President Obama Writes About Health Care Reform in JAMA

All aboard!

In a first for the Journal of the American Medical Association ("JAMA"), President Obama has authored a Special Communication on "United States Health Care Reform."

As the Population Health Blog would expect of any modern sitting President's essay on any political achievement, there are no new insights, no new useful lessons learned and no regrets. The reader is instead treated to an Affordable Care Act (ACA) legacy-building "bus tour" of selected facts and gratuitous framing of the Affordable Care Act (ACA). a

Briefly, Mr. Obama points out that, thanks to the ACA, the national uninsured rate dropped by 7% from 16% to 9%, which was accompanied by a 3.5% increase in the number of individuals with a personal physician and 2.4% increase in access to medicine. He takes credit for declines in the inflation rate for health care spending, decreases in consumer out-of-pocket health care spending, the rise of value based care, and improvements in quality of care.

The President goes on to putter around the edges with some suggestions for "building on progress to date":

• The state level Health Insurance Marketplaces would benefit from "further adjustments and recalibrations."
• Medicaid expansion needs to be extended to all 50 states.
• MACRA, CMMI, and ACOs need to continue to grow.
• Support should be provided for Precision Medicine, the Brain Initiative and Cancer Moonshot.
• Financial assistance for Marketplace health insurance premiums should be increased.
• A Medicare-like public plan should be offered in areas of the country "where competition is limited."
• The federal government should "increase" transparency for drug costs, expand rebates to support lower consumer prices, and negotiate drug pricing.
• Resist calls for repealing the excise tax on high-cost employer-provided plans.

He closes with "lessons for policymakers":

• While change is difficult, "hyperpartisanship" makes it doubly so. The tools of hyperpartisan sabotage include "inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation."
• Special interests "like the pharmaceutical industry" still "pose a continued obstacle to change."
• The ACA is an example of American middle ground pragmatism between the extremes of vouchers for all and single payer. It should continue.

The PHB's Take

As years of over-lawyering has taught Americans (indeed, JAMA has put the academic credential "JD" after Barack Obama's name), real peer-reviewed policymaking benefits not only from the truth, but the whole truth.

What makes this JAMA piece less than the whole truth is failure to mention (other than in passing) how lingering of the Great Recession is what blunted the majority health care inflation, that a shocking amount of treasure as well as political capital was used for a seemingly modest 7% absolute reduction in the uninsured rate, that government sponsored plans will likely put the remaining regional insurers out of business, and that the prospect that any company doing business in the U.S. being legally compelled to share proprietary cost information is highly unlikely.

Oh, and by the way, short of firing up some more money-printing presses or some real reforms, Uncle Sam has no money to pay for any of the additional proposed suggested goodies.  There is no political appetite for shoveling any more federal money toward health care.