Rahul Rekhi

 

Recent Posts by Rahul Rekhi

  • Memo to Lawmakers: Young Americans Demand More Health Care, Not Less

    Feb 13, 2013Rahul Rekhi

    President Obama's SOTU mentioned Medicare, but he still fails to realize that young people are ready for even greater investment in health care.

    President Obama's SOTU mentioned Medicare, but he still fails to realize that young people are ready for even greater investment in health care.

    Last night, President Obama delivered a State of the Union address that outlined an ambitious second term agenda while touting a steadily recovering economy and asserting the need to strike a budget deal that preserves the generational promise of Medicare. What he did not mention, however, is an underlying but oft-neglected truth: that our national health care debate still neglects the needs, perspectives, and interests of young adults. The State of the Union may be stronger, but for young Americans around the country, its health requires a new prescription. This is perhaps most critical in two key but distinct areas: innovation and mental illness.

    Consider, firstly, that the health reform debate—subsumed into the longstanding clashes on the federal debt and deficit—has lately centered on cost cutting. Thus far, such discourse has largely been framed as benefiting young Americans, those who, the argument goes, will bear the brunt of the nation's debt burden in the absence of immediate cuts to the federal healthcare budget. However, from a young person’s perspective, there exists compelling evidence for a converse narrative: public health care as an incubator for innovation. The safety net that health care provides actually emboldens young people to take risks, to try creating the next Facebook or Google, rather than play it safe for fear of being denied care in later years. 

    Evidence of the critical role that public health care can play in entrepreneurship and innovation is plentiful in the research literature. For instance, a recent RAND Corporation study observed the prevalence of so-called "entrepreneurship lock": a phenomenon in which prohibitively high costs of obtaining health insurance as individuals preclude workers from leaving large firms that can offer subsidized premiums to strike out on their own. But we can also look across the Atlantic to see the catalytic properties of such social insurance—and the costs of not providing it—in action. For example, Sweden, a nation that possesses a social safety net among the world’s most robust, ranked 2nd globally on the INSEAD’s Global Innovation Index. The US, with comparatively meager public insurance, came in at a distant 10th. Such nations as Norway, Finland, Denmark, and Switzerland–hardly bastions of Randian self-sufficiency—also handily outstripped our own ranking on this measure.

    This is not to say that public health care is the only factor that will determine the fates of Googles to come. But this data should prompt us to reformulate our rhetoric around programs like Medicare and Medicaid: not as hammocks, but springboards. We should not be focused on heavy-handed cost-shifting measures that merely limit the scope of coverage, but instead how to thoughtfully modernize the fundamental societal value that these programs provide. It is precisely this values-based approach to national health care financing that young Americans value most greatly, as attested to by thousands of students in the Roosevelt Institute | Campus Network’s recently published Government By and For Millennial America.

    Arguably the most significant example of this false dichotomy between cost and value is mental health care. Much has been made of our healthcare system’s dismal performance on health indicators, but in no field does this ring truer than in psychiatric care. Yet what’s often overlooked is that mental healthcare is, above all, a youth problem, afflicting no demographic more than my fellow young Americans—my classmates, colleagues, and friends. Millennials, as a demographic, report rates of depression well above the baseline: almost 9 percent of 20-somethings in America are thought to have developed major depression, panic disorder, or anxiety. The shocking nature of this statistic is only amplified by considering that a full 75 percent of diagnosable, life-long mental health illnesses develop by age 24. Yet an estimated 75-80 percent percent of youth in need of mental health services do not receive any care.

    But potential solutions abound, even for such a complex problem. If states are the laboratories of our democracy, mental health has proven no exception. Even while the U.S. lags nationally on mental health—rated a ‘D’ by the National Alliance on Mental Illness—states like Connecticut, Massachusetts, and Maryland lead the pack in developing thoughtful, innovative proposals to improve the quality and coverage of care. Moreover, a recent study out of UCLA in California demonstrates that sound mental healthcare can actually be a cost-saving measure.

    Ultimately, progress on both of these fronts depends on whether our political leaders choose to prioritize young Americans across the nation. The health of an entire generation hangs in the balance.

    Rahul Rekhi is a student at Rice University and the Senior Fellow in Health Care Policy for the Roosevelt Institute | Campus Network.

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  • The Fight for Health Care Reform Isn't Over Yet

    Nov 13, 2012Rahul Rekhi

    As part of the "Millennial Priorities for the First 100 Days" series, a call for President Obama to finish the health care overhaul he began with the Affordable Care Act.

    As part of the "Millennial Priorities for the First 100 Days" series, a call for President Obama to finish the health care overhaul he began with the Affordable Care Act.

    While the principle focus of this year’s presidential campaign was clearly the economy, the election carried more profound implications for the future of American health care then any other area of policy. The choice was clear: would we see the reaffirmation of the Affordable Care Act and with that, an opportunity for its provisions to be phased in at last? Or would we see a rapid repeal and systemic overhaul under the ascendant Romney administration? With the reelection of President Obama, the signature health care legislation of his first term is secure. But to truly reform our health care system, he still has much more work to do in his second term.

    Because of President Obama’s historic win, he will be able to fully implement provisions that extend health coverage to over 30 million Americans, end denial of care on the basis of pre-existing conditions, and allow young Americans nationwide to remain covered while continuing their education. But despite this leap forward, significant challenges to our health care system remain. Though the Affordable Care Act tackled the coverage problem, concerns about ever-rising health care costs--and the concomitant budgetary pressures--remain at the forefront. Moreover, debates about end-of-life care, prevention, and the proper role of medical technology in our health care system remain unresolved.

    Some of these health policy concerns will take years to tackle. Others must necessarily extend beyond even President Obama’s term limit. But there should be a particular focus on issues regarding health science and technology that we must tackle in the first 100 days, while the electoral mandate remains clear.

    The consensus among health economists of all stripes is clear: medical technology is the single most significant driver of rising health care costs in America. These advancements, while making significant gains in extending our lifespans and improving the quality of life for the U.S., simultaneously impose significant cost burdens and threaten the fiscal sustainability of our health care system. The Affordable Care Act takes steps to address this concern, most notably by funding so-called “comparative effectiveness research,” a systematic means of assessing the therapeutic efficacy of clinical treatments and weeding out those that exhibit no health benefits despite their substantial costs. This isn’t rationing—it’s rational.

    However, due to political pressures, “Obamacare” contained no provision or mechanism for the results of such comparative effectiveness research to be implemented in a meaningful way. Even the one model that it did call for—the Independent Payment Advisory Board, a “Federal Reserve” of medicine—has been effectively neutered by congressional officials and only served an advisory role. If we are to truly and systematically address the cost burdens of health technology in a meaningful way, what we need is a form of health technology assessment, such as the one pioneered by the National Institute for Health and Clinical Excellence in the United Kingdom. Until then, we will have a patchwork policy at best, and a downright nonexistent one at worst.

    Realizing the benefits of these technologies will also necessitate a regulatory overhaul. Despite (occasional?) failures and controversies, the Food and Drug Administration deserves great acclaim for helping to ensure the safety of the American patient for the last century. But the critical nature of this mandate does not obviate the benefits that could be derived from a deep overhaul of the FDA approval process. For instance, there is ample opportunity to bring the FDA into the 21st century, with opportunities to authorize statistical modeling techniques that allow for smaller, leaner, and quicker clinical trials guidelines, and by mandating that the results of all drug trails be published online. These are measures with potentially broad bipartisan support.

    Policy has also fallen short in the development of these technologies. Case in point: funding for the National Institutes of Health has largely remained flat in recent years, even under the Obama administration. Yet the importance of biomedical research in maintaining America’s edge in innovation cannot be overstated. It’s no coincidence that over half of the Nobel Laureates in medicine have come from within our borders; it is this edge on health science and technology that has allowed life-saving treatments such as statins, angioplasty, and MRIs into the clinic. As other nations begin to ramp up their investments in biomedical research, it is critical that the U.S. not lose its position of global leadership.

    These health policy areas represent means for the president to reaffirm his vision for our health care system. Admittedly, with a looming fiscal cliff, persistently high unemployment, and issues of energy and immigration beginning to enter the national spotlight, turning back to health care may carry with it great political risk. However, while the Affordable Care Act was initially highly polarizing and contentious across the electorate, there is emerging evidence that as its provisions are phased in, support among Americans is growing—and fast. Reaching across the aisle early with these bipartisan policies to further advance our nation’s health care can cement the president’s principle legacy, setting the tone for another transformative term. Ultimately, their impacts will extend well beyond the next 100 days or even the next two years, for the path to a truly 21st century health care system lies ahead.

    Rahul Rekhi is a student at Rice University and the Senior Fellow in Health Care Policy for the Roosevelt Institute | Campus Network.

     

    Barack Obama image via Shutterstock.com.

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  • The Romney-Ryan Medicare Plan is Bad for Students and Seniors

    Sep 21, 2012Rahul Rekhi

    Shifting health care costs onto seniors will break a social compact that all Americans rely on.

    Shifting health care costs onto seniors will break a social compact that all Americans rely on.

    With Election Day finally in sight, the last few weeks have been brimming with slogans, speeches, and sound bites. But while Republicans and Democrats are working from a similar playbook, there’s a gaping chasm between their competing visions of the social safety net, and the future of Medicare hangs in the balance. In short, the Republicans claim their voucher plan would reduce health care costs, but the truth is that the seniors who depend on Medicare would be forced to pay the price.

    The policy clash boils down to a single notion: vouchers. Mitt Romney and Paul Ryan are proposing a voucher-based Medicare system—one in which seniors are given vouchers to trade for insurance plans on a national exchange or market. The value of these vouchers is capped at a specific value, with the aim of curbing rising health care costs. And in fact, it is completely true that the Romney-Ryan voucher system will reduce Medicare costs, as promised. But it will do so by pushing those expenses onto Medicare enrollees, by forcing them to pay more out of pocket to cover their medical expenses as health care costs rise. What the GOP is proposing, in other words, is not exactly cost-cutting, but rather cost-shifting from government to seniors. If the yearly national allowance of vouchers has expired and your heart begins to fail, well, at least take solace in the fact that Mr. Ryan’s plan lowers Medicare costs by 20 percent.

    If you’re only looking at the arithmetic, voucherizing Medicare is a clear and easy solution to bending the health care cost curve. Unlike, say, prevention and wellness campaigns, it’s not hard to project the level of cuts such vouchers will allow for. But this policy simplicity and straightforwardness mask an equally straightforward truth. Rather than attempt to extract amorphous, messy savings through biomedical innovation, electronic records, waste reduction, comparative effectiveness research, or incentivizing quality of care—in other words, achieving collective savings through progressive reforms—Romney and Ryan propose to gut Medicare and hand senior citizens the entrails. And this is hardly hyperbole; the nonpartisan CBO itself stated that the plan “could lead to reduced access to health care; diminished quality of care for Medicare beneficiaries…[and] less investment in new, high-cost technologies.”

    That’s not to say that changes to the structure of Medicare are not needed, or will not require tradeoffs; they will. Real discussions, for instance, will have to be had over such hot-button topics as end-of-life care, or limits on the use of expensive, clinically unproven medical technologies. Refinements to these policies would bring Medicare into the 21st century, making it more nimble and in tune with technological advancement and social change. But they also preserve its central guarantee: that our nation’s retirees, having put in a lifetime of hard work and civic service, will receive quality, affordable health care to support them through their later years.

    Fifty years ago, with the creation of Medicare under LBJ, thousands of soon-to-be enrollees—aunts, uncles, professors, my friends’ parents and my own—grew up trusting in this promise. And though, as a student, it will be nearly half a century before I qualify for the program, I recognize all too well the gravity of the decision we now face. It is one, after all, that will be borne most heavily by my peers, since the costs that are shifted to seniors today will be thrust upon us tomorrow as health care costs continue to rise. And young Americans will feel the consequences of voucherization well before we reach the age of eligibility, for the security that Medicare provides allows us to take risks when we're younger, to try to create the next Facebook or Instagram, rather than play it safe for fear that we'll be left destitute or denied care in our later years. To chip away at the heart and soul of our social safety net is, in a sense, to hinder innovation itself.

    Ultimately, the choice we face is simple: to uphold this mandate or reject it fundamentally; to maintain the promise of health care access for our elderly or begin chipping away at the coverage we provide in the name of budget-balancing. This debate is about a decades-old American social compact, and its effects will reverberate, shaping the futures of not only my own generation but also the ones to come. For the health of our citizens and our safety net, there is only one right answer.

    Rahul Rekhi is a student at Rice University and the Senior Fellow in Health Care Policy for the Roosevelt Institute | Campus Network.

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  • The Next Target for Health Reformers: Opening Access to Medical Research to Spur Innovation

    Mar 7, 2012Rahul Rekhi

    health-care-money-150As part of the 10 Ideas: Prescriptions for Health Reform series, the recognition of a little noticed problem: our medical innovation system is hampered by huge fees to access important res

    health-care-money-150As part of the 10 Ideas: Prescriptions for Health Reform series, the recognition of a little noticed problem: our medical innovation system is hampered by huge fees to access important research.

    We recently saw a comprehensive overhaul of our health delivery system not seen since the likes of Lyndon B. Johnson. Indeed, the Affordable Care Act has ushered in a new era in American health care. However, the United States' health research and development (R&D) paradigm -- our health discovery system, the engine of our health technological progress -- is at its own crossroads, poised to undergo a similar transformation.

    In the U.S., biomedical research is federally funded by the National Institutes of Health, which allocates more than $70 billion a year in research funding to scientists across the country. The private sector adds another $50 billion into the mix. American physicians and researchers who receive these grants go on to develop the health care innovations that we've come to take for granted.

    The importance of this biomedical innovation ecosystem cannot be overstated. After all, of the arguably six most important medical innovations of the past 25 years -- MRI/CT Scans, ACE inhibitors, balloon angioplasty, statins, mammography, and bypass grafts -- four were developed in the U.S., reaping tremendous rewards for American health care. Moreover, in the last 10 years, only seven Nobel Prizes in medicine have gone to researchers outside the country, compared to 15 within our borders. These statistics, while far from comprehensive, are indicative of a competitive advantage in biomedical innovation.

    Yet, for all its vaunted progress, our health R&D paradigm faces pressing and significant limitations. Getting at one of the core weaknesses of this system requires examining the basics of the R&D procedure. The process is simple: a researcher obtains funding from the NIH, among other sources, to carry out experiments and obtain results at his or her home institution. These results are then submitted to, and potentially published by, a scientific research journal, the publishers of which compile the results and include them in their publication. Subscribers of this journal can then examine the results of the study.

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    It is the latter step that's the crux of the issue. These journal articles, and their results and data, are hidden behind journal subscriptions that cost as much as $25,000 a year, putting them beyond the reach of anyone who can't afford them. For example, many physicians -- most significantly those in rural areas -- do not have access to the cutting-edge medical research they need to provide the highest quality of care. Patients, too, are often simply unable to research the pathologies that plague them and their families, hindering their ability to make informed medical decisions. Most of all, students and educators are denied access to the latest scientific developments, which is a major blow to the learning process.

    The effects of these barriers also extend to the research pipeline. For instance, the rate at which we translate basic biomedical discoveries into novel therapies has stagnated in recent years. In fact, despite a doubling of the federal budget for biomedical research and development, the number of new drug approvals fell from 53 in 1996 to 19 in 2009, and although 800,000 medical research papers helping to identify novel therapeutic targets were published in 2008, a paltry 21 new drugs found their way to the market. A recent study in the New England Journal of Medicine found that the primary contributor to this so-called "Valley of Death" is "the centralization of authority within large, inherently cautious bureaucracies in government, universities, foundations, and companies...[which] disregar[d]...the diversity of approaches that are necessary for innovation." In reality, this exists in part because scientists, physicians, and biotech entrepreneurs lack access to cutting-edge research developments and data -- currently monopolized by large research institutions in government, academia, and industry -- to materialize their ideas.

    There's a compelling case, therefore, to enact what's called open-access research: making all research publicly available through an unrestricted online database. Indeed, a study published by an economist at Victoria University established that enacting open access policies would reap over $1 billion in benefits over the next 30 years due to the catalysis of innovation in the creation of novel drugs and medical treatments. This amounts to an eight-to-one rate of return.

    A movement to enact open access research policies is currently being led by several nonprofits, most notably the Right to Research Coalition. The implications of this policy, however, have not yet hit the mainstream. To students, at least, the movement has remained under the radar. But open access research permits patients, students, physicians, entrepreneurs, and educators to reap the benefits of cutting-edge medical research. Free access to data can spur drug development, providing the life-saving treatments of the future. This system needs to change. The foundation of our healthcare innovation ecosystem depends on it.

    Rahul Rekhi is a Roosevelt Institute | Campus Network member from the Rice University chapter, where he is studying bioengineering and economics.

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  • Young People Won't Stand for Health Care Repeal

    Jan 18, 2011Rahul Rekhi

    health-care-money-150Repealing the law goes against the interests of today's college students -- and all citizens.

    health-care-money-150Repealing the law goes against the interests of today's college students -- and all citizens.

    Party politics is a back-and-forth struggle for ideological supremacy, often rendering sound policy the victim of partisanship. But every once in a while you see a bill come along that is ostensibly above reproach, progressively post-partisan, universally appealing -- a bill so undeniably sweeping in its scope, so unyielding in its reform, that one expects sheer force of reason to for once crack the monolithic gridlock of partisan bickering.

    Or so I thought.

    The legislation provides health insurance coverage to an additional 32 million Americans, grants small businesses $40 billion worth of tax credits, creates state-based free-market insurance exchanges, reduces prescription drug costs for seniors, reincentivizes primary and preventative care, provides thousands of dollars of scholarships and loan repayments for medical students willing to work in primary care, and ends coverage denial based on pre-existing conditions, all while cutting the federal deficit by $143 billion over the next decade and $1.2 trillion over the following one. When a bill like that is being put up for repeal, I, as both a student and a citizen, am not only dazed, but baffled.

    Admittedly, perhaps the health reform package didn't go far enough. Lacking the "public option," this bill could have conceivably done more to check the power of private insurance corporations and move away from employer-based coverage to more effectively reform our broken paradigm. Still, as tempting as it is to make the perfect the enemy of the good, such omissions hardly warrant the complete rescission of an otherwise significant leap forward in American health care.

    Sure enough, however, that's exactly what's happening. With the newly minted 112th Congress sworn in, the Republicans -- buoyed by their resounding victory in the 2010 midterm elections -- have vowed to dismantle health care reform.

    Republican legislators have argued that their successes at the polls in November signify the American populace's disapproval with the Affordable Care Act -- that their triumph in the midterm election lends them a democratic imperative to repeal the bill. Taken at face value, this conviction almost seems reasonable -- perhaps even called for.

    Truly, though, how many Americans favor giving insurance companies near monopolistic market power? Support adding billions (and eventually, trillions) of dollars to the federal deficit? Celebrate the pre-existing conditions clause? How many American citizens are okay with being uninsured when unemployed -- having no health insurance coverage when least able to pay their medical bills? Even the most vehement critics of the health care bill would be hard pressed to, in good faith, find anyone against any of these individual provisions.

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    Of course, the many benefits of the bill strike a deeply personal chord as well. Consider the bill's provisions banning age-related discrimination in insurance policies. At first glance, this stipulation almost certainly appears to have been crafted with elderly patients in mind. Yet consider how generally unacquainted students are with the ever-tortuous health insurance paradigm we have in the US. Most of us, still seemingly invincible and never really having to think about our health at all, are simply ill-equipped to navigate the tangled web of eclectic policies and coverage plans offered by insurance companies. As a result, we are extremely vulnerable to predatory insurance practices -- to wit, it's easy to rip us off. For most students who subsist on limited means as it is, this is not only difficult to deal with, but quite frequently bank-breaking.

    But that's not all. For me and many of my peers, the first few post-college years are among the most stressful of our entire lives, as we attempt to lay the foundations for our life-long career while simultaneously paying off burdensome student loans. The current economic climate only exacerbates this issue. Recently, securing that first job has become not so much an endeavor, but a struggle. Bear in mind, then, how before the passage of the Affordable Care Act, students were dropped from their parents' insurance plans in some states as early as 19 years old, ensuring that our lives literally depended on getting that first job. This unabashedly backwards status quo is made even more ridiculous when one considers the frequency with which, in this increasingly global marketplace where education is more and more critical for securing a stable, well-paying profession, many of us pursue graduate education. At that point, we often go several years without substantive employment -- and consequently, several years without coverage. This, for many of my older cousins and friends, was the real American Dream: work hard, study hard, and you'll surely be successful -- just don't get sick along the way.

    The GOP may have capitalized on voter discontent with sluggish economic growth, or perhaps the Obama administration as a whole, but there is no reason to believe that a repeal of this bill is at all demanded by (or in the best interests of) the American people, much less their children.

    What else, then, possibly justifies the imperative to repeal the act? Cost? Can't be -- as alluded to above, the bill significantly reduces the deficit. Rising premiums? Nope -- according to the nonpartisan CBO, the Affordable Care Act will actually slightly decrease premiums for employer-based insurance. Kills jobs? Negative again -- another recent report by the CBO indicates that the legislation will have a negligible effect on unemployment.

    This is not to say that the health care bill is perfect -- certainly the 1000-page legislation is not without flaws. That being said, the call for repealing health reform appears to be all about party politics. And that is something that I won't stand for, my fellow students won't stand for, and above all, the American people won't stand for.

    Rahul Rekhi is a sophomore at Rice University, where he is studying bioengineering and economics.

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