services and 10 percent for prescription drugs. National spending on hospital care is projected to exceed $1.5 trillion in 2023, and is expected to grow by about 5.6 percent per year over the coming decade (a rate likely to significantly exceed general inflation). Much of this growth is driven by consolidation among hospitals and health systems, which then use their size and local market power to demand … Read More

Risk Adjustment And Promoting Health Equity In Population-Based Payment: Concepts And Evidence

“[Introduction] [..] population-based payment models, as in the Medicare Shared Savings Program or Medicare Advantage (MA) program, can facilitate the resource reallocations necessary to address health care disparities. Risk adjustment is the mechanism by which payment is allocated in these models. Traditionally, risk adjustment has been conceived and executed purely as a predictive exercise. Regression is used to predict total annual per person spending as a function of demographic and clinical characteristics. A person’s predicted spending is converted to a risk score, which is applied to a base regional rate to determine the prospective payment or benchmark for that person. … Read More

Corporate Investors in Primary Care — Profits, Progress, and Pitfalls

“driven by an increasing focus on “total-cost value-based care” — a model in which health care providers are paid to manage the total cost of care for their patients and the size of each patient’s capitated budget may be increased on the basis of the patient’s health risks and the provider’s performance on quality metrics. Though potentially beneficial for certain well-insured patients, the trend of corporate investment in primary care could threaten equitable access to care, raise health care costs, and reduce physicians’ clinical autonomy. [..] As Medicare and commercial payers move toward total-cost value-based payments, such as capitation, and … Read More

Society of Family Planning interim clinical recommendations: Self-managed abortion

“While the medical risks of SMA [self-managed] may be few, the legal risks for people attempting SMA may be significant. Although only three states currently have laws explicitly criminalizing SMA, almost half of U.S. states have at least one law in place that could be used to prosecute people attempting or assisting with SMA. These policies include legislation explicitly banning SMA, criminalizing harm to the fetus, and criminalizing abortion. For those who have been targeted with criminalization for SMA, many came into contact with law enforcement following interactions with healthcare professionals. However, to date, legal experts are unaware of any … Read More

KHN’s ‘What the Health?’: A Conversation with Peter Lee on What’s Next for the ACA

“[Kaiser Health News chief Washington correspondent Julie Rovner:] So Covered California operates very differently from most of the other state-based marketplaces. And, as a result, it has done a better job covering more people at lower premiums than I think any other state, right? [Executive Director of Covered California, the largest state-run ACA marketplace, Peter Lee:] Absolutely. Well, lower premiums relative to where we start. California’s an expensive state, but our premiums in California in the last seven years went up about 45%. Nationally, they went up about 80%. So we’ve seen premiums increase dramatically. But you’re right, we’ve done … Read More

Don’t Look Up? Medicare Advantage’s Trajectory And the Future of Medicare

“short of comprehensive reform by Congress, CMS may find it challenging to build value in Medicare over this decade if TM’s [traditional Medicare] scaffolding erodes [due to the rise of Medicare Advantage (MA)]. Much can be done under CMS’s existing authorities to promote efficiency and equity, but, under Medicare’s present configuration, that requires preservation of TM. Without substantive legislative reform on the horizon, regulatory policy will thus need to keep the long view in mind, lest several years of inertia set in motion an unalterable course to a lesser outcome. [..] MA has been clearly successful in managing utilization more … Read More

How Did This Many Deaths Become Normal?

“The United States reported more deaths from COVID-19 last Friday than deaths from Hurricane Katrina, more on any two recent weekdays than deaths during the 9/11 terrorist attacks, more last month than deaths from flu in a bad season, and more in two years than deaths from HIV during the four decades of the AIDS epidemic. At least 953,000 Americans have died from COVID, and the true toll is likely even higher because many deaths went uncounted. COVID is now the third leading cause of death in the U.S., after only heart disease and cancer, which are both catchall terms … Read More