Flint: How Did This Happen And What Does It Mean?

In my opinion, the biggest health care story of the week is the continued fallout from the lead contamination of the water supply in Flint, Michigan. The Flint crisis underscores two egregious faults of the U.S. health care system: underinvestment in population health and persistent disparities based on race and class.

While Governor Snyder did recently apologize, this is a never event. It simply should not happen. The reason it did can be traced back to a cost-cutting decision made by the emergency manager Gov. Snyder appointed to run the city’s finances. Gov. Snyder is something of a moderate in his party (he championed the expansion of Medicaid under the ACA, for example). Nonetheless, the anti-government/pro-austerity ideology which has come to dominate today’s GOP stands indicted by the public health meltdown in Flint.

Progress Closing The Coverage Gap, But Election Shadow Looms

There was a lot of discussion of Medicaid this week, with Louisiana moving forward, and progress in South Dakota. But in other states, not so much.

Governor John Bel Edwards (D-LA) signed an executive order to expand coverage and the state is now looking at ways it can expedite enrollment for hundreds of thousands of low-income uninsured residents. Meanwhile, CMS Administrator Vikki Wachino has just completed a visit to South Dakota and both federal and state officials are reporting progress in their discussions. On the other hand, a legislative committee in Wyoming dealt a setback to Governor Matt Meade’s effort to close the gap in his state, while Tennessee lawmakers appear intent on waiting for the outcome of the 2016 presidential election before making a move. Given the health and economic benefits of coverage, frankly there is no excuse for waiting.

ACA Replace Debate Takes An Unexpected Turn

Six years after taking control of the House, Republican Congressional leaders won’t commit to actually producing a replacement plan. That’s not the unexpected part. That would be at other end of the ideological spectrum where Bernie Sanders has touched off something of a firestorm with his “Medicare for all” proposal. Of course, as John McDonough points out, the plan is dead even before it arrives in Congress so the debate is more symbolic than real. However, symbols can be important. In this case, Senator Sanders is using his plan not so much as a guide to policy, which it is not, but to signal to liberal activists in the Democratic Party, whose support he needs to win the nomination, that he is one of them. Since no major progressive health legislation is going to pass the Congress, a more realistic question for the candidates is how they would use the executive authority they do have to improve the ACA. Of course, that is much too wonky a conversation for public debate, so don’t expect it any time soon.

Drug Prices Remain A Hot Topic

Dean Baker offers a more charitable read of the utility of Sanders’ health plan, but what is most interesting and helpful about his column is his takedown of the pharmaceutical industry for their price gouging. PhRMA has upped their lobbying expenditures as part of their campaign to fend off any action to rein in prices, but the issue continues to attract attention from both sides of the aisle. Next week, the Center for American Progress follows up their fall report with a briefing on policy options to reduce drug spending that includes researchers, physicians, members of Congress and industry stakeholders.

Too Much Of A Good Thing?

The Commonwealth Fund is out with a blog highlighting the fact that competition in both federal and state marketplaces remains robust overall, but having a lot of plan choices is a mixed blessing. As Trudy Lieberman points out, too many choices can make it difficult, if not impossible, to compare plans.

One solution would be to standardize plan offerings across the metal tiers to make comparisons easier. The Obama administration is considering creating standardized benefit plans in the federal marketplace, but their proposal does not go far enough because it leaves the decision on whether to offer the standard plan to the discretion of carriers.

More evidence that people are generally not very good health care shoppers comes from a new study published in JAMA Internal Medicine that found that people with high-deductible plans were not any better at price shopping for care than people with more traditional coverage. The new study aligns with earlier research from the National Bureau of Economic Research that found that high deductibles were at best a blunt instrument for health care cost containment — causing people to alter their behavior in ways that were not necessarily rational or beneficial to their health. 

And Finally… The Secret To Health Care Quality Revealed (It’s Not Quality Measurement)

The best health policy quote of the week comes from Avedis Donabedian, considered by many to be the father of modern health care quality measurement. In an excellent New York Times article that highlights much of what is wrong with our current approach to health care quality measurement, Professor Robert Wachter from University of California San Francisco Medical School quotes Donabedian, then nearing the end of his life, as saying, “The secret of quality is love.” Hard to top that.