Misdirected efforts aren’t making Americans any healthier
Posted Jan. 18, 2013, at 11:33 a.m.
We Americans seem to be obsessed with our health. You cannot watch TV, read a magazine or surf the Web without being inundated with articles and ads touting some new way get healthier. As one result, we spend about double what other countries do on health care for our people. But are many of those resources being misdirected?
A report released recently by the Institute of Medicine and the National Research Council suggests they are. Their report documents the fact that, despite our high health care spending, Americans persistently die younger and live in poorer health than residents of most other wealthy countries. The life expectancy of Americans is now near the bottom among all developed countries.
A report released last September — that I discussed in an earlier column — estimated that about 30 percent of what we as a nation spend on health care is spent on things that have little or no effect on curing illness or on improving our health — in other words, wasted. But even that which is spent effectively for medical care is directed mostly at fixing something that is already broken — a patient with a heart attack, for example — rather than preventing the illness in the first place. While we are able to cure infections, control hypertension or diabetes and treat or replace worn out joints, we are much less effective at preventing such illnesses.
It is becoming increasingly clear that many modern-day causes of disease, disability and mortality have their roots in what are known as “the social determinants of health.”
The IOM-NRC report pointed out that car accidents, gun violence and drug overdoses are major contributors to reduced life expectancy for Americans under age 50, as were high rates of heart attacks, lung disease and diabetes. Why, as a nation, are we so sick?
Some answers to that question can be found in a recent book, “ The Spirit Level,” by British epidemiologists Kate Pickett and Richard Wilkinson. In it, they suggest an even more basic cause of our dismal national performance: extreme inequality of income, where the U.S. tops the list of wealthy countries. We are suffering from excessive accumulation of wealth at the top, growing poverty at the bottom, and a hollowing-out of the middle class.
Based on data from 23 rich countries and all 50 U.S. states, they compare the prevalence of nine types of physical and social pathology with the level of income inequality among each state in the U.S. and in each country. The U.S. is ranked at or near the top for income inequality among wealthy countries.
Misdirected efforts aren’t making Americans any healthier
Posted Jan. 18, 2013, at 11:33 a.m.
We Americans seem to be obsessed with our health. You cannot watch TV, read a magazine or surf the Web without being inundated with articles and ads touting some new way get healthier. As one result, we spend about double what other countries do on health care for our people. But are many of those resources being misdirected?
A report released recently by the Institute of Medicine and the National Research Council suggests they are. Their report documents the fact that, despite our high health care spending, Americans persistently die younger and live in poorer health than residents of most other wealthy countries. The life expectancy of Americans is now near the bottom among all developed countries.
A report released last September — that I discussed in an earlier column — estimated that about 30 percent of what we as a nation spend on health care is spent on things that have little or no effect on curing illness or on improving our health — in other words, wasted. But even that which is spent effectively for medical care is directed mostly at fixing something that is already broken — a patient with a heart attack, for example — rather than preventing the illness in the first place. While we are able to cure infections, control hypertension or diabetes and treat or replace worn out joints, we are much less effective at preventing such illnesses.
It is becoming increasingly clear that many modern-day causes of disease, disability and mortality have their roots in what are known as “the social determinants of health.”
The IOM-NRC report pointed out that car accidents, gun violence and drug overdoses are major contributors to reduced life expectancy for Americans under age 50, as were high rates of heart attacks, lung disease and diabetes. Why, as a nation, are we so sick?
Some answers to that question can be found in a recent book, “ The Spirit Level,” by British epidemiologists Kate Pickett and Richard Wilkinson. In it, they suggest an even more basic cause of our dismal national performance: extreme inequality of income, where the U.S. tops the list of wealthy countries. We are suffering from excessive accumulation of wealth at the top, growing poverty at the bottom, and a hollowing-out of the middle class.
Based on data from 23 rich countries and all 50 U.S. states, they compare the prevalence of nine types of physical and social pathology with the level of income inequality among each state in the U.S. and in each country. The U.S. is ranked at or near the top for income inequality among wealthy countries.
Medical Bills Crush Brooklyn Man’s Hope of Retiring
By JOHN OTIS
Retirement was just about a year away, or so John Concepcion thought, when a sudden health crisis put his plans in doubt.
“I get paralyzed, I can’t breathe,” he said of the muscle spasms he now has regularly. “It feels like something’s going to bust out of me.”
Severe abdominal pain is not the only, or even the worst, reminder of the major surgery Mr. Concepcion, 62, of Sheepshead Bay, Brooklyn, underwent in June. He and his wife of 36 years, Maria, are now faced with medical bills that are so high, Ms. Concepcion said she felt faint when she saw them.
Mr. Concepcion, who is superintendent of the apartment building where he lives, began having back pain last January that doctors first believed was the result ofgallstones. In March, an endoscopy showed that tumors had grown throughout his digestive system. The tumors were not malignant, but an operation was required to remove them, and surgeons had to essentially reroute Mr. Concepcion’s entire digestive tract. They removed his gall bladder, as well as parts of his pancreas, bile ducts, intestines and stomach, he said.
The operation was a success, but then came the bills.
“I told my friend: are you aware that if you have a major operation, you’re going to lose your house?” Ms. Concepcion said.
Can Oregon save American health care?
By Sarah Kliff ,
PORTLAND, Ore. – In 2011, Oregon Gov. John Kitzhaber faced a vexing problem: The state had a $2 billion hole in its Medicaid budget and no good way to fill it.
He could cut doctors’ pay by 40 percent, but that might lead to them quitting Medicaid altogether. He could drop patients or benefits, but that would only compound costs in the long run. A former emergency room doctor, Kitzhaber remembers culling the Medicaid rolls in the 1980s, when he served as a state senator.
“When I went back home, and went back to the emergency department, I saw a couple of people who came in who lost coverage under that decision,” he said. “One of them was a guy who had had a massive stroke. These people don’t disappear.”
So Kitzhaber did something that many before him have done in desperate times. The governor who favors cowboy boots over dress shoes made a bet that Oregon could not afford to lose.
The deal Kitzhaber struck was this: The Obama administration would give the state $1.9 billion over five years, enough to patch the budget hole. The catch: To secure that, Oregon’s Medicaid program must grow at a rate that is 2 percent slower than the rest of the country, ultimately generating $11 billion savings over the next decade. If it fails, those federal dollars disappear.
Oregon is pursuing the Holy Grail in health-care policy: slower cost growth. If it succeeds, it could set a course for the rest of the country at a pivotal moment for the Affordable Care Act. Under the law, many states will expand Medicaid programs to cover everyone below 133 percent of the federal poverty line, adding 7 million Americans to the program in 2014 and leaving states looking for the most cost-effective way to cover that influx of patients.
In Oregon alone, Medicaid is expected to enroll 400,000 new patients by 2022, nearly doubling its current numbers, according to an Urban Institute analysis.
As Oregon’s population grows, the state has come to realize that Medicaid is not a bottomless bucket of money. The state’s budget cannot sustain that. Instead, it strives to deliver what health policy experts call “the triple aim”: higher-quality care that leads to better outcomes, all delivered at a lower cost.
“Oregon is trying to change the way that health care is delivered with incentives to deliver smarter, better care, instead of just imposing budget changes that cut back on health care,” said Cindy Mann, director of the Center for Medicaid and State Operations. “They’re doing this statewide and it’s very exciting for us.”
Under the new deal, Oregon does not get a lump-sum payment. Instead, the federal government doles out the $1.9 billion over five years. If the state cannot deliver cost savings up front, while hitting certain quality metrics, it’s cut off. The money it needs to keep doctor salaries stable and patients’ benefits covered dries up.
Doctor sees shift to single-payer care
By Mark Sommer
Buffalo News, Jan. 17, 2013
Single-payer health care remains the only way to meet public health needs, and demand for it will reignite as changes brought by the Affordable Care Act fail to make health care cheaper and continue to leave tens of millions uninsured, the head of a national physicians organization said Thursday.Buffalo News, Jan. 17, 2013
Dr. Andy Coates, president of Physicians for a National Health Program, which represents more than 18,000 members, spoke to The Buffalo News Editorial Board. He later spoke at a forum sponsored by Partnership for the Public Good.
Coates, who practices in a community hospital in Albany and teaches in the departments of medicine and psychiatry at the University at Albany, said he constantly sees rising premiums and deductibles force low-income patients to choose between critical health needs and basic survival.
“I had a man [recently] who bled half of his blood volume, and he insisted on discharge because he had a day-by-day hospital co-pay of over $200, had no savings and hadn’t been able to pay his bills because it hadn’t snowed enough to plow snow like he usually does. He just absolutely insisted on going home when our advice was that he should be in a hospital making sure he didn’t continue to bleed,” Coates said.
“This kind of thing is unbelievably common.”
He predicted changes under way in health care will fall far short.
No comments:
Post a Comment