• Reading list

    Temperature, Human Health, and Adaptation: A Review of the Empirical Literature, by Olivier Deschenes  (The National Bureau of Economic Research)

    This paper presents a survey of the empirical literature studying the relationship between health outcomes, temperature, and adaptation to temperature extremes. The objective of the paper is to highlight the many remaining gaps in the empirical literature and to provide guidelines for improving the current Integrated Assessment Model (IAM) literature that seeks to incorporate human health and adaptation in its framework. I begin by presenting the conceptual and methodological issues associated with the measurement of the effect of temperature extremes on health, and the role of adaptation in possibly muting these effects. The main conclusion that emerges from the literature is that despite the wide variety of data sets and settings most studies find that temperature extremes lead to significant reductions in health, generally measured with excess mortality. Regarding the role of adaptation in mitigating the effects of extreme temperature on health, the available knowledge is limited, in part due to the lack of real-world data on measures of adaptation behaviors. Finally, the paper discusses the implications of the currently available evidence for assessments of potential human health impacts of global climate change.

    Early Impact of the Affordable Care Act on Health Insurance Coverage of Young Adults, by Joel C. Cantor, Alan C. Monheit, Derek DeLia and Kristen Lloyd (Health Services Research)

    Research Objective. To evaluate one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA), which permits young adults up to age 26 to enroll as dependents on a parent’s private health plan. Nearly one-in-three young adults lacked coverage before the ACA.

    Study Design, Methods, and Data. Data from the Current Population Survey 2005–2011 are used to estimate linear probability models within a difference-in-differences framework to estimate how the ACA affected coverage of eligible young adults compared to slightly older adults. Multivariate models control for individual characteristics, economic trends, and prior state-dependent coverage laws.

    Principal Findings. This ACA provision led to a rapid and substantial increase in the share of young adults with dependent coverage and a reduction in their uninsured rate in the early months of implementation. Models accounting for prior state dependent expansions suggest greater policy impact in 2010 among young adults who were also eligible under a state law.

    Conclusions and Implications. ACA-dependent coverage expansion represents a rare public policy success in the effort to cover the uninsured. Still, this policy may have later unintended consequences for premiums for alternative forms of coverage and employer-offered rates for young adult workers.

    Slowing Medicare Spending Growth: Reaching for Common Ground, by Michael E. Chernew, Richard G. Frank, and Stephen T. Parente (The American Journal of Managed Care)

    The Overuse of Diagnostic Imaging and the Choosing Wisely Initiative, by Vijay M. Rao and David C. Levin (Annals of Internal Medicine)

    Ethics of Commercial Screening Tests, by Erik A. Wallace, John H. Schumann and Steven E. Weinberger (Annals of Internal Medicine)

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    • I’m sorry but I don’t have access to the full article “Early Impact of the Affordable Care Act on Health Insurance Coverage of Young Adults” but the project findings are self-evident and broaching on hilarious. To call the ACA a “rare public policy success in the effort to cover the uninsured” is ridiculous. In the same vein, if we passed The Affordable iPhone Act and MANDATED that every employer buy their employees and their dependents an iPhone, it would be a guaranteed public policy success ensuring that everyone got the latest and greatest consumer device.

      When the government mandates an employer to do something, it will most likely be a “rare public policy success”. However, is it truly a success story when a private sector player’s liberty is infringed? It’s a tad too Orwellian for me.

      One unintended consequence is going to be that employers are going to start pulling back their subsidization of dependent coverage so that it is unaffordable to their employees to cover their family members. You will also see the creation of multiple coverage tiers (5-10+) so for every dependent you add as an employee, you will pay more for each of them. In most cases, those affected will be individuals disqualified from premium subsidies in the exchange due to their income so ultimately whether they buy coverage for their dependents from their employer or the exchange, they will have less take home pay for discretionary consumption which will be a drag on the economy.

      In a few years, we will be asking ourselves, was the “benign” act of forcing employers to cover dependents to the age of 26 (i.e., the “slacker” mandate) really worth it?

    • One problem with imaging studies is that they have gotten too good. The technical quality has over-run our ability to use that knowledge. Contemporary radiologists can visualize 6 mm mesenteric lymph nodes, 3 mm pulmonary stellate lesions, and small white spots on MRI’s that I don’t think we clinicians know how to evaluate in a beneficial manner. A good example of this problem is DCIS of the breast which has increased in incidence about ten fold in one generation without a corresponding impact on breast cancer incidence or mortality. Can we shut down our 2012 scanners till we learn how to use the information from the 1995 scanners properly?