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Science Policy Around the Web – October 14, 2016

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By: Fabricio Kury, MD

Source: pixabay

2016 Elections

What 10 health care experts would ask Trump and Clinton about health care

Health care finally had presence in the U.S. presidential race during the second debate this last Sunday. While Politico fact-checked what was said at the debate, the team at Advisory Board listed questions that should be of concern to the presidential candidates. Below is an overview of the topics and contexts of some of these questions.

Amitabh Chandra brought the important issue of Medicaid expansion. The Patient Protection and Affordable Care Act (PPACA, or ACA, a.k.a. “Obamacare”), signed into law in 2010, included provisions to expand Medicaid eligibility to all people with income up to 133% of the federal poverty line. However, unlike Medicare which is federally funded, Medicaid is jointly funded by each state and the union. The Supreme Court has ruled that the federal government cannot coerce states into expanding Medicaid, and, as of early 2016, 18 states had opted not to expand.

Douglas Holtz-Eakin and Martin Gaynor bring the perennial topic of free market-based versus government-based health care. Proponents of market-based approaches, such as Donald Trump, argue that competition can lower costs and thereby increase access, including for people currently uninsured. Government-based health care, also known as single-payer health care, is the case where the government provides or subsidizes care for everyone. This option, to a degree, is supported by Hillary Clinton. The Affordable Care Act, defended by Democrats and despised by Republicans, sought to establish a “middle-ground” approach. It promotes a U.S. health care system based on private insurance, but competition among the insurers would be stronger thanks to health insurance exchanges, where consumers are empowered to make better decisions. Under the ACA, everyone is obligated to have insurance, and vulnerable population groups, such as those living close to the poverty line, receive subsidies to lower the costs of their premiums. Moreover, the ACA, as well as other pieces of legislation, promotes alternative payment models, which seek to reimburse care for its value rather than number of procedures, encounters, services, i.e., its volume. In 2015Centers for Medicare and Medicaid Services (CMS) announced plans to tie 90% of Medicare payments to value as early as 2018.

Farzad Mostashari makes a rather stingy question for Clinton because of her support for the ACA. One of the predicted impacts of this law is generalized consolidation in the health care industry. However, consolidation can hamper competition, and moreover there is evidence that smaller practices are those ripe for the best improvements in quality and cost. How will small physician practices compete with large conglomerates, the largest of which are akin to Kaiser Permanente or the Geisinger Health System? Nicholas Bagley and Margaret O’Kane reinforce this concern by inquiring directly about how to address such excessive consolidation.

Finally, Robert Wachter, author of the praised book The Digital Doctor, asks about how to rein the resilient costs of health care, which today occupy almost 1 dollar out of every 5 in the entire U.S. economy. Clinton’s answer could be something close to the ACA’s Accountable Care Organizations approach, in which a group of providers receive bonus payments if they spend less than expected. Trump, as he mentioned in the last presidential debate when answering a question from the audience, believes in the power of market competition to lower health care costs.

Overall, this presidential election is also a contrasting choice between proceeding with the Democrat-supported Affordable Care Act and realizing the Republican pledge of dismantling this law to come up with something else. Bob Kocher and Ezekiel Emanuel, who worked in the White House in drafting the ACA, have laid their defense for “Obamacare” in this article. (Daily briefing, Advisory Board)

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Written by sciencepolicyforall

October 14, 2016 at 10:14 am

Posted in Linkposts

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