Local governments cutting hours over Obamacare costs
By Reid Wilson,
Many cash-strapped cities and counties facing the prospect of shelling out hundreds of thousands of dollars in new health-care costs under the Affordable Care Act are opting instead to reduce the number of hours their part-time employees work.
The decisions to cut employee hours come 16 months before employers — including state and local governments — will be required to offer health care coverage to employees who work at least 30 hours a week. Some local officials said the cuts are happening now either because of labor contracts that must be negotiated in advance, or because the local governments worry that employees who work at least 30 hours in the months leading up to the January 2015 implementation date would need to be included in their health-care plans.
On Tuesday, Middletown Township, New Jersey said it would reduce the hours of 25 part-time workers in order to avoid up to $775,000 in increased annual health-care costs. Earlier this month, Bee County, Tex., said it would limit its part-time workers to 24 hours per week when the new fiscal year starts on Oct. 1.
Last month, department heads in Brevard County, Fla., were told to plan similar cuts in advance of the 2015 deadline. Brevard County Insurance Director Jerry Visco estimated the new mandate would cost the county $10,000 per part-time employee — or $1.38 million a year if all 138 part-time employees who work more than 30 hours a week are covered, he told Florida Today. The Brevard County libraries have already cut hours for 37 employees.
“It’s not something we prefer to do, but the cost of health insurance is significant and would really impact municipal budgets,” said Anthony Mercantante, Middletown’s township administrator. “It’s not something we can take on, particularly when we don’t know some of the other ramifications of the Affordable Care Act. There are far more questions than answers right now.”
Middletown spends about $9 million a year, out of its $65 million budget, on employee health policies, Mercantante said.
Elsewhere, Lynchburg, Va. administrators have cut hours for 35 to 40 part-time employees. Chesterfield County, just south of Richmond, is likely to cut the hours of “several hundred” employees, the county director of human resources told the Richmond Times-Dispatch earlier this year. Chippewa County, Wisc., will drop 15 part-time positions to avoid up to $163,000 in annual health care costs, the county administrator told Wisconsin Public Radio in April.
In a statement provided to GovBeat, White House Council of Economic Advisors chairman Jason Furman said there is no evidence that the Affordable Care Act is incentivizing employers to add part-time rather than full-time positions.
“Since the ACA became law, nearly 90% of the gain in employment has been in full-time positions. Furthermore, the law is helping make health insurance coverage more affordable which supports job growth,” Furman said. “Just yesterday, we learned that the growth in employers’ health care premiums has slowed significantly recently, to less than a third of the growth rate in the late ’90s and early 2000s.”
Other supporters of the law suggested the cuts could actually cost counties and cities more money than if they simply paid for part-time workers’ health care costs.
Eugene Robinson: GOP in Fantasyland
By Eugene Robinson,
The make-believe crusade by publicity-hound Republicans to somehow stop Obamacare is one of the most cynical political exercises we’ve seen in many years. And that, my friends, is saying something.Charlatans are peddling the fantasy that somehow they can prevent the Patient Protection and Affordable Care Act from becoming what it already is: the law of the land. Congress passed it, President Obama signed it, the Supreme Court upheld it, many of its provisions are already in force, and others will soon take effect.
No matter how contemptuous they may be about Obamacare, opponents have only two viable options: Repeal it or get over it.
Sen. Ted Cruz (R-Tex.) the Canadian American who appears to be running for president, has grabbed headlines and air time by being the loudest advocate of an alleged third option: Congress could refuse to fund Obamacare, thereby starving it and effectively killing it. This is a ridiculous fantasy, as Cruz, who has brains beneath all that bombast, surely knows.
Congress needs to pass a continuing resolution to fund the government beyond Sept. 30, the end of the fiscal year. The idea, if you can call it one, is that Republicans can refuse to pass any funding bill that contains money for implementing Obamacare.
Theoretically, Republicans could pull this off in the House, where they hold the majority. But the chance that a bill stripped of money for the Affordable Care Act could make it through the Senate, where Democrats hold power, is precisely zero. The chance that a House-Senate conference would starve Obamacare to death while Sen. Harry Reid (D-Nev.) remains the majority leader is also zero.
And if by some miracle such a bill were to make it to Obama’s desk, the chance he would sign it is way less than zero. To swallow the snake oil that Cruz and some other hard-right conservatives are peddling, you have to believe Obama is willing to nullify the biggest legislative accomplishment of his presidency.
So with the bill vetoed and no authorization to spend money, much of the government would have to shut down.
http://www.washingtonpost.com/opinions/eugene-robinson-the-gops-shutdown-fantasy/2013/08/22/52697d1a-0b3f-11e3-b87c-476db8ac34cd_print.html
The time bomb in Obamacare?
By George F. Will,
A willow, not an oak. So said conservatives of Chief Justice John Roberts when he rescued the Affordable Care Act (ACA) — a.k.a. Obamacare — from being found unconstitutional.But the manner in which he did this may have made the ACA unworkable, thereby putting it on a path to ultimate extinction.
This plausible judgment comes from professor Thomas A. Lambert of the University of Missouri Law School, writing in Regulation, a quarterly publication of the libertarian Cato Institute.
The crucial decision, he says, was four liberal justices joining Roberts’s opinion declaring that the ACA’s penalty for not complying with the mandate to purchase health insurance is actually a tax on not purchasing it. With this reasoning, the court severely limited the ability of the new health-care regime to cope with its own predictable consequences.
What was supposed to be, constitutionally, the dispositive question turned out not to be. Conservatives said that the mandate — the requirement that people engage in commerce by purchasing health insurance — exceeded Congress’s enumerated power to regulate interstate commerce. Liberals ridiculed this argument, noting that since the judicial revolution wrought during the New Deal, courts have given vast deference to Congress regarding that power. The ridicule stopped when five justices, including Roberts, agreed with the conservative argument.
This did not, however, doom the ACA because Roberts invoked what Lambert calls “a longstanding interpretive canon that calls for the court, if possible, to interpret statutes in a way that preserves their constitutionality.” Roberts did this by ruling that what Congress called a “penalty” for not obeying the mandate was really a tax on noncompliance.
This must, Lambert thinks, have momentous — and deleterious — implications for the functioning of the ACA. The problems arise from the interplay of two ACA provisions — “guaranteed issue” and “community rating.”
The former forbids insurance companies from denying coverage because of a person’s preexisting health condition. The latter, says Lambert, requires insurers to price premiums “solely on the basis of age, smoker status, and geographic area, without charging higher premiums to sick people or those susceptible to sickness.”
http://www.washingtonpost.com/opinions/george-will-the-time-bomb-within-obamacare/2013/01/18/673a113c-6108-11e2-9940-6fc488f3fecd_print.html
Covered California enrollment website may not be ready by Oct. 1
California's new health insurance marketplace said its website may not be fully operational Oct. 1 when enrollment begins under the Affordable Care Act.
By Chad Terhune5:00 AM PDT, August 23, 2013
| advertisement |
Less than six weeks before the launch of a major healthcare overhaul, California officials are scrambling to get their online enrollment system ready in time.
Thursday, the state's new health insurance marketplace said its website may not be fully operational Oct. 1 when consumer enrollment begins under the Affordable Care Act. But officials said they would know more after the results of key computer tests early next month.
This month, Oregon said its online enrollment wouldn't be ready Oct. 1 and it would take only paper and phone applications from consumers for the first few weeks.
Full coverage: Healthcare law comes to California
"We have not made that call yet," said Peter Lee, executive director of Covered California, which is implementing the federal health law in the state. If online enrollment isn't immediately available, Lee said, there would be other ways to sign up through call centers, enrollment counselors and agents before coverage kicks in Jan. 1. "The date we care about is Jan. 1 when coverage takes effect."
Still, there is concern that even a short postponement in online enrollment may turn off some potential participants. But officials think a minimal delay wouldn't significantly hamper sign-ups. Open enrollment in the insurance exchange will run from Oct. 1 to March 31 in the first year.
But some provisions of the health law have already been delayed at the federal level, and health-policy experts say more missed deadlines could embolden critics and further undercut tepid public support for the controversial overhaul.
"In the current environment, any postponement will be fodder for political attacks," said Joel Ario, a former federal health official and a managing director at Manatt Health Solutions, a Washington consulting firm. "I think states will be very careful not to have delays unless they have to. These political fights don't help."
http://www.latimes.com/business/la-fi-health-insurance-enroll-20130823,0,5007410,print.story
'Substantial,' rapid progress sought for MaineCare rides
Commissioner Mayhew says, 'We need to see, in a matter of weeks, a significant turnaround.'
AUGUSTA – Health and Human Services Commissioner Mary Mayhew said Thursday that progress is being made on MaineCare's new transportation system but much more must be done to improve service for low-income residents who need rides to doctor's appointments, therapy and other medical services.
"We need to see substantial progress," said Mayhew in brief remarks before the Legislature's Appropriations Committee. "We need to see, in a matter of weeks, a significant turnaround."
Two out-of-state contractors took over the job of arranging rides for MaineCare recipients on Aug. 1, and since then the state has been flooded with complaints about missed rides to appointments.
Previously, local nonprofits coordinated and provided rides with few problems, numerous MaineCare patients have told the Portland Press Herald.
The state has reported more than 2,000 complaints, but hasn't yet released official numbers with a breakdown by region.
The Legislature has little role in the Department of Health and Human Services' initiative to hire contractors to comply with federal Medicaid requirements.
But lawmakers have been getting an earful from constituents, and the Appropriations Committee, with oversight of state finances, has been monitoring the issue.
Maine man returns from surgery in Thailand with positive review
Posted Aug. 22, 2013, at 3:18 p.m.
As Jeff Wheeler recounts his recent trip to Southeast Asia, he mentions the major shoulder surgery he underwent in Thailand almost as an afterthought.
Wheeler of Westport Island returned Sunday night from a three-week trip that began with sightseeing in Vietnam and Cambodia and concluded with a full replacement of his left shoulder at a Bangkok hospital.
The only major complication was meteorological, not medical. Bad weather prevented a planned stop at a popular tourist destination in northeast Vietnam, a seascape of limestone pillars in the Gulf of Tonkin, Wheeler said.
“The only disappointment was not getting to Ha Long Bay,” he said. “But that’s the nature of travel, you take the bitter with the sweet.”
Wheeler, a 59-year-old retired construction boilermaker, traveled across the globe as a “medical tourist,” lured by far less costly treatment than he could find in the U.S. He’s among a few hundred thousand Americans expected to travel overseas this year in search of affordable medical care, from nose jobs to root canals to joint replacements. Fueled by rising health care costs in the U.S., medical tourism can open the door to high-quality treatments at steep discounts.
Wheeler paid roughly $9,000 for his shoulder replacement in Thailand, about 80 percent less than he would have shelled out here at home.
The growing industry caters primarily to the uninsured and people with insufficient insurance, or plans that don’t cover certain elective procedures or carry painfully high deductibles.
Staff at Piyavate Hospital in Bangkok, where Wheeler underwent surgery on Aug. 13 were attentive and professional, he said.
“I think they were actually more thorough because they didn’t want to have a Westerner come over and get a bad result with surgery,” Wheeler said.
Representatives from Planet Hospital, the Calabasas, Calif., medical tourism company that arranged his trip, met with him and assigned a local woman to shepherd him through the process, he said. Wheeler also had his other shoulder X-rayed — he may return for a second surgery for a possible rotator cuff problem — and had a tooth filled by a Thai dentist while he was there, he said.
“My shoulder’s causing me a little bit of pain but not bad,” he said. “Everything’s healing well.”
ACO is the hottest three-letter word in health care
An Alaska-Sized Price Difference: A Circumcision In Anchorage Hospitals Can Cost $2,110 or $235
By Annie Feidt, Alaska Public Radio Network
It’s not just patients who are stunned to see what a hospital charges for services.
Two groups of pediatricians in Anchorage are taking a stand after learning that one of the city’s hospitals, Alaska Regional Hospital, is charging $2,110 for a circumcision, almost 10 times more than the $235 that Providence Hospital, the city’s other major health facility, charges. Those prices are on top of the doctor’s bill.
“We were, I think, shocked by the price we were hearing,” says Dr. Charles Ryan, one of the physicians at Anchorage Pediatric Group. He and his partners no longer perform circumcisions at the 250-bed Alaska Regional. Another pediatric practice, LaTouche Pediatrics, also has stopped most of its circumcisions there.
The Calculus of Primary Care
By ABIGAIL ZUGER, M.D.
My patient Kevin developed a terrible rash. By the time he showed up, a few weeks into his new life as human scratching post, he was red and flaky from scalp to ankles. I asked a few basic questions and knew in less than 30 seconds exactly what to do for him.
Which was to get rid of him as quickly as possible.
As I explained to Kevin at some length, I have the ability to address basic, garden-variety itches, but he clearly needed more than I was ever likely to learn about skin disease; what he needed was a dermatologist.
And so off he went, with some ad-hoc creams and a dermatology referral in hand.
Two weeks later, he was back. He had missed the appointment and used up all the creams. “Doc, you’ve got to do something,” he pleaded, scratching his shoulder blade against the back of the chair. “I’m dying here.”
And so off he went, with more educated pharmaceutical guesswork and another dermatology appointment.
And then, incredibly, he was back. He had made it to the dermatologist’s crowded office, found the wait intolerably long, and left, scratching, to come back to me.
We looked at each other. “Why are you here?” I asked. “Because you’re my doctor,” said he. Check and mate. Now what?
The calculus of primary care demands a certain amount of blind faith. Not unlike various biblical concepts — the loaves, the fishes, the burning bush — it conflates finite and infinite, arguing that an entity can be endlessly consumed yet remain whole.
That entity is of course the patient, indivisible and organic and yet the sum of countless parts. In Kevin’s case, I had tried to do what primary caretakers do dozens of times a day: pass a problematic fraction of him into more capable hands. For him it was only the skin I disowned, but other patients are carved like chickens: heart, lungs, feet, gut, brain, all heading out into different zones of expertise.
The theory holds that you can hack a patient to bits, metaphorically speaking, yet still provide care to a seamlessly reintegrated whole.
Some genius practitioners can actually do just that, reassembling the parts so effortlessly that even their owner feels good. Or maybe it is the patients who are the geniuses, as they manage to forge yet another productive relationship with yet another expert of idiosyncratic temperament and demands.
A Glut of Antidepressants
By RONI CARYN RABIN
Over the past two decades, the use of antidepressants has skyrocketed. One in 10 Americans now takes an antidepressant medication; among women in their 40s and 50s, the figure is one in four.
Experts have offered numerous reasons. Depression is common, and economic struggles have added to our stress and anxiety. Television ads promote antidepressants, and insurance plans usually cover them, even while limiting talk therapy. But a recent study suggests another explanation: that the condition is being overdiagnosed on a remarkable scale.
The study, published in April in the journal Psychotherapy and Psychosomatics, found that nearly two-thirds of a sample of more than 5,000 patients who had been given a diagnosis of depression within the previous 12 months did not meet the criteria for major depressive episode as described by the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (or D.S.M.).
The study is not the first to find that patients frequently get “false positive” diagnoses for depression. Several earlier review studies have reported that diagnostic accuracy is low in general practice offices, in large part because serious depression is so rare in that setting.
Elderly patients were most likely to be misdiagnosed, the latest study found. Six out of seven patients age 65 and older who had been given a diagnosis of depression did not fit the criteria. More educated patients and those in poor health were less likely to receive an inaccurate diagnosis.
The vast majority of individuals diagnosed with depression, rightly or wrongly, were given medication, said the paper’s lead author, Dr. Ramin Mojtabai, an associate professor at the Johns Hopkins Bloomberg School of Public Health.
Most people stay on the drugs, which can have a variety of side effects, for at least two years. Some take them for a decade or more.
“It’s not only that physicians are prescribing more, the population is demanding more,” Dr. Mojtabai said. “Feelings of sadness, the stresses of daily life and relationship problems can all cause feelings of upset or sadness that may be passing and not last long. But Americans have become more and more willing to use medication to address them.”
By contrast, the Dutch College of General Practitioners last year urged its members to prescribe antidepressants only in severe cases, and instead to offer psychological treatment and other support with daily life. Officials noted that depressive symptoms may be a normal, transient reaction to disappointment or loss.
Let’s Talk about a Real Healthcare System (And, No, I Don't Mean "Obamacare")
Let’s talk about healthcare. I don’t mean debating the Affordable Care Act. I mean healthcare, as in: If everyone needs healthcare, guarantee that everybody gets it.
I know, when it comes to healthcare, it’s easy to get into a debate for or against Obamacare. But we nurses see the world through a different lens: our patients.
Good healthcare is a fundamental resource that keeps America’s big engine running. Every day, as we do our best to care for our patients, nurses see people with chronic disease like asthma or diabetes who can’t afford insurance costs or medication. Maybe they’re absent from work, tired, and distracted from trying to manage their health on a shoestring. They run the risk of hospitalization. They struggle for a distant unreachable shore hoping something will help. They can’t get ahead because their health keeps dragging them down.
And yet the answer isn’t on the horizon, the answer is in our pockets, in our hands. It’s our taxes. We pay them and we ought to benefit from them.
There’s one thing that every American does. Every working American (ok, except the Wall Street crowd) pays taxes. But what do we pay taxes for? Increasingly, we wonder where our money is going, how our money is serving our communities, and how our tax money is helping us and our families.
There are dozens of arguments about what our tax dollars should be doing. But what if we spent a portion of our tax dollars on the one thing that would position every American, young and old, on the road to success? That one thing is good health. You need it to go to school, get to your job, excel at what you do, and dream big dreams that will make our country great again.
We must do better and nurses have a solution. The United States ranks first in costs but 37th in health outcomes in the world. We do even worse for infant morality and life expectancy.
So nurses are proposing another way. We’re saying that our taxes should pay for our healthcare. It works for seniors, it works for Congressmembers, and it will work for all of us.
This week, we launched an online campaign, asking voters to demand this from Congress.
Controlling Health Care Spending, Revisited
By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
A hotly debated question among health policy wonks is whether the decline in the year-to-year growth in health spending in the United States, which started in 2002 (see Figure 1), will leave that growth rate at a permanently lower level.
I had a blog post on this question in January 2012, drawing no conclusion but noting that over the longer term the growth rate just had to come down closer to the level of growth in gross domestic product.
An intriguing question is what drives the fluctuations in the growth of health spending clearly visible in Figure 1. It was a topic at a recent symposium convened by the Altarum Center for Sustainable Health Spending.
In a joint effort, Thomas Getzen, professor emeritus of economics at Temple University; Gary Claxton and Larry Levitt, senior vice presidents of the Henry J. Kaiser Family Foundation, and Charles Roehrig, vice president of the Altarum Institute, developed a statistical model in which the annual growth rate in nominal national health spending (not adjusted for inflation) in any given year over the long period 1965-2012 is assumed to be driven primarily by two macroeconomic variables: (1) the inflation rate in the current and the previous two years, measured by the G.D.P. deflator, and (2) the growth rate in real G.D.P. in the current year, as well as in the previous five years. The approach is called “lagged regression analysis.”
In a joint effort, Thomas Getzen, professor emeritus of economics at Temple University; Gary Claxton and Larry Levitt, senior vice presidents of the Henry J. Kaiser Family Foundation, and Charles Roehrig, vice president of the Altarum Institute, developed a statistical model in which the annual growth rate in nominal national health spending (not adjusted for inflation) in any given year over the long period 1965-2012 is assumed to be driven primarily by two macroeconomic variables: (1) the inflation rate in the current and the previous two years, measured by the G.D.P. deflator, and (2) the growth rate in real G.D.P. in the current year, as well as in the previous five years. The approach is called “lagged regression analysis.”
The model was able to explain 85 percent of the observed variation in the annual growth of national health spending, as is illustrated in the authors’ chart, which depicts the actual and the predicted growth rate in nominal health spending.
One concludes from this analysis that both year-to-year fluctuations in national health spending and the longer-term trend in that growth rate are driven primarily by current and prior-year changes in macroeconomic conditions.
One also infers from the model that if either inflation or the growth in real G.D.P. in the United States should pick up again, then the growth of national health spending should be expected to pick up again as well.
There is an emerging consensus among health economists, however, that other factors within United States health care itself have contributed to the decline in health spending growth and will prevent that growth rate from returning to levels observed in previous decades.
A Limit on Consumer Costs Is Delayed in Health Care Law
By ROBERT PEAR
WASHINGTON — In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.
The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.
The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.
The discovery is likely to fuel continuing Republican efforts this fall to discredit the president’s health care law.
Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.
Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.
The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.
In many cases, the companies have separate computer systems that cannot communicate with one another.
A Powerful Tool in the Doctor’s Toolkit
By DANIELLE OFRI, M.D.
It was well past midnight and most of the patients had settled in. The hospital ward was quiet, except for “the howler.”
The howler was a patient in his 30s who earned his nickname for his nightly bouts of yelling. This was in the early 1990s, during the peak of the AIDS epidemic. I was a second-year medical resident at Bellevue Hospital, in charge of the sprawling AIDS ward that night. Admissions were rolling in, one after another, each more feverish and emaciated than the previous.
This patient was already receiving hefty doses of pain medication, yet he kept screaming to the nurses about his pain. This went on, night after night, despite extensive medical evaluations to see if there were any missed explanations for his pain.
Nothing seemed to help, and the nightly yowling was agitating the other patients and driving the nursing staff to distraction. The head nurse paged me at 3 a.m. “You have to do something,” she said.
I went to the patient’s room. It was my fourth visit of the night, and the patient and I were both pretty exasperated with each other. He was sullen and cranky; I was exhausted and at my wits’ end.
I pulled out a syringe and carefully drew up one c.c. of plain saline. “You know about Tylenol,” I said, showing him the liquid-filled syringe. “You’ve heard of Tylenol #3. There’s even a Tylenol #4. This” — and here I paused for dramatic effect— “this is Tylenol #5.”
The patient stopped howling and gave me an interested look. Then he lowered his pajamas and allowed me to inject his gluteus maximus. Afterward, I pulled up a chair to his bedside and we waited together, allowing the minutes to tick unhurriedly by.
After what seemed like a mutually agreeable time, I stood up and bid him goodnight. The patient put his head to the pillow and promptly fell asleep. The ward was silent for the rest of the night.
I felt terribly guilty that I had committed an outright deception with this patient — something that is a true no-no. But on the other hand, it was the first night he got a full night of sleep, to say nothing of all the other patients on the ward and the rest of the staff.
When I related this story to Dr. Ted J. Kaptchuk, director of the program in placebo studies at Harvard, he gave a sigh of recognition. “We all have our moments of desperation,” he said. “Usually around midnight.”
Dr. Kaptchuk does not condone deception, but his research bears out that how caregivers present and administer treatments has a powerful effect on clinical outcomes
Price-posting: Oh look! Another healthcare cost 'solution' gimmick
By Victoria Powell, MS3
Short White Coat, Inc., blog, Aug. 2, 2013
Short White Coat, Inc., blog, Aug. 2, 2013
The Surgery Center of Oklahoma has been in the spotlight recently because of its decision to post all of its prices for its procedures online. This has been heralded as increasing transparency in healthcare costs and implicitly demonizes other hospitals in the area that haven’t followed suit, like traditional academic centers.
Why haven’t hospitals done this a long time ago, so the uninsured can bargain shop for their knee replacement instead of being stuck with a huge bill they’ll have to go into bankruptcy to afford? It’s an attractive idea, especially when presented as oversimplified as it has been to the public.
In isolation, price-posting is just another market-based artifice, more zeitgeist of our accelerating entrenchment in our broken, healthcare-as-commodity model than any real solution. Nothing illustrates it better than this quote in the NYT opinion piece from the co-founder of the Surgery Center himself, “Patients are holding plane tickets to Oklahoma City and printing out our prices, and leveraging better deals in their local markets.”
HOLD UP DOC. There are a few BIG assumptions here:
1) The medical procedure you need is known to you in advance – that is, it isn’t an emergency.
2) You have the ability to pay SOMETHING, but either don’t have insurance or lack specific coverage for the procedure, etc.
3) You are physically and mentally able to bargain shop for the healthcare you need. There are many people who need healthcare services who aren’t able to do this – people with dementia requiring long-term care, a person in a coma from a car accident, a person with a debilitating psychiatric problem – it’s not hard to bring examples to mind.
We find that what this really represents is a very specific marketing tactic to a targeted audience – mostly healthy people who need an elective surgery to improve their quality of life. Clearly a very important demographic, but it by no means representative of everyone seeking healthcare.
Moment of Truthiness
By PAUL KRUGMAN
We all know how democracy is supposed to work. Politicians are supposed to campaign on the issues, and an informed public is supposed to cast its votes based on those issues, with some allowance for the politicians’ perceived character and competence.
We also all know that the reality falls far short of the ideal. Voters are often misinformed, and politicians aren’t reliably truthful. Still, we like to imagine that voters generally get it right in the end, and that politicians are eventually held accountable for what they do.
But is even this modified, more realistic vision of democracy in action still relevant? Or has our political system been so degraded by misinformation and disinformation that it can no longer function?
Well, consider the case of the budget deficit — an issue that dominated Washington discussion for almost three years, although it has recently receded.
You probably won’t be surprised to hear that voters are poorly informed about the deficit. But you may be surprised by just how misinformed.
In a well-known paper with a discouraging title, “It Feels Like We’re Thinking,” the political scientists Christopher Achen and Larry Bartels reported on a 1996 survey that asked voters whether the budget deficit had increased or decreased under President Clinton. In fact, the deficit was down sharply, but a plurality of voters — and a majority of Republicans — believed that it had gone up.
I wondered on my blog what a similar survey would show today, with the deficit falling even faster than it did in the 1990s. Ask and ye shall receive: Hal Varian, the chief economist of Google, offered to run a Google Consumer Survey — a service the company normally sells to market researchers — on the question. So we asked whether the deficit has gone up or down since January 2010. And the results were even worse than in 1996: A majority of those who replied said the deficit has gone up, with more than 40 percent saying that it has gone up a lot. Only 12 percent answered correctly that it has gone down a lot.
Am I saying that voters are stupid? Not at all. People have lives, jobs, children to raise. They’re not going to sit down with Congressional Budget Office reports. Instead, they rely on what they hear from authority figures. The problem is that much of what they hear is misleading if not outright false.
A Dry Pipeline for Psychiatric Drugs
By RICHARD A. FRIEDMAN, M.D.
Fully 1 in 5 Americans take at least one psychiatric medication. Yet when it comes to mental health, we are facing a crisis in drug innovation.
Sure, we have many antidepressants, antipsychotics, hypnotic medications and the like. But their popularity masks two serious problems.
First, each of these drug classes is filled with “me too” drugs, which are essentially just copies of one another; we have six S.S.R.I. antidepressants that essentially do the same thing, and likewise for the 10 new atypical antipsychotic drugs.
Second, the available drugs leave a lot to be desired: patients with illnesses like schizophrenia, major depression and bipolar disorder often fail to respond adequately to these medications or cannot tolerate their side effects.
Yet even though 25 percent of Americans suffer from a diagnosable mental illness in any year, there are few signs of innovation from the major drug makers.
After a series of failed clinical trials in which novel antidepressants and antipsychotics did little or no better than placebos, the companies seem to have concluded that developing new psychiatric drugs is too risky and too expensive. This trend was obvious at the 2011 meeting of the American Society for Clinical Pharmacology and Therapeutics, where only 13 of 300 abstracts related to psychopharmacology and none related to novel drugs. Instead, they are spending most of their research dollars on illnesses like cancer, heart disease and diabetes, which have well-defined biological markers and are easier to study than mental disorders.
To understand this predicament, it helps to know how we got here.
All of our current antidepressants, antipsychotics and anti-anxiety drugs share the same molecular targets in the brain as their prototypes from the 1950s. For example, the new antipsychotic drugs block dopamine receptors in critical brain regions, just like the first antipsychotic, Thorazine, synthesized in 1950. And all of our current antidepressants increase the levels of one or more of the neurotransmitters serotonin, dopamine or norepinephrine, just like the early tricyclic antidepressants.
With rare exceptions, it is hard to think of a single truly novel psychotropic drug that has emerged in the last 30 years. True, the new psychotropic drugs are generally safer and more tolerable than older prototypes, but they are no more effective. So why has the pharmaceutical industry churned out so many copycat drugs?
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