Blog: The View from Here

  • Health Care Costs—Mapping the Forest and Finding a Path

    Feb 21, 2019 | Christopher F. Koller, President

    Health care costs comprise an expansive and poorly mapped forest. There are plenty of fearful features to the wilderness, including rising pharmaceutical costs, consolidating providers, multiplying administrators, aging populations, chronic diseases, and poor health behaviors. Different regions—Medicare, Medicaid, and private health insurance—evoke different and conflicting concerns and … Read more

  • “Deaths of Despair” – Prevention for a Growing Crisis

    Jan 28, 2019 | Christopher F. Koller, President

    I teach a public health course on the US health system. As the grizzled realist in the room, I remind my bright-eyed “public healthers” that being right is not the same as being effective. That while an ounce of prevention really is worth a pound of cure, it is not enough to hector the rest of us constantly. And that to make prevention efforts work, they have to understand where all the money … Read more

  • To Work and To Love—Health in Theory and Practice

    Dec 17, 2018 | Christopher F. Koller, President

    Sigmund Freud said, “Love and work are the cornerstones of our humanness.” That insight—that productive labor and positive human relationships improve one’s physical and mental health—is part of the increased interest in health care’s role in addressing the social determinants of health. The absence of these factors—such as economic stability, safe neighborhoods, access to education … Read more

  • Dear Governor – About Those Statements on Health Care Affordability

    Nov 27, 2018 | Christopher F. Koller, President

    Dear Newly-elected Governor: Congratulations on your victory on November 6th and for assembling successful campaign messages that resonated with so many in your state. Now about those statements on health care affordability. You are one of 19 new governors this year and I hope you and your colleagues did not overcommit yourselves on health care when you were out on the campaign trail. In … Read more

  • Maine’s Family Caregiving Referendum—Revolt of the Sandwiched?

    Oct 30, 2018 | Christopher F. Koller, President

    The “sandwich generation” refers to folks who look after both older family members and their own kids. These people—often in their 40s and 50s—are simultaneously coordinating the logistics and drama of both high school and home care. In Maine, a ballot referendum this fall to make home care more available to residents could give caregivers there a shot at relief, if enough others share … Read more

  • Provider Payment Reform: Right Course, Wrong Students?

    Sep 24, 2018 | Christopher F. Koller, President

    For the last eight years, the US health care system, led by Medicare, has been going to school, learning how to do comprehensive provider payment reform. The most important courses have focused on how to improve performance for entire populations of people. Efforts to promote accountable care organizations (ACOs) in particular have attempted to use payment changes to establish a seismic shift in … Read more

  • When Things Go Wrong: Accountability and the Flint Water Crisis

    Aug 28, 2018 | Christopher F. Koller, President

    Things had gone very wrong for Aaron and the Israelites. The brother of Moses had lost both of his sons after they dared to approach God directly, contrary to God’s directions. The entire tribe was suffering God’s wrath as a result. Moses asked God what could be done to help Aaron. God directed Moses to have Aaron—among other sacrifices—choose a goat to “be presented alive before … Read more

  • Making the Sandwich the Right Way: Improving the Quality of Home- and Community-Based Services

    Jul 24, 2018 | Christopher F. Koller, President

    My uncle did not kick her out, but he made it hard for the home health care worker to do her job. It’s just that he loved his wife of 60 years so much. And he had worked hard to care for her as she lost her mobility, her hearing, her eyesight, and her memory. He was used to doing things in his own way—the right way. So he could not help but give the home health care worker instructions on how … Read more

  • Global Hospital Budgets in Maryland: When Economics and Altruism Align

    Jun 14, 2018 | Christopher F. Koller, President

    Maryland—the land of crabs, the Chesapeake Bay, loyal Orioles fans, and a 1970s era hospital rate-setting scheme that nobody ever got around to unwinding—vaulted to the top of the interest list for pointy-headed health policy types in 2013 when officials renegotiated the terms of their agreement with Medicare. Read more

  • Long Lives for All: Dumb Luck, Personal Virtue, or Public Policy?

    May 31, 2018 | Christopher F. Koller, President

    Aspiring martyrs aside, most of us would put a long and happy life pretty high on our list of personal priorities. Our chances of a long life (Figure 1) are somewhat a function of dumb luck—accidents and genes pick no favorites. But there are also individual behaviors we can choose to take; actions our loved ones and our scolds have encouraged us to adopt—like healthy diets and regular … Read more