The ills of money-driven medicine
Posted May 17, 2012, at 11:57 a.m.A couple of weeks ago, nine medical specialty societies released a list of 45 medical tests and procedures they believed are significantly overused. On the heels of this announcement was a conference on “Avoiding Avoidable Care” attended by about 150 experts, mostly physicians. I attended.We spent two days discussing the reasons for and ethics of unnecessary medical care in the U.S. Instead of blaming others (such as patients or malpractice lawyers), the doctors at this conference mostly agreed that “If you’re looking for an explanation for medical care overuse — too many tests, procedures and prescriptions — follow the money.”The amount of overuse was estimated to be around 30 percent of all medical care. We spend $2.7 trillion annually on medical care in the U.S. Thirty percent of a big number is still a big number, about $800 billion in this case. In our industrialized health care system, moving “product” is important, whether or not it is really necessary.
A couple of weeks ago, nine medical specialty societies released a list of 45 medical tests and procedures they believed are significantly overused. On the heels of this announcement was a conference on “Avoiding Avoidable Care” attended by about 150 experts, mostly physicians. I attended.
We spent two days discussing the reasons for and ethics of unnecessary medical care in the U.S. Instead of blaming others (such as patients or malpractice lawyers), the doctors at this conference mostly agreed that “If you’re looking for an explanation for medical care overuse — too many tests, procedures and prescriptions — follow the money.”
The amount of overuse was estimated to be around 30 percent of all medical care. We spend $2.7 trillion annually on medical care in the U.S. Thirty percent of a big number is still a big number, about $800 billion in this case. In our industrialized health care system, moving “product” is important, whether or not it is really necessary.
Patrick defends universal care, urges cost control
Speaking to both state and national audiences, Governor Deval Patrick today defended the idea of government promoting near universal health care, even as he called on lawmakers, health care providers, and the business community to work jointly on controlling its cost.
The twin targets reflected his role both as leader of the state and a top surrogate speaker for President Obama. The Democratic president is defending his federal health care overhaul from criticism by Mitt Romney, the presumptive Republican presidential nominee who enacted the state’s health care reforms when he preceded Patrick as Massachusetts governor.
Senate, House approve state budget; Democrats call bill a ‘sham’
Posted May 15, 2012, at 5:02 p.m.
AUGUSTA, Maine — A state budget rewrite that makes up for an $80 million shortfall largely through cuts in social services won initial Senate and House approval Tuesday as the Republican majority pushed the bill through following impassioned debates.
Republicans said the budget makes needed, structural changes in the Department of Health and Human Services to bring Maine in line with other states and make the department’s safety net of programs affordable over the long term.
Democrats labeled the GOP-backed budget bill as “heartless” and a “sham,” saying it cuts or eliminates programs that are critical to thousands of Mainers, and that part of it is based on shaky financial expectations. It passed 19-16 in the Senate and 74-69 in the House but faced further votes in both chambers.
The budget seeks to close the remaining $80 million hole in the DHHS budget for the year starting July 1. It is also the last revision in the state’s two-year, $6 billion budget that earlier this year faced a shortfall exceeding $200 million.
Adding to social service cuts made earlier this year, it would remove 19- and 20-year-olds from MaineCare, reduce funding for Head Start, cut Family Planning funding, eliminate state funding for home health care visits, remove about 1,500 low-income elderly and disabled people from a prescription drug assistance program, and make eligibility more difficult for the children’s health insurance program, among other cuts.
Maternal Deaths Plunged Over 2 Decades, to About 287,000 in 2010, U.N. Reports
By DONALD G. McNEIL Jr.
The number of women dying from pregnancy and childbirth has dropped sharply in the last two decades, according to a report by a consortium of United Nations agencies set to be released on Wednesday.
Maternal deaths fell to about 287,000 in 2010, the report said. The decline is attributable to increases in contraception and in antiretroviral drugs for mothers with AIDS, and to greater numbers of births attended by nurses, doctors or midwives with medical training.
The agencies said the deaths had fallen by 47 percent from the United Nations’ 1990 estimate of 543,000, but the organization has been revising its historical estimates in response to skeptical research by a rival group of epidemiologists at the University of Washington.
Two years ago, that group, the Institute for Health Metrics and Evaluation, which was founded by the Bill and Melinda Gates Foundation as a sort of check on the World Health Organization, contradicted a long-held United Nations finding that maternal deaths had remained stubbornly above 500,000 a year.
Doubt Cast on the ‘Good’ in ‘Good Cholesterol’
By GINA KOLATA
The name alone sounds so encouraging: HDL, the “good cholesterol.” The more of it in your blood, the lower your risk of heart disease. So bringing up HDL levels has got to be good for health.
Or so the theory went.
Now, a new study that makes use of powerful databases of genetic information has found that raising HDL levels may not make any difference to heart disease risk. People who inherit genes that give them naturally higher HDL levels throughout life have no less heart disease than those who inherit genes that give them slightly lower levels. If HDL were protective, those with genes causing higher levels should have had less heart disease.
Researchers not associated with the study, published online Wednesday in The Lancet, found the results compelling and disturbing. Companies are actively developing and testing drugs that raise HDL, although three recent studies of such treatments have failed. And patients with low HDL levels are often told to try to raise them by exercising or dieting or even by taking niacin, which raised HDL but failed to lower heart disease risk in a recent clinical trial.
“I’d say the HDL hypothesis is on the ropes right now,” said Dr. James A. de Lemos, a professor at the University of Texas Southwestern Medical Center, who was not involved in the study.
Dr. Michael Lauer, director of the division of cardiovascular sciences at the National Heart, Lung and Blood Institute, agreed.
Coffee Drinkers May Live Longer
By TARA PARKER-POPEKevork Djansezian/Getty Images
Your morning cup of coffee may start to taste even better after a major government study found that frequent coffee drinkers have a lower risk of dying from a variety of diseases, compared with people who drink little or no coffee.
The report, published online in The New England Journal of Medicine on Wednesday, analyzed the coffee-drinking habits of more than 400,000 men and women ages 50 to 71, making it the largest-ever study of the relationship between coffee consumption and health.
Previous studies have offered conflicting results on the relative benefits or harms associated with regular coffee consumption. While coffee contains caffeine, a stimulant that may temporarily increase heart rate and blood pressure in some people, coffee also contains hundreds of unique compounds and antioxidants that may confer health benefits. Further confusing much of the research into coffee is the fact that many coffee drinkers are also smokers, and it has been difficult to untangle the relative health effects of coffee and cigarettes.
To learn more, researchers from the National Institutes of Health analyzed diet and health information collected from questionnaires filled out by 229,119 men and 173,141 women who were members of the American Association of Retired Persons (AARP) between 1995 and 1996. The respondents were followed until 2008, by which point 52,000 had died.
Mass. health care debate pits cost vs. quality — and young vs. old
Though education spared Massachusetts the fate of other former industrial states, like Michigan, we have an odd way of showing that our future depends on human capital. In 2001, the Commonwealth spent $8.3 billion (in current dollars) on education and a larger but still comparable amount, $10.8 billion, on health care. But in Governor Patrick’s 2013 budget, the gap is far wider: The $15.2 billion for health care is more than double the $6.9 billion he proposes for education.
This comparison hints at the stakes as the House and Senate discuss bills to restrain health spending. Unless lawmakers succeed, rising medical spending threatens to crowd out everything else, including the schooling that will determine Massachusetts’ economic future.
WellPoint shareholders say no to political spending proposal
At an annual meeting marked by shouts and a street protest, WellPoint shareholders on Wednesday rejected a proposal pushed by labor unions and liberal health advocacy groups to change the way the company discloses its political spending.
Union representatives and other protesters repeatedly interrupted Chairwoman and CEO Angela Braly after she opened the meeting and introduced proposals for shareholder voting.
One person presented a petition she said was signed by 15,000 people asking the Indianapolis company for more disclosure.
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