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Single Payer Would Radically Transform Health Policy Research

The May 2023 issue of Health Affairs, the leading health policy journal, has 20 articles. In our assessment, 9 of them would be unnecessary and another 7 simplified if the US had truly universal and standard health insurance. These health policy resources could be redirected to critical non-insurance issues in access, equity and disparities, and outcomes.

May 6, 2023

Health Affairs Table of Contents May 2023

(Parenthetical assessments by HJM.)

Availability Versus Accessibility: Identifying COVID-19 Testing Deserts Across Massachusetts (Largely a coverage issue; simplified.)

The Role of Financial Incentives in Biosimilar Uptake in Medicare: Evidence from the 340B Program (Drug pricing issue; simplified.)

Benchmarking Changes and Selective Participation in The Medicare Shared Savings Program (ACO issue; likely moot.)

Trend Toward Older Maternal Age Contributed to Growing Racial Inequity in Very-Low-Birthweight Infants in the US (Partially an insurance issue; simplified)

Federal Funding for Discovery and Development of Costly HIV Drugs Was Far More Than Previously Estimated (Informs drug pricing; still needed.)

Medicaid Payment For Postpartum Long-Acting Reversible Contraception Prompts More Equitable Use (Coverage issue; moot.)

Insurer Market Power and Hospital Prices in the US (Insurer patterns; moot.)

Hospital-Physician Integration Is Associated with Greater Use of Cardiac Catheterization and Angioplasty (Provider ownership & practice issues; likely still relevant.)

The Costs of Disparities in Preventable Heart Failure Hospitalizations in The US South, 2015–17 (Partially insurance issue; simplified.)

Enrollment and Characteristics of Dual-Eligible Medicare and Medicaid Beneficiaries in Integrated Care Programs (Insurance issue; moot.)

The Neighborhood Atlas Area Deprivation Index for Measuring Socioeconomic Status: An Overemphasis on Home Value (Equity; still relevant)

Changes In Health Coverage During The COVID-19 Pandemic (Insurance issue; moot.)

Buprenorphine Treatment for Opioid Use Disorder: Comparison of Insurance Restrictions, 2017–21 (Insurance issue; moot.)

‘We’ll Decide for You’: A Patient Is Rushed at Hospital Discharge (Partially insurance issue; simplified.)

Inequities In the Use of High-Quality Home Health (Largely insurance issue; simplified.)

Risk Adjustment and Health Equity (Insurance issue; probably moot.)

The Neighborhood Atlas Area Deprivation Index and Recommendations for Area-Based Deprivation Measures (Equity issue; still relevant.)

The Health Plan Price Transparency Data Files Are a Mess- States Can Help Make Them Better (Insurance complexity issue; moot.)

Identifying Scalable Strategies to Maintain Coverage as Medicaid Continuous Enrollment Ends (Insurance issue; moot.)

Why International Recruitment Won’t Solve the US Nursing Staffing Crisis (Largely financial issue; simplified.)

Comment by: Jim Kahn

Much health policy research examines the harms of and potential fixes for un- and underinsurance – problems created by our chaotically fragmented health insurance.

Our review of the table of contents of the premier US health policy journal suggests that the government and academic health policy community focuses on issues that would disappear with universal high quality health insurance, including drug price regulation – under single payer.

The considerable collective skills of health policy researchers should, could, and would be re-directed to the issues that are not fully resolved with single payer, such as disparities in access, care, and outcomes related to economic status and race.

Health policy researchers would also be called upon to study and refine the performance of single payer. For example, how should drug prices be set? How do provider reimbursement levels affect care patterns and outcomes? What is the impact of covering long-term care? How do clinical outcomes in the real world vary by choice of medical strategies? In another post, I’ll more fully describe a single payer health policy research agenda.

The contributions of health policy research must be unleashed by removing from the research portfolio the highly frustrating and largely futile research focused on trying to fix our irremediably broken insurance system. Policy band-aids, no matter how cleverly designed, won’t fix major pathology.

Liberate and empower health policy research!

About the Commentator, Jim Kahn

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Jim (James G.) Kahn, MD, MPH (editor) is an Emeritus Professor of Health Policy, Epidemiology, and Global Health at the University of California, San Francisco. His work focuses on the cost and effectiveness of prevention and treatment interventions in low and middle income countries, and on single payer economics in the U.S. He has studied, advocated, and educated on single payer since the 1994 campaign for Prop 186 in California, including two years as chair of Physicians for a National Health Program California.

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