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Kaiser Health News reported on a trend where policymakers are again opening up to the idea that simply increasing access to health care might not be enough to improve poor health for some patients. Other factors, such as not having stable housing or access to healthy foods, can hamper efforts to improve patients' health. To be fair, the article points out that some previous attempts to address these other factors have not produced the desired outcomes.

Kaiser Health News reported on a trend where policymakers are again opening up to the idea that simply increasing access to health care might not be enough to improve poor health for some patients. Other factors, such as not having stable housing or access to healthy foods, can hamper efforts to improve patients' health. To be fair, the article points out that some previous attempts to address these other factors have not produced the desired outcomes.

Understandably, Medicaid appears to have been designed with certain restrictions in mind: funding for the health of the indigent was not to be spent on other things. However, working only within the silo of what is normally considered health services may severely restrict the usefulness of that work for certain patients. What appears to be shifting is that with the passage of the Affordable Care Act and many states expanding Medicaid coverage, researchers have years of additional data that "simply increasing access to health care is not nearly enough to improve patients' health." With that realization, some state governments have requested waivers from the original Medicaid restrictions, allowing them more flexibility to address these other factors.

The Supreme Court of the United States heard a third challenge to the constitutionality of the Affordable Care Act (ACA), and in a 7-2 decision, decided to dismiss the legal arguments on the basis of a lack of standing, or the ability to show that the plaintiffs were actually or were about to be harmed. The first challenge to the ACA that went to the Supreme Court was one of overreach: that the federal government lacked constitutional authority to require citizens to purchase health insurance (known as the individual mandate, to be enforced with a fine administered through tax filings). In that case, the Supreme Court decided that the individual mandate was actually a tax, which Congress is allowed to levy (never mind that some proponents of the ACA specifically said that the individual mandate was not a tax). The crux of the second challenge to the ACA that the Supreme Court heard rested on whether "State" only meant a state (like California), or if it could mean the federal government; the Supreme Court decided on the expanded meaning. Between the first challenge and the most recent challenge, a Republican-controlled Congress legislated that the fine for the individual mandate would be set to zero. The third challenge then refers back to the first challenge: if there is no tax, does the federal government have the authority to pass the ACA, requiring individuals to buy insurance? Interestingly, the court majority decided that the plaintiffs lacked standing, thereby dismissing the case. The dissenting justices provided examples in which they believed the plaintiffs would indeed be harmed by the ACA, as well as cases in which plaintiffs had a more tenuous connection to harm and yet were allowed to sue.

The Supreme Court of the United States heard a third challenge to the constitutionality of the Affordable Care Act (ACA), and in a 7-2 decision, decided to dismiss the legal arguments on the basis of a lack of standing, or the ability to show that the plaintiffs were actually or were about to be harmed. The first challenge to the ACA that went to the Supreme Court was one of overreach: that the federal government lacked constitutional authority to require citizens to purchase health insurance (known as the individual mandate, to be enforced with a fine administered through tax filings). In that case, the Supreme Court decided that the individual mandate was actually a tax, which Congress is allowed to levy (never mind that some proponents of the ACA specifically said that the individual mandate was not a tax). The crux of the second challenge to the ACA that the Supreme Court heard rested on whether "State" only meant a state (like California), or if it could mean the federal government; the Supreme Court decided on the expanded meaning. Between the first challenge and the most recent challenge, a Republican-controlled Congress legislated that the fine for the individual mandate would be set to zero. The third challenge then refers back to the first challenge: if there is no tax, does the federal government have the authority to pass the ACA, requiring individuals to buy insurance? Interestingly, the court majority decided that the plaintiffs lacked standing, thereby dismissing the case. The dissenting justices provided examples in which they believed the plaintiffs would indeed be harmed by the ACA, as well as cases in which plaintiffs had a more tenuous connection to harm and yet were allowed to sue.

It appears that the majority justices would allow unconstitutional laws to remain in place, as long as there was no penalty. To someone outside the legal profession like me, this allowance seems to place an uneven burden on citizens who wish to be law-abiding even if enforcement is not relevant. The majority's opinion also delays clarity on the merits of the case, allowing for potentially unconstitutional laws to remain in effect until harm can be proved and someone affected sues and that plaintiff is successful in reaching the Supreme Court (which is never guaranteed).

I have read elsewhere that this was probably the best result for both political parties. Portions of the ACA have become popular, and if Republicans are known to dismantle the legislation, they might encounter difficulty getting re-elected. Politics can be messy.

Kaiser Health News reported on the growth of various efforts to extend primary care and make it more accessible to patients. There appear to be a growing number of healthcare provider groups that charge an access fee (one firm currently charges $199/year) and in return, promise better service, including more availability and more timely appointments. These provider groups sometimes target larger employers by offering onsite clinics.

Kaiser Health News reported on the growth of various efforts to extend primary care and make it more accessible to patients. There appear to be a growing number of healthcare provider groups that charge an access fee (one firm currently charges $199/year) and in return, promise better service, including more availability and more timely appointments. These provider groups sometimes target larger employers by offering onsite clinics.

The article cited an interesting study showing that one employer, SpaceX, benefited from lower overall healthcare costs, even though spending on primary care was higher than others. There is a general sentiment that US under-invests in primary care by paying specialists more, luring more people who are training to be doctors to become specialists. There does not seem to be strong indication that insurance companies are about to change their reimbursement policy significantly for doctors remaining on fee-for-service, and it is interesting that some employers are experimenting with this approach. Insurers are, however, looking at value-based compensation policies, which might have similar effects. Much more data will need to be collected to see if any of these approaches meaningfully slows the growth in healthcare costs.

The Washington Post published an article that is critical of online reviews, starting with an account of one couple's reliance on online reviews in selecting an addiction treatment facility which proved ineffective in stopping a drinking addiction. The article outlines some strategies that technology firms might employ to try to detect fraudulent reviews. The article also discusses one woman's journey into combating fake reviews and discovering dozens of Facebook groups where businesses trade reviews. Notably, fake reviews are not specific to the medical field; it is a problem that can plague items such as books and household goods, and even the concept of verified reviews can be gamed.

The Washington Post published an article that is critical of online reviews, starting with an account of one couple's reliance on online reviews in selecting an addiction treatment facility which proved ineffective in stopping a drinking addiction. The article outlines some strategies that technology firms might employ to try to detect fraudulent reviews. The article also discusses one woman's journey into combating fake reviews and discovering dozens of Facebook groups where businesses trade reviews. Notably, fake reviews are not specific to the medical field; it is a problem that can plague items such as books and household goods, and even the concept of verified reviews can be gamed.

The article does highlight what might be the root of the problem: "And in the absence of reliable and easily accessible information about doctor performance, most patients are going to continue to resort to online reviews, Yaraghi, the Miami professor, said." The medical community has seen many internal disagreements about how to measure quality, but also seems to be reluctant resolve those disagreements. In the absence of benchmarks from the industry, the question is whether these online reviews are -- on average -- helpful or not. My feeling is that online reviews (not just for doctors) are generally helpful, but they should only be considered as one component of a person's decision process.

One commenter on the article noted: "Part of the problem is that there is virtually no information about doctors out there other than their speciality [sic] and where they got their degree. Occasionally you can get where they did their residency and internship. ... So, where do you turn? Reviews posted on the internet are about the only thing out there." One commentator's solution? "Doctors should really start soliciting reviews from every single patient they treat. Yes a small minority might post negative reviews, but the vast majority will post positive ones that will outweigh the negative ones."

Kaiser Health News reported on Colorado's efforts to rein in drug prices. In addition to wanting to import drugs from Canada, the state legislature is considering a "prescription drug affordability board." Apparently, the board would be permitted to set price limits for up to twelve drugs annually, but could recommend other courses of actions.

Kaiser Health News reported on Colorado's efforts to rein in drug prices. In addition to wanting to import drugs from Canada, the state legislature is considering a "prescription drug affordability board." Apparently, the board would be permitted to set price limits for up to twelve drugs annually, but could recommend other courses of actions.

While the legislation has not yet been signed into law, the pharmaceutical industry has opposed it. It seems a little unclear to me whether such a law would pass constitutional challenges, but that this legislation has the backing that it has suggests that the public is wary of high drug prices and is willing to consider legislative and regulatory actions.