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November 21, 2017
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Karen Handmaker
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Consumerism
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It’s Compassion, Everyone!

Last week we lost Uwe Reinhardt, the famous health economist at Princeton University, his passionate voice and memorable sense of humor.  Reading articles and posts remembering Uwe, a German who fled Europe during WWII for Canada, who was best known not only for his outstanding analyses of thorny healthcare questions but for his reminder to all of us that there are people behind the numbers.  And, to the extent that our health policies and practices lead to outcomes that are unfair, he constantly pushed for solutions to make healthcare access more equitable.

Less than two weeks before Uwe passed away, Dave Johnson and Zeke Emanuel published a Viewpoint in JAMA called Measuring the Burden of Health Care Costs on US Families: The Affordability Index, which, at its core, raises fundamental questions about the fairness of a healthcare system that continues to take a bigger and bigger chunk out of middle class incomes.

Even before this article was publicly available, Uwe read it and provided both a compliment and a challenge in an editorial comment on JAMA.  He praised Dave and Zeke for proposing a measure that is “compact and easy to calculate”, calling it “a welcome new potential tool in the armamentarium of health statistics.”  As a macroeconomic measure, the trend line displayed by graphing the Affordability Index makes the unmistakable point that the cost of an employer-sponsored health insurance policy now represents almost 31% of the average American family’s income, up from only 14% in 1999.

However, pushing us all to go further to demystify this statistic, Uwe asks “What does that number [31%] really mean?” In other words, what microeconomic measure can we produce and make accessible that will resonate with American consumers and help derail the impact the runaway train of healthcare costs is indeed having on families?

In fact, he proposed that we use data from the annual Medical Expenditure Panel Survey (MEPS) and related data sources to create a user-friendly interactive tool for the media and the general public to make this information widely available and understandable.  He concludes by saying, “…such a data system could help constrain the folklore on which health policy so often is conducted and provide to legislators robust data about the fragile US health insurance system over which they preside.”

We totally agree with Uwe.  On the same day JAMA published Dave and Zeke’s article, 4sight Health published a companion Market Corner Commentary, “Introducing the Affordability Index: High-Cost Private Health Insurance Reduces Family Incomes” in which we also call for regular publication of the Affordability Index to draw public attention to the heavy price Americans pay for healthcare coverage.

To Uwe, the health economist who in 2003 said “It’s the Prices, Stupid!” about why healthcare costs outrageously more in the United States than in other countries, we would like to say thank you for making us recognize the power of consumable information to change our healthcare system for the better.

In his view of the world, a better healthcare system is one that is inexpensive and equitable and we must continue to strive for such a system in our country.  Thank you, Uwe, for reminding us to always ask, “What does our system say about our values?” After all, it is compassion for the people behind the numbers that must guide us

About the Author

Karen Handmaker

Karen is an engaging population health management expert with a passion for new models and technologies to improve health and healthcare with the “consumer at the center.”
She is widely recognized for cultivating and maintaining strong, long term multi-level client relationships, strategic planning, thought leadership and industry knowledge. Karen is a recognized speaker, writer and trainer on population health management and primary care transformation. She earned admission into the IBM Industry Academy, is a NCQA PCMH Certified Content Expert, and a longtime member of the Population Health Management Journal Editorial Board.
Karen’s current areas of interest include integrating health and social care, enhancing personalized health and wellness through analytics and machine learning applications, championing and enabling market-driven products and services that produce measurable value across stakeholders.
Karen lived in Hong Kong for six years where she co-founded Fiscal Health, a first-of-a kind local healthcare consulting firm offering a range of services in managed care and health economics Karen received a BA in American Studies at Trinity College in Hartford, CT (Phi Beta Kappa) and her Master in Public Policy from Harvard University.

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