Tuesday, August 16, 2016
Candor and thoughtfulness
In a first for an occupant of the White House, President Barack Obama has authored a lengthy appraisal of health care reform efforts in the United States in a top-notch medical journal, JAMA. The essay looks in detail at the effects of the Affordable Care Act (“ObamaCare”) thus far on access to health coverage and the trends in health care spending.
Beside the historic first of a sitting President publishing a significant health care think-piece, what's notable is the candor with which Obama appraises the ACA, both its successes and failures. He offers a roadmap going forward for how we can further expand coverage and continue to diminish the portion of our spending devoted to health care (both as a government and as individuals, i.e. what we pay out-of-pocket).
The 2 most impressive achievements of the ACA are the drop in numbers of uninsured Americans (from 16% to 9% of the population) and the slowing of health care inflation. The article is a bit wonky, so here is a key portion of the argument about how the ACA has slowed health care spending: “From 2010 through 2014, mean annual growth in real per-enrollee Medicare spending has actually been negative, down from a mean of 4.7% per year from 2000 through 2005 and 2.4% per year from 2006 to 2010 … Similarly, mean real per-enrollee growth in private insurance spending has been 1.1% per year since 2010, compared with a mean of 6.5% from 2000 through 2005 and 3.4% from 2005 to 2010 …
“As a result, health care spending is likely to be far lower than expected. For example, relative to the projections the Congressional Budget Office (CBO) issued just before I took office, CBO now projects Medicare to spend 20%, or about $160 billion, less in 2019 alone.”
What I also find interesting is the ancillary material: Like all JAMA authors, President Obama was required to submit a financial disclosure form to demonstrate no apparent financial conflicts of interest in his presentation of data and policy recommendations. As an attachment to the article, the White House included the President's annual financial public disclosure statement. A couple of take homes for me: Index Funds. The President sensibly has retirement investments in Vanguard index funds. There's even information about the mortgage on his Chicago home. If interest rates stay the way they are, he should definitely think about refinancing soon.
This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.
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