Most Americans Want Changes to Affordable Care Act

Gallup: “Americans’ assessments of the Affordable Care Act (ACA) remain relatively unchanged after the Nov. 8 election, with more continuing to disapprove (53%) than approve (42%) of the law.”

“Going forward, the vast majority of Americans want to see the law changed. This includes the 37% who want it repealed and replaced, along with a total of 43% of Americans who want the law kept, but with major changes.”

Researchers Have Found a Troubling New Cause of Death for Middle-Aged White Americans

Washington Post: “This week, a pair of economists have advanced a new theory. They suggest that, for many workers, a major shift in the structure of the U.S. economy may have been fatal.”

“The researchers, Justin Pierce and Peter Schott, found evidence that trade with China has resulted in greater rates of suicide and poisonings (including fatal drug overdoses) after 2000, when President Clinton and Republican lawmakers allowed a major increase in imports.”

“Pierce and Schott suggest that as competition with Chinese manufacturing forced U.S. factories to close, many of the Americans who were laid off never got their lives back together. Instead, they fell into depression or addiction. White adults, in particular, suffered from the change in policy.”

A Closer Look at 7 Republican Obamacare Replacement Plans

Vox’s Sarah Kliff took a closer look at seven Republican Obamacare replacement plans, including Paul Ryan’s “Better Way,” the Senate’s Patient CARE Act, and multiple repeal bills and think-tank proposals.

Here are her findings.

“If we can say one thing about most Republican plans, it is this: They are better for younger, healthy people and worse for older, sicker people. In general, conservative replacement plans offer less financial help to those who would use a lot of insurance. This will make their insurance subsidies significantly less expensive than Obamacare’s.”

Why Keeping Only the Popular Parts of Obamacare Won’t Work

New York Times: “Donald J. Trump says he wants to do away with much of Obamacare, but he has signaled that parts of the law that banned those practices are good policy he’d want to keep. ‘I like those very much,’ he told The Wall Street Journal last week about the law’s rules that prevent discrimination based on pre-existing conditions.”

“Those policies that make the insurance market feel fairer for sick Americans who need it can really throw off the prices for everyone else. That’s why Obamacare also includes less popular policies designed to balance the market with enough young, healthy people.”

“Taking away those unpopular pieces of the law and keeping the popular pre-existing conditions piece might seem like a political win. But it would result in a broken system.”

One Health Care Fix We All Can Agree On

Ceci Connolly: “…one shining example of bipartisan agreement is the desire to move away from fee-for-service medicine to a value-based system. Rather than focus on the number of tests, scans, and medical procedures that can be ordered, the aim is to pay for better care instead of simply paying for more.”

“Policy makers took a promising step in that direction when they included quality incentive payments in the popular Medicare Advantage program. Now however, a glitch is causing unintended consequences for millions of seniors resulting in millions missing out on this patient-centered quality revolution.”

“Fortunately, there is bipartisan support in Washington to fix this problem, including a bill, H.R. 4275, introduced in the U.S. House of Representatives. Congress and the Administration need to address the issue before packing their bags for the holidays so that beneficiaries in high-quality 4- and 5-star Medicare Advantage plans are not deprived of benefits to which they are entitled under law.”

The White House’s Top Economist on the Future of Obamacare

Sarah Kliff: “Jason Furman has become accustomed to proclamations of Obamacare’s collapse.”

“‘Having been involved in the [Affordable Care Act] since 2009, I have heard it pronounced dead hundreds of times,’ says Furman, who chairs the White House Council of Economic Advisers. ‘Half of those times were before it was even signed [into law], and half were since then.'”

“I spoke with Furman and his colleague Matt Fiedler, chief economist at the CEA, Friday afternoon about Obamacare’s marketplaces, what the premium increases mean, and why they believe a death spiral would be impossible given the health law’s structure.”

Scientists Taught a Robot to Smoke to Fight Lung Disease

Wyss Institute: “While it is well known that cigarette smoking is a major cause of lung disease, and a key exacerbating factor for patients suffering from chronic obstructive pulmonary disease (COPD), it has not been possible to effectively model its deleterious effects on human lungs under normal breathing conditions.”

“Leveraging their previously developed human lung small airway-on-a-chip model for inflammatory disorders including COPD and asthma, the Wyss Institute’s team led by Founding Director Donald Ingber, M.D., Ph.D., designed a smoking instrument that integrates with the airway chips and faithfully recapitulates smoking behavior with cells derived from healthy people and patients with COPD.”

Americans Are Dying Faster

Bloomberg: “The latest, best guesses for U.S. lifespans come from a study (PDF) released this month by the Society of Actuaries: The average 65-year-old American man should die a few months short of his 86th birthday, while the average 65-year-old woman gets an additional two years, barely missing age 88.”

“This new data turns out to be a disappointment. Over the past several years, the health of Americans has deteriorated—particularly that of middle-aged non-Hispanic whites. Among the culprits are drug overdoses, suicide, alcohol poisoning, and liver disease, according to a Princeton University study issued in December.”

Restructuring Subsidies Could Help Fix ObamaCare

Sarah Kliff: “For as long as I’ve covered Obamacare, I’ve always found Caroline Pearson to be an exceptionally smart and honest observer of the law. Pearson is a senior vice president at the research firm Avalere Health, and I called her up Tuesday morning to talk about Obamacare’s spiking premiums.”

Pearson: “I think what you have to do is rethink the subsidy structure and benefit design structure to make coverage more appealing for people between 200 and 300 percent of the poverty line.

If you look at the report that [the Department of Health and Human Services] put out on Monday, the average income of the marketplace population is 165 percent of the poverty level. It is a very low-income population.

The mandate penalties are not working to compel people into the market, but the subsidies are in. Absent higher mandate penalties, which even in a Democratic Congress is hard, you might see getting rid of the subsidies for people between 300 and 400 percent of the poverty line and doubling down on the people between 200 and 300 percent. If you could get better enrollment among that group, it might stabilize the market.”

Even More Evidence That Mammograms Have Been Oversold

FiveThirtyEight: “A study published online today by the The New England Journal of Medicine added to a growing body of evidence that for every woman who has been helped by a mammogram screening1 for breast cancer, many more have been harmed.”

“Screening did result in more cancers being detected, he said, but the data suggests that only about 30 of the 162 additional small tumors per 100,000 women that screening mammograms found would ever have progressed to a dangerous stage. That means that 132, or 81 percent, of the 162 extra tumors detected represented ‘overdiagnosis’ — the discovery and treatment of tumors that were never destined to harm.”

More Evidence Expanding Medicaid Increases Emergency Room Visits

Washington Post: “According to the new study, people who gained Medicaid visited the emergency room about 65 percent more often than individuals who did not gain Medicaid in the first six months — and the trend continued out to two years. The estimates of increased emergency department use at 12 months, 18 months and 24 months are ‘similar and, for the most part, statistically indistinguishable from each other,’ the authors wrote.”

“People covered by Medicaid were more likely to both see a physician at a regular office visit and also go to the emergency room, casting doubt on the idea that people were using health coverage to shift their health care to a primary care doctor.”

Does Economic Growth Kill People?

Washington Post: “Everyone wants economic growth, right? It’s part of every politician’s package of promises. Expanding economies make people richer, and study after study shows that the wealthier lead happier, healthier lives.”

“Yet in recent years, accumulating evidence suggests that rising incomes and personal well-being are linked in the opposite way. It seems that economic growth actually kills people.”

“Christopher Ruhm, an economics professor at the University of Virginia, was one of the first to notice this paradox. In a 2000 paper, he showed that when the American economy is on an upswing, people suffer more medical problems and die faster; when the economy falters, people tend to live longer.”

“In other words, there are great benefits to being wealthy. But the process of becoming wealthy — well, that seems to be dangerous.”

Why More Doctors Need to Vote

Dhruv Khullar: “Doctors don’t vote — at least not enough.”

“We’re less likely to vote than lawyers, other professionals, farmers, and the general population. In some recent elections, less than one-third of doctors voted.”

“Regardless of party affiliation, more politically active physicians could add an important voice to our political and social discussions. Health care accounts for the largest share of the economy, at more than 17 percent of the gross domestic product. In the 2012 presidential election, health care was the second most important issue to voters. This year, prescription drug pricing emerged as a major public concern, and both Republican and Democratic voters favor government intervention to help reduce prices.”