Public policy attacks on public health and mental health, intrusions in doctor/patient privacy, the continuing fight over the Affordable Care Act, and our collective loss of faith in private health insurance were among the top health policy story lines of 2011.
This year, eight stories make my short list. Not all of these stories made big headlines during the year. But they have had, or will have, an outsized impact on our lives.
I’ll begin the countdown this week with four that capture and continue some of the major trends of the recent past. Next week, I’ll offer four more that hint at where health policy may go in the future.
8. The Shooting of a Congresswoman. In January, the first big health policy story of the year was about violence and mental illness – the horrible wounding of a member of Congress, and the murder of several people around her. As the media struggled to make sense of this, it raised once again the relationship between mental illness and violence. What it failed to do was to report that, while this particular shooter seemed mentally imbalanced, most perpetrators of violence are not, and many victims of violence either already have mental illness, or will develop it as a result.
The continuing trend – Our jails are our nation’s largest mental health institutions, and will remain so until we invest more in prevention and treatment of mental illness.
7. The End of the Iraq War. The War in Iraq may have ended this month, but its health effects will be with us and our veterans for many years to come. A GAO report released in Octobergot little mainstream media attention, but was blunt in its description of the effects of this war and others on veterans’ mental health. The 2.1 million unique veterans who received mental health treatment in the five year period between 2006 and 2010 represented over 30% of the veterans who received any type of health care. The fastest-growing groups of veterans receiving mental health treatment during this period were the 213,000 Iraq and Afghanistan veterans with mental health needs. And 38% of all Iraq/Afghanistan veterans who received health care during that time required mental health care.
The continuing trend – So long as we remain at war, veterans’ health and mental health services will need to be expanded significantly throughout the foreseeable future, and, as taxpayers, we will need to pay for them.
6. The Death of the CLASS Act. What does it say when the first major provision of health reform to be killed off in a bipartisan way was the one provision that had enjoyed bipartisan support for a generation? There are at least two things about long term care most of us don’t want to face. The first is that most of us will need it someday. The second is that practically none of us can afford it on our own. Rather than coming up with a meaningful public/private partnership to pay for it after almost thirty years of trying, the Administration and Congress quietly killed CLASS in October, choosing once again to keep the current, broken system in place. This is the one where we first impoverish people when they get old and sick, and then let government pay the whole bill.
The continuing trend – Medicaid will remain the default payer for long term care. Costs will continue to skyrocket, we’ll all continue to complain, and long term care insurance won’t gain a greater foothold in the market any time soon.
5. Low PCIP Enrollment Numbers. The most compelling evidence in 2011 that we may have finally lost our faith in private insurance was found in the late summer reports of the low enrollment in the Pre-Existing Condition Insurance Program (PCIP). This is a program that eligible uninsured people were supposed to embrace, because it pretty much guaranteed that it would pay out far more for their health care than it collected in premiums, saving each of them lots of money. But when only 30,000 of the 4 million eligible people enrolled as of July, most of the rest seemed to be saying that they would rather take their chances on permanent financial ruin than insurance. Or that they were already so impoverished by illness that they no longer had anything to lose.
The continuing trend – If the health insurance industry cannot restore our trust, even the people who need it most will opt out, relying only on safety net government funding.
Next week: The final Our Health Policy Matters column of the year looks at four more big stories of the year, and their implications for the future.
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