Tag Archives: healthcare

The Intrinsic Durability of Obamacare

Source: Quora

Despite having control of the Senate, House, and Presidency, Republicans have been repeatedly unsuccessful in their attempts at repealing the Affordable Care Act and replacing it with an alternative. The fight drags on; on Tuesday, the Senate narrowly voted to advance to floor debate, and needed Vice President Mike Pence to cast a tie-breaking vote. An economic concept called loss aversion provides some insight into the uphill battle Republicans are facing with a healthcare replacement. It also indicates that voters are even less likely to support a “repeal-now, replace-later” plan.

Introduced by behavioral economists Daniel Kahneman and Amos Tversky, loss aversion refers to the idea that people feel more pain when they lose something than pleasure when they gain something.

Kahneman explains the phenomenon in this way: Let’s say I told you that I was going to toss a coin; If it lands tails, you pay $10. How much money would you need to gain if you won, before you took the bet? “People want more than $20 before it is acceptable,” says Kahneman, “And now I’ve been doing the same thing with executives or very rich people, asking about tossing a coin and losing $10,000 if it’s tails. And they want $20,000 before they’ll take the gamble.”

Companies use this glitch to influence our behavior, too. Would you pursue a $10 rebate as doggedly as you would avoid a $10 surcharge? Gaining something is only about half as enjoyable as losing something is painful, according to empirical studies. So in the world of politics the threat of losing something, be it a part of your income or a service you’ve become accustomed to, can have a heavy impact.

This became the case with the Affordable Care Act. Initially, and for many years, the ACA was opposed by the majority of Americans. It was not until serious discussion of losing the act became part of the public discourse that the ACA gained majority approval in Gallup polls.

While it is the Republican Party’s general consensus that Obamacare should be repealed, the Congressional Budget Office’s well-publicized projections of coverage loss, Medicare loss, and insurance regulation loss have made their proposals deeply unpopular to the public. In June, the CBO forecasted that the Senate’s plan would leave 22 million more people uninsured. The gains that they tried to sell, like decreasing taxes and lowering the deficit, have not been very effective. In an unexpected move last Tuesday, Republican Senators Mike Lee and Jerry Moran joined Senators Susan Collins and Rand Paul in announcing they would vote against the Senate’s latest bill. Because Republicans have only 52 seats in the Senate, losing any more than two votes is fatal. These defections sank the bill, which was only narrowly supported.

Finding consensus between the moderate and hard-right wings of the party has proven to be extremely difficult. “This has been a very, very challenging experience for all of us,” McConnell told reporters following the bill’s collapse. “It’s pretty obvious that we don’t have 50 members who can agree on a replacement.”

Once something becomes the status quo, it becomes more difficult to do away with because of loss aversion. It is this phenomenon that makes it difficult to alter welfare and service programs once they have been put in place, and it is one reason why Social Security is a third rail in Washington.

Politically, Obamacare is inherently difficult to repeal. Obamacare sought and succeeded at creating a rapid expansion of coverage over the course of President Obama’s tenure. An expansion in the economy that, once in place, created a new status quo; not only for individuals, but for health-related businesses. Interestingly, many at the far right of the Republican party came to power during the Tea Party movement. It was a movement that began in response to the threat of a different loss from the status quo; the increase in taxes that came with Obamacare.

The Senate’s latest proposal, to repeal parts of the Affordable Care Act with no required replacement until two years down the line, would increase the number of uninsured by 17 million next year and 32 million by the end of a decade. Immediately after its introduction, this idea was opposed by three Republican Senators, Shelley Capito of West Virginia, Lisa Murkowski of Alaska, and Susan Collins of Maine, who announced they would vote against it.

This plan is likely to generate and even stronger sense of loss aversion. Supporting Senator McConnell’s plan to repeal now is essentially a choice between keeping the status quo, and rolling the dice with the hopes of getting a better outcome in the future. This will be an even harder sell than the one from last week.

Political rhetoric about loss is common and effective. “Loss” was something that President Trump used to great effect in the election, by saying that people will lose their guns, lose their money (through higher taxation), or lose their job to globalization. Rhetoric is not reality however. Should Congress pass a bill that takes away people’s healthcare, voters will feel the losses directly. Despite Tuesday’s vote, repealing Obamacare is still a long shot.

Neil Browning is a 2017 Master of Public Policy graduate interested in public health, development, and international affairs. He was the editor-in-chief of the Sanford Journal from 2016-17.

Consumer Choice in Health Insurance Markets Under the Affordable Care Act

If you’ve never had to shop for health insurance, consider yourself lucky. Between searching for affordable premiums, making sense of co-pays and coinsurance, and finding a plan with your favorite doctor, choosing a good health plan can be a daunting task. As a health policy student, I tried my hand last month at choosing a plan on the North Carolina exchange. Despite being well-versed in insurance concepts, I too struggled to figure out which plan would be best for me among the many options.

The Affordable Care Act (ACA) has been successful in its goals of increasing access to health insurance while preserving choice and competition in health insurance markets. It brought nearly 11 million people into the individual market who previously didn’t have insurance, and it offered them a variety of health insurance options to choose from. Despite achieving such historic milestones, however, it remains to be seen what the future might hold for the ACA. Until then, policymakers must continue working to make the process of buying insurance easier for the average American. Continue reading

New proposed nutrition labels are here!

In a follow-up to an earlier blog entry this week, yesterday the Food and Drug Administration announced new proposed food labels. On the labels, calories and servings per container are more prominently displayed in a larger size. The new labels will also clarify that the nutrition information listed is for one serving, specifying the serving size directly, instead of leading the consumer to possibly assume that the nutrition information is for the entire container. In addition, added sugars were proposed to be added to the label to complement total sugars. To comment on the proposed labels, go to www.regulations.gov within the next 90 days.

Proposed nutrition facts label from the FDA:

Nutrition Facts Label Proposed Format (350x660)

Image courtesy of the FDA.



A great week for child nutrition and health

I was about to go to bed last night when I decided to check the blog of Marion Nestle, a well known nutrition expert, to get the latest food policy news. I was caught off guard when I saw this title, “Let’s Move! announces universal school meals!”. I checked the links, as well as the USDA website, for confirmation of the news. Sure enough, the bottom of a USDA news release confirmed the news. A recently completed school meals pilot project was going to be implemented nationwide starting July 1st of this year.

To summarize what happened, schools with 40% or more of their students receiving free school meals will be able to serve free meals to all students enrolled at that school. The costs of paying for the extra students will be cancelled out by reduced paperwork and eligibility verification costs by using current data from the SNAP and TANF programs to enroll students in the free school meals program. This implementation is good, because it reduces negative stigma at school for the children who are eligible for the free meals, and also allows more children access to good nutrition.

What is that I heard? School meals are nutritious? There is an announcement on that too this week! Ninety percent of schools have reported compliance with the new rules for school meals under the 2011 Healthy, Hunger-Free Kids Act. Yes, the final parts of the Act were not perfect, as certain lawmakers wanted to count pizza sauce and potatoes as vegetables, but it also had a lot of great benefits, such as reducing the limit on sodium, increasing the amounts of whole grains served over refined grains, increasing the amounts of fruits and vegetables served, and setting standards on the types of vegetables to serve every week to get more nutritional variety, not to mention color and taste.

And that wasn’t all. I woke up this morning to the news that CDC researchers just produced a report showing a 43 percent decrease in obesity among two to five year old children. While the overall obesity rate stayed the same, it is positive news that things are changing for the better for our young children and future adults. Getting back to schools, new limits on advertising of unhealthy foods at schools and school sporting events was also announced, and should also help to reduce consumption of unhealthy foods and hopefully obesity rates as well.

The big news for us adults may come tomorrow, with an expected announcement regarding food labels. It’s about time that food labels are revamped to be easier to read. First of all, the type is small. For a person like me with 20/20 vision, the size is not a problem, but for many other people it may be difficult for them to read the nutrition label. Second, there is probably too much information on the label for all but us nutrition geeks.

Right now the hot thing in nutrition labeling is the front of the package label, and using a stop light system based on government nutrition guidelines so that consumers can easily identify foods high in things like calories, sugar, sodium or fat. The United Kingdom has already been working on a stop light system. Even Chile got into the act, implementing a system of colored warning labels that must be placed on foods high in calories, fat, sodium and sugar. While they are not perfect, it is progress. Let’s green light this process and give front-of-package food labeling regulations a go here in the United States!




Guarding against unneeded health prevention

A recent New York Times article pointed to the risk of taking dietary supplements, stating that new data suggested that dietary supplements account for nearly 20 percent of drug-related liver injuries that turn up in hospitals, up from seven percent 10 years ago. The article was preceded by other recent articles on blood pressure, multivitamins and anti-bacterial soaps. All four related in some way to guarding against excessive health prevention measures.

We are often told by advertisers of the benefits of certain health-maintenance products such as dietary supplements, drugs and the like of the improved health we can have by taking these products, yet we often lack the time to research and understand if they are truly beneficial for us. Often, we assume that the government maintains some sort of checks on health products, although government’s role can often be limited. As was pointed out in the New York Times article, Americans spend an estimated $32 billion on dietary supplements every year, but a 1994 federal law prevents the Food and Drug Administration from approving or evaluating most dietary supplements before they are sold.

Often in the political arena, we say that we don’t want government to hinder our economy with a lot of red tape. Regarding our health, our statement should be different, regardless of party affiliation. We need strong government institutions to make sure that consumers are not mislead. While proper, routine use of multivitamins may be of very low risk (and benefit), the use of an herbal supplement by a teenage boy to “burn fat” in the New York Times article damaged his liver to the point that he was advised to no longer play sports. A strong system of regulation backed by thorough research is important in the health arena. The challenge, of course, is that the needed research can often be expensive and long-term, with conclusions that are not always black and white.

Who is responsible for the health of this child?

Aixa Cano was described in a recent AP article as a shy, 5-year old girl from Chaco, a poor farming province in northern Argentina. What makes her different than most 5-year old girls is that Aixa was born with hairy moles all over her body. She fared better than her neighbor, Camila, a 2-year old girl born with multiple organ problems. Doctors, who cannot explain Aixa’s condition, say her birth defect may be linked to agrochemicals. The Argentine national government must hold itself responsible to protect the health of children born in rural areas.

Agrochemical use in Argentina has increased greatly according to the AP report, increasing from 9 million gallons in 1990 to 84 million gallons today. While it has led to a huge growth in agricultural production, rates of cancer and birth defects have increased dramatically in Argentina’s rural farming communities. In Aixa’s home province of Chaco, regional birth reports given by the AP show congenital birth defects soaring from 19.1 to 85.3 cases per 10,000 people in the decade after genetically modified seeds and their partner agrochemicals were approved in Argentina.

So if we were to assume an excessive use of agrochemicals leads to birth defects in children like Aixa, who is responsible for their misuse? Farmers and agrochemical companies, whether we like it or not, work to make money and not improve public health. If farmers don’t spray enough chemicals and their crop decreases, they lose money. Regarding the local government, while they should be out to protect public health, this mission can often be lost in the cause of economic development, which in rural communities often comes from agriculture. Thus, in my opinion the Argentine national government is at fault. The national government, while still influenced by the agriculture industry, is more able to resolve the problem than rural provincial governments because it is more isolated from agriculture’s impact considering the diversity of the national economy.

To remedy the problem, there are three things that I believe the Argentine national government can do better. First, it should change agrochemical regulation standards from being made at a provincial level to a national level. This will create clearer standards, and avoid undue influence by industry in poor provinces that depend highly on agriculture. Second, the national government should complete the work of the presidential commission formed in 2009 to study agrochemicals and health. They can do this by properly funding programs to fortify local government monitoring of agrochemical application, along with programs to educate farming communities on proper agrochemical use and application. Finally, the government should listen to its constituents and fund studies to investigate the potential health effects of agrochemical use.