A MacArthur 'genius' rethinks health care

The ideas and innovators shaping health care

Aug 15, 2023 View in browser   By Erin Schumaker, Daniel Payne and Evan Peng FORWARD THINKING The Massachusetts Institute of Technology economics professor and MacArthur “genius grant” felow is proposing universal coverage as a solution, where basic care would be free. | Courtesy of Amy Finkelstein Amy Finkelstein thinks she can fix U.S. health care. The Massachusetts Institute of Technology economics professor and MacArthur “genius grant” fellow is the author of a new book with Liran Einav: We’ve Got You Covered: Rebooting American Health Care. It argues that piecemeal policies can’t correct our current system. Their solution: Universal coverage. Enrollment would be automatic. Basic care would be free. And no one would lose insurance if they left their job or earned enough to rise above the poverty line. Americans could still buy an extra layer of private health insurance — something the authors envision two-thirds of Americans doing. Erin caught up with Finkelstein to learn more. This interview has been edited for length and clarity. What problem are you trying to solve?  Health insurance is not delivering on its function. Over 1 in 10 Americans under 65 are uninsured at any given moment, and of the 30 million Americans who are uninsured, 6 in 10 are eligible for free or heavily discounted health insurance coverage. And yet they don’t have that coverage. Even people fortunate enough to not only have insurance, but to maintain that health insurance coverage, can face catastrophic medical expenses when they get care that’s supposedly covered. Not only is an enormous amount of medical debt held by the public, but most of it is incurred by households that have health insurance. What would your plan cover and how would it compare to what we have now?  Primary care, preventive care, surgical procedures, essential medical treatments, hospitalizations, urgent, non-urgent and emergency care would be covered. But there’s a lot of things it won’t cover. There will be longer wait times for non-urgent care than people with private insurance currently experience, more like the wait times in the current Medicaid program for low-income individuals. Second, there will be less choice compared to what people with traditional Medicare coverage have now: any procedure they want with any choice of doctor. There will be versions of gatekeeping and care management. Can you envision a Congress that will approve a plan like yours? Yes. In every country that adopted universal, basic coverage, it was an enormous political struggle. As the political climates change, as they always and often do, and new policy windows open, we’re clear-eyed and ready with what we want to accomplish. The standard dialogue, in which every other high-income country was destined to have universal health insurance but the U.S., because of our unique political culture or the power of the American Medical Association or lack of a powerful labor movement, is just a gross misreading of history.   A NEW PODCAST FROM POLITICO: Our new POLITICO Tech podcast is your daily download on the disruption that technology is bringing to politics and policy around the world. From AI and the metaverse to disinformation and cybersecurity, POLITICO Tech explores how today’s technology is shaping our world — and driving the policy decisions, innovations and industries that will matter tomorrow. SUBSCRIBE AND START LISTENING TODAY.     WELCOME TO FUTURE PULSE Punta Cana, Dominican Republic | Carmen Paun This is where we explore the ideas and innovators shaping health care. The Food and Drug Administration has granted Pfizer accelerated approval for its drug Elrexfio. The therapy is for advanced multiple myeloma, a rare and difficult-to-treat blood cancer. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Evan Peng at epeng@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Ben Leonard talks with Madison Fernandez, author of POLITICO’s Weekly Score, about the momentum building among Virginia Democrats, who are betting that defending abortion rights will lead to wins in the state’s fall elections despite their 2021 losses on the issue in the state. Listen to today’s Pulse Check podcast WORLD VIEW Marijuana and nicotine vaping have both become more common among young adults. | AP Photo/Richard Vogel Europe is sounding the alarm about teen vaping. While there’s near universal agreement that e-cigarettes have helped some adults quit smoking, a rapid rise in European teenagers using the products has governments, doctors and public health experts worried, POLITICO’s Ashleigh Furlong reports. Aggressive lobbying around the issue a decade ago led governments to take a light touch when they regulated e-cigarettes. But today’s disposable e-cigarettes, widely available in pastel colors and candy flavors that appeal to kids and teens, have lawmakers considering stricter rules. Change is on the way. Here’s how Europe is mobilizing to discourage teen vaping: France: The country’s national committee against smoking has recommended a ban on all flavors. France’s former health minister said in May that he favored banning cheap, disposable e-cigarettes sold in brightly colored packaging, known as “puffs.” Germany: The Bavarian government is pushing for a European Union-wide ban on disposable vapes. Meanwhile,Germany’s drug czar has said that reining in packaging design, color and shape could make e-cigarettes less popular among young people. United Kingdom: The U.K. is considering regulating packaging, marketing and flavors and taxing vapes to discourage use. At the same time, the U.K. is pushing e-cigarette companies to apply for medical licenses for vapes and providing vape starter kits to smokers to help them transition away from traditional cigarettes.   DON’T MISS POLITICO’S TECH & AI SUMMIT: America’s ability to lead and champion emerging innovations in technology like generative AI will shape our industries, manufacturing base and future economy. Do we have the right policies in place to secure that future? How will the U.S. retain its status as the global tech leader? Join POLITICO on Sept. 27 for our Tech & AI Summit to hear what the public and private sectors need to do to sharpen our competitive edge amidst rising global competitors and rapidly evolving disruptive technologies. REGISTER HERE.     REALLY? Some doctors purveyed misinformation on social media during the pandemic, according to a new study. | Joe Raedle/Getty Images Leading health authorities, including the surgeon general and the FDA, warned of health misinformation as a top threat during the pandemic. But according to a new study,sometimes doctors on social media were the ones purveying it. The study, published in JAMA Network Open today, examined Twitter, Facebook, Instagram, Parler and YouTube posts to learn more about the Covid-19 misinformation U.S.-based doctors shared on the platforms between January 2021 and December 2022. The researchers defined misinformation as claims about Covid prevention or treatment that the Centers for Disease Control and Prevention didn’t support or contradicted CDC guidance. While the study was small — researchers identified just 52 doctors spreading misinformation — and doesn’t include data from the first year of the pandemic, it sheds light on a few trends: — The doctors spreading misinformation tended to be licensed. About a third were primary care doctors. — One-third were affiliated with groups known for spreading medical misinformation, such as America’s Frontline Doctors. — The most common type of misinformation spread by doctors was the claim that vaccines were unsafe or ineffective. They also advocated for unproven treatments, spread misinformation about masks and social distancing and promoted conspiracy theories. Why it matters: “Physicians are often considered credible sources of medical and public health information, increasing the potential negative impact of physician-initiated misinformation,” the study authors write. When patients are harmed, doctors usually go unpunished. A recent Washington Post investigation that analyzed disciplinary records from medical boards in all 50 states found that doctors who jeopardized patients’ lives during the pandemic and its aftermath faced few consequences. Of the 480 Covid misinformation-related complaints the Post tracked down over the last three years, they could identify only 20 instances in which doctors were penalized for them.   Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Evan Peng @thepngfile   Follow us

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