Category Archives: Medicine & Health

Health Policy Post! My Actual Day Job!

I work at a state Medicaid agency that’s planning to cut payments to doctors who can get that dough back by improving their patient outcomes. It’s generally called “paying for value.” Its opposite, “paying for volume,” pays docs for the number of services they provide, rather than their patients’ improved ability to bike to the river.

Clearly we need to pay for health care quality instead of for however many brains one can stuff into an MRI machine.

But we also know that social factors–jobs, education, immigration status, housing and food security–determine up to 80% of a person’s health. Not their doctor. Not their genes. Not their kale smoothies or meditation apps.

So paying doctors for outcomes may not make much sense for doctors who primarily serve people with low wage jobs in polluted neighborhoods and generally live without the kind of accumulated advantages that allow me, for example, to hit the bookstore for something to read on the airplane, which I’m flying tomorrow to a small town with a fantastic pastry shop and a famous theater.

Dhruv Khullar points out that scoring doctors who take public insurance against doctors who don’t, and paying them less when their patients inevitably can’t manage their chronic conditions as well, will probably result in lower-income people getting worse care.

And we haven’t yet figured out how to use the health care system to address people’s actual health needs: food, safe and secure housing, child care, decent wages.

I’ve been saying this around the office for a while, that value-based payments may punish doctors for poverty the same way that teacher evaluation systems punish teachers for poverty.

But Dr. Khullar is a doctor published in the New York Times, and I’m a pee-yoo-rocrat blogging for about 3 readers (hi guys!).

So not that I can do much about it, but I’ll spend my Fourth of July thinking about how to leverage health care funding streams to mitigate social inequity. Also cake. Happy Fourth.

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The Joy of Cooking Facts

This lovely paean to Joy of Cooking  crushes both the bogus science critiquing the cookbook and the broader cultural problem of trying to get reliable science about food and health. Continue reading

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Keep Your Heads Up, Friends

1000-1500 kids are about to walk past my office building to the state capitol to demand that government value their lives at least as much as they value guns. I hope they can bring this fight to help kids in Flint have clean fucking water for the first time in years.

Some of the best articles I’ve read recently, all verging on the political:

Continue reading

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CHIP Reauthorization

Congress last-last-last-minute renewing CHIP for 6 years (instead of the CBO-recommended 10 years) feels like the ice cream cone your dad buys you after telling you how bad he feels that you made him beat you up.

Good governing, guys.

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On Medicaid Work Requirements

As expected, and I’m shocked they took this long, Donald Duck’s administration announced that they will allow states to institute work requirements for Medicaid recipients.

A few panic-staving reminders: Continue reading

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Sometimes People Get Sick

Eliot Kukla wrote a beautiful meditation on the ways that our vulnerabilities and weaknesses define us.

Approximately 0.6 percent of American adults identify as transgender, just under 0.2 percent of the world population is Jewish, and 100 percent of us will get sick, yet it is being chronically sick that makes me feel like an outsider. That’s how much our society fears and rejects the core human experience of being ill, of having a body that gets sick, that ages, that is not controllable.

The United States’ mandate to be forever strong and self-sufficient belies the reality of human experience: we are neither.  Continue reading

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