What Tomorrow Holds for U.S. Health Care

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Experts offer solutions to pressing issues in American health care.

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Problems with the U.S. health care system—including the rising costs of prescription drugs, the current opioid abuse crisis, and continued gaps in access to care—have moved front and center in national policy debates.

But despite the urgency of these problems, politicians have not reached any consensus on how to solve them. The Trump Administration has sought to empower states to craft solutions to health care problems that affect their own populations, while Democrats like Senator Bernie Sanders (I-Vt.) and Representative Pramila Jayapal (D-Wash.) have advocated for a national health insurance system they call “Medicare for All.”

These differences in policy positions would seem to indicate that the future of American health care policy remains far from predictable. They also suggest that ample room exists for non-governmental actors—such as academic experts and health care institutions—to take the lead in developing solutions to the health care issues that affect Americans every day.

Against this backdrop, The Regulatory Review has invited numerous experts to analyze pressing concerns with the current U.S. health care system and offer their ideas for the future.

The contributors to this series are: Benjamin A. Barsky, an editor of The Regulatory Review at the University of Pennsylvania Law School; Aaron J. Glickman, a policy analyst at the Perelman School of Medicine at the University of Pennsylvania; Stephanie P. Hales, a partner at Sidley Austin LLP; Allison K. Hoffman, a professor at the University of Pennsylvania Law School; Simone Hussussian, an editor of The Regulatory Review at the University of Pennsylvania Law School; Robert M. Kaplan, a professor at the UCLA Fielding School of Public Health and the Stanford University School of Medicine; Mason Marks, fellow at Yale Law School; Jonathan D. Moreno, a professor at the University of Pennsylvania; Isabel M. Perera, a fellow at the Perelman School of Medicine at the University of Pennsylvania; Philip E. Rubin, the Chief Executive Officer emeritus of Haskins Laboratories and a professor at the Yale University School of Medicine; Theodore W. Ruger, dean of the University of Pennsylvania Law School; Rachel E. Sachs, a professor at the Washington University in St. Louis School of Law; Gabriel Scheffler, a fellow at the Penn Program on Regulation at the University of Pennsylvania Law School; Dominic A. Sisti, a professor at the Perelman School of Medicine at the University of Pennsylvania; and Carmel Shachar, the executive director of Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics.

Defining and Establishing Goals for Medicare for All

April 29, 2019 | Carmel Shachar, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics

It is increasingly difficult to find a Democratic presidential hopeful who has not paid at least some lip service to “Medicare for all.” Medicare for all, however, means many things to many people. As the fight to become the Democratic presidential candidate unfolds, it will be important to see how this term gets defined.

Prescription Drug Affordability

April 30, 2019 | Rachel E. Sachs, Washington University in St. Louis School of Law

The question of prescription drug pricing and affordability has assumed far greater salience for American patients over the last several years. But one issue that has not received much examination is how the recent lawsuit led by several Republican state attorneys general seeking to declare unconstitutional the Patient Protection and Affordable Care Act has the potential to exacerbate the problems Americans already face affording their prescription drugs.

The Institutions for Mental Diseases Exclusion Rule is an Anachronism

May 1, 2019 | Aaron J. Glickman, Perelman School of Medicine, Isabel M. Perera, Perelman School of Medicine, and Dominic A. Sisti, Perelman School of Medicine

One controversial feature of the national mental health regulatory regime is the exclusion of Medicaid payments for so-called institutions for mental diseases. This exclusion has failed to prevent the coercive institutionalization of seriously mentally ill individuals. A number of recent regulatory changes have chipped away at the exclusion and are a useful first step toward needed reform.

Modernizing the Human Subjects Regulations

May 2, 2019 | Philip E. Rubin, Haskins Laboratories and Yale University School of Medicine

Every day, individuals around the world take part in research studies, including biomedical and behavioral experiments. But the ways in which the federal government will choose to respond to new research issues of pressing concern, like the development of personalized medicine or the use of novel neuro-technologies, remain unclear.

Can Health Regulation Move Beyond Markets?

May 6, 2019 | Allison K. Hoffman, University of Pennsylvania Law School

When President Barack H. Obama signed the Patient Protection and Affordable Care Act into law, few people could have imagined that Democrats would now be debating whether “Medicare for all” should be a centerpiece of their 2020 policy goals. This debate is evidence of the beginning kernels of a major conceptual shift in health policy and, in turn, health law and regulation.

Is the 21st Century Cures Act a Solution or a Problem?

May 7, 2019 | Robert M. Kaplan, UCLA Fielding School of Public Health and Stanford University School of Medicine

In December, 2016, the U.S. House of Representatives and the U.S. Senate came together to pass the 21st Century Cures Act. The Act includes many attractive features. But it also contains provisions that could increase risks to patients.

Waiving Away Medicaid

May 8, 2019 | Gabriel Scheffler, University of Pennsylvania Law School

Thousands of Americans are losing their Medicaid coverage due to a previously obscure waiver provision in the Social Security Act known as Section 1115. Administrator Verma has defended her agency’s actions by arguing that “people moving off of Medicaid is a good outcome because we hope that means they don’t need the program anymore.” There is little reason to believe that her hope is justified.

Why Less Suicide Prediction on Social Media Is More

May 9, 2019 | Mason Marks, Yale Law School

In 2017, Facebook announced it was using artificial intelligence to predict suicide. In an article published in February, Ian Barnett and John Torous propose installing a second suicide screening program on top of Facebook’s existing system. Such a system is unlikely to be effective and would expose users to increased privacy and safety risks.

The Role of Appropriate Access to Care in Reducing Health System Costs

May 13, 2019 | Stephanie P. Hales, Sidley Austin LLP

Many policymakers are turning to patient access restrictions to reduce spending and, as such, control costs. Cost-containment objectives are undoubtedly necessary to pursue. But policies that seek to advance those objectives by imposing barriers to individuals’ access to care can actually increase costs, rather than reduce them.

Will an All-Payer System Lower Health Care Costs?

May 14, 2019 | Simone Hussussian, University of Pennsylvania

Many policymakers advocate for a single-payer system, or “Medicare for all,” as the solution for sharply rising health care costs. But states may also be able to play a role in containing these costs without shifting to a single-payer system.

Making Law Student Mental Health a Priority

May 15, 2019 | Benjamin A. Barsky, University of Pennsylvania, and Theodore W. Ruger, University of Pennsylvania Law School

Mental health and substance abuse problems affect individuals working in every profession. Institutions dedicated to preparing individuals to enter professional careers need to take the lead in addressing this problem—a mission that Penn Law has taken to heart through several recent initiatives.

Should Pandora’s Brain Be Regulated?

May 16, 2019 | Jonathan D. Moreno, University of Pennsylvania

The creation of human-like intelligence in a non-biological being would be the greatest achievement in human history. But what role should regulatory regimes play? Should an agency be empowered to verify that the standards are being administered? By the time the singularity has been achieved, a recall may be beside the point. At that point, in the words of the Borg in Star Trek, “resistance is futile.”