Converting Medicare to Premium Support Would Likely Lead to Two-Tier Health Care System, by Paul N. Van de Water (Center on Budget and Policy Priorities)
Secret Weapon: The “New” Medicare as a Route to Health Security, by Mark Schlesinger and Jacob S. Hacker (Journal of Health Politics, Policy and Law)
Over the past twenty years, Medicare has been transformed from a single-payer insurer into a hybrid of complementary public and private insurance arrangements. Despite creating ongoing controversy, these changes have resulted in an ironic and largely overlooked strategic potential: Medicare’s evolving hybrid form makes it the most promising vehicle for overcoming the historical obstacles to universal health insurance in the United States. To make this surprising case, we first explore the distinctive political dynamics of programs that, like today’s Medicare, are hybrids of public and private arrangements. We then consider how these political dynamics might circumvent past barriers to universal health insurance. Finally, we discuss the strengths and weaknesses of alternative pathways through which Medicare could be expanded to promote health security.
Requiem for the CLASS Act, by Howard Gleckman (Health Affairs)
The demise of a national voluntary long-term care insurance program has left advocates uncertain where the political and financial support for a similar measure will come from in the future.
How the Patient-Centered Outcomes Research Institute Can Best Influence Real-World Health Care Decision Making, by Alan M. Garber (Health Affairs)
The Affordable Care Act of 2010 created the Patient-Centered Outcomes Research Institute to promote and fund comparative effectiveness research and to ensure that the product of this research improves real-world health care decisions. Notwithstanding limitations imposed by Congress on the institute’s ability to influence federal payers’ coverage and payment policies, the organization now has considerable potential to help standardize and coordinate comparative effectiveness research in the United States. Still, many questions remain about how this important new entity will function—and a central challenge will be to produce comparative effectiveness assessments that can be readily disseminated to, and used by, a wide range of health care stakeholders, especially providers and patients. I recommend that the institute adopt a comparative effectiveness assessment format that compares interventions on the basis of their clinical risks and benefits, economic considerations, and the insights they might offer into medical care. I also offer an example of how this proposed assessment and rating approach might work in the presentation of findings that weigh cardiac bypass versus angioplasty as alternatives for the treatment of coronary disease in which multiple coronary arteries require intervention.
How Comparative Effectiveness Research Can Help Advance ‘Personalized Medicine’ in Cancer Treatment, by Scott D. Ramsey, David Veenstra, Sean R. Tunis, Louis Garrison, John J. Crowley and Laurence H. Baker (Health Affairs)
The use of biomarkers to “personalize” cancer treatment—identifying discrete genes, proteins, or other indicators that can differentiate one type of cancer from another and enable the use of highly tailored therapies—offers tremendous potential for improved outcomes and lower treatment costs. However, the rapid development of cancer biomarker, or genomic, tests—combined with a paucity of evidence to support the effectiveness of the tests—presents a challenge for patients, clinicians, and other stakeholders. In this article we propose that comparative effectiveness research be used to strengthen what is now a haphazard process for developing and marketing cancer biomarker tests. We suggest novel funding approaches and a systematic process for moving from regulatory approval to the generation of evidence that meets the needs of stakeholders and, ultimately, patients.
Chronic Disease and the Shifting Focus of Public Health: Is Prevention Still a Political Lightweight? by Rick Mayes and. Thomas Oliver (Journal of Health Politics, Policy and Law)
Why is it so politically difficult to obtain government investment in public health initiatives that are aimed at addressing chronic disease? This article examines the structural disadvantage faced by those who advocate for public health policies and practices to reduce chronic disease related to people’s unhealthy lifestyles and physical environments. It identifies common features that make it difficult to establish and maintain initiatives to prevent or reduce costly illness and physical suffering: (1) public health benefits are generally dispersed and delayed; (2) benefactors of public health are generally unknown and taken for granted; (3) the costs of many public health initiatives are concentrated and generate opposition from those who would pay them; and (4) public health often clashes with moral values or social norms. The article concludes by discussing the importance of a new paradigm, “health in all policies,” that targets the enormous health and economic burdens associated with chronic conditions and asserts a need for new policies, practices, and participation beyond the confines of traditional public health agencies and services.
The Moral Standing of the Market, by Amartya Sen (Social Philosophy and Policy)
How valuable is the market mechanism for practical morality? What is its moral standing? We can scarcely doubt that as individuals we do value tremendously the opportunity of using markets. Indeed, without access to markets most of us would perish, since we don’t typically produce the things that we need to survive. If we could somehow survive without using markets at all, our quality of life would be rather abysmal. It is natural to feel that an institution that is so crucial to our well-being must be valuable. And since moral evaluation can hardly be indifferent to our interests and their fulfillment, it might appear that there is nothing much to discuss here. The market’s moral standing “has to be” high.
The powers and pitfalls of payment for performance, by Alan Maynard (Health Economics)
The developmental origins of health, by James J. Heckman (Health Economics)
The Constitutionality of the ACA’s Medicaid-Expansion Mandate, by Glenn Cohen and James F. Blumstein (The New England Journal of Medicine)
Drug Shortages – A Critical Challenge for the Generic-Drug Market, by Bruce A. Chabner (The New England Journal of Medicine)