Op-Ed: Our Profit-Centered Private Medical Industry Is Cutting Back on Hospital Care
December 24, 2013 |
With all the clamor over the website woes of the rollout of the Affordable Care Act finally ebbing, let's hope the media can begin to notice some changes in the delivery of health care that will have more far-reaching consequences for health care quality and access long after the sign-up problems are a distant memory.Despite the hysteria on the right, some components of the ACA are clearly welcome, especially the Medicaid expansion in those states where the governors are not standing with pitchforks in the door to block health coverage for the working poor.
Yet there's plenty of trouble ahead, most evident with the cost shifting from insurers and providers to workers and families.
Many are now aware that the insurance plans offered through the exchanges are chock full of added out-of-pocket costs.
The cost problem extends well into the provider setting, as is now just being gleaned through some reporting on price gouging [3] by many big hospitals which jack up costs to patients through steeper co-pays, requiring cash up front before administering care, Medical Credit Scoring to determine if patients are a payment risk, and hounding patients for payment afterwards.
Less reported are the escalating problems on the care delivery side.
Let's start with a new survey [4] out from Citi Research, via Reuters, which reports that "hospital inpatient admissions in November fell to their weakest level in more than a decade."
Two big chains illustrate the trend. Henry Ford Health System in Detroit had a 6 percent drop the first seven months of this year, Modern Healthcare reported in August. California-based Kaiser Permanente has reduced its average daily census by 11 percent the past four years.
No one, of course, wants to be hospitalized. Sometimes you must be. A hospital is where you receive 24-hour nursing care, where they have the ability to quickly shift you to an operating room or intensive care floor if your condition suddenly deteriorates, and where they have the most specialized equipment.
But the hospital industry, increasingly dominated by giant corporations, either for-profit or acting like for-profits, are making higher profits elsewhere - in outpatient settings, especially surgery centers and boutique care centers, and investments, for example.
http://www.alternet.org/print/op-ed-hidden-erosion-safe-hospital-care
The painful path to Obamacare deadline
By John Whitesides18 hours ago
WASHINGTON (Reuters) - Tuesday is a moment of truth for Obamacare.
It marks the final deadline for most Americans to sign up for health insurance under President Barack Obama's 2010 Affordable Care Act, popularly known as Obamacare, if they want coverage starting on January 1.
If enough people - and the right mix of young and old - do not enroll, the ambitious program designed to provide health benefits to millions of uninsured and under-insured Americans risks eventually unraveling.
The deadline caps a turbulent roll-out this year for Obamacare and the HealthCare.gov website that is key to enrolling millions of people in the initiative. The website crashed upon its launch on October 1, frustrating users trying to shop for insurance plans. It now is functioning much better, but is still not at 100 percent.
Despite the continuing problems, the administration is expressing confidence that Obamacare is getting back on track after enrollment accelerated in December, with more than 1 million people signing up for private insurance.
Here is a look at some notable moments in the months leading up to Obamacare's troubled launch.
Bridging the care gap
Hospital miscues have decreased, but what about after discharge?
By Larry Tye
| GLOBE CORRESPONDENT
DECEMBER 25, 2013
TWO DECADES ago I wrote a four-part series for this newspaper on hospitals that operated on the wrong joint or organ — sometimes even the wrong patient — and made other mistakes that shamed the hospital and sickened its patients. It left a journalist like me convinced there must be a way to prevent errors like those.
Three weeks ago the knife cut into me. When the surgeon scribbled his initials on my left shoulder in blue ink to remind him which side was to be repaired, I was reassured. When I was asked to confirm my name and birth date 10 times within 90 minutes, I didn’t complain. But the medical team’s in-hospital meticulousness did not extend to my bedside at home: It took four phone messages, two e-mails, and four days to get a call-back on what I worried was a post-operative infection. (It wasn’t.)
All told, my day surgery convinced me that things have improved dramatically — but not enough — in rooting out hospital miscues and keeping patients from being readmitted.
I know change isn’t easy, not with all the moving parts, human and mechanical, in today’s high-tech hospital. Over my short stay at Brigham and Women’s, I was attended to by legions of administrators and volunteers, nurses, orderlies, doctors, and doctors-in-training. The fact that all were applying the safety lessons medical pioneers had preached to me decades ago — from ensuring they had the right patient and procedure, to taking time in the operating room to check my X-ray and their blood supply — was wondrous. So were the instructions on how to ensure nothing went amiss with my recovery and how to reach my doctor if it did. They even told me, in writing, what exercise to do: “Walking is good for you, and you may also climb stairs.”
I did both, and got back on my exercise bike when my doctor said I could, four days after he operated. That same day I got word that the complex cyst he had removed was benign.
But not all was well. The surgeon’s orders that I didn’t need an overnight stay had gotten tangled; the hospital insisted I would be there three nights and told my insurer, which denied coverage. “Please understand,” the company wrote in a letter that arrived home just as I did, “if you have had this service, your plan will not pay for it.” My mental anguish was nothing next to my physical distress, which had been easing but was back full-strength after my cycling workout. I left my first voicemail at my doctor’s office that morning, asking for a follow-up exam. No reply. Over the weekend I experienced the drainage, swelling, and “pain that does not go away with pain medicine” listed on my instructions for “when should I call my doctor.” As an ex-marathoner I know how to bear pain, but as an ex-medical reporter I know that infection is a common complication of surgery and needs to be addressed urgently.
Sign-Up Period Extended Again for Health Plan
By ROBERT PEAR
WASHINGTON — The Obama administration said Tuesday that it would provide more time for people to complete their applications for health insurance if they could show that they missed the deadline because of problems with the federal health care website.
The move was the latest in a series of deadline changes, exemptions and clarifications that have confused insurers and many Americans and opened the administration to increasing criticism from Republicans who have opposed the Affordable Care Act from the start and have repeatedly tried to overturn it.
It was not clear on Tuesday how many people would be affected, or how consumers would prove that website errors had prevented them from signing up by the deadline on Tuesday night.
The announcement itself was vague, saying only that if website problems had prevented any consumers from enrolling, they might qualify for what the government has called “a special enrollment period.” The administration did not say how long that would last. Nor did it define what website errors might be involved.
Republicans said the announcement — coming a day after the federal website recorded more than two million visits — showed that President Obama was desperate to increase enrollment, widely seen as a measure of the success of the health care law.
For their part, administration officials said the move was a common-sense response to heavy traffic on the website, which they cited as evidence of a huge need for more affordable insurance. Some 48 million Americans are uninsured. Many could qualify for subsidized coverage under the Affordable Care Act.
Tara McGuinness, a White House spokeswoman, said the administration was not providing “a blanket extension,” but was offering to provide “assistance to individuals on a case-by-case basis.”
And Kurt DelBene, the new troubleshooter for the site, said it was performing well. “With the highest volumes we have seen to date, response time is fast, and the error rate is low,” he said.
The move did not mollify insurers who have grown concerned as new problems have erupted since the rollout on Oct. 1 and are worried about how they will be able to provide coverage for everyone who wants it by Jan. 1, when that coverage is supposed to go into effect.
“The goal posts keep moving,” William G. Schiffbauer, a lawyer who represents insurance companies, said Tuesday evening. “That raises questions about whether insurers can collect premiums in a timely manner to pay claims from doctors and hospitals.”
“The latest step creates confusion for consumers and insurers,” he added.
The Affordable Care Act’s free-market economics
By Editorial Board, Published: December 25
FIRST, PRESIDENT Obama’s Affordable Care Act (ACA) forced millions to switch their insurance plans. Now, critics say, those people can’t keep their doctors, either. Another broken promise? More proof the ACA is a disaster?
Not quite: As with all of those canceled policies, this “outrage” isn’t good evidence that the law is flawed, no matter what the president may have promised.
The issue is that some of the people who must switch health plans are transitioning into policies with narrow networks that don’t always include the doctors, hospitals and other providers they used before. Anecdotes have emerged of people parting with physicians they’ve trusted for years.
Yet, even for people who have never switched plans, this sort of thing happened well before the ACA; insurers constantly negotiate with providers over inclusion in coverage networks and payment rates. Doing so is one way insurers can keep costs down in the individual insurance market. In the past, other ways to control costs included skimping on benefits and turning away the sick and the old. Now, the ACA is about to stop the last two practices, a key, and popular, feature of the law. That leaves trimming provider networks as one of the last tools open to insurers to restrain premiums.
The preceding WaPost editorial ignores the potential savings that could be realized by eliminating the estimated $750 billion in unnecessary services, administrative inefficiency, excessive profiteering and fraud in our existing system, some of which the ACA exacerbates. Cutting back on networks is far from the only or even the best way to reduce the costs of the healthcare system.Trimming provider networks is not "one of the last tools open to insurers to restrain premiums" as the editorial suggests.
-SPC
Obamacare backfires — on everyone
By Robert J. Samuelson, Published: October 23
The Affordable Care Act (“Obamacare”) turns out to represent dreadful miscalculations by both the president and his Republican adversaries. Doubtlessly, Barack Obama imagined that achieving something close to “universal” health insurance would guarantee his legacy. It would make him the liberal heir to Franklin Roosevelt and Lyndon Johnson. Forget it. Even if Obamacare worked flawlessly — that’s now a joke — it’s too small to rank with the New Deal or the Great Society. Meanwhile, Republicans say Obamacare threatens liberty and would lead to a federal “takeover” of health care. This fiction, pursued fanatically with policies risking anarchy, has earned the GOP a deserved public backlash.
As readers of this column know, I’m no fan of Obamacare. Before it was introduced, I advised against it. It would be divisive, I argued. Just when the country — suffering economic collapse — needed to rebuild confidence, it would subvert confidence. Later, I objected that it didn’t do enough to control spiraling health spending. Finally, I worried that the ACA’s costs and complexities would deter some firms from hiring. I still believe all these criticisms.
What I don’t believe are liberals’ and conservatives’ self-serving myths. In their world, defending or destroying Obamacare has become a defining political choice of our time. Actually, it isn’t. Partisan arguments are disconnected from health-care realities. To see why, let’s examine some myths.
Start with the conservative variety, which brought us the (partial) government shutdown and debt-ceiling brinkmanship. Conservatives fear that once people start receiving insurance subsidies, they’ll become hooked on their newest “entitlement.” Game over. Government runs health care. The trouble is, this game was over decades ago. Governments now pay nearly half of all health-care costs, mainly through Medicare and Medicaid. Government also subsidizes health care through the tax code by not counting employer-provided insurance as taxable income.
U.S. health care is a messy mixture of government intervention and private markets. Doctors, hospitals, drug companies and medical device-makers exist mainly in the market. The government regulates and pays them. The system is flawed. Costs are high. There is waste. Still, conflicts reflect muddled public opinion: Americans reject “socialized medicine” but believe health care is a “right.” Despite more subsidies and regulations, Obamacare perpetuates this system of blurred public-private power sharing.
Would repealing Obamacare reduce budget deficits, as many conservatives hope? Probably not. True, the program is estimated to cost nearly $2 trillion over a decade. But this would be more than offset by tax increases and lower Medicare reimbursement rates. If these were also repealed, deficits might rise slightly, projects the Congressional Budget Office.
Finally, jobs. Here, conservatives are correct. The ACA may cause some companies to limit hiring or cut hours to escape the law’s requirement to provide health insurance. (The law exempts firms with fewer than 50 full-time workers; full-time is 30 hours a week or more.) But the conservatives’ pro-jobs argument is undercut by their behavior. The hard-line demand to “defund” Obamacare could have forced the government to default on its bills. The likely resulting economic slump and unemployment would have vastly overshadowed any ACA job losses.
The Affordable Care Act (“Obamacare”) turns out to represent dreadful miscalculations by both the president and his Republican adversaries. Doubtlessly, Barack Obama imagined that achieving something close to “universal” health insurance would guarantee his legacy. It would make him the liberal heir to Franklin Roosevelt and Lyndon Johnson. Forget it. Even if Obamacare worked flawlessly — that’s now a joke — it’s too small to rank with the New Deal or the Great Society. Meanwhile, Republicans say Obamacare threatens liberty and would lead to a federal “takeover” of health care. This fiction, pursued fanatically with policies risking anarchy, has earned the GOP a deserved public backlash.
As readers of this column know, I’m no fan of Obamacare. Before it was introduced, I advised against it. It would be divisive, I argued. Just when the country — suffering economic collapse — needed to rebuild confidence, it would subvert confidence. Later, I objected that it didn’t do enough to control spiraling health spending. Finally, I worried that the ACA’s costs and complexities would deter some firms from hiring. I still believe all these criticisms.
What I don’t believe are liberals’ and conservatives’ self-serving myths. In their world, defending or destroying Obamacare has become a defining political choice of our time. Actually, it isn’t. Partisan arguments are disconnected from health-care realities. To see why, let’s examine some myths.
Start with the conservative variety, which brought us the (partial) government shutdown and debt-ceiling brinkmanship. Conservatives fear that once people start receiving insurance subsidies, they’ll become hooked on their newest “entitlement.” Game over. Government runs health care. The trouble is, this game was over decades ago. Governments now pay nearly half of all health-care costs, mainly through Medicare and Medicaid. Government also subsidizes health care through the tax code by not counting employer-provided insurance as taxable income.
U.S. health care is a messy mixture of government intervention and private markets. Doctors, hospitals, drug companies and medical device-makers exist mainly in the market. The government regulates and pays them. The system is flawed. Costs are high. There is waste. Still, conflicts reflect muddled public opinion: Americans reject “socialized medicine” but believe health care is a “right.” Despite more subsidies and regulations, Obamacare perpetuates this system of blurred public-private power sharing.
Would repealing Obamacare reduce budget deficits, as many conservatives hope? Probably not. True, the program is estimated to cost nearly $2 trillion over a decade. But this would be more than offset by tax increases and lower Medicare reimbursement rates. If these were also repealed, deficits might rise slightly, projects the Congressional Budget Office.
Finally, jobs. Here, conservatives are correct. The ACA may cause some companies to limit hiring or cut hours to escape the law’s requirement to provide health insurance. (The law exempts firms with fewer than 50 full-time workers; full-time is 30 hours a week or more.) But the conservatives’ pro-jobs argument is undercut by their behavior. The hard-line demand to “defund” Obamacare could have forced the government to default on its bills. The likely resulting economic slump and unemployment would have vastly overshadowed any ACA job losses.
Will Mainers fly to co-op for health insurance?
That’s the question, as a fledgling nonprofit takes on a mountain of debt to be only the second provider in our marketplace.
LEWISTON — Maine’s new health insurance marketplace, where people sign up for 2014 health benefits under the Affordable Care Act, almost formed as a monopoly, entirely controlled by Anthem Blue Cross Blue Shield.
Customers purchasing subsidized plans on the marketplace would have been limited to choosing between Anthem offerings if not for a series of unlikely events. Maine’s sparse and largely rural population would have made it a prime candidate for a monopolistic market, experts say.
Instead, Maine is one of 10 states with two insurers, thanks to a $64.6 million federal loan to form a co-op under an often-overlooked program created by the Affordable Care Act. In most of the states, three or more insurers offer plans that customers can choose from. So far, 73 percent of Maine consumers are choosing MCHO over Anthem, according to co-op officials.
“Without the existence of this co-op, there would be no competition on the marketplace. There would be no choice,” said Kevin Lewis, CEO of the new Lewiston-based co-op, Maine Community Health Options.
If Anthem had been the sole insurer, Maine would have joined New Hampshire and West Virginia as the only states with one insurance provider in the marketplace. Those shopping for insurance on www.HealthCare.gov are often self-employed or part-time workers who earn too much to qualify for MaineCare but were previously priced out of the individual insurance market and often were uninsured.
LEWISTON — Maine’s new health insurance marketplace, where people sign up for 2014 health benefits under the Affordable Care Act, almost formed as a monopoly, entirely controlled by Anthem Blue Cross Blue Shield.
Customers purchasing subsidized plans on the marketplace would have been limited to choosing between Anthem offerings if not for a series of unlikely events. Maine’s sparse and largely rural population would have made it a prime candidate for a monopolistic market, experts say.
Instead, Maine is one of 10 states with two insurers, thanks to a $64.6 million federal loan to form a co-op under an often-overlooked program created by the Affordable Care Act. In most of the states, three or more insurers offer plans that customers can choose from. So far, 73 percent of Maine consumers are choosing MCHO over Anthem, according to co-op officials.
“Without the existence of this co-op, there would be no competition on the marketplace. There would be no choice,” said Kevin Lewis, CEO of the new Lewiston-based co-op, Maine Community Health Options.
If Anthem had been the sole insurer, Maine would have joined New Hampshire and West Virginia as the only states with one insurance provider in the marketplace. Those shopping for insurance on www.HealthCare.gov are often self-employed or part-time workers who earn too much to qualify for MaineCare but were previously priced out of the individual insurance market and often were uninsured.
Starting Jan. 1, Mainers can ask their doctors for a price list of common procedures
By Mario Moretto, BDN Staff
Posted Dec. 25, 2013, at 2:16 p.m.
AUGUSTA, Maine — For years, most patients have received medical procedures without knowing the cost. Want to know how much you’ll shell out for that X-ray or CT scan? Many would simply wait for the bill.
But starting in 2014, practitioners in Maine will be required to compile a list of their most commonly performed procedures — anything done more than 50 times per year — and the price that would be paid by an uninsured patient. Practitioners, from chiropractors to hospital internists, must inform patients about the availability of the list and provide copies upon request.
An Act to Require Public Disclosure of Health Care Prices, a bill by Sen. Dick Woodbury, I-Yarmouth, passed during the last legislative session and was signed into law by Gov. Paul LePage. The bill replaced an older law that simply required the posting of prices.
That effort was never really followed, said Gordon Smith, executive vice president of the Maine Medical Association, by phone Tuesday.
“We did some education with our members at that time, but in all honesty, over a period of 10 years, it wasn’t observed,” he said.
While organizations similar to his in other states, such as Arizona, have opposed such transparency measures, Smith said MMA supported the aim of Woodbury’s bill.
“People, ethically, are entitled to know,” he said. “For 60 or 70 years, we relied so much on third-party payment that people just got away from needing or wanting to know the price of something. But there are people who are going to be paying cash, whether they are uninsured or carry a big deductible.”
Still, Smith is working with Woodbury and the Maine Hospital Association to amend the law. Another bill by Woodbury, accepted into the truncated second legislative session, will be the vehicle for those amendments. Efforts to contact Woodbury on Tuesday were unsuccessful.
One of the provisions the trio hope to change is the requirement that practitioners provide complete lists of all services conducted more than 50 times annually.
Jeff Austin, lobbyist for MHA, said such a comprehensive list would include a lot of information that one patient wouldn’t need, and could risk overwhelming someone in the vulnerable position of being uninsured and needing medical care.
“The goal is to get people information about their own care,” he said. “If you’re going to get your tonsils out, you don’t need to see the price of back surgery. The codes associated with your own care are more to the patient than a list of codes that have nothing to do with their care. We don’t want to confuse people.”
By Mario Moretto, BDN Staff
Posted Dec. 25, 2013, at 2:16 p.m.
AUGUSTA, Maine — For years, most patients have received medical procedures without knowing the cost. Want to know how much you’ll shell out for that X-ray or CT scan? Many would simply wait for the bill.
But starting in 2014, practitioners in Maine will be required to compile a list of their most commonly performed procedures — anything done more than 50 times per year — and the price that would be paid by an uninsured patient. Practitioners, from chiropractors to hospital internists, must inform patients about the availability of the list and provide copies upon request.
An Act to Require Public Disclosure of Health Care Prices, a bill by Sen. Dick Woodbury, I-Yarmouth, passed during the last legislative session and was signed into law by Gov. Paul LePage. The bill replaced an older law that simply required the posting of prices.
That effort was never really followed, said Gordon Smith, executive vice president of the Maine Medical Association, by phone Tuesday.
“We did some education with our members at that time, but in all honesty, over a period of 10 years, it wasn’t observed,” he said.
While organizations similar to his in other states, such as Arizona, have opposed such transparency measures, Smith said MMA supported the aim of Woodbury’s bill.
“People, ethically, are entitled to know,” he said. “For 60 or 70 years, we relied so much on third-party payment that people just got away from needing or wanting to know the price of something. But there are people who are going to be paying cash, whether they are uninsured or carry a big deductible.”
Still, Smith is working with Woodbury and the Maine Hospital Association to amend the law. Another bill by Woodbury, accepted into the truncated second legislative session, will be the vehicle for those amendments. Efforts to contact Woodbury on Tuesday were unsuccessful.
One of the provisions the trio hope to change is the requirement that practitioners provide complete lists of all services conducted more than 50 times annually.
Jeff Austin, lobbyist for MHA, said such a comprehensive list would include a lot of information that one patient wouldn’t need, and could risk overwhelming someone in the vulnerable position of being uninsured and needing medical care.
“The goal is to get people information about their own care,” he said. “If you’re going to get your tonsils out, you don’t need to see the price of back surgery. The codes associated with your own care are more to the patient than a list of codes that have nothing to do with their care. We don’t want to confuse people.”
Why Are Americans Spending More on Healthcare Than Any Other Nation, While Getting Lower-Quality Care?
December 6, 2013 |
The following is an excerpt from Dr. Elizabeth H. Bradley and Lauren A. Taylor's new book, The American Health Care Paradox: Why Spending More is Getting Us Less(Perseus Books [4], 2013).
Joe is a twenty-eight-year-old man with type 1 diabetes, living in the United States. He lacks permanent housing and has been staying in a friend’s condemned, boarded-up house. To avoid being seen there, Joe enters through the marshlands behind the house. His shoes are full of holes, but he cannot afford to replace them. Joe’s diet has similarly suffered from his lack of income; he some- times goes several days without fresh food, which negatively af- fects his diabetes. Also, after a lifetime of poor insulin control, he is starting to lose circulation in his feet. Last year, Joe had two toes removed on his right foot to save his life (hospital cost: $7,132). Still, neuropathy continues to cause him decreased sensitivity in and increased risk of trauma to his feet. The doctor he last saw emphasized the importance of keeping his feet dry, getting proper nutrition, and taking his costly insulin as prescribed, all of which Joe is eager to do. Since that appointment, Joe has been diligent in taking his insulin, but dry feet and proper nutrition remain dif- ficult to achieve due to his living conditions and unemployment. His doctor has already raised the issue of having to have more toes removed on his left foot (cost: $14,430), and without immediate changes, Joe will need to have a below-the-knee amputation in the years ahead (cost: $17,347) and will likely need a wheelchair (cost: $1,042). The estimated cost of his medical expenses will top $30,000, paid by a state medical assistance program that is funded by taxpayers. Amid a system marked by the most advanced medical treatment in the world, Joe is dying a slow, painful, and expensive death. A decent pair of shoes costs $50.
We begin with the true story of a young man living in the United States. While that story may sound like the basis of a Hollywood plot, we encountered similar stories throughout our research on the American health care system. It goes without saying that Joe needs more than a good pair of shoes to improve his health; he also needs accessible shelter and nutritious food. But the cost of these interventions still pale compared with $30,000 in medical treatment he is currently on track to accrue in the coming years. Furthermore, shelter, food, and shoes might enable him to return to work and not suffer a lifetime dependent on a wheelchair. Joe, and many others like him, illustrate how inadequate attention to social services and supports can lead to exorbitant health care expenses. We confront the consequences of this imbalance experienced by people across the income spectrum. Joe’s is one story, which, replicated across the country, begins to unravel the paradox that has perplexed policymakers for decades: How is it that the United States spends more per capita than any other nation on health care, while Americans fare worse in many measures of health?
December 6, 2013 |
The following is an excerpt from Dr. Elizabeth H. Bradley and Lauren A. Taylor's new book, The American Health Care Paradox: Why Spending More is Getting Us Less(Perseus Books [4], 2013).
Joe is a twenty-eight-year-old man with type 1 diabetes, living in the United States. He lacks permanent housing and has been staying in a friend’s condemned, boarded-up house. To avoid being seen there, Joe enters through the marshlands behind the house. His shoes are full of holes, but he cannot afford to replace them. Joe’s diet has similarly suffered from his lack of income; he some- times goes several days without fresh food, which negatively af- fects his diabetes. Also, after a lifetime of poor insulin control, he is starting to lose circulation in his feet. Last year, Joe had two toes removed on his right foot to save his life (hospital cost: $7,132). Still, neuropathy continues to cause him decreased sensitivity in and increased risk of trauma to his feet. The doctor he last saw emphasized the importance of keeping his feet dry, getting proper nutrition, and taking his costly insulin as prescribed, all of which Joe is eager to do. Since that appointment, Joe has been diligent in taking his insulin, but dry feet and proper nutrition remain dif- ficult to achieve due to his living conditions and unemployment. His doctor has already raised the issue of having to have more toes removed on his left foot (cost: $14,430), and without immediate changes, Joe will need to have a below-the-knee amputation in the years ahead (cost: $17,347) and will likely need a wheelchair (cost: $1,042). The estimated cost of his medical expenses will top $30,000, paid by a state medical assistance program that is funded by taxpayers. Amid a system marked by the most advanced medical treatment in the world, Joe is dying a slow, painful, and expensive death. A decent pair of shoes costs $50.
We begin with the true story of a young man living in the United States. While that story may sound like the basis of a Hollywood plot, we encountered similar stories throughout our research on the American health care system. It goes without saying that Joe needs more than a good pair of shoes to improve his health; he also needs accessible shelter and nutritious food. But the cost of these interventions still pale compared with $30,000 in medical treatment he is currently on track to accrue in the coming years. Furthermore, shelter, food, and shoes might enable him to return to work and not suffer a lifetime dependent on a wheelchair. Joe, and many others like him, illustrate how inadequate attention to social services and supports can lead to exorbitant health care expenses. We confront the consequences of this imbalance experienced by people across the income spectrum. Joe’s is one story, which, replicated across the country, begins to unravel the paradox that has perplexed policymakers for decades: How is it that the United States spends more per capita than any other nation on health care, while Americans fare worse in many measures of health?
Common Knee Surgery Does Very Little for Some, Study Suggests
By PAM BELLUCK
A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports.
The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion.
The study, conducted in Finland, involved a small subset of meniscal tears. But experts, including some orthopedic surgeons, said the study added to other recent research suggesting that meniscal surgery should be aimed at a narrower group of patients; that for many, options like physical therapy may be as good.
The surgery, arthroscopic partial meniscectomy, involves small incisions. They are to accommodate the arthroscope, which allows doctors to see inside, and for tools to trim torn meniscus and to smooth ragged edges of what remains.
The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.
“Those who do research have been gradually showing that this popular operation is not of very much value,” said Dr. David Felson, a professor of medicine and epidemiology at Boston University. This study “provides information beautifully about whether the surgery that the orthopedist thinks he or she is doing is accomplishing anything. I think often the answer is no.”
A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports.
The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion.
The study, conducted in Finland, involved a small subset of meniscal tears. But experts, including some orthopedic surgeons, said the study added to other recent research suggesting that meniscal surgery should be aimed at a narrower group of patients; that for many, options like physical therapy may be as good.
The surgery, arthroscopic partial meniscectomy, involves small incisions. They are to accommodate the arthroscope, which allows doctors to see inside, and for tools to trim torn meniscus and to smooth ragged edges of what remains.
The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.
“Those who do research have been gradually showing that this popular operation is not of very much value,” said Dr. David Felson, a professor of medicine and epidemiology at Boston University. This study “provides information beautifully about whether the surgery that the orthopedist thinks he or she is doing is accomplishing anything. I think often the answer is no.”
E.R. Costs for Mentally Ill Soar, and Hospitals Seek Better Way
By JULIE CRESWELL
RALEIGH, N.C. — As darkness fell on a Friday evening over downtown Raleigh, N.C., Michael Lyons, a paramedic supervisor for Wake County Emergency Medical Services, slowly approached the tall, lanky man who was swaying back and forth in a gentle rhythm.
In answer to Mr. Lyons’s questions, the man, wearing a red shirt that dwarfed his thin frame, said he was bipolar, schizophrenic and homeless. He was looking for help because he did not think his prescribed medication was working.
In the past, paramedics would have taken the man to the closest hospital emergency room — most likely the nearby WakeMed Health and Hospitals, one of the largest centers in the region. But instead, under a pilot program, paramedics ushered him through the doors of Holly Hill Hospital, a commercial psychiatric facility.
“He doesn’t have a medical complaint, he’s just a mental health patient living on the street who is looking for some help,” said Mr. Lyons, pulling his van back into traffic. “The good news is that he’s not going to an E.R. That’s saving the hospital money and getting the patient to the most appropriate place for him,” he added.
The experiment in Raleigh is being closely watched by other cities desperate to find a way to help mentally ill patients without admitting them to emergency rooms, where the cost of treatment is high — and unnecessary.
While there is evidence that other types of health care costs might be declining slightly, the cost of emergency room care for the mentally ill shows no sign of ebbing.
Nationally, more than 6.4 million visits to emergency rooms in 2010, or about 5 percent of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse. That is up 28 percent from just four years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, Md.
By one federal estimate, spending by general hospitals to care for these patients is expected to nearly double to $38.5 billion in 2014, from $20.3 billion in 2003.
RALEIGH, N.C. — As darkness fell on a Friday evening over downtown Raleigh, N.C., Michael Lyons, a paramedic supervisor for Wake County Emergency Medical Services, slowly approached the tall, lanky man who was swaying back and forth in a gentle rhythm.
In answer to Mr. Lyons’s questions, the man, wearing a red shirt that dwarfed his thin frame, said he was bipolar, schizophrenic and homeless. He was looking for help because he did not think his prescribed medication was working.
In the past, paramedics would have taken the man to the closest hospital emergency room — most likely the nearby WakeMed Health and Hospitals, one of the largest centers in the region. But instead, under a pilot program, paramedics ushered him through the doors of Holly Hill Hospital, a commercial psychiatric facility.
“He doesn’t have a medical complaint, he’s just a mental health patient living on the street who is looking for some help,” said Mr. Lyons, pulling his van back into traffic. “The good news is that he’s not going to an E.R. That’s saving the hospital money and getting the patient to the most appropriate place for him,” he added.
The experiment in Raleigh is being closely watched by other cities desperate to find a way to help mentally ill patients without admitting them to emergency rooms, where the cost of treatment is high — and unnecessary.
While there is evidence that other types of health care costs might be declining slightly, the cost of emergency room care for the mentally ill shows no sign of ebbing.
Nationally, more than 6.4 million visits to emergency rooms in 2010, or about 5 percent of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse. That is up 28 percent from just four years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, Md.
By one federal estimate, spending by general hospitals to care for these patients is expected to nearly double to $38.5 billion in 2014, from $20.3 billion in 2003.
2 States May Seek Refunds From Health Site Creator
By RICK LYMAN
Two states that hired the same lead contractor to build their online marketplaces for health insurance under President Obama’s Affordable Care Act have experienced so many problems and delays that they are threatening to withhold millions of dollars in payments to the company and even seek refunds.
Massachusetts health officials said they will meet in early January to decide whether to suspend payments to the company, CGI Federal, which has also been criticized — and questioned during a congressional hearing — for its central role in building the problem-plagued federal health insurance exchange. The state may also seek a refund from the firm, which is an American subsidiary of the Canadian-based CGI Group.
Already, Vermont has refused to pay $5.1 million of its contract with the company and is trying to get hundreds of thousands of dollars refunded. The two states’ problems with CGI were reported by The Boston Globe.
Under the Affordable Care Act, eligible Americans who do not have health insurance through their workplace or another source can sign up for coverage through a health care exchange that will provide a menu of options and information on subsidies. Open enrollment runs through March; those who have not signed up by then could face penalties.
Fourteen states, including Massachusetts and Vermont, created their own online marketplaces, and the rest depend on the exchange operated by the federal government.
While the federal site had a rocky rollout on Oct. 1, several of the state exchanges also stumbled. In Hawaii, the site created by CGI performed so poorly that the head of the exchange stepped down this month. Other exchanges — including Kentucky’s and California’s, on which CGI worked as a subcontractor — have performed relatively well.
Two states that hired the same lead contractor to build their online marketplaces for health insurance under President Obama’s Affordable Care Act have experienced so many problems and delays that they are threatening to withhold millions of dollars in payments to the company and even seek refunds.
Massachusetts health officials said they will meet in early January to decide whether to suspend payments to the company, CGI Federal, which has also been criticized — and questioned during a congressional hearing — for its central role in building the problem-plagued federal health insurance exchange. The state may also seek a refund from the firm, which is an American subsidiary of the Canadian-based CGI Group.
Already, Vermont has refused to pay $5.1 million of its contract with the company and is trying to get hundreds of thousands of dollars refunded. The two states’ problems with CGI were reported by The Boston Globe.
Under the Affordable Care Act, eligible Americans who do not have health insurance through their workplace or another source can sign up for coverage through a health care exchange that will provide a menu of options and information on subsidies. Open enrollment runs through March; those who have not signed up by then could face penalties.
Fourteen states, including Massachusetts and Vermont, created their own online marketplaces, and the rest depend on the exchange operated by the federal government.
While the federal site had a rocky rollout on Oct. 1, several of the state exchanges also stumbled. In Hawaii, the site created by CGI performed so poorly that the head of the exchange stepped down this month. Other exchanges — including Kentucky’s and California’s, on which CGI worked as a subcontractor — have performed relatively well.
With Health Law Cemented, G.O.P. Debates Next Move
By JONATHAN WEISMAN
WASHINGTON — With the first enrollment deadline now passed, Republicans who have made the repeal of President Obama’s health care law their central aim are confronting a new reality: More than two million Americans are expected to be getting their health insurance through the Affordable Care Act come Jan. 1.
The enrollment figures may be well short of what the Obama administration had hoped for. But the fact that a significant number of Americans are now benefiting from the program is resulting in a subtle shift among Republicans.
“It’s no longer just a piece of paper that you can repeal and it goes away,” said Senator Ron Johnson, Republican of Wisconsin and a Tea Party favorite. “There’s something there. We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare.”
And that underscores a central fact of American politics since Franklin D. Roosevelt signed the Social Security Act during the Depression: Once a benefit has been bestowed, it is nearly impossible to take it away.
Republicans are considering several ideas for how to proceed. Mr. Johnson argued that Congress should do away with the mandate that most people obtain insurance, but not the online exchanges at the heart of the law. Instead, he said, the options in the marketplaces should be augmented by other choices that fall short of the law’s coverage standards, such as catastrophic health plans. (Many policy analysts and insurance companies say such a move would not work, because the mandates are essential to delivering a diverse pool of uninsured people.)
Senator Lindsey Graham, Republican of South Carolina, said that health care strategy was the hottest topic of debate in closed-door political sessions.
“The hardest problem for us is what to do next,” Mr. Graham said. “Should we just get out of the way and point out horror stories? Should we come up with a mini Contract With America on health care, or just say generally if you give us the Congress, the House and the Senate in 2014, here’s what we will do for you on multiple issues including health care? You become a more effective critic when you say, ‘Here’s what I’m for,’ and we’re not there yet. So there’s our struggle.”
WASHINGTON — With the first enrollment deadline now passed, Republicans who have made the repeal of President Obama’s health care law their central aim are confronting a new reality: More than two million Americans are expected to be getting their health insurance through the Affordable Care Act come Jan. 1.
The enrollment figures may be well short of what the Obama administration had hoped for. But the fact that a significant number of Americans are now benefiting from the program is resulting in a subtle shift among Republicans.
“It’s no longer just a piece of paper that you can repeal and it goes away,” said Senator Ron Johnson, Republican of Wisconsin and a Tea Party favorite. “There’s something there. We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare.”
And that underscores a central fact of American politics since Franklin D. Roosevelt signed the Social Security Act during the Depression: Once a benefit has been bestowed, it is nearly impossible to take it away.
Republicans are considering several ideas for how to proceed. Mr. Johnson argued that Congress should do away with the mandate that most people obtain insurance, but not the online exchanges at the heart of the law. Instead, he said, the options in the marketplaces should be augmented by other choices that fall short of the law’s coverage standards, such as catastrophic health plans. (Many policy analysts and insurance companies say such a move would not work, because the mandates are essential to delivering a diverse pool of uninsured people.)
Senator Lindsey Graham, Republican of South Carolina, said that health care strategy was the hottest topic of debate in closed-door political sessions.
“The hardest problem for us is what to do next,” Mr. Graham said. “Should we just get out of the way and point out horror stories? Should we come up with a mini Contract With America on health care, or just say generally if you give us the Congress, the House and the Senate in 2014, here’s what we will do for you on multiple issues including health care? You become a more effective critic when you say, ‘Here’s what I’m for,’ and we’re not there yet. So there’s our struggle.”
Hospice firms draining billions from Medicare
By Peter Whoriskey and Dan Keating, Published: December 26
Hospice patients are expected to die: The treatment focuses on providing comfort to the terminally ill, not finding a cure. To enroll a patient, two doctors certify a life expectancy of six months or less.
But over the past decade, the number of “hospice survivors” in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer.
The proportion of patients who were discharged alive from hospice care rose about 50 percent between 2002 and 2012, according to a Post analysis of more than 1 million hospice patients’ records over 11 years in California, a state that makes public detailed descriptions and that, by virtue of its size, offers a portrait of the industry.
The average length of a stay in hospice care also jumped substantially over that time, in California and nationally, according to the analysis. Profit per patient quintupled, to $1,975, California records show.
This vast growth took place as the hospice “movement,” once led by religious and community organizations, was evolving into a $17 billion industry dominated by for-profit companies. Much of that is paid for by the U.S. government — roughly $15 billion of industry revenue came from Medicare last year.
At AseraCare, for example, one of the nation’s largest for-profit chains, hospice patients kept on living. About 78 percent of patients who enrolled at the Mobile, Ala., branch left the hospice’s care alive, according to company figures. As many as 59 percent of patients left the AseraCare branch in nearby Foley, Ala., alive. And at the one in Monroeville, 48 percent were discharged from the hospice alive.
“It was definitely good news,” said Bessie Blount, whose father received hospice care from the Monroeville outfit and left after about a year, she said.
About three years later, her father, Chocolate Blount, 91, is still alive.
“He has good days and bad days,” she said.
Hospice patients are expected to die: The treatment focuses on providing comfort to the terminally ill, not finding a cure. To enroll a patient, two doctors certify a life expectancy of six months or less.
But over the past decade, the number of “hospice survivors” in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer.
The proportion of patients who were discharged alive from hospice care rose about 50 percent between 2002 and 2012, according to a Post analysis of more than 1 million hospice patients’ records over 11 years in California, a state that makes public detailed descriptions and that, by virtue of its size, offers a portrait of the industry.
The average length of a stay in hospice care also jumped substantially over that time, in California and nationally, according to the analysis. Profit per patient quintupled, to $1,975, California records show.
This vast growth took place as the hospice “movement,” once led by religious and community organizations, was evolving into a $17 billion industry dominated by for-profit companies. Much of that is paid for by the U.S. government — roughly $15 billion of industry revenue came from Medicare last year.
At AseraCare, for example, one of the nation’s largest for-profit chains, hospice patients kept on living. About 78 percent of patients who enrolled at the Mobile, Ala., branch left the hospice’s care alive, according to company figures. As many as 59 percent of patients left the AseraCare branch in nearby Foley, Ala., alive. And at the one in Monroeville, 48 percent were discharged from the hospice alive.
“It was definitely good news,” said Bessie Blount, whose father received hospice care from the Monroeville outfit and left after about a year, she said.
About three years later, her father, Chocolate Blount, 91, is still alive.
“He has good days and bad days,” she said.
By John Whitesides
Related Stories
- Analysis: How the White House is rebranding Obamacare for 'young invincibles' Reuters
- Obamacare signup deadline pushed back to Tuesday Reuters
- The Obamacare Delays Just Keep on ComingThe Fiscal Times
- HealthCare.gov's Sickly Launch Defined Bad IT Projects in 2013 The Wall Street Journal
- Obama goes "bronze" in symbolic healthcare signup Reuters
WASHINGTON (Reuters) - Tuesday is a moment of truth for Obamacare.
It marks the final deadline for most Americans to sign up for health insurance under President Barack Obama's 2010 Affordable Care Act, popularly known as Obamacare, if they want coverage starting on January 1.
If enough people - and the right mix of young and old - do not enroll, the ambitious program designed to provide health benefits to millions of uninsured and under-insured Americans risks eventually unraveling.
The deadline caps a turbulent roll-out this year for Obamacare and the HealthCare.gov website that is key to enrolling millions of people in the initiative. The website crashed upon its launch on October 1, frustrating users trying to shop for insurance plans. It now is functioning much better, but is still not at 100 percent.
Despite the continuing problems, the administration is expressing confidence that Obamacare is getting back on track after enrollment accelerated in December, with more than 1 million people signing up for private insurance.
Here is a look at some notable moments in the months leading up to Obamacare's troubled launch.
By John Whitesides
Related Stories
- Analysis: How the White House is rebranding Obamacare for 'young invincibles' Reuters
- Obamacare signup deadline pushed back to Tuesday Reuters
- The Obamacare Delays Just Keep on ComingThe Fiscal Times
- HealthCare.gov's Sickly Launch Defined Bad IT Projects in 2013 The Wall Street Journal
- Obama goes "bronze" in symbolic healthcare signup Reuters
WASHINGTON (Reuters) - Tuesday is a moment of truth for Obamacare.
It marks the final deadline for most Americans to sign up for health insurance under President Barack Obama's 2010 Affordable Care Act, popularly known as Obamacare, if they want coverage starting on January 1.
If enough people - and the right mix of young and old - do not enroll, the ambitious program designed to provide health benefits to millions of uninsured and under-insured Americans risks eventually unraveling.
The deadline caps a turbulent roll-out this year for Obamacare and the HealthCare.gov website that is key to enrolling millions of people in the initiative. The website crashed upon its launch on October 1, frustrating users trying to shop for insurance plans. It now is functioning much better, but is still not at 100 percent.
Despite the continuing problems, the administration is expressing confidence that Obamacare is getting back on track after enrollment accelerated in December, with more than 1 million people signing up for private insurance.
Here is a look at some notable moments in the months leading up to Obamacare's troubled launch.
WASHINGTON (Reuters) - Tuesday is a moment of truth for Obamacare.
It marks the final deadline for most Americans to sign up for health insurance under President Barack Obama's 2010 Affordable Care Act, popularly known as Obamacare, if they want coverage starting on January 1.
If enough people - and the right mix of young and old - do not enroll, the ambitious program designed to provide health benefits to millions of uninsured and under-insured Americans risks eventually unraveling.
The deadline caps a turbulent roll-out this year for Obamacare and the HealthCare.gov website that is key to enrolling millions of people in the initiative. The website crashed upon its launch on October 1, frustrating users trying to shop for insurance plans. It now is functioning much better, but is still not at 100 percent.
Despite the continuing problems, the administration is expressing confidence that Obamacare is getting back on track after enrollment accelerated in December, with more than 1 million people signing up for private insurance.
Here is a look at some notable moments in the months leading up to Obamacare's troubled launch.
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