The Cancer of Optimism
By HAIDER JAVED WARRAICH
BOSTON
I MET her in 2011, during my first few weeks as an intern in internal medicine. She was not the kind of patient who had appeared in my textbooks. She had been admitted from rehab after expressing an intent to take her own life, and I soon learned that her body was as troubled as her mind.
She had heart failure from a condition called hypertrophic obstructive cardiomyopathy, in which an overgrown muscular wall keeps blood from properly flowing out of the heart. She might have been born with it, or acquired it from years of neglected high blood pressure. Her blood pooled in her swelling legs and seeped into her lungs, causing her to wheeze constantly. She was in her late 50s, but seemed much older.
While learning her medical history, I also got to know her. A former artist, derailed by addiction, she had become alienated from her career and her family. She had let the problems in her heart fester and had never received consistent treatment.
At this point, she wasn’t a suitable candidate for heart surgery. But I felt there was still hope. A procedure called alcohol septal ablation could potentially reduce her symptoms. It involved injecting alcohol into a blood vessel to strangle the blood supply to the muscular part of the heart obstructing blood flow. The patient was desperate to have the procedure performed; she hoped to experience a life outside of hospitals, to reconnect with her family, to start painting again. With my sense of righteous optimism intact from my medical school days, I convinced the other doctors that, in spite of the risks, we should try it.
The procedure was uneventful, but when I was updated on the patient’s condition the next morning, I was stunned. Overnight, she had gone into complete heart block: a failure of the electrical transmissions that cause the heart to beat, a rare but known complication of the procedure. She temporarily lost her pulse, underwent CPR and electrical defibrillation. A pacemaker had to be inserted. She was transferred to the intensive care unit.
Funding a national single-Payer system
“Medicare for all” would save billions, and could be redistributive.
BY GERALD FRIEDMAN
“The Expanded & improved Medicare for all act” (hr 676) would establish a single authority responsible for paying for health care for all americans. providing universal coverage with a “single-payer” system would change many
aspects of american health care. While it would raise some costs by providing access to care for those currently uninsured or under-insured, it would save much larger sums by eliminating insurance middlemen and radically simplifying payment to doctors and hospitals. While providing superior health care, a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits. a single-payer system would also make health-care financing dramatically more progressive by replacing fixed, income-invariant health-care expenditures with progressive taxes. This series of charts and graphs shows why we need a single-payer system and how it could be funded. D&S
G E R A L D F R I E D M A N is a professor of economics at the University of Massachusetts-Amherst.
http://www.pnhp.org/sites/default/files/docs/2012/Dollars%20and%20Sense.pdf
Many part-timers are facing a double whammy from President Obama's Affordable Care Act.
The law requires large employers offering health insurance to include part-time employees working 30 hours a week or more. But rather than provide healthcare to more workers, a growing number of employers are cutting back employee hours instead.
The result: Not only will these workers earn less money, but they'll also miss out on health insurance at work.
LIVE CHAT: Join us at 3 p.m. Pacific with your questions and comments
Consider the city of Long Beach. It is limiting most of its 1,600 part-time employees to fewer than 27 hours a week, on average. City officials say that without cutting payroll hours, new health benefits would cost up to $2 million more next year, and that extra expense would trigger layoffs and cutbacks in city services.
Part-timer Tara Sievers, 43, understands why, but she still thinks it's wrong.
"I understand there are costs to healthcare reform, but it is surely not the intent of the law for employees to lose hours," said the outreach coordinator at the El Dorado Nature Center in Long Beach. "It's ridiculous the city is skirting the law."
Across the nation, hundreds of thousands of other hourly workers may also see smaller paychecks in the coming year because of this response to the federal healthcare law. The law exempts businesses with fewer than 50 full-time workers from this requirement to provide benefits.
But big restaurant chains, retailers and movie theaters are starting to trim employee hours. Even colleges are reducing courses for part-time professors to keep their hours down and avoid paying for their health premiums.
Overall, an estimated 2.3 million workers nationwide, including 240,000 in California, are at risk of losing hours as employers adjust to the new math of workplace benefits, according to research by UC Berkeley. All this comes at a time when part-timers are being hired in greater numbers as U.S. employers look to keep payrolls lean.
One consolation for part-timers is that many of them stand to benefit the most from the healthcare law's federal premium subsidies or an expansion of Medicaid, both starting in January.
The law will require most Americans to buy health insurance or pay a penalty. Yet many lower-income people will qualify for government insurance or be eligible for discounted premiums on private policies.
http://www.latimes.com/business/la-fi-part-time-healthcare-20130502,0,3005638,print.story
“Medicare for all” would save billions, and could be redistributive.
BY GERALD FRIEDMAN
“The Expanded & improved Medicare for all act” (hr 676) would establish a single authority responsible for paying for health care for all americans. providing universal coverage with a “single-payer” system would change many
aspects of american health care. While it would raise some costs by providing access to care for those currently uninsured or under-insured, it would save much larger sums by eliminating insurance middlemen and radically simplifying payment to doctors and hospitals. While providing superior health care, a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits. a single-payer system would also make health-care financing dramatically more progressive by replacing fixed, income-invariant health-care expenditures with progressive taxes. This series of charts and graphs shows why we need a single-payer system and how it could be funded. D&S
G E R A L D F R I E D M A N is a professor of economics at the University of Massachusetts-Amherst.
http://www.pnhp.org/sites/default/files/docs/2012/Dollars%20and%20Sense.pdf
Part-timers to lose pay amid health act's new math
Some workers are having their hours cut so employers won't have to cover them under Obamacare. But many will benefit from the healthcare law's premium subsidies and Medicaid expansion.
By Chad Terhune
Los Angeles Times
5:00 AM PDT, May 2, 2013
The law requires large employers offering health insurance to include part-time employees working 30 hours a week or more. But rather than provide healthcare to more workers, a growing number of employers are cutting back employee hours instead.
The result: Not only will these workers earn less money, but they'll also miss out on health insurance at work.
LIVE CHAT: Join us at 3 p.m. Pacific with your questions and comments
Consider the city of Long Beach. It is limiting most of its 1,600 part-time employees to fewer than 27 hours a week, on average. City officials say that without cutting payroll hours, new health benefits would cost up to $2 million more next year, and that extra expense would trigger layoffs and cutbacks in city services.
Part-timer Tara Sievers, 43, understands why, but she still thinks it's wrong.
"I understand there are costs to healthcare reform, but it is surely not the intent of the law for employees to lose hours," said the outreach coordinator at the El Dorado Nature Center in Long Beach. "It's ridiculous the city is skirting the law."
Across the nation, hundreds of thousands of other hourly workers may also see smaller paychecks in the coming year because of this response to the federal healthcare law. The law exempts businesses with fewer than 50 full-time workers from this requirement to provide benefits.
But big restaurant chains, retailers and movie theaters are starting to trim employee hours. Even colleges are reducing courses for part-time professors to keep their hours down and avoid paying for their health premiums.
Overall, an estimated 2.3 million workers nationwide, including 240,000 in California, are at risk of losing hours as employers adjust to the new math of workplace benefits, according to research by UC Berkeley. All this comes at a time when part-timers are being hired in greater numbers as U.S. employers look to keep payrolls lean.
One consolation for part-timers is that many of them stand to benefit the most from the healthcare law's federal premium subsidies or an expansion of Medicaid, both starting in January.
The law will require most Americans to buy health insurance or pay a penalty. Yet many lower-income people will qualify for government insurance or be eligible for discounted premiums on private policies.
http://www.latimes.com/business/la-fi-part-time-healthcare-20130502,0,3005638,print.story
Many opt for high-deductible health plans despite risks
Plans offering low monthly premiums but requiring high upfront payments when care is needed can be a poor choice for those without a lot of cash on hand.
Alice Marie Francis believes it's important to have health insurance, but finding a plan that fit her budget was no easy task. "Money is tight," says the 50-year-old Burbank mother of two, whose children are insured by their father's work-based policy.
To make sure she had coverage that didn't break the bank, she opted for a high-deductible health plan — an increasingly popular option with lower monthly premiums but high upfront costs before most insurance payments kick in.
High-deductible plans are typically recommended for younger policyholders who are in good health and have less need for doctor visits and prescription drugs, and for people with incomes high enough to cover the cost of routine medical care.
But patients like Francis opt for it anyway, despite the risks. She pays just $123 a month, but if she gets sick she'll have to shell out $3,300 to meet her deductible before insurance helps her pay the bills.
As a result, Francis says she does whatever she can to avoid the doctor. "I ensure that I take very good care of myself," she says.
For people like Francis who don't have a lot of cash on hand, these policies can be a poor choice. Often, they hesitate to seek care when they become ill or injured.
Be careful if you move to a higher-deductible plan from one with a lower deductible, says Linda Blumberg, an economist and senior fellow at the Urban Institute, a Washington think tank.
"You've got to be putting away money as you go along so if something bad happens you're prepared and you're not in a situation where you can't access the care you need."
New Worries for Democrats on Health Law
By JACKIE CALMES
WASHINGTON — As the administration struggles to put in place the final, complex piece of President Obama’s signature health care law, an endeavor on a scale not seen since Medicare’s creation nearly a half-century ago, Democrats are worried that major snags will be exploited by Republicans in next year’s midterm elections.
Many Democrats also want to see a more aggressive and visible president to push the law across the country. This week Mr. Obama is returning to the fray to an extent unseen since he signed the law in 2010, including a White House event on Friday to promote the law’s benefits for women, the first in a series of appearances for health care this year.
A number of health insurance changes have already taken place, but this fall, just as the 2014 election season heats up, is the deadline for introducing the law’s core feature: the insurance marketplaces, known as exchanges, where millions of uninsured Americans can buy coverage, with subsidies for many.
For the third time, Republicans are trying to make the law perhaps the biggest issue of the elections, and are preparing to exploit every problem that arises. After many unsuccessful efforts to repeal the law, the Republican-led House plans another vote soon. And Republican governors or legislatures in many states are balking at participating, leaving Washington responsible for the marketplaces.
“There are very few issues that are as personal and as tangible as health care, and the implementation of the law over the next year is going to reveal a lot of kinks, a lot of red tape, a lot of taxes, a lot of price increases and a lot of people forced into health care that they didn’t anticipate,” said Brad Dayspring, spokesman for the National Republican Senatorial Committee. “It’s going to be an issue that’s front and center for voters even in a more tangible way than it was in 2010.”
That year a conservative backlash against the new law helped Republicans take control of the House. But last year Mr. Obama was re-elected, and Democrats gained seats in Congress.
Democrats are worried about 2014 — a president’s party typically loses seats in midterm years — and some have gone public with concerns about the pace of carrying out the law. Senator Harry Reid of Nevada, the majority leader, told an interviewer last week that he agreed with a recent comment by Senator Max Baucus of Montana, a Democratic architect of the law, who said “a train wreck” could occur this fall if preparations fell short.
The White House has allayed some worries, with briefings for Democrats about their public education plans, including PowerPoint presentations that show areas with target populations down to the block level.
Slowdown in Health Costs’ Rise May Last as Economy Revives
By ANNIE LOWREY
WASHINGTON — One of the economic mysteries of the last few years has been the bigger-than-expected slowdown in health spending, a trend that promises to bolster wages and help close the wide federal deficit over the long term — but only if it persists.
Major new studies from researchers at Harvard University, the Henry J. Kaiser Family Foundation and elsewhere have concurred that at least some of the slowdown is unrelated to the recession, and might persist as the economy recovers. David M. Cutler, the Harvard health economist and former Obama adviser, estimates that, given the dynamics of the slowdown, economists might be overestimating public health spending over the next decade by as much as $770 billion.
Between 2009 and 2011, total health spending grew at the lowest annual pace in the last five decades, at just 3.9 percent a year, although rising out-of-pocket costs have hit millions of families. In contrast, between 2000 and 2007, those annual growth figures ranged between 6.2 and 9.7 percent, according to government figures. Data from the Altarum Institute, a nonprofit research organization in Ann Arbor, Mich., suggests that the low pace of growth has continued through 2012 and early 2013.
The studies — including some released Monday in the journal Health Affairs — shed new light on the precise mix of factors that have led to the flattening-out.
Economists concur that the deep recession and sluggish recovery are the main reasons for slowing growth in spending. During the recession, millions of Americans lost their jobs, and thus their insurance coverage; millions more struggling families were reluctant to see a physician or undergo a procedure. But the slowdown in health costs proved steeper than forecast. It also occurred in populations whose health spending was mostly sheltered from the economic gyrations, like Medicare patients.
That led economists to surmise that other factors were at play. In new research, the Kaiser Family Foundation estimated that the recession accounted for about three-quarters of the lower spending trajectory, with the rest attributed to other factors not directly related to the economy. Professor Cutler of Harvard calculates that the recession accounted for about 37 percent.
Among other factors, the studies found that rising out-of-pocket payments had played a major role in the decline. The proportion of workers with employer-sponsored health insurance enrolled in a plan that required a deductible climbed to about three-quarters in 2012 from about half in 2006, the Kaiser Family Foundation has found. Moreover, those deductibles — the amount a person needs to pay before insurance steps in to cover claims — have risen sharply. That exposes workers to a larger share of their own health costs, and generally forces them to spend less.
What Health Insurance Doesn’t Do
By ROSS DOUTHAT
IN one of the most famous studies of health insurance, conducted across the 1970s, thousands of participants were divided into five groups, with each receiving a different amount of insurance coverage. The study, run by the RAND Corporation, tracked the medical care each group sought out, and not surprisingly found that people with more comprehensive coverage tended to make use of it, visiting the doctor and checking into the hospital more often than people with less generous insurance.
But the study also tracked the health outcomes of each group, and there the results were more surprising: With a few modest exceptions, the level of insurance had no significant effect on the participants’ actual wellness.
Needless to say, experts have been arguing about what the RAND results mean ever since. But the basic finding — that more expensive health insurance doesn’t necessarily lead to better health — just received a major boost. The state of Oregon expanded its Medicaid program via lottery a few years ago, and researchers released the latest data on how health outcomes for the new Medicaid users differed from those for the uninsured. The answer: They didn’t differ much. Being on Medicaid helped people avoid huge medical bills, and it reduced depression rates. But the program’s insurance guarantee seemed to have little or no impact on common medical conditions like hypertension and diabetes.
As liberals have been extremely quick to point out, these findings do not necessarily make a case against the new health care law, which includes a big Medicaid expansion as well as subsidies for private insurance. After all, the first purpose of insurance is economic protection, and the Oregon data shows that expanding coverage does indeed protect people from ruinous medical expenses. The links between insurance, medicine and health may be impressively mysterious, but staving off medical bankruptcies among low-income Americans is not a small policy achievement.
This is true. But it’s also true that the health care law was sold, in part, with the promise (made by judicious wonks as well as overreaching politicians) that it would save tens of thousands of American lives each year. There was so much moral fervor on the issue, so much crusading liberal zeal, precisely because this was not supposed to be just a big redistribution program: it was supposed to be a matter of life and death.
But if it turns out that health insurance is useful mostly because it averts financial catastrophe — which seems to be the consensus liberal position since the Oregon data came out — then the new health care law looks vulnerable to two interconnected critiques.
First, if the benefit of health insurance is mostly or exclusively financial, then shouldn’t health insurance policies work more like normal insurance? Fire, flood and car insurance exist to protect people against actual disasters, after all, not to pay for ordinary repairs. If the best evidence suggests that health insurance is most helpful in protecting people’s pocketbooks from similar disasters, and that more comprehensive coverage often just pays for doctor visits that don’t improve people’s actual health, then shouldn’t we be promoting catastrophic health coverage, rather than expanding Medicaid?
Liberals don’t like catastrophic plans because, by definition, they’re stingier than the coverage many Americans now enjoy. But this is where the second critique comes in: If the marginal dollar of health care coverage doesn’t deliver better health, isn’t this a place where policy makers should be stingy, while looking for more direct ways to improve the prospects of the working poor? Some kind of expanded health security is clearly a good thing — but if we want to promote economic mobility as well, does it really make sense to pour about a trillion dollars into a health care system that everyone agrees is deeply dysfunctional, when some of that money could be returned to Americans’ paychecks instead?
Maine Medical Center institutes hiring freeze in face of $13.4 million loss
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Posted May 06, 2013, at 7:38 p.m.
PORTLAND, Maine — Maine Medical Center, the state’s largest hospital, has declared a hiring and travel freeze, among other things, in an attempt to plug a multimillion-dollar hole in the hospital’s operating budget.
Through the end of March, the hospital’s operating loss was $13.4 million, CEO Richard Petersen wrote April 24 in a memo to employees, which the hospital provided to the Bangor Daily News. The loss occurred in the first half of the hospital’s fiscal year, which runs from Oct. 1 to Sept. 30.
The hospital is in “a negative financial position that it has not witnessed in recent memory,” Petersen wrote. “This places us significantly behind budget.”
Maine Medical Center’s $13.4 million shortfall is in the hospital’s “net patient service revenue,” which in total is just shy of $900 million.
Several factors contributed to the operating loss, according to Petersen’s memo. Beginning in December, the hospital began to experience a drop in inpatient and outpatient volumes, he wrote.
“Some of these volume drops can be attributed to our work in reducing infections and reducing the number of readmissions, but this certainly cannot explain it all,” Petersen wrote.
Steven Michaud, president of the Maine Hospital Association, said Maine Medical Center is not the only hospital dealing with falling patient volumes.
“It’s a phenomenon happening all over the state,” Michaud said Monday. “We’re seeing significant impacts on large hospitals, as well as small, rural, urban, everything. It’s everywhere and it’s pretty significant.”
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