A lab brat’s path of discoveryJack Russellhttps://www.dropbox.com/s/7gpx9cxccdzcu20/Jack%20Russell%20Commentary%2C%20Mount%20Desert%20Islander%20copy.pdf
HHC Sees 20% Increase in Number of Uninsured Patients
Too Much Medical Care?
By TARA PARKER-POPEA few years ago, my daughter sprained her ankle at dance camp. What happened next offers a glimpse into some of the problems in our nation's health care system.
For years, we've been hearing that the United States spends more on health care than any other country, even as it lags far behind other countries in terms of quality of care.
The numbers are staggering. Health spending in the United States neared $2.6 trillion in 2010 - that's 10 times the $256 billion spent in 1980. The Institute of Medicine estimates that in 2009, the most recent year for which data are available, the country spent about $210 billion on unnecessary medical services.
Broken down, this means that the United States spends about $8,000 per person annually on health care - that's about 50 percent more than Norway and Switzerland. In the United States, hospital stays are far more expensive than those in other countries, averaging about $18,000 per discharge, compared with less than $10,000 in Sweden, Australia, New Zealand, France and Germany.
But what do these numbers really mean to the average patient? What's going on in the doctor's offices and hospitals around the country to create such bloated spending?
That's where my daughter's ankle comes in. At the time, the injury seemed unremarkable. Her pediatrician suggested waiting it out, but after a month with no improvement, I sought a second opinion from a sports medicine specialist, who ordered an M.R.I., but ended up referring her to a pediatric orthopedic surgeon.
The specialist examined the ankle and ordered another M.R.I. as well as extensive blood work. After seven vials of blood, my daughter nearly passed out.
When Less Treatment Is More
By PAULINE W. CHEN, M.D.The patient, a slender middle-aged woman who'd had multiple operations and radiation for a cancer in her belly several years earlier, was struggling with nausea and vomiting again. Initially, the pattern was familiar: She would vomit every time she tried to eat. After a day or two, the problem, probably a kink in her intestines caused by residual scar tissue, would resolve on its own.
This time, however, the vomiting persisted. By the time she arrived at our hospital, she was so dehydrated that the skin on her face looked like fine crepe hanging from her brow and cheekbones.
Some of the doctors who heard her story were certain she needed an operation. That debilitating kink, they thought, could be snipped away in minutes by a surgeon's skilled hand!
But her own surgeon held off. He explained that finding the precise band of scar causing her obstruction would be difficult and perhaps dangerous. With all the dense scarring from her previous operations and radiation, he wasn't certain that he could find the offending kink, nor that his patient would necessarily benefit from surgery.
Instead, he gave her intravenous hydration and decompressed her intestines with a small tube threaded though her nose into her stomach. After a week, the woman was eating again and ready to go home.
"Sometimes the hardest thing for us doctors to do," her surgeon said to me, "is to know when not to do anything."
I was reminded of the relevance of his remark for both doctors and patients when I read a study on breast cancer treatment published this month in The Journal of Clinical Oncology.
For years, the standard treatment for most women with early-stage invasive breast cancer has been to cut out the tumor and then administer radiation. But eight years ago in a major study, that approach was re-evaluated for women over age 70. It turned out that putting older women with less aggressive early cancers through the additional rigors and complications of radiation -- fatigue, rash and the need to visit a radiation center daily for a month or more -- had no effect on their survival rates.
What We Can Learn From Third-World Health Care
By PAULINE W. CHEN, M.D.The young doctor had just returned from a month working in a country in Africa, familiar to the rest of us only through pictures of its impoverished population and news reports of recurring natural disasters and political upheavals. "You must feel exhausted but great," a senior colleague commented. "You went in there and you really helped those people."
But my younger colleague felt neither exhausted nor relieved to be back home, she confided when the older doctor had left the room. She had cared for dozens of patients with abscesses and broken bones, tumors and arrow wounds, relying on nothing more than a single rickety X-ray machine, a handful of battered surgical instruments and the aid of one well-connected local nurse.
"We could get so much done with so little over there," she said. "It's like we're not doing something right over here."
Put another way, the American health care system has become the great international paradox, spending more but getting less.
With all the most advanced technology and equipment, spending far more on health care than any other nation - a whopping $2.6 trillion annually, or over 17 percent of our gross domestic product- the United States consistently underperforms on some of the most important health indicators. Our infant mortality rates, for example, are worse than those in countries like Hungary, Cuba and Slovenia. Our life expectancy rates are not much better; in global rankings, we sit within spitting distance of Cuba, Chile and Libya.
This quality conundrum dogs us, even as our best and brightest have tried to imagine a more cost-efficient system. Some have pursued the carrot-and-stick route, linking quality measures to reimbursement. Others have attempted to reduce quality to its most basic parts, creating checklists and to-do lists. And still others have rearranged networks of hospitals, clinics, physician practices and payments, conjuring up a breathtaking array of combinations, permutations and bundles of care in order to create more cost-efficient systems.
Hospitals Worry Over Cut in Fund for Uninsured
By NINA BERNSTEIN
President Obama’s health care law is putting new strains on some of the nation’s most hard-pressed hospitals, by cutting aid they use to pay for emergency care for illegal immigrants, which they have long been required to provide.
The federal government has been spending $20 billion annually to reimburse these hospitals — most in poor urban and rural areas — for treating more than their share of the uninsured, including illegal immigrants. The health care law will eventually cut that money in half, based on the premise that fewer people will lack insurance after the law takes effect.
But the estimated 11 million people now living illegally in the United States are not covered by the health care law. Its sponsors, seeking to sidestep the contentious debate over immigration, excluded them from the law’s benefits.
As a result, so-called safety-net hospitals said the cuts would deal a severe blow to their finances.
The hospitals are coming under this pressure because many of their uninsured patients are illegal immigrants, and because their large pools of uninsured or poorly insured patients are not expected to be reduced significantly under the Affordable Care Act, even as federal aid shrinks.
The hospitals range from prominent public ones, like Bellevue Hospital Center in Manhattan, to neighborhood mainstays like Lutheran Medical Center in Brooklyn and Scripps Mercy Hospital in San Diego. They include small rural outposts like Othello Community Hospital in Washington State, which receives a steady flow of farmworkers who live in the country illegally.
The number of uninsured New Yorkers who sought healthcare services at HHC hospitals, nursing homes and health centers in 2011 continued to increase for the fifth year in a row and has grown by 20 percent to 478,000 since 2006 |
For Big Drug Companies, a Headache Looms
By EDWARD WYATT
WASHINGTON — It would seem a business executive’s dream: legally pay a competitor to keep its product off the market for years.
Congress has failed to stop it, and for more than a decade generic drug makers and big-name pharmaceutical companies have been winning court rulings that allowed it.
Until this month. On July 16, a federal appeals court in Philadelphia issued a decision that the arrangement is anticompetitive on its face. It potentially sets up a confrontation before the United States Supreme Court. If it were to accept the case, the outcome could profoundly affect drug prices and health care costs.
The Philadelphia ruling by the Third Circuit Court of Appeals conflicted with decisions from at least three other federal circuit courts, giving the Supreme Court a strong reason to hear the case within the next few years.
“The Third Circuit has rebalanced the issue and teed it up for the Supreme Court,” said Eleanor M. Fox, an antitrust expert and professor at the New York University Law School. The agreements between generic and branded drug manufacturers “are cases of competitor collaboration, which the Supreme Court has called ‘the supreme evil of antitrust.’ ”
The stakes are enormous for brand-name drug makers, which would face lower profits, and for pharmacies, insurance companies and patients, who could benefit from the savings.
In the case of Cipro, a powerful antibiotic with annual sales exceeding $1 billion, Bayer paid $400 million to a generic drug maker, Barr Laboratories, and other companies. In exchange, the generic makers said they would withhold their own lower-priced generic versions of the drug until 2003, when Bayer’s patent on the brand-name drug expired.
Cutting U.S. health-care costs doesn’t have to be harmful
By Bryan R. Lawrence,
Now that the Supreme Court has found the Affordable Care Act’s individual mandate constitutional, there is a danger that we will revert to our old health-care politics — Republicans warning about “death panels” and socialized medicine, and Democrats wanting more tax revenue to protect Medicare.
All of that misses the point. Medicare costs per beneficiary grew by 5.5 percent annually from 2000 to 2011 (excluding the costs of Medicare Part D). Over the next 75 years, they are projected to grow at a slower rate, 4.3 percent annually, as Congress stops its annual “doc-fix” avoidance of its own legally required reductions in physician payments and as the ACA’s cost-control experiments prove effective.
But the 2012 Medicare trustees’ report casts doubt on whether that slower rate will happen. Medicare already pays doctors just 80 percent of private insurance rates. For the doc fix not to be implemented again next year, payments to physicians would have to be cut by 31 percent. Many doctors would stop seeing Medicare patients, and that would make another another doc fix politically inevitable.
Medicare’s trustees also worry that the ACA’s cost controls may not work. “Actual future costs for Medicare are likely to exceed those shown by the current-law projections in this report, possibly by substantial amounts,” they concluded. To them, that 4.3 percent growth rate looks low.
Why does this matter? In its 2011 financial report for the federal government, the Government Accountability Office calculates that health-care cost growth that is just 1 percent faster would require that the Treasury Department set aside, today, an additional $36 trillion to fund future promises (this includes Medicaid, which is expected to grow at rates similar to Medicare).
That’s roughly 240 percent of our gross domestic product. Greece was pushed into crisis with a debt-to-GDP ratio of 113 percent.
LePage should try arguing against saving people’s lives
Posted July 26, 2012, at 2:44 p.m.
The argument against extending Medicaid in Maine and other states under the Affordable Care Act has largely centered on money and state’s rights. What has not been discussed until recently is that the expansion could save lives.
A study by Harvard researchers, published Wednesday by The New England Journal of Medicine, found that when more poor people had health insurance, fewer people died. Part of the research was conducted in Maine. If that doesn’t add another good reason to the argument about why the state should cover more vulnerable populations, we’re not sure what does.
The U.S. Supreme Court ruling on the president’s health care law gave states the flexibility to decide themselves whether to expand Medicaid. The expansion of the program is a major part of how the health care overhaul plans to extend coverage to about 30 million uninsured people.
Gov. Paul LePage said a final decision about whether to expand Medicaid in Maine will be made after November elections, but he has spoken harshly against the law and the expansion.
And his administration is continuing to argue in favor of making $10 million in Medicaid cuts that Republican legislators approved in May. That’s the case even though the secretary of the U.S. Department of Health and Human Services and the nonpartisan Congressional Research Service said states may not scale back their existing Medicaid services.
It would be wise for the administration to move beyond political preference and make a decision based on data. The study by Harvard’s School of Public Health analyzed data from New York, Arizona and Maine, all of which expanded their Medicaid programs within the last decade to cover people not normally eligible: low-income adults without children or disabilities.
The study collected the mortality rates of the three states from both the five years before and after the Medicaid expansions and compared them to those in four neighboring states — Pennsylvania, Nevada, New Mexico and New Hampshire — that had not had expansions.
Maine asked to refund federal government $9.2M for overbilling Medicaid
Posted July 26, 2012, at 3:47 p.m.
AUGUSTA, Maine — The federal government wants Maine to repay more than $9 million that the Department of Health and Human Services overbilled in the Medicaid program over four years.
Maine splits the bill for the health insurance program, which covers low-income and disabled residents and is known as MaineCare in the state, with the feds. From 2005 to 2009, DHHS used an erroneous federal match rate and overbilled the Centers for Medicare and Medicaid Services by $9.2 million, according to a report by the U.S. Department of Health and Human Services’ Office of Inspector General, which investigates fraud, waste and abuse in the department’s programs.
The state is negotiating with the federal government to lower the refund amount.
DHHS used the wrong federal match rate on 90 percent of the 637,057 claims that the inspector general reviewed, according to the report. The errors occurred as DHHS adjusted previously paid claims from health care providers to reflect changing federal match rates.
The federal match can fluctuate based on a state’s per capita income and other factors.
The match rate fluctuated frequently with the influx of federal stimulus money, according to Stefanie Nadeau, director of MaineCare Services. The overbilling occurred under the state’s previous claims processing system, which since has been replaced, she said.
DHHS is looking for the feds to weigh in on whether the current claims system is properly calculating the match rate, Nadeau said.
“We want to make sure the way we configured our system today is appropriate,” she said.
While DHHS overbilled for some claims during the four-year audit period, it may have underbilled the federal government since 2009 as the match rate dropped and stimulus funds dried up, Nadeau said. The department is looking to settle on a refund amount somewhere in the middle, she said.
The health care 'repeal and replace' hoax
By Jack BernardThe Charleston Gazette, July 26, 2012
CHARLESTON, W.Va. -- "Repeal and replace!" That is a very catchy slogan indeed. Of course, any objective observer knows that it has very little chance of happening, but it still makes for a great sound bite.
Since 2007, the Democrats have had to override Republican Senatorial filibusters 360 times, far more than ever before. This concerns me for two reasons. First, using the filibuster thwarts democracy and may be unconstitutional. Second, excessively employing the filibuster sets a precedent for others to follow when they are in the minority.
Let's assume a very unlikely Republican sweep occurs in 2012. Romney wins, the House stays Republican and the Senate goes for the GOP with 51 or 52 Senators. Chances are still slim that repeal will take place due to the filibuster rule. Eight or nine Democrats would have to jump ship and vote with the Republicans, my party, to repeal the law before it really has a chance to be fully implemented in 2014.
Will Rogers once stated: "I do not belong to any organized political party, I am a Democrat." But, to a growing degree, that party is showing more solidarity in support of its positions. Why? Because moderates in both parties have been run out of office. Getting liberal Democrats to support a Republican repeal effort is highly improbable unless a compelling case can be made that what replaces it will meet with clear public support.
What should most concern my party's leaders about its proposals is that they are unlikely to ever generate much backing from the voters. People may not approve of the insurance mandate, but that does not mean that they want the Ryan alternative: Medicare turned into a voucher program, with the risk shifted from the federal government to senior citizens. Or, that states and their taxpayers are going to happily accept the Medicaid program being turned into a block grant whereby in the long-term they have to cut services or enrollment unless they raise state taxes.
On the policy wonk side, these efforts are laughable. No systemic changes are entailed. These proposals merely shift the burden from the federal government to the elderly and the states. They do little to constrain cost increases through changes in the delivery and financing of care, unless you count forcing poorer, sicker old people to refrain from getting needed care due to the expense being dumped in their laps.
http://www.pnhp.org/print/news/2012/july/the-health-care-repeal-and-replace-hoax
CHARLESTON, W.Va. -- "Repeal and replace!" That is a very catchy slogan indeed. Of course, any objective observer knows that it has very little chance of happening, but it still makes for a great sound bite.
Since 2007, the Democrats have had to override Republican Senatorial filibusters 360 times, far more than ever before. This concerns me for two reasons. First, using the filibuster thwarts democracy and may be unconstitutional. Second, excessively employing the filibuster sets a precedent for others to follow when they are in the minority.
Let's assume a very unlikely Republican sweep occurs in 2012. Romney wins, the House stays Republican and the Senate goes for the GOP with 51 or 52 Senators. Chances are still slim that repeal will take place due to the filibuster rule. Eight or nine Democrats would have to jump ship and vote with the Republicans, my party, to repeal the law before it really has a chance to be fully implemented in 2014.
Will Rogers once stated: "I do not belong to any organized political party, I am a Democrat." But, to a growing degree, that party is showing more solidarity in support of its positions. Why? Because moderates in both parties have been run out of office. Getting liberal Democrats to support a Republican repeal effort is highly improbable unless a compelling case can be made that what replaces it will meet with clear public support.
What should most concern my party's leaders about its proposals is that they are unlikely to ever generate much backing from the voters. People may not approve of the insurance mandate, but that does not mean that they want the Ryan alternative: Medicare turned into a voucher program, with the risk shifted from the federal government to senior citizens. Or, that states and their taxpayers are going to happily accept the Medicaid program being turned into a block grant whereby in the long-term they have to cut services or enrollment unless they raise state taxes.
On the policy wonk side, these efforts are laughable. No systemic changes are entailed. These proposals merely shift the burden from the federal government to the elderly and the states. They do little to constrain cost increases through changes in the delivery and financing of care, unless you count forcing poorer, sicker old people to refrain from getting needed care due to the expense being dumped in their laps.
http://www.pnhp.org/print/news/2012/july/the-health-care-repeal-and-replace-hoax
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