“A Strict and Arbitrary Document”
Ronald Dworkin, “Why the Mandate Is Constitutional: The Real Argument,” New York Review of Books:
If the Court does declare the act unconstitutional, it would have ruled that Congress lacks the power to adopt what it thought the most effective, efficient, fair, and politically workable remedy—not because that national remedy would violate anyone’s rights, or limit anyone’s liberty in ways a state government could not, or be otherwise unfair, but for the sole reason that in the Court’s opinion our constitution is a strict and arbitrary document that denies our national legislature the power to enact the only politically possible national program. If that opinion were right, we would have to accept that our eighteenth- century constitution is not the enduring marvel of statesmanship we suppose but an anachronistic, crippling burden we cannot escape, a straitjacket that makes it impossible for us to achieve a just national society.
Food for thought on a rainy Monday morning.
Report: Success of RomneyCare Shows Promise of ACA
Towards the end of this month, the Supreme Court is scheduled to hear six hours of oral argument on the Affordable Care Act, the longest such session since the Voting Rights Act was challenged in 1965. At stake is the constitutionality of the individual mandate—a key component of the ACA that requires individuals to purchase health insurance or pay a fine. Opponents of the law allege that power falls outside the purview of the Commerce Clause, which allows the federal government to regulate interstate commerce. And if the individual mandate is ruled unconstitutional, the entire ACA may become unworkable: because another part of the law prohibits insurers from discriminating against people with pre-existing conditions, experts expect the cost of premiums to skyrocket without a mechanism for persuading healthy people to buy insurance. The Supreme Court could also delay a ruling until 2014, when the mandate actually takes effect.
Until then, our best bet for assessing the long-term impact of the ACA is to look at how “RomneyCare” has fared in Massachusetts, where it is overwhelmingly popular—and, as it turns out, largely successful. According to new research by Charles Courtemanche and Daniela Zapata, former governor Mitt Romney’s 2006 blueprint for “ObamaCare” has already achieved significant improvements in self-reported physical and mental health for Massachusetts residents. Their working paper, “Does Universal Coverage Improve Health? The Massachusetts Experience,” notes a significant improvement in residents’ functional limitations, joint disorders, body mass indexes and physical activity, suggesting that near universal access to preventative care had a marked effect on quality of life. The reform’s effects were especially pronounced for women, minorities, near-elderly adults and low-income individuals, helping close the gap between blacks’ and whites’ self-reported health by 22 percent.
The report’s authors are quick to emphasize the similarities between the ACA and the Massachusetts bill it is based on, suggesting the success of RomneyCare can be reproduced at the national level. Both laws rely on a strategy of “incremental universalism,” improving coverage through modifications to the extant system rather than the more radical single-payer approach many Democrats had initially hoped for. Both comprise three interrelated reforms—insurance market reorganization, an individual mandate, and subsidies—that Republicans supported throughout the 1990s. In Massachusetts, this combination lowered the number of uninsured to just 2% within four years, the highest rate of coverage in the nation. Can we expect the same from ObamaCare?
Lawsuits aside, the challenges facing the ACA are daunting. No health care reform of this size or scope has ever been implemented, and Courtemanche and Zapata worry that Medicare cuts included in the bill could mitigate the gains in health from coverage expansion. “On the other hand,” they note, “baseline uninsured rates were unusually low in Massachusetts” to begin with, so the potential coverage expansion under the ACA may offer corresponding health improvements many times greater at the national level.
The Washington Post’s Ezra Klein adds another reason for optimism:
The national reforms, unlike the Massachusetts reforms, included major investments in comparative-effectiveness research, electronic health records, accountable care organizations and pay-for-quality pilots. If any or all of those initiatives pay off, they could dramatically improve our understanding of which treatments work and force the health-care system to integrate that new knowledge into everyday treatment decisions very quickly.
Photo credit John Shinkle/POLITICO
Reblogged: “Why an MRI costs $1,080 in America and $280 in France”
There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.
That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.
There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, “it’s the prices, stupid.”
Simple Solutions to Complex Problems
Via Sarah Kliff, the OECD’s Obesity Update 2012 provides an important example of a complex problem (soaring health care costs) that could be addressed, in part, by a relatively simple solution (healthier diet and exercise).
President Obama has caught plently of flak in the past for similarly modest proposals, like painting roofs white to reduce air conditioning and electricity costs, or keeping car tires properly inflated to improve mileage. Thankfully, that hasn’t stopped the administration from moving ahead with new rules for government-subsidized school meals, which must now include whole grains, reduced fat and salt, and twice as many fruits and vegetables.
It’s a step in the right direction. The OECD estimates that an obese person incurs 25 percent higher medical bills than a person of normal weight in any given year, with obesity responsibile for 5 to 10 percent of all health care expenditures in the United States. And that number should rise by 2020, when the OECD predicts three out of every four Americans will be overweight or obese. So, as employers and families struggle to pay ever-higher premiums, a renewed focus on practical, preventative health policy—like school nutrition regulations—is surely a step in the right direction.
Rising Health Care Costs, Redux
Yesterday I looked at the Commonwealth Fund’s latest annual report, which shows that U.S. health care costs continue to be the highest in the world—about twice the average of most industrial nations.
Today, Century Foundation Fellow Harold Pollack tweets the following graph from a 2009 paper by Henry Aaron and Paul Ginsburg, “Is Health Spending Excessive? If So, What Can We Do About It?,” providing more evidence that “the case that the United States spends more than is optimal on health care is overwhelming.” According to the graph, which compares life expectancy and health spending per capita in the United States to several OECD countries (many of which use a single-payer model), the United States is really in a league of its own. When it comes to excessive costs and poor health outcomes, no other nation even comes close.
Graph of the Day: Health Care Costs Continue to Rise
America’s health care crisis may not be the front page news that it was back in 2009 and 2010, but that doesn’t mean that costs have come down. On the contrary, the latest data from the Commonwealth Fund’s annual report shows that U.S. health care costs are as out of control as ever, and still rising.
According to Commonwealth’s 2011 report, more than one-in-four sick adults were unable to pay or experienced difficulty paying their medical bills in the past year. Nearly half of patients with complex health problems reported not visiting a doctor, not filling a prescription, or not seeking recommended care because they were worried about unaffordable costs or medical debt. That is double the number of people reporting similar problems in the eleven other industrialized nations that were polled, except for Australia, New Zealand, and Germany. Americans were also found to experience the worst health outcomes, despite spending more per capita on health care than any other country: nearly $8,000 per person annually. The next closest country, Norway, spent nearly $3,000 less.
Other data collected by the study reveal some admirable successes. While the American health care system was weighed down by the highest rate of obesity—and consequently three times the average number of diabetes-related amputations—the United States also had the fewest daily smokers of all but Sweden. And despite experiencing the highest number of deaths per capita amenable to health care, Americans also had the best five-year breast cancer survival rate and the most extensive cervical cancer screening program of any industrialized country.
Consider this: If we stacked single dollar bills on top of one another, $2.6 trillion would reach more than 170,000 miles — nearly three-quarters of the way to the moon. Or, compare our spending to that of other countries. France has the fifth largest economy in the world, with a gross domestic product of nearly $2.6 trillion. The United States spends on health care alone what the 65 million people in France spend on everything: education, defense, the environment, scientific research, vacations, food, housing, cars, clothes and health care. In other words, our health care spending is the fifth largest economy in the world.
Poll: 86% of U.S. Workers Are Obese Or Unhealthy, Cost Billions in Productivity Losses
Via ThinkProgress:
A new Gallup poll reveals that 86 percent of U.S. workers are obese or have a chronic health issue that could cost the economy “more than $153 billion a year in lost productivity from increased sick days.” With approximately 450 million days of work missed each year because of weight and other health problems, another study puts the economic cost at around $1.1 trillion.
Americans Pay More, Get Less for Health Care
By Benjamin Landy
The United States spends more money on health care as a percentage of GDP than any other nation on Earth. A staggering 16.2% of our economy is tied up in health expenditures.
And yet, the United States had the worst life expectancy of any of its peer nations, behind even Cuba, which surpassed the US in 2007. By some measurements, life expectancy in America actually dipped slightly from 2007 to 2008, declining from 77.9 to 77.8 years.
According to a new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, most counties within the United States are falling significantly behind Japan, Canada, and other peer nations, which have been enjoying substantial gains in life expectancy every year. Specifically, the researchers found that between 2000 and 2007, more than 80 percent of counties in the United States dropped in their health standing compared to the average of the ten nations with the highest life expectancies. Several poor counties in Mississippi were found to have lower life expectancies than Honduras and El Salvador.
“We are finally able to answer the question of how the US fares in comparison to its peers globally,” said Dr. Christopher Murray, the Director of the IHME and co-author of the study. “Despite the fact that the US spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes. That’s a staggering statistic.”
Reposted from my Graph of the Day Series at Taking Note.
