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Uwe Reinhardt

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GOP ideologues will have to face healthcare math


Princeton healthcare economist Uwe Reinhardt writes in Vox that the Republicans can repeal the Affordable Care Act but they can’t repeal the mathematics of healthcare and especially the huge expense of caring for the chronically ill. He notes that:

In 2013, 10 percent of patients accounted for nearly two-thirds of healthcare spending and 1 percent accounted for more than a fifth of spending.

He says that a central question is: “Which treatments should high-cost patients receive and how should they be financed?’’

The ACA subsidizes care for high-cost patients through  such provisions as the individual mandate and community rating premiums, which  force younger, healthier individuals to pay more than their “fair” share in premiums. Republican ideology against the ACA targets rising premiums, but, he notes,  “the health insurance debate will be driven mostly by actuarial logic, not ideology.”

The GOP will face the problem of how to finance healthcare for the very sick  — and generally older — part of the population. Giving everybody a refundable tax credit, as proposed by House Speaker Paul Ryan’s “A Better Way,” wouldn’t do much for a very sick person charged very high actuarially “fair” premiums.

The complaints by younger, healthier people about what they see as their too-high premiums and co-pays ignore the reality of all health insurance, if it is to work  — that the healthier must help subsidize the unhealthy, and that younger, healthier people should bear in mind that they, too, will eventually get sick as they age.

As Vox’s Sarah Kliff points out, Mr. Ryan’s proposal “makes insurance better for people who are young and healthy. It makes insurance worse for people who are old and sick.”

Mr. Reinhardt asks if GOP-run government will be “content to leave millions of Americans without the benefits of health insurance, and the access to essential healthcare it provides.”

There would be quite a political reaction t0 throwing the 22 million people who have gained health insurance through the ACA off the insurance rolls.

To read Professor Reinhardt’s piece, please hit this link.

Better care, but where are the savings?


The Philadelphia Inquirer looks at how the Affordable Care Act is speeding changes in how hospitals treat people with chronic conditions.

For example, the Temple University Health System is part of a federal initiative with the Einstein Health System and the Philadelphia Corporation for Aging on a care model called a “bridge coordinator.”

 The Inquirer says this program uses  social workers to “connect with patients in the hospital at risk of readmission, follow them post discharge and continue to check on them at home by phone.”

Steve Carson, Temple’s vice president for clinical integration, told The Inquirer that readmission rates for those ‘bridge coordinator’ patients fell 35 percent.

But, the paper said “While individual hospitals may see improvements in care and cost reductions, healthcare economist Uwe Reinhardt said it’s too soon to tell whether the U.S. health system  reforms are creating nationwide savings, although the changes may well be improving patients’ experiences.

“The process doesn’t work this quickly. We will probably need 10 years to determine its effectiveness. The problem with Americans is we are extremely impatient people and we don’t like to hear that some things take a lot longer to know,” he said.

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