Commentary on "Competing Visions for Consumer Engagement in the Dawn of the Trump Administration".

In this commentary on Hwang, Garrett and Miller's piece, we explain how value-based insurance design can help bring together both supporters and skeptics of the consumer-directed health care. Our commentary also notes the hazards that disruptive repeal-and-replace legislation might pose for consumer engagement efforts generally.

Differences in life expectancy due to race and educational differences are widening, and many may not catch up.

It has long been known that despite well-documented improvements in longevity for most Americans, alarming disparities persist among racial groups and between the well-educated and those with less education. In this article we update estimates of the impact of race and education on past and present life expectancy, examine trends in disparities from 1990 through 2008, and place observed disparities in the context of a rapidly aging society that is emerging at a time of optimism about the next revolution in longevity. We found that in 2008 US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s.

Addressing the nursing workforce: a critical element for health reform.

Fundamental health reform is integral to putting the country on the path to economic recovery. These goals-health reform and economic recovery-will not be met unless we build, empower, and deploy a twenty-first-century health care workforce. A reformed health care system must include an adequate supply of well-trained professionals who can deliver care to all Americans.

A consumer perspective on physician payment reform.

Changing the incentives to providers through payment policy is a critical step toward realizing our goals for excellent health care performance. As a part of the needed transformation, both providers and consumers will need to be mindful of resources and of the fact that more services do not always lead to better health. Without serious efforts to promote engagement by patients and caregivers, however, the goals of payment reform could be defeated.