Health Care Reform Articles - April 6, 2015

Health: The Right Diagnosis and the Wrong Treatment

Marcia Angell

APRIL 23, 2015 ISSUE

America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System

by Steven Brill

Random House, 512 pp., $28.00

Steven Brill has achieved the seemingly impossible—written an exciting book about the American health system. In his account of the passage of the Affordable Care Act (now known as Obamacare), he manages to transform a subject that usually befuddles and bores into a political thriller. There was reason to think he might pull it off; his lengthy 2013 Timemagazine exposé of the impact of medical bills on ordinary people was engrossing. But his success also owes much to the Bob Woodward method of writing best sellers about government policy: interviews with hundreds of insiders, many anonymous, some evidently willing to talk to him to increase their chances of being shown in a favorable light.

For example, one of Brill’s principal sources and a great favorite is Liz Fowler, chief health counsel to Senator Max Baucus, chairman of the Senate Finance Committee, which oversaw the legislation. Brill credits her with being “more personally responsible than anyone for the drafting of what became Obamacare.” He is unbothered by the fact that she was vice-president for public policy at WellPoint, the country’s second-largest private insurance company, before taking her job with Senator Baucus, or by the fact that shortly after passage of the law (and a brief stint with the administration), she became head of global health policy at the drug company Johnson & Johnson—even though both of these industries benefited greatly from Obamacare.

By contrast, Brill is appropriately critical of others who used the revolving door between industry and government, such as Billy Tauzin, the congressman who pushed through the industry-friendly Medicare drug benefit in 2003 and then became head of the pharmaceutical industry’s trade association. The excuse he gives for Fowler is that she was not a lobbyist, but that is hardly the point.

In view of his method, it’s not surprising that there is as much political gossip and score-settling in Brill’s book as analysis. Nevertheless, his description of our dysfunctional health system is dead-on. He shows in all its horror how the way we distribute health care like a market commodity instead of a social good has produced the most expensive, inequitable, and wasteful health system in the world. (The US now spends per capita two and a half times as much on health care as the average for the other OECD countries, while still leaving tens of millions of Americans uninsured.) Brill makes it clear that the problems are unlikely to be fixed by Obamacare. For that alone, his book deserves to be widely read.

http://www.nybooks.com/articles/archives/2015/apr/23/health-right-diagnosis-and-wrong-treatment/?pagination=false&printpage=true

When ‘Moneyball’ Meets Medicine

APRIL 2, 2015

by Jeremy Smith

What’s worse: Ebola or AIDS? Measles or malnutrition? Lung cancer or low back pain? As individuals, as a nation, and as a global community, where should we focus our time and money to improve lives the most?

The way we usually answer these questions is to count the number of deaths: The more people killed, the more important the problem. Counting deaths is so familiar that few have thought to question it. But death toll alone says nothing about how long people live, and good health is much more than not being dead.

Every year, for example, more than six million people worldwide die of stroke. Only about 300,000 people die worldwide of meningitis. So is stroke 20 times worse for humanity than meningitis? Not necessarily — because most people who die of stroke are age 75 or older, while those most likely to die of meningitis are infants. Death is an inevitability, but a death in very early childhood is a tragedy. All else being equal, saving the lives of infants should still be one of our global health systems’ top priorities.

http://www.nytimes.com/2015/04/05/upshot/when-moneyball-meets-medicine.html?em_pos=small&emc=edit_up_20150403&nl=upshot&nlid=1311158&ref=headline&abt=0002&abg=0

Doctors need to treat their patients with respect

By Thomas FarragherGLOBE COLUMNIST  APRIL 04, 2015

When was the last time you were an hour late for a deeply important professional meeting, sauntered in, sat down and — without so much as a word of apology — began to talk business as if nothing at all were amiss?

I’m guessing never.

But every month or two, I drive a dear friend to one our city’s venerated monuments to medicine, which asks her to show up at 10 a.m. Routinely, lunchtime comes and goes, and she’s escorted in to see the doctor about 1 p.m.

She’s grown used to it. It makes my head explode.

We are blessed to live in a medical mecca, where world-acclaimed hospitals employ medical professionals whose skills are unequaled, people who perform live-saving miracles that move patients and their families to tears of gratitude.

So how is it that these medical wizards, so deft in operating suites and emergency rooms, can be so utterly tone-deaf when it comes to basic courtesy, dignity, and respect?

“Nothing’s more important than respect,’’ said Jim Conway, an adjunct lecturer at the Harvard School of Public Health. “It can’t just be an aspiration. You have to build this into your system.”

And now, remarkably, that’s beginning to happen. Hospitals are treating the kind of suffering imposed by their medical professionals, not by disease or its treatment, as seriously as infections and falls.

So you can imagine how difficult it was for me to resist the urge to seek a group hug the other day with those on the vanguard of this movement at Beth Israel Deaconess Medical Center.

“Whether it’s physical or emotional, it’s all bad,’’ said Dr. Lauge Sokol-Hessner, the hospital’s associate director of inpatient quality. “When we talk about respect and dignity, those are important terms because it’s somehow even deeper than a medication error.’’

Like all hospitals, Beth Israel Deaconess has an urgent protocol it follows when so-called “never events” occur, like wrong-sided surgery or the amputation of the wrong limb. But now, it’s beginning to apply that kind of rigor when dignity is at risk.

http://www.bostonglobe.com/metro/2015/04/03/doctors-need-treat-their-patients-with-respect/XUuE6oyXGz2dpyVNoRx6LJ/story.html#skip-target1

9 New York Doctors Are Accused of Defrauding Medicaid Using Homeless People

By STEPHANIE CLIFFORDMARCH 31, 2015

“Free sneakers, shoes and boots today,” Bernard Rorie shouted, standing outside a soup kitchen in East New York, Brooklyn, where he was being recorded by investigators

Mr. Rorie was recruiting homeless people, prosecutors said, and whoever had a valid Medicaid card would be packed into a van and sent to medical clinics around New York City. There, after hours of unnecessary tests and fake diagnoses, the homeless people would be sent off with sneakers — selected from stacks of shoeboxes in the clinics’ basements. The doctors, staff members and billing specialists, meanwhile, would rack up hundreds or thousands of dollars per recruit in false Medicaid claims, prosecutors said.

On Tuesday, nine New York doctors were among 23 people indicted in State Supreme Court in Brooklyn in connection with the sneaker scheme, which the Brooklyn district attorney’s office said made almost $7 million and took advantage of thousands of homeless people.

The charges in the indictment include health fraud, enterprise corruption and money laundering.

“At the heart of this health care fraud scheme was the exploitation of poor people,” Kenneth P. Thompson, the Brooklyn district attorney, said on Tuesday. “This was a Medicaid mill.”

While Medicaid and Medicare fraud cases are common, this one was notable for the number of participants and the use homeless people as fake clients.

From a warehouse in Sunset Park, Eric Vainer, 43, oversaw the operation with the help of his mother, Polina, 66, prosecutors said. “We can use the same patients like guinea pigs for anything we want,” Mr. Vainer was recorded saying in a government wiretap.

http://www.nytimes.com/2015/04/01/nyregion/9-new-york-doctors-indicted-in-medicaid-fraud-using-homeless-patients.html?mabReward=R5&action=click&pgtype=Homepage&region=CColumn&module=Recommendation&src=rechp&WT.nav=RecEngine

Obamacare: A deeply flawed system

By Tom Walsh
The Ellsworth American (Maine), April 2, 2015

The big winners in the Affordable Care Act are not those newly enrolled, but the status quo players in the deeply flawed American health care delivery system: the health insurance industry, Big Pharma drug companies, for-profit hospitals, overpaid doctors and other co-conspirators in an American health care system that, by any objective standard, is a complete failure.

Unfortunately, the emphasis of this federal legislation (translates: Obamacare) is "affordable." To couch it in terms of "health care reform" is a rhetorical joke. The quality of health care in America is not being "reformed" in any way through a program that, bottom line, not only encourages, but now requires, Americans to buy into a health care system that remains deeply flawed. It's an approach that makes health care less expensive and more accessible, but not better in terms of quality of care.

In 2005, Paul and Gretchen Volenik moved from Hancock County to Nova Scotia to take advantage of Canada's common-sense, no-insurance-required approach to health care delivery. Between 1994 and 2002, Paul was a state representative in the Maine Legislature, where he was the point man advocate for a state-funded universal health care system that would provide medical care to every citizen of Maine. When that never happened, the Voleniks moved north.

"It's like a train," Paul says of the so-called health care reform. "The engineer is driving the health care train, and he stops at each stop and picks up a few more people, maybe children, or a group of low-income people. But he fails to notice that the train is on fire and that people are leaping off it in all directions, because the system is ridiculous. Until you get rid of the immense power of the drug companies, until you get rid of the inflated salaries of the hospital administrators, you will never have an effective health care system."

And we don't. In the world of health care statistics, "outcomes" means results. You know, little things like infant mortality and life expectancy. The outcome numbers, as they have for years, undercut the Big Lie that America has the "best health care system in the world." No. It doesn't. Not even close. Not when you look at those pesky outcome numbers.

"The United States health care system is the most expensive in the world," says a June 2014 analysis by the Commonwealth Fund. "The U.S. underperforms relative to other countries on most dimensions. Among the 11 nations studies in this report -- Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States -- the U.S. ranks last, as it did in 2010, 2007, 2006, and 2004. ... Most troubling, the U.S. fails to achieve better health outcomes than the other countries. ... The U.S. is last or near last on dimensions of access, efficiency, and equity. ... The U.S. ranks last overall with poor access scores on all three indicators of health lives -- mortality amenable to medical care, infant mortality, and health life expectancy at age 60."

There it is. Why bore you by drilling down into the stats? Suffice to say the numbers in terms of America's health care efficacy are not close to good. Among the world's industrialized countries, the American health care system, in terms of results, isn't within the top 20.

In 1974, while America's mindset was being distracted by Watergate and Richard Nixon's personal and political meltdown, there was a U.S. senator running around Capitol Hill, loudly preaching the gospel of what he termed "national health insurance." Too loudly, apparently, for the K Street lobbyists for Big Pharma drug companies, the American Medical Association and the American Hospital Association, who took note and collectively circled the wagons, making sure this potential drift away from the extremely lucrative status quo wouldn't come to be. To Sen. Ted Kennedy's dismay, it didn't. Nor has it, 40 years later. In the meantime, an estimated 210,000 Americans die each year from preventable medical errors, making such errors the third leading cause of death in the United States, after heart disease and cancer.

So jump aboard the train. Only now it's not an option, it's required. In the meantime, remember this: The only way to survive the American health care system is to stay out of it.

Good luck with that.

Tom Walsh of Gouldsboro is an award-winning medical and science writer.

http://www.ellsworthamerican.com/

Americans Don’t Feel the Slowdown in Health Costs

by Drew Altman

Kaiser Family Foundation polling from 2013 of public perceptions of how quickly health insurance premiums have been rising.

Kaiser Family Foundation

National spending on health care and insurance premiums has risen at historically low rates in recent years. But, as the chart above shows, even when spending and premiums experienced record-low growth in 2013, only 3% of Americans said health costs had been rising slower than usual, and 52% said they had been growing faster than usual. The American people are not out to lunch; their view of the problem of health costs is very different from that of experts.

The amount that people with employer-based insurance pay for premiums has risen 212% in the last 15 years, while wages have risen 54% and inflation 43%. Deductibles and other forms of cost sharing have also risen steadily, so much so that about a quarter of privately insured Americans don’t have the savings to pay their deductibles. Drug prices have been rising sharply. Even though drugs represent just 10% of overall health spending, people experience the co-pay cost every time they go to a pharmacy or order online. With premiums, deductibles, and drug costs rising at a time when wages have been relatively flat, it’s no wonder Americans haven’t felt relief from the slowdown in health-cost growth, even if their premiums have been rising more slowly than in the past.

Experts (myself included) often focus on cost measures such as health spending as a percentage of GDP and the rate of increase in health spending. These measures are important because what we spend on health affects our ability to address other national priorities. In more than 20 years of regular polling on health-care issues by the Kaiser Family Foundation, I have found that Americans with coverage care about:

* Their premium costs, or the share of premiums they pay if they have employer coverage;

* Their deductibles and other forms of cost sharing, especially when deductibles have been rising steadily;

* Their drug costs (this is particularly an issue for the chronically ill, who use a lot of drugs);

* Whether their insurance covers the services they think they will need;

* Whether they can go to the doctor or hospital they want without having to pay more. People are more willing to accept a lower premium for less choice if they do not have a regular doctor or hospital;

* The hassle and red tape in health care and health insurance. Increasingly, people care about getting information to be informed about their health and make smarter insurance and health care decisions.

Two other things stand out:

Seniors care a lot about Medicare and sometimes vote on the issue.

And Americans overall don’t care as much as experts do about improving quality and eliminating unnecessary care. In general, people think that quality is good and they want more care not less.

http://blogs.wsj.com/washwire/2015/03/31/americans-dont-feel-the-slowdown-in-health-costs/?mg=blogs-wsj&url=http%253A%252F%252Fblogs.wsj.com%252Fwashwire%252F2015%252F03%252F31%252Famericans-dont-feel-the-slowdown-in-health-costs

 

PERSONAL HEALTH

For Older Adults, a Rising Risk of Subdural Hematoma

By JANE E. BRODY

 APRIL 6, 2015 5:45 AM

You don’t have to hit your head to develop an insidious bleed between the soft covering of your brain and the brain itself that in days, weeks or months can threaten your health or life.

The condition, called chronic subdural hematoma, is becoming increasingly common as the population ages, prompting an NYU Langone Medical Center neurosurgeon, Dr. Uzma Samadani, to urge her colleagues to gear up for a growing number of cases likely to require neurological intervention.

By 2030, when a fifth to a quarter of the American population will be older than 65, chronic subdural hematoma, or SDH, is expected to afflict 60,000 Americans a year, which would make it the most common reason for brain surgery, surpassing brain tumors and metastases, Dr. Samadani and colleagues reported last month in The Journal of Neurosurgery.

Head trauma from, say, a fall or another accident remains an important cause of the disorder, though in a third to a half of cases, patients cannot recall an injury that might account for it. In many instances, the trauma, if there was one, was so trivial it was forgotten, like walking into an open cupboard door or hitting one’s head getting in or out of a car.

Indirect trauma that jostles the brain is more common. About half of patients who report having fallen did so without hitting their heads.

http://well.blogs.nytimes.com/2015/04/06/for-older-adults-a-rising-risk-of-subdural-hematoma/?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Health law affecting many taxpayers’ refund checks

by Ricardo Alonzo zalvidar - ap

WASHINGTON — As the April 15 tax deadline nears, people who got help paying for health insurance under the Affordable Care Act are seeing the direct effect on their refunds — hundreds of dollars, for better or worse.

The law offers tax credits so people without access to job-based health insurance can buy private coverage. Because these subsidies are tied to income, consumers must accurately estimate what they will make for the coming year.

That’s been a challenge for millions of people.

Guess on the low side, get more help now with premiums, but owe money later at filing time. Overestimate income, expect bucks back from the taxman.

Many consumers might not have understood how it works when they signed up. Some experts caution that such complications could discourage uninsured people from getting covered.

Rob Tuck of Dublin, Calif., said he had anticipated a refund of about $400 on his 2014 taxes. But that almost has been wiped out because he had to repay some of the subsidy. He changed jobs during the year, and his income went up a little.

Tuck, who works for a San Francisco-area tech-support company, said he enrolled to avoid tax penalties for being uninsured but feels penalized anyway now.

“I was expecting to get dinged a little bit, but I was actually kind of surprised when it came down that much,” he said.

Kelsey Park started out 2014 in Dallas, earning good commissions by selling wedding gowns. She left for graduate school at the University of Alabama in Tuscaloosa and signed up for coverage through the law. She ended up overestimating her income because she didn’t get another job as anticipated.

Park’s tax refund came to $2,500, partly because she had too much income tax withheld and partly because she received a smaller health care subsidy than she was entitled to.

http://www.bostonglobe.com/news/nation/2015/04/05/health-law-affect-refunds-for-many-taxpayers/X04bdVCe0InrcJHOLB4snJ/story.html#