Blog: The View from Here

  • 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

  • Their Pain, Our Gain

    Apr 30, 2018 | Christopher F. Koller, President

    Hey, health care industry—(all of us, payers, providers, industry hangers-on)—are you paying attention to what’s happening in our public schools? How public school teachers in West Virginia, Oklahoma, Kentucky, and Arizona have had to resort to public protests and walkouts to draw attention to poor funding levels in their states? How spending cuts have led to four-day school weeks, … Read more

  • Gun Violence, Advocacy, and Leadership

    Mar 29, 2018 | Christopher F. Koller, President

    As the know-it-all big brother, I take the job of telling my sister what to do very seriously. So when she starts giving me lessons in my supposed wheelhouse—the making of public policy to improve population health—I am brought up short; especially when the lessons are about strength, courage, and the role of advocacy to change set-in-stone policies—in this case, regarding the regulation of … Read more

  • Paying the Piper

    Feb 28, 2018 | Christopher F. Koller, President

    Because the federal government can print money, the federal government can spend it. And spend it did, when the Affordable Care Act—even as adjusted by the Supreme Court—picked up 100% of the tab for newly eligible Medicaid enrollees, instead of the national average of 55%. But now that federal share is slowly decreasing—to 90% by 2020—and states that expanded Medicaid, lacking the … Read more

  • Exemplary Public Service

    Jan 29, 2018 | Christopher F. Koller, President

    “Don’t steal. The government hates competition.” —Bumper sticker. While grousing about the burden of taxes and shoddy government services like the Department of Motor Vehicles is a popular—and often justified—pastime, a deeper and more serious antipathy to the role of government in our society has again come to the fore in recent years. Some attribute its roots to the Reagan Revolution … Read more