Interview with Steven Brill, author of "Bitter Pill", this week's Time Magazine cover story
JUDY WOODRUFF: Next: a big story on the big price tags attached to medical care.
Steven Brill spent months reporting his 26,000-word cover story in the latest issue of "TIME" magazine looking at what's behind our country's high cost of health care. What he found was startling: a few days of lab work that costs more than a car, a trip to an emergency room for indigestion that totaled more than a semester in college, and many more examples.
In response, the American Hospital Association released a statement that claimed the system is broken and that -- quote -- "Patients may look at a hospital bill and think the prices they see only reflect the direct care they received, when in fact what's reflected are all the resources to provide the care."
Steven Brill joins me now.
Welcome to the NewsHour.
STEVEN BRILL, TIME Magazine: Hi, Judy. How are you?
JUDY WOODRUFF: I'm well.
Let me just begin by, you paint a devastating picture of the American health care system, and you talk, of course, about a system that is based on private enterprise, the private marketplace in America. I guess my question is...
Steven Brill spent months reporting his 26,000-word cover story in the latest issue of "TIME" magazine looking at what's behind our country's high cost of health care. What he found was startling: a few days of lab work that costs more than a car, a trip to an emergency room for indigestion that totaled more than a semester in college, and many more examples.
In response, the American Hospital Association released a statement that claimed the system is broken and that -- quote -- "Patients may look at a hospital bill and think the prices they see only reflect the direct care they received, when in fact what's reflected are all the resources to provide the care."
Steven Brill joins me now.
Welcome to the NewsHour.
STEVEN BRILL, TIME Magazine: Hi, Judy. How are you?
JUDY WOODRUFF: I'm well.
Let me just begin by, you paint a devastating picture of the American health care system, and you talk, of course, about a system that is based on private enterprise, the private marketplace in America. I guess my question is...
Portland forum to examine health-care access
Portland forum to examine health-care access
The group, Maine AllCare, is hosting an educational forum, "What If Everyone Had Health Care in Maine?" on Sunday, March 3. The event will also include a screening of a 2012 documentary film, "The Healthcare Movie," narrated by actor Kiefer Sutherland.
The movie contrasts the U.S. health-care system, with its patchwork of public and private services, and Canada's government-sponsored system, which guarantees care by hospitals, doctors and dentists for every citizen.
Sutherland is the grandson of Tommy Douglas, a former premier of the Canadian province of Saskatchewan, who pioneered the country's efforts to create a universal health-care system in the 1960s.
Critics of U.S. health care often point to Canada as an example of how care can be provided more effectively and more economically.
Research has shown that the United States spends more per capita on health care than any country in the world, while measurements of public health – such as average life expectancy and infant mortality rates – are consistently worse in the United States than in Canada and other developed countries.
"Health care is a human right, but it certainly doesn't seem to be in this country," Philip Caper, a founder of Maine AllCare who will be moderating Sunday's discussion, said last week.
Caper is a Brooklin physician who once served as a health-care staffer to former U.S. Sen. Edward Kennedy, D-Mass., and who writes a column about health care for the Bangor Daily News.
It’s the Sugar, Folks
By MARK BITTMAN
Sugar is indeed toxic. It may not be the only problem with the Standard American Diet, but it’s fast becoming clear that it’s the major one.
A study published in the Feb. 27 issue of the journal PLoS One links increased consumption of sugar with increased rates of diabetes by examining the data on sugar availability and the rate of diabetes in 175 countries over the past decade. And after accounting for many other factors, the researchers found that increased sugar in a population’s food supply was linked to higher diabetes rates independent of rates of obesity.
In other words, according to this study, obesity doesn’t cause diabetes: sugar does.
In other words, according to this study, obesity doesn’t cause diabetes: sugar does.
The study demonstrates this with the same level of confidence that linked cigarettes and lung cancer in the 1960s. As Rob Lustig, one of the study’s authors and a pediatric endocrinologist at the University of California, San Francisco, said to me, “You could not enact a real-world study that would be more conclusive than this one.”
The study controlled for poverty, urbanization, aging, obesity and physical activity. It controlled for other foods and total calories. In short, it controlled for everything controllable, and it satisfied the longstanding “Bradford Hill” criteria for what’s called medical inference of causation by linking dose (the more sugar that’s available, the more occurrences of diabetes); duration (if sugar is available longer, the prevalence of diabetes increases); directionality (not only does diabetes increase with more sugar, it decreases with less sugar); and precedence (diabetics don’t start consuming more sugar; people who consume more sugar are more likely to become diabetics).
The key point in the article is this: “Each 150 kilocalories/person/day increase in total calorie availability related to a 0.1 percent rise in diabetes prevalence (not significant), whereas a 150 kilocalories/person/day rise in sugar availability (one 12-ounce can of soft drink) was associated with a 1.1 percent rise in diabetes prevalence.” Thus: for every 12 ounces of sugar-sweetened beverage introduced per person per day into a country’s food system, the rate of diabetes goes up 1 percent. (The study found no significant difference in results between those countries that rely more heavily on high-fructose corn syrup and those that rely primarily on cane sugar.)
Medicare paid $5.1B for poor nursing home care
The Associated Press
SAN FRANCISCO — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.
The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.
One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.
By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.
Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.
The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.
One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.
By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.
Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.
Maine should have Medicaid conscience, too
Sometimes, politicians surprise you.
For years, Republican Florida Gov. Rick Scott railed against the president’s Affordable Care Act. And when the U.S. Supreme Court ruled the act constitutional in June, Scott, a former hospital executive, made clear he would not expand Medicaid, a health insurance program for the poor. He said increasing coverage would make the eventual costs to his state too high.
Gov. Paul LePage has used the same argument. In a Nov. 16 statement, the administration said it “will not expand Medicaid under the current structure that exists because it is not affordable.”
The health care law requires states to expand Medicaid access by raising income eligibility limits. The federal government originally said it would penalize any state that failed to comply with the expansion by withholding Medicaid funds, but the court ruled that penalty unconstitutional. So states can decline expansion without losing current federal funding.
Last week, Scott surprised the nation when he became the seventh Republican governor to support the expansion of Medicaid. He said he would agree to the expansion for the period the federal government would cover its costs entirely. Under the law, the federal government would fund 100 percent of the cost of “newly eligible adults” up to 133 percent of the federal poverty level for the first three budget years. Then it would cover 95 percent of the costs in 2017; 94 percent in 2018; 93 percent in 2019; and 90 percent in 2020 and future years.
We hope LePage listened to the reasoning Scott gave. “No mother or father should despair over whether they have access to high-quality health care for their sick child,” Scott said. Especially with the federal funding, “I cannot in good conscience deny Floridians that needed access to health care.”
That phrase, “in good conscience,” is missing from the debate in Maine. It has fallen into the minority of states — and the only one in New England — to reject or lean toward rejecting the Medicaid expansion. In doing so, Maine is closing its eyes to the possibility of improving public health and reducing health differences linked to economic disadvantages.
It’s also making other parts of the law hazardous. The Affordable Care Act reduces federal payments to hospitals over time, in expectation that more people on Medicaid and private insurance will reduce the amount of charity care hospitals have to provide. So in states that don’t expand Medicaid coverage, hospitals will face financial losses as they continue to treat the uninsured, according to the Harvard Law School Center for Health Law and Policy Innovation. The worry is that the costs will be passed onto patients with private insurance, increasing their premiums.
It’s reasonable for LePage to have concerns about how federal and state governments will pay for the Medicaid expansion. But the administration would be ill-advised to make such a large policy decision based on an as-yet unproven fear that the federal government won’t hold up its end of the deal. Maine Department of Health and Human Services Commissioner Mary Mayhew told Florida lawmakersearly this month that she had difficulty seeing how the federal government could afford the expansion amid consistent budget crises. However, not agreeing to the Medicaid expansion could make it more difficult for the federal government to carry out its overall health reform goals.
Saving on health care at the cost of people's health
Health care spending in the US has slowed because fewer people can afford health services
By Margaret Flowers, M.D.
Al-Jazeera, Feb. 27, 2013
Al-Jazeera, Feb. 27, 2013
In his recent State of the Union speech, President Obama remarked in one short sentence that "Already, the Affordable Care Act [ACA] is helping to slow the growth of health care costs". That was the extent of his comments on the historic health care bill he signed into law in March 2010 after more than a year of pushing health reform through Congress. It is true that total health care spending in the US has slowed, but it does not have much to do with the ACA. Instead, it is another symptom of the ailing market-based health system in the US which is causing poor health outcomes and growing inequality.
The US is unique among industrialised nations when it comes to health care. All other wealthy nations have some type of national universal health system that is publicly financed. The US relies primarily on a market-based health care system in which most private health insurance is tied to employment. There are public programmes, Medicaid, for those who are in extreme poverty, but these are subject to state-balanced budget pressures and struggle to meet the needs of their populations. And there is a public-private system for people 65 years of age and older, Medicare, that is financed through taxes at the Federal level. Overall, health coverage is private except for many people who do not qualify for public programmes and find private health insurance unaffordable.
Privatised health system: A failed experiment
The US health system is a failed experiment. Since the 1980s when the US moved aggressively to privatise the financing and delivery of health care, the cost of care, health disparities and the number of people without insurance have climbed. The US spends more per capita on health care than any other country and has excellent health facilities, but in the US, patients receive the amount of health services they can afford rather than what they need.
In fact, health care spending per capita in the US is two and a half times what the average OECD (Organisation for Economic Co-operation and Development) nation spends. Total health spending constitutes a greater piece of the Gross Domestic Product (GPD), currently at 17.9 percent, than the OECD average of 9.5 percent. Yet, nearly 50 million people in the US have no insurance at all. And tens of millions more are under-insured, meaning they have insurance but suffer significant financial barriers to care and face bankruptcy in the event of a serious accident or illness.
Market doesn't work for health
By James Binder, M.D.
The Charleston (W.Va.) Gazette, Feb. 27, 2013
The Charleston (W.Va.) Gazette, Feb. 27, 2013
A major shift is occurring in health and no one seems to be noticing. Computers have taken priority over patients. Wow! It doesn't matter whether the patient is seen in the emergency room, a physician's office or in a hospital, completing documentation on the computer is paramount. The patient better stay out of the way.
Is it impersonal? Of course. Is it a problem? Certainly. Over and over again, medical research has demonstrated that a physician's ability to engage with the patient and create a strong therapeutic relationship is the best predictor of positive health outcomes.
How did we come to this point in health care? My belief is that the answer is clear and simple. We have allowed health-care decisions to be made by a fragmented business conglomerate in which profit is the chief motive. The marketplace has never and will never work for health care.
Private insurance companies spend 31 percent of the health dollar on advertising and an excessive bureaucracy, instead of for patient care. The idea that competition will lower costs has not worked despite 50 years of trying. When we become ill and vulnerable, which we all will at some point in our lives, we are not in a position to be discriminatory consumers in the marketplace. Even if we were, 50 percent of us live in areas, most often rural, where there is no choice.
To foster the transformation to electronic records, proponents of the marketplace approach told us that digital electronic records would improve the quality of health care and save money. They lobbied very hard to get legislation passed in 2009 supporting the use of electronic records in health care.
It did not save money for consumers. The cost of health care continues to skyrocket. It did bring windfall profits to a few strategically placed companies in the medical-industrial complex. The New York Times reported Feb. 19 that AllScripts doubled its sales from $548 million in 2009 to $1.44 billion in 2012.
With time, we are likely to learn more flexible ways of using computers so they don't act as obstacles to a solid physician-patient alliance. The second problem may be more difficult to resolve. If we employ a fragmented, competitive marketplace model, companies will continue to create expensive electronic digital systems that do not communicate with each other. Their goal is to maximize the billing potential of hospital and other providers they serve. Solving this problem will require us to change our health-care financing method.
Fighting for health care that doesn’t leave you broke & naked
A profile of Dr. Elizabeth Frost
By Jacob WheelerTogether with her friend, Dr. Ann Settgast, Frost co-founded the Minnesota Chapter of Physicians for a National Health Program (PNHP) five years ago. The group holds rallies and speaks at hospitals across the state to recruit new members to its cause — and now boasts more than 1,000 members in Minnesota. Frost also has the ear of state lawmakers such as Sen. John Marty and Rep. David Bly, who hope to expand health care access in Minnesota.
“Single-payer” health care would make health care universal and ensure equal access to best treatment, expanding President Obama’s Affordable Care Act. Under single-payer, everyone would be entitled to the best available care, no matter the size of their wallet. Citizens could keep their health insurance coverage even if they lost or changed jobs, and be allowed to retain their preferred doctor or caregiver. By encouraging preventative care, proponents say a single-payer system would significantly lower costs (as much as $350 billion a year, they estimate). Perhaps most importantly, a single-payer system would end health insurance industry meddling. Patients could make decisions based on health needs, not on what a billing department dictates.
Frost, 39, is a Washington, D.C., native who went to medical school at Case Western Reserve in Cleveland and serves as a family physician at the Hennepin County Medical Center’s East Lake Clinic. She came to Minneapolis 11 years ago to live near her sister and her niece and nephew. One of the reasons she has stayed here is Minnesota’s focus on improving health care services which, while far from ideal, offer better access to care than many other states do. Frost, who refers to herself as “something of a do-gooder,” believes that her work as a physician extends beyond diagnosing defects or prescribing medicine.
Her tireless advocacy for single payer stems from her experience caring for her patients, and her concern that the present health system doesn’t offer adequate care.
“I had a patient who came to see me who was 64 years old and had chest pains,” Frost says when asked to illustrate the problem. “I recommended he go to the emergency room to get evaluated for his chest pains, and he refused because he didn’t have health insurance. He said ‘I’m gonna wait until I’m 65 to have this evaluated.’
“About a week later he went to the ER after having a massive heart attack. He died a few weeks later. If the Medicare age limit was 64 instead of 65, then that patient would be alive today.”
http://www.pnhp.org/print/news/2013/february/fighting-for-health-care-that-doesn’t-leave-you-broke-naked
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