Health Care Reform Articles - June 18, 2014

2014 UPDATE
MIRROR, MIRROR ON THE WALL
How the Performance of the U.S. Health Care System Compares Internationally
Karen Davis, Kristof Stremikis, David Squires, and Cathy Schoen June 2014 

ABSTRACT The United States health care system is the most expensive in the world, but comparative analyses consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in prior editions of Mirror, Mirror. The United Kingdom ranks first, followed closely by Switzerland. Since the data in this study were collected, the U.S. has made significant strides adopting health information technology and undertaking payment and delivery system reforms spurred by the Affordable Care Act. Continued implementation of the law could further encourage more affordable access and more efficient organi- zation and delivery of health care, and allow investment in preventive and population health measures that could improve the performance of the U.S. health care system. http://www.commonwealthfund.org/%7E/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf

American 'Healthcare' Exceptionalism: Highest Costs, Worst Care

New report exposes failures of for-profit system and prompts renewed calls for universal care

- Sarah Lazare, staff writer A new report reveals that the the U.S. health care system is the most expensive in the world yet delivers the worst care among 11 industrialized nations, in what critics charge is further proof that the private insurance model is broken. "The only solution is to move away from the private insurance model that keeps costs up and real care down," Drew Joy, member of the Southern Maine Workers Center,told Common Dreams. "What we need is a publicly and equitably funded universal health care system, and in order to get it we must organize for our human rights." Released on Monday by the Commonwealth Fund, the report examines Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, looking at patient and physician surveys as well as data from the Organization for Economic Co-operation and Development and the World Health Organization. The U.S.'s dismal rating is not new. The country has come in dead last every year this survey has been produced—in 2004, 2006, 2007, and 2010—with lack of access to health care, failures in equitability, and inefficiencies cited as key reasons for its latest low-ranking. In the report, the U.S. scores last in "mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60." Low-income people in the U.S., the report notes, are "much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs." One of the key reasons for this is due to a U.S. private health insurance system that saddles people with high out-of-pocket expenses and "unstable coverage" that is rarely portable and often based on employment status. "People don't deserve health care in relation to how much money they have. They deserve health care because they are human beings." "In the U.S., if you lose your job you lose insurance. If your income changes you lose eligibility. People can quickly change from being insured to uninsured," said David Squires, a co-author of the report, in an interview with Common Dreams. "There is also the issue of coverage that isn't sufficient to cover the cost of care. We talk about the under-insured—people who have health insurance but it is not enough." http://www.commondreams.org/headline/2014/06/17-4?print

Dr. Arnold Relman, ex-N.E. Journal of Medicine editor, dies at 91

Was a forceful voice in health care debate

By Bryan Marquard

  | GLOBE STAFF   JUNE 17, 2014

Eloquent and forceful on the page or the podium, Dr. Arnold Relman led the New England Journal of Medicine for more than 13 years, raising a sometimes lonely voice to warn about the dangers of for-profit medicine when many in politics and his profession raced to embrace a free market approach.

Dr. Relman also was one of the nation’s foremost writers about the rising cost of health care. Persistent to the end, he received the galleys of his final article just a few days before he died of cancer in his Cambridge home early Tuesday, on his 91st birthday.

During more than a dozen years editing the New England Journal, he expanded the reach of the august research publication and made it a forum where a rapidly evolving field’s top writers debated the day’s most important economic, ethical, and public policy issues.

Related

• 1/28: Relman on becoming a patient

“We should not allow the medical-industrial complex to distort our health care system to its own entrepreneurial ends,” he wrote in an early editorial. The response in the health care world was mixed, with some praising Dr. Relman and others suggesting he did not grasp the market forces at work.

Dr. Jerome Kassirer, who succeeded Dr. Relman as editor and is now a distinguished professor at the Tufts University School of Medicine, said that “by publishing an enormous number of important studies of the health care system, he helped to formulate the debate. In his time, there were no other strong sources that you could go to for discussion of these issues. The New England Journal was it.”

http://www.bostonglobe.com/metro/2014/06/17/arnold-relman-former-new-england-journal-medicine-editor-was-forceful-voice-health-care-debate/k4Flrz8z2xgWyilyMB555I/story.html?s_campaign=email_BG_TodaysHeadline

On Breaking One’s Neck

Arnold Relman

FEBRUARY 6, 2014 ISSUE

I am a senior physician with over six decades of experience who has observed his share of critical illness—but only from the doctor’s perspective. That changed suddenly and disastrously on the morning of June 27, 2013, ten days after my ninetieth birthday, when I fell down the stairs in my home, broke my neck, and very nearly died. Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.

As background, I should first explain that this was not my first experience as a patient. Over the years I had acquired a multitude of ailments common to the elderly, most of which were minor. However, I have a few more serious health problems, including long-standing atrial fibrillation (an irregularity of my heart rhythm) that requires the daily administration of warfarin, an anticoagulant drug, to prevent the formation of blood clots inside my heart. More recently, I developed aortic stenosis, a slowly progressive narrowing of the heart valve that controls the outflow of blood into the aorta. So far, it has not caused any cardiovascular symptoms, but it could do so at any time.

http://www.nybooks.com/articles/archives/2014/feb/06/on-breaking-ones-neck/

How Health Care Systems Stack Up

By THE EDITORIAL BOARDJUNE 16, 2014

Britain and Switzerland were top scorers in a study examining the quality and efficiency of health care systems in 11 advanced nations by a leading American research organization. As usual, the United States finished last over all and last on several important measures of cost and health outcomes, despite having the most costly system in the world.

The analysis was performed by the Commonwealth Fund, a nonprofit institution that specializes in health care issues. It is based on three international surveys conducted in 2011, 2012 and 2013 of how doctors and patients view medical practices in their health systems and on data gathered by the World Health Organization and the Organization for Economic Cooperation and Development.

The poor results for the United States reflect the high cost of its medical care and the absence of universal health insurance, a situation being addressed by the Affordable Care Act. The federal law is already increasing the number of Americans with health coverage and will substantially cut the number of uninsured in coming years. Other advanced nations are far ahead in the game because they have long had universal health coverage and promoted strong ties between patients and doctors.

The United States ranked last on measures involving the cost of care, the efficiency of delivering it (too many duplicate tests, avoidable emergency room visits, and administrative hassles), and the fairness of its system (lower-income Americans go without care more often than their counterparts in other countries). It also ranked last on indicators of healthy lives as measured by infant mortality, healthy life expectancy at age 60 and deaths that might have been avoided through medical care.

In this category, Britain also did poorly; France, Sweden and Switzerland led the pack. The best American showing was third in delivering preventive care and providing recommended tests and treatments for the chronically ill.

http://www.nytimes.com/2014/06/17/opinion/how-health-care-systems-stack-up.html?emc=edit_tnt_20140616&nlid=1311158&tntemail0=y&_r=0

Lawmakers urge Medicare coverage for cancer test

By Hope Yen

  | ASSOCIATED PRESS   JUNE 18, 2014

WASHINGTON — More than 130 lawmakers are urging the Obama administration to expand coverage for a lung cancer test under Medicare that could cost the program billons, calling the screening important for vulnerable seniors.

In a letter to the Centers for Medicare and Medicaid Services, the lawmakers called for a timely decision on coverage for low-dose CT scans for older patients at higher risk of developing lung cancer.

The US Preventive Services Task Force last December recommended the test for people ages 55 through 79 who smoked a pack of cigarettes a day for 30 years, or the equivalent. That’s about 10 million Americans. The low-dose CT scan will be covered by private insurance as required by the Affordable Care Act with no copays, beginning Jan. 1.

But the new health care law does not require Medicare to cover the screenings, which cost $100 to as much as $400. The Centers for Medicare and Medicaid Services is reviewing the proposal, with a preliminary decision expected by November.

‘‘Americans pay into Medicare throughout their working lives and deserve to have access to potentially life-saving evidence-based screenings that can prevent further health costs down the road,’’ according to the letter sent this month.

The letter was led by Representatives Jim Renacci, Republican of Ohio; Charles Boustany, Republican of Louisiana; John Barrow, Democrat of Georgia; and Richard Neal, Democrat of Massachusetts. It was signed by 130 other lawmakers.

A Centers for Medicare and Medicaid Services spokesman said the agency’s decision will be based on whether the test is ‘‘reasonable and necessary,’’ without regard to its cost to Medicare. He declined additional comment until the agency responds to lawmakers.

http://www.bostonglobe.com/news/nation/2014/06/17/lawmakers-urge-medicare-coverage-for-cancer-test/q7bW6xngoW3phVXd4dBQWM/story.html?s_campaign=email_BG_TodaysHeadline

She Wasn’t Called ‘Sleepless Beauty’

Want a Good Night’s Sleep? Make a Plan.

JUNE 17, 2014

Dr. Amy Wechsler, a New York dermatologist, recently had a patient walk into her office and point to a wrinkle that had not been there a week before.

“I asked what had changed in her life, and sure enough, she hadn’t been sleeping,” Dr. Wechsler said.

Beauty is sleep; sleep, beauty. But in our harried multitasking worlds, sleep, like truth, can sometimes be compromised.

Dr. Wechsler, the author of “The Mind-Beauty Connection,” said that there’s no quick fix to getting enough sleep, only a slow, mindful one.

“There has to be a plan, you have to slow down,” she said. For those who are on the fast track and desperate to look rested, Botox between the eyebrows can help fake it in the short term, she said, but it does not address the root of the problem.

Nor do sleep aids like Zolpidem (found in Ambien), which can be easy to abuse and hazardous to your health. The main issue for most of us, according to Michael Breus, a psychologist who calls himself the Sleep Doctor, is anxiety.

“And for that you need something to calm your brain,” he said.

http://www.nytimes.com/2014/06/19/fashion/want-a-good-nights-sleep-make-a-plan.html?emc=edit_tnt_20140617&nlid=1311158&tntemail0=y

Maine Voices: VA has issues, but its bright spots show value of Medicare-for-all system

Enhanced single-payer health insurance would save lives and money and provide high-quality care.

BRUNSWICK — Not surprisingly, columnist Steve Robinson of the Maine Heritage Policy Center has jumped onto the story of the Department of Veterans Affairs scandal to sound the alarm about “single-payer” and “socialized medicine” (“VA corruption devastating for Michaud, single-payer fans,” June 7).

As physicians and concerned citizens, we offer a more rational and reasoned perspective. The problems within the VA have in fact presented another opportunity for us to shine a light on the many benefits of an improved version of Medicare for all.

Historically, there have been long waits for care at the VA. This is not unique to the VA. Compared to the rest of Americans, eligible veterans have better access to quality health care, and in some areas the VA has been unable to recruit enough doctors and mental health professionals to keep up with demand.

This is not all the VA’s fault: There is a national shortage of primary care doctors, and there is no evidence that wait times in the private sector for primary care are any shorter. For example, a family practitioner who arrived in rural Maine last August now has a wait time of almost 11 months for new patients. Many practices in Maine and elsewhere are not accepting any new patients.

Long waits for VA care are often associated with the time it takes to determine if veterans are eligible to receive care at the VA. Not all veterans are eligible. Currently, about 2.3 million veterans and their family members are uninsured, representing about 5 percent of the 47 million medically uninsured Americans in our country today.

When people are uninsured, and don’t get the care they need, the results can be catastrophic. We have learned that an estimated 40 veterans reportedly died while waiting for VA care in Phoenix.

This is tragic. However, in Maine, more than 130,000 of our citizens lack health insurance and are unable to access health care. It is estimated that because of this, 150 Mainers will die this year.

Even more devastating, more than 46,000 Americans die every year because they cannot access the care that they need, mostly because they lack health insurance or have substandard plans. In dramatic contrast, if we were to expand and improve Medicare to cover all Americans, these “excess deaths” would be avoided.

http://www.pressherald.com/2014/06/18/maine-voices-va-has-issues-but-its-bright-spots-show-value-of-medicare-for-all-system/

Parasites, Killing Their Host

The Food Industry’s Solution to Obesity

JUNE 17, 2014

You can buy food from farmers — directly, through markets, any way you can find — and I hope you do. But unless you’re radically different from most of us, much of what you eat comes from corporations that process, market, deliver and sell “food,” a majority of which is processed beyond recognition.

The problem is that real food isn’t real profitable. “It’s hard to market fruit and vegetables without adding value,” says Marion Nestle, a professor of nutrition, food studies and public health at New York University. “If you turn a potato into a potato chip you not only make more money — you create a product with a long shelf life.” Potatoes into chips and frozen fries; wheat into soft, “enriched” bread; soybeans into oil and meat; corn into meat and a staggering variety of junk.

How do we break this cycle? You can’t blame corporations for trying to profit by any means necessary, even immoral ones: It’s their nature.

You can possibly blame them for stupidity: Even a mindless parasite knows that if it kills its host the party’s over, and by pushing products that promote “illth” — the opposite of health — Big Food is unwittingly destroying its own market. Diet-related Type 2 diabetes and cardiovascular disease disable and kill people, and undoubtedly we’ll be hearing more about nonalcoholic steatohepatitis, or NASH, an increasingly prevalent fatty liver disease that’s brought on by diet and may lead to liver failure.

Food companies are well aware of the health crisis their products cause, and recognize that the situation is unsustainable. But one theory has it that as long as even one of the big food companies remains cynical and uncaring about its market, they all must remain so.

Chief among the hopeful arguments is one that goes something like this: The first big food outfit to recognize that its future lies in creating a market for healthy and even environmentally neutral food (let’s throw in justice for workers and animal welfare while we’re at it!) may show the way to the future of healthy food as a sound business model. Some profitable corporations nibble at the edges of this already, but — as a piece in the current Harvard Business Review points out — American capitalists have become poor innovators.

Only the naïve, however, would believe that Big Food is generally working toward this. As Nestle and Michele Simon, author of “Appetite for Profit,” have been saying for years, these organizations represent not the public interest but the corporate one, and since they haven’t devised a way to improve or even maintain their bottom lines selling real food, they have to appear to be selling “better” food.

http://www.nytimes.com/2014/06/18/opinion/mark-bittmanthe-food-industrys-solution-to-obesity.html?hp&rref=opinion

Anthem's Obamacare rates to increase less than 10% in California

CHAD TERHUNE

In the strongest indication yet where Obamacare rates are headed, industry giant Anthem Blue Cross said its California premiums for individual coverage will increase less than 10% on average next year.

Health insurance rates in California during the initial rollout of the Affordable Care Act were better than expected, helping boost enrollment to 1.4 million people in the Covered California exchange.

But Anthem and some other insurers across the country had previously predicted double-digit rate hikes in 2015 that could hamper future enrollment and renewals when sign-ups start again in November.

In a speech Thursday at Town Hall Los Angeles, however, Anthem Blue Cross President Mark Morgan said Californians would fare better than that. He said the age and projected medical costs of new enrollees are in line with the company's expectations thus far.

"We will not have double-digit increases in our Covered California operations," Morgan said in his speech. "That's a good indication of how we feel about the success of our early work, because there are other parts of the country where we are hearing 20% and higher."

Anthem is the largest for-profit health insurer in California and the biggest company by enrollment in the state exchange. It's a unit of industry giant WellPoint Inc., which sells Obamacare policies in California and 13 other states.

http://www.latimes.com/business/la-fi-anthem-rates-20140613-story.html

IPC The Hospitalist defrauded Medicare and Medicaid, U.S. lawsuit says

STUART PFEIFER

The U.S. Justice Department has accused a North Hollywood healthcare company of defrauding the federal government of millions of dollars by overbilling for services its doctors performed.

In a lawsuit filed Monday in Chicago, federal lawyers said IPC The Hospitalist Co. bilked Medicare and Medicaid by billing for more expensive care than was provided.

The company assigns doctors to hospitals in 28 states, then bills insurers, including government programs, for treatment they provide. The company reported $610 million in revenue last year.

The U.S. attorney's office for the Northern District of Illinois said it was acting on complaints originally made in a whistle-blower lawsuit by Dr. Bijan Oughatiyan, a former IPC doctor.

In a 2009 lawsuit, Oughatiyan alleged that the company instructed its doctors to upcode, or bill health insurers for a higher level of care than they provided. After its own investigation, federal lawyers decided to pursue the case themselves. Oughatiyan could be entitled to a portion of the money that the government recovers from the company.

cComments

Got something to say? Start the conversation and be the first to comment.

ADD A COMMENT

0

IPC said in a statement that it would "work expeditiously toward a resolution with the Department of Justice."

"The company believes it has a strong compliance focus, and that it operates with appropriate billing policies, procedures, provider training and compliance programs and controls," IPC said in the statement. "It is not possible to predict when this matter may be resolved or what impact, if any, the outcome of this matter might have on the company's consolidated financial position."

The government's lawsuit seeks unspecified damages, but it could lead to a recovery in the tens of millions of dollars, said Matthew Organ, a Chicago attorney who represents Oughatiyan.

http://www.latimes.com/business/la-fi-ipc-medicare-overcharge-20140618-story.html

Mainers paying average of $99 in monthly premiums on exchange

Figures show that 89 percent of Mainers who signed up selected plans that the federal government helps pay for with tax credits.

AUGUSTA — Mainers who signed up for health care coverage on the federally run exchange are paying an average of $99 per month in premiums.

The U.S. Department of Health and Human Services figures released Wednesday show that 89 percent of Mainers who signed up on the exchange selected plans that the federal government helps pay for with tax credits.

The department said that the average monthly premium in Maine before credits were taken into account was $443 and fell 78 percent with the subsidy.

The average tax credit for Maine plans was $344 a month. The federal government pays the credit directly to insurers. Mainers who chose silver plans, the most common, paid an average monthly premium of $87.

More than 44,000 Mainers signed up on the exchange during open enrollment period.

http://www.pressherald.com/2014/06/18/mainers-paying-average-of-99-in-monthly-premiums-on-exchange/

Congress’ solution to fix VA scandal has little track record of working

Posted June 18, 2014, at 12:13 p.m.

At least there’s one constituency that can stir the U.S. Congress to act: the nation’s veterans.

The U.S. House and Senate last week took swift action to address the secret-waitlist scandal at the Department of Veterans Affairs. In a rare feat for today’s Congress on a major issue, the two chambers’ actions attracted nearly unanimous support.

At the core of Congress’ solution to a crisis of access in the VA health care system is allowing more veterans to access non-VA care on the VA’s dime. Both the House and Senate bills would allow veterans who live more than 40 miles from a VA hospital or clinic — a situation that applies to many Maine veterans — and veterans who have been experiencing long delays to more easily seek care outside of the VA system.

Lawmakers have pitched that provision as a short-term fix to a pervasive access problem. The House legislation, for example, allows the expanded non-VA access for only two years. But we doubt that such action will even serve as a short-term fix to the VA’s access problem.

First, as VA patients experience difficulty accessing care, many patients outside of the VA system are experiencing many of the same issues.

The consulting firm Merritt Hawkins recently surveyed wait times for doctors’ appointments in 15 large cities. The results varied widely. In the Boston area, the average wait time to see a physician was 45.2 days, compared with a low of 10.2 days in Dallas. The wait-time disparity for a family physician was even greater: In Boston, it was 66 days, compared with five days in Dallas. The cumulative average wait time for all physicians was 19.5 days.

In the VA system, the agency’s recently released access audit found that 96 percent of the time, veterans waited 30 days or less to secure an appointment time. At the Togus VA Medical Center in Maine, the rate was 99 percent.

The underlying problem is that there are too few doctors in the United States compared with its industrialized peers, and the VA has difficulty filling critical vacancies both for primary care and specialties. The Senate acknowledged this reality with its legislation, which allows the VA to devote $500 million to hiring medical staff.

The VA does have one advantage going for it when it comes to recruiting: It runs the largest clinical health care training program in the U.S.

But even if the provider shortages weren’t an issue outside of the VA, allowing VA patients to more easily seek non-VA care still wouldn’t be a compelling short-term solution. In its assessment of the Senate legislation, the Congressional Budget Office predicts the VA will have difficulty in quickly setting up a system to contract for outside health care. In addition to figuring out the mechanics, the VA needs a mechanism to ensure its patients will receive high-quality care when they are treated outside of the VA.

http://bangordailynews.com/2014/06/18/opinion/congress-solution-to-fix-va-scandal-has-little-track-record-of-working/print/