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Thursday, December 4, 2014

Health Care Reform Articles - December 4, 2014

Theater of the Macabre: U.S. Health Care in 2014

by
Donna Smith
What are we doing?  Really. What is it we are doing to one another?  Our health care system is so dysfunctional and so profit-driven that most of us have come to accept as routine the inhumane, greedy and dangerous practices many (most) providers employ when we become their widgets. 
It's a theater of the macabre, and the players on stage are you and me and every other American who finds himself or herself injured or ill and in need of medical attention.  So it was last night when my husband's blood pressure soared to dangerous levels and he felt the vague ache of the chest pain that in the past has signaled an on-coming cardiac event.  It took some convincing, but I got him to go to the emergency room shortly before midnight.
Exempla-St. Joseph's Hospital is a fine hospital in our area, and that's where we ended up.  In the emergency room, nurses wasted no time in taking my husband, Larry, to an ER bed and starting the EKG, blood work and other assessments that would help the doctors know better what was going on.  Larry was still pretty shook up but clearly a bit relieved to be in a place where if he was on the verge of a heart attack (or had already had another one), he would likely survive.  It is terrifying for him to wonder when or if that next big event will come.
Once he was settled and test results were pending, a business office representative came into our room.  She asked the usual sorts of questions about insurance coverage and handed us some Medicare literature and patients' rights handouts.  Then she did what she probably legally is compelled to do but what ought to be illegal in any hospital.  She said to Larry, "You know if you are admitted, we do not accept your Humana supplemental insurance up on the floors.  Down here in the ER, we accept it, but not once you go upstairs.  Our competitors at St. Luke's take it, though, so I guess you just need to know that."  She went on to show her disdain for the Affordable Care Act/Obamacare, and acknowledged that she would support an improved and expanded Medicare for all, single-payer type reform.  "Who wouldn't want that?" she asked as she left the room and thanked us for our time.
I watched Larry's face tense and his cheeks flush as he started worrying about what we might owe if he were admitted.  He looked to me for some indication of what we ought to do.  I was certain if I told him that might mean we'd owe a substantial amount to St. Joe's for his care if he became an in-patient, he'd probably had said "No way" and demanded to go to a facility that accepted both his Medicare and the Humana supplemental for which he pays more than $200 each month.  We already owe this hospital for in-patient care given to me last January and biopsies in April that we are struggling to get paid off, and Larry would never tolerate owing them more.  Since I didn't want him to get all stressed out again and since that stress might well exacerbate the symptoms for which we were seeking care, I worked quickly to reassure him that he should not worry.  Never mind that his new cardiologist does her surgeries at this hospital, and now we find out his insurance may not provide full coverage.  What a mess.

Good News Inside the Health Spending Numbers


Inside the continuing slowdown in the growth in health spending is evidence that the American health care system may be changing in ways that could make it more affordable in the years to come.
As my colleague Robert Pear reported, health spending in 2013 grew at the lowest rate since government officials started tracking it — back in 1960. Taken alone, that fact might not be meaningful, but 2013 is the fourth consecutive year that health spending growth has kept pace with the growth in the overall domestic economy, suggesting something more durable than random. The slowdown in health spending growth began in 2002 and has become more pronounced in recent years.
And there are lots of good signs about how that spending is declining. The prices of medical services are growing more slowly than overall inflation, and the volume of hospitalizations has gone down. Spending by the federal Medicare program, private health insurance and people’s out-of-pocket expenditures all declined, suggesting that the savings were systemwide and not due to changes in just one kind of insurance.

Enrollments Under Health Law Continue at Solid Pace

By 

WASHINGTON — More than 300,000 people selected health plans in the federal insurance marketplace last week, bringing the two-week total to 765,000 for this fall’s open enrollment period, the Obama administration said Thursday.
The numbers suggest that enrollment, though slower than in the first week, continues at a solid pace. Administration officials said they expected activity to pick up just before Dec. 15, the deadline for people to sign up for coverage that takes effect on Jan. 1. Consumers have until Feb. 15 to change or make their selections for the rest of 2015.
“The first deadline is just a couple of weeks away,” said Sylvia Mathews Burwell, the secretary of health and human services. “We’re encouraging everyone who is already covered through the marketplace to come back and shop because there could be savings.”
Federal officials are a long way from achieving that. When the open enrollment period began on Nov. 15, about 6.7 million people already had coverage through exchanges created under the 2010 health care law. The numbers released by the administration indicate that 398,000 consumers with such coverage have renewed it or chosen other health plans on the federal exchange.

Chronic Diseases Are Killing More in Poorer Countries

By 

Chronic diseases like cancer and heart disease are rising fast in low- and middle-income countries, striking far younger populations than in rich countries and causing much worse outcomes, according to a new report.
Deaths from chronic diseases have risen by more than 50 percent in low- and middle-income countries over the past two decades, according to the report, by the Council on Foreign Relations. The increase is part of a shift in global mortality patterns in which infectious diseases, such as malaria and tuberculosis, have declined substantially and are no longer the leading cause of death in the developing world.
The shift in poorer countries is being driven by urbanization and other major changes that have led to improvements in aspects of public health, such as hand washing, sanitation and vaccines. That has led to sharp declines in infant mortality, and in turn, to increases in life spans. The average life expectancy in Africa, for example, has increased by about eight years since 2000, according to the World Health Organization.
Chronic diseases claim the vast majority of lives in rich countries like the United States, and some experts have said that the rise of such diseases in poorer countries is actually a sign of success, as it is evidence that people in those places are now living long enough to die of diseases that typically hit in old age.
But the report — which uses yet-to-be-published 2013 data from the Institute for Health Metrics and Evaluation, a health research organization — finds that chronic diseases are disproportionately striking younger populations in developing countries.

‘Superbugs’ Kill India’s Babies and Pose an Overseas Threat

By 
AMRAVATI, India — A deadly epidemic that could have global implications is quietly sweeping India, and among its many victims are tens of thousands of newborns dying because once-miraculous cures no longer work.
These infants are born with bacterial infections that are resistant to most known antibiotics, and more than 58,000 died last year as a result, a recent study found. While that is still a fraction of the nearly 800,000newborns who die annually in India, Indian pediatricians say that the rising toll of resistant infections could soon swamp efforts to improve India’s abysmal infant death rate. Nearly a third of the world’s newborn deaths occur in India.
“Reducing newborn deaths in India is one of the most important public health priorities in the world, and this will require treating an increasing number of neonates who have sepsis and pneumonia,” said Dr. Vinod Paul, chief of pediatrics at the All India Institute of Medical Sciences and the leader of the study. “But if resistant infections keep growing, that progress could slow, stop or even reverse itself. And that would be a disaster for not only India but the entire world.”
In visits to neonatal intensive care wards in five Indian states, doctors reported being overwhelmed by such cases.
“Five years ago, we almost never saw these kinds of infections,” said Dr. Neelam Kler, chairwoman of the department of neonatology at New Delhi’s Sir Ganga Ram Hospital, one of India’s most prestigious private hospitals. “Now, close to 100 percent of the babies referred to us have multidrug resistant infections. It’s scary.”
These babies are part of a disquieting outbreak. A growing chorus of researchers say the evidence is now overwhelming that a significant share of the bacteria present in India — in its water, sewage, animals, soil and even its mothers — are immune to nearly all antibiotics.

Exploring the shortcomings and fault lines of the Affordable Care Act

The case for single payer – Medicare for All

By Jeoffry B. Gordon, M.D., M.P.H.
December 3, 2014
The Patient Protection and Affordable Care Act (ACA) has as its main and overriding purpose the expansion and subsidization of health insurance coverage for many (usually poor and uninsured) Americans who were previously unable to reliably access medical services. Under its auspices, the federal law has provided for health insurance enrollment for 1 million to 3 million additional 19- to 26-year-olds; 6 million new, expanded Medicaid enrollees; and 7.2 million commercial Qualified Health Plan enrollees. Of the latter, about 80 percent qualify for financial subsidy. Taking into account additional factors, e.g. the fact that some of the new enrollees were previously insured, there has been a net gain of about 10 million people who have coverage. Yet even at full expansion, it is estimated that the ACA will not insure another 30 million U.S. residents.
It is now five years since the ACA came into being and one year since it started financing patient care. Thus it is an excellent time to review its inadequacies from a health policy point of view.
As will be seen from the compilation of observations below, the ACA expansion, which is based upon the commercial health insurance model, is extraordinarily complex, inefficient, and monstrously expensive. And in the end, under the ACA, having health insurance is not a guarantee of receiving needed medical care nor, in many cases, is it truly affordable and providing financial security for American families. It is not a universal national health scheme which allows full access to the broad capabilities of American medicine. An expanded Medicare-for-all system (single payer), built on nearly 50 years of successful experience, would be far less complex, more equitable, and hugely less expensive. The single-payer paradigm would totally eliminate as unnecessary the many complex, confusing, expensive, and wasteful characteristics listed below by instituting universal coverage, eliminating the insurance middleman, and allowing all licensed providers.


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