Some unions protest Obamacare’s impact on Multiemployer Health Plans
The Affordable Care Act (ACA) of 2010, also known as Obamacare, presents challenges to the multiemployer plans through which some unions bargain collectively to provide health care insurance for their members. These plans, often called Taft Hartley Plans, currently cover about 26 million workers, families, and retirees. Unless there is a major regulatory change made by Health and Human Services, these union negotiated plans will be struck a harsh blow once the exchanges go into effect in 2014.
A quiet effort by many unions to persuade the Obama administration to make this change is now becoming very public.
In an Op Ed published in The Hill, Joseph T. Hansen, President of the United Food and Commercial Workers (UFCW), said,
“But as currently interpreted, the ACA would block these plans from the law’s benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law’s penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers. In other words, they will be forced to change their coverage and quite possibly their doctor. Others will be channeled into Medicaid, where taxpayers must pick up the tab.
21 graphs that show America’s health-care prices are ludicrous
By Ezra Klein,
Every year, the International Federation of Health Plans — a global insurance trade association that includes more than 100 insurers in 25 countries — releases survey data showing the prices that insurers are actually paying for different drugs, devices, and medical services in different countries. And every year, the data is shocking.
The IFHP just released the data for 2012. And yes, once again, the numbers are shocking.
This is the fundamental fact of American health care: We pay much, much more than other countries do for the exact same things. For a detailed explanation of why, see this article. But this post isn’t about the why. It’s about the prices, and the graphs.
One note: Prices in the United States are expressed as a range. There’s a reason for that. In other countries, prices are set centrally and most everyone, no matter their region or insurance arrangement, pays pretty close to the same amount. In the United States, each insurer negotiates its own prices, and different insurers end up paying wildly different amounts. That’s what Steven Brill’s explosive article was about, and it’s why you see U.S. prices expressed as a range rather than a single number.
After all these graphs, this final graph shouldn’t be a surprise.
Why an MRI costs $1,080 in America and $280 in France
By Ezra Klein,
Steve Brill’s massive Time article focused national attention on the price of health-care services in the United States. Sarah Kliff got further data showing an MRI can cost anywhere from $400 to $1,861 in Washington, DC alone. But as startling as the price difference between one hospital and another, or one insurer and another, can be in America, the difference between America and other countries is even more extraordinary. I wrote this piece in March 2012. But it’s worth revisiting now.
There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.
That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.
There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, “it’s the prices, stupid.”
As it’s difficult to get good data on prices, that paper blamed prices largely by eliminating the other possible culprits. They authors considered, for instance, the idea that Americans were simply using more health-care services, but on close inspection, found that Americans don’t see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, actually. We spend less time in the hospital than Germans and see the doctor less often than the Canadians.
“The United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do,” they concluded. “This suggests that the difference in spending is mostly attributable to higher prices of goods and services.”
Can Statins Cut the Benefits of Exercise?
By GRETCHEN REYNOLDS
An important new study suggests that statins, the cholesterol-lowering medications that are the most prescribed drugs in the world, may block some of the fitness benefits of exercise, one of the surest ways to improve health.
No one is saying that people with high cholesterol or a family history of heart disease should avoid statins, which studies show can be lifesaving. But the discovery could create something of dilemma for doctors and patients, since the people who should benefit the most from exercise — those who are sedentary, overweight, at risk of heart disease or middle-aged — are also the people most likely to be put on statins, possibly undoing some of the good of their workouts.
For the new study, which was published online in The Journal of the American College of Cardiology, researchers from the University of Missouri and other institutions gathered a group of overweight, sedentary men and women, all of whom had multiple symptoms of metabolic problems, including wide waistlines, high blood pressure or excess abdominal fat.
Most had slightly but not dangerously elevated cholesterol levels.
None had exercised regularly in the past year.
All underwent muscle biopsies and treadmill testing to determine their aerobic fitness — which was generally quite low — and agreed to continue with their normal diet.
Then they all began a supervised 12-week exercise program, during which they visited the university lab five times a week and walked or jogged on a treadmill for 45 minutes at a moderately vigorous pace (about 65 to 70 percent of their individual aerobic maximum).
Half of the group also began taking a daily 40-milligram dose of simvastatin, a particular type of statin sold under the brand name Zocor.
At the end of 12 weeks, the participants fitness and muscles were retested.
Statins, as most of us know, are medications designed to reduce the body’s cholesterol levels, particularly levels of low-density lipoprotein, or “bad” cholesterol. The drugs routinely are prescribed for those with high cholesterol and other risk factors for heart disease, and some physicians believe that they should be used prophylactically by virtually everyone over 50.
UC hospitals cancel surgeries, divert patients amid strike
The walkout by patient care workers shuts down some services at medical centers in L.A., Irvine, San Diego, San Francisco and Sacramento.
By Anna Gorman and Maria L. La Ganga, Los Angeles Times5:50 PM PDT, May 21, 2013
A strike by University of California patient care workers Tuesday caused the cancellation of hundreds of surgeries, the closure of laboratory stations and the diversion of emergency room patients, officials said.
The hospitals prepared for the two-day strike by postponing elective surgeries and hiring temporary workers, but services still were affected after thousands of employees took to the picket line at the medical centers in Los Angeles, Irvine, San Diego, San Francisco and Sacramento, where the UC Davis facility is located.
American Federation of State, County and Municipal Employees union leaders said they staged the strike because of concerns over staffing levels, pension changes and patient safety. UC officials defended their safety record and said they have offered a fair contract to union members. The two sides have been negotiating for nearly a year.
At Ronald Reagan UCLA Medical Center, hundreds of workers wore matching green shirts and carried noisemakers and whistles. As they walked in a circle outside the hospital, they chanted, "All day, all night, safe staffing is our right!"
Cecilia Calvillo, who works as a mammogram technician, said she participated in the strike to demand better staffing. Calvillo said she has to rush from one patient to another and frequently can't give them the time and attention they deserve.
"When you don't have what you need staffing-wise, these patients don't get what they need," she said.
Certified nursing assistant Sara Tyhurst said that she has seen her responsibilities and patient load multiply in her 15 years at the medical center — while her income largely has stayed the same. Tyhurst said she takes care of 13 patients at a time and does the equivalent of three different jobs.
"It's unfair that we give [the hospital] all we've got," she said. "They don't give us anything in return."
Despite calls for all union members to strike, many came to work anyway, said Tom Rosenthal, UCLA Medical Center's chief medical officer. "Many people chose to put their patients first."
Rosenthal hired about 400 replacement workers and redeployed about 150 workers to other areas of the hospital. Those on strike included respiratory therapists, pharmacy technicians and nursing assistants. The trauma center and emergency room were running as usual, but there were some minor delays around the hospital, Rosenthal said.
Ester Rivera drove from Bakersfield to UCLA so her 85-year-old mother could have a pelvic ultrasound, but the she wasn't able to have the scan. She did have a few other scheduled tests, which took nearly five hours to complete. "It's sort of frustrating," she said. "Now we have to come back."
Hospital payback, Medicaid expansion hinge on LePage
The House and Senate approve a bill that would pay state hospitals back $186 million, and give basic health coverage to 60,000 Mainers using federal dollars.
By Steve Mistler smistler@pressherald.com
Staff Writer
Staff Writer
AUGUSTA – With a veto from Gov. Paul LePage looming, Democrats in the Legislature continued their high-stakes bid Tuesday to link the governor's hospital payback plan with the expansion of Medicaid.
Democrats in the Senate and House advanced L.D. 1546 despite attempts by Republicans to delay or change the bill, which would extend health care coverage to about 60,000 Mainers while paying the state's $186 million share of debt to its 39 hospitals.
The Senate voted 20-15 to approve the bill. Independent Sen. Richard Woodbury of Yarmouth voted with the Democrats. The House debate went well into the evening before members voted 87-57 in favor of the bill, largely along party lines.
In his first speech of the legislative session, House Speaker Mark Eves, D-North Berwick, urged Republicans to join Democrats to support a bill that settles both issues at once.
"The members of this body have a choice," he said. "Will you support a plan that pays the hospitals and accepts federal health care dollars to cover more Mainers? Or will you chose to deny and delay health care for tens of thousands of Maine people, putting politics ahead of the people's health and our hospitals?"
Republicans were united in their opposition. Some suggested that the push by the Democratic majority could have implications for other legislative work.
"The die has been cast," said House Minority Leader Kenneth Fredette, R-Newport.
Consumers who saw TV drug ads more likely to be prescribed medication
Posted May 22, 2013, at 9:26 a.m.
I learned last week about two prescription drugs I’d never heard of before — not from my doctor, but from TV commercials.
Axiron is applied like deodorant — under your arm. Well, under the arm of a man who has low testosterone and has been prescribed the product by a doctor. “It’s a new day,” the ad says.
Prolia is an injection medication for post-menopausal osteoporosis, plugged by actress Blythe Danner, 70, who says the stage phrase “Break a leg” has new meaning for her. The ad advises: “Ask your doctor if Prolia is right for you.”
That sounds like good advice, since everyone knows that TV ads are designed to entice us to use a product. But new research shows that ads also have influence in the doctor’s office — and to a degree that may subject patients to more harm in the form of side effects than good.
A 2013 study of 100,000 adults surveyed between 2001 and 2007 found that men and women who had more exposure to direct-to-consumer advertising for statin drugs were 16 to 22 percent more likely to receive a diagnosis of high cholesterol — and were also more likely to be prescribed statins.
The people who saw the most ads for statins may have asked for the drug by name or scheduled a doctor’s visit to talk about symptoms mentioned in commercials. Doctors may also be influenced by the ads, says the study’s lead author, Jeffrey Niederdeppe, an assistant professor of communication at Cornell University who specializes in the effects of mass media campaigns and health news coverage on health behavior and social policy.
The rates of diagnoses and prescriptions were highest among those who had the fewest risk factors for cardiac events: They did not have coronary heart disease or diabetes and had never experienced a heart attack.
So, do statin ads promote over-diagnosis and over-treatment, especially as research on the usefulness of statins in low-risk populations is still a subject of debate?
“The first step in addressing high cholesterol is always diet and exercise,” Niederdeppe says. “So this increase in prescription rates — are these appropriate? Or are they at the expense of diet and exercise, which have no side effects?”
The findings add to a large body of research characterizing how ads influence interactions between doctors and patients, including studies that use actors to role-play patient behavior. Not only do patients walk in requesting a particular brand name medication, doctors feel pressure to accommodate these requests.
“I’ll be candid — and I’m a practicing internist — it’s something of a hassle for a busy clinician to have to invest half the visit or more going over this with a patient,” says Molly Cooke, president of the American College of Physicians, which is opposed to direct-to-consumer advertising.
“In markets with heavy advertising, more medicine is sold; that’s been shown before,” says Joseph Ross, a physician at Yale University. “The new paper showed that marketing affected prescriptions in people who were at very low risk, where there’s not much benefit and it exposes them to risks.”
The risks are related to side effects, sometimes common and annoying, other times rare and serious. All drugs have the potential for side effects.
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