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."

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

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.pdf

You'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....

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.

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.

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.

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:

http://www.nytimes.com/2009/10/12/health/policy/12insure.html?_r=1&hpw