Health affairs
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Historical Article
The long road to health reform requires bipartisan leadership.
The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10: (1) make health reform a top legislative priority; (2) be leaders, not partisans; and (3) develop broad policy consensus but leave the policy details to Congress.
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This paper examines the introduction of a prioritized list of fifty-six health conditions in Chile, for which access to treatment is guaranteed. This is an important health reform issue, and the discussion of Chile's rich and complex approach may benefit other countries. ⋯ The dominant criteria were high burden of disease and social preferences. Cost-effectiveness was introduced after the fact to identify effective treatments at a cost that the country could afford.
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The greatest lesson of the failure of comprehensive health reform in the early 1990s is that politics comes first. Even the best-laid policy plans are worthless if they lack the political support to pass. ⋯ And it means formulating political strategies that are premised on the contemporary realities of the hyperpolarized U. S. political environment, rather than wistfully recalled images of the bipartisan politics of old.
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Tax incentives for employer-sponsored insurance and other medical spending cost about $200 billion annually and have pervasive effects on coverage and costs. This paper surveys a range of proposals to reform health care, either by adding new tax incentives or by limiting or replacing the existing tax incentives. Replacing the current tax preference for insurance with an income-related, refundable tax credit has the potential to expand coverage and reduce inefficient spending at no net federal cost. But such an approach by itself would entail substantial risks, so complementary reforms to the insurance market are essential to ensure success.
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Controlled Clinical Trial
Benefits and costs of immunizing children against influenza at school: an economic analysis based on a large-cluster controlled clinical trial.
Current influenza vaccination recommendations focus on immunizing high-risk people; however, influenza mortality and morbidity remain elevated. U. S. policymakers are considering expansion of flu vaccination recommendations to include school-age children (ages 5-18). ⋯ This study examines the cost consequences of a large multistate, school-based influenza immunization program. The results show that immunization reduces disease among children and adults and is cost-saving to society. An epidemiologically based influenza immunization policy might be an important supplement to the existing risk-based policy.