This week, Human Rights Watch sponsored a showing of "The Return" a thoughtful examination of life after prison. It follows the lives of two prisoners released from life sentences and their re-integration into family and community life. One makes it, and the other is still struggling with mental illness and addiction by the story’s end.
Let’s talk about the real world and recent economic and political history for a moment.
Just in time for the debates, the Commonwealth Fund has presented a comparison of the Clinton and Trump health proposals. http://www.commonwealthfund.org/interactives/2016/sep/comparing-candidates-health-proposals/
The Committee for a Responsible Budget recently updated its analysis of the campaign promises and their costs over the next decade from Prospective Presidential Nominees Donald Trump and Hillary Clinton. See http://crfb.org/papers/promises-and-price-tags-preliminary-update and http://crfb.org/papers/promises-and-price-tags-fiscal-guide-2016-election
One of the best questions at last year’s ITUP conference involved the differences and overlap between Section 2703 Health Homes and the new Section 1115 waiver for whole person care pilots. Both address the same fundamental challenge in the American health system – the lack of important connectivity among its excellent but disparate parts. This is particularly problematic in Medi-Cal due to the behavioral health/physical health divide. Both initiatives address the same populations of severely ill patients who are high users of emergency rooms, many of whom have severe co-occurring physical and behavioral health conditions, and a significant number are homeless individuals.
CMS recently reported on Medicaid enrollment growth from the third quarter of 2013 compared to June 2016 (in other words the first 2 and ½ years of the ACA’s Medicaid expansion). California’s Medi-Cal enrollment growth was 54.6%. The average for all states adopting the Medicaid expansion was 35.6%.
I’ve had an utterly lovely six months off since leaving ITUP. It’s now time for me to get back to work. The Office of Lucien Wulsin is now open for business. I’ll be affiliating with organizations where our interests and skills align, and you’ll be hearing more about this soon I hope.
Presidential candidates Clinton and Trump now each have child-care and maternity leave proposals. Trump has just unveiled his proposal while the specifics of the Clinton plan have been out there throughout the primaries. The differences are quite large and highly instructive about the two candidates.
Real household income went up by 5.2% -- the fastest growth on record – from 2014 to 2015. Poverty fell by 3.5 million – the largest one year drop since 1968. The uninsured rate fell to 9.1% -- its lowest rate ever. http://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-256.pdf and https://www.whitehouse.gov/blog/2016/09/13/income-poverty-and-health-insurance-united-states-2015
In 2012 the Commonwealth of Massachusetts set overall spending caps for insurers and providers. These global spending caps may be working. https://www.bostonglobe.com/business/2016/09/07/health-care-spending-mass-again-exceeds-target/7HvYRD1RGxeJAe3nFTsIEL/story.html
This is the most recent federal survey of the nation’s uninsured from the first quarter of 2016. These surveys are compiled and released quarterly and thus catalogue the nation’s remarkable progress in reducing its number of uninsured under the Affordable Care Act (ACA).
Seven or eight years ago, Walter Zelman approached me at the annual ITUP conference and said he had a student in his health policy class at Cal State LA who’d be a perfect fit at ITUP. He vastly underestimated how much Sara Watson would help us.
In the recent months, Aetna and United have stopped offering coverage through many Exchanges. In California, Blue Cross Anthem and Blue Shield increased their premiums by close to 20%. What’s happening? What lessons should we be learning? What corrective actions are needed?
The Kaiser Family Foundation has followed the impacts of the Affordable Care Act on uninsured Californians over four reporting periods. They followed a group of over 2000 uninsured from 2013 to 2016. Nearly three fourths gained coverage; primarily through Medicaid (1/3rd), then employment-based coverage (1/5th) and Covered California (1/10th). They were far more likely to report their health needs are being met, their financial worries lessened. Eighty percent said their experiences were positive; they are satisfied with their choice of hospitals and primary care doctors and over 2/3rds are pleased with their choice of specialists.
The Commonwealth Fund has recently published its report on the impacts of the ACA on reducing the numbers of uninsured. The ACA increased coverage for the poor, the moderate income, the young, for whites, blacks and Latinos and for those working for small employers.
Joseph Stiglitz describes the changes in the rules undergirding the American economy over the past 40 years that have promoted short-term profit taking as opposed to long-term investments and their impacts in slowing the growth of the American economy. http://rooseveltinstitute.org/rewriting-rules-report.
The average stock was held for seven years in 1940, for two years in 1987 and for seven months by 2007. Corporate CEO pay as compared to the average worker’s salary has grown from 20/1 in 1965 to 295/1 in 2013. Firms are not investing their capital in equipment needed and designed to increase worker productivity, but rather in stock buy-backs and shareholder dividends.
Ben Somers and colleagues compared changes under the ACA in Texas, Arkansas and Kentucky. The latter two adopted the Medicaid expansion under the ACA while Texas did not. The results between 2013 and 2015 were startling.
In Texas the uninsured rate for low income Texans fell from 39% to 32%. In Arkansas, it fell from over 40% to 14%; in Kentucky it fell from over 40% to 9%.
Nobel Prize winning economist Joseph Stiglitz’ report for the Roosevelt Institute entitled “Rewriting the Rules of the American Economy” notes the recurrent financial crises that plague our economic health and recommends ending “too big to fail”, regulating the shadow banking industry and off shore banking, transparency in all financial markets, reducing credit and debit card fees, stricter penalties for financial malfeasance, and reforming the rules of the Federal Reserve. http://rooseveltinstitute.org/rewriting-rules-report.
Fifteen years ago Joseph Stiglitz won the Nobel Prize for his research on information asymmetries and their impacts on free markets. In his report for the Roosevelt Institute entitled “Rewriting the Rules of the American Economy” he recommends a fresh look at anti-trust, at intellectual property rights, at global trade agreements and at government roles in negotiating health prices. http://rooseveltinstitute.org/rewriting-rules-report.
He points out that we have moved quite drastically from a manufacturing economy to a service and knowledge economy and that the 100 year old anti-trust rules from the turn of the 19th century into the 20th need to be updated to reflect a very different economy.
Health care is a classic case of market failure for several reasons: the asymmetric information about health care effectiveness between the patient and the providers, the third party payer role of the insurer or government, and the natural plan and provider monopolies in rural America and the oligopolies created by hospital system and health plan mergers.
I’ve been immersed in Nobel Prize winning economist Joseph Stiglitz' report for the Roosevelt Institute entitled “Rewriting the Rules of the American Economy”. http://rooseveltinstitute.org/rewriting-rules-report His perspective is that for the past thirty-five years or so we have been tilting the rules governing the American economy ever more towards the interests of the top 1%. This is causing slow growth, endemic financial crises like the Great Recession, the wage-stagnant job recovery that has succeeded it under President Obama and the jobless recovery that preceded it under President Bush, the shrinking of the middle class, widening income inequality, stagnation of economic opportunities for the poor and the loss of American manufacturing jobs. He contends that a thorough going economic reform is necessary to restore economic equilibrium, redirect incentives and create the infrastructure of a healthy American economy. It is very provocative and deeply thoughtful.
His report (2015) predates the rise of Bernie Sanders and Donald Trump but presages their arguments about a “rigged” economic system. A number of his recommendations can now be found in the Democratic platform and in some of the policy recommendations from Secretary Clinton and Senator Sanders’ campaigns and in some of Donald Trump’s rhetoric as well (but no policy recommendations).