The United States needs to see the doctor
By Harold Meyerson,
January has turned out to be a banner month for fans of American exceptionalism. As documented in voluminous detail in a 404-page report released last week by the National Research Council and the Institute of Medicine, Americans lead shorter lives than Western Europeans, Australians, Japanese and Canadians. Of the 17 countries measured, the United States placed dead last in life expectancy, even though we lead the planet in the amount we spend on health care (17.6 percent of gross domestic product in 2010 vs. 11.6 percent each for France and Germany). We get radically less bang for the buck than comparable nations. If that’s not exceptionalism, I don’t know what is.Americans die young. The death rate for Americans younger than 50, the report showed, is almost off the comparative charts. A range of exceptionally American factors — car usage and lack of exercise, junk-food diets, violent deaths from guns, high numbers of uninsured and a concomitant lack of treatment, the high rate of poverty — all contribute to this grim distinction. Of the 17 nations studied, the United States ranks first in violent deaths, at roughly three times the level of second-ranking Finland and 15 times that of Japan, which ranked last. This list includes violent deaths by all means, not just gunshots, so it’s a pretty fair measure of either different people’s inherent propensity toward violence or the access people have to deadly weapons when they get violent. (To look at this list and conclude that guns have nothing to do with the rate of violent deaths, you have to believe that Americans are just much more murderous than anybody else.)
The study enumerates other key, if unsurprising, factors in our shortness of life. “Americans are more likely to find their health care inaccessible or unaffordable,” it concludes. “Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.”
But a funny thing happens to Americans’ life expectancy when they age. The U.S. mortality rate is the highest of the 17 nations until Americans hit 50 and the second-highest until they hit 70. Then our mortality ranking precipitously shifts: By the time American seniors hit 80, they have some of the longest life expectancies in the world.
What gives? Have seniors discovered the Fountain of Youth? Do U.S. geriatricians outpace all our other physicians?
http://www.washingtonpost.com/opinions/harold-meyerson-us-health-care-leaves-much-to-be-desired/2013/01/15/6b154846-5f5d-11e2-b05a-605528f6b712_print.html
In health, we’re not No. 1
By Robert J. Samuelson,
It turns out that being American is bad for your health, relatively speaking.
Anyone interested in health care ought to digest the findings of a massive new report from the National Research Council and the Institute of Medicine, which compared Americans’ health with that of people in other advanced countries. After spending 18 months examining statistics and studies, the panel reached a damning conclusion: The United States ranks below most advanced countries.
Consider. Life expectancy at birth is 78.2 years in the United States, lower than the 79.5-year average for the wealthy countries belonging to the Organization for Economic Cooperation and Development (OECD); Japan’s life expectancy is 83. Among 17 advanced countries, the United States has the highest level of diabetes. For 21 diseases, U.S. death rates were higher in 15 (including heart and lung diseases) than the average for these same countries.
Here, in somewhat clunky language, is the report’s sobering summary:
“The U.S. health disadvantage is more pronounced among socioeconomically disadvantaged groups, but even advantaged Americans [described as ‘white, insured, college-educated’] appear to fare worse than their counterparts in England and some other countries.”
What to make of this?
The report’s most important contribution is to show that much of the U.S. “health disadvantage” doesn’t reflect an inadequate health-care system but lifestyle choices, personal behaviors and social pathologies. The gap in life expectancy is concentrated in Americans under 50. Among men, nearly 60 percent of the gap results from more homicides (often gun-related), car accidents (often alcohol-related) and other accidents (often drug-related) than in comparable nations. For children under 5, car accidents, drowning and fire are the largest causes of death.
Teen pregnancy is another big problem. Among girls 15 to 19, the pregnancy rate is about 3.5 times the average of other advanced societies. “Adolescent motherhood affects two generations, children and mothers,” the report notes. Adolescent mothers often don’t finish high school. “Their children face a greater risk of poor child care, weak maternal attachments [and] poverty.” Similarly, the incidence of AIDS in America is nearly nine times the OECD average.
The health-care system can’t cure these ills, which are social problems with health consequences. Those who expect the introduction of the main elements of the Affordable Care Act (”Obamacare”) in 2014 to improve Americans’ health dramatically are likely to be disappointed. The lack of insurance is a problem, but it is not the main health problem, in part because the uninsured already receive much uncompensated care.
First the cat, now the health system puts the bite on me
A $55,000 hospital bill includes $16 for a generic Tylenol pill. Obamacare may end the systematic inflation of prices.
David LazarusJanuary 15, 2013
Call it the $55,000 cat bite.
That's the rough total in medical costs (so far) for a cat bite on my hand that turned into an infection that turned into surgery that turned into a week in the hospital. Cruddy cat.
When I first wrote about the episode in November, I observed that it opened my eyes about various aspects of the healthcare system, not the least of which was the extraordinary care provided by nurses and the state-of-the-art resources available to doctors.
I still have my left hand, thanks to them.
But the bill has finally arrived, and I'm a good deal less impressed with the money side of our medical system. Put simply, it's nuts.
Quiz: Test your healthcare knowledge
Case in point: My cozy hospital room at UCLA Medical Center in Santa Monica was priced at $4,000 a night. Four thousand. You can book a 1,400-square-foot Premier Suite at the Beverly Hills Hotel for less than that.
Another case in point: Sixteen bucks for a Tylenol. Actually, not even a proper Tylenol. That's for the generic equivalent.
"It's totally crazy," admitted Dr. David Feinberg, who isn't just some innocent bystander when it comes to UCLA's medical pricing. He's the president of UCLA Health System. He runs the place.
"Our billing system is terrible," Feinberg told me. "I get some explanations of benefits from my insurer, and I don't understand what they are."
To be fair, it's not just UCLA that's guilty of loony pricing. It's almost all hospitals and clinics.
This is the flip side to our exceptional levels of treatment — the insane and systematic inflation of prices to accommodate contracts with insurers and so-called cost shifting that leaves people lucky enough to have insurance holding the bag for those who don't.
Happily, that system may be coming to an end thanks to Obamacare. More on that in a moment.
First, let's take a closer look at some of the charges I racked up during my hospital stay. At four grand a night, that's $24,000 right there.
The surgery on my hand: $12,282. Anesthesia: $780. MRI: $3,290. Assorted drugs: $3,412. Laboratory services: $4,534. Inserting a tube in my arm so I could have an intravenous drip at home: $2,352.
All in all, the various services and supplies I received were priced at $52,660.53. The assorted doctor visits and physical-therapy appointments that have accompanied this mess added a few thousand more to the equation.
My employer-provided insurer, Blue Cross Blue Shield of Illinois, will cover $38,448 of the hospital bill. My total amount due: $1,504.47.
That leaves $14,212.53 unaccounted for. Feinberg said it simply has disappeared. Poof!
"It's funny money," he explained. "It's not even there."
Now, I just want to point out that we spend nearly $3 trillion a year on healthcare in this country, which represents about 17% of the overall economy, which is more than any other country in the world. And we're talking about funny money?
http://www.latimes.com/business/la-fi-lazarus-20130115,0,3881624,print.column
LePage wants to pay off hospital debt
He says if the Legislature approves his plan, then he will issue the $105 million in voter-approved bonds.
PORTLAND — Gov. Paul LePage announced a plan Tuesday to pay off $186 million inMedicaid debt to Maine's 39 hospitals by issuing a revenue bond secured by future liquor sales.
Paying off the debt would help to protect the state's credit rating and draw $298 million in federal Medicaid reimbursements to Maine's medical centers, LePage said.
If the Legislature approves his hospital payment plan, he said, he will issue $105 million in voter-authorized general obligation bonds that he has so far refused to release.
That includes $51.5 million for transportation infrastructure improvements and $53.5 million for land conservation, clean-water improvements and higher-education construction projects.
"We pay the hospitals," LePage said, "then I'll issue the (other) bonds."
LePage spoke at a rare news conference, held at the construction site of the University of New England's dental college. He said his plan would inject $700 million into Maine's economy in 2013, helping to preserve and create jobs, especially in construction and health care.
That infusion would include $100 million in government facilities bonds that LePage wants to issue to replace the Maine Correctional Center in Windham.
Steven Michaud, president of the Maine Hospital Association, was one of several hospital officials who praised LePage's effort to make sure the state pays its overdue bill for Medicaid services.
Michaud said that paying hospitals what they're owed would help create jobs, promote investment in medical infrastructure and increase access to health care.
Many hospitals have been cutting positions and borrowing against lines of credit "just to meet payroll" and pay other bills, he said.
LePage's hospital payment plan calls for the state to regain control over liquor sales in a new contract to be negotiated this year. The state's contract with the firm that now manages liquor sales and distribution runs out in mid-2014.
LePage says he will issue voter-approved bonds if Legislature backs hospital plan
Posted Jan. 15, 2013, at 5:25 p.m.
AUGUSTA, Maine — Gov. Paul LePage announced on Tuesday that he will release $105 million in bonds previously authorized by voters if the Legislature agrees to a $100 million revenue bond for a new prison and his newly announced plan to repay Maine hospitals hundreds of millions of dollars toward previous years’ debt.
The announcement represents a step away from LePage’s long-held refusal to issue the voter-approved bonds because he said the state’s financial position was not robust enough for borrowing. The governor often has cited the debt to hospitals as a prime example of bills that need to be paid by the state before more debt is accrued.
The state’s hospitals are owed $484 million from the state’s MaineCare program, which is an extension of the federal Medicaid program. Of that sum, the state is responsible for $186 million; the rest would flow to Maine hospitals from federal matching funds.
LePage proposed Tuesday that the $186 million come from revenue bonds that the state would issue against future earnings from liquor sales. As part of the plan, the governor also is proposing that the state reacquire liquor operations that were privatized in 2004. That means that if the plan is approved by the Legislature, the Maine Bureau of Alcoholic Beverages & Lottery Operations would assume oversight of liquor distribution but would continue to subcontract distribution and delivery.
“By paying the state’s bills, we strengthen our economy and the hospitals that care for and employ Maine people,” said LePage in a Tuesday afternoon news release.
As recently as Friday, when members of LePage’s Cabinet released details of the administration’s biennial budget proposal for the two fiscal years beginning in July of this year, LePage said he intended to approve the voter-authorized bonds during the next couple of years. Tuesday’s announcement that he will issue those bonds this year, contingent on the Legislature agreeing to his plans for the hospital debt and new $100 million correctional facility, represents a major change in the governor’s position.
Pingree helps unravel ‘red tape’ for Portland health center, secures crucial funding
Posted Jan. 15, 2013, at 5:36 p.m.
PORTLAND, Maine — For the second time in two weeks, Portland public health care providers are receiving news that funding is on its way in time to keep clinic doors open.
U.S. Rep. Chellie Pingree, D-Maine, announced Tuesday that the Portland Community Health Center will receive slightly more than $680,000 in federal funding to maintain and expand services at the Park Avenue institution.
The Tuesday announcement comes after Pingree helped the center transition from being a municipal operation to an independent nonprofit at the beginning of 2013. The changeover involved what the congresswoman’s office described Tuesday as “red tape that had threatened the short-term funding necessary to keep the health center operating.”
According to Pingree’s office, a division of the U.S. Department of Health and Human Services input the center’s grant information to its computer system incorrectly, threatening to delay the funding by weeks. But the congresswoman and her representatives pushed the department to expedite the funding after the correction was made in the system, center officials said.
“We really appreciate Congresswoman Pingree going to bat for us at a critical moment,” Leslie Brancato, chief executive officer of the center, said in a prepared statement. “The funding we needed to pay our staff last week had gotten held up because of a bureaucratic snafu and only after she got involved were we able to get it sorted out.”
The Portland Community Health Center provides medical and mental health care “for those in need without regard to their ability to pay,” according to Pingree’s office. Last week, the City of Portland announced that another of the city’s health care venues for low income residents, the Community Free Clinic on India Street, was saved from the brink of closure thanks to $93,000 in private donations during the past month.
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