Jonathan S. Skinner

New York Times Opinion

By Paul Krugman-Opinion Columnist

Last Friday the Medicare trustees released their latest report on the system’s finances, and it contained some unexpected good news:Expenditures are running below projections, and the Hospital Insurance Trust Fund won’t be exhausted as soon as previously predicted.

But one important reason for this financial improvement was grisly: Covid killed a substantial number of Medicare beneficiaries. And thevictims were disproportionately seniors already suffering from severe — and expensive — health problems. “As a result, the survivingpopulation had spending that was lower than average.”

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Policygenius

By Myles Ma

The U.S. spent an all-time high of $4.1 trillion on health care in 2020, representing almost 20% of the gross domestic product. [1] Unlike other countries, the question of who pays that expense is spread out among different government and private funders who each follow different rules, leading to vastly divergent costs. To make things more confusing, the cost of health care varies even more based on where you live.

July 09, 2021 by Bill Platt

The Fuchs award cited the economics professor's work to improve health care systems.

Jon than Skinner research professor of economics and a professor at the Geisel School of Medicine, has received the Victor Fuchs Award for Lifetime Contributions to the Field of Health Economics from the American Society of Health Economists (ASHE).

"This is the highest honor one can achieve in the health economics field," says Nina Pavcnik, the Niehaus Family Professor in International Studies.

Deaths from all causes — not just Covid-19 — are up since the pandemic started, a CDC report found.

By Julia Belluz@juliaoftoronto Oct 21, 2020, 10:10am EDT

The official Covid-19 mortality figures might be dramatically underestimating the real deathtoll of the pandemic in the US, according to a new report from the Centers for Disease Control and Prevention (CDC).

From late January to early October, nearly 300,000 “excess deaths” occurred in America, the report authors estimate. That’s about a third more than the 216,025 coronavirus deaths the US reported in the same period.

Weathered, wiry and in his early 60s, the man stumbled into clinic, trailing cigarette smoke and clutching his chest. Over the previousweek, he had had fleeting episodes of chest pressure but stayed away from the hospital.

“I didn’t want to get the coronavirus,” he gasped as the nurses unbuttoned his shirt to get an EKG. Only when his pain had becomerelentless did he feel he had no choice but to come in.

In pre-pandemic times, patients like him were routine at my Boston-area hospital; we saw them almost every day. But for much of thespring and summer, the halls and parking lots were eerily empty. I wondered if people were staying home and getting sicker, and Iimagined that in a few months’ time these patients, once they became too ill to manage on their own, might flood the emergency rooms,wards and I.C.U.s, in a non-Covid wave.

The COVID-19 coronavirus has saturated the United States, and it appears to be spreading quickly in some places that are planning to ease social distancing restrictions soon, a new study shows.

As we approach the 10-year anniversary of the Affordable Care Act (ACA), Democratic presidential candidates are sparring over what to do in its second decade. Should we build on the ACA? Or scrap it, relying instead on private markets or “Medicare for All”? As the debate heats up, it’s worth reflecting on what the ACA has accomplished so far — and what it hasn’t.

That does not mean that all the care provided to dying patients — or to any patient — is valuable. Another study finds that high end-of-life spending in a region is closely related to the proportion of doctors in that region who use treatments not supported by evidence — in other words, waste.

“People at high risk of dying certainly require more health care,” said Jonathan Skinner, an author of the study and a professor of economics at Dartmouth. “But why should some regions be hospitalizing otherwise similar high-risk patients at much higher rates than other regions?”

There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. And our complex payment system causes us to spend far more on administrative costs. The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems.

Just because other countries use the hospital more doesn’t mean that every hospitalization in the United States is appropriate. Jonathan Skinner, a professor at Dartmouth, who has studied patterns in health care use in the United States, noted that there probably is money to be saved by eliminating some of the extra scans and operations that are much more common in the United States than elsewhere.

According to economics professor and professor at The Dartmouth Institute for Health Policy and Clinical Practice Jonathan Skinner, lowering the prices of drugs is necessary.

“It’s certainly true that when you give drug companies a monopoly through the patent system on particular drugs that they’ve developed and there’s a general policy that Medicare and private health insurance have to pay whatever it is that the drug companies charge,” Skinner said. “It’s not surprising that the prices they charge are very high.”

Skinner added that he believes Azar to have a firm understanding of drug pricing from his experience in the private sector and said that it will be interesting to see whether the secretary is able to bring a “stronger set of tools” to cut back on prices based on his time at Eli Lilly.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 ended the Sustainable Growth Rate formula that for years had resulted in an eleventh-hour intervention by Congress to avoid drastic reductions in Medicare physician payments. MACRA also established incentives for clinician payments to become increasingly based on value with the intent of rewarding clinicians who produce better outcomes at lower costs. Efforts are underway to establish the outcomes and quality measures that will be included in the new payment systems.

It's hard to plan for retirement, and one of the trickiest questions is: How much should I save?

The honest answer is: It depends. "The best-laid plans can be undone by a messy divorce, a disabling disease, or a stock market crash," Jonathan Skinner, a professor of economics at Dartmouth College, wrote in a study on the topic. Your future health-care expenses are almost impossible to predict, for example, especially as Congress considers big changes to the system.

You might think that once drugs, devices and medical procedures are shown to be effective, they quickly become available. You might also think that those shown not to work as well as alternatives are immediately discarded.

Reasonable assumptions both, but you’d be wrong.

Instead, innovations in health care diffuse unevenly across geographic regions — not unlike the spread of a contagious disease. And even when studies show a new technology is overused, retrenchment is very slow and seemingly haphazard.

Countries around the world are struggling with rising healthcare bills. Every introduction of pricey new biologics, surgical procedures, and exotic “precision” treatments causes ever-increasing fiscal stress, leading to deficit spending, cutbacks in other government services, and insurance costs shouldered by firms and employees alike. Yet, freezing budgetary allocations is clearly not an option, as citizens in our ageing societies are likely to demand more and better access to new health innovations, and essential healthcare services. What can be done?

The difference between the U.S. and most of the rest of the world “is very stark,” said Jonathan Skinner, a professor of economics at Dartmouth College.

Newborns in 29 countries, including Japan, Australia and Spain, had life expectancies above 80 years in 2015, according to the World Health Organization. The average global life expectancy was 71.4 and rising, according to that agency’s most recent report.  

More Medicare dollars spent on treatment of a heart attack patient doesn't lead to better health outcomes, according to a new study.

A JAMA study published Wednesday found that mortality rates stayed constant for heart attack patients up to 180 days after discharge even as spending on cardiac procedures and post-acute care rose. But the study did find mortality dropped among patients who received early percutaneous coronary intervention, also known as angioplasty with a stent.

If only the good die young, Americans are unfortunately getting better.

U.S. life expectancy dipped by a little more than a month last year from 2014, to 78.8 years, according to a report from the National Center for Health Statistics. It's the first decline in more than two decades. And after years of gains, U.S. life expectancy has been essentially flat for a few years, which means an inauspicious trend could be in the works.

The decline "could be a blip, but even if it’s flat, we have a real problem," said Jonathan Skinner, a professor at the Dartmouth Institute for Health Policy & Clinical Practice.

Much of the spending has been worth it. While the U.S. spends the most of any country by far, health care is becoming a larger part of nearly every economy. That makes sense. Better medicine is buying longer lives. Yet medical spending is so high in the U.S. that the White House now projects that if it keeps growing, it could, in 25 years, reach a third of the economy and devour 30 percent of the federal budget. That will mean higher taxes. If we can’t accept that, says Gruber, we’re going to need different technology. “Essentially, it’s how do we move from cost-increasing to cost-reducing technology? That is the challenge of the 21st century,” he says.

That is the big question in this month’s MIT Technology Review Business Report. What technologies can save money in health care? As we headed off to find them, Jonathan Skinner, a health economist at Dartmouth College, warned us that they are “as rare as hen’s teeth.”

Aug. 26 (Bloomberg) -- Medicare continues to exhibit remarkably slow growth: a modest 3 percent over the past year. That’s great news, but a debate is raging about whether this is caused by a weak economy (and therefore will reverse as the economy recovers) or other factors (and therefore may persist, drastically improving the budget outlook).

With the first Baby Boomers headed for retirement within a bare decade, worries are growing about the huge burden this group will place on the federal budget in the 21st century--and politicians are busy unveiling plans to keep Social Security and Medicare afloat.

How realistic are such fears? In a study in the Journal of Economic Perspectives, Ronald Lee of the University of California at Berkeley and Jonathan S. Skinner of Dartmouth College underscore the high degree of uncertainty attached to current demographic and economic projections.

Only a few years ago, it looked as if the U.S. had finally managed to put a leash on surging health-care expenditures, which consume some 14% of gross domestic product. Now, with costs picking up steam again, the search is on for ways to control spending--not only to ease the pain for current employers, workers, and taxpayers, but also to lighten the massive burden that lies ahead when the baby boom generation enters its retirement years.

One potentially useful tack is suggested by a new study by economist Jonathan Skinner of Dartmouth College and physician John E. Wennberg of Dartmouth Medical School that focuses on geographic disparities in Medicare spending. Specifically, the study looks at differences in outlays and care for patients in the last six months of their lives, a period that accounts for some 30% of total Medicare expenditures.

The Senate voted in June to require upper-income seniors to pay higher premiums for their Medicare insurance. President Clinton, while expressing support for the general idea of means-testing Medicare, forced Republicans to drop the plan. But new research suggests that the GOP was on the right track. When it comes to Medicare, lower-income seniors are paying the bills for betteroff recipients. The reason: Rich people use more medical services, especially physicians' services. And they live longer, so they have more years to cash in on Medicare.

Economists Mark McClellan of Stanford University and Jonathan Skinner of Dartmouth College compared the lifetime cost of Medicare taxes with the flow of benefits from the health plan for the elderly. As expected, they found that today's retirees enjoy a substantial subsidy from today's workers: Benefits for a couple that turned 65 in 1990 will exceed the taxes they paid, on a present-value basis, by $33,600. But the researchers were in for a surprise when they looked at the flows of money within that age group. They found that each individual with an income below the median will transfer, on average, $800 to individuals with above-median incomes.

True, upper-income elderly have paid more taxes: A person in the top 10% of this cohort paid $7,600 more in taxes than one in the poorest 10%. But the better-off seniors use $8,600 more in lifetime Medicare benefits than do the poorest retirees.

Medicare was established in 1967, so today's elderly paid taxes for only part of their work lives. In contrast with today's retirees, McClellan and Skinner found that today's 52-year-olds--who were 22 when Medicare began--can expect an average subsidy from younger workers of only $2,200 per couple. But lowerincome members of this group will still end up subsidizing richer ones.