JAMA Forum: Common Ground on Health

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Knowing only life expectancy, child mortality, and the rate of death related to opioids, is it possible to guess whether a US county voted Democratic or Republican in the 2016 Presidential election?

And the answer is: No, it’s not possible.

As students and faculty at the Johns Hopkins Bloomberg School of Public Health discovered when they created an online game (available for anyone to try, at https://bit.ly/2OFpMqE), there is just too much overlap between red and blue counties on these 3 core measures of health.

The 2018 election suggests that, after a decade of turmoil, a bipartisan health agenda finally may be emerging to match our nation’s common ground in health challenges. This agenda includes:

  • Health insurance for people with preexisting conditions. Quite a few politicians who voted or sued to undo the protections afforded by the Affordable Care Act changed their tunes (and their websites) when confronted by voters worried about losing coverage. This fact, combined with Democratic control of the US House of Representatives, will keep the core elements of insurance market reforms in place.
  • Medicaid expansion. Voters in 3 deep red states—Idaho, Nebraska, and Utah—passed ballot initiatives to expand Medicaid to low-income populations. The campaign to pass these measures emphasized both compassion and fiscal prudence. Residents of these states will soon see tangible benefits, creating momentum for others to follow. As a Harvard economist Benjamin Sommers explained, Medicaid “makes a major difference in patients’ ability to access health care, to pay their bills, and in many studies, we see improved health outcomes too.”
  • Action on opioids. About 2 weeks before the election, Congress passed with large majorities and President Trump signed legislation on the opioid epidemic. For the first time, Medicare will cover treatment that includes the effective medication methadone. Although the bill left a number of important opportunities for progress unrealized, continued public interest (and the persistence of high rates of overdose) may lead to more aggressive actions.
  • Lower drug prices. Just before the election, the US Department of Health and Human Services announced plan to impose an international benchmark for certain drug prices in the Medicare program. As the department moves forward to implement this approach, it will have a tailwind of broad public support for additional efforts to lower prices.
  • Payment reform. In the weeks before the election, the Innovation Center at the Centers for Medicare & Medicaid Services announced expansion of models for oncology, rural health, diabetes prevention, and children’s health. States from across the political spectrum are participating in innovative approaches to paying for health care.

These are far from the only areas of  wide agreement in health policy. A number of others are backed by evidence, ready for bipartisan support, and awaiting official action. These include investing resources in local public health departments; responding to the growing impact of climate change; adding reasonable measures to control access to firearms; protecting access to health care for women; and stopping punitive immigration measures that harm children.

Political divisions still hold back progress on these issues. Today’s toxic environment is filled with rhetoric of hate and fear that distracts from evidence and understanding. The ugliness of the nation’s dialogue has led some to conclude that progress in certain areas is impossible. It’s not uncommon for people to sigh—even in the midst of crisis—that nothing will ever change.

The election suggests otherwise. New leaders of the House of Representatives will have the opportunity to conduct focused oversight, add budgetary resources, and propose new legislation on topics of great interest to the American people. Such pressure—combined with grassroots and professional mobilization—can eventually push aside roadblocks to action at the state and federal level

There will be opposition, of course; those who disagree with even the most popular health policies have every right to make their case. The good news is that efforts by health professionals to have an impact on the national debate are gaining traction. Recently, doctors have been able to counter the National Rifle Association by speaking up about the impact of lax gun laws on their patients. The American Academy of Pediatrics is working to upend family separation and call into question other immigration policies harmful to children.

In the exam room, there are no Democrats and Republicans. When it comes to community health challenges, there’s much more that unites than divides the United States. Both red and blue areas of the country can benefit from creative local efforts to improve health and save lives.

The nation faces grave health challenges that are beyond politics. The election results, and signs of a bipartisan health agenda, are a reason for hope.

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About the author: Joshua M. Sharfstein, MD, is Vice Dean for Public Health Practice and Community Engagement at the Johns Hopkins Bloomberg School of Public Health. He previously served as Secretary of the Maryland Department of Health and Mental Hygiene, as the Principal Deputy Commissioner of the US Food and Drug Administration, and as Commissioner of Health for Baltimore. He is also a consultant to Audacious Inquiry and to Sachs Policy Group. A pediatrician, he lives with his family in Baltimore. (Image: Chris Hartlove)

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.



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