I had the pleasure of attending the WHCE's Health Care Reform Panel tonight, where several health care folks debated on the controversial (or more controversial) points of the current health care reform movement. The one that I'd like to discuss is the effect of the public option on the health insurance industry as a whole with regards to transparency.
Here are the (paraphrased, not verbatim) perspectives from a couple of the panelists ...
Catherine Dodd, Interim Director, San Francisco Health Services System: The public option would add value to the health care system because we need transparency in exactly where the money is going. Private insurers don't have to disclose such information, while Medicare (a public option) is required to do so because it is funded by tax dollars and governmental funds. Citizens want to know where how their tax dollars are being spent. If there is a new public option that offers transparency, the competition would push private insurers to provide information on the breakdown of where premium dollars go. They would do this in order to keep their customers from changing to the public option.
Jenni Vargas, VP for Business Development, Stanford Hospital & Clinics: How will the public option keep insurers honest? It won't. It will just be one other competitor in the health insurance industry. The public option would serve the population that insurers are not currently serving, or won't want to serve. Since it won't use underwriting, the public option would be taking in patients that the insurance companies probably wouldn't want to cover in the first place. Customers that are satisfied with their current care won't switch just because their insurers don't disclose the minute details of how each premium dollar is being used.
Thoughts? Agree/disagree & reasons?
Tuesday, October 27, 2009
Monday, October 26, 2009
Woman loses coverage because she was raped
Hi All,
This is a really sad interview conducted by Anderson Cooper on a woman who was raped and who lost her insurance coverage because of it. She needed to follow standard procedure of taking anti-HIV medications for a month after her rape and ended up getting dropped from her coverage. It'll be interesting to hear what you have to say.
Senator Reid announces public plan with "opt-out" provision
Hey Everyone,
I have some breaking news on health reform. Today, Senate Majority Leader Harry Reid announced that health care legislation will include a public option, however, individual states will be allowed to opt out of the plan. Under this provision, states will be allowed to determine whether the public option is right for them, and if not, they will not be forced to offer the public plan. It looks like Olympia Snowe, the lone Republican supporter of health reform, has stated that she will not support Senator Reid's plans, and wants the public option completely out of the legislation. A link to the article is posted below. Let me know what you think the ramifications of this announcement will be for health reform.
Sunday, October 25, 2009
Prison Hospice
I read this article with great interest.
http://www.nytimes.com/2009/10/18/health/18hospice.html?scp=1&sq=%22months%20to%20live%22&st=cse
It's about a prison hospice in which inmates work as volunteers. Some of the volunteers have committed murder themselves and most have lost friends because of violence. The experience of helping their fellow inmates as they are dying changes the way they view death. Through this model, inmates have companionship during their last days, and those who are caring for them have a potentially rehabilitative experience.
http://www.nytimes.com/2009/10/18/health/18hospice.html?scp=1&sq=%22months%20to%20live%22&st=cse
It's about a prison hospice in which inmates work as volunteers. Some of the volunteers have committed murder themselves and most have lost friends because of violence. The experience of helping their fellow inmates as they are dying changes the way they view death. Through this model, inmates have companionship during their last days, and those who are caring for them have a potentially rehabilitative experience.
How much is your life worth?
According to NICE, around $22,750 every 6 months....
NICE is a funny way to refer to an organization whose job it is to approve/deny drugs and medical care to patients. It's a British government agency (part of the British National Health Service), and the acronym stands for the National Institute for Health and Clinical Excellence. They use cost-effectiveness data to come up with these figures!
Here are the main highlights:
"The institute, known as NICE, has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750, to save six months of a citizen’s life.
"Any drug that provides an extra six months of good-quality life for £10,000 — about $15,150 — or less is automatically approved, while those that give six months for $22,750 or less might get approved. More expensive medicines have been approved only rarely. The spending limits represent the health institute’s best guess for how much the nation can afford."
The article talks about a couple where the husband the British health system refused to pay for his treatment for kidney cancer because the drug was too expensive. Hi wife, Joe Hardy, is quoted as saying, “Everybody should be allowed to have as much life as they can.”
The article is a little old - written in December of 2008. Here's the link: http://www.nytimes.com/2008/12/03/health/03nice.html?scp=6&sq=british%20national%20health%20service&st=cse
We talked a little about culture in class at some point (or some class - they all seem to meld into one fairly easily) and how we're just not a society that's very accepting of death...how perhaps attitudes surrounding death need to change before we realize that maybe it's better for our loved ones to spend the last few months of their lives at home instead of in a hospital.
Yup I know - easier said than done...but maybe it would make dealing with death easier if we took only one small step and just talked about it more in our daily lives.
A very rambling post - I hope you found it somewhat useful! I'm always up for talking about death btw. And life. :)
NICE is a funny way to refer to an organization whose job it is to approve/deny drugs and medical care to patients. It's a British government agency (part of the British National Health Service), and the acronym stands for the National Institute for Health and Clinical Excellence. They use cost-effectiveness data to come up with these figures!
Here are the main highlights:
"The institute, known as NICE, has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750, to save six months of a citizen’s life.
"Any drug that provides an extra six months of good-quality life for £10,000 — about $15,150 — or less is automatically approved, while those that give six months for $22,750 or less might get approved. More expensive medicines have been approved only rarely. The spending limits represent the health institute’s best guess for how much the nation can afford."
The article talks about a couple where the husband the British health system refused to pay for his treatment for kidney cancer because the drug was too expensive. Hi wife, Joe Hardy, is quoted as saying, “Everybody should be allowed to have as much life as they can.”
The article is a little old - written in December of 2008. Here's the link: http://www.nytimes.com/2008/12/03/health/03nice.html?scp=6&sq=british%20national%20health%20service&st=cse
We talked a little about culture in class at some point (or some class - they all seem to meld into one fairly easily) and how we're just not a society that's very accepting of death...how perhaps attitudes surrounding death need to change before we realize that maybe it's better for our loved ones to spend the last few months of their lives at home instead of in a hospital.
Yup I know - easier said than done...but maybe it would make dealing with death easier if we took only one small step and just talked about it more in our daily lives.
A very rambling post - I hope you found it somewhat useful! I'm always up for talking about death btw. And life. :)
Friday, October 23, 2009
Using holistic medicine to help contain costs?
I was speaking yesterday with the ex-directory of the Osher Center, UCSF's complementary medical center. He is good friends with Andrew Weil (whom he calls "Andy") and other holistic practitioners, but he also trained at both Harvard and Stanford medical schools and was Associate Chief of Nephrology and Medical Director of the Artificial Kidney Center at the Santa Clara Valley Medical Center. (In other words, he's well-versed in both worlds and not easy to dismiss as a "quack") My question to him, and one I raise to you all now as well, is what role could a more holistic approach to health take in the US's attempts to lower costs? I wrote my thesis on Chile's adoption of both indigenous medicine and CAM (complementary and alternative medicine) in mainstream public clinics. By adopting both for very specific conditions, they were able to reach a larger population and save costs. The doctor I spoke with yesterday seemed frustrated, at least partly, by the "reductionism" of modern medicine, how it breaks down health into little tiny portions (looking at each disease and molecule individually) and ignoring interactions. (I'm simplifying for the sake a manageable-length blog post.) His comments, combined with what I'd found in Chile, made me wonder if the US might be able to benefit from incorporating more holistic views of health, and if alternative therapies might in some cases help in cutting back on those 40% of health problems attributable to lifestyle. I'm not talking about prescribing a homeopathic tincture for a heart attack, and I'm certainly not suggesting avoiding vaccines bc they're "not natural", but things like making sure people's nutrition and vitamin intake is balanced (e.g. Had I known two months ago that my Vitamin D levels were low, it's quite likely I would have avoided a stress fracture, saving 5 doctor visits, 9 Xrays, 4 physical therapy visits and over $1000) or making more of a medical point of helping people manage stress. It's quite possible, too, that natural and lower-cost methods could be used to equal or better effect than some high-cost drugs. Before you throw that idea out as quackery - my mom suffered worse-than-usual nauseau from two different chemo regimens. After working through every single anti-nausea prescription her doctor gave her with no result, she finally tried something a bit more natural (legal here but perhaps not NJ yet, so I'll leave it at that) with much better results and none of the awful side effects (except some coughing, which provided some good "laughter therapy").
I'm certainly not saying that we make a mass migration over to alternative/holistic medicine or that we start forcing doctors to incorporate it into their practice or anything radical, but I do wonder if there are aspects of complementary and holistic care that could provide lower-tech, cheaper ways to avoid and handle health problems. It would take research and strict controls to make sure it's done in a safe way, but I wonder if it's even possible or reasonable to bring the two different medical worlds (CAM and mainstream) closer together.
I'm certainly not saying that we make a mass migration over to alternative/holistic medicine or that we start forcing doctors to incorporate it into their practice or anything radical, but I do wonder if there are aspects of complementary and holistic care that could provide lower-tech, cheaper ways to avoid and handle health problems. It would take research and strict controls to make sure it's done in a safe way, but I wonder if it's even possible or reasonable to bring the two different medical worlds (CAM and mainstream) closer together.
This American Life -- Health Care Edition
Hi all,
I'm sure there are some This American Life fans in our class, so I wanted to point your attention to the last two weeks' episodes of this radio program produced by Chicago Public Radio. Both deal with multiple issues in the health care debate.
For those who don't know, This American Life is a radio show produced by Ira Glass that tells the stories of Americans dealing with ordinary problems to the extraordinary. There are usually anywhere from 2-5 stories per show and they're tied together with some uniting theme.
I know it's a bit more time consuming than reading a NYT article, but if you have 2 hours free, I definitely think these two programs are worth listening to. If not for new information, then for the clever editing and touching and informational anecdotes that experts and lay people tell about their roles in our health care industry. Oh, they're FREE to podcast too!
Links:
Episode 391 - More is Less: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1320
Episode 392 - Someone Else's Money: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1321
Also, in case anyone is interested, Ira Glass (the host) will be speaking at Berkeley's Zellerbach Hall on Dec. 5. Not sure if tickets are still available, but this show should definitely be interesting.
I'm sure there are some This American Life fans in our class, so I wanted to point your attention to the last two weeks' episodes of this radio program produced by Chicago Public Radio. Both deal with multiple issues in the health care debate.
For those who don't know, This American Life is a radio show produced by Ira Glass that tells the stories of Americans dealing with ordinary problems to the extraordinary. There are usually anywhere from 2-5 stories per show and they're tied together with some uniting theme.
I know it's a bit more time consuming than reading a NYT article, but if you have 2 hours free, I definitely think these two programs are worth listening to. If not for new information, then for the clever editing and touching and informational anecdotes that experts and lay people tell about their roles in our health care industry. Oh, they're FREE to podcast too!
Links:
Episode 391 - More is Less: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1320
Episode 392 - Someone Else's Money: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1321
Also, in case anyone is interested, Ira Glass (the host) will be speaking at Berkeley's Zellerbach Hall on Dec. 5. Not sure if tickets are still available, but this show should definitely be interesting.
Thursday, October 22, 2009
When Preventative Care Leads to More Harm Than Good
Preventative medicine is thought to be cost-effective in that diseases can be both prevented or caught in the early stages. However, an interesting article came out in the NY Times yesterday, stating that “some patients are enduring aggressive treatments for cancer that could have gone undetected for a lifetime without [harm].” Furthermore, “some cancers found through screening and treated in its earliest stages still end up being deadly.” This suggests that screening can lead to costly, unnecessary treatments that affect patients’ quality of life without improving survival. Of course, it should be acknowledged that screening leads to good outcomes as well, such as appropriate treatment for aggressive cancers. But where should the line be drawn? When is there too much screening? What should be done to protect patients from being diagnosed with pseudo-diseases and experiencing the psychological and physical consequences of overtreatment?
Link: http://www.nytimes.com/2009/10/22/health/22screen.html?_r=1&ref=health
Link: http://www.nytimes.com/2009/10/22/health/22screen.html?_r=1&ref=health
Sunday, October 18, 2009
2 Opinions
Here are 2 different opinions in the health care debate and in support of the public option in particular:
The first is an editorial in the New York Times, "The Public Plan, Continued." The author explains how the Senate Finance and Health, Education, Labor, and Pensions (HELP) Committees must now reconcile their two versions of a bill, the former having struck the public option and the latter still insisting on its inclusion. The opinion of the editorial board lies closer to the HELP Committee's version supporting a strong public option but "with care taken to mitigate adverse effects on rural areas," such as low rates of reimbursement for rural hospitals.
The second is from Robert Reich, former US Secretary of Labor under Clinton and current professor at the Goldman School of Public Policy at UC Berkeley, on his personal blog: "Why Obama Has to do What Letterman Did: Refuse to Pay Hush Money." Reich is critical of both Big Pharma and Doctors, as represented by the AMA, nearly equating their demands on the White House's plan to extortion. He proposes that if the President caves to their demands, it is middle-income taxpayers who will ultimately be forced to provide the hush money in the forms of "still higher premiums, co-payments, and deductibles, higher drug prices, Medicare premiums, and taxes." Reich also warns that if Obama is too soft on the Senate and lets important cost containment efforts fail, we may be dealing with an even scarier prospect than further increasing health care costs: Sarah Palin in 2012.
The first is an editorial in the New York Times, "The Public Plan, Continued." The author explains how the Senate Finance and Health, Education, Labor, and Pensions (HELP) Committees must now reconcile their two versions of a bill, the former having struck the public option and the latter still insisting on its inclusion. The opinion of the editorial board lies closer to the HELP Committee's version supporting a strong public option but "with care taken to mitigate adverse effects on rural areas," such as low rates of reimbursement for rural hospitals.
The second is from Robert Reich, former US Secretary of Labor under Clinton and current professor at the Goldman School of Public Policy at UC Berkeley, on his personal blog: "Why Obama Has to do What Letterman Did: Refuse to Pay Hush Money." Reich is critical of both Big Pharma and Doctors, as represented by the AMA, nearly equating their demands on the White House's plan to extortion. He proposes that if the President caves to their demands, it is middle-income taxpayers who will ultimately be forced to provide the hush money in the forms of "still higher premiums, co-payments, and deductibles, higher drug prices, Medicare premiums, and taxes." Reich also warns that if Obama is too soft on the Senate and lets important cost containment efforts fail, we may be dealing with an even scarier prospect than further increasing health care costs: Sarah Palin in 2012.
Friday, October 16, 2009
Policy battle brewing in NYC
This'll be interesting to watch.
NY State Health Commissioner mandates that all health care workers get vaccinated against swine/seasonal flu, but enforcement is temporarily paused under a restraining order while three nurses sue.
http://cityroom.blogs.nytimes.com/2009/10/16/judge-halts-mandatory-flu-vaccines-for-health-care-workers/?hp
Personal liberty is at stake, but so is patient safety. I wasn't aware of this, but apparently vaccination policies for health workers so far have been voluntary; this mandate threatens fines, and even termination. You can see the ferocity of people's opinions in the comments section. What's your take?
NY State Health Commissioner mandates that all health care workers get vaccinated against swine/seasonal flu, but enforcement is temporarily paused under a restraining order while three nurses sue.
http://cityroom.blogs.nytimes.com/2009/10/16/judge-halts-mandatory-flu-vaccines-for-health-care-workers/?hp
Personal liberty is at stake, but so is patient safety. I wasn't aware of this, but apparently vaccination policies for health workers so far have been voluntary; this mandate threatens fines, and even termination. You can see the ferocity of people's opinions in the comments section. What's your take?
Thursday, October 15, 2009
Dr. Gupta, Miracle Wrangler
Listening to Sanjay Gupta - CNN star doc and once a buzzworthy possibility for Surgeon General - on the radio the other night, I found myself gritting my teeth. His new book, "Cheating Death," explores medical cases in which the process of death is slowed, then reversed. Excerpt here:
http://www.abcnews.go.com/GMA/Books/read-excerpt-cheating-death-sanjay-gupta/Story?id=8792520&page=4
I'm equally fascinated by the mechanics of death and the tinkering that can take place to subvert it, but something about his framing irked me. The notion of evading the inevtiable being valued above all else - isn't this what's driving our usage and cost and medical-choice-in-the-name-of-freedom?
Won't this eventually swell the cost of emergency care, if more and more Americans demand chilled saline and forced hypothermia to save their loved ones? But putting it in the context of my own parents - would this be something I appreciate about living in America, that I in fact can demand unorthodox treatment?
I don't like the action-hero title, your overly enthusiastic delivery, or your grasping for Jules Verne; but, Dr. Gupta, I kinda see your point.
http://www.abcnews.go.com/GMA/Books/read-excerpt-cheating-death-sanjay-gupta/Story?id=8792520&page=4
I'm equally fascinated by the mechanics of death and the tinkering that can take place to subvert it, but something about his framing irked me. The notion of evading the inevtiable being valued above all else - isn't this what's driving our usage and cost and medical-choice-in-the-name-of-freedom?
Won't this eventually swell the cost of emergency care, if more and more Americans demand chilled saline and forced hypothermia to save their loved ones? But putting it in the context of my own parents - would this be something I appreciate about living in America, that I in fact can demand unorthodox treatment?
I don't like the action-hero title, your overly enthusiastic delivery, or your grasping for Jules Verne; but, Dr. Gupta, I kinda see your point.
Wednesday, October 14, 2009
Reestablishment of the White House Initiative on Asian Americans and Pacific Islanders
Today, President Obama followed Clinton's lead from a decade ago to recognize the needs of the Asian American and Pacific Islander (AAPI) Communities by signing the executive order for the reestablishment of the White House Initiative on Asian Americans and Pacific Islanders, which would improve the quality of life in underserved AAPI communities by increasing access and participation in federal programs. Because AAPI's are continually aggregated together in data and research despite the many diverse groups and needs, they are vulnerable to less federal funding and access to programs that could significantly make an impact. I'm really excited that President Obama acknowledges the challenges AAPI communities face, especially in health and educational disparities due to the "model minority myth" and lack of adequate research. This was the reason why I went into public health in the first place! :)
Some excerpts from his speech:
"It's tempting, given the strengths of the Asian American and Pacific Islander communities, for us to buy into the myth of the "model minority," and to overlook the very real challenges that certain Asian American and Pacific Islander communities are facing: from health disparities like higher rates of diabetes and Hepatitis B; to educational disparities that still exist in some communities -- high dropout rates, low college enrollment rates; to economic disparities -- higher rates of poverty in some communities, and barriers to employment and workplace advancement in others."
"It's the impact of a Department of Health and Human Services that funds research on the diseases that disproportionately affect Asian American and Pacific Islander families. It's the impact of a Justice Department that upholds the Voting Rights Act and its promise of language assistance and equal access to the polls. And it's the impact of evidence-based research and data collection and analysis on AAPI communities -- so that no one is invisible to their government."
To watch the video, go here and skip to the speech: http://www.whitehouse.gov/video/The-President-Observes-Diwali/
Some excerpts from his speech:
"It's tempting, given the strengths of the Asian American and Pacific Islander communities, for us to buy into the myth of the "model minority," and to overlook the very real challenges that certain Asian American and Pacific Islander communities are facing: from health disparities like higher rates of diabetes and Hepatitis B; to educational disparities that still exist in some communities -- high dropout rates, low college enrollment rates; to economic disparities -- higher rates of poverty in some communities, and barriers to employment and workplace advancement in others."
"It's the impact of a Department of Health and Human Services that funds research on the diseases that disproportionately affect Asian American and Pacific Islander families. It's the impact of a Justice Department that upholds the Voting Rights Act and its promise of language assistance and equal access to the polls. And it's the impact of evidence-based research and data collection and analysis on AAPI communities -- so that no one is invisible to their government."
To watch the video, go here and skip to the speech: http://www.whitehouse.gov/video/The-President-Observes-Diwali/
Tax Capping - What Do You Think?
I'm far from being an economist, but reading and hearing about tax capping today in 200c was by far the most promising financing mechanism I've come across thus far. I know Professor Dow commented on this at the Healthcare Reform Workshop this past month, but a lot of that frankly flew over my head...but today, it made sense! Wow...I finally saw the light.
I understand that eliminating tax breaks is probably sensitive, but the "Win-Win" article written by Jonathan Gruber was actually fairly enlightening. It was realistic, in that he recognized that eliminating it would be a no-no, and so reducing it would be a good bet. I don't find that so bad now do you? Given that it'll generate a good amount of revenue to fund many of these proposed reforms at the same rate at which costs rise makes total sense to me. Call me naive, but when I was employed, it didn't even occur that my premiums were tax-free, I simply chose the cheapest premium and didn't even make the calculation if I was going to save more in taxes had I chosen a more expensive one! I totally agree with Professor Robinson's arguments for tax capping. I think it's realistic and fairly on the moderate side of things.
Frankly, I am a bit disheartened because the bill seems to be losing the whole point of meaningful reform, at least in my definition of "meaningful" - which in my ideal world - means cost-control and realistically financed universal access if not coverage. After reading about the Healthy SF fact sheet today, the plan seemed promising. A group of friends were at Cha Cha Cha (tapas bar with awesome sangria and mojito by the way) in SF last Friday, and one of us pointed out that there was actually a line item for Healthy SF on our $100 bill (fyi, there was about 6 of us and we were hungry and had alcohol) for a mere $2.50. Seriously, that's like 1/50th of the total cost which is pretty much nothing! I'd be curious about whether or not SF does report healthier outcomes and I'd be curious as to how they'd measure that and determine that but it seems to be working well.
I am completely perplexed frankly by all this. We expect so much but we are unwilling to pay for anything or assume any responsibility; but when we don't get it and all hell breaks loose, we look to other people (i.e. gov't) and say "Well, why aren't you doing anything???" I guess this goes back to the fundamental values of our society in general I guess. Are we seriously that fickle??? I think I may have just posed a rhetorical question.
All disclaimer out there, I'm a self-professed Obama fan, and completely admire the guy for taking on this job amidst all the madness right now. It doesn't mean I agree with everything he's doing but in my opinion, he deserves the Nobel Peace Prize for just maintaining some sort of peace and order in trying to pass health care reform. On the global level, I'm not so sure and even if you disagree- just be happy for the guy for the sake of being happy for someone who got an award. Ok I know it's trivial and a bit like comparing apples to oranges, but we were generally happy for Taylor Swift when she won the VMA even though many people didn't think she deserved it and that Beyonce has done so much more, why can't we be happy for the President we voted into office for winning the Peace prize? Yes, I digree I know...but disagree with me by all means!
I understand that eliminating tax breaks is probably sensitive, but the "Win-Win" article written by Jonathan Gruber was actually fairly enlightening. It was realistic, in that he recognized that eliminating it would be a no-no, and so reducing it would be a good bet. I don't find that so bad now do you? Given that it'll generate a good amount of revenue to fund many of these proposed reforms at the same rate at which costs rise makes total sense to me. Call me naive, but when I was employed, it didn't even occur that my premiums were tax-free, I simply chose the cheapest premium and didn't even make the calculation if I was going to save more in taxes had I chosen a more expensive one! I totally agree with Professor Robinson's arguments for tax capping. I think it's realistic and fairly on the moderate side of things.
Frankly, I am a bit disheartened because the bill seems to be losing the whole point of meaningful reform, at least in my definition of "meaningful" - which in my ideal world - means cost-control and realistically financed universal access if not coverage. After reading about the Healthy SF fact sheet today, the plan seemed promising. A group of friends were at Cha Cha Cha (tapas bar with awesome sangria and mojito by the way) in SF last Friday, and one of us pointed out that there was actually a line item for Healthy SF on our $100 bill (fyi, there was about 6 of us and we were hungry and had alcohol) for a mere $2.50. Seriously, that's like 1/50th of the total cost which is pretty much nothing! I'd be curious about whether or not SF does report healthier outcomes and I'd be curious as to how they'd measure that and determine that but it seems to be working well.
I am completely perplexed frankly by all this. We expect so much but we are unwilling to pay for anything or assume any responsibility; but when we don't get it and all hell breaks loose, we look to other people (i.e. gov't) and say "Well, why aren't you doing anything???" I guess this goes back to the fundamental values of our society in general I guess. Are we seriously that fickle??? I think I may have just posed a rhetorical question.
All disclaimer out there, I'm a self-professed Obama fan, and completely admire the guy for taking on this job amidst all the madness right now. It doesn't mean I agree with everything he's doing but in my opinion, he deserves the Nobel Peace Prize for just maintaining some sort of peace and order in trying to pass health care reform. On the global level, I'm not so sure and even if you disagree- just be happy for the guy for the sake of being happy for someone who got an award. Ok I know it's trivial and a bit like comparing apples to oranges, but we were generally happy for Taylor Swift when she won the VMA even though many people didn't think she deserved it and that Beyonce has done so much more, why can't we be happy for the President we voted into office for winning the Peace prize? Yes, I digree I know...but disagree with me by all means!
Big Food vs. Big Insurance
Not sure if this article has been mentioned in the past (as, you know, "Today in the New York Times..." seems to be something we say in every class), but the NYT published this on September 9, 2009 about how all this talk about health care reform has not touched on the fundamental question of food reform in the U.S.
In this article, the authors bring up that fact that "we’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet.One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care."
A significant amount of healthcare money is being spent on chronic conditions. So, it seems that it would make sense that saving costs on health care expenditures starts more upstream than treating people after they develop diabetes. But whether because tackling the entire food industry is too daunting or whether it's just not a priority to the current Administration, I feel that this factor on the American population's health can not be ignored.
There has been some discussion on the soda tax, but other methods of improving the American diet include diversifying the regional food economy and making school lunches healthier and from regional growers instead of far-away food manufacturers.
Anyway, I'm going to conclude with (1) the link to the article:
http://www.nytimes.com/2009/09/10/opinion/10pollan.html?pagewanted=1&_r=1
and (2) a quote from a very frustrated Dr. Cox (to an overweight CHD patient) from the NBC show "Scrubs" which pertains to food and health. "Guess what, you are what you eat, and clearly you've gone out and eaten a big fat man."
In this article, the authors bring up that fact that "we’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet.One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care."
A significant amount of healthcare money is being spent on chronic conditions. So, it seems that it would make sense that saving costs on health care expenditures starts more upstream than treating people after they develop diabetes. But whether because tackling the entire food industry is too daunting or whether it's just not a priority to the current Administration, I feel that this factor on the American population's health can not be ignored.
There has been some discussion on the soda tax, but other methods of improving the American diet include diversifying the regional food economy and making school lunches healthier and from regional growers instead of far-away food manufacturers.
Anyway, I'm going to conclude with (1) the link to the article:
http://www.nytimes.com/2009/09/10/opinion/10pollan.html?pagewanted=1&_r=1
and (2) a quote from a very frustrated Dr. Cox (to an overweight CHD patient) from the NBC show "Scrubs" which pertains to food and health. "Guess what, you are what you eat, and clearly you've gone out and eaten a big fat man."
Pay for Performance
Hey guys,
Just to follow-up on our discussion on Pay for Performance issues in class this afternoon...a friend in the MBA-MPH program worked a lot with P4P in SoCal before coming to Berkeley, and found that unfortunately it's got a lot of kinks that still need to be worked out (as we talked about today.) He sent me this video; it's pretty interesting what studies have found on how people's problem-solving methodologies change the second you give them some sort of consequence/goal/penalty/incentive riding on the outcome of their decisions. This video talks about the psychology of problem-solving in general, not specifically how it relates to physicians, but my friend said that he saw the application of this concept when he was working with the docs on the P4P initiative. The video's a little long, but you get the main points from the first 5-10 minutes :-)
-nina
http://www.youtube.com/watch?v=rrkrvAUbU9Y
Just to follow-up on our discussion on Pay for Performance issues in class this afternoon...a friend in the MBA-MPH program worked a lot with P4P in SoCal before coming to Berkeley, and found that unfortunately it's got a lot of kinks that still need to be worked out (as we talked about today.) He sent me this video; it's pretty interesting what studies have found on how people's problem-solving methodologies change the second you give them some sort of consequence/goal/penalty/incentive riding on the outcome of their decisions. This video talks about the psychology of problem-solving in general, not specifically how it relates to physicians, but my friend said that he saw the application of this concept when he was working with the docs on the P4P initiative. The video's a little long, but you get the main points from the first 5-10 minutes :-)
-nina
http://www.youtube.com/watch?v=rrkrvAUbU9Y
Drivers of Health Care Spending
Hi All,
Just wanted to share with you the CBO report that shows the primary drivers of health care costs:
http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdfYou'll notice that defensive medicine ranks low on this list... at the same time you'll notice that the parameters assessed vary widely in their overall impact among the three studies....
Tuesday, October 13, 2009
Senate Finance Committee Approves Baucus Bill
As you probably know by now, today the Senate Finance Committee approved Max Baucus' health care reform proposal on a 14-9 vote. Not only is this a big deal for being the last version of the health care proposal bill to get out of a committee, but this event is also generating quite a stir because of Republican Olympia Snowe's decision to break from party lines and vote with the 13 Democrats.
http://www.nytimes.com/2009/10/14/health/policy/14health.html?ref=us
Also on the NYT website is a small collection of blog entries from scholarly contributors about today's event (http://roomfordebate.blogs.nytimes.com/2009/10/13/why-one-vote-matters-in-the-senate/). Some of the interesting points that I found include:
1. The very fact that we're making such a big deal of one Senator not voting with her party demonstrates the hyper-partisan political environment that exists at the moment. Is it a necessarily bad thing that no other Republicans have signed on to this bill, or is it just a normal part of legislating big issues?
2. How long will Olympia Snowe continue to vote with the Democrats? Will she be willing to support a public option? If so, with what conditions?
3. Can Congresswoman Snowe's vote encourage other Republicans to vote with the Democrats? Maine seems to be an interesting case, though Senator Snowe is a Republican, the state itself is regarded by many as an "independent" (words of Larry Sabato). Therefore it is not surprising to see the representatives from Maine "stray [from party lines] with some frequency." It could be argued that Snowe represents voting for what her constituents wants versus what her party wants.
http://www.nytimes.com/2009/10/14/health/policy/14health.html?ref=us
Also on the NYT website is a small collection of blog entries from scholarly contributors about today's event (http://roomfordebate.blogs.nytimes.com/2009/10/13/why-one-vote-matters-in-the-senate/). Some of the interesting points that I found include:
1. The very fact that we're making such a big deal of one Senator not voting with her party demonstrates the hyper-partisan political environment that exists at the moment. Is it a necessarily bad thing that no other Republicans have signed on to this bill, or is it just a normal part of legislating big issues?
2. How long will Olympia Snowe continue to vote with the Democrats? Will she be willing to support a public option? If so, with what conditions?
3. Can Congresswoman Snowe's vote encourage other Republicans to vote with the Democrats? Maine seems to be an interesting case, though Senator Snowe is a Republican, the state itself is regarded by many as an "independent" (words of Larry Sabato). Therefore it is not surprising to see the representatives from Maine "stray [from party lines] with some frequency." It could be argued that Snowe represents voting for what her constituents wants versus what her party wants.
Monday, October 12, 2009
Information-rich environments....and calorie-rich burgers
This article:
http://www.nytimes.com/2009/10/06/nyregion/06calories.html?_r=1&ref=nyregion
is about the new New York City law that restaurants must prominently display the calorie counts of all items. A study analyzed people's receipts and found that the law had no effect on calorie consumption in low-income neighborhoods. However, people have said in surveys that they believe the extra information has made a difference in their eating patterns.
Proponents of choice in the health-care sector believe that consumers will make good decisions as long as information is available to them. In this particular case, that doesn't seem to be true. Too bad it didn't work, since this is an intervention that costs very little, and reaches every person that walks into a restaurant.
http://www.nytimes.com/2009/10/06/nyregion/06calories.html?_r=1&ref=nyregion
is about the new New York City law that restaurants must prominently display the calorie counts of all items. A study analyzed people's receipts and found that the law had no effect on calorie consumption in low-income neighborhoods. However, people have said in surveys that they believe the extra information has made a difference in their eating patterns.
Proponents of choice in the health-care sector believe that consumers will make good decisions as long as information is available to them. In this particular case, that doesn't seem to be true. Too bad it didn't work, since this is an intervention that costs very little, and reaches every person that walks into a restaurant.
Hi Everyone-
I saw this interesting article in the NYT this morning. While there are way, WAY more issues at play than just costs (religion, morals, reproductive choice, etc), I was struck by the fact that, at least in individual anecdotes, that insurance companies end up spending much more money caring for the often premature babies born as multiples from intrauterine insemination, rather than paying for the more expensive IVF treatments up front. This touches on a few of the different themes we've discussed in class:
-I know that this is not at all a case where we would say that IVF is a "preventive" measure, but it does raise questions about investing dollars upstream rather than downstream.
-This raises some issues about cost-effectiveness research, and how it relates to patient demand. If couples were to be given cost-effectiveness data on the different fertility treatments, do you think demand for any of these types of treatments would go down?
-What about the idea of including pain and suffering estimations in cost-effectiveness research? Here comes controversy! I don't think Americans would ever accept being told you could put a "price on life," or that we would ever be comfortable with some research board deciding the monetary value of a life that is going under extensive medical treatments. Just look at how much we value keeping an elderly person alive for a few days, even if she is barely conscious and hooked up to tubes in the ICU.
I know that fertility treatments and reproductive choice are a controversial issue...just want to see what others out there might be thinking.
I saw this interesting article in the NYT this morning. While there are way, WAY more issues at play than just costs (religion, morals, reproductive choice, etc), I was struck by the fact that, at least in individual anecdotes, that insurance companies end up spending much more money caring for the often premature babies born as multiples from intrauterine insemination, rather than paying for the more expensive IVF treatments up front. This touches on a few of the different themes we've discussed in class:
-I know that this is not at all a case where we would say that IVF is a "preventive" measure, but it does raise questions about investing dollars upstream rather than downstream.
-This raises some issues about cost-effectiveness research, and how it relates to patient demand. If couples were to be given cost-effectiveness data on the different fertility treatments, do you think demand for any of these types of treatments would go down?
-What about the idea of including pain and suffering estimations in cost-effectiveness research? Here comes controversy! I don't think Americans would ever accept being told you could put a "price on life," or that we would ever be comfortable with some research board deciding the monetary value of a life that is going under extensive medical treatments. Just look at how much we value keeping an elderly person alive for a few days, even if she is barely conscious and hooked up to tubes in the ICU.
I know that fertility treatments and reproductive choice are a controversial issue...just want to see what others out there might be thinking.
AHIP assails health care legislation
Here's a good follow up to my group's presentation on private financers last Wednesday. America's Health Insurance Plans (AHIP) has taken a strong stance against health care legislation drafted by Senate Democrats. The organization states that the legislation will drive up premiums and the cost of coverage for a family, as well as encourage people to defer buying insurance until they are sick.
Enjoy:
Sunday, October 11, 2009
Would you have faith in a system that looked like this?
This was a rather comical organizational chart that I ran across on a congressman's website. While pretty ridiculous, it is worth a laugh. This is apparently being circulated among Republican congressional leadership as a visual representation of what those Democrats are up to in their government takeover plans.
Enjoy: http://fleming.house.gov/uploads/Org%20Chart%20of%20Dem%20Health%20Plan.pdf
Enjoy: http://fleming.house.gov/uploads/Org%20Chart%20of%20Dem%20Health%20Plan.pdf
Thursday, October 8, 2009
The Decline of The Professional??
In reference to our discussion on Wednesday (10/07) about the changing dynamics of the health care profession, here is the NY Time's article discussing the changing public opinion of The Professional that has possibly contributed to those dynamics.
http://www.nytimes.com/2008/01/06/fashion/06professions.html?scp=4&sq=Profession&st=nyt
One particular paragraph sums up one opinion on the shift: "This decline, Mr. Florida argued, is rooted in a broader shift in definitions of success, essentially, a realignment of the pillars. Especially among young people, professional status is now inextricably linked to ideas of flexibility and creativity, concepts alien to seemingly everyone but art students even a generation ago." If definition of success is the ability to be flexible and creative, then I think that the Professional can still be viewed as an icon of success - it takes more than an understanding of physiology to be a good medical practitioner, in fact, I've heard medicine referred to as an art form as much as it is referred to as a science. That being said, maybe it's not only a shift in the ideals of success that have led to a decline of The Professional....
Thoughts?
CBO and the Healthcare Plan
I found this to be an interesting contemporary article regarding the use of policy analysis. We don't hear about the Congressional Budget Office (CBO) very much in the news, or in our day to day lives, but when they give support to a bill, or champion a legislators belief or value system, it is touted as a triumph.
If the CBO found that the plan would not have decreased the deficit, or if it was found to increase the deficit slightly with the same coverage estimates, do you think it would be a NYT newsworthy article? Do you think it would still be championed by the Dems,? Do you think it would actually have any impact on legislative process or decision-making regarding the Baucus Plan itself?
http://www.nytimes.com/2009/10/08/health/policy/08health.html?_r=1
If the CBO found that the plan would not have decreased the deficit, or if it was found to increase the deficit slightly with the same coverage estimates, do you think it would be a NYT newsworthy article? Do you think it would still be championed by the Dems,? Do you think it would actually have any impact on legislative process or decision-making regarding the Baucus Plan itself?
http://www.nytimes.com/2009/10/08/health/policy/08health.html?_r=1
Wednesday, October 7, 2009
NPR Series called "Health Care: Are You Covered?"
Here is a shout out to all you NPR fans out there!
I was listening to NPR yesterday morning and heard another story from their series called "Health Care: Are You Covered?"
I have realized over the past few weeks that I have been listening to these stories with great interest, so I wanted to share them.
The series is a set of personal stories from people all over the US about how they pay for health care costs for themselves and their families. It covers stories of people from the uninsured to people who have the best coverage one could ask for.
This website is where you can go to just listen to a few people and read their stories:
http://www.npr.org/templates/story/story.php?storyId=112867626
I think something like this is a good way of getting people's personal stories out there, for others to relate to and learn from. Let me know what you think!
I was listening to NPR yesterday morning and heard another story from their series called "Health Care: Are You Covered?"
I have realized over the past few weeks that I have been listening to these stories with great interest, so I wanted to share them.
The series is a set of personal stories from people all over the US about how they pay for health care costs for themselves and their families. It covers stories of people from the uninsured to people who have the best coverage one could ask for.
This website is where you can go to just listen to a few people and read their stories:
http://www.npr.org/templates/story/story.php?storyId=112867626
I think something like this is a good way of getting people's personal stories out there, for others to relate to and learn from. Let me know what you think!
Monday, October 5, 2009
Eveeryone in the US has been looking for new models of health care systems for a long time. Journalists alternately cling to and tear apart systems in various countries while academics and analysts write whole tomes trying to draw lessons applicable to the USA. Just when it seemed we'd run out of countries (Britain, Canada and France are such old news, and Cuba's politically off-limits), Switzerland started getting more attention.
On Sept 30th the NY Times ran an article about the benefits of the Swiss health care system and how perhaps they could provide answers to the US (http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?_r=1&ref=health). Other news agencies have been and are running similar stories (Here's NPR's from July 08). The gist of the argument is that the Swiss are managing to insure the entire population using only private insurance companies. Competition is maintained, coverage is mandatory and everything runs more or less smoothly, or so it seems. The NY Times quotes Regina Herzlinger, Harvard Business School professor, as saying, “What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf. And there’s no waiting lists or rationing.” Outcomes are quite good, with a high life expectancy (79/84 m/f - http://www.who.int/countries/che/en/) and overall satisfaction with the system is good, but how much of a utopia is it really? Some news articles touched on the ideas of high costs...both overall (While it's no USA, Switzerland's health care still costs 11% of GDP) and individually. Premiums are paid mostly by individuals and are regressive, though the government does step in to help the 35-40% of households paying more than 8% of their income to premiums. (NYTimes) Cost-sharing (copays etc) are also higher in Switzerland than other countries. But for all that, it might be worth it if the system works?
The thing is, it's not working. At least not perfectly. The Neue Zurcher Zeitung, one of Switzerland's main newspapers, ran this article today with the headline "Health Insurers have too little reserve; Premiums of 18 funds could increase in the summer." The article talks about how the private insurance companies are struggling and how at least 18 of them will most likely raise their (already very high) premiums within the next year or risk folding completely. It looks as though even this country, then, is not as much of a model as we'd hoped.
On Sept 30th the NY Times ran an article about the benefits of the Swiss health care system and how perhaps they could provide answers to the US (http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?_r=1&ref=health). Other news agencies have been and are running similar stories (Here's NPR's from July 08). The gist of the argument is that the Swiss are managing to insure the entire population using only private insurance companies. Competition is maintained, coverage is mandatory and everything runs more or less smoothly, or so it seems. The NY Times quotes Regina Herzlinger, Harvard Business School professor, as saying, “What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf. And there’s no waiting lists or rationing.” Outcomes are quite good, with a high life expectancy (79/84 m/f - http://www.who.int/countries/che/en/) and overall satisfaction with the system is good, but how much of a utopia is it really? Some news articles touched on the ideas of high costs...both overall (While it's no USA, Switzerland's health care still costs 11% of GDP) and individually. Premiums are paid mostly by individuals and are regressive, though the government does step in to help the 35-40% of households paying more than 8% of their income to premiums. (NYTimes) Cost-sharing (copays etc) are also higher in Switzerland than other countries. But for all that, it might be worth it if the system works?
The thing is, it's not working. At least not perfectly. The Neue Zurcher Zeitung, one of Switzerland's main newspapers, ran this article today with the headline "Health Insurers have too little reserve; Premiums of 18 funds could increase in the summer." The article talks about how the private insurance companies are struggling and how at least 18 of them will most likely raise their (already very high) premiums within the next year or risk folding completely. It looks as though even this country, then, is not as much of a model as we'd hoped.
Sunday, October 4, 2009
Flying Doctors
This time around I thought I'd write about an incredible federally-funded program I learned about in Australia called the Royal Flying Doctors Service. The Service provides aero-medical emergency and primary care assistance to Australians living, and traveling, in the remote lands of the outback, many of whom make emergency calls from satellite radios provided by the Flying Doctors Service. They fly to over 660 patients per day and span an area equal in size to Western Europe.
One of the most impressive features of the Service is its focus on preventative services. Doctors, flight nurses, and other practitioners staff over 30 clinics spanning remote Australia (several thousand kilometers) offering vaccinations, checkups, and dental exams. They also provide radio or telephone consultative services 24 hours a day, which are available for emergency or routine health concerns. One of my favorite components of the program is that they extensively provide 3500 "medical chests" to isolated properties, indigenous communities, cattle stations, etc. These chests contain numerous drugs and supplies with which patients can treat themselves with telephone assistance from a nurse or doctor. They even hold regular field days to educate children and adults on how to incorporate health promotion in their everyday lives.
I toured their Central Operations office while in central Australia and it's like a well oiled machine. Their quality metrics are excellent and they have an impressive safety record. I wonder if we can use some of the values and goals of the Royal Flying Doctors Service in some of our domestic health policy considerations. We may not need airplanes to reach our remote, immigrant, or less educated populations, but I think we can learn a lot.
If you want to read about this some more, here is the site - www.flyingdoctor.net
One of the most impressive features of the Service is its focus on preventative services. Doctors, flight nurses, and other practitioners staff over 30 clinics spanning remote Australia (several thousand kilometers) offering vaccinations, checkups, and dental exams. They also provide radio or telephone consultative services 24 hours a day, which are available for emergency or routine health concerns. One of my favorite components of the program is that they extensively provide 3500 "medical chests" to isolated properties, indigenous communities, cattle stations, etc. These chests contain numerous drugs and supplies with which patients can treat themselves with telephone assistance from a nurse or doctor. They even hold regular field days to educate children and adults on how to incorporate health promotion in their everyday lives.
I toured their Central Operations office while in central Australia and it's like a well oiled machine. Their quality metrics are excellent and they have an impressive safety record. I wonder if we can use some of the values and goals of the Royal Flying Doctors Service in some of our domestic health policy considerations. We may not need airplanes to reach our remote, immigrant, or less educated populations, but I think we can learn a lot.
If you want to read about this some more, here is the site - www.flyingdoctor.net
Saturday, October 3, 2009
Making prescription drugs more affordable, or sneaky marketing tactic?
A recent article in the Wall Street Journal discussed how “a growing number of dug makers are offering [discount and rebate] coupons that help reduce out-of-pocket costs of some prescription drugs.” According to the article, the coupons are mostly for newer brand-name drugs, and they can lower or even eliminate co-pays for the drugs, depending on the insurance plan.
On the consumer advocates side, the argument is that these coupons help patients save both on drugs they are already using and on new therapies that the patients may want to try. Essentially, they view these coupons as “co-pay assistance.” The other side argues that these coupons may undercut insurers’ cost-control measures, because they may steer consumers towards brand-name medicines that aren’t on the preferred list of pharmacy-benefit plans with tiered formularies. While a coupon could eliminate the patient’s co-pay for a new, brand-name drug, the insurer still has to pay the negotiated wholesale price. This means that there is the potential that use of these coupons could “lead to higher premiums in the long run.”
Here’s the link to the article…
http://online.wsj.com/article/SB125339394529025429.html
On the consumer advocates side, the argument is that these coupons help patients save both on drugs they are already using and on new therapies that the patients may want to try. Essentially, they view these coupons as “co-pay assistance.” The other side argues that these coupons may undercut insurers’ cost-control measures, because they may steer consumers towards brand-name medicines that aren’t on the preferred list of pharmacy-benefit plans with tiered formularies. While a coupon could eliminate the patient’s co-pay for a new, brand-name drug, the insurer still has to pay the negotiated wholesale price. This means that there is the potential that use of these coupons could “lead to higher premiums in the long run.”
Here’s the link to the article…
http://online.wsj.com/article/SB125339394529025429.html
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