A Policy Prescription for 2016

3. Gun Violence & Mental Health

Some would say that the only thing mental health and gun violence have in common is that politicians keep conflating the two issues. To a small degree, that is correct. However, as long as , I feel that dealing with both issues simultaneously makes some sense.

We have enumerated two strategies that would weaken the link between firearms and death ( and ). Perhaps politicians could agree to implement them. At a minimum, the current ban on federal research into the public health implications of firearms should end.

Unfortunately, policy makers are unlikely to make a dent in rooting out evil, which in my opinion, is why we have so much violence in our society. But by reducing the likelihood that evil people have access to one of the most lethal means to execute their plans is a great first step.

4. Value in Health Care

If value is merely quality per unit price, we will never truly have value in health care without clear transparency in either domain. But I remain . Price transparency might allow third parties to interpret the value equation.

For instance, efforts at (but not quality) in states that did not already have some form of quality score card. However, quality transparency hasn’t necessarily led to patients seeking care from higher quality providers however.

On the other hand, health insurers often utilize transparency information and have a through their insurance designs (e.g. narrow networks).

For now, we should expect the value equation and increased efforts at price and quality transparency to benefit insurers. Whether or not those benefits trickle down to consumers is another question. If you doubt my take on it, simply read Sarah Kliff’s adventure wherein she tried to save America a few bucks but ended up giving herself a medical-system-induced migraine by shopping for a cheaper MRI.

Nevertheless, expect value in health care to remain in the forefront of the public’s health policy agenda as it shifts from coverage to cost, much like what happened after RomneyCare in Massachusetts. And if you want to learn more about the trend, come to our Policy Prescriptions® Symposium in June.

5. The Cadillac Tax

Regarding the Affordable Care Act, there is only one major provision left to implement, that of the . While there is likely to be great debate over this revenue producing aspect of the health reform law, I would heavily judge candidates in their approach to the Cadillac Tax.

As constructed, the provision will reduce the incentive for over-insurance in health care. However, as I have mentioned in prior years, to all people with a qualified health plan. The value of health insurance above that cap would therefore be subject to the taxpayer’s marginal tax rate, effectively converting the current tax treatment of health insurance subsidies from a very regressive to a more progressive one. This would also allow for equivalency of tax treatment for employer-sponsored and individually-purchased insurance.

What is amazing about the Cadillac Tax is that politicians on both sides of the aisle want to repeal it, ranging from Bernie Sanders to House Majority Leader Paul Ryan. The practical issue is the cost. The policy issue is that repeal would worsen the perverse incentive for patients to demand over treatment.

Thus, I could not support a candidate who would repeal the Cadillac Tax without replacing it with an equally effective and fairer system: a refundable tax credit for all who have health insurance while simultaneously eliminating the tax-free treatment of employer-sponsored health insurance.

Candidates, take note. If you want my vote in November you must do three things: (1) let Medicare negotiate pharmaceutical prices, (2) propose real methods of preventing gun violence, and (3) preserve the ethos of the Cadillac Tax.