American Health Care as a Source of Humor
By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
From time to time I stand accused of injecting humor into my public presentations on health policy in the United States. As a German-born economist, I find it hurtful.
Germans pride themselves on their lack of humor. Economists, for their part, pride themselves on being practitioners of the dismal science. We are the professionalbuzzkills who put caveats on any good news.
Now imagine both traits packaged into one human being: you have yours truly. It is not that I inject humor into our otherwise august debate on health policy. Rather, the health system in the United States is in many ways so risible that it comes across as droll even when a dour German-born economist describes it.
One of those risible moments occurred this week when the Centers for Medicare and Medicaid Services of the Department of Health and Human Services delivered agiant spreadsheet on hospital charges and payments.
The spreadsheet has data in 65,536 rows and 12 columns. It covers, for each of more than 3,000 hospitals, charges and payments for the 100 most frequently billed inpatient cases, along with the average covered charges hypothetically billed by those hospitals for those cases.
The spreadsheet has data in 65,536 rows and 12 columns. It covers, for each of more than 3,000 hospitals, charges and payments for the 100 most frequently billed inpatient cases, along with the average covered charges hypothetically billed by those hospitals for those cases.
The distribution of this giant spreadsheet instantly brought headlines in major daily publications, telling the world that billing charges for a given case vary widely among hospitals even within one city.
Really?
Why was this news? That charges vary enormously among hospitals surely must have been known for many years. As early as 2004, for example, Lucette Lagnado of The Wall Street Journal reported that on the paper’s front page.
I recall producing from her data, for a 2006 paper, “The Pricing of U.S. Hospital Services: Chaos Behind a Veil of Secrecy,” the following slide. More such wondrous charges can be found in Ms. Lagnado’s article.
Readers of this blog may recall several posts on the pricing of hospital services, commenting on such variations.
Perhaps the news in this case was that at long last the government had bestirred itself to publish data on which it had been sitting for decades. Indeed, why it had not done so eons ago is an intriguing question.
CMMC excluded from proposed Anthem health plan
Published on Friday, May 10, 2013 at 5:05 pm | Last updated on Friday, May 10, 2013 at 5:05 pm
Patients in western and southern Maine will lose access to local doctors and hospitals under a “backroom deal” between MaineHealth and the state’s largest health insurer, according to an executive at another health system excluded from the arrangement.
The deal could affect thousands of Maine residents, one consumer advocate said.
MaineHealth, the parent organization of Maine Medical Center in Portland, has partnered with Anthem Blue Cross and Blue Shield to offer a new insurance product on Maine’s health insurance exchange, an online market where consumers and small businesses can buy coverage beginning next October. The exchanges are a key component of President Barack Obama’s health reform law, which aims to widen coverage to 30 million people.
By excluding hospitals from the new insurance plans that compete with MaineHealth, Anthem and MaineHealth are undermining the intent of the reform law to improve access to affordable health care, said Chuck Gill, vice president for public affairs at Central Maine Healthcare.
Central Maine Healthcare’s hospitals — Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital — were excluded from the proposed network of providers that would serve patients who sign up for the new plans, he said.
“The only common thread is that the people who are excluded are the people who compete with MaineHealth or their affiliates,” Gill said.
http://m.sunjournal.com/news/0001/11/30/cmmc-excluded-proposed-anthem-health-plan/1362237
The deal could affect thousands of Maine residents, one consumer advocate said.
MaineHealth, the parent organization of Maine Medical Center in Portland, has partnered with Anthem Blue Cross and Blue Shield to offer a new insurance product on Maine’s health insurance exchange, an online market where consumers and small businesses can buy coverage beginning next October. The exchanges are a key component of President Barack Obama’s health reform law, which aims to widen coverage to 30 million people.
By excluding hospitals from the new insurance plans that compete with MaineHealth, Anthem and MaineHealth are undermining the intent of the reform law to improve access to affordable health care, said Chuck Gill, vice president for public affairs at Central Maine Healthcare.
Central Maine Healthcare’s hospitals — Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital — were excluded from the proposed network of providers that would serve patients who sign up for the new plans, he said.
“The only common thread is that the people who are excluded are the people who compete with MaineHealth or their affiliates,” Gill said.
http://m.sunjournal.com/news/0001/11/30/cmmc-excluded-proposed-anthem-health-plan/1362237
America the Clueless
By FRANK BRUNI
THE problems with our country’s political discourse are many and grave, but an insufficient attention to Obamacare isn’t among them. We have talked Obamacare to death, or at least into home hospice care. The “Obamacare” shorthand itself reflects our need to come up with less of a mouthful than “Patient Protection and Affordable Care Act,” given how regularly the topic recurs. “Obamacare” is like “J. Lo” or “KFC.” It saves syllables and speeds things along.
So explain this: according to a recent poll, roughly 40 percent of Americans don’t even know that it’s a law on the books.
Now if I learned that 40 percent weren’t aware of when Obamacare was to be fully implemented or whether any of it had yet gone into practice or precisely how it’s likely to affect them, I wouldn’t be surprised or distressed. Obamacare is nothing if not unwieldy and opaque: “Ulysses” meets “Mulholland Drive.” The people confused about it include no small number of the physicians I know and probably a few of the law’s authors to boot.
But 40 percent of Americans are clueless about its sheer existence. Some think it’s been repealed by Congress. Some think it’s been overturned by the Supreme Court. A few probably think it’s been vaporized and replaced with a galactic edict beamed down from one of Saturn’s moons. With Americans you never know.
According to a survey I stumbled across just weeks ago, 21 percent believe that a U.F.O. landed in Roswell, N.M., nearly seven decades ago and that the federal government hushed it up, while 14 percent believe in Bigfoot.
According to another survey, taken last year, about 65 percent of us can’t name a single Supreme Court justice. Not the chief one, John Roberts. Not the mute one, Clarence Thomas. Not even the mean one, Antonin Scalia. Though when it comes to Scalia, perhaps the body politic suffers less from ignorance than from repressed memory.
That we Americans are out to lunch isn’t news. But every once in a while a fresh factoid like the Obamacare ignorance comes along to remind us that we’re out to breakfast and dinner as well. And it adds an important, infrequently acknowledged bit of perspective to all the commentary, from us journalists and from political strategists alike, about how voters behave and whom they reward. We purport to interpret an informed, rational universe, because we’d undercut our own insights if we purported anything else.
But only limited sense can be made of what is often nonsensical, and the truth is that a great big chunk of the electorate is tuned out, zonked out or combing Roswell for alien remains. Polls over the last few years have variously shown that about 30 percent of us couldn’t name the vice president, about 35 percent couldn’t assign the proper century to the American Revolution and 6 percent couldn’t circle Independence Day on a calendar. I’m supposing that the 6 percent weren’t also given the holiday’s synonym, the Fourth of July. I’m an optimist through and through.
http://www.nytimes.com/2013/05/12/opinion/sunday/bruni-america-the-clueless.html?hp&pagewanted=print
Dangers found in lack of safety oversight for Medicare drug benefit
By Tracy Weber, Charles Ornstein and Jennifer LaFleur | ProPublica,
Ten years ago, a sharply divided Congress decided to pour billions of dollars into subsidizing the purchase of drugs by elderly and disabled Americans.
The initiative, the biggest expansion of Medicare since its creation in 1965, proved wildly popular. It now serves more than 35 million people, delivering critical medicines to patients who might otherwise be unable to afford them. Its price tag is far lower than expected.
But an investigation by ProPublica has found the program, in its drive to get drugs into patients’ hands, has failed to properly monitor safety. An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive for their patients. Federal officials have done little to detect or deter these hazardous prescribing patterns.
Searches through hundreds of millions of records turned up physicians such as the Miami psychiatrist who has given hundreds of elderly dementia patients the same antipsychotic, despite the government’s most serious “black box” warning that it increases the risk of death. He believes he has no other options.
Some doctors are using drugs in unapproved ways that may be unsafe or ineffective, records showed. An Oklahoma psychiatrist regularly prescribes the Alzheimer’s drug Namenda for autism patients as young as 12; he says he thinks it calms them. Autism experts said there is scant scientific support for this practice.
The data analysis showed widespread prescribing of drugs such as carisoprodol, which was pulled from the European market in 2007. In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug to patients 65 and older. The muscle relaxant, also known as Soma, is on the American Geriatrics Society’s list of drugs seniors should avoid.
The data, obtained under the Freedom of Information Act, makes public for the first time the prescribing practices and identities of doctors and other health-care providers. The information does not include patient names or the reasons why doctors prescribed particular drugs, so reporters interviewed the physicians to learn their rationales.
Medicare has access to reams of data about its patients, their diagnoses and the medical services they received. It could analyze all of this information to determine whether patients are being prescribed appropriate drugs for their conditions.
But officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government. Congress never intended for CMS to second-guess doctors — and didn’t give it that authority, officials said.
Why do hospital costs vary so widely?
Industry leaders try to answer that question after last week’s release of data from the Centers for Medicare and Medicaid Services, but caution that ‘almost nobody pays those prices.’
Consumers gained access for the first time to the rates charged by hospitals for the most common inpatient procedures, but for the average patient the data won't matter.
The Maine Hospital Association estimated that fewer than 5 percent of Maine hospital patients would get bills reflecting sticker prices, which are known in the industry as "chargemaster rates." The bulk of patients get coverage through private insurance or through government programs, or qualify for free care from hospitals, the hospital association said.
The release of data from the Centers for Medicare and Medicaid Services, made public for the first time last week, listed the amounts 3,300 U.S. hospitals charged for the 100 most common inpatient procedures. The figures showed the average price charged by each hospital, as well as the lower amount actually paid by Medicare, the government program for the eldery.
Lewiston heart center saves lives, earns praise from former opponents
Posted May 12, 2013, at 6:02 a.m.
LEWISTON, Maine — More than a decade ago, Rich Livingston went to Augusta to urge the state to approve a controversial heart center in Lewiston.
Maine had only two such centers, which meant Lewiston-Auburn-area patients typically had to travel nearly an hour to Portland or two hours to Bangor if they needed a full-service program for open-heart surgery, angioplasty or other intensive cardiac care.
Central Maine Medical Center’s Central Maine Heart and Vascular Institute would be a great thing for the community, Livingston thought. A closer alternative for people suffering heart attacks.
You know, other people.
“I certainly wasn’t planning to use it,” he said.
Then, one morning last fall, Livingston, 68, woke in a cold sweat. Intense pain flared across his shoulders and radiated down both arms. His jaw hurt. He was nauseated.
He knew the symptoms. He was having a heart attack.
“I actually expected I was going to die,” he said. “I thought I’d be dead in minutes. Either the symptoms would abate on their own or I’d be dead. It couldn’t continue the way it was.”
But it did continue. Finally, sometime in late morning — three or four hours later — Livingston called his son and asked to be taken to the hospital.
He arrived at the Central Maine Heart and Vascular Institute within minutes.
Ten years after it opened, Livingston credited the heart center with saving his life.
“I waited way longer than I should have to get to the hospital,” he said. “Had I, at that point, needed to be transported out of town, I would have been in even more trouble than I was.”
A decade ago, the proposed heart center was controversial, its fate uncertain. Other hospitals said it wasn’t needed. A state-commissioned study said the center would almost certainly be “a low-volume one that would face difficult challenges.”
A decade later, the heart center has been lauded by residents, patients, doctors and outside rating experts, not only for its emergency procedures but also for its heart health rehab program. One of three such cardiac programs in the state, it is the go-to place for area heart patients.
Tomorrow, the Central Maine Heart and Vascular Institute will officially mark its 10th anniversary.
“The health-care capabilities of this community were not complete without this,” Livingston said.
No comments:
Post a Comment