Taking Note

One Simple Stimulus for Both the Economy and Health

When President-elect Barack Obama takes office, he will be preoccupied with a broad range of enormous and complex challenges, including a downward spiraling economy and two wars. But some problems that might seem lower on the priority list also present relatively manageable opportunities to make meaningful progress in ways that would greatly benefit the country. One such target for saving money and improving lives is dealing with tobacco—the nation’s number one cause of preventable death and one of its greatest contributors to high health care expenditures. 

According to one of the new reports that the CDC released two Fridays ago, at least 443,000 people in the U.S. died prematurely each year from 2000 to 2004 as a result of smoking and/or exposure to secondhand smoke. It may appear that fewer people smoke nowadays than even just a decade ago, but this is an increase, not a decrease, from the number of annual tobacco-related deaths between 1997 and 2001, which was 438,000. By any measure, this is a considerable number of deaths—more than 10 percent of the 4.2 million premature tobacco-related deaths worldwide reported by the World Health Organization in 2000.

Health and financial costs resulting from smoking have also increased over the same period of time from $167 billion to $193 billion. This new total includes $96 billion in public and private health care expenditures caused by smoking and $97 billion in productivity losses. (And this latter figure only includes costs from productive work lives shortened by smoking-caused death; it does not include costs from smoking-caused disability during work lives, smoking-caused sick days, or smoking-caused productivity declines while on the job.)

The Millennial Generation and the 2008 Election

The Millennial generation (birth years 1978 to 1996 or 2000, depending on definition) made a huge impact on this election.  I have made a detailed analysis of this impact and how it is likely to grow in the future in a new report, Generation We and the 2008 Election.  Here are some of the key findings form that report.

In 2008, 18-29 year olds, now all members of the Millennial generation , voted Democratic by a stunning 66-32 margin.  And they did so with remarkable generational consistency: 18-24 year olds voted 66-32 Democratic while 25-29 year olds voted 66-31 Democratic.  Essentially no difference.

Obama’s support among 18-29 year olds was remarkably broad, extending across racial barriers.  He carried not just Hispanic 18-29 year olds (76-19) and black (18-29 year old (95-4) but also white 18-29 year olds (54-44).  Obama’s 10 point advantage among white 18-29 year olds contrasts starkly with his 15 deficit among older whites.

Obama’s huge overall margin among Millennials contributed mightily to his strong victory this November.  Indeed, without 18-29 year olds, Obama’s popular vote margin would have been slightly under one percentage point.  That figure implies that the overwhelmingly proportion of Obama’s popular vote victory (87 percent) was attributable to the support of 18-29 year old Millennials.  Indeed, without these Millennial voters, Obama would have been hard-pressed to claim much of a mandate from his election victory.

Maybe Government Isn’t So Bad After All

One of the more interesting results from the 2008 national exit poll—and one that hasn’t gotten wide enough circulation—is that Americans now believe government should be doing more to solve problems. This is in contrast to believing that government is doing too many things best left to businesses and individuals. By an 8-point margin, 51-43, voters endorsed more government involvement on election day.

Even more interesting is how young voters aged 18 to 29 felt about government. By an overwhelming 69-27 margin, these voters said government should be doing more to solve problems.

Looking back from 2025

America’s media tend to look on the bright side. "Terrorism will be less relevant in 2025," Fox News headlined its account of the quadrennial "global trends" forecast of the National Intelligence Council. "Al Qaeda’s appeal to falter," the New York Times assured its readers.

But perhaps the British Broadcasting Corporation was more on the mark in distilling the Global Trends 2025 report into a headline. It ran the story as: "US global dominance ‘set to wane’."

In one of the most sobering assessments ever to emerge from this periodic forecast, America’s intelligence seers warn that a variety of factors "increasingly will constrain US freedom of action" over the next quarter-century. Terrorism is almost incidental. The rapid shift of wealth and economic power already under way from West to East is, they say, "without precedent in modern history."

The Front Lines of Primary Care

In a recent post, Health Beat described the policy strategies that must be employed in order to address the primary care crisis in the United States.  This post focuses on the human side of the primary care crunch by highlighting the personal experiences of doctors. Moving from the policy to the personal adds an all-important qualitative element to our understanding of just why American primary care is in such dire straits. 


The Basics

That said, numbers still help set the stage: in 1990, 9 percent of graduating medical students planned to work in primary care/internal medicine; today just 2 percent are choosing primary care. Meanwhile, we know that primary care can help patients avoid expensive, unnecessary medical procedures; obtain regular preventive care; and manage the chronic illnesses that make up between 75 and 80 percent of our $2.3 trillion national health care bill. We can’t afford to run out of PCPs.

The Nuclear Challenge for Obama

One of the most ominous issues which President-elect Barack Obama will face in his first months in office is the matter of the growing array of nuclear weapons around the globe. Today there are 27,000 nuclear weapons of various kinds in the world today – of which 26,000 belong to the US and Russia. How does this country work toward reducing the numbers of these dangerous devices to lower the possibility of nuclear mishaps and ward off the chances of accidental missile launches and prevent bombs like these from falling into the hands of terrorists?

Revisiting Obama and the Book Business

Among other distinctions Barack Obama brings to the White House is the fact that he is the most successful author ever to occupy the presidency. Obama’s memoir, Dreams of My Father, and The Audacity of Hope, the manifesto he wrote in his first year as a senator, have sold millions of copies in the United States and around the world. No other books by a political figure come close in terms of sales, or in the case of Dreams, literary skill, with the possible exception of John F. Kennedy’s Profiles in Courage.

Four Crises on Obama's Horizon

No one should be surprised that president-elect Barack Obama's first press conference, three days after his historic November 4th victory, was devoted almost exclusively to the economy. Obama was also quick to remind reporters that there is only one president at a time, and his turn does not begin until January 20. While domestic challenges will dominate his agenda, a not-insignificant list of Middle East crises will confront America's 44th president as well. Here are four of the more urgent issues in which Israel has a keen interest, and which are likely to force themselves onto the Obama team transition agenda and its early days in office.

"Spread the Wealth" Controversy Hits Doctors

This post was written by Niko Karvounis and Maggie Mahar

Last week Senator Max Baucus (D-MT) offered a “Call to Arms” for health care reform by way of a 98 page policy document. Because Baucus’ document was a sweeping, comprehensive look at America's health care problems, media coverage tended to focus on its grand principles rather than specific policy details. But when it comes to health care policy, it's all about the details, among which Baucus includes the following sticking point: a proposal to increase payments to primary care providers at the expense of compensation for specialists.

Baucus rightly recognizes that primary care is “undervalued” in our health care system. The Medicare reimbursement schedule—which is the model for private insurers rates—pays a lot more for removing a wart than it does, say, for talking to patients about their medications. Doing something to a patient (procedural care) is compensated much more than is doing something with a patient (cognitive care). The result is that generalists, including family practitioners, internists, primary care providers (PCPs), geriatricians and palliative care specialists make a lot less than proceduralists.

New Administration's Bold Approach Receives Support

The incoming Obama administration has set a number of ambitious goals for itself. Refreshingly, the public, far from being cynical about this, is remarkably optimistic that the new administration can actually succeed in meeting these goals.

In a recent Gallup poll, the top eight goals about which the public expressed optimism were: improve conditions for minorities and the poor (80 percent believe the new administration will be able to do this); increase respect for the United States abroad (76 percent); improve education (71 percent); improve the quality of the environment (70 percent); reduce unemployment (67 percent); bring troops home from Iraq in a way that doesn’t harm the United States (66 percent); improve the health care system (64 percent); and create a strong economic recovery (64 percent).