The Fork in the Road for Health Care
By UWE E. REINHARDTUwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
Milliman, the global actuarial and employee benefit consulting firm, released its annual Milliman Medical Index for 2012 on May 15. Based on a large, nationwide sample of families with employment-based health insurance, the index tracks the total cost of spending on health for a typical family of four under age 65 that is covered by an employment-based, preferred-provider health insurance plan.
The virtue of this index lies in its inclusion of out-of-pocket spending in total health spending. Just tracking premiums for employment-based health can be misleading, if employers shift more and more of the cost of health care out of their benefit package into deductibles or coinsurance paid by employees, exclude certain benefits altogether or otherwise limit coverage.
For 2012, the nationwide average of the total health spending for a typical family of four was estimated by Milliman to be $20,728. On a regional basis, that average varies from a low of $18,365 in Phoenix to $24,965 in Miami.
A just-released study by the Health Care Cost Institute shows that much of these spending increases are the result of rising prices and not of rising use. Reporting on the study, Julie Appleby of Kaiser Health News notes,
Rationing Life-Years
By UWE E. REINHARDTUwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
My previous post, “The Fork in the Road for Health Care,” elicited a lively exchange of thoughtful commentary. While many Americans have always pretended that the United States could avoid rationing of health care, one way or another we have tacitly accepted such rationing all along, and we will do it with even more vigor in the future.
The discussion of my post reminded me of a fascinating column written in 2009 by N. Gregory Mankiw. He noted that he takes a statin pill every morning and that a physician “estimated that statins cost $150,000 for each year of life saved.” Musing whether the payoff was worth that much money, Professor Mankiw sought insight in the following hypothetical:
http://economix.blogs.nytimes.com/2012/06/08/rationing-life-years/?pagemode=printImagine that someone invented a pill even better than the one I take. Let’s call it the Dorian Gray pill, after the Oscar Wilde character. Every day that you take the Dorian Gray, you will not die, get sick or even age. Absolutely guaranteed. The catch? A year’s supply costs $150,000.
Anyone who is able to afford this new treatment can live forever. Certainly, Bill Gates can afford it. Most likely, thousands of upper-income Americans would gladly shell out $150,000 a year for immortality.
Fast Access to Records Helps Fight Epidemics
By MILT FREUDENHEIM
Public health departments around the country have long scrutinized data from local hospitals for indications that diseases like influenza, tuberculosis, AIDS, syphilis and asthma might be on the rise, and to monitor the health consequences of heat waves, frigid weather or other natural phenomena. In the years since 9/11, this scrutiny has come to include signs of possible bioterrorism.
When medical records were maintained mainly on paper, it could take weeks to find out that an infection was becoming more common or that tainted greens had appeared on grocery shelves. But the growing prevalence of electronic medical records has had an unexpected benefit: By combing through the data now received almost continuously from hospitals and other medical facilities, some health departments are spotting and combating outbreaks with unprecedented speed.
More than one-third of the nation’s 5,000 acute care hospitals now use electronic medical records, and the share of primary care doctors using them has doubled to 40 percent in the last two years, said Dr. Farzad Mostashari, the Obama administration’s national coordinator for health information technology.
The technology’s spread is helping “officials faced with events of public health significance to know sooner, act faster and manage better,” said Dr. Seth Foldy, a senior adviser to the Centers for Disease Control and Prevention.
In February, public health officials in Michigan noted an increase in electronic reports from clinical laboratories indicating E. coli cases in several counties. Eleven patients were identified, including six who were hospitalized.
In less than a week, officials had enough evidence to warn the public that the infection appeared to be linked to clover sprouts in food at the Jimmy John’s sandwich chain, said James Collins, director of the communicable diseases division at the state’s Department of Community Health. The chain quickly removed the sprouts, and by April, the 11-state outbreak was over.
Trauma in the ER: Who covers the uninsured?
If the Supreme Court strikes down Obama's health insurance mandate, hospitals still must treat all emergencies — and everyone pays.
By Noam N. Levey, Los Angeles Times
8:11 PM PDT, June 18, 2012
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But as they worked to save his life, doctors and nurses at the capital's largest hospital ran a dizzying battery of lab tests and high-tech scans. Surgeons operated repeatedly, at one point removing a portion of his skull to relieve pressure on the brain.
As happens daily in emergency rooms nationwide, the uninsured patient received medical care guaranteed by a generation-old federal mandate that requires hospitals to care for all in need, regardless of ability to pay.
http://www.latimes.com/news/nationworld/nation/la-na-emergency-care-20120619,0,3220576,print.story
Most Americans won't like healthcare ruling -- whatever it is
By Mark Z. Barabak12:39 PM PDT, June 18, 2012
http://www.latimes.com/news/politics/la-pn-most-americans-wont-like-healthcare-ruling-whatever-it-is-20120618,0,491929,print.story
Millions will go without insurance even with overhaul
Tom Murphy / The Associated Press
One of the biggest misconceptions about President Obama's health care overhaul isn't who the law will cover, but rather who it won't.
If it survives Supreme court scrutiny, the landmark overhaul will expand coverage to about 30 million uninsured people, according to government figures. But an estimated 26 million Americans will remain without coverage — a population that's roughly the size of Texas and includes illegal immigrants and those who can't afford to pay out-of-pocket for health insurance.
"Many people think that this health care law is going to cover everyone, and it's not," says Nicole Lamoureux, executive director of the Alexandria, Va.-based National Association of Free & Charitable Clinics, which represents about 1,200 clinics nationally.
California to lose big if Supreme Court scraps U.S. healthcare law
The state, one of the biggest beneficiaries of the Affordable Care Act, would lose out on as much as $15 billion annually in new federal money slated to come its way.
By Chad Terhune, Anna Gorman and Erin Loury, Los Angeles Times
June 20, 2012
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