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Wednesday, May 14, 2014

Health Care Reform Articles - May 14, 2014

Ignoring a Solution to Chronic Drug Shortages

Monday, 12 May 2014 09:01By T.J. Lewan, Remapping Debate | News Analysis
Since shortages of critical drugs became a fixture of the American medical landscape a decade ago, pundits have proposed an array of incentives to encourage more production from pharmaceutical companies. But an obvious alternative or supplement — having the government manufacture the drugs — appears not to have made it to anyone’s list.
A factory designed, built and run by Uncle Sam could manufacture drugs in short supply — not least the older, low-profit but still highly effective generic medications that drug makers cannot, or simply will not, produce. And yet, when Remapping Debate raised the possibility, the initial reactions of economists, physicians, industry analysts, and others ranged from stammering, chuckling and long, sometimes awkward, pauses, to bewilderment and shock.

Several people we interviewed struggled to explain their reservations by pointing out that the government has no experience in medicine making. Some flatly rejected the idea because, in their view, it was a long shot to gain political traction. Others said the concept gave them pause because it ran afoul of their beliefs of how a free market system ought to operate.
There were those who said a government entry into the generics business might destabilize the markets and send prices for all drugs soaring. (No evidence of this was forthcoming, and several people who said this later altered their opinion, saying the idea had potential.)
No one we reached out to in a position of authority — including at the FDA, Centers for Disease Control, or the National Institutes of Health — gave any hint that they were considering these questions or giving any thought as to how a federal drug factory could work.
But there were also those who — after first inquiring if we were serious — wholeheartedly endorsed the merits of a state drug-manufacturing capability.
Reversing Government "De-industrialization"
The idea that governments would manufacture drugs is not novel. In fact, governments churn out medications for citizens in 80 countries around the globe, including Brazil, India, Denmark, Thailand, and Indonesia, according to the World Health Organization; in many places public and private enterprises coexist without incident.
Stephen S. Morse, a professor of epidemiology at the Mailman School of Public Health at Columbia University, says it’s remarkable that more than a decade into what are indisputably the worst and most widespread drug shortages in American history no one has yet thought to suggest or seriously consider a government option — at the very least, to study the benefits and drawbacks of it. 
“It’s an interesting question I find rather puzzling,” says Morse, who directs a program at Columbia that specializes in risk assessment of emerging infectious diseases, including influenza. “Even the most conservative economists, the University of Chicago people and so on, have always believed that the one legitimate role for government — they do not admit to any others — is to take up the slack when there are market failures. And there seems to be a market failure here.”

“And yet,” he adds, “no one thinks to have government take an active role in this case, which is interesting because, if there is a market failure going on, as there clearly is, who is supposed to step in — foreign manufacturers?”
Since the 1980s, the U.S. government has increasingly moved away from manufacturing anything — what some call the “de-industrialization” of government. Not long ago, however, the federal government was an active and effective player in the production of things needed to keep citizens healthy.
For decades after World War II, public agencies and institutes produced vaccines for biological threats, substances “which are harder to make because you have to do a lot of work on clinical trials as well as safety,” Morse says. The Salk Institute-Government Services Division once made specialty, bio-defense vaccines for things like Rift Valley fever, a mosquito-borne illness, and states like Michigan and New York made serums for smallpox, anthrax, and whooping cough, before leaving it to industry in the 1990s.

http://truth-out.org/news/item/23635-ignoring-a-solution-to-chronic-drug-shortages



More Insured, but the Choices Are Narrowing

By 
In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.
These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.
Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s.
“We have to break people away from the choice habit that everyone has,” said Marcus Merz, the chief executive of PreferredOne, an insurer in Golden Valley, Minn., that is owned by two health systems and a physician group. “We’re all trying to break away from this fixation on open access and broad networks.”
But while there is evidence that consumers are willing to sacrifice some choice in favor of lower prices, many critics, including political opponents of the new health care law, remain wary about narrowing networks. A concern is that insurers will limit access to specialists or certain hospitals. “Too often, Obamacare cancels the policy you wanted to keep and tells you what policy to buy,” Senator Lamar Alexander, a Tennessee Republican, said in a speech in April.
http://www.nytimes.com/2014/05/13/business/more-insured-but-the-choices-are-narrowing.html?hp&_r=0&assetType=nyt_now

Moving Against Heart Disease

By NICHOLAS BAKALAR
 

In women over 30, physical inactivity may be the greatest single contributor to heart disease risk.
Researchers followed 32,154 Australian women in three age groups: those born in 1973-1978, 1946-1951 and 1921-1926. They used a mathematical formula called population attributable risk, or P.A.R., that indicates the percentage reduction in disease that would be achieved in a given population if exposure to a specific risk were eliminated. The study was published online last week in The British Journal of Sports Medicine.
They found that the importance of the most common risk factors for heart disease — smoking, high blood pressure, physical inactivity and excess weight — varies with age.
In women under age 30, for example, the greatest contributor to heart disease is smoking. Stopping smoking would reduce the risk of heart disease in this group twice as effectively as reducing high body mass index.
But for women in their 70s, being physically active would lower the P.A.R. almost three times as much as smoking cessation, and significantly more than reducing blood pressure or achieving a healthy body weight.
“It’s a heads-up for women in their 30s, 40s, 50s to get moving,” said the lead author, Wendy J. Brown, a professor of health at the University of Queensland. “And if they are moving, to move more.”
http://well.blogs.nytimes.com/2014/05/12/moving-against-heart-disease/?_php=true&_type=blogs&emc=edit_hh_20140513&nl=health&nlid=1311158&_r=0

Harvard: Overused Medical Services Cost Medicare Billions

By Jordan Rau
MAY 12TH, 2014, 4:05 PM
Medical overtreatment is the inverse of former Supreme Court Justice Potter Stewart’s definition of pornography: while easy to define in concept, it can be hard to know it when you see it.
A treatment that is appropriate for one patient can also be unnecessary or even counterproductive for another, depending on the patient’s condition. This has been a major obstacle for studies seeking to pinpoint overused services, which by the most expansive estimates may account for as much as a third of the nation’s health spending.
Using a novel method, a study released Monday by researchers from the Harvard Medical School Department of Health Care Policy evaluated the prevalence in Medicare of 26 tests and procedures that have been found to offer little or no clinical benefit. The services were mostly culled from mainstream lists, including studies in medical journals, the Choosing Wisely campaign and theU.S. Preventive Services Task Force. The procedures included a form of back surgery in which collapsed spinal disks are filled with cement, as well as CT scans or MRIs on people with headaches.
The study in the journal JAMA Internal Medicine concluded that at least one in four Medicare beneficiaries received one of these 26 “low-value” services during 2009, and possibly significantly more. Two of the researchers, Aaron Schwartz and Dr. J. Michael McWilliams, said in an interview the total number of unnecessary treatments was surely higher, since their study encompassed just 26 tests and procedures.
“There are hundreds of other low-value services,” said McWilliams, a Harvard professor.

Hospitals’ Purchase Of Doctors Leads To Higher Prices, Spending, Study Finds

By Phil Galewitz
MAY 5TH, 2014, 4:00 PM
A new study gives ammunition to what health economists and health insurers have argued for years: When hospitals buy physician practices, the result is usually higher hospital prices and increased spending by privately insured patients.
The study, published Monday in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007.  The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians.
Hospitals have increasingly bought physician practices over the past decade, arguing it helps them coordinate care and control costs. But insurers and many economists say hospitals’ main motivation is negotiating higher prices with insurers and building referrals to grow admissions.
The Affordable Care Act has accelerated the trend by encouraging the establishment of Medicare accountable care organizations that pay large groups of providers based on how well they control costs and improve quality.
The Federal Trade Commission has been watching the growing collaborations between hospitals and physicians, and until now has intervened to stop them only when one organizations controls so many physicians in one community that it is considered anti-competitive. Experts say the Stanford study could give the FTC ammunition to more closely examine and potentially block future hospital purchases.
Do Seniors Have Too Many Medicare Plans To Choose From?
By Phil Galewitz
MAY 14TH, 2014, 5:00 AMMost seniors face a dizzying array of options each year when it comes time to choose a Medicare health or prescription drug plan. Beneficiaries can select from an average of 18 health plans and 31 prescription drug plans. In South Florida, they have 88 plan choices altogether.

While choice may sound like a good thing, many seniors say they find it difficult to compare plans. As  a result, they often stick with the same plan even if it is not best suited to them, according to a new report from the Kaiser Family Foundation based on conversations with beneficiaries in Memphis, Tennessee; Tampa, Florida; Baltimore; and Seattle. (Kaiser Health News is an editorially independent program of the foundation.)
Many seniors said they did not want to switch plans because the process was so frustrating, the report said. That can cost them money because companies change prices and benefits almost every year.
At a briefing on the report Tuesday, Barry Schwartz, a psychology professor at Swarthmore College and author of the book, “Paradox of Choice,” explained that older people tend to make choices that are “good enough,” while younger people often search for the “perfect” choice.
But Judith Stein, executive director of the Center for Medicare Advocacy, a consumer advocacy group, said that Medicare beneficiaries sometimes find that a health plan that is “good enough” when they are healthy does not meet their needs when they are sick. That’s because a plan may not include coverage for the hospital or doctor they want, or may charge too much for the drug their doctor recommends.

Brew Pub Owner Frustrated That Health Plan Prices Still Jumping

By SARAH JANE TRIBBLE, IDEASTREAM
MAY 14, 2014

Paul Siperke is the co-owner of Fat Head's, a popular brew pub in Cleveland. He has fewer than 50 full-time employees, so he's classified under the Affordable Care Act as a small business. 

He doesn't have to provide health insurance to his employees, but that's what he's been doing since the bar opened in 2009, despite some pretty dramatic volatility in rates.
"They just seemed to keep going up every year," he says. "One year we got a 38 percent increase, another year we got 11. One year we got three."

This year, under the Affordable Care Act, he saw another hike — this one about 20 percent.

"It just seems odd that we get such a drastic price increase when nothing has really changed with us as far as our employees and health issues," he says.
Most of the workers at Fat Head's are in their 20s and 30s. They are healthy, enthusiastic about their jobs and grateful for health coverage.

Until now, if employees were healthy and claims were few (as they are at Fat Head's), the company's cost of insuring those employees was relatively low. But, for a small business, if even one employee was in a car accident or was diagnosed with cancer, the amount the insurance company charged the firm to cover those employees could skyrocket the next year. The insurance industry called this "experience rating," and it is changing under the health law, says Steve Millard, who heads a small business association in Cleveland.

"If you're a really healthy company and have a really good rate relative to everybody else today, you're probably going to pay a lot more for insurance [going forward]," he says, but, "on the flip side, if you have chronic conditions and difficulties, and an older workforce and are paying a lot more, you'll probably see some benefit in health care reform."

This means more businesses will see their insurance costs go up than down, at least in the short term. The Council of Smaller Enterprises, the regional support group for small businesses that Miller heads, estimates about 20 percent of smaller companies in northeast Ohio are seeing some sort of price relief this year. The other 80 percent are getting price hikes.

Northeast Ohio is a microcosm of what is happening nationally. In February, a federal report commissioned by Congress projected that about two-thirds of small businesses across the country will see the costs of their employee health plans rise.

"The initial sticker shock that's occurring this year or next year, or the following year when plans finally have to come into ACA compliance — that's what I'm really worried about," says Kevin Kuhlman , the manager for legislative affairs at the National Federation of Independent Business. "I'm worried that small business owners will not be able to continue offering policies because the costs are too high."

Exercise ‘Snacks’ to Control Blood Sugar

May 14, 2014, 12:01 am

Multiple, brief, snack-sized portions of exercise may control blood sugar better than a single, continuous workout, according to new research that adds to a growing body of evidence about the wisdom of spreading exercise throughout the day.

For some time, scientists have been intrigued by the idea that breaking up exercise into repeated, short sessions might be as beneficial as longer workouts, and most related experiments to date have been encouraging. In a 2012 study of people with symptoms of hypertension, for instance, volunteers controlled their blood pressure better throughout the day if they completed three 10-minute walks rather than one 30-minute stroll.

But little research in this area had been directed at people with blood sugar problems. So, for the new study, published this month in Diabetologia, scientists in New Zealand recruited nine adult men and women with medically confirmed insulin resistance, a common precursor of Type 2 diabetes. The scientists checked their volunteers’ general health, aerobic capacity and blood sugar responses to food. As would be expected, the volunteers developed severely elevated blood sugar after they ate, an unhealthy condition that continued for hours.

The researchers then asked their participants to exercise in the lab on three separate occasions. During one session, the men and women walked on a treadmill at a moderate pace for 30 minutes, finishing half an hour before dinner. Their blood sugar levels were tracked that day and into the next.

On the other occasions, the volunteers broke their workouts into three, bite-size portions, which the researchers helpfully dubbed “exercise snacks,” undertaken shortly before breakfast, lunch and dinner. In one case, these snacks consisted of high-intensity intervals, with the volunteers walking as fast as they could manage for one minute on a treadmill, powering down to a gentle stroll for an additional minute, and repeating that sequence six times, for a total of 12 minutes.

In the final session, the volunteers again completed three walking intervals, but these were interspersed with a minute of high-intensity, upper-body resistance training using stretchy bands. The volunteers would walk for a minute, rest, hurry from the treadmill to the bands, perform as many pulling and wood-chopping types of exercises as possible in a minute, rest, then rush back to the treadmill to complete another walking interval. The total exercise time, again, was 12 minutes, and the sessions were repeated before each meal.

The results were striking. Physical activity of any kind is, of course, known to lower and regulate blood sugar levels, because contracting muscles draw sugar from the bloodstream to fuel their efforts. And that finding was reaffirmed here. After the 30-minute walk, the participants’ post-dinner blood sugar levels were lower than they had been in the baseline testing. But only with the two snacking-style workouts were those effects visible throughout the day, not just after dinner, and they lingered, with volunteers’ blood sugar remaining lower than during the baseline testing for about 24 hours after a day of exercise snacking.



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