New America on Health Policy

"Saving our future requires tough choices today" may be a banal sentiment, but it's not an easy one to challenge. That is the headline on the "Fiscal Wake-Up Tour," a slide show created by David M. Walker, formerly head of the Government Accountability Office. In hopes that it will be to the long-term budget deficit what Al Gore's "An Inconvenient Truth" slide show has been to climate change, Pete Peterson has set aside a billion dollars out of his recent… more

Thirty-five years ago, in his classic Management: Tasks, Responsibilities, Practices, Peter Drucker declared that the means by which most people had long run their organizations -- through a mix of perks and punishment, rewards and reprimands -- was all but dead.

"The basic fact," Drucker wrote, "is that the traditional... approach to managing, that is the carrot-and-stick way, no longer works."

It was striking, then, to read a few weeks ago of Whirlpool's decision to suspend 39 workers who had claimed to… more

Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost. We identify five fundamental building blocks for a high-performance health system and urge action to create a national center for effectiveness research, develop models of accountable health care entities capable of providing integrated and coordinated care, develop payment models to reward high-value care, develop a national strategy for performance measurement, and pursue… more

The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10:

A few weeks ago, devoted listeners of National Public Radio were treated to an episode of the award-winning radio series The Infinite Mind called "Prozac Nation: Revisited." The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.

The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur… more

Polls show that health care ranks near the top of voters’ concerns, especially among Democrats. And for those who say “the economy” is the top issue, health care is usually a major part of their financial worries.

And yet, voters must be awfully confused about where the Democrats stand on health care. On the one hand, both Barack Obama and Hillary Clinton say they want to insure everyone -- and in much the same way. On the other hand, more

Do you want to Google your genes or peer into your future risks of heart disease or cancer? Now you can, according to direct to consumer testing companies. Gone are the days when genetic testing was limited to doctors ordering tests for rare, but prognostically potent, single gene disorders such as Huntington’s disease, Duchenne’s muscular dystrophy, or cystic fibrosis. Thanks to an explosion of newly discovered single nucleotide polymorphisms, or SNPs (pronounced snips), companies are marketing genetic tests for traits… more

In his new book, The Healthcare Fix: Universal Insurance for All Americans (MIT Press, 2007), Laurence J. Kotlikoff demonstrates that at some point between 2035 and 2050, the costs of Medicare and Medicaid (two health-care programs that serve only a minority of the population), combined with the costs of Social Security, will approximate the total current cost of the entire federal government as a percentage of GDP. Medicare and Medicaid, without Social Security, will surpass the current cost of government… more

Once upon a time there was an industry called pharma that was interested in doing well and doing good. Run by doctors and chemists, drug companies employed battalions of researchers whose scientific efforts resulted by mid-century in a flood of life-saving drugs, including antibiotics, vaccines, tranquilizers, antihistamines and steroids. As George Merck, president of the company founded by his father, put it in 1950, "We try never to forget that medicine is for the people. It is not for the… more

On November 11, 2000, Mark Quasius, then 37, learned that the strange sensation in his right ear was caused by a rare carcinoma in his upper sinuses.

After a variety of treatments, including multiple surgeries on his head, lungs, pancreas, and hip bones, the prognosis for his advanced adenoid cystic carcinoma is pretty good. After consultation with Andrew Putnam, MD, a palliative care specialist at Lombardi Cancer Center and Georgetown University Hospital, his life is pretty good too. Dr. Putnam brought… more

Felt a little short of breath the other day, walking up a hill. Uh-oh. A nugget of worry lodged for a moment in my mind. At 50-something, I'm in decent enough shape. I don't smoke. I walk several miles most days, and I can still beat my 40-something friend at tennis. Not exactly a candidate for a heart attack. But still. I've read all those stories about women like me, the ones with no risk factors for cardiac disease who… more

"Socialized medicine" is the bogeyman that just won't die. The epithet has been hurled at every national health plan since the New Deal -- even Medicare, which critics warned would strip Americans of their freedom.

And now it's back. Republicans from President Bush on down have invoked the specter of socialism in denouncing Democrats' attempts to expand publicly funded health insurance for children. Erstwhile GOP presidential contenders Rudy Giuliani and Mitt Romney lambasted the health plans of the leading Democratic candidates… more

With the March 4 primaries delivering finality on one side of the partisan divide and uncertainty on the other, it’s a good time to take stock of where the candidates are on health care. For now, most attention has centered on the scrap between Hillary Clinton and Barack Obama over an “individual mandate” requiring everyone to have health insurance. But this fight will look like a college seminar discussion compared with the take-no-prisoners battle that’s likely to emerge between John… more

New generation antidepressants aren’t all they’re cracked up to be. That seems to be the central message in the meta-analysis published this week by Irving Kirsch and colleagues in PLoS Medicine,[1] and it was this message that made the headlines. Kirsch’s conclusion follows on the heels of similar studies showing that statins are useful in only a small subset of patients taking the drugs[2] and earlier studies finding that the safety and performance of cyclo-oxygenase-2 (COX 2) inhibitors were worse… more

As the primary fight between Hillary Rodham Clinton and Barack Obama reaches fever pitch, the domestic policy battle has boiled down to a single technical phrase: "individual mandate."

Clinton's healthcare plan includes such a mandate, requiring that everyone obtain health coverage. Obama's does not (though he does require that children get coverage). This difference, Clinton is insisting, is reason enough for anyone who wants universal coverage to support her. As Clinton argued in last Thursday's debate: "If you do not have… more

For American progressives, it's hard to name a more pressing -- or long-awaited -- goal than achieving universal health coverage. Today, prospects for that goal seem better than they have in years, if not for the fact that the Democratic presidential hopefuls are bickering over the details of how to do it.

But obsessing over universal coverage has obscured a far more complex and worrisome problem in our healthcare system, and that is the question of costs.

The United States, as we… more

The current crop of Presidential candidates sound a lot like they did in prior years with promises of new targeted tax breaks, loophole closures, increased taxes on the rich and new spending programs. Have the candidates not read the doom and gloom budget reports from the Government Accountability Office (GAO), Congressional Budget Office (CBO) and others?

The fiscal agenda for the next President and Congress must include some very difficult decisions that go beyond just tweaking the tax system. Below,… more

As Gov. Arnold Schwarzenegger has released his budget threatened by $14 billion of red ink, many are asking whether California can afford the ambitious health care reforms that passed the state Assembly in December. Given the social and economic costs of leaving as many as 6.5 million Californians uninsured, the better question may be: Can we afford not to? Those worried by the possible impact of the budget gap on health reform include Senate President Pro Tem Don… more

David DeGrazia has sketched out a health reform proposal that combines the monopsony purchasing power of a single public payer with managed competition among health plans and implicitly among providers, alone or in groups. The proposal differs from the archetypal “Medicare fee-for-service for all” model in creative ways, and indeed it is developed to address some of the standard fears about whether a single-payer system squelches choice and incentives for innovation. But DeGrazia’s truly novel claim is that this version… more

The blue-ribbon commission has an inauspicious history in American public policy. Most often, assembling a dozen or two bipartisan grandees to deliberate soberly about a problem for several years is merely a way of evading the problem.

But there are exceptions. Though it will probably pass unnoticed, Dec. 22 of this year will mark the 20th anniversary of the creation of one of the most successful policy commissions in modern U.S. history: The National Commission on Children. Chaired by… more