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Tuesday, January 29, 2013

Health Care Reform Articles - January 29, 2013

Single Payer — It Remains The Only Answer

A Crash Course in Playing the Numbers




The chances are that you turn to this part of the newspaper in search of some reliable tools for optimizing your health. The chances are that you periodically visit a doctor for the same reason.
Alas, what you seek cannot be found in either place, not if it’s certitude you’re after. Whether you are healthy, moribund or traversing the stages of decrepitude in between, every morsel of medical advice you receive is pure conjecture — educated guesswork perhaps, but guesswork nonetheless. Your health care provider and your favorite columnist are both mere croupiers, enablers for your health gambling habit.
Staying well is all about probability and risk. So is the interpretation of medical tests, and so are all treatments for all illnesses, dire and trivial alike. Health has nothing in common with the laws of physics and everything in common with lottery cards, mutual funds and tomorrow’s weather forecast.
Thus, no matter how many vitamin-based, colon-cleansing, fat-busting diet and exercise books show up in 2013, the most important health book of the year is likely to remain Charles Wheelan’s sparkling and intensely readable “Naked Statistics,” even though it’s not primarily about health.
A professor of public policy and economics at Dartmouth, Mr. Wheelan earned journalism credentials writing for The Economist and has previously drawn on both careers to produce “Naked Economics” (2002), an accessible guide for the lay reader. “Naked Statistics” is similar, a riff on basic statistics that is neither textbook nor essay but a happy amalgam of the two.
It is not the place to learn for the first time about medians and means, but definitely the place to remember what you were once supposed to know about these and other key concepts — and, more important, why you were supposed to know them.
And that means you. While a great measure of the book’s appeal comes from Mr. Wheelan’s fluent style — a natural comedian, he is truly the Dave Barry of the coin toss set — the rest comes from his multiple real world examples illustrating exactly why even the most reluctant mathophobe is well advised to achieve a personal understanding of the statistical underpinnings of life, whether that individual is watching football on the couch, picking a school for the children or jiggling anxiously in a hospital admitting office.
Are you a fan of those handy ranking systems based on performance data, guaranteed to steer you to the best surgeons in town? If so, you are up to your armpits in descriptive statistics, and Mr. Wheelan has some advice for you: beware. The easiest way for doctors to game those numbers is by avoiding the sickest patients.

Vermont gov wants more time on$1.6B health plan

By By Dave Gram on January 25, 2013
MONTPELIER, Vt. (AP) — After two years of pressure to say how it was going to pay for its single-payer health care plan, Gov. Peter Shumlin's administration on Thursday released a new accounting of what Vermont's universal health care system might cost, but left for later how it would be paid for.
Reports released by the governor's office say Vermonters would have to pay $1.6 billion in new taxes to pay for their share of a single-payer system that can't be implemented until 2017. But that would be more than offset by the fact that most individual and employers would no longer be buying private health insurance, a savings of $1.9 billion, the report said.
Exactly what kinds of taxes would provide that $1.6 billion will be decided in a public discussion process whose details are to be announced next month, administration officials said.
A state law passed in 2011 with strong legislative support called for Vermont to move well beyond the federal health overhaul of 2010 to something closer to what Canada has in place: a universal health insurance system in which the government ensures everyone has coverage. Shumlin's administration estimates the total cost of universal health care to be $3.5 billion, with much of that being covered by federal contributions.

Maine speakers testify against human services cutbacks

Nearly 100 people speak out against Gov. Paul LePage's proposed cuts to the state DHHS budget.

By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer
AUGUSTA — Rena Heath, a senior who lives on a fixed income, was the first of nearly 100 people to testify Monday against more than $14 million in proposed cuts to Maine's current health and human services budget.
Heath urged legislators to block a $985,000 reduction in Medicaid prescription drug funding for elderly and disabled Mainers, while other speakers opposed pending cuts to General Assistance, substance abuse services, mental health care and payments to providers.
"Cutting access to prescription drugs will unnecessarily endanger lives and will likely result in higher costs to Maine's already overburdened and costly health care system," said Heath, a volunteer AARP advocate who lives in Hallowell.
The proposed reduction to the Low Cost Drugs for the Elderly and Disabled Program is part of Gov. Paul LePage's effort to address a $90 million shortfall in the Department of Health and Human Services budget ending June 30.
The shortfall has been blamed largely on higher-than-planned costs for MaineCare, the state's Medicaid program, after federal economic stimulus money ran out two years ago. However, MaineCare general fund expenditures are projected to be about $30 million less than in the last fiscal year, said DHHS Commissioner Mary Mayhew.

Doctors say excessive workloads put hospital patients at risk

Posted Jan. 29, 2013, at 9:42 a.m.
NEW YORK — Almost half of hospital doctors said they routinely see more patients than they can safely manage, leading in some cases to unneeded tests, medication errors and deaths, according to a survey by researchers at Johns Hopkins University.
Seven percent of 506 hospital-based physicians surveyed said their heavy workload likely led to a patient complication, and 5 percent reported it probably caused a death over the past year. The findings are published in a research letter released Monday by JAMA Internal Medicine.
Doctors are increasingly taking on more patients to compensate for cuts in payments from health insurers, the researchers said. That workload is projected to increase as the 2010 health law expands insurance coverage to 30 million more Americans. The researchers, based at Johns Hopkins University in Baltimore, said there is a risk that rising patient volumes may increase costs by decreasing quality.
“Excessively increasing the workload may lead to suboptimal care and less direct patient care time, which may paradoxically increase, rather than decrease costs,” the study’s authors wrote.
Forty percent of doctors said they saw an unsafe number of patients at least once a month with 25 percent saying it prevented them from fully discussing treatment options or answering questions, according to the survey.
Researchers electronically surveyed doctors in November 2010 using a physician networking website. The average age of the physicians was 38 with an average salary of $180,000. Doctors said they could safely manage 15 people during a shift if they were able to devote 100 percent of their time to patient care.
Lawmakers have moved to prevent medical errors by putting restrictions on the number of hours doctors in training can work and set standards for nursing staffing levels. There are no similar limits on workloads for physicians who focus primarily on care of hospitalized patients.




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