U.S. Healthcare – Moving Forward

US Healthcare System Talk - ACA Importance

Last week I gave a presentation to the leaders of some women’s health advocacy organizations about where the U.S. healthcare system is heading, i.e., where we go from the current situation with the A.C.A. We had a great discussion, and the organizer of the event emailed me afterward to say, “Amazing is all I can say. You are the first person who could speak to [the] ACA in which people listened and engaged.”

Some of the key points I made included:

Focus on the future. Don’t relive the past.
Move forward from today’s strengths and weaknesses. The slide below describes health insurance coverage for 2015 showing dramatic increases in coverage in individual insurance and Medicaid, and a decrease in the uninsured.

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Health, Healthcare, and Government Spending (and a Culture of Health)

November 29, 2016 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Information & Communications, Innovation, Medicaid, Medicare, Politics, Private-Employer Based Health Insurance, Public Health, State-Level Healthcare Reform / 1 Comment

Why governments care about health spending and healthcare, how they are connected to overall government spending and priorities, and why addressing social determinants of health is so important for making lasting improvements, were the subjects I covered in a presentation at George Mason’s graduate policy school in September. My goal was to provide the soon-to-be policy analysts and advisers with a framework for understanding those issues so they will be able to provide useful recommendations to their future decision making bosses. (See the slide below for the topics covered in the presentation.) Links to videos of the talk are below, along with short descriptions – I think that Part 6 is particularly good.…

Challenges Estimating Future U.S. Healthcare Spending

June 23, 2016 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicaid, Medicare, Politics / No Comments

The challenges of estimating future U.S. healthcare spending (and why projections are so often so inaccurate) is the focus of the third video segment from my guest lecture at George Mason University about Health and Budget Policy – see below. (The first two are in previous blog posts and are on the HealthPolCom YouTube Channel.)

The final two video segments on the topics of Medicaid, and the Changing U.S. Healthcare System will be posted next week. The five subjects covered in the video segments from the guest lecture are:

U.S. Spending on Health and Healthcare
Medicare and U.S. Healthcare Spending
Challenges for Estimating Future Healthcare Spending
Medicaid: Federal and State Fiscal Issues
Changing U.S.

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Medicaid and State Level Health Transformations

July 8, 2014 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Information & Communications, Medicaid, Politics, State-Level Healthcare Reform / No Comments

I recently guest lectured on Medicaid and state level health transformation at a George Mason University public policy class.

To start, I led the class through a discussion of how states differ from each other around 14-plus factors related to healthcare delivery, financing, policy, and politics. In this discussion we talked about the importance of policy makers appreciating those factors as they consider how to improve health, and the different routes states have taken for Medicaid improvements and expansion. (See picture of white board below.)

We had a great discussion, and I emphasized the importance of both multi-stakeholder alignment, and health information systems that can provide data for transparency and accountability – which together are fundamental to health improvement and reform efforts.…

Sovaldi® and Curing Hep C – Myths and Other Facts

June 16, 2014 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health Policy and Communications Blog, Innovation, Medicaid, VA/DoD / 7 Comments

The introduction of new oral medicines that can cure chronic hepatitis C infections (including Sovaldi®) have led to some intense discussions permeated with misleading information about the pricing of new medicines, how such medicines are “game changers,” and the implications for budget-crunched payers. Below I summarize some key points about those issues.

1. Myth #1: How Medicines are Priced

One of the perpetuating myths about biopharmaceuticals is that medicines are priced to recoup research and development costs.¹ It’s a myth. As I’ve written about elsewhere prescription medicine prices are set like everything else in a regulated free market: Companies set prices to maximize revenues and profits based upon the market opportunities and the value the new medicine provide compared to the consequences of the disease and other treatment options – including no treatment at all. …

Health Reform and Transformation in San Diego & California

June 10, 2013 / Michael D. Miller MD / Delivery of Healthcare, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicaid, Medicare, State-Level Healthcare Reform / 1 Comment

I recently sat down with Kevin Hirsch, MD, President of Scripps Coastal Medical Group* to talk about health reform and transformation in the San Diego region. (See video below.)

Dr. Hirsch’s insights are interesting and timely because California often precedes the rest of the country in adopting new approaches to healthcare delivery and financing problems. An example of this may be California’s 2006 Hospital Fair Pricing Act, which addressed very high hospital bills for the uninsured. This month’s Health Affairs includes an article that analyzes the impact of this law, and the authors’ findings contrast markedly with Steven Brill’s Time magazine article, “Bitter Pill: Why Medical Bills Are Killing Us.”…

Health Reform and Low-Income People in Washington DC

April 11, 2013 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicaid, Politics, Public Health, State-Level Healthcare Reform / No Comments

I recently sat down with George Jones, Bread for the City’s CEO, to talk about health reform and the challenges low-income people in Washington DC have accessing healthcare. The video of our discussion is below. A couple of notes: 1. George’s title changed from Executive Director to CEO about a year ago. I’ve known George for more than 15 years, so my bad when I introduce him as the Executive Director. 2. Please excuse my verbal stumbles and be impressed by George’s answers – we filmed this in one take in his small, hot office at Bread for the City. I’m confident there will be improvement in future videos – and of course, your feedback is always welcome!…

Health Promotion, Prevention, Wellness, and Government Fiscal Policies

March 14, 2013 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Medicaid, Medicare, Politics, Private-Employer Based Health Insurance, Public Health / No Comments

I recently had the opportunity to give guest lectures at Georgetown University and the University of Virginia. At Georgetown I focused on employer’s perspectives on health promotion and disease prevention. (Videos of portions of that discussion are below.) At UVA’s Batten School of Public Policy I discussed fiscal issues and policies for government healthcare programs, e.g. Medicare and Medicaid. (A few slides from that discussion are below….. sorry no video.)

The opportunity to talk with our future clinicians, health system administrators, and policy makers was heartening and a bit terrifying. While the students are eager and passionate, I wonder about their historical understanding of our complex healthcare systems and the policies, programs, and initiatives that got us to where we are today.…

Health Spending: For What, To Whom, and Where It Is Heading

February 5, 2013 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicaid, Medicare / 1 Comment

The data for 2011 US healthcare spending was reported in the January issue of Health Affairs. Below are some graphs showing how spending was distributed across the different categories of healthcare services in the years 2000, 2007, and 2011, as well as who paid for the spending. (My analyses and commentary follow these graphs. The source for all graphs is Health Affairs, 32, no. 1 (2013):87-99)

What Healthcare Spending Went For:

Where Healthcare Spending Funds Came From:Three highlights from the Health Affairs article are:

The distribution of healthcare spending for various services and providers has been relatively constant despite significant growth in total and per capita spending.

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Era of Accountable Care

October 24, 2011 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicaid, Medicare, Private-Employer Based Health Insurance / 1 Comment

For many months I’ve been talking about the array of health transformation initiatives the Department of Health and Human Services has been deploying as both demonstrations and programmatic changes. I’ve been characterizing this strategy to create more accountability as an evolving menu, buffet, or map – sort of like those magical Harry Potter maps where the lines keep appearing on the parchment to create a recognizable image.

As part of releasing the final rules for the Medicare Shared Savings Program, HHS also put forth a document subtitled “Menu of Options for Improving Care,” which is a list of some of the landmarks in the future map of an Era of Accountable Care.…

Accountable Care Now

March 7, 2011 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Medicaid, Medicare / 1 Comment

If all arrows in Washington pointed to the same spot for solving the healthcare and Federal spending problems could the politicians, pundits and policy people agree? Or would it take some new and powerful force to shine a spotlight and focus the collective vision on this solution, and what would that force be?

These are the two questions I’ve been asking myself as the battle over Federal spending has become near white-hot, and as it has become increasingly clearer that long-term Federal solvency and deficit reduction will require addressing the growth in healthcare spending – particularly Medicare.

[Source: Kaiser Family Foundation “Medicare Spending and Financing,” February 2011]

To summarize the highlights of this situation:

Cutting non-defense discretionary Federal spending can’t produce the reductions needed to significantly impact the deficit – contrary to the general misunderstanding about how the Federal budget is spent.

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The Path Forward for National Health Reform

January 31, 2010 / Michael D. Miller MD / Delivery of Healthcare, Health System Reform, Medicaid, Medicare, Politics / 2 Comments

The path forward for health reform is becoming clearer now that the dust from the Democrats losing their 60th vote in the Senate is settling. While a freestanding, comprehensive law now seems very unlikely, achieving the core goals of health reform are possible via the regular order of a Reconciliation bill, demonstrations and pilot programs, waivers, existing authorities, and the appropriations process.

It’s the Stupid Economy
First, the President has appropriately reraised jobs and the economy to be his highest priority. This shift may both help defuse the hyperpartisaness that has enveloped health reform, and increase action to improve the economy and create jobs since they are the source of the public’s ongoing angst and frustration. …

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