The Genius of the Mandate
By ROSS DOUTHAT
WHEN the Obama White House set out to make the liberal dream of universal health coverage a reality, it faced two obvious political obstacles. The first was the power of the interlocking interest groups — insurance companies, physician associations, pharmaceutical companies — that potentially stood to lose money and power in a comprehensive reform. The second was the price tag of a universal health care entitlement, which promised to be high enough to frighten vulnerable members of Congress.
The key to overcoming both obstacles, it turned out, was the mandate to purchase health insurance.
In arguments before the Supreme Court last week, the health care mandate was defended as a kind of technocratic marvel — the only policy capable of preventing the complex machinery of reform from leaking smoke and spitting lug nuts.
But the mandate is actually a more political sort of marvel. In the negotiations over health care reform, it protected the Democratic bill on two fronts at once: buying off some of the most influential interest groups even as it hid the true cost of universal coverage.
‘Embarrass the Future?’
By LINDA GREENHOUSELinda Greenhouse on the Supreme Court and the law.
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Nothing in the Supreme Court arguments in the health care case last week, or in the subsequent commentary, has changed my opinion that this is an easy case. It’s the court that made it look hard.
I don’t mean the torrent of wisecracks at the government lawyers’ expense from Justice Antonin Scalia, who despite his clownish behavior in channeling the Tea Party from the bench is surely smart enough to know the difference between broccoli and health care. Rather, I mean the tough but fair questions from the members of the court who actually seemed to be wrestling with the issues: Justices Anthony M. Kennedy and Samuel A. Alito Jr. and Chief Justice John G. Roberts Jr. The Affordable Care Act will be upheld if least one of these justices is satisfied that the briefs, the arguments, and his own judicial perspective provide sufficient answers to the questions.
Americans Cutting Back on Drugs and Doctor Visits
By KATIE THOMAS
Patients cut back on prescription drugs and doctor visits last year, a sign that many Americans are still struggling to pay for health care, according to a study released Wednesday by a health industry research group.
The report, issued by the IMS Institute for Healthcare Informatics, said 2011 was also a breakthrough year for the drug industry, which introduced 34 new medicines, the most in a decade, to treat diseases including cancer, multiple sclerosis, hepatitis C and others.
The number of prescriptions issued to patients declined by 1.1 percent compared with 2010, and visits to the doctor fell by 4.7 percent, the report said. Visits to the emergency room, by contrast, increased by 7.4 percent in 2011, an increase that the report’s authors said was linked to the loss of health insurance resulting from long-term unemployment.
Michael Kleinrock, director of research development at the institute, which consults for the drug industry, said his research showed that some people with health insurance at the start of the recessionactually increased their visits to the doctor out of fear they were about to lose insurance.
Do Patients Want More Care or Less?
By DAVID NEWMAN, M.D.Mike Groll/Associated PressA patient undergoing a CT scan.
The woman’s wheeze was a head-turner, audible from across the emergency department. Along with a hacking cough, the musical, whistling sound prompted her to leave the children asleep with her sister one night and seek relief at the E.R.
Inhaled medicines were able to quiet her lungs, and with a clear chest X-ray and easy breathing restored, the diagnosis was simple: acute bronchitis.
While diagnosing bronchitis, a common respiratory infection, is often easy, treating the condition is more difficult. Medicines may calm the symptoms, but the only cure is time. Most notably, antibiotics, though commonly prescribed, are no better than a placebo for bronchitis. Yet discussing this can be a bit of a minefield for physicians, particularly when patients are used to antibiotics for such infections. So when I sat down to talk to my patient, I was surprised when she cut me off.
“If it’s O.K. with you” she said, wiping her nose with a tissue, “I’d like to avoid antibiotics, with all those side effects.”
The Collapse of Employment-Based Coverage
Reed Abelson at Economix points us to a startling study on the effects of the Great Recession on health insurance. You can see similar trends in the Census data, but for whatever reason this survey — carried out by a highly reputable group — is even stronger. Here’s the key picture:
Toward Universal Health Coverage
By DAVID DE FERRANTI and JULIO FRENK
Two recent events underscore the disparity between the United States and the rest of the world on health coverage. Last week, American reactions to the Supreme Court hearings showed how deeply divided the nation is on the subject. This week, at an international forum in Mexico City, country delegates from around the globe made clear that they are not only aiming for universal coverage but also rapidly getting there.
Except for the United States, the 25 wealthiest nations now have some form of it. Others are not far behind, including Brazil and Thailand. Even nations at lower income levels, such as the Philippines, Vietnam, Rwanda and Ghana are working toward it. India, South Africa, China and Colombia are on the move, too.
Mexico has just crossed the goal line. Its reformers would be the first to say that many more improvements are needed, but their accomplishment is nonetheless noteworthy because they faced challenges no less daunting than the United States does today — and had fewer resources to draw on (Mexico’s economy is one tenth the size of the United States’). Special interests resisted change, dysfunctional fragmentation impeded progress, and poor, highly needy groups dispersed in remote locations had to be reached.
Down the Insurance Rabbit Hole
By ANDREA LOUISE CAMPBELL
Cambridge, Mass.
ON the second day of oral arguments over the Affordable Care Act, Solicitor General Donald B. Verrilli Jr., trying to explain what sets health care apart, told the Supreme Court, “This is a market in which you may be healthy one day and you may be a very unhealthy participant in that market the next day.” Justice Antonin Scalia subsequently expressed skepticism about forcing the young to buy insurance: “When they think they have a substantial risk of incurring high medical bills, they’ll buy insurance, like the rest of us.”
May the justices please meet my sister-in-law. On Feb. 8, she was a healthy 32-year-old, who was seven and a half months pregnant with her first baby. On Feb. 9, she was a quadriplegic, paralyzed from the chest down by a car accident that damaged her spine. Miraculously, the baby, born by emergency C-section, is healthy.
Were the Obama health care reforms already in place, my brother and sister-in-law’s situation — insurance-wise and financially — would be far less dire. My brother’s small employer — he is the manager of a metal-fabrication shop — does not offer health insurance, which was too expensive for them to buy on their own. Fortunately, my sister-in-law had enrolled in the Access for Infants and Mothers program, California’s insurance plan for middle-income pregnant women. AIM coverage extends 60 days postpartum and paid for her stay in intensive care and early rehabilitation.
But when the 60 days is up next week, the family will fall through the welfare medicine rabbit hole. As a scholar of social policy at M.I.T., I teach students how the system works. Now I am learning, in real time.
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