obamacare Archives - Page 2 of 2

Apr 15

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The Perils of Step-by-Step Healthcare

Medicare represents some of the greatest and worst qualities of our health care system. The positive is that it provides coverage for people over the age of 65 no matter what. After your 65^th birthday you receive a little red, white and blue card in the mail that guarantees you can go see a doctor for little cost. The program serves many of our most vulnerable populations and has helped to bring many elderly people out of poverty.

On the other hand, Medicare is the foremost example of our fractured, piecemeal health care system that attempts to fix problems after they’ve occurred instead of trying to prevent them. Instead of having a simple, unified health care system, we rely on Medicare, Medicaid, non-profits and other charity groups to fill in the pieces when people don’t have employer health insurance. Medicare was built one part at a time, just as our health care system and just as Obamacare are being phased in year by year.

When Medicare was introduced into the Social Security Act by President Johnson in July 1965, the program consisted of two parts – A and B. Part A covers 80 percent of hospital costs. Part B covers 80 percent of inpatient and primary care. This type of payment is referred to as cost-sharing. President Reagan tried to implement catastrophic coverage (Medicare paid for services up to a certain amount, depending on your income). So many protests resulted that he switched back to cost-sharing.

But, as you can imagine, paying for that extra 20 percent can get pretty costly. So Part C was introduced in 1997 to help both the elderly and private insurance. If you decided to enroll in part C, or Medicare Advantage, you would choose to pay a higher monthly premium instead of that 20 percent. During this same time, the Sustainable Growth Rate was implemented, which was intended to limit the increase in cost of doctor’s services, but has been suspended every year since 2002.

This lack of control added to Medicare spending, and so did the last part of the program, Part D, which covers drugs. But even this provision left coverage incomplete, with many people trapped in a “doughnut hole” with high out-of-pocket costs. So even with these four parts in Medicare coverage, you’re still paying quite a bit for your comprehensive coverage. Fortunately, if you’re low-income you can apply for more assistance or even qualify for Medicaid which will pay that 20 percent.

If you’re living with a disability, you also qualify for Medicare, but if you have a work history you may have to wait for up to two years. If you don’t, you will also qualify for Medicaid. Either way, you’ll need to lawyer up.

Yet, one of the greatest parts about Obamacare, is minimizing the out-of-pocket costs for Medicare beneficiaries. The law phases in rebates for drug costs, free primary care services and ways to improve quality of care. The biggest benefit is drug coverage as eventually, it will be 75 percent covered and will save people a lot of money since those pills can add up.

Nonetheless, since the law was enacted, Medicare has still been subject to changes because of sequestration by capping reductions to payments and limiting out-of-pocket expenses. Fortunately in Obama’s plan, the “doughnut hole” will be closed by 2015 instead of 2020 and (unfortunately for hospitals) teaching hospitals and hospital debts will be paid less. Another controversial new provision is having wealthier Medicare beneficiaries pay more. Others have proposed Medicare changes but none offer Obamacare’s biggest addition to the program – the elimination of the “doughnut hole.”

All these changes and back-and-forth make it even harder for Medicare beneficiaries to understand. Drug coverage for this vulnerable population could mean saving an extra few hundred dollars a month, or more importantly an ER scare. I doubt most Medicare beneficiaries follow health reform closely and if they do, I bet they’re still confused about what pieces are going to be implemented that will affect them. Like our health care system, we need a concrete plan that will curb costs and improve quality of care in place of making changes step-by-step as things go wrong. Step-by-step, day-by-day doesn’t work. What we need is a fresh start!

IMAGE CREDIT. seniorjournal.com.

Apr 02

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Happy Birthday, Obamacare!

By Leanne Demery | Health | No Comments

Happy Belated Birthday Obamacare! In just three little years the Affordable Care Act has made some big changes but has a whole lot more to do. All of the law’s provisions won’t be in full effect until around 2020 but that doesn’t mean the law hasn’t made a big impact already.

Most of us have heard that the law has put a tax on using tanning beds, provides free preventative services, lets young adults stay on their parent’s insurance until the age of 26, will require everyone to buy health insurance, and will create health insurance marketplaces called “exchanges.” Most people don’t know the bulk of what the law has done, so in celebration of the birth of Obamacare, here’s just some of what this ambitious law has accomplished. A full list of the ACA timeline can be found here.

Prevention is worth a pound of cure…

A lot of what Obamacare has focused on in the past three years is preventative services. In its first year the law created the National Prevention, Health Promotion and Public Health Council which passed the National Prevention Strategy and the law required any new health insurance plans to include minimum prevention services. It’s been a good few years for primary care doctors too, as their programs have received billions of dollars in funding and new residencies were added for primary care in an attempt to draw more pre-meds to a sorely under-staffed field. In the past few years the ACA has also focused on workplace wellness as it provided grants to small employers with a wellness program, and tax credits to large employers who invested in certain treatment projects.

While all this has been going on, the only thing that the average person might have noticed is new nutritional info on vending machines and at chain restaurants. But even more monumental changes have been made to the two heavyweights of America’s healthcare system – Medicare and Medicaid. A massive assessment of services is underway with the creation of the Medicaid and CHIP Payment Advisory Board. More immediately, the federal government has allowed states to begin to offer home and community-based services through Medicaid, which means more senior centers, transportation, home health aides, meal delivery or anything else that can help someone remain independent living at home.

Closing the doughnut hole…

As for Medicare, one of the biggest changes was tackling the prescription “doughnut hole.” In 2003, when the Bush administration added Medicare Part D to provide for certain types of drug coverage, the provision did not help pay for annual drug expenses between $2,250 and $5,100. Starting in 2010, Medicare patients started receiving $250 in rebates for brand name drugs, and then the following year they could get a 50 percent discount plus federal subsidies for generics. This year they can receive federal subsidies for brand-name drugs. Doughnut hole closed!

Figuring out how we pay for it all…

A lot of the ways in which the ACA is being funded (about 50 percent of it) is through Medicare and many of these funding changes occurred within the past three years. Some of this is funding received through trying out other models of payment instead of fee-for-service such as bundled payment programs and Accountable Care Organizations, which have recently been piloted. Other funding comes from an increase in Medicare Advantage premiums and a decrease in federal subsidies for this program, as well as a reduction in payment for Medicare patients who have been recently re-admitted to the hospital. This year too, wealthy elderly had a Medicare tax increase of 0.9 percent to help pay for the law.

And what it means for you…

For the future, a big obstacle will be getting the word out! The changes that affect everyone (the individual and employer mandate, exchanges, tax credits, Medicaid expansion) begin next year. Don’t delay! Now’s the time to educate yourself about how you’ll be affected and what your options will be. For all of Obamacare’s limitations, you’re sure to find it’s more than a party favor.

IMAGE CREDIT. Foxnews.com.

Mar 19

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A Brief History of Belt-Tightening

By Leanne Demery | Health | No Comments

When Barack Obama announced health reform as a part of his first presidential campaign, the cost of healthcare was never a major priority. Expanding coverage was always the main intent despite the fact that the United States spends more on health care than any other country in the world, reaching almost three trillion dollars or about 17 percent of the nation’s GDP. So if you’re going to attempt comprehensive health reform, why wouldn’t you have cost control included? If you take a look at other attempts of cost control in the past, you can see how the piece-meal attempts have not gotten close to fixing the problem.

The last time a president directly controlled health care costs was in 1971 under President Nixon with his executive order to freeze wages and prices. His Cost of Living Council allowed physician’s fees to increase by only 2.5 percent a year but its authority expired in 1974. The council however, did spark in interest into looking at how hospitals were paid, which were at that time on a per diem basis. The department of Health, Education and Welfare then came up with a payment system based upon diagnosis, now called the Diagnosis Related Grouping (DRG) system and widely used throughout the world. In 1984 Medicare adopted DRG, which is based upon the average cost of treating a patient per a particular diagnosis. During Nixon’s time in office Medicare also changed to have a regulated room and board cost to all hospitals and limited the per diem cost, which was not regulated. Yet, eight states at that time decided to control the rates that Medicare paid to hospitals, and today Maryland is the only state left standing.

After Nixon sparked the idea of health reform and cost containment, President Ford attempted a unique approach. Under the National Health Planning and Resource Development Act, local planning agencies were created to approve new facilities or buy expensive equipment. The agencies were presented with Certificates of Need (CON) to determine if spending was appropriate. The program was inefficient as CONs sometimes were too hard to get, and was eventually eliminated under President Reagan.

Then we have President Carter who was ambitious with his attempt at cost control. Twice during his presidency his proposals for limiting hospital’s total revenues were defeated. At this time, congress must have been feeling pretty optimistic as they agreed to have hospitals voluntarily contain costs. And that policy is still in use today.

The next attempt at cost control was under the Balanced Budget Act of 1997 that proclaimed physicians’ fees would decrease in the future if they exceeded a targeted amount set the previous year. It was enacted for the first two years, but since 2002 congress has postponed the decrease each year and has even allowed small increases. So much for that!

From past attempts at controlling costs, it was obvious a total re-haul of health care spending would be difficult. Obama knew he had to start (somewhat) small to pass something. Though it was an absolute battle to pass, it was a walk in the park compared to what could have been, or what could have never happened at all.

Nonetheless, Obamacare has a few provisions that will feebly attempt to control costs, mostly through regulation of insurance company administration costs by adopting a set of standards (all effective by January 2016) and through Medicare. Medicare Advantage plans have been greatly subsidized in the past, but will be greatly reduced by 2019. Also, the Independent Payment Advisory Board (IPAB) will establish growth spending rates by 2018 and will decrease funding if Medicare exceeds this target. The other provisions allow for tests or trials to control, such as centering care around primary care physicians, which is why many preventative services are free of cost.

Most of the cost control attempts in Obamacare are experimental. And USA Today claims that in the past three years Obamacare has slowed health care spending growth. Others would strongly disagree. Considering we spend the most on health care in the world, and have the 38^th best health system (it makes me cringe to say this), Obamacare is better than nothing.

IMAGE CREDIT. Emory University.

Mar 05

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Bills, Bills, Bills

By Leanne Demery | Health | No Comments

If you have yet to read Steven Brill’s TIME cover story, “Bitter Pill: Why Medical Bills are Killing Us,” you should. It’s long, but it’s worth it. Though the public has been worrying about medical costs since the Great Depression, Brill does a great job illustrating just how expensive medical care is and how Obamacare doesn’t really do much to offset costs. After reading this article I asked myself a few questions. The first was, why are medical bills really so high?

The simple answer is because of the fee-for-service payment system that doctors in the U.S. have fought so long to keep. It’s a method of payment older than our country itself. When doctors would do home visits in colonial times they would charge patients per mile traveled on the horse and buggy. And although doctors don’t directly charge us for the gas to get to work in the morning, we are charged for medical education, administrative costs and other costs that aren’t directly related to one service. Even when you go to a hospital you are charged twice – once from the doctor and once from the hospital. The professional authority of doctors has allowed them to control their own fees for services as separate from the total cost.

This causes the second issue of doctors and hospital administrators dictating prices. Doctors have always charged patients on their ability to pay and not on the quality of service or on effort. For example, surgery costs have steadily increased but the actual effort of a doctor to perform a surgery has decreased. At one time only the doctor would be charged for a surgery because he did most of the work including pre-op care and rehab, now he is still charged at the same rate, but you are now paying technicians, assistants and others who are billed as well. Procedures have been simplified but medical costs remain high and continue to rise.

One of Brill’s main opinions was that an expansion of Medicare could help control costs, yet medical historian Paul Starr argues that it was the third party government programs and private insurers that led to medical inflation in the first place. Because most of the time patients don’t see their bills, the general public is unaware of the true cost. Another reason is that because third-party payers reimburse, hospitals and doctors were encouraged to raise the rates of reimbursement to offset expenses instead of figuring out how to lower costs in the first place.

All of which begs another question: how can non-profit hospitals make so much profit? Hospitals originally started to provide free care for individuals whose families couldn’t take care of them and for a while they served only charitable care. But with the increase of the middle class, patients wanted better rooms and better services so doctors and hospitals began to charge more. Because of surgery and technology, hospitals became institutions with a lot of jobs, people and money floating around. Hospitals are usually governed by an elected board of trustees but when they aren’t affiliated with a university or religious institution, can easily be bought out by a big corporation.

So these hospitals with a non-profit, tax-exempt label get to keep their status even if they are now owned by a corporation and then governed by corporate management. Even many state hospitals have been sold to corporate entities. The other scenario is when a non-profit hospital then buys for-profit entities such as restaurants, rehabs, clinics, nursing homes etc. It seems that the status quo for hospitals is to increase available services and fees, expand buildings and usurp other medical entities, which all drastically raise costs for the patient. At the same time, the hospitals argue this is what patients want — top of the line technology, more services and bigger and nicer buildings. So I guess (certain) patients are getting what they want, and they’re paying for it too.

My last question was, why hasn’t anything been done to stop the medical monstrosity of health care costs? The quick answer is there have been efforts but most have been focused on Medicare and Medicaid, not on the entire system, and none have had an impact. The full explanation is for another time. As Brill notes in his article, Obamacare makes some minor, meager efforts at controlling costs but nothing impressive, mostly because of such strong hospital lobbying.

However much controlling costs is essential to having a more efficient health care system, expanding coverage was always the main priority of Obamacare. But Obamacare is adapting to peoples’ worries, as the administration recently announced they will require insurance companies to report any price increases. With Obamacare we’ve jumped over one hurdle on expanding access to care. Now we can hopefully pave a path to reducing costs.

Image courtesy of: www.helpingyoucare.com

Feb 22

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Disease Prevention is Sexy

By Adam Conway | Health, The Global Is Local | One Comment

Preventative health care is sexy. This is true in politics — as a means of addressing our long-term cost issues — but also to providers and patient advocates in terms of quality. We have heard a lot about preventative care in the last few years, especially with the discussion and passage of the PPACA (the Patient Protection and Affordable Care Act), a.k.a. “Obamacare.” But some argue that preventative care is just as expensive as the alternative.

So, does preventative care actually save money?

Regardless of whether or not it works, lowering costs by increasing preventative care is far from a new idea. A very brief search yielded this 1977 article touting the cost-effectiveness of preventative care. The theory is straightforward, and I will not belabor you with the details. In brief, however, it goes like this:

Some kinds of health care are expensive, and are often tied to chronic physical or psychological conditions. Treating those conditions early and often — improving habits and monitoring various indicators — rather than late and intensively should lower costs overall, since emergency or acute care in hospitals is very, VERY expensive. Oh, and health care expenditures are going up, in case you hadn’t heard. (And although Medicare and Medicaid are part of the problem, they are far from the biggest part of the story…)

US Healthcare Spending as a Percent of GDP

That’s the short and sweet version. Feel free to look out there on that world wide web for far more in-depth discussion and articles, or look into one of the many excellent books on the subject. Also, I recommend the blog post by my colleague, Leanne Demery, who provides analysis of one of the Affordable Care Act’s major provisions, State Insurance Exchanges.

In some form or another, earlier, preventative interventions are the basis for many of our health reform efforts, both current and past. Usually there is some lip service to quality of care, too, but savings sell. They’re sexy.

So what is the problem? Take care of people before they are sick, save money doing it, pat yourself on the back and call it a day!

The problem is simply that preventative care is ALSO expensive. In addition, if preventative care is successful, it may simply delay future costs. This argument is not new either, as Marcia Angell writes in the Journal of the American Medical Association in 1985: “Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one.” There’s also a fantastic study often cited by health economists by Manning et. al. proving that smokers and drinkers who die early based on their unhealthy behaviors actually are a net gain on the health economy.

Let’s circle back to the original question though: Does preventative care lower costs?

To help me answer this question, I had the pleasure of speaking with Doctor Jay Sanders yesterday. Among many other roles, he is a Professor of Medicine at Johns Hopkins University’s School of Medicine. He was quoted in Tuesday’s Kaiser Health News report on health kiosks in Walmart stores. These unmanned kiosks are self-service booths that allow customers to respond to questions about their health, diet, and family health history.

Dr. Sanders argued that the Preventative Care/Cost Reduction situation has been misrepresented. He pointed out that in the short-to-medium term (1-15 years), increased preventative care will almost certainly not decrease costs and instead probably drive them up. This does NOT mean that preventative care will cost more overall. Long term costs will likely come down, but the specifics are yet to be seen, and the time factor has been left out of the discussion.

To be successful, according to Dr. Sanders, health care needs to get smarter, more targeted, and more present for patients. He cites technological innovations, some of which are being developed and implemented here in our region, as potential game-changers. For instance, Under Armour and Zephyr are making items of clothing with embedded technology to monitor vital signs for athletes and gather other information for their coaches. Soon these items will be affordable consumer products that can be tied to our mobile devices, gathering data for us to share with our doctors about heart rhythms, activity levels, and asthma symptoms, among other metrics.

Finally, Dr. Sanders pointed out, the onus is on us as individual patients to generate better outcomes. Smart phones, apps, and wearable technology should make us more aware, at the least.

I agree with him, and I draw a tenuous parallel with democracy. We deserve the health, or government, that we get. If we want something different, we really ought to be more involved. If the Affordable Care Act is successful, we should not necessarily expect that success to be immediate. Instead, a long view is necessary, a chance to allow the experiment to take place.

As a parting thought, keep in mind that our spending as a country has not exactly yielded great results in the past. Quite frankly, a new approach could hardly make things worse:

Life expectancy vs health spending

IMAGE CREDITS, University of California at Santa Cruz Health Atlas;

Organization for Economic Cooperation and Development

Feb 19

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Obamacare Keeps Calm and Carries On

By Leanne Demery | Health | No Comments

The final count is in! The federal government will be providing health insurance exchanges for 26 states. On February 15th, states had their last chance to opt for a federal partnership to run an exchange – essentially an online marketplace for health insurance. States will always have the option to take control of the exchanges themselves (which the feds would prefer), but for now only the other 24 states have chosen to set up their own and have them running by October 1st of this year.

Some states were skeptical that they would have the funds and manpower ready to meet that deadline. But many Republican-led states simply refused to run their own exchanges because they didn’t want to be a part of Obamacare, despite the fact that most Americans agree that exchanges will work best under state control. The department of Health and Human Services ideally wanted all of the states to take control of the exchanges and will have to work hard to adjust its original plans, as has so often been the case for Obamacare. The story of the president’s signature reform has been one of change.

Indeed, that we have exchanges at all is the result of a shift in position. The basis for the exchanges is the individual mandate, which requires all U.S. citizens (with certain exceptions) to have health insurance by January 1, 2014. Originally, President Obama was against the individual mandate – a topic hotly debated in his primary battle with Hilary Clinton. Once president, he saw that there was no other choice. Without the mandate, the government couldn’t require insurers to turn away sick people as some people might wait until they were sick to buy insurance.

As of now, uninsured people with pre-existing medical conditions have been able to enroll in the government’s Pre-Existing Condition Insurance Plan, but the Obama administration announced Friday that they had to cap the plan due to financial restrictions. Other changes have been made since Obama originally proposed his vision for health reform. Obama had wanted to include a public option or a publicly-run insurance plan (similar to Medicare, which is government-run) to compete with the private insurers in the exchanges. This would potentially drive down insurance premiums and lower administrative and medical service costs.

But a public option would be tricky to get right since it wouldn’t work if too many people were enrolled, or too few. If enrollments in a public option were too numerous, providers wouldn’t be able to “cost shift” – currently, by charging higher premiums to private, fee-paying patients, doctors and hospitals gain back losses from providing services to Medicare patients, Medicaid patients and the uninsured. Conversely, if there were severe enrollment restrictions and too few people were enrolled in a public option, it would most likely be those with a high risk. This would leave the public option bankrupt and private insurers rolling in the dough from having so many healthy people enrolled.

And of course a public option is considered by conservatives to be a first-step toward a single-payer health system (a health system in which one entity pays for all health services), which liberals would cheer, but which they believe to be dangerous government intrusion on the workings of the market.

As a compromise on the public option, the Senate offered a Medicare expansion to enroll people at the lower age of 55. Neither this nor the public option could get passed so the Consumer Operated and Oriented Plan (CO-OP) was born. A CO-OP is a non-profit insurance plan controlled by the patients it insures and must be included in all state exchanges. The government is offering low-cost loans to both new groups and existing ones. Twenty-four states have received loans and their CO-OPs will be highly monitored to make sure they will repay loans and are meeting goals.

Even after clearing so many obstacles, many are still skeptical the plan for Obamacare can be carried out. Will a federal exchange be ready by October? For one, it’s an enormous feat of information technology and logistics that will need to connect many government departments such as Homeland Security (to verify citizenship) and the IRS (to determine subsidy eligibility). By July, insurance plans for the exchanges are expected to be chosen, but will HHS have and choose the best plans?

Could the federally-run exchange look like a public option?

Will states eventually take over their own exchanges?

Will people even know about the exchanges by next year?

Will the exchanges really provide competitions for insurers?

And will policymakers be forced to make yet more changes to address these questions?

As America’s great experiment with healthcare reform unfolds, only time will tell.

IMAGE CREDIT. endthefedusa.ning.com.

Jan 08

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Obamacare – Exchanges, Optimism and Irony

By Leanne Demery | Health | No Comments

The New Year brings us optimism, good spirits and hope that America will be one step closer to equality in health care. Over the holidays, states and the Department of Health and Human Services were hard at work developing the health insurance exchanges, or in other words, an easier way for certain individuals and small business owners to purchase health insurance.

The exchanges must be ready by October 2013 for enrollment and be fully operational by January 2014. Yes, that’s optimism at its finest. In mid-December 2012 states had to decide if they were going to run the exchanges themselves or use the government plan. Though, until February 15, 2013 states can still opt for a federal partnership. So far, 19 states decided to operate the exchange themselves, seven decided to receive some help from the government and 25 have defaulted to a federal exchange.

Basically, exchanges are going to be organizations (either a government agency or a non-profit) that will help make finding health insurance simple and straightforward and will keep prices competitive among plans. Massachusetts already has had a great functioning exchange since 2007 called Health Connector. Utah also has had a functioning exchange since 2009 for small businesses but will need to expand to individuals.

All exchanges, state-run or not, will need to meet minimum standards set by the Affordable Care Act which includes hiring ‘navigators’ for assistance, client education, basic health benefits, maintaining a website, and rating health insurance plans. All exchanges must offer two plans and one must be from a non-profit. Ideally, if you are looking for insurance you’ll be able to go onto a website, browse plans, have all your questions answered either online or by phone and be enrolled with an affordable plan that fancies you within 30 minutes. Good thing it’s January so we’re all feeling extra optimistic! By 2014 people who don’t have employer health insurance (those with lower incomes will receive subsidies) and small business with up to 100 employees will be able to find health insurance plans through an exchange. By 2017, states can decide if they want to offer exchanges to larger employers.

Originally, the intent was for exchanges to all be state-run since state legislatures probably know what works best for them as far as setting eligibility, plans and funding. It was expected that only states with small populations would default to a federal exchange, but the two most populous states with 20 percent of the nation’s uninsured, Texas and Florida, have opted for the default.

Most states that chose to have a federal Exchange did so early in advance claiming that the exchanges would be too expensive or to try to sabotage Obamacare since they don’t agree with the law. All but four states received grants to help offset costs which mainly went to hiring IT work. The states with partnership exchanges will be able to manage plans and customer service and the hope here is that the Department of Health and Human Services will try to work with states as much as possible to individualize the exchanges so that all states will have the opportunity to move to a state-based model in the future.

The irony here is that the Republican states that chose a federal exchange are going against their fundamental Republican ideals. They complain that Obamacare is big government but they certainly don’t seem to have a problem making government’s role bigger in this case. I’m staying optimistic though, the world didn’t end, Obamacare is in full effect, Republicans can still flip-flop on exchanges and I’m hoping people will remember once again George Washington’s warning in his farewell address of damaging divides due to partisan political spirits.

Nov 13

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Obamacare –A Reform that Keeps the Status Quo

By Leanne Demery | Health | No Comments

Since the turn of the 20th century there have been people calling for healthcare reform in the United States. Why did it take over a hundred years? In the United States, the major players would rather keep things the same than make a drastic change. Obama knew that many before him had failed miserably. So Obamacare builds on our current, privatized, for-profit health care system (that’s right, Obamacare is actually the opposite of socialized medicine). Our system has a lot of groups with a lot of benefits and most do not want to sacrifice them for universal care. To reform healthcare, you have to make changes, but not too many or else you won’t keep enough people happy.
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Oct 30

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Obamacare Explained

By Leanne Demery | Health | No Comments

Health policy in the United States is unique, to say the least. We are the only developed economy that does not have nationalized health care and despite popular belief, the United States does not have the best healthcare in the world even though we spend the most on it. According to the World Health Organization, the United States ranks 37^th in health care – just behind Costa Rica and above Slovenia and Cuba. So how did we get into this economic and unhealthy mess? It’s a long story full of scandals, politics, history, economics, and American culture. In this space, I’ll seek to tell that story and explain healthcare policy, and the debates that swirl around it, in accessible terms.

In just a week, Americans will go to the polls to decide whether President Obama will get a second term. Healthcare reform – the president’s signature legislative achievement – hangs in the balance. Read More

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