By ASHISH JHA, MD

Austin Frakt and Aaron Carroll recently approached me about a New York Times UpShot piece aiming to rank eight healthcare systems they had chosen: Australia, Canada, France, Germany, Singapore, Switzerland, the United Kingdom, and the United States. This forced me to think about a pretty fundamental question: what do we want from a healthcare system?

I would argue that most people want a healthcare system where they can get timely access to high quality, affordable care and one that also promotes innovation of new tests and treatments. But underlying these sentiments are a lot of important issues that need unpacking. First, what does it mean to be able to access care when you need it? A simple way to think about this is being able to see a doctor (or other healthcare professional) quickly and easily and in cases where there are follow-on tests, procedures, and treatments, you can get them without much delay. This brings up one important point: while experts often discount the importance of timeliness, regular people generally don’t: anyone who has waited weeks or months for a follow-up after an abnormal test result or to get a needed surgery knows that waiting times are not just an inconvenience. Delayed access can be stressful, agonizing and in some instances, downright harmful.

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BY MADHAVI VEMIREDDY, MD            SPONSORED CONTENT

Our day-to-day interactions with technology are changing expectations and aspirations for almost every touch point in modern life. We want instant feedback and action at the push of a button, from the digital shopping cart to the doctor’s office. That is part of why there is a constant stream of new apps and tech services being released across every industry, including wellness. But the barrage of options can be a problem of its own nature.

To better understand what people want and how to deliver resources that resonate and stick, we spent time studying how real people engage (or don’t) with personal health and well-being. What we found was instantly familiar yet full of deeply personal insights that made the struggle real and the solution obvious.

So often we design towards an end-goal or finish line. As we were reminded through our research, health is not static. For the healthy, those with chronic conditions, those actively managing to avoid serious health issues, the issues are all the same: it’s a challenge to live your healthiest life every day. It’s a daily struggle to avoid the foods we shouldn’t eat; it’s a daily struggle to exercise; it’s a daily struggle to live in the “white space” between doctor appointments.Continue reading…

By PAUL KECKLEY

Last week, the Senate Health, Education, Labor and Pensions Committee wrapped up hearings focused on stabilizing the individual insurance market leaving unresolved an issue that separates Dem’s and Rep’s on the committee: just how much freedom states should have in managing their insurance markets. At issue are the Section 1332 waivers which allow states to reduce essential benefits in health insurance policies, thus allowing insurers to sell policies that cover less with lower premiums.

Also last week, Republican Senators Lindsey Graham and Bill Cassidy offered what they called the “last chance” for Republicans to repeal and replace the Affordable Care Act. Their bill would repeal the individual and employer mandates and replace the ACA’s tax credits, Medicaid expansion, and cost-sharing payments with block grants to states so governors would have more flexibility and authority in managing their Medicaid programs and insurance markets.

But arguably more media attention was directed at Sen. Bernie Sanders’ proposal to replace the current employer-sponsored health insurance system with “Medicare for All” which would be phased on over four years and be funded by increased employer payroll taxes and higher taxes for those earning more than $250,000. What appeared to garner the media’s attention was the cadre of 15 Democrats in the Senate and 117 in the House who endorsed his proposal, though its price tag is unknown.

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By ALYX STERNLICHT                            
The tech industry is notoriously lacking diversity. Health tech also lacks diversity in both the innovators creating technology and the technology targeting diverse users.

Last Fall, at Health 2.0’s annual conference, Health 2.0, with support from the Robert Wood Johnson Foundation, hosted a panel focusing on minority entrepreneurs and building tech products for underrepresented groups. The discussion that followed the panel was a passionate and thought provoking conversation. Some feedback included questions like: “Why isn’t this discussed more often?” and “there is dire need for inclusive products and support of underrepresented groups in tech.” With that feedback Health 2.0 decided to do something about diversity in health tech.
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BY SUHAS GONDI

The Trump administration’s recent announcement to end the Deferred Action for Childhood Arrivals (DACA) program instilled fear and outrage in communities across the country. As a medical student with friends and classmates with DACA status, I am particularly disappointed in the poor and compassionless judgment of our nation’s leader. I fear for my peers who have worked incredibly hard and overcome the most daunting of obstacles to get where they are today, and who now could see it all taken away from them. Their now tenuous situation is unimaginable to me. But I also fear the impact of this decision on my non-DACA classmates, on our training, and on our futures. There is certainly a moral case to keep DACA alive, but the effects of its repeal on the healthcare system writ large make apparent that it’s also a bad idea for all Americans.

The American Medical Association (AMA) letter to Congress spells out many of the reasons why. Study after study has shown that, due to multiple demographic changes, physician demand will far outpace supply over the next decade. By 2030, the US will face an estimated shortfall of up to 104,900 physicians. Even now, we are witnessing how a lack of doctors in rural and other federally designated Health Professional Shortage areas results in inadequate access to care for too many, and directly contributes to worse health. As AMA CEO James Madara wrote in the letter, “the DACA initiative could help introduce 5,400 previously ineligible physicians into the U.S. health care system in the coming decades,” and work towards alleviating this persisting issue.

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By SAURABH JHA, MD

“There are some enterprises in which a careful disorderliness is the true method” – Herman Melville, Moby Dick

Asymmetry of Error

During the Ebola epidemic calls to ban flights from Africa from some quarters were met by accusations of racism from other quarters. Experts claimed that Americans were at greater risk of dying from cancer than Ebola, and if they must fret they should fret more about cancer than Ebola. One expert, with a straight Gaussian face, went as far as saying that even hospitals were more dangerous than Ebola. Pop science reached an unprecedented fizz.

Trader and mathematician, Nassim Taleb scoffed at these claims. Comparing the risk of dying from cancer to Ebola was flawed, he said, because the numerator and denominator of cancer don’t change dramatically moment to moment. But if you make an error estimating the risk of Ebola, the error will be exponential, not arithmetic, because once Ebola gets going, the changing numerator and denominator of risk makes a mockery of the original calculations.

The fear of Ebola, claimed Taleb, far from being irrational, was reasonable and it was its comparison to death from cancer and vending machines which was irrational and simplistic. Skepticism of Ebola’s impact in the U.S. was grounded in naïve empiricism – one which pretends that the risk of tail events is computable.

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