The Rich Live Longer Everywhere.
For the Poor, Geography Matters.
By NEIL IRWIN and QUOCTRUNG BUI
For poor Americans, the place they call home can be a matter of life or death.
The poor in some cities — big ones like New York and Los Angeles, and also quite a few smaller ones like Birmingham, Ala. — live nearly as long as their middle-class neighbors or have seen rising life expectancy in the 21st century. But in some other parts of the country, adults with the lowest incomes die on average as young as people in much poorer nations like Rwanda, and their life spans are getting shorter.
In those differences, documented in sweeping new research, lies an optimistic message: The right mix of steps to improve habits and public health could help people live longer, regardless of how much money they make.
One conclusion from this work, published on Monday in The Journal of the American Medical Association, is that the gap in life spans between rich and poor widened from 2001 to 2014. The top 1 percent in income among American men live 15 years longer than the poorest 1 percent; for women, the gap is 10 years. These rich Americans have gained three years of longevity just in this century. They live longer almost without regard to where they live. Poor Americans had very little gain as a whole, with big differences among different places.
A new divide in American death
White women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s and 50s in a slow-motion crisis driven by decaying health in small-town America, according to an analysis of national health and mortality statistics by The Washington Post.
Among African Americans, Hispanics and even the oldest white Americans, death rates have continued to fall. But for white women in what should be the prime of their lives, death rates have spiked upward. In one of the hardest-hit groups — rural white women in their late 40s — the death rate has risen by 30 percent.
The Post’s analysis, which builds on academic research published last year, shows a clear divide in the health of urban and rural Americans, with the gap widening most dramatically among whites. The statistics reveal two Americas diverging, neither as healthy as it should be but one much sicker than the other.
In modern times, rising death rates are extremely rare and typically involve countries in upheaval, such as Russia immediately after the collapse of the Soviet Union. In affluent countries, people generally enjoy increasingly long lives, thanks to better cancer treatments; drugs that lower cholesterol and the risk of heart attacks; fewer fatal car accidents; and less violent crime.
But progress for middle-aged white Americans is lagging in many places — and has stopped entirely in smaller cities and towns and the vast open reaches of the country. The things that reduce the risk of death are now being overwhelmed by things that elevate it, including opioid abuse, heavy drinking, smoking and other self-destructive behaviors.
White men are also dying in midlife at unexpectedly high rates. But the most extreme changes in mortality have occurred among white women, who are far more likely than their grandmothers to be smokers, suffer from obesity or drink themselves to death.
White women still outlive white men and African Americans of both sexes. But for the generations of white women who have come of age since the 1960s, that health advantage appears to be evaporating.
‘We don’t know why it came to this’
As white women between 25 and 55 die at spiking rates, a close look at one tragedy
They had been expecting a full processional with a limousine and a police escort, but the limousine never came and the police officer was called away to a suspected drug overdose at the last minute. That left 40 friends and relatives of Anna Marrie Jones stranded outside the funeral home, waiting for instruction from the mortician about what to do next. An uncle of Anna’s went to his truck and changed from khakis into overalls. A niece ducked behind the hearse to light her cigarette in the stiff Oklahoma wind.
“Just one more thing for Mom that didn’t go as planned,” said Tiffany Edwards, the youngest surviving daughter. She climbed into her truck, put on the emergency flashers and motioned for everyone else to follow behind in their own cars. They formed a makeshift processional of dented pickups and diesel exhaust, driving out of town, onto dirt roads and up to a tiny cemetery bordered by cattle grazing fields. In the back there was a fresh plot marked by a plastic sign.
“Anna Marrie Jones: Born 1961 — Died 2016.”
Fifty-four years old. Raised on three rural acres. High school-educated. A mother of three. Loyal employee of Kmart, Walls Bargain Center and Dollar Store. These were the facts of her life as printed in the funeral program, and now they had also become clues in an American crisis with implications far beyond the burnt grass and red dirt of central Oklahoma.
White women between 25 and 55 have been dying at accelerating rates over the past decade, a spike in mortality not seen since the AIDS epidemic in the early 1980s. According to recent studies of death certificates, the trend is worse for women in the center of the United States, worse still in rural areas, and worst of all for those in the lower middle class. Drug and alcohol overdose rates for working-age white women have quadrupled. Suicides are up by as much as 50 percent.
Drug prices in Boston are dozens of times higher than overseas
by Ed Silverman
Prescription drugs generally cost more in the US than in other countries. And a new analysis found this is especially true in Boston, where consumers can expect to pay many times more for their medicines than the international benchmark pricing used by the World Health Organization.
The median costs of brand-name and generic drugs in Boston were 158 and 38 times higher, respectively, than the international benchmark. Similarly, median costs for brand-name and store-brand over-the-counter medicines were 21 and 11 times higher than the benchmark, according to the analysis, which was published in the Journal of Pharmaceutical Policy and Practice.
“Very few people pay the full price (for prescription medicines), because they typically have some type of insurance, but we’re showing that even with those discounts, they’re still paying more” than in other countries, said Richard Laing, a professor of international health at Boston University, who led the analysis. He noted that the WHO set a target of four times the international benchmark as an acceptable pricing level for consumers.
Could Sanders’ Social Justice Ideas Really Work? Take a Look at These Places
In his new film, “Where to Invade Next,” Michael Moore shows us what free college and health care for all can actually look like
In an election year, we hear endless promises of what our politicians will do to help the people. But are the ideas we’re hearing from Bernie Sanders and others—like Medicare for all, free college tuition, paid family leave—just slogans to pander to voters suffering under stagnating wages and burdensome debt? Could those ideas ever actually take hold?
If you want to see what a people-first agenda looks like in action, check out Michael Moore’s latest movie Where to Invade Next. Moore plants a flag in one country after another to “claim their good ideas.” In the process we meet a lot of people who are truly enjoying life.
http://www.yesmagazine.org/peace-justice/could-sanders-social-justice-ideas-really-work-take-a-look-at-these-places-20160408?utm_source=YTW&utm_medium=Email&utm_campaign=20160408
News About Obamacare Has Been Bad Lately. How Bad?
Ever since passage of the Affordable Care Act, a fierce debate has been waged over whether the law would work as advertised. While advocates promised that the design of new insurance markets would transform the way consumers buy health insurance, critics warned that the new market would never succeed. Reed Abelson and Margot Sanger-Katz have had front-row seats to the debate, and the two reporters took a few minutes to discuss when — and if — the market would stabilize.
Margot: It’s been a few weeks of bad news about the Obamacare marketplaces. On Friday, we learned that UnitedHealth has decided to pull out of Obamacare marketplaces in two states. The week before, the Blue Cross and Blue Shield Association put out a paper offering not-too-subtle hints that some members were losing money. Reed, you wrote recently about how surprising stasis in the employer insurance market means we can look forward to much smaller Obamacare marketplaces than most people expected when the health law passed. And the parade of struggling start-up insurer companies has extended to Maine’s Community Health Options, one of the co-ops that had long been held up as one of the most successful. Health insurers need to submit their rates to regulators in the next few weeks — or decide to exit markets. Should we be worried about a health insurance apocalypse?
Reed: I think people have a tendency to catastrophize, especially when it comes to Obamacare. UnitedHealth, which is one of the nation’s largest health insurers, has only reluctantly embraced the new market, and the company is always held up as an example of why the sky is falling and why Obamacare is going to crash and burn: If United can’t make it, no one can.
United has only a small fraction of the individual market, but some of the Blues are also struggling. What is most troubling is the fact that many insurers are losing money. You may not sympathize much with the insurance companies — and no one does — but they have to make enough money to pay claims. Do you think those losses are temporary — or a sign that the market is fundamentally unstable and potentially unsustainable?
The Obamacare Replacement Mirage
by Paul Krugman - NYT
Hype springs eternal — certainly when it comes to Paul Ryan, whose media image as a Serious, Honest Conservative and policy wonk seems utterly impervious to repeated demonstrations that he is neither serious nor honest, and that he actually knows very little about policy. And here we go again.
But what really amazes me about the latest set of stories is the promise that Ryan will finally deliver the Republican Obamacare alternative that his colleagues in Congress have somehow failed to produce after all these years. No, he won’t — because there is no alternative.
Or maybe I should say that there is no alternative to the right. Alternatives to the left do exist. True socialized medicine — an American NHS — would be feasible economically; so would single-payer, in the form of Medicare for all. The reasons we aren’t doing those are political.
But on the right, is there a more free-market, more privatized system that could replace the Affordable Care Act without causing the number of uninsured to soar? No, as some of us have tried to explain many times.
Once again: a useful starting point is the problem of people with pre-existing conditions. How can they be offered affordable insurance? You can prohibit insurers from discriminating on the basis of medical history — community rating. But if that’s all you do, only sicker people will sign up; many will wait until they get sick to buy insurance; and so costs will be high due to a bad risk pool.
So non-discrimination must be combined with an individual mandate, the requirement that everyone get insurance. But what about people who can’t afford it? There must be subsidies to lower-income families, so that they can.
What you end up with, then, is community rating + individual mandate + subsidies — that is, with Obamacare. There’s nothing arbitrary about it, and you can’t pick and choose from the elements: it’s a three-legged stool that needs all three legs to stand. And it can’t be made cheaper, either — the subsidies are already on the low end, requiring that the allowed policies can involve higher deductibles than they really should.
And all this, in turn, is the reason Republicans haven’t come up with an alternative. It’s not because they’re timid, or lazy, or stupid (they may be all these things, but that’s not why they’ve come up short). It’s because there is no alternative that wouldn’t involve taking coverage away from tens of millions.
So no, Ryan isn’t going to roll out a magical solution to this problem in the next couple of months. Even if he were the policy wonk he pretends to be, he couldn’t do the impossible.
This controversial rule could change how doctors profit from using the most expensive drugs
by Carolyn Y. Johnson - Washington Post
A controversial effort by the Obama administration to reform how doctors earn money from administering injection drugs would reduce their earnings on the most expensive drugs while making many older generics more lucrative, according to a new analysis.
A high-stakes debate exploded last month over the administration's drug payment pilot program, which would test a fundamental change in how doctors are reimbursed for giving chemotherapy and other injectable drugs through Medicare. Medicare has
The opposition to the pilot shared by drug companies and doctors -- parties that don't always see eye-to-eye on drug prices -- led Peter Bach, director of the Center for Health Policy Outcomes at Memorial Sloan Kettering Cancer Center to look more closely at how the policy would affect reimbursements for cancer drugs. In an analysis released Monday, his team reports that, for about half the drugs -- typically older, generic ones -- doctors would get better reimbursement under the pilot program. For the rest -- particularly the most expensive, new drugs -- they would get a less generous fee than they currently receive.
Bach's team also found that just a handful of commonly used, high-priced cancer drugs are driving doctors' and hospitals' income under the current reimbursement scheme. And they argue that the status quo also appears to allow drug companies to steadily increase prices in a way that mutually benefits doctors and pharmaceutical companies.
Will Obamacare end 'job lock'?
by Dean Baker
The Affordable Care Act was first and foremost intended to extend health insurance coverage to a broader segment of the population. It has largely succeeded, with the uninsured rate among the non-elderly population falling to 10.7 %, from more than 18% just before the law took effect.
However, it was also hoped that the ACA would end “job lock,” a situation where a worker stays at a job because it's the only way she can count on getting health insurance for herself or her family. Millions of workers with a serious, preexisting health condition faced this problem, knowing they'd encounter sky-high rates in the individual market.
As a result, workers stayed at jobs that didn't fully make use of their skills or give them opportunities for advancement or that, for whatever reason, made them unhappy. The need for insurance also prevented workers from trying to start their own business or taking a part-time job to spend more time with their family.
Small, Piecemeal Mergers in Health Care Fly Under Regulators’ Radars
by Reed Abelson - NYT
Federal officials are expected to argue in court starting Monday that a large hospital merger in the Chicago area could hurt consumers and should be stopped. It would be the latest in a series of efforts by regulators to push back against a wave of consolidation among major health care providers.
But a frenzy of smaller transactions is also profoundly changing the landscape, many of which face little regulatory resistance.
The deals are often for a couple of doctors here, or a hospital there, making them too small to attract much attention. But as those deals add up, they are creating groups that in some cases dominate local or regional markets. And they are raising questions about whether the gaze of antitrust officials is directed in the right place.
“There’s a lot of consolidation going on at a lot of levels,” said Leemore S. Dafny, a former federal official who is a health economist at Northwestern University.
She added, “I don’t think the antitrust laws are set up to stop it.”
Doctors and hospitals are making the calculation that bigger is definitely better. Consolidation, they say, helps them better coordinate care and manage patients, making care more effective and less expensive.
Skeptics, however, say that the small combinations can eventually translate into higher costs. By gaining market share, they say, hospitals are able to charge more for their care and gain more influence about where patients are sent for lucrative services.
Shopping for Health Care: A Fledgling Craft
Four years ago, Dave deBronkart spoke at a medical conference, with his face displayed on a giant screen. Afterward, a doctor told him that a spot on his face looked like basal cell carcinoma.
She was right. That cancer was unlikely to spread, but it needed to be treated, and deBronkart’s health insurance policy had a $10,000 deductible. Any treatment, then, would come out of his pocket. How would he find the right treatment at the right price?
The reason deBronkart was attending the conference was that he is an advocate for patient involvement in health care. So he decided that, as an experiment, he would invite proposals on his blog, e-PatientDave. He outlined what he was looking for and asked health care providers to bid for his business.
No one did, of course. “I didn’t expect to get a response,” he said. “Hospitals don’t have a ‘submit a bid’ department. But you hear over and over that patients are the reason for high health costs. I pursued it as far as I could to explore what happened when a patient tries to be a responsible consumer.”
He began calling around to hospitals asking the price of various procedures. “The hospitals said ‘we don’t know; ask your insurance company.’ The insurance company said ‘we don’t know; ask your hospital,’” said deBronkart. “That was when I smelled a great big rat.”
After many, many calls, he chose his surgery: excision, total price $868. Today he is fine.
But his point stands: Health care operates very differently from anything else we buy.
The misguided — and costly — evolution of ‘Romneycare’
By Josh Archambault and Jim Stereos
The Affordable Care Act is now six years old. Perhaps more important for Massachusetts, this month marks the 10th anniversary of “Romneycare,” making it a good time to review that law’s impact.
Governor Mitt Romney’s original proposal was simple: Stop subsidizing hospital care and redirect the money to ensure that all residents have “minimum coverage” — in his mind, catastrophic insurance. Individuals could choose and pay for anything beyond that. The premise was that taxpayers should not have to cover the cost of care for those unwilling to pay for it.
A Health Connector was to serve as an exchange where individuals could buy insurance directly and which would test-drive market reforms.
Unlike President Obama, Romney did not implement his creation. In Governor Patrick’s hands, Romney’s “minimum coverage” soon rivaled the most generous plans in other states, and a large portion of enrollees in the exchange paid no premiums. The Legislature expanded catastrophic coverage to include 20 additional mandates on small businesses and individuals.Today the Connector’s few offerings are over-standardized, with little variety or innovation in plan design. The exchange has attracted principally subsidized enrollees, and the remaining private market is very expensive.
https://www.bostonglobe.com/opinion/2016/04/11/the-misguided-and-costly-evolution-romneycare/hxkIrY0Y0o2FmjVfrjxNhL/story.html
In medical research, financial conflicts of interest do matter
by Marcia Angell
A front-page story by Charles Ornstein in the Globe reports increasing concern about editorial decisions at The New England Journal of Medicine (NEJM), one of which is to defend the practice of medical researchers having personal financial ties to drug companies whose products they are testing. The NEJM’s national correspondent referred to critics of such conflicts of interest as “pharmascolds.”
I was on the editorial staff of NEJM from 1979 until 2000, serving as executive editor from 1988 until 1999, and then as editor in chief before I stepped down in 2000. So I have firsthand knowledge of the evolution of its conflict-of-interest policies and the reasons for them.
In 1984, the NEJM became the first medical journal to require authors of papers submitted to it to disclose all financial ties to companies that could financially benefit from the results. The editor at the time, Arnold S. Relman, was concerned by the growing financial associations — in addition to research sponsorship — between drug companies and supposedly independent researchers, and by the influence of sponsoring companies on the way that research was conducted and reported.
Maine Senate passes Medicaid expansion by one-vote margin
Despite the Senate vote and likely passage in the House, the bill faces an inevitable veto from Gov. Paul LePage.http://www.pressherald.com/2016/04/12/maine-senate-passes-medicaid-expansion-by-one-vote-margin/
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