In general, assume I’ve not read anything on a “Reading List” post. Beginning today, I’ll be clearly indicating which are books. Anything not indicated as such is an article. Also, all summaries and abstracts are taken from the site to which I link. They’re not written by me unless indicated otherwise.
What now? Despite the rancorous, divisive, year-long debate in Washington, many Americans still don’t understand what the historic overhaul of the health care system will—or won’t—mean. In Landmark, the national reporting staff of The Washington Post pierces through the confusion, examining the new law’s likely impact on us all: our families, doctors, hospitals, health care providers, insurers, and other parts of a health care system that has grown to occupy one-sixth of the U.S. economy.
Landmark’s behind-the-scenes narrative reveals how just how close the law came to defeat, as well as the compromises and deals that President Obama and his Democratic majority in Congress made in achieving what has eluded their predecessors for the past seventy-five years: A legislative package that expands and transforms American health care coverage.
For many years, scientists thought that the human brain simply decayed over time and its dying cells led to memory slips, fuzzy logic, negative thinking, and even depression. But new research from neuroscientists and psychologists suggests that, in fact, the brain reorganizes, improves in important functions, and even helps us adopt a more optimistic outlook in middle age. Growth of white matter and brain connectors allow us to recognize patterns faster, make better judgments, and find unique solutions to problems. Scientists call these traits cognitive expertise and they reach their highest levels in middle age.
In her impeccably researched book, science writer Barbara Strauch explores the latest findings that demonstrate, through the use of technology such as brain scans, that the middle-aged brain is more flexible and more capable than previously thought. For the first time, long-term studies show that our view of middle age has been misleading and incomplete. By detailing exactly the normal, healthy brain functions over time, Strauch also explains how its optimal processes can be maintained. Part scientific survey, part how-to guide, The Secret Life of the Grown-Up Brain is a fascinating glimpse at our surprisingly talented middle-aged minds.
Strauch, medical science and health editor at the New York Times, sets out to offer reassurance to parents baffled by their kids’ seemingly irrational and erratic behavior. She discusses the latest research, including brain scans that show changes in the brain’s structure and function that could explain the crazy behavior exhibited by teens. In addition to reviewing various research projects around the country, Strauch also includes discussions with both parents and teenagers. Parents lament their inability to understand why a straight-A student suddenly loses interest in school or starts behaving miserably. The teens are surprisingly open about their often ill-advised behavior, but seem unable to offer reasons for such actions. One possible explanation, still debated by scientists, is whether adolescence is a critical brain period, that is, an important period of development. Particularly interesting is the chapter Crazy by Design, in which Strauch offers evidence of the cognitive and emotional development of teens. Just as there are growth spurts for babies and young children, there are developmental milestones for teens roughly ages 11, 15 and 19. For example, While a younger teen might see a parent as a hypocrite if he holds two opposing views, an older teenager would begin to understand how two things can be true at the same time, and weigh the evidence for each. While the book does not offer how-to guidance, readers will be struck by the wonderfully candid comments by those interviewed as well as Strauch’s insightful narrative.
Convincing the Public to Accept New Medical Guidelines, By Christie Aschwanden. As summarized by Kaiser Health News:
After a scientist found that runners’ widespread habit of using ibuprofen before long races didn’t help them, and may even cause more inflammation than doing nothing, a group of runners presented with the evidence still said they would continue using the drug, reports Miller-McCune, a Santa Barbara-based public policy magazine. The researcher who conducted the study said, “They really, really think it’s helping. … Even in the face of data showing that it doesn’t help, they still use it.”
That reaction is not usual. “A surprising number of medical practices have never been rigorously tested to find out if they really work. Even where evidence points to the most effective treatment for a particular condition, the information is not always put into practice.” But, the reticence to accept new ideas in medicine may be an obstacle for government officials who hope to spend billions of dollars on so-called comparative effectiveness research that would determine which treatments are most effective. “These efforts are bound to face resistance when they challenge existing beliefs”
In the 1970s and 1980s, a number of states adopted all-payer rate-setting systems as strategies to control the rate of increase in health care costs. These systems brought stakeholders to the table to negotiate the allocation of costs associated with caring for the uninsured and created, briefly, an opportunity for states to address access problems more broadly with the participation of major stakeholders. This article uses a case study of Maine and comparisons with other states to argue that the payment disparities between public and private payers that have grown over time since the demise of all-payer systems constitute a significant barrier to successful health reform.
Health policy debates are replete with discussions of federalism, most often when advocates of reform put their hopes in states. But health policy literature is remarkably silent on the question of allocation of authority, rarely asking which levels of government ought to lead. We draw on the larger literatures about federalism, found mostly in political science and law, to develop a set of criteria for allocating health policy authority between states and the federal government. They are social justice, procedural democracy, compatibility with value pluralism, institutional capability, and economic sustainability. Of them, only procedural democracy and compatibility with value pluralism point to state leadership. In examining these criteria, we conclude that American policy debates often get federalism backward, putting the burden of health care coverage policy on states that cannot enact or sustain it, while increasing the federal role in issues where the arguments for state leadership are compelling. We suggest that the federal government should lead present and future financing of health care coverage, since it would require major changes in American intergovernmental relations to make innovative state health care financing sustainable outside a strong federal framework.
This paper employs a nationally representative, household-based dataset in order to test how the compensation method of both the specialists and the primary care providers affects surgery rates. After controlling for adverse selection, I find that when specialists are paid through a fee-for-system scheme rather than on a capitation basis, surgery rates increase 78%. The impact of primary care physician compensation on surgery rates depends on whether or not referral restrictions are present.