Medicare, Medicaid, Federal Deficit Top National Health Policy Issues
Bowers, Lois A., Medical Economics
Stuart Altman, PhD, an economist and Sol C. Chaikin Professor of National Health Policy in the Heller School for Social Policy and Management at Brandeis University, Waltham, Massachusetts, recently spoke with Medical Economics Editor-in-Chief Lois A. Bowers, MA, about states' role in the healthcare system, trends in payment models, and other issues.
Q: What do you think the biggest issue in national health policy is right now?
A: Long-term, it's Medicare and the federal deficit Medicare is the dominant one. And this issue about substantially cutting Medicaid and then turning it over to the states to do then what they want There's no way the states could redesign the Medicaid program to withstand an $800 billion cut without really slashing and [changing] who's eligible and what they pay.
Q: What do think the states' role should be in healthcare compared with the role of the federal government?
A: Some level of government needs to have an involvement and concern about total healthcare spending, not just what government spends.
Because each state can look at its healthcare system differently, I think it makes sense for the states to take a hard look at what's going on in the state with respect to total healthcare spending and decide what they want to do about it
Massachusetts is the only state that is, in my mind, doing the right thing and doing what I think in the future many other states may choose to do. The state has mandated that insurance companies provide different forms of insurance, one of which is what we call limited network or tiered network. We've also recently passed a cost-containment bill that looks at all spending in the state and sets a benchmark of where we would like total state spending to grow. …