The following NYT article by Angus Deaton makes one wonder how much of the growing US income and wealth inequality is due to transfers from those who pay for health care - taxpayers, holders of insurance policies including employers and employees, and out-of-pocket payments from individuals - to corporate and other providers of health care goods and services.
As our percent of GDP attributable to health care is now approaching 20%, the contribution of health care transfers to growing income and wealth inequality has to be significant.
-SPC
The U.S. Can No Longer Hide From Its Deep Poverty Problem
by Angus Deaton - NYT - January 24, 2018
You might think that the kind of extreme poverty that would concern a global organization like the United Nations has long vanished in this country. Yet the special rapporteur on extreme poverty and human rights, Philip Alston, recently made and reported on an investigative tour of the United States.
Surely no one in the United States today is as poor as a poor person in Ethiopia or Nepal? As it happens, making such comparisons has recently become much easier. The World Bank decided in October to include high-income countries in its global estimates of people living in poverty. We can now make direct comparisons between the United States and poor countries.
Properly interpreted, the numbers suggest that the United Nations has a point — and the United States has an urgent problem. They also suggest that we might rethink how we assist the poor through our own giving.
According to the World Bank, 769 million people lived on less than $1.90 a day in 2013; they are the world’s very poorest. Of these, 3.2 million live in the United States, and 3.3 million in other high-income countries (most in Italy, Japan and Spain).
As striking as these numbers are, they miss a very important fact. There are necessities of life in rich, cold, urban and individualistic countries that are less needed in poor countries. The World Bank adjusts its poverty estimates for differences in prices across countries, but it ignores differences in needs.
An Indian villager spends little or nothing on housing, heat or child care, and a poor agricultural laborer in the tropics can get by with little clothing or transportation. Even in the United States, it is no accident that there are more homeless people sleeping on the streets in Los Angeles, with its warmer climate, than in New York.
The Oxford economist Robert Allen recently estimated needs-based absolute poverty lines for rich countries that are designed to match more accurately the $1.90 line for poor countries, and $4 a day is around the middle of his estimates. When we compare absolute poverty in the United States with absolute poverty in India, or other poor countries, we should be using $4 in the United States and $1.90 in India.
Once we do this, there are 5.3 million Americans who are absolutely poor by global standards. This is a small number compared with the one for India, for example, but it is more than in Sierra Leone (3.2 million) or Nepal (2.5 million), about the same as in Senegal (5.3 million) and only one-third less than in Angola (7.4 million). Pakistan (12.7 million) has twice as many poor people as the United States, and Ethiopia about four times as many.
Deeply Poor in Wealthy Lands
A tally of those living on $4 a day or less in selected developed countries.
Percentage of total population that is poorest …
… and their estimated numbers:
United
States
5.3 million
(nearly the
population of
Minnesota)
Total
13.8 million
(nearly the pop-
ulation of Sweden
and Ireland
combined)
European
Union
6.9 million
Australia 157,000
This evidence supports on-the-ground observation in the United States. Kathryn Edin and Luke Shaefer have documented the daily horrors of life for the several million people in the United States who actually do live on $2 a day, in both urban and rural America. Matthew Desmond’s ethnography of Milwaukee explores the nightmare of finding urban shelter among the American poor.
It is hard to imagine poverty that is worse than this, anywhere in the world. Indeed, it is precisely the cost and difficulty of housing that makes for so much misery for so many Americans, and it is precisely these costs that are missed in the World Bank’s global counts.
Of course, people live longer and have healthier lives in rich countries. With only a few (and usually scandalous) exceptions, water is safe to drink, food is safe to eat, sanitation is universal, and some sort of medical care is available to everyone. Yet all these essentials of health are more likely to be lacking for poorer Americans. Even for the whole population, life expectancy in the United States is lower than we would expect given its national income, and there are places — the Mississippi Delta and much of Appalachia — where life expectancy is lower than in Bangladesh and Vietnam.
Beyond that, many Americans, especially whites with no more than a high school education, have seen worsening health: As my research with my wife, the Princeton economist Anne Case, has demonstrated, for this group life expectancy is falling; mortality rates from drugs, alcohol and suicide are rising; and the long historical decline in mortality from heart disease has come to a halt.
I believe, as do most people, that we have an obligation to assist the truly destitute. For those who believe that aid is effective, this is reflected in their own giving, or by supporting national and international organizations like the United States Agency for International Development, the World Bank or Oxfam.
For years, in determining this spending, the needs of poor Americans (or poor Europeans) have received little priority relative to the needs of Africans or Asians. As an economist concerned with global poverty, I have long accepted this practical and ethical framework. In my own giving, I have prioritized the faraway poor over the poor at home.
Recently, and especially with these insightful new data, I have come to doubt both the reasoning and the empirical support. There are millions of Americans whose suffering, through material poverty and poor health, is as bad or worse than that of the people in Africa or in Asia.
Practical considerations reinforce the argument for recognizing America’s poor in the global context. There is a better chance of monitoring the effects of domestic spending than of foreign spending. Money spent by and for fellow citizens, either individually or collectively, is subject to democratic evaluation by both donors and recipients, who can see the effects and who can show their approval or disapproval in the voting booth. Those who donate for projects in Africa often find it difficult to know what good their gifts are doing, let alone to discover whether the intended beneficiaries actually receive or appreciate them.
Official aid from the United States is mostly set by geopolitics — the leading recipients are Afghanistan, Israel and Iraq. Yet the United States is committed to eliminating $1.90-a-day poverty in the world, a target that is not contingent on poverty at home. Britain insists on spending 0.7 percent of its gross domestic product on foreign aid, in spite of occasional difficulties in finding suitable projects and in spite of domestic suffering caused by austerity at home.
None of this means that we should close out “others” and look after only our own. International cooperation is vital to keeping our globe safe, commerce flowing and our planet habitable.
But it is time to stop thinking that only non-Americans are truly poor. Trade, migration and modern communications have given us networks of friends and associates in other countries. We owe them much, but the social contract with our fellow citizens at home brings unique rights and responsibilities that must sometimes take precedence, especially when they are as destitute as the world’s poorest people.
Trust, in each other and in American institutions, is vital for our social and economic well-being: It allows us to work, buy, sell and vote with some reasonable expectation that our behavior will be met with fairness and good will.
But trust has been declining for decades, and the most tangible and immediate damage may be to public health and safety. Mistrust in the medical profession — particularly during emergencies like epidemics — can have deadly consequences.
In 1966, more than three-fourths of Americans had great confidence in medical leaders; today, only 34 percent do. Compared with people in other developed countries, Americans are considerably less likely to trust doctors, and only a quarter express confidence in the health system.
During some recent disease outbreaks, less than one-third of Americans said they trusted public health officials to share complete and accurate information. Only 14 percent trust the federal government to do what’s right most of the time.
Less Likely to Engage in Healthful Behaviors
Trust is the cornerstone of the doctor-patient relationship, and patients who trust their doctors are more likely to follow treatment plans. One study found that nearly two-thirds of patients with high levels of trust always take their medications, but only 14 percent of those with low levels of trust do.
Another study found that trust is one of the best predictors of whether patients follow a doctor’s advice about things like exercise, smoking cessation and condom use. Mistrust can lead people to skip the flu shot or forgo the measles vaccine for their children —with potentially serious consequences for individual patients and the broader population.
Trust is also critical for patient satisfaction, and makes it more likely that patients keep seeing the same doctor — which can have other positive effects, like fewer emergency department visits.
There are large disparities in trust along socioeconomic and racial lines (often for good reason), and building trust among vulnerable and marginalized patients may be particularly important.
For patients with H.I.V., for instance, trust in medical providers is associated with a higher likelihood of taking antiretroviral drugs, better reported mental and physical health, more clinic visits, and fewer emergency department visits. States with higher levels of social trust tend to have lower rates of late H.I.V. diagnoses — after the disease has progressed — partly because people feel more comfortable seeking care and getting tested.
Stifling Innovation
Low levels of trust can hurt innovation. We think of medical innovation as being driven by doctors, scientists and entrepreneurs, but patients play an important role, too. They must be willing to try new treatments and technologies for them to spread, but are unlikely to do so if they don’t trust in the therapy’s effectiveness or the prescriber’s motives.
One study found that for cancer patients considering experimental chemotherapy, trust in their physician was one of the most important reasons they enrolled in a clinical trial — on par with the belief that the treatment would be effective.
Today, in the era of wearable devices and electronic health records, trust that personal data will be kept secure and private — and that such technologies are useful — remains a barrier to greater acceptance and use. Despite millions of dollars being poured into telemedicine, Americans are still much less likely to trust diagnoses made remotely than those made in person.
Responding to Epidemics
Perhaps most concerning is evidence that low levels of trust can weaken the ability of governments and public health agencies to respond to epidemics. A recent studysuggests that Ebola spread more widely and persisted longer than it otherwise would have if there were higher levels of institutional trust.
Researchers surveyed people in Liberia about their knowledge of Ebola, about how much they trusted the government, and how likely they were to take recommended precautions against Ebola. These precautions included adopting safe burial practices; abiding by restrictions on travel, social gatherings and curfews; keeping a bucket of chlorinated water at home; and avoiding physical contact with those displaying symptoms.
People who didn’t trust the government were much less likely to take recommended precautions. They weren’t less well informed about Ebola, nor did they hold more erroneous beliefs. They just trusted less.
Can Trust Be Rebuilt?
Trust, of course, requires trustworthiness. Waning trust in the health system is partly a result of the sometimes well-founded public perceptionthat its key players pursue profits at the expense of patients. (The United States is the only wealthy advanced nation that has not committed to universal health care.)
But there are steps medical leaders and public health officials can take to show they deserve to be trusted. People’s trust depends fundamentally on three questions: Do you know what you’re doing? Will you tell me what you’re doing? Are you doing it to help me or help yourself?
Clear, transparent communication and a history of fulfilled trust are important, and health care providers can also build trust by disclosing conflicts of interest; creating expectations for long-term relationships; and promoting shared interests and smaller power differences with patients. Giving patients easier access to their medical notes, for instance, may help them feel more in control of their care and increase trust in their providers — especially for vulnerable populations.
Many patients have also traditionally been wary of the motives and methods of medical research. Partnering with patients and communities to give them greater say in the goals, design and dissemination of research can help ease a sense that research is being conducted “on them” instead of “with them.”
More engagement between individual patients and physicians through collaborative endeavors may have the added benefit of capitalizing on a paradox of Americans’ trust: We’re highly trusting of our own doctors and generally satisfied with our own care, but we distrust medical leaders and the health system as a whole.
Governments should also consider using trusted spokesmen and spokeswomen during crises. In a disease outbreak caused by bioterrorism, for example, Americans are more likely to trust information coming from the Centers for Disease Control and Prevention than the Department of Health and Human Services or the F.B.I. Demonstrably false statements from high-level government officials can have lasting consequences for Americans’ trust in institutions.
All institutions are imperfect, and some are plainly corrupt. A degree of skepticism is inevitable and important. But when doubt becomes pervasive, it can erode the glue that binds society together, and the medicine that keeps us healthy.
Public employee unions cry foul after state cuts health insurance options
by Priyanka Dayal McCluskey - The Boston Globe - January 23, 2018
Labor unions that represent Massachusetts public employees are fuming over a stunning decision by a state commission to limit their health plan options and are lashing out against the move, which affects hundreds of thousands of people and shakes up the local insurance industry.
Under the changes, which take effect in July, commercial plans from the popular insurers Tufts Health Plan, Harvard Pilgrim Health Care, and Fallon Health no longer will be available.
Several union representatives slammed Thursday’s vote by the Group Insurance Commission, an obscure but critical state agency, and what they called a lack of transparency leading up to the decision. They said they learned of the planned vote the night before it happened — or, in many cases, not until after the fact.
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The commission manages health benefits for 442,000 state and local employees, retirees, and their families. The change is supposed to save the state $20.8 million next year, officials said.
“We’re all disgusted with the process,” said Jim Durkin, legislative director for AFSCME Council 93, which has about 20,000 members on state health benefits. “The insulting process that happened last week has to change. We’ll no longer accept eleventh-hour moves to force votes that could have a significant impact on our members and their families for years to come.”
Officials at the commission, whose members are appointed by the governor, defended the process. They said they had discussed the idea of “consolidating” health plan options for several months. They added that they surveyed members and conducted listening tours before adopting the changes.
But officials said they were prohibited by procurement rules from sharing specific details before last week’s vote.
Steven A. Tolman, president of the Massachusetts AFL-CIO, said the decision came as a shock.
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“Just about every single union that represents public employees has been hearing from members about what this means to them and their families,” he said.
“How could it happen without any notice? Without any public input? The process . . . shows a complete lack of consideration toward employees.”
The changes will require tens of thousands of people who get their coverage through the commission to move to new insurers. But state officials said that almost everyone will be able to keep their doctors.
Three commercial insurer options remain: Neighborhood Health Plan of Boston, Health New England of Springfield, and UniCare, a local division of the for-profit Indianapolis-based insurer Anthem.
Ashley Maagero Lee, chief of staff at the commission, said in a prepared statement that “the GIC has been regularly communicating our strategic direction of the procurement over the past several months.”
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“Despite the fact that we’re eliminating some plans,” she said, “the most important thing we heard from our members was the ability for people to keep their doctors and their networks and we believe that people will be able to do that.”
Governor Charlie Baker said that commission officials should sit down with labor representatives immediately to explain the changes.
“The GIC needs to get out and get very aggressive about communicating with the labor folks and with others about the particulars and how this will relate to their members,” he told reporters Friday.
The employees affected include a variety of public workers, such as teachers, social workers, probation officers, firefighters, state university workers, and others.
The commission has yet to finalize the benefits that will be covered under its new insurance plans and how much those plans will cost. It is holding public hearings this week, and union representatives say they’re encouraging workers to attend. There is no sign, however, that the commission will reverse its decision.
“The anger among my membership is unlike anything I’ve seen,” said Peter MacKinnon, president of SEIU Local 509, which represents human service workers. “This is hitting home, and it’s becoming really personal. Health insurance is so important, so vital for everyone. People are going to have to make difficult choices about what plans to switch to and hope they get the same level of coverage that they had before.”
Barbara Madeloni, president of the Massachusetts Teachers Association, and David Holway, president of the National Association of Government Employees, said the state process that led to the health insurance changes represents a disrespect for hardworking public employees.
“To have this rug pulled out from under them, it’s outrageous,” Holway said.
Kentucky’s New Idea for Medicaid Access: Pass Health Literacy Course
by Austin Frakt - NYT - January 22, 2018
If you’re on Medicaid in Kentucky and are kicked off the rolls for failing to meet the state’snew work requirements, Kentucky will be offering a novel way to reactivate your medical coverage: a health or financial literacy course you must pass.
The precise content of the courses is not yet worked out but may include instruction onhousehold budgeting, opening a checking account, weight management and chronic disease management, said Kristi Putnam, a manager with Kentucky Health, the new state Medicaid program that includes work requirements. She said quizzes would be included that people must pass to complete the course.
Kentucky says the courses, along with the bigger elements of the recently approved waiver it received from federal Medicaid rules, will help to “empower individuals to improve their health.”
The courses are just one way people subject to and failing to meet work requirements could regain coverage. But some health policy experts express dismay with the approach. For one thing, many Americans, not just those who seek Medicaid, struggle withhealth and financial literacy. And to some, literacy quizzes — however well intentioned — evoke the tests used to impede voting registration of black Americans in the Jim Crow South.
“Requiring people to pass a health literacy course to get care — care for conditions that might prevent them from passing — is just expensive, punitive and cruel,” said Atul Gawande, a surgeon and a health care researcher with the Harvard T.H. Chan School of Public Health.“It serves no health benefit whatsoever. You have to be concerned about requirements like literacy tests, which states have a bad history of applying selectively and arbitrarily.”
Ms. Putnam said the courses were “intended to be a tool/support for people to improve both health and finances, and not a barrier in any way.”Her agency, she said, is looking into ways to provide help to people who might struggle with understanding the courses.
There is no standard definition for health literacy. Ms. Putnam said Kentucky’s “pertains to learning about healthy habits, how to manage chronic conditions, effectively utilizing health care benefits and understanding commercial market insurance concepts.”
However defined, health literacy is related to literacy and numeracy more generally. To understand and use health-related information, you need some fluency with written or spoken language, and usually with numbers and basic math as well. People with low skills in other forms of literacy or numeracy also have lower health literacy.
Apart from instruction aimed at specific populations with certain conditions — such as training to self-manage chronic diseases like diabetes and hypertension, or even birth training classes for pregnant women and their partners — health literacy courses are uncommon. (Say Ah! is one source for health literacy resources.)
Financial literacy courses are more widely available but still not a routine part of general education.
“If these topics are taught at all in primary education, they certainly aren’t addressed consistently or in an evidence-based way,” said Harold Pollack, a professor at the University of Chicago who was a co-author of a book on basic financial education. “But singling out the Medicaid population for classes as a condition for access to insurance suggests that shrinking and stigmatizing the program, not literacy, is the goal.”
Numerous studies document the widespread need for greater health and financial literacy. By one estimate, one-third of adults have health literacy deficits. For example, most people make errors in selecting health plans and don’t know basic features of the plans they choose.
The last large national survey of U.S. adult literacy (including health literacy) was conducted in 2003. One study found that 60 percent of Medicaid enrollees had only “basic” or “below basic” health literacy, meaning, for example, they could not recognize a medical appointment on a hospital appointment form (below basic) or would have trouble understanding why a specific test was recommended for someone with certain symptoms, even when given a clearly written and accurate explanation (basic).
But Medicaid enrollees are not the only ones. Nearly the same proportion of Medicare enrollees also had basic or below basic health literacy. Privately insured people scored better. They are typically younger than Medicare enrollees, and they typically have higher education levels and are less likely to have cognitive impairments than those with public coverage. However, only a small minority even of the privately insured had a “proficient” level of health literacy — meaning, for example, that they could deduce the employee share of health insurance costs from a table that listed that cost as a function of income and family size.
Another study, based on data collected in 2013, showed adults’ blood test results alongside the normal range (typical of reports many of us receive from our doctors after blood tests). Only about half of the subjects could recognize if the blood glucose level indicated on the test was outside the normal range. Of those with diabetes — to whom blood glucose measurement and levels should be familiar given the importance to their condition — only 56 percent could identify out-of-range values.
Poor health literacy is associated with worse health care outcomes and higher health care spending. But causality could run both ways. It is likely that people in greater need of health care are also less likely to have high literacy skills in general. It’s also possible that poor health literacy contributes to worse self-management of health and lifestyle issues that could result in worsening health and increased health care use.
Likewise, low financial literacy can contribute to insufficient or inefficient saving. One national survey found that only 14 percent of respondents got all the answers right on a five-question quiz about financial topics like interest rates, inflation, bond prices and mortgages. Only 37 percent got four out of five. (As an example of its difficulty, the true/false mortgage question was: “A 15-year mortgage typically requires higher monthly payments than a 30-year mortgage, but the total interest paid over the life of the loan will be less.”)
Addressing these issues through financial literacy education improves financial outcomes. A recent review of financial literacy research found that providing financial literacy education in school settings is effective. So is the approach of targeting education during teachable moments, as when individuals are making financial decisions: taking out a loan, establishing a saving plan, and the like. The Kentucky program would do neither.
Though policy experts are divided on the merits of Kentucky’s health and financial literacy program, they may at least be in agreement that education in both needs improvement. That’s true not just for would-be Medicaid enrollees, but for many of the rest of us, too.
CAHC’s presentation to the Task Force on Health Care Coverage for All of Maine
The following testimony was provided on January 22, 2018 to the Task Force on Health Care Coverage for All of Maine, a legislative study group created by SP 592 in the 128th Maine Legislature. CAHC was invited to provide comments related to health care, health coverage, and economics.
Statement of Steve Butterfield, Policy Director
Consumers for Affordable Health Care
To the Task Force on Health Care Coverage for All of Maine
Monday, January 22, 2018
Senator Whittemore, Representative Sanborn, and members of the Task Force, I’d like to thank you all for this opportunity to present to you today.
My name is Steve Butterfield, and I am the policy director at Consumers for Affordable Health Care – or “CAHC” – a nonpartisan nonprofit organization based here in Augusta. Since 1988, CAHC has advocated the right to quality, affordable health care for every person in Maine.
I was asked to be here today to speak about the “economics” of health care. I’d like to focus my remarks on the ways in which the cost of health care and health coverage can impact individual consumers and their families, and the decisions people make about when and how they access the care they need.
To begin, let me lay out a simple truth: costs are a barrier to care. People cannot get the care they need if they cannot afford that care. That is true if they cannot afford insurance premiums or deductibles, or cannot afford to see a doctor or go to the hospital, or cannot afford to fill a prescription. I have provided links and citations in my statement today that will lead you to high-quality, comprehensive, unbiased research that shows the following:
cost is a barrier that impacts consumer behavior;
costs are rising faster than consumers can keep up with;
consumers cannot “shop” their way to saving the overall trend in our health system, nor should they be expected to;
and that is because Americans do not “use” or even try to use more health care than consumers in other, comparable countries.
In other words, while it is undeniable that health care costs are rising and that American families are feeling the strain, this is not a situation that they have caused, or even heavily contributed to. America’s health care system already has a tendency to overburden consumers with excessive demands[1]: to serve as their own diagnosticians, care coordinators, social workers, attorneys, medical coders, and billing experts. Asking them to also fix a cost problem that they are in no position to influence is as cruel as it will be unproductive.
Cost is a barrier
According to survey data published last week by the Kaiser Family Foundation, approximately 1 in 10 Americans reports avoiding or forgoing necessary medical care because of the cost of receiving that care.[2] Another survey of 2016 data shows that 33% of Americans avoided care because of cost.[3] The cost barrier is particularly burdensome for uninsured individuals, individuals who report worse overall health, and those with higher deductibles.
This situation is, in some ways, improving. The Affordable Care Act (ACA) is responsible not only for significant coverage gains, but also has been credited with being responsible for cutting personal bankruptcy filings in half by driving down the number of individuals facing bankruptcy as a result of medical costs.[4] The implementation of the ACA consequently correlates with a decline in the number of Americans who reported difficulty accessing care due to costs, as this chart shows:
One point of concern I’d raise is that, even as coverage rates are increasing – and, with the recent expansion of Medicaid in Maine, I’d expect our state-level data to improve dramatically over the next year or two – many consumers with insurance are facing new cost barriers through increases in their out-of-pocket cost sharing amounts, such as deductibles.
While the ACA limits deductibles and annual out-of-pocket maximums for many plans, the cost share amounts are still significantly higher than most Americans can afford. One estimate by the Federal Reserve showed that 44% of Americans would not be able to cover a $400 emergency from their savings.[5] With the maximum deductible for a bronze plan set at over $7,000, deductibles rising in the employer sector as well[6], and with insurance plan designs increasingly relying on consumers meeting significant amounts of their deductibles or out-of-pocket maximums before the plan assists in paying for many services, it is clear that even insured consumers are going to be put in positions where the cost of care will once again become a major burden.
And in fact, we are already seeing some evidence of this. Hospitals have reported increases in the number of insured consumers who are unable to pay their bills.[7]
“It’s the prices, stupid.”
The trajectory of increase in health care spending has been driven far more by increases in the cost of health care than by utilization of health care. In other words, even when they avoid or delay care, avoid treatments, and avoid filling prescriptions – which they do, in response to cost concerns – Americans are getting slammed by the unstoppable march of health care costs.
The title of this section refers to a landmark 2003 study by four health economists which compared the U.S. health sector to other Organization for Economic Cooperation and Development (OECD) countries – nations comparable to the U.S. in terms of overall development and economic status – and found that “the difference in spending [on health care between the U.S. and other countries] is caused mostly by higher prices for health care goods and services in the United States.”[8]
While that study is from 2003, newer research shows the same problem. In fact, in an article published in November in the Journal of the American Medical Association, researchers investigated how five factors – population growth, population aging, disease prevalence or incidence, service utilization, and service price and intensity – impacted health care spending increases in the U.S. between 1996 and 2013. They found that more than 50% of the increase was due to service price alone.[9] In other words, our problem is not that we buytoo much: rather, it is that we pay too much.
Rising health care costs have continued[10] to dramatically outpace overall economic growth, or inflation, or wages. While there has been some slowing in recent years, it’s important to note that we’re talking about a decrease from, say, 9% in 2011 to “only” 6% in 2016 (according to data from PriceWaterhouseCooper[11]). That’s particularly alarming when compared against overall wage growth, which is statistically more or less stagnant – rising only 10% in inflation-adjusted terms since 1973.[12]
Consumers can’t shop us to safety
In a well-functioning market, it would be reasonable to expect competition to lead to market-driven control of price growth. However, there are limitations to the applicability of that approach in the health care market.
Research has shown that the percentage of health care services that are both “shoppable” and in which consumers bear a significant enough percentage of out-of-pocket costs to have an incentive to comparison-price accounts for only 7% of overall health spending.[13] While that’s not insignificant, and while we certainly advocate that transparent and valid price data must be available to consumers to help inform their decision-making, it is also not enough for interventions in this component alone to significantly impact the overall cost curve.
In other words, increasing price transparency is an important piece of the puzzle, but we need more focus on the actual drivers of health care spending growth – prices – and less on blaming consumers for a problem they aren’t causing.
American consumers are not over-utilizers
To synthesize all of the data I’ve presented above, I’ll close with this.
If I could permanently eliminate one pernicious, persistent, and fallacious idea from the conversation around America’s health care costs, it would be the idea that American consumers are unhealthy profligate spendthrifts who go to the doctor so much that the system cannot bear the strain.
Let me be absolutely clear: this is wrong, wrong, wrong, wrong, wrong.
Not only is there no actual evidence that this is systemically true, the opposite is actually the case[14]. We are not over-utilizers. Study[15]after study[16] after study[17] shows that the problem is prices, not service delivery or utilization.
Bypassing Major Networks, 1.6 Million Tune In for Sanders 'Medicare for All' Town Hall
Senator held online event to counter corporate media's coverage of healthcare, frequently "interrupted by commercials by the drug companies"
by Julia Connely - Common Dreams - January 24, 2018
Sen. Bernie Sanders's (I-Vt.) town hall on Medicare for All drew more than one million online viewers in addition to the hundreds of attendees who packed an auditorium at the U.S. Capitol to capacity.
Speaking with multiple panels featuring single-payer healthcare advocates and experts—including Dr. Don Berwick, who oversaw Medicare and Medicaid under President Barack Obama—Sanders moderated a nearly two-hour discussion about the failures of the current U.S. healthcare system and how its costs and outcomes compare to those in countries with universal healthcare.
When Sanders asked Berwick whether there is any legitimate economic reason not to expand Medicare to all Americans, he replied, "No, there's no reason. It's just will."
"You can stand up for people," Berwick added. "Why wouldn’t we do that for all Americans, not just people over 65?"
The discussion also covered the economic impact of Medicare for All. While Republicans have spent years pushing the narrative about high tax rates as a result of government-funded healthcare, owners of businesses large and small explained to the national audience the increasingly heavy financial burden that the for-profit system is putting on both their companies and their employees.
In his closing remarks, Sanders noted that a town hall broadcast exclusively online was necessary to provide viewers with the facts on Medicare for All. Although 53 percent of Americans now support government-funded healthcare for all, he said, corporate media outlets hardly cover the issue.
"The reason we're doing this program tonight is you don't see this stuff," he said. "It ain't gonna be on CBS. It ain't gonna be on NBC. What astounds me is we already have a pretty good majority of the American people who already believe in universal health care, believe that it is the government's responsibility to make sure that health care is a right. And we have reached that stage with media not talking about the issue at all."
Apple wants you to put your medical records on the iPhone
by Carolyn Y. Johnson - The Washington Post - January 24, 2018
Imagine this: You're on vacation and slip and fall at the pool. You head to the hospital, where doctors ask if you're taking any medications or have had any recent medical procedures. Instead of trying to recall the names of all your pills or your medical history while in pain, you easily pull up your medical record on your phone.
Apple, the tech giant that has been hungrily eyeing the health care sector for years, announced Wednesday it would soon allow people in certain hospital systems to tether their medical records to their iPhones, getting easy access to seven categories of information, including immunizations, lab results or allergies.
The medical records capability will roll out through a beta available to the general public in coming months. It's an update of a less sophisticated medical records function in Apple's Health app. Previously, people could download specific medical records and add them to the app, but the new version will aggregate information and update it as a person's medical record evolves.
The announcement comes about a decade after Google launched a similar effort — and then pulled the plug, noting in its blog that its offering was used by a narrow bandwidth of people — tech-savvy patients and caregivers and fitness enthusiasts.
“But we haven't found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people,” Google leadership wrote on its blog in 2012.
Microsoft has a similar product, HealthVault.
“If you rewind the clock, when they did their efforts in technology-speak, that could be considered a lifetime ago,” said Darren Dworkin, chief information officer of Cedars-Sinai in Los Angeles, one of the hospitals working with Apple to make the record available to patients. “We also just interact with technology in a different way all these years later. Every one of us has a phone in our pocket or not too far from our pocket; it seems so logical, and frankly empowering, to have health information at our fingertips.”
Apple could theoretically bring much-needed ease of use to medical information, by presenting the medical record in a more easily understandable format than existing clunky web portals. Dworkin emphasized that the iPhone is a trusted platform, which could ease concerns about patient privacy.
For years, patients have been able to log in to access their health records Web portals. Some health systems offer apps where people can access lab results, message their doctors or make appointments. The new Apple offering will have the advantage of being able to integrate information from multiple providers, better reflecting how people seek and receive care in the real world, where a person's primary-care doctor and specialist may not be at the same hospital.
“We all are very focused on trying to improve the patient experience, trying to make sure the patient feels empowered and able to manage and own their own health information. It should be like checking my email, like making a purchase online,” said Stephanie Reel, chief information officer of Johns Hopkins Medicine, one of the hospital systems.
The other hospital systems participating are: Cedars-Sinai, Penn Medicine, Geisinger Health System, UC San Diego Health, UNC Health Care, Rush University Medical Center, Dignity Health, Ochsner Health System, MedStar Health, OhioHealth and Cerner Healthe Clinic.
Apple has worked with three vendors of electronic medical records for the first wave of its apps: Epic, Cerner and AthenaHealth. More hospitals and other electronic health vendors will be able to join in coming months.
The opportunity is big, but compatibility issues and technological challenges are real, said Dan Mendelson, president of Avalere Health, a consulting company.
“What they’re describing is exciting and everybody wants it. But for those of us who have been doing this for a while, we’ve seen many capable companies hit the stiff resistance of the incompatibility of medical records,” Mendelson said. “The lack of standardization in the market makes it very difficult to jump in and put out consumer products that are viable.”
Apple, in Sign of Health Ambitions, Adds Medical Records Feature for iPhone
by Natasha Singer - NYT - January 24, 2018
In the latest indication of Apple’s growing ambitions in the digital health market, the tech giant on Wednesday unveiled a new feature that would allow users to automatically download and see parts of their medical records on their iPhones.
The feature is to become part of Apple’s popular Health app. It will enable users to transfer clinical data — like cholesterol levels and lists of medications prescribed by their doctors — directly from their medical providers to their iPhones, potentially streamlining how Americans gain access to some health information.
A dozen medical institutions across the United States — including Johns Hopkins Medicine in Baltimore and Cedars-Sinai in Los Angeles — have agreed to participate in the beta version of the new feature. Apple plans to open the beta test to consumers on Thursday.
Apple said it will not see consumers’ medical data, which is encrypted and stored locally on the iPhone, unless the user chooses to share it with the company.
“It’s really strange to me that you can easily pull up all of your spending record on your credit card going back a long way in every detail, yet your health is way more important and you don’t have easy access to your health information,” said Jeff Williams, Apple’s chief operating officer. “We want to make sure that consumers are empowered with information about their health.”
Apple, more than the others, has been reticent to publicize its long-term vision for health technology. But recent product introductions, like the new health records feature, highlight how focused Apple is on using its iPhone, Apple Watch and apps to give people more control over their health care.
In addition to the iPhone Health app, Apple has developed ResearchKit, software to help researchers develop iPhone apps to conduct health studies, and HealthKit, a platform that allows consumers to share health data on their iPhone or Apple Watch with health and fitness apps. Apple is also sponsoring clinical research, called the Apple Heart Study, at Stanford University to determine whether an app for the Apple Watch can detect irregular heart rhythms.
A review of Apple’s current job openings also gives clues about the company’s wider ambitions in the health care sector.
According to the company’s site, Apple is seeking a hardware engineer to develop “next-generation” health sensors for products like the iPhone and iPad; software engineers for the company’s “health special projects team” to join “an exciting new project at an early stage”; an engineering manager for the company’s motion technologies team “to help shape the next set of groundbreaking features” in fitness and health; and a biomedical scientist to help design studies for health, wellness and physiological measurement apps.
“We will empower you to engage with a variety of internal teams and external partners to continually question the limitations of technology implemented in health products,” says an Apple job description for a health tech hardware development engineer.
Apple’s personal medical record feature is hardly a new idea. With much fanfare about a decade ago, both Google and Microsoft introduced free services — called Google Health and Microsoft HealthVault — that helped consumers centralize their personal health data.
But the concept of the personal medical record did not generate widespread adoption in that era, which predated the popularization of the iPhone and mobile apps. Google shut down Google Health in 2011. Microsoft still offers its HealthVault service.
