Nobel Prize Dialogue Berlin 2019 Towards Health: Equality, Responsibility and Research, Friday Nov. 8

I'll be speaking in Berlin again today:

Below is one announcement, with the agenda (and a list of speakers and panelists is here):
BERLIN 2019
TOWARDS HEALTH
Equality, Responsibility and Research

10:00 A.M. – 12:30 P.M.
Opening Remarks
Jörg Hacker, Laura Sprechmann

What Does ‘Health’ Mean to You?
Peter Agre, Tolu Oni, Ursula Staudinger
Moderator: Adam Smith

Funding Research for a Healthier Future: How Should We Set Priorities?
Tomas Lindahl, Ernst Dieter Rossmann, Eleftheria Zeggini
Moderator: Juleen Zierath

Kidney Exchange
Alvin Roth

How Can We Increase Organ Donation and Transplantation?
Ernst Dieter Rossmann, Alvin Roth, Christiane Woopen
Moderator: Adam Smith

Musical Intermezzo: Berliner Cellharmoniker
How Climate Change Is Affecting Our Health
Kristie Ebi

What Can We Do About the Health Risks of Climate Change?
Kristie Ebi, Sabine Gabrysch, Sylvia Hartmann
Moderator: Gustav Källstrand



Health Inequalities Throughout The Life Course
Michael Marmot

How Can We Reduce Health Inequalities?
Nicola Bedlington, Kathryn Dewey, Michael Marmot
Moderator: Peter Tinnemann

LUNCH BREAK 12:30 P.M. – 1:45 P.M.
LUNCHTIME CONVERSATIONS 12:30 P.M. – 1:45 P.M.
The Microbiome: a New Dimension in Health
Suzanne Devkota
Moderator: Adam Smith

Behind the Scenes of the Nobel Prize
Gustav Källstrand und Juleen Zierath
Moderator: Katja Patzwaldt

PARALLEL SESSIONS 1:45 P.M. – 3:15 P.M.
Lichthof
Vaccine Hesitancy
Michel Goldman, Tikki Pang, Harald zur Hausen
Moderator: Juleen Zierath

You are Entitled to Your Own Opinion, But Not to Your Own Facts
Tikki Pang

Health Challenges in Low- and Middle-Income Countries
Peter Agre, Tolu Oni, Tikki Pang
Moderator: Peter Tinnemann

Atrium
Mental Health and Longer Lives: Positive Plasticity of Cognitive Aging
Ursula Staudinger

Mental Health, Cognition and Ageing
Edvard Moser, Ursula Staudinger
Moderator: Adam Smith

The Future of Drug Development and Precision Medicine
Nicola Bedlington, Michel Goldman, Tomas Lindahl, Eleftheria Zeggini
Moderator: Adam Smith

COFFEE BREAK 3:15 P.M. – 3:45 P.M.
ATRIUM 3:45 P.M. – 4:45 P.M.
The Role of Diet
Suzanne Devkota, Kathryn Dewey, Harald zur Hausen
Moderator: Juleen Zierath

What Level of Healthcare Can Society Afford?
Michel Goldman, Heyo Kroemer, Alvin Roth, Christiane Woopen
Moderator: Peter Tinnemann

Who Is Responsible For Our Health?
Nicola Bedlington, Kristie Ebi, Heyo Kroemer, Michael Marmot, Edvard Moser, Tikki Pang
Moderator: Adam Smith

Closing Remarks
Laura Sprechmann

Emanuel and Fuchs on health care in the NYT"

Here it is (four, because six would be too confusing...)

Four Key Things You Should Know About Health Care 
By Ezekiel J. Emanuel and Victor R. Fuchs
Sept. 12, 2019

"Fallacy No. 1: Employers pay for employees’ health insurance.
...
"Fallacy No. 2: Medicare for All is unaffordable.
...
"Fallacy No. 3: Insurance companies’ profits drive health care costs.
...
"Fallacy No. 4: Price transparency can bring down health care costs."

Universal health coverage under siege from both the right and the left, in the U.S. and Mexico

Here's a commentary in The Lancet, comparing attacks on the Affordable Care Act in the U.S. and on Seguro Popular in Mexico.

A dark day for universal health coverage, by Julio Frenk, Octavio Gómez-Dantés, and Felicia Marie Knaul

"Dec 14, 2018, was a dark day for universal health coverage (UHC). To begin with, a federal judge in Texas, USA, ruled that the Affordable Care Act (ACA) is unconstitutional.1 That same day, the new President of Mexico, Andrés Manuel López Obrador, announced his intention to abolish the country's largest public insurance programme, known as Seguro Popular (People's Health Insurance).2 The ACA and Seguro Popular have extended health coverage to millions of previously uninsured families, most of them among the poorest in their respective countries. Signed into law in 2010, the ACA roughly halved the number of uninsured, from 46·5 million then to 26·7 million in 2016, towards the end of the Obama administration.3,  4 Following legislative approval, Seguro Popular began full-scale implementation in Mexico in 2004. Public expenditure increased to finance coverage for non-salaried workers and their families, approximately half of Mexico's total population, who were excluded from employment-based social insurance. By 2018, 53 million beneficiaries had access to 290 essential and 65 high-cost interventions.
...
"The challenge to the ACA has been headed by the right wing of the US Republican Party, whereas the attack to Seguro Popular comes mostly from the far left factions of the President's Morena party. This is an example of the way in which opposing political extremes can converge in their attack against centrist positions.
...
"Seguro Popular is one of the most thoroughly evaluated programmes in the world. A 2006 Lancet Series set out the evidence base for the design of this innovative initiative.7,  8 A comprehensive review9 published 8 years into implementation identified a large body of peer-reviewed articles, including one of the few randomised assessments of a large-scale social intervention.10 The evidence strongly points to major benefits of Seguro Popular in terms of financial protection and effective coverage,11 without labour market distortion.12 In a recent cover article on UHC, The Economist featured Seguro Popular among the most successful efforts in low-income and middle-income countries, noting how “studies suggest that Seguro Popular has drastically reduced the number of Mexicans facing catastrophic health costs and reduced infant mortality”

Vic Fuchs on desirable health insurance overhaul

In JAMA (gated:(.  Vic isn't optimistic about the political prospects of large scale reform of health insurance, but he has some thoughts about where we've gone wrong, and where we might try to go.

November 27, 2018
How to Make US Health Care More Equitable and Less Costly
Begin by Replacing Employment-Based Insurance
Victor R. Fuchs, PhD1
JAMA. 2018;320(20):2071-2072. doi:10.1001/jama.2018.16475

"With few exceptions, employment-based insurance is administered by health insurance companies. In consultation with employers, many of whom are self-insured, the insurance companies design benefit and premium schedules, negotiate reimbursement rates with hospitals and physicians, and approve or disapprove medical center, physician, and patient claims. There are only a few very large health insurance companies and many small ones, but none has been successful in restraining expenditures. The inability of large insurance companies to bargain more effectively with hospitals and physicians is a systemic problem.

"Most health care is delivered locally and, partly as a result of mergers and acquisitions, a predominant or premier hospital and affiliated physicians in a local market may have more bargaining power than even the largest insurance company. In some markets, a large insurance company is forced to pay more than twice the Medicare fee in part to retain a popular health care system on its plan.
...

"Box 1.

Characteristics of an Alternative Approach to Employment-Based Insurance

• Universal eligibility: Unlike employment-based insurance and many of the special government programs with sharply defined eligibility criteria, everyone would be insured for comprehensive health care, including hospital care, physician and other professional services, and prescription medications.
• Funding: This would come from a broad-based tax dedicated to health care.

...

Box 2.

Suggested Guidelines for an Alternative Approach to the Organization and Delivery of Medical Care

• Rely as much as possible on private-sector responsibilities and initiatives
• Limit the government’s role to broad decisions that do not require a large bureaucracy to implement
• Give consumers a choice of health care plans at annual enrollment. In contrast, giving insured patients a choice for individual hospitals and physicians leads to higher not lower expenditures. Choice should also include the right of individuals to buy more than the basic plan that would be paid for with their after-tax dollars.
• Provide for competition among health plans; this will be more valuable than competition among individual physicians.⁷ Competition should focus on service and quality of care.
• Develop reimbursement methods other than fee-for-service. Some economists maintain that risk-adjusted capitation payment to plans is the best way to achieve cost-effective care. Plans receiving capitation payment could offer productivity incentives to physicians if desirable."

Matching patients to health care in China

When I travel in China, one topic that often comes up is that there should be a better way of matching patients to doctors in Chinese hospitals.  Here's a story in the NY Times about that:

China’s Health Care Crisis: Lines Before Dawn, Violence and ‘No Trust’ 
By Sui-Lee Wee

"Well before dawn, nearly a hundred people stood in line outside one of the capital’s top hospitals.

"They were hoping to get an appointment with a specialist, a chance for access to the best health care in the country. Scalpers hawked medical visits for a fee, ignoring repeated crackdowns by the government.
...
"The long lines, a standard feature of hospital visits in China, are a symptom of a health care system in crisis.
...
"China has one general practitioner for every 6,666 people, compared with the international standard of one for every 1,500 to 2,000 people, according to the World Health Organization.

Instead of going to a doctor’s office or a community clinic, people rush to the hospitals to see specialists, even for fevers and headaches. "

An electronic board at the entrance of Peking Union Hospital displays the number of doctors available and their specialty.CreditGilles Sabrié for The New York Times

Gaming the Affordable Care Act (ACA)

One of the big lessons of market design is that participants have big strategy sets. Here's a new paper that explores some of what that has implied about how the Affordable Care Act is gamed by some participants.

Take-Up, Drop-Out, and Spending in ACA Marketplaces

Rebecca Diamond, Michael J. Dickstein, Timothy McQuade, Petra Persson

NBER Working Paper No. 24668
Issued in May 2018
NBER Program(s):Health Care, Public Economics, Industrial Organization 

The Affordable Care Act (ACA) established health insurance marketplaces where consumers can buy individual coverage. Leveraging novel credit card and bank account micro-data, we identify new enrollees in the California marketplace and measure their health spending and premium payments. Following enrollment, we observe dramatic spikes in individuals' health care consumption. We also document widespread attrition, with more than half of all new enrollees dropping coverage before the end of the plan year. Enrollees who drop out re-time health spending to the months of insurance coverage. This drop-out behavior generates a new type of adverse selection: insurers face high costs relative to the premiums collected when they enroll strategic consumers. We show that the pattern of attrition undermines market stability and can drive insurers to exit, even absent differences in enrollees' underlying health risks. Further, using data on plan price increases, we show that insurers largely shift the costs of attrition to non-drop-out enrollees, whose inertia generates low price sensitivity. Our results suggest that campaigns to improve use of social insurance may be more efficient when they jointly target take-up and attrition.

When an academic conference can save lives (market for interventional cardiologists)

The Chronicle of Higher Ed has the story:
Academic Conferences May Save Lives — by Keeping Big-Name Doctors Busy

Here's the medical paper on which it is based:
Acute Myocardial Infarction Mortality During Dates of National Interventional Cardiology Meetings
Anupam B. Jena, Andrew Olenski, Daniel M. Blumenthal, Robert W. Yeh, Dana P. Goldman, John Romley,
Journal of the American Heart Association. 2018

"Thousands of physicians attend national scientific meetings annually. Within hospitals, the composition of physicians who attend scientific meetings may differ from nonattendees who remain behind to treat patients, potentially resulting in differences in care patterns and outcomes for patients hospitalized during meeting dates. A quasi‐experimental evaluation of outcomes of patients hospitalized with acute cardiovascular conditions during the American Heart Association (AHA) and American College of Cardiology (ACC) annual meetings compared with identical nonmeeting days in the surrounding weeks found that, within teaching hospitals, patients admitted with cardiac arrest or high‐risk heart failure during meeting dates had lower adjusted 30‐day mortality compared with similar patients on nonmeeting dates"

Economists' declaration on universal health coverage

Larry Summers has organized a widely signed open letter supporting universal health coverage as a sensible global development goal. Here's the press release:

267 ECONOMISTS WORLDWIDE AGREE: UNIVERSAL HEALTH COVERAGE MAKES ECONOMIC SENSE
18 SEPTEMBER 2015 – A global coalition of 267 economists representing 44 countries is calling on policymakers to prioritize universal health coverage as an essential pillar of economic development. The Economists’ Declaration on Universal Health Coverage, published today in The Lancet medical journal, was convened by The Rockefeller Foundation and led by Lawrence H. Summers, Charles W. Eliot University Professor and President Emeritus at Harvard University.

Signatories include Nobel Laureates Joseph Stiglitz, Kenneth Arrow, Alvin Roth, Vernon Smith and Christopher Pissarides; the current and former chief economists of the World Bank, Kaushik Basu and Justin Yifu Lin; noted health economists Anne Mills and Victor Fuchs; and renowned economic thinkers Thomas Piketty, Linah Mohohlo, Bjørn Lomborg, Tony Atkinson, John Irons and Paul Collier. Economists on every continent are supporting the Declaration.

Launched as global leaders prepare to enact the Sustainable Development Goals – an ambitious agenda for the next 15 years that includes universal health coverage among its targets – the Economists’ Declaration proclaims that ensuring everyone can obtain high quality essential health services without suffering financial hardship is right, smart and affordable.

“Universal health coverage isn’t only the right thing to do – it’s also the economically smart thing to do,” said Lawrence H. Summers. “The data clearly show that health is essential to eradicating extreme poverty and promoting economic growth. I launched this Declaration to urge world leaders to act on that evidence.”

The Economic Case for Universal Health Coverage

The Declaration cites the considerable evidence supporting the signatories’ assertion that all countries have the opportunity to achieve universal health coverage and should prioritize reforms and investments toward it.

• Historic Opportunity: With the right investments to increase availability of today’s health tools and discover, develop and deliver new interventions, the world has an unprecedented opportunity to dramatically reduce preventable maternal, child and infectious disease deaths and achieve a “grand convergence” in health across the world’s population by 2035.
• Cost of Health: 150 million people fall into poverty every year paying for health. The 100+ countries already taking steps toward universal health coverage are demonstrating that it protects families from this risk, fostering more cohesive societies and more productive economies.
• Driving Economic Growth: In the past decade, health improvements were responsible for nearly a quarter of full income growth in low- and middle-income countries. It is estimated that the economic benefits of investing in basic health care will be 10 times greater than the costs.
• Building Resilience: Universal health coverage lessens the impact of shocks on communities. The debilitating effects of Ebola could have been mitigated by building up public health systems in Guinea, Liberia and Sierra Leone at one third the cost of the Ebola response so far.

“With nearly half the world’s population now living in a country advancing toward universal health coverage, the case for universal coverage is strong and growing stronger. There is still work to be done to ensure more equitable access to life-saving services for the poorest and most vulnerable people,” said Judith Rodin, President of The Rockefeller Foundation. “The Rockefeller Foundation convened this Declaration by the world’s leading economists to demonstrate the financial benefits and feasibility of universal health coverage. With their resounding support, it is time to invest the resources to make health for all a reality.”

“We are at a juncture of history where the world can afford basic health coverage for all,” saidKaushik Basu, Senior Vice President and Chief Economist of the World Bank. “Given economic growth, donor country commitments and new mechanisms to raise local funds, countries, no matter at what stage of development, can provide universal health coverage.”

Health Is an Investment, Not a Cost

More than 100 countries across the development spectrum have begun working toward universal health coverage, increasingly demonstrating its feasibility. The Economists’ Declaration calls for increased domestic funding, donor country commitments and political leadership to advance pro-poor reforms toward universal health coverage.

“Healthy people are the engine of a country’s economic growth. Universal health coverage ensures that engine is constantly fueled,” said Linah Mohohlo, the Governor of the Bank of Botswana. “Our ability to build the planet we deserve depends on governments and global leaders stepping up to deliver on the promise of health for all people.”

“As the gap between rich and poor keeps growing, we must prioritize policies that work to counter inequality,” said Joseph Stiglitz, University Professor at Columbia University. “Universal health coverage does just that, ensuring everyone has access to health care, without which they cannot succeed, and strengthening economies as a result.”
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Here's the full text of the letter.