MLA 2014: John P. McGovern Lecture

Dr. Aaron Carroll, author for The Incidental Economist blog, spoke about the Affordable Care Act.  Here are highlights from the session:

  • The Iron Triangle – cost:quality:access
    • can only improve 1-2 aspects of the triangle at one time without compromising the other aspects
  • US has been stagnant with covering health care
    • 3-legged stool (not that type of stool, sicko)
      • regulations: everyone should be able to get insurance even if they have a pre-existing condition
      • individual mandate: everyone needs to buy insurance, even if they are healthy
      • subsidies: provide tax credits to make the insurance affordable
  • access isn’t just about insurance — percent of people waiting 6 days or more to see doctor: US=2/3 during nights, weekends, holidays
  • “richer half of Americans are more likely to avoid care because of cost than the poor half in other industrialized countries”
  • we suck at access
  • healthcare is going to ruin us in the future
  • this is not a public-payer problem – rate of healthcare premium growth far exceeds the comparatively flat rate in employee salaries
  • regulations and limited spaces in medical education are contributing to these
  • Note to self: play with OECD data
  • JAMA August 14, 2013 – Years of Life Lost (Table 4 – Rank of Age-Standardized YLL Rates Relative to the 34 OECD Countries in 2010) <– great visual resource to demonstrate exactly how we fail in quality categories
  • States oppose Medicaid expansion for 2 reasons
    • hidden costs
    • woodwork problem – those previously eligible for Medicaid but sign up now fall into the old rates paid by the states, not the new federal expansion
  • about 1 in 3 births are covered by Medicaid and 1/3 of children in US
  • average individual policy costs $6k; 2012-2013 poverty line is about $11k – they simply can’t afford it
  • Medicaid is
  • those not expanding Medicaid forego $35bn
  • providers will still care for uninsured but get even less money
  • all reform tries to spend less money
  • health care spending is growing more slowly than almost every before
  • reform is great for the company and terrible for health care industries
  • less money is going in = big changes for us
  • medical device tax estimated to raise $30bn over a decade (2.3%) –> biggest change is that they CANNOT pass this cost on to consumers –> have to make the case for rolling out this expense on tech
  • for insurance companies, prediction models will be critical
  • networks will become more important
  • #1 thing causing physician dissatisfaction: EHRs
  • How Librarians Relate aka Our Clear Takeaways
    • adhering to guidelines is going to be key – searching & understanding the lit
    • accountable care demands more info transfer
    • there is no way for a physician to remain current without help

  •  privacy is a real issue

Other Tweets of Interest or Entertainment from the Talk



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