Wednesday, August 31, 2022

Hot topics in health policy

Last night, in a short talk to medical students and residents on "Health Policy in Family Medicine," I outlined three paths to become involved in the health policy space as a family physician, paralleling the ways that policy has intersected with my own career:

1. Clinical guidance and practice guidelines. How do research findings make their way into clinical practice recommendations? Where evidence is lacking or inconclusive, how are the judgment calls made and who gets to make them? Examples include my experiences as a medical officer for the U.S. Preventive Services Task Force, a guideline panelist for the American Academy of Family Physicians and collaborating specialty groups, and a member of the HHS Secretary's Advisory Committee on Breast Cancer in Young Women.

2. Advocacy for patients and population health. Advocacy can take many forms: interpersonal (e.g., lobbying local, state, or federal officials), writing opinion pieces, or serving as a source for a news story. I consider Common Sense Family Doctor and my Twitter account to be my main advocacy platforms, though on occasion I've written editorials in high-profile publications such as JAMA. During the COVID-19 pandemic, I spent a good deal of time pushing back against vaccine hesitancy and anti-vax sentiments in my community and online.

3. Advocacy for health professionals and primary care. While at Georgetown, I directed a health policy fellowship that trained recent family medicine residency graduates in research that demonstrated the value (and financially undervalued nature) of primary care. I continue to support the Robert Graham Center's work by publishing an ongoing series of Policy One-Pagers in American Family Physician.

Health policy isn't an abstract subject for me. In my medical career, I've seen firsthand the benefits to patients of the 2003 Medicare Modernization Act (which provided prescription drug coverage to millions of older adults), the 2010 Affordable Care Act (which extended access to affordable health insurance to tens of millions and provided consumer protections and guaranteed preventive services to all), and this year's Inflation Reduction Act, which allows Medicare to negotiate the prices of a limited number of expensive drugs, caps Medicare patients' out-of-pocket insulin costs at $35 per month and their total prescription out-of-pocket costs at $2000 per year. In addition, the IRA extended enhanced health insurance marketplace subsidies that were set to expire this year through 2025, which will preserve the affordability of private plans for lower-income patients who are self-employed or work for small employers that don't offer health care benefits. This legislation will make a major difference in many of my patients' lives by making it easier for me to provide them with the best care possible.