The Patient Protection and Affordable Care Act (ACA) will celebrate it 14th year of existence this coming March. Long-standing goals associated with health reform legislation over the decades were to increase the proportion of the U.S. population that benefits from having health insurance coverage and lowering the spiral of ever rising health care costs. Latest information from the Centers for Medicare & Medicaid Services (CMS) serves as a scorecard for measuring such achievements, According to that source, ACA Marketplace enrollment continues at a record-breaking pace. As of December 15, 2023, for HealthCare.gov states and December 9, 2023, for State-based Marketplaces, preliminary data project that more than 19 million consumers will enroll in 2024 coverage through the ACA Market-places, which exceeds by over seven million the number when President Biden took office. On December 15 of last year, the deadline for coverage starting January 1, 2024, more than 745,000 individuals selected a Marketplace plan through HealthCare.gov, the largest single day in history.
As reported in an article in the journal Health Affairs, health care spending in the U.S. grew 4.1% to reach $4.5 trillion in 2022, which still was a faster rate of growth than the increase of 3.2% in 2021. The insured share of the population reached a historic high of 92.0% in 2022 as enrollment in private health insurance increased at a faster rate relative to 2021 and Medicaid enrollment continued to experience strong growth. The share of the economy accounted for by the health sector was 17.3% in 2022, which was down from a peak of 19.5% in 2020, but was more consistent with the average share of 17.5% during 2016–19.
Large Language Models And Digital Health
Looking ahead rather than retrospectively, as discussed in an editorial in the January 2024 issue of the journal The Lancet Digital Health, it took only five days for ChatGPT's user base to reach one million following the launch of GPT-3.5 in November 2022. Now, it has around 180 million users. The enormous global interest in large language models (LLMs), the models that power ChatGPT, is fueled by their massive potential. LLMs have been used to make varied advancements across multiple fields in 2023, but how will they affect patients’ health in 2024?
The Fall 2023 issue of the Institute Letter from the Institute for Advanced Study at Princeton University furnishes a larger context for contemplating future advancements in technology. Decades ago, J. Robert Oppenheimer, Albert Einstein, and John von Neumann, along with other Institute faculty channeled much of their effort toward what AI researchers today call the “alignment” problem: how to make sure our discoveries serve us instead of destroying us. Oppenheimer’s conviction was that “the safety” of a nation or the world “cannot lie wholly or even primarily in its scientific or technical prowess.” If humanity wants to survive technology, he believed it needs to pay attention not only to technology but also to ethics, religions, values, forms of political and social organization, and even feelings and emotions. He set out to make the Institute a place for thinking about humanistic subjects like Russian culture, medieval history, or ancient philosophy, as well as about mathematics and the theory of the atom. He believed we need to be reminded that no alignment of technology with humanity can be achieved through technology alone. Technological challenges are growing, but the cultural abyss separating STEM from the arts, humanities, and social sciences has only grown wider.
Federal Budget Deficits And Government Spending Controversies
Each year, the federal budget deficit grows. Efforts to deal with the problem that entail reducing expenditures on government programs or increasing the level of taxation continue to be unpopular with large portions of the electorate. Characteristics of this perennial problem are reflected in the difficulty Congress faces each year in passing appropriation bills, which is described in another article in this issue of the ASAHP newsletter.
Many proposed spending cuts each year involve the health sector of the U.S. If enacted, the National Institutes of Health and the Centers for Disease Control and Prevention would be among the entities that would find it more challenging to carry out core functions aimed at enhancing individual and community health status. Other agencies that would be affected severely are the Health Resources and Services Administration, which focuses on the health workforce, and the Agency for Healthcare Research and Quality, a perennial target for total elimination.