Friday, November 21, 2008

Obama & Health Care: Most Likely Outcomes

Obama has some hefty challenges awaiting him in the White House for sure.  The rough economy and war overseas will have to be immediate priorities in January.  Health care reform is also in that list of top priorities.  Last week, Johns Hopkins School of Public Health (JHSPH) held their 4th event in the Universal Healthcare Series, "Moving Toward Universal Healthcare:  Alternative approaches to reform in the US."  Harvard's Dr. David Himmelstein was among the speakers, whom pointedly noted that we've had plenty of opportunities for reform, which have failed (think Clinton's 1992 effort and many multiple state attempts).  He pointed out that now is our opportunity for reform.  

In today's issue of The Lancet, Nellie Bristol discusses Obama's plans for our country and the world's health (Obama's plans for US and global health care).   Many project the following are most probable and feasible Obama's immediate administration:  reversal of Bush's ban on stem cell research, expansion of State Children's Health Insurance Program (SCHIP), reversal in "Mexico City policy" (aka global gag rule), and the establishment of a comparative effectiveness group (similar to UK's National Institute for Health & Clinical Excellence).  

To expand on probable immediate actions, Obama is likely to remove some of the restrictions Bush placed on stem cell research (to only use existing stem-cell lines).  Secondly, SCHIP was vetoed by Bush last year after approval from both houses of Congress.  Most likely coverage will be expanded by $35 billion to $60 billion (paid by cigarette taxes).  Children make up 20% of the US uninsured population (Kaiser Foundation).  Expansion of SCHIP appears likely.  Next, the Mexico City policy (global gag policy) requires NGOs to agree to neither "perform nor actively promote abortion as a method of family planning in other nations."  It was enacted by Reagan in 1984, overturned by Clinton, and put back into place by Bush.   Finally, the comparative effectiveness group would look at evidence-based medicine and the Medicare system for physician reimbursements to give guidelines for clinical practice.  

What will be the long-term results though?  Will we move away from employer-based health insurance?  Will we cover all Americans?  Will we have better preventive care and can we improve health outcomes with new policy reform?  How much will we spend on global health, when the US needs the health improvement also?  

It's certainly an interesting time to be near Washington DC and in the field of Health Policy & Management.  Be sure to advocate and put full pressure on local representatives to push for health care reform (there is also currently a $1m media campaign targeted at newly elected officials to "keep their promises" for health care reform).  

If we don't reform US health care now, (when) will we?