Must Reads: Back to School ObamaCare Edition

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Sarah Arnquist
Sarah Arnquist is editor and co-founder of the Global Health Hub. She is a health policy consultant in California. Previously, she worked in global health research at Harvard University and before that as a newspaper reporter, contributing to the New York Times and other print and online publications. She has a master’s degree in public health from the Johns Hopkins Bloomberg School of Public Health.

 obama care time magazine coverThe Global Health Hub is starting a new series called “must reads” that will range from books, to academic journal articles, and also the popular press.  Our first installment focuses on the key issue in U.S. health care at the moment: implementation of ObamaCare.

Not since the creation of Medicare and Medicaid, and arguably not even then, has there been an equally exciting time to work in or examine U.S. health care delivery. This article mixes suggestions to understand ObamaCare, track implementation in real time, and also provides suggestions for foundational reading to better understand ongoing debates.

ObamaCare: The Basics

To understand ObamaCare, first you must watch cartoons. Seriously.

The Kaiser Family Foundation has two animated shorts to help you understand.

Use other tools the foundation created to help you understand what’s happening: FAQs, a subsidy calculator, and flow charts. Each state will be slightly different and so be sure to examine the profiles for the states you care about.

Play by Play

If you’re interested in closely tracking the politics and implementation of ObamaCare, here are some people whose writing I follow:

  • Jonathan Cohn is a senior editor at the New Republic. He’s liberal, but transparent about that so you can factor that into your interpretation of his analysis.
  • The New York Times national correspondent Abby Goodnough’s only job this year is to cover the implementation of ObamaCare. Ground zero for her reporting will be Louisville, Kentucky.
  • Sarah Kliff at the Washington Post also provides good analysis.
  • NPR’s correspondents are doing a good job focusing on the ObamaCare basics: what is it, who gets it, and what will it cost.

Background

Why is ObamaCare seemingly so complicated?  It’s because of where we started.

Atul Gawande explains in a 2009 New Yorker article the concept of “path dependence” — how each nation’s health system is a product of its historical experience. The essay is a quick study on the systems in several European nations plus a history of how the U.S. system developed.

Gawande predicted the following outcome from the health reform debates of 2009: “Whatever the system’s contours, we will still find it exasperating, even disappointing. We’re not going to get perfection. But we can have transformation — which is to say, a health-care system that works. And there are ways to get there that start from where we are.”

For more U.S. health care history, check out Jonathan Cohn’s book, Sick. Cohn walks readers through the history of Medicare, Medicaid, EMTALA, ERISA, HIPAA and other acronyms. In a very readable, accessible manner, he illustrates how the financing of health care impacts the delivery of care we receive.

If you’re interested in the political history of U.S. health reform, here’s an interactive timeline that shows 100 years of work on health reform. I’m biased that it’s great because I helped create it, but the theme that emerges is the recycling of the same issues and ideas again and again.

The Price of U.S. Health Care

Why does health care cost so much in the United States? There is no simple answer to that question, and the published literature on it could fill a library on its own.

Contemporary analysis on the issue can be found in Elisabeth Rosenthal’s ongoing series at the New York Times. Rosenthal wrote an overview piece on the $2.7 trillion medical tab, an article exploring the high costs of childbirth, and another on joint replacements and trend of medical tourism. You can also listen to Rosenthal’s interview with Terry Gross on Fresh Air.

My graduate school adviser, Gerard Anderson, and several other prominent economists concluded in Health Affairs back in 2003 why health care costs more in the U.S. than other wealthy countries: “It’s the prices, stupid.” Americans don’t go to the doctor more often or use more health care services than other countries. W just pay much higher prices.  Here, Ezra Klein of the Washington Post has a short essay on the price of health care.

Quantity of U.S. Health Care

There also is a sizable amount of literature about the quantity of health care Americans receive, with a particular focus on the wide variation between health care markets that results in meager changes in population health status.

If this topic interests you, read Shannon Brownlee’s book, Overtreated, and do a PubMed search for the following names: John Wennberg and Elliot Fischer. They created the Dartmouth Atlas, which has led the view that scientific standards ought to replace a lot of the “art” in the practice of medicine.

Conclusion

Debates over balancing costs, quality and access in U.S. health care will not subside with the implementation of ObamaCare. In fact, Uwe Reinhardt cautions the following: “The central political dilemma in American health policy — leave health care to those who can afford it or increase tax revenues to broaden coverage — will continue as far as the eye can see.”

Future installments of Must Reads may examine more closely this quandary over seemingly opposing goals: decreasing costs and increasing access.

This is far from an exhaustive list of the Must Reads on U.S. health policy and ObamaCare. It’s really just a taste, and an admittedly progressively leaning taste. Please suggest additional thought-provoking writers, articles, and books in the comment section below.