As Hospital Prices Soar, a Stitch Tops $500
By ELISABETH ROSENTHAL
SAN FRANCISCO — With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.
On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great — they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother.
Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.”
In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.
A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to theInternational Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.
At Lenox Hill Hospital in New York City, Daniel Diaz, 29, a public relations executive, was billed $3,355.96 for five stitches on his finger after cutting himself while peeling an avocado. At a hospital in Jacksonville, Fla., Arch Roberts Jr., 56, a former government employee, was charged more than $2,000 for three stitches after being bitten by a dog. At Mercy Hospital in Port Huron, Mich., Chelsea Manning, 22, a student, received bills for close to $3,000 for six stitches after she tripped running up a path. Insurers and patients negotiated lower prices, but those charges were a starting point.
SAN FRANCISCO — With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.
On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great — they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother.
Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.”
In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.
A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to theInternational Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.
At Lenox Hill Hospital in New York City, Daniel Diaz, 29, a public relations executive, was billed $3,355.96 for five stitches on his finger after cutting himself while peeling an avocado. At a hospital in Jacksonville, Fla., Arch Roberts Jr., 56, a former government employee, was charged more than $2,000 for three stitches after being bitten by a dog. At Mercy Hospital in Port Huron, Mich., Chelsea Manning, 22, a student, received bills for close to $3,000 for six stitches after she tripped running up a path. Insurers and patients negotiated lower prices, but those charges were a starting point.
A New Wave of Challenges to Health Law
By SHERYL GAY STOLBERG
WASHINGTON — More than a year after the Supreme Court upheld the central provision of President Obama’s health care overhaul, a fresh wave of legal challenges to the law is playing out in courtrooms as conservative critics — joined by their Republican allies on Capitol Hill — make the case that Mr. Obama has overstepped his authority in applying it.
A federal judge in the District of Columbia will hear oral arguments on Tuesday in one of several cases brought by states including Indiana and Oklahoma, along with business owners and individual consumers, who say that the law does not grant the Internal Revenue Service authority to provide tax credits or subsidies to people who buy insurance through the federal exchange.
At the same time, the House Judiciary Committee will convene a hearing to examine whether Mr. Obama is “rewriting his own law” by using his executive powers to alter it or delay certain provisions. The panel also will examine the legal theory behind the subsidy cases: that the I.R.S., and by extension, Mr. Obama, ignored the will of Congress, which explicitly allowed tax credits and subsidies only for those buying coverage through state exchanges.
“We have agencies under this administration having an attitude that they can fix a statute, that they can improve upon a statute, that they can look at a statute’s clear language and disregard it,” Scott Pruitt, the Oklahoma attorney general, who is bringing one of the cases, said in an interview Monday. “The president himself has said on more than one occasion, ‘I can’t wait on Congress.’ In our system of government, he has to.”
The subsidy lawsuits grow out of three years of work by conservative and libertarian theorists at Washington-based research organizations like the Cato Institute, the American Enterprise Institute and the Competitive Enterprise Institute. The cases are part of a continuing, multifaceted legal assault on the Affordable Care Act that began with the Supreme Court challenge to the law and shows no signs of abating.
“After the A.C.A. was enacted and after the president signed it, a lot of people — me included — decided that we weren’t going to take this lying down, and we were going to try to block it and ultimately either get the Supreme Court to overturn it or Congress to repeal it,” said Michael F. Cannon, a health policy scholar at the libertarian-leaning Cato Institute, who helped develop the legal theory for the subsidy cases and will testify in the House on Tuesday.
WASHINGTON — More than a year after the Supreme Court upheld the central provision of President Obama’s health care overhaul, a fresh wave of legal challenges to the law is playing out in courtrooms as conservative critics — joined by their Republican allies on Capitol Hill — make the case that Mr. Obama has overstepped his authority in applying it.
A federal judge in the District of Columbia will hear oral arguments on Tuesday in one of several cases brought by states including Indiana and Oklahoma, along with business owners and individual consumers, who say that the law does not grant the Internal Revenue Service authority to provide tax credits or subsidies to people who buy insurance through the federal exchange.
At the same time, the House Judiciary Committee will convene a hearing to examine whether Mr. Obama is “rewriting his own law” by using his executive powers to alter it or delay certain provisions. The panel also will examine the legal theory behind the subsidy cases: that the I.R.S., and by extension, Mr. Obama, ignored the will of Congress, which explicitly allowed tax credits and subsidies only for those buying coverage through state exchanges.
“We have agencies under this administration having an attitude that they can fix a statute, that they can improve upon a statute, that they can look at a statute’s clear language and disregard it,” Scott Pruitt, the Oklahoma attorney general, who is bringing one of the cases, said in an interview Monday. “The president himself has said on more than one occasion, ‘I can’t wait on Congress.’ In our system of government, he has to.”
The subsidy lawsuits grow out of three years of work by conservative and libertarian theorists at Washington-based research organizations like the Cato Institute, the American Enterprise Institute and the Competitive Enterprise Institute. The cases are part of a continuing, multifaceted legal assault on the Affordable Care Act that began with the Supreme Court challenge to the law and shows no signs of abating.
“After the A.C.A. was enacted and after the president signed it, a lot of people — me included — decided that we weren’t going to take this lying down, and we were going to try to block it and ultimately either get the Supreme Court to overturn it or Congress to repeal it,” said Michael F. Cannon, a health policy scholar at the libertarian-leaning Cato Institute, who helped develop the legal theory for the subsidy cases and will testify in the House on Tuesday.
The real fix for Obamacare's flaws: Medicare for all
There's no reason to rollback the progress the ACA has made. But we should go all the way and dump the for-profit system
RoseAnne De Moro
Lost amidst the well-chronicled travails of the Affordable Care Act rollout are the long term effects of people struggling to get the health coverage they need without going bankrupt.
If that sounds familiar, it's because that's been the main story line of theUS healthcare system for several decades. Sadly, little has changed.
Still, with all the ACA's highly publicized snafus, and less discussed systemic flaws, there's no reason to welcome the cynical efforts to repeal or defund the law by politicians whose only alternative is more of the same callous, existing market-based healthcare system.
US nurses oppose the rollback and appreciate that several million Americans who are now uninsured may finally get coverage, principally through the expansion of Medicaid, or access to private insurance they've been denied because of their prior health status.
At the same time, nurses will never stop campaigning for a fundamental transformation to a more humane single-payer, expanded Medicare for all system not based on ability to pay and obeisance to the policy confines of insurance claims adjustors.
Website delays – the most unwelcome news for computer acolytes since the tech boom crashed – are not the biggest problem with the ACA, as will become increasingly apparent long after the signup headaches are a distant memory.
What prompted the ACA was a rapidly escalating healthcare nightmare, seen in 50 million uninsured, medical bills plunging millions into un-payable debt or bankruptcy, long delays in access to care, and record numbers skipping needed treatment due to cost.
The main culprit was our profit-focused system, with rising profiteering by a massive health care industry, and an increasing number of employers dropping coverage or just dumping more costs onto workers.
The ACA tackles some of the most egregious inequities: lack of access for many of the working poor who will now be eligible for Medicaid or subsidies to offset some of their costs for buying private insurance through the exchanges, a crackdown on several especially notorious insurance abuses, and encouragement of preventive care.
But the law actually further entrenches the insurance-based system through the requirement that uncovered individuals buy private insurance. It's also chock full of loopholes.
Some consumers who have made it through the website labyrinth have found confusing choices among plans which vary widely in both premium and out of pocket costs even with the subsidies, a pass through of public funds to the private insurers.
The minimum benefits are also somewhat illusory. Insurance companies have decades of experience at gaming the system and warehouses full of experts to design ways to limit coverage options.
The ACA allows insurers to cherry pick healthier enrollees by the way benefit packages are designed, and as a Washington Post article noted on 21 November, consumers are discovering insurers are restricting their choice of doctors and excluding many top ranked hospitals from their approved "network".
The wide disparity between the healthcare you need, what your policy will cover, and what the insurer will actually pay for remains.
Far less reported is what registered nurses increasingly see – financial incentives within the ACA for hospitals to prematurely push patients out of hospitals to cheaper, less regulated settings or back to their homes. It also encourages shifting more care delivery from nurses and doctors to robots and other technology that undermines individual patient care, and that may work no better than the dysfunctional ACA websites.
Is there an alternative? Most other developed nations have discovered it, a single-payer or national healthcare system
Insurers Claim Health Website Is Still Flawed
By ROBERT PEAR and REED ABELSON
Weeks of frantic technical work appear to have made the government’s health care website easier for consumers to use. But that does not mean everyone who signs up for insurance can enroll in a health plan.
The problem is that so-called back end systems, which are supposed to deliver consumer information to insurers, still have not been fixed. And with coverage for many people scheduled to begin in just 30 days, insurers are worried the repairs may not be completed in time.
“Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group.
The issues are vexing and complex. Some insurers say they have been deluged with phone calls from people who believe they have signed up for a particular health plan, only to find that the company has no record of the enrollment. Others say information they received about new enrollees was inaccurate or incomplete, so they had to track down additional data — a laborious task that would not be feasible if data is missing for tens of thousands of consumers.
In still other cases, insurers said, they have not been told how much of a customer’s premium will be subsidized by the government, so they do not know how much to charge the policyholder.
In trying to fix HealthCare.gov, President Obama has given top priority to the needs of consumers, assuming that arrangements with insurers could be worked out later.
The White House announced on Sunday that it had met its goal for improving HealthCare.gov so the website “will work smoothly for the vast majority of users.”
In effect, the administration gave itself a passing grade. Because of hundreds of software fixes and hardware upgrades in the last month, it said, the website — the main channel for people to buy insurance under the 2010 health care law — is now working more than 90 percent of the time, up from 40 percent during some weeks in October.
http://www.nytimes.com/2013/12/02/business/white-house-praises-gains-on-health-site.html?pagewanted=2&_r=0&hp&pagewanted=print
Fast Recovery for Health Care Website
By THE EDITORIAL BOARD
The Obama administration says it has made enormous improvements in its website for enrolling consumers in new health insurance plans. There are still major hurdles to surmount, but the strides made raise the prospects that the website will be able to help millions of Americans buy policies from private insurers on new insurance exchanges, either by Dec. 23, the deadline for policies that will take effect on Jan. 1, or by March 31, the deadline for taking out coverage without being fined. There will be federal subsidies to help those on modest incomes pay the premiums.
The website, HealthCare.gov, was supposed to be ready on Oct. 1, but an array of technical problems made it impossible for all but a trickle of customers to compare policies and enroll in a plan. For some weeks in October, the site was down 60 percent of the time. That dire situation at the front end of the process has been largely corrected through a frantic repair effort over the past five weeks, but it won’t be enough unless the final back-end stage of enrollment is fixed as well.
On Sunday, the administration issued a progress report asserting that the system was running smoothly for a vast majority of users, that the site was now working more than 90 percent of the time, and that consumers were getting much better feedback from the site than before. Thanks to software and hardware improvements, the average page is loading in less than a second compared with an average of 8 seconds in late October, and the number of frustrating error messages that block people from using the site has fallen below 1 percent.
Palliative Care, the Treatment That Respects Pain
By JANE E. BRODY
Anyone faced with a life-threatening or chronic illness should be so lucky as Catherine, a 27-year-old waitress in New York.
Dr. Diane E. Meier, a palliative care specialist at Mount Sinai Medical Center, recalled her young patient’s story in an article published in 2011 in the Journal of Clinical Oncology. Catherine, who was not further identified to preserve her privacy, was diagnosed with leukemia and suffered intractable bone pain, unrelieved by acetaminophen with codeine.
Still, she was unwilling to take opioids to relieve the pain because a family member had had problems with substance abuse. Dr. Meier and her team were called in to help, and their counsel allayed the young woman’s fears of addiction and helped her understand that pain relief was an important part of her treatment. Catherine recovered, eventually attending graduate school and marrying. Her story, Dr. Meier wrote, told us something about the importance of palliative care: Her doctors were focused on curing her cancer, but it was her suffering that “posed significant — but remediable — burdens on the patient.”
Palliative care physicians like Dr. Meier focus on the relief of that suffering, and not just for the dying. All patients deserve palliative care whether they are terminally ill, expected to recover fully, or facing years with debilitating symptoms of a chronic or progressive disease.
“The vast majority of patients who need palliative care are not dying,” Dr. Meier, the director of the Center to Advance Palliative Care, said in an interview. “They are debilitated by things like arthritic pain that affect the quality of their lives and ability to function, and can eventually impact their survival.”
If I had received palliative care following my double knee replacement, I might have avoided the serious pain that left me depressed and unable to resume a normal life for many more weeks than it should have. If my elderly aunt had access to palliative care when she was placed in intensive care, she might not have become delirious and suffered an abrupt progression of dementia from which she never recovered.
The benefits of palliative care include fewer trips to the emergency room or hospital, lower medical costs, improved ability to function and enjoy life and, several studies have shown, prolonged survival for the terminally ill. These virtues far outweigh what it would cost to make this service universally available in hospitals,nursing homes, clinics, assisted living facilities and patients’ homes.
Obama, building ladders to the middle class
By E.J. Dionne Jr.,
LOUISVILLE, Ky.
The debate over the Affordable Care Act can stay small, focusing on Web site failures and other short-term difficulties facing the law. Or it can get bigger, with wider insurance coverage seen as part of a larger struggle for social justice in a nation growing steadily less equal.
On Wednesday in Washington, President Obama decided it was time to go bigger. With HealthCare.gov finally beginning to work, the president sought a return to the ground he fought from so effectively during the 2012 campaign. He pledged that the rest of his term would be devoted to reversing “the relentless, decades-long trend” toward “a dangerous and growing inequality and lack of upward mobility that has jeopardized middle-class America’s basic bargain.”
Mourning that “a child born into the bottom 20 percent has a less than 1-in-20 shot at making it to the top,” Obama insisted: “We are a better country than this.”
He unapologetically defended his health-care law, noting that it “will ultimately reduce a major source of inequality.” In the process, he called out Senate Minority Leader Mitch McConnell, who faces a tough reelection fight next year in Kentucky, home of one of the nation’s most successful rollouts of the new system.
“If the Senate Republican leader still thinks he is going to be able to repeal this someday,” Obama said, “he might want to check with the more than 60,000 people in his home state who are already set to finally have coverage that frees them from the fear of financial ruin.”
And Obama put forward his strongest call yet for an increase in the minimum wage, raising the stakes on a popular cause that Democrats hope to make central to the 2014 midterms.
His speech reflected the administration’s view that, while it could not try to move the public debate toward the rest of its economic agenda until it made noticeable improvements in the health-care Web site, the technical progress it announced this week frees it to go back on offense.
The address, delivered at an event organized by the Center for American Progress, sets up a contest between two narratives that will affect the future of both policy and politics.
By trying to make the problems of Obamacare the overriding question in American politics, Republicans want to deflate hopes that government programs can counter inequality even as the party highlights Obama’s administrative failures.
Democrats, by contrast, will argue that Republicans are trying to undercut the Affordable Care Act because they oppose any efforts to use government to right existing injustices or upset current economic privileges. Obama insisted that “government action . . . can make an enormous difference in increasing opportunity and bolstering ladders into the middle class.” He pointedly challenged Republicans to offer their own policies toward these ends.
“If Republicans have concrete plans that will actually reduce inequality, build the middle class, provide more ladders of opportunity to the poor, let’s hear them,” he said. “If you still don’t like Obamacare — and I know you don’t — even though it’s built on market-based ideas of choice and competition in the private sector, then you should explain how, exactly, you’d cut costs and cover more people and make insurance more secure.”
Families See Colorado as New Frontier on Medical Marijuana
By JACK HEALY
FOUNTAIN, Colo. — As their children cooed from wheelchairs and rocked softly in their arms, the marijuana migrants of Colorado clasped hands, bowed their heads and said a prayer of cautious thanks.
They thanked God for the dinner of roast turkey and mashed potatoes, for their children and for the marijuana-based serum that has drawn 100 families to Colorado on a desperate pilgrimage to quell the squalls of seizures inside their children’s heads. They have come from Florida and Virginia, South Carolina and New York, lining up to treat their children with a promising but largely untested oil that is considered legal medicine in this cannabis-friendly state.
“Thank you for bringing us together,” said Aaron Lightle, whose wife and 9-year-old daughter, Madeleine, moved here after the girl’s neurologists suggested removing part of her brain to stop her relentless seizures. “In crazy ways, maybe. But hey, we’re here.”
Amen, they said.
Their migration is one of myriad ways that a once-illicit drug is reshaping life here in Colorado, which now stands at the forefront of the national debate over legalizing drugs. While these families are seeking treatment through a medical marijuana system that has existed for years, they are arriving at a time when the drug is becoming a mainstream part of public life, made legal for recreational use in a historic vote last year.
The Justice Department has warily allowed Colorado and Washington State, which passed a similar measure, to go ahead with their plans to regulate recreational marijuana, even though it remains illegal under federal law. The first retail marijuana shops in Colorado are poised to open in January. Strains of sativa and indica plants flourish in basements across the state. This week, the Denver City Council moved toward allowing people to smoke marijuana on their property, though smoking in public would still be prohibited.
The new arrivals call themselves marijuana refugees. Many have left jobs and family members behind in states where marijuana remains outlawed, or cannot be used to treat children. While some have moved their entire families, others are splintered, paying rent and raising children in two states. During the holidays, they join family gatherings through video chats and swap iPhone pictures of Christmas trees.
But as more arrive to register their children as medical-marijuana patients, they have knitted together a random family here, across the suburbs and foothills of Colorado’s Front Range. They are Muslims and conservative Christians, liberal Democrats and conservative Republicans
LePage slams U.S. for missed referrals of MaineCare cases
But Democrats say many of the problems are of the governor’s own making.
Gov. Paul LePage on Thursday criticized the head of the U.S. Department of Health and Human Services for computer snafus related to the rollout of www.HealthCare.gov that could prevent some people from receiving MaineCare in 2014.
LePage sent a letter to Kathleen Sebelius attacking her for providing “misleading and inaccurate” information to Maine residents since the website launched Oct. 1.
The problem involves residents who used the federally run HealthCare.gov website to sign up for insurance coverage and learned that they qualify for Medicaid, the federal program that provides health care to low-income people. The residents were supposed to be automatically enrolled in Maine- Care, the state’s version of Medicaid, but computer problems prevented states from being notified of the enrollments, leaving the residents in a bureaucratic limbo.
About 600 Mainers couldn’t be enrolled in MaineCare because their information had not been shared with the state government.
“Since you have no guidance for when your computer systems will start sending the necessary information to Maine, the administrative burden that will fall on state staff will be overwhelming, especially with the likelihood that the number of applications will continue to grow,” LePage wrote. “I want to be clear that our state will not accept, nor bear the burden of what the federal government has caused in its failed system launch.”
FDA investigating surgical robots used at three Maine hospitals
Posted Dec. 05, 2013, at 6:43 p.m.
A surgical robot used by three Maine hospitals is under federal scrutiny following reports that the units may stall during procedures and problems possibly linked to the devices are on the rise.
Intuitive Surgical Inc., the maker of the $1.5 million da Vinci robotic surgery system, issued an “urgent medical device recall” on Nov. 11 alerting customers that friction in the instrument arms of some of the robots can cause the units to stall momentarily, according to a Dec. 3 notice on the U.S. Food and Drug Administration’s website. The problem affects up to 1,386 of the instrument arms worldwide.
While the notification was classified as a “recall,” the robots aren’t being pulled from operating rooms. The FDA uses the classification to identify medical devices that could “cause temporary or medically reversible” health problems. Intuitive Surgical has asked its customers to inform health care workers of the notification and schedule inspections of the devices.
The da Vinci robot, promoted heavily by many hospitals as a cutting-edge surgical technology, is in use at Eastern Maine Medical Center in Bangor, MaineGeneral Medical Center in Augusta, and Maine Medical Center in Portland. All three hospitals said Thursday that they’ve found the device to be safe.
The da Vinci is commonly used for prostate and gallbladder removal and weight-loss surgery, among other procedures. Surgeons can manipulate tiny surgical instruments attached to the robot’s arms using hand controls at a computer system situated a few feet away from the patient. A video camera on one of the arms provides a view inside the patient’s body.
The FDA is investigating a spike in the number of problems reported with the robotic surgeries. The agency said last month that the number of “adverse event reports,” which include deaths, injuries and system malfunctions, had more than doubled of Nov. 3 compared with all of last year, Bloomberg News reported.
An FDA spokeswoman told the Associated Press that the increase may reflect greater awareness among doctors and hospitals of the need to report problems. It also could reflect wider use of the technology.
Between 2007 and 2011, the number of procedures performed with robots including the da Vinci skyrocketed by more than 400 percent in the United States, according to a study by Martin Makary, an associate professor of surgery at the Johns Hopkins University School of Medicine. Despite the widespread adoption, a “haphazard” system of reporting complications leaves a muddied picture of the safety of robotic surgery, Makary said in a news release about the study.
The following article is just one example of "your healthcare dollars at work"
Single payer, anybody?
-SPC
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