I am re-sending the following article titled "Bitter Pill", by Time Magazine journalist Steven Brill because of its importance in laying out a pervasive problem in healthcare that has heretofore received little attention - massive overpricing of many healthcare goods and services.
This post is followed by a link to an interview with Brill by The Daily Show's Jon Stewart, that adds additional insights and punch to the 20,000 word Time article. The interview begins about 15 minutes into the show. You may have to sit through one, two, or three commercials before you get to the interview, but it is well worth the wait, even if you don't especially like Burger King!
Bitter Pill: Why Medical Bills Are Killing Us
By Steven BrillFeb. 20, 2013
1. Routine Care, Unforgettable Bills
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.
Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.
About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/
The Daily Show with Jon Stewart
http://www.thedailyshow.com/full-episodes/thu-february-21-2013-steven-brill
44,000 to lose Medicaid coverage in Maine
By Tracy Jan
LEWISTON, Maine — Louis Bourgoin seems an unlikely symbol of the latest battle over health care spending. The 68-year-old retired shipyard worker is undergoing chemotherapy for liver cancer. He lives in a state once renowned for its efforts to insure the poor, and Mainers stood to benefit even more under President Obama’s health care plan.
Then the letter from the administration of Governor Paul LePage arrived. Bourgoin and his wife were told last month they were about to lose thousands of dollars in annual Medicaid benefits starting in March.
“It’s going to hurt,” Bourgoin said, looking across the spartan living room at his wife. “The government doesn’t care. It means we’re just going to not eat very much.”
By the end of the year, more than 44,000 Mainers — seniors, the disabled, parents, and childless adults — will be dropped from the government-subsidized health insurance program. They represent roughly 13 percent of the state’s Medicaid population, and include the very group that national health reform sought to insure through the Medicaid expansion the Supreme Court has deemed optional.
LePage, meanwhile, seems an unlikely politician to wield such power. The oldest son of 18 children, he ran away from home at age 11, lived on the streets of this once-thriving mill town, and eventually was elected as a Tea Party-backed candidate in 2010
Now the paths of Bourgoin and LePage have crossed because the governor is among more than a dozen Republicans rejecting billions of federal dollars in Obamacare funding for Medicaid expansion. LePage is even going further, cutting benefits available before national health reform passed.
Hospitals cut back on dangerous early elective deliveries
By Phil Galewitz, KHN Staff Writer
Posted Feb. 21, 2013, at 2:05 p.m.
For decades, doctors have been warned about the dangers of delivering babies early without a medical reason. But the practice remained stubbornly persistent.
Now, with pressure on doctors and hospitals from the federal government, private and public insurers and patient advocacy groups, the rate of elective deliveries before 39 weeks is dropping significantly, according to latest hospital survey from The Leapfrog Group, a coalition of some of the nation’s largest corporations that buy health benefits for their employees.
The national average of elective early deliveries fell to 11.2 percent last year from 14 percent in 2011 and 17 percent in 2010. Nearly 800 U.S. hospitals report their data to Leapfrog, about a third of U.S. facilities offering maternity services.
“This data shows more hospitals are responding to the evidence,” said Cindy Pellegrini, senior vice president of the March of Dimes, which has been educating women and working with hospitals and doctors to lower early delivery rates. “This means babies are being born healthier and having a better start in life, and have a much greater likelihood of avoiding health consequences later on in life.”
Babies born before 39 weeks are more likely to have feeding and breathing problems and infections that can result in admissions to neonatal intensive care units than those who are born later, studies show. The elective deliveries can also cause developmental problems that show up years after birth.
Inducing labor early also carries risks for mothers because it increases the chances they will need Cesarean sections.
Since 1979, the American College of Obstetricians and Gynecologists has recommended against deliveries or induced labor before 39 weeks unless there is a medical indication, such as the mother’s high blood pressure or diabetes or signs that the fetus may be in distress.
Still, an estimated 10-15 percent of U.S. babies continued to be delivered early without medical cause, according to a report last year by the Department of Health and Human Services.
Leapfrog CEO Leah Binder said she’s encouraged by the latest figures, but says rates are still too high at many hospitals — with some as high as 40 percent. “This is a move in right direction, but more needs to be done,” Binder said.
Mediterranean Diet Can Cut Heart Disease, Study Finds
By GINA KOLATA
About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study found.
The findings, published on the New England Journal of Medicine’s Web site on Monday, were based on the first major clinical trial to measure the diet’s effect on heart risks. The magnitude of the diet’s benefits startled experts. The study ended early, after almost five years, because the results were so clear it was considered unethical to continue.
The diet helped those following it even though they did not lose weight and most of them were already taking statins, or blood pressure or diabetes drugs to lower their heart disease risk.
“Really impressive,” said Rachel Johnson, a professor of nutrition at the University of Vermont and a spokeswoman for the American Heart Association. “And the really important thing — the coolest thing — is that they used very meaningful end points. They did not look at risk factors like cholesterol of hypertension or weight. They looked at heart attacks and strokes and death. At the end of the day, that is what really matters.”
Until now, evidence that the Mediterranean diet reduced the risk of heart disease was weak, based mostly on studies showing that people from Mediterranean countries seemed to have lower rates of heart disease — a pattern that could have been attributed to factors other than diet.
And some experts had been skeptical that the effect of diet could be detected, if it existed at all, because so many people are already taking powerful drugs to reduce heart disease risk, while other experts hesitated to recommend the diet to people who already had weight problems, since oils and nuts have a lot of calories.
Heart disease experts said the study was a triumph because it showed that a diet is powerful in reducing heart disease risk, and it did so using the most rigorous methods. Scientists randomly assigned 7,447 people in Spain who were overweight, were smokers, had diabetes or other risk factors for heart disease to follow the Mediterranean diet or a low-fat one.
Low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard for patients to maintain — a reality born out in the new study, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation.
“Now along comes this group and does a gigantic study in Spain that says you can eat a nicely balanced diet with fruits and vegetables and olive oil and lower heart disease by 30 percent,” he said. “And you can actually enjoy life.”
A Complex Role for Medicare in the Standoff in Washington
By JOHN HARWOOD
WASHINGTON — In some ways, the partisan standoff over looming budget cuts resembles earlier links in the chain of fiscal battles that began two years ago.
But the politics of one core dispute between Democrats and Republicans — what to do about Medicare — are changing. And some of those changes complicate President Obama’s agenda, even as he continues to flex his postelection muscle.
One shift is the shrinking magnitude of the Medicare spending problem — a consequence, at least for now, of a recent slowdown in the rise of health care costs. That diminishes the willingness of Congressional Democrats, and perhaps the administration, too, to accept the sort of Medicare curbs that Mr. Obama has indicated that he favors.
Another is a moderation in the public stance of Republican leaders. In recent weeks, they have advocated smaller changes to Medicare than the “premium support” or voucher plan that Mitt Romney advocated and that Mr. Obama denounced in last year’s presidential campaign.
As a result, Mr. Obama’s ability to deliver a bipartisan compromise on entitlement spending may be waning even as Republicans edge closer to one.
The reduction in Medicare spending levels is the more drastic change.
In August 2010, the Congressional Budget Office estimated that Medicare would cost $6.5 trillion from 2012 to 2020. A few months later, a deficit reduction panel appointed by Mr. Obama called those spending levels unsustainable.
But the budget office’s latest projections have pegged Medicare spending over the same period at $6.1 trillion. That $400 billion decline exceeds the $303 billion in savings over that period recommended in 2010 by the panel, which was led by former Senator Alan K. Simpson, a Republican, and Erskine B. Bowles, who served as a chief of staff under President Bill Clinton.
The causes of the decline, which could include the impact of a weak economy as well as adjustments by doctors and hospitals to policy changes in the 2010 health care law, remain unclear. As does the decline’s duration.
Even so, Harold M. Ickes, a longtime Democratic strategist and a veteran of Mr. Clinton’s White House, said that “it’s going to be a hard case to make among Democrats that entitlements should be cut” as long as that trend persisted.
Yet no one argues that the deceleration in health costs has resolved the looming fiscal squeeze caused by the aging of the baby boom generation. Among the more optimistic liberal economists, Dean Baker of the Center for Economic and Policy Research argues that the trend, if it continues, will eventually resolve 75 percent of the long-term budget challenge posed by Medicare.
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