Health policy expert Bob Kocher likes to show a slide of the signature page of the Affordable Care Act, which he helped draft when he worked in the White House. The mottled page shows an official time stamp of March 23, 2010, and the choppy signature of President Obama, who had to use the 22 pens he would later gift each member of Congress who helped him pass the landmark health-care law.
“We thought it would be pretty simple,” Kocher recalled with a grin. “We had 60 Democrats in the Senate and a huge majority in the House, a popular president. But then you saw what happened.”
Kocher was the keynote speaker at Health Policy through 2020: The ACA, Payment Reform and Global Challenges, a half-day symposium of speakers and panels covering some of the greatest challenges facing health care and policy here at home and abroad.
“Everything that you could imagine that would throw a monkey wrench into it, did,” said Kocher, a physician and partner at the Silicon Valley venture capital firm, Venrock, which invests in health-care and technology startups. Six years after its rocky start — and ongoing threats to repeal the law by Republicans — Kocher still believes the ACA has had a tremendously important impact on the nation.
“Despite the single worst launch of a website in the history of the internet,” he said, 20 million more Americans now have access to health care; 13 million more are privately insured by their companies; and 7 million more are enrolled in Medicaid. “I believe the ACA is working better than expected by virtue of the fact that there’s nobody in the ecosystem who is not behaving differently,” Kocher said.
Stanford School of Medicine Dean Lloyd B. Minor shared what he called “some surprising statistics” with the 200 people at the symposium on Oct. 14. When looking at a pie chart representing the determinants of health, Minor said, only 5 percent are genetically based, 20 percent are based on health care and another 20 percent are due to behavioral factors. But a full 55 percent of the determinants of health are socially and environmentally determined, Minor said, and that presents challenges for academic medical centers. “I’m really excited in that I believe that we are beginning to come up with some ways we can address that need, as a leading academic medical center, to chart the future for how we can improve the delivery of health care in our country and then ultimately around the world,” Minor said.
“For us, that vision for how we fulfill that need begins with what we describe as precision health,” Minor said precision medicine, now embraced by the Obama administration, is about using genomics, big data science and personalization in order to individualize the treatment of acute diseases such as cancer, heart and neurological diseases. “It’s about understanding the determinants and predisposing factors of disease in being able to more effectively intervene earlier,” he said. “And of course there’s no better place to do that than at Stanford because our academic medical center is such an integral part of this great research university.”
Stanford Health Policy core faculty members Grant Miller, Marcella Alsan and Eran Bendavid discuss upcoming challenges and innovations in global health. Miller shows that the easiest way to improve health — particularly in middle- and low-income countries — is to change environments. One of his current projects provides free fortified rice to residents of Tamil Nadu, India, and vitamins to those in need without asking them to alter their behavior. Alsan connects history, health and development to understand why some populations are healthier than others and how to close the gap. Bendavid discusses his work with the President‘s Emergency Plan for AIDS Relief (PEPFAR) which has provided about $70 billion in HIV aid to significantly decreased mortality.
Stanford Health Policy‘s Douglas Owens, Kathryn McDonald and David Chan discuss the importance of value when assessing health care costs and reducing diagnostic errors.
Stanford Health Policy‘s Kate Bundorf discusses the effects the 2016 election could have on health if Hillary Clinton or Donald Trump were elected. This non-partisan panel examined both candidates‘ proposals for health care in the United States.