Staying the course in shifting winds

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Note: The thoughts and opinions expressed are those of the author and do not necessarily represent the opinions of this publication.

The arrival of a new administration in Washington, DC, has introduced sweeping change in federal health policy and public health funding. This should be expected: health care and health research spending represent approximately 18% of US GDP, and nearly 30% of all federal funding. This sector includes over a trillion dollars in Medicare spending, and nearly $900 billion in federal Medicaid and the Children’s Health Insurance Program that together provide for 94 million low-income children, parents, older adults, and people with disabilities.¹ This funding also includes support for the Veterans Health Administration and the National Institutes of Health.

These are enormous sums, and prudent governance demands that they are carefully monitored and controlled. And with numbers like this, it is inevitable that there are savings to be found. It is hard to argue that Medicare Advantage, with an annual cost of $462 billion and cost per beneficiary that is 22% greater compared with similar services delivered under traditional Medicare, represents good value for the American people.² Of note, the savings of an estimated $83 billion garnered by shelving Medicare Advantage and returning exclusively to traditional Medicare would easily exceed the total annual budget of the VA health system at $68 billion, and dwarf that of the entire NIH which stands at $47 billion.

Clearly there is opportunity, indeed a responsibility, to craft change. However, policy architects must recognize that in the health care arena the process of change can have a profound impact on individual health and well-being, in some cases with life and death consequences. This is the perspective that informs the Academy’s advocacy on behalf of patients, our profession, and the public, and our engagement in the transition currently underway. I’d like to use this opportunity to outline some of the Academy’s fundamental positions that are brought to these discussions.

Stephen McLeod, MD

The Academy believes that policy must place public health at the forefront. Pragmatic public health policy acknowledges the reality of finite resources, which demand the most efficient and effective deployment. These decisions must be informed by and consistent with scientific evidence, accurate data, and rigorously conducted research. Good science is predicated on critical review by both the public and the scientific community, and this requires open communication and discussion free from censorship.

The Academy argues for responsible policy that is sustainable and looks to the future. This position means that the exigencies of current fiscal challenges must be balanced by the prospects of the future. It underlies our sustained advocacy for addressing a paralyzingly large proportion of federal health care spending—physician payment reform and its implications for access to care—along with other forward-looking priorities such as support for graduate medical education and investment in biomedical research.

The Academy is committed to advancing policy that establishes the highest quality of care for all, and in so doing strives for both quality and equity without compromise. This includes a defense of vital care that is provided through Medicaid, and through the VA health system, addressing differential care compelled by commercial Medicare plans, building capacity for eye care across the nation’s Federally Qualified Health Centers, and supporting the development of a workforce that meets the needs of a diverse population.

The Academy recognizes that in our intricately connected world, and as was proved by the COVID-19 pandemic, health care is global. The nation and the world are best served by the United States not merely participating but leading in the global arena, and the Academy is committed to supporting ophthalmology and our colleagues worldwide.

Ultimately, public health touches virtually all aspects of our society, and its importance cannot be overstated. A partnership between policymakers and physicians at the front lines of care is of utmost importance and is consistent with our stated mission “to protect sight and empower lives by serving as an advocate for patients and the public, leading ophthalmic education, supporting research, and advancing the profession of ophthalmology.” To this end, the Academy will continue to defend the interests of our patients and to advocate for necessary change in an ever-evolving world.

Stephen McLeod, MD

E: media@aao.org

McLeod is chief executive officer for the American Academy of Ophthalmology.

References

1. Centers for Medicare and Medicaid Services. National health expenditure fact sheet. Centers for Medicare and Medicaid Services. Accessed February 26, 2025. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet

2. Freed M, Biniek JF, Damico A, Neuman T. Medicare Advantage in 2024: enrollment update and key trends. KFF. Published August 8, 2024. Accessed February 26, 2025. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2024-enrollment-update-and-key-trends/