Atul Gawande on the importance of preventative care and the disastrous Senate "health" bill

Atul Gawande (previously) is a highly respected expert on systems thinking, preventative medicine and dying with dignity has published an excellent editorial about the medical shortcomings of the Senate GOP's tax-break/health cut bill.



The essay builds on a paper in the New England Journal of Medicine that Gawande published with Harvard health economists Katherine Baicker and Ben Sommers, analyzing a decade's worth of health insurance data with particular regard to Medicare and Medicare expansion.


Gawande's conclusion is that Medicaid is a good deal: people with Medicaid like their coverage, and all the outcomes for Medicaid patients are comparable to, or superior to the outcomes of people with top-notch private coverage. The major impact of insurance is an increase in routine, preventative care, which can "help explain why people who have health insurance are twenty-five per cent more likely to report being in good or excellent health."

They contrast this emphasis on preventive care with the conservative/Republican emphasis on "catastrophic events" and coverage that only kicks in when you get hit by a bus or diagnosed with cancer. The "the path of life isn’t one of steady health punctuated by brief crises."


The Senate bill would also ultimately make people who buy insurance on the A.C.A. exchanges—people without coverage from an employer or from Medicaid—pay far more money for far worse coverage, especially if they are age fifty or older. The standard “reference” plan on the exchanges would cover barely more than half of medical costs, while cost-sharing subsidies for working-class people would be eliminated, and the level of tax credits available to them would be cut, too. The result: the median deductible would jump from the current five hundred dollars to more than six thousand dollars. The annual premium for a sixty-year-old earning fifty thousand dollars in my home town of Athens, Ohio, would triple, to fourteen thousand dollars. In many parts of the country, things would be much worse. (In Anchorage, Alaska, for example, premiums would be thirty-six thousand dollars.) The bill, in other words, promises terrible coverage at unaffordable prices. Millions of people would have to give up insurance, leaving them without protection and the entire individual-insurance market at risk of collapse.


The trade-offs here are indefensible. The bill would take a trillion dollars away from health coverage for the bottom fifty per cent of the population to give a tax cut to the top two per cent. The Center on Budget and Policy Priorities did the math: one consequence of the legislation is that three-quarters of a million people would be thrown off of the Medicaid rolls to give the four hundred highest earners in the country a thirty-three-billion-dollar tax cut. The bill would put thousands of nursing homes, clinics, and hospitals into financial trouble. And for patients it would mean more medical debts, more untreated sickness, and more deaths. A basic test of government is its ability to prevent large-scale harm to its citizens’ health and survival. This bill, and this Administration, are failing that test.


How the Senate’s Health-Care Bill Threatens the Nation’s Health
[Atul Gawande/New Yorker]


(via Marginal Revolution)


(Image: Pulmonological)

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