Unchecked Obesity Rates Could Bankrupt Nation

By Merrill Goozner
The Fiscal Times
Originally published September 19, 2012

Obesity rates have doubled over the past two decades and will almost double again over the next two decades unless the public comes to grips with its swelling waistlines, a new study says.

The rising tide of obesity threatens to send health care costs soaring. Already, the nation spends an estimated $147 billion to $210 billion per year on obesity-related diseases including Type 2 diabetes, hypertension, heart disease, and arthritis. Unless the projections are altered dramatically, additional medical costs associated with treating preventable, obesity-related diseases could swell by another $48 billion to $66 billion by 2030, the report said.

“We have this middle-aged cohort who are obese today and in the next 10 to 20 years will become quite costly,” said Jeffrey Levi, executive director of Trust for America’s Health, which co-authored the report with the Robert Wood Johnson Foundation. “They’re the really tough nuts to crack when it comes to combating obesity.”

The entire story is here.

Government Can Play Important Role in Obesity Epidemic, Expert Argues

ScienceDaily
Originally published September 18, 2012

Addressing the obesity epidemic by preventing excess calorie consumption with government regulation of portion sizes is justifiable and could be an effective measure to help prevent obesity-related health problems and deaths, according to a Viewpoint in the September 19 issue of JAMA, and theme issue on obesity.

Thomas A. Farley, M.D., M.P.H., Commissioner of the New York City Department of Health and Mental Hygiene, presented the article at a JAMA media briefing.

"Americans consume many more calories than needed, and the excess is leading to diabetes, cardiovascular disease, and premature mortality. Since the 1970s, caloric intake has increased by some 200 to 600 calories per person per day. Although it is unclear how important changes in physical activity are to the surge in obesity prevalence, it is quite clear that this increase in calorie consumption is the major cause of the obesity epidemic—an epidemic that each year is responsible for the deaths of more than 100,000 Americans and accounts for nearly $150 billion in health care costs," writes Dr. Farley.

The entire story is here.

Study of U.S. Health Care System Finds Both Waste and Opportunity to Improve

By Annie Lowrey
The New York Times
Originally published on September 11, 2012

The American medical system squanders 30 cents of every dollar spent on health care, according to new calculations by the respected Institute of Medicine. But in all that waste and misuse, policy experts and economists see a significant opportunity — a way to curb runaway health spending, to improve medical outcomes and even to put the economy on sounder footing.

“Everybody from Paul Krugman to Paul Ryan agrees it is essential to restrain costs,” said Dr. Mark D. Smith, the president of the California HealthCare Foundation and the chairman of the committee that wrote the report, referring to the liberal economist and Op-Ed columnist for The New York Times, and the conservative Wisconsin congressman who is Mitt Romney’s vice-presidential running mate. “The health care industry agrees, too.”

The Institute of Medicine report — its research led by 18 best-of-class clinicians, policy experts and business leaders — details how the American medical system wastes an estimated $750 billion a year while failing to deliver reliable, top-notch care. That is roughly equivalent to the annual cost of health coverage for 150 million workers, or the budget of the Defense Department, or the 2008 bank bailout.

The entire story is here.

Medical waste: America loses billions to sloppy health care

Pittsburgh Post Gazette
Originally published September 10, 2012

The influential Institute of Medicine has completed a comprehensive review of the nation's health care system, and here's the frightening diagnosis: Nearly $750 billion a year is wasted on unnecessary care, excessive administrative costs, fraud, duplication and poor communication.

The institute's conclusions may not be surprising to anyone who has had to reschedule an appointment because tests results were not available or to repeat a procedure in order to get accurate data. In fact, the group's study found that 20 percent of patients experienced the former and 25 percent the latter.

The entire story is here.

Health Care Spending in Last Five Years of Life Exceeds Total Assets for One Quarter of U.S. Medicare Population

ScienceDaily

Originally published September 8, 2012

As many as a quarter of U.S. Medicare recipients spend more than the total value of their assets on out-of-pocket health care expenses during the last five years of their lives, according to researchers at Mount Sinai School of Medicine. They found that 43 percent of Medicare recipients spend more than their total assets minus the value of their primary residences.

The findings appear online in the current issue of the Journal of General Internal Medicine.

The amount of spending varied with the patient's illness. Those with dementia or Alzheimer's disease spent the most for health care, averaging $66,155, or more than twice that of patients with gastrointestinal disease or cancer, who spent an average of $31,069. Dementia patients often require special living arrangements, which accounts for the sizeable difference in cost.

Theentire story is here.

Rationing Health Care More Fairly

By Eduardo Portor
New York Times - Business Day
Originally published August 24, 2012

Older adults are understandably anxious about the political sniping over the future financing of Medicare. That is precisely the intention of the presidential campaigns.

Yet the cross-fire over who will cut Medicare by how much sidesteps a critical issue about the future of our medical care: If we must ration our care to hold down costs in the future, how can we do it in a fair, efficient and transparent way?

Mitt Romney’s campaign was brazenly misleading in its charge that the president’s health plan would cut medical services to older adults by reducing Medicare spending by $716 billion. The president’s savings will come mostly from smaller payments to managed care companies, which provide the same services as Medicare at a higher cost, and from slower growth in reimbursement rates to health care providers.

But the response of President Obama’s campaign also aimed to stoke voters’ fears. It stressed — rightly — that the plan to curb Medicare costs proposed last year by Representative Paul D. Ryan, Mr. Romney’s vice-presidential running mate, would add thousands of dollars to older Americans’ out-of-pocket expenditures. Yet it ignored Mr. Ryan’s recent efforts to soften the plan.

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Rationing is inevitable in a world with finite resources. We do it in this country, too, and it is still one of the least fair and most inefficient rationing systems in the world. You get care if you have the money to pay for it; if not, you probably won’t.

The wealthiest 30 percent of the population accounts for nearly 89 percent of health care expenditures, according to a government study. Tens of millions of Americans — those whose employers don’t provide health insurance, who are too poor to pay for it themselves and yet are too rich to use Medicaid — get the least health care of all.

The entire article is here.

5% of Americans Spend 50% of Health Care Dollars

By Merrill Goozner
The Fiscal Times
Originally published July 31, 2012

The key argument in favor of the individual health insurance mandate, which was upheld last month by the Supreme Court in a 5-4 vote, was that everyone uses health care eventually. Therefore, it is only fair that everyone pays into the insurance pool. Without a mandate, when access to affordable coverage becomes guaranteed in 2014, some people will simply wait until they get sick before buying a plan.

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A new issue brief from the National Institute of Health Care Management adds grist to the mill of those who rebelled against the universal insurance mandate. The study showed that in 2009 half the population – fully 150 million people – spent an average of just $236 per person on health care. That was a paltry $36 billion for the entire group out of $1.3 trillion in personal health care expenditures.

On the other side of the use spectrum, however, just five percent of the population – about 15 million people – spent a whopping $623 billion or about half of all personal health care expenditures. That came to nearly $41,000 per patient.

The entire story is here.

Healthcare Data Breaches Still Rising

By Deborah Hirsch
HealthTechZone Contributor
Originally published July 19, 2012

Here are some excepts:

The healthcare industry has the highest percentage of data breaches of any sector, according to a report by Symantec. Healthcare also had the highest number of reported breaches, at 43 percent, Patricia Resende reports.

And the costs continue to rise, with each breach costing organizations $5.5 million, and each compromised record, $194, the Symantec study reports. And even though the costs have dropped slightly from several years ago, according to a Ponemon study, healthcare is the one area where they have not. Physicians’ offices and small clinics say they have lost more than 54,000 patient records due to breaches since 2009.

And they’ve occurred all over the country, from Utah, where the files of almost 300,000 Medicaid patients were breached in March, to Boston, where the laptop of a Boston Children’s Hospital employee at a South American conference containing more than 2000 patient records was stolen.

The entire story is here.

From an Ethics of Rationing to an Ethics of Waste Avoidance

By Howard Brody, MD, PhD
The New England Journal of Medicine
Originally published on May 24, 2012

Dr. Howard Brody

Bioethics has long approached cost containment under the heading of “allocation of scarce resources.”  Having thus named the nail, bioethics has whacked away at it with the theoretical hammer of distributive justice. But in the United States, ethical debate is now shifting from rationing to the avoidance of waste. This little-noticed shift has important policy implications.

 Whereas the “R word” is a proverbial third rail in politics, ethicists rush in where politicians fear to tread. The ethics of rationing begins with two considerations.  First, rationing occurs simply because resources are finite and someone must decide who gets what. Second, rationing is therefore inevitable; if we avoid explicit rationing, we will resort to implicit and perhaps unfair rationing methods.

The main ethical objection to rationing is that physicians owe an absolute duty of fidelity to each individual patient, regardless of cost. This objection fails, however, because when resources are exhausted, the patients who are deprived of care are real people and not statistics. Physicians collectively owe loyalty to those patients too. The ethical argument about rationing then shifts to the question of the fairest means for allocating scarce resources — whether through the use of a quasi-objective measure such as quality-adjusted life-years or through a procedural approach such as increased democratic engagement of the community.

The entire story is here.

An interview with Dr. Brody is here.

Thanks to Gary Schoener for this lead.

Backers of health insurance rate regulation edge closer to ballot

Los Angeles Times
Originally published May 19, 2012

Supporters of a proposed ballot measure seeking tighter regulation of health insurance rates in California turned in 800,000 petition signatures, confident that they will qualify for the Nov. 6 election.

In the coming weeks, county election offices and the California secretary of state will determine whether the measure meets the requirement for 504,760 valid signatures of registered voters. The deadline to qualify is June 28.

The initiative is expected to spark an expensive campaign battle over rising health insurance rates, which have angered thousands of California consumers in recent years. This measure seeks to regulate rate increases for health policies sold to individuals and small businesses, which cover about 5 million people. It doesn't affect plans purchased by larger employers that cover about 15 million Californians.

The entire story is here.

For Hospitals and Insurers, New Fervor to Cut Costs

By Reed Abelson
The New York Times - Health
Originally published May 23, 2012

Giselle Fernandez is only 17 but she has had more than 50 operations since she was born with a rare genetic condition. She regularly sees a host of pediatric specialists, including an ophthalmologist, an endocrinologist and a neurologist at UCLA Health System.

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After years of self-acknowledged profligacy, hospitals, doctors and health insurers say there is a strong effort under way to bring medical costs under control. Their goal is to slash the rate of growth in the nation’s $2.7 trillion health care bill by roughly half to keep it more in line with overall inflation.

Private insurers, employers and government officials are providing urgency to these efforts, and the federal health care law passed two years ago helped accelerate them.

Even if the Supreme Court decides next month to declare the entire law unconstitutional, many experts in the field say the momentum is likely to continue.

The entire story is here.

Waiting for Health Care

By Peter Nicks
The New York Times - Op-DOCS
Originally published May 20, 2012

“The Waiting Room” developed from stories my wife, a speech pathologist at Highland Hospital, told me about the struggles and resilience of her patient population. And a few years ago, as the contentious vote for health care reform got louder, it occurred to me that the people who were not participating in the debate were the very people we were fighting over: those stuck in waiting rooms at underfunded public hospitals all over the country. How would the patients in the waiting room at Highland Hospital respond to President George W. Bush’s statement, echoed by many others, that we already have universal health care in this country because, by law, nobody can be turned away from an emergency room for lack of ability to pay?

The entire story is here.

Individual Health Policies Fall Short, a Study Finds

By Reed Abelson
The New York Times - Health
Originally published May 23, 2012

More than half of all medical insurance policies sold to individuals now fail to meet the standards of coverage set by the federal health care law under review by the Supreme Court, a new study says.

Even if the law is upheld, employer-provided insurance plans are likely to continue to be more generous, but the law would significantly improve the quality of coverage for individuals in several ways, the researchers concluded.

Insurers would be required, for example, to limit how much people pay toward their own medical bills, even if they have a chronic and expensive condition. Insurers would also have to provide a comprehensive set of benefits, like maternity coverage that is now excluded by some policies, and cover pre-existing medical conditions, which may be excluded under certain policies.

The entire story is here.

Insurers Embrace "Virtual" Doctor Visits

By Phil Galewitz
KHN Staff Writer
Originally published May 6, 2012

Tired of feeling "like the walking dead" but worried about the cost of a doctor's visit, Amber Young sat on her bed near tears one recent Friday night in Woodbury, Minn.

That's when she logged onto an Internet site, run by NowClinic online care, a subsidiary of UnitedHealth Group (which also owns UnitedHealthcare), and "met" with a doctor in Texas.

After talking with the physician via instant messaging and then by telephone, Young was diagnosed with an upper respiratory illness and prescribed an antibiotic that her husband picked up at a local pharmacy. The doctor's "visit" cost $45.

"I was as suspicious as anyone about getting treated over the computer," said Young, 34, who was uninsured then. "But I could not have been happier with the service."

Read the entire story here.

What Can Plato Teach Us About the Health Insurance Mandate?

By Nicholas J. Diamond
The Hastings Center: Bioethics Forum
Health Policy
Originally published on April 23, 2012

As any philosopher worth his or her salt can tell you, health insurance is not among the array of topics in Plato’s corpus. Even so, a lesson on citizenship from one of his more famous dialogues, “Crito,” can teach why the insurance mandate in the Affordable Care Act ought to make sense to us.

In “Crito,” Socrates, ever Plato’s central figure, explains why he ought to submit to the death sentence imposed on him by Athenian law, despite his friend Crito’s willingness to facilitate his escape. For Socrates, escape would be unjust because of the duty he has implicitly adopted in being an Athenian citizen.

The entire story is here.

Here’s why health insurance is not like broccoli

By Ezekiel Emanuel

The Great Debate - Reuters

Originally published March 29, 2012

The fate of universal healthcare coverage that the United States has been trying to achieve for over 100 years may boil down to broccoli.

The broccoli argument is simple and was frequently referred to in the recent Supreme Court arguments: If the government can require people to buy health insurance, why couldn’t it require people to buy broccoli, which also enhances people’s health? This question, at the heart of the conservative objection to the individual mandate to buy health insurance, illustrates the so-called limiting principle the Supreme Court must rule on: Under the Commerce Clause, does Congress have the constitutional power to compel people to act, in ways they might object to, when their inaction can harm others?

The High Court never got clear on why health insurance is not like broccoli and can thus be constitutionally regulated. There are two important differences that inform the principle for limiting congressional power to compel people to purchase goods and services.

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The difference between broccoli and health insurance is simple. It leads to a clear limiting principle. Congress can urge people to eat their broccoli, but not compel them to buy it, because the broccoli market will function regardless of what people do. Congress can compel people to buy their health insurance because otherwise there will be no health insurance market.

The entire story is here.

Getting Doctors to Think About Costs

By Pauline Chen, MD
The New York Times - Health
Originally Published on March 15, 2012

My first formal lesson on health care costs occurred one afternoon on the wards when I was a medical student. The senior doctor in charge, a silver-haired specialist known for his thoughtful approach to patient care, had assembled several students and doctors-in-training to discuss a theoretical patient with belly pain. After describing the patient’s history and physical exam, he asked what tests we might order.

One doctor-in-training proposed blood work. A fellow student suggested a urine test. Another classmate asked for abdominal X-rays.

My hand shot up. “A CAT scan,” I crowed with confidence. “I’d get a CAT scan!”
There was complete silence. Everyone turned to stare at me.

The senior doctor coughed. “That’s an awfully expensive test,” he said, a grimace appearing on his face. Another student asked him just how much a CT scan cost, and he shifted uncomfortably in his seat and shrugged. “I don’t really know,” he said, “but I do know that we can’t just think about the patient anymore.”

He took a deep breath before continuing, “We are now being forced to consider costs.”

That was 20 years ago, when the managed care movement was first in the headlines. Today his lesson still rings true, as doctors continue to struggle to reconcile cost consciousness with quality care. And doctors-to-be are not getting much help in learning how to do so.

Here is the whole story.

The Unintended Consequences of Conflict of Interest Disclosure

By George Loewenstein, PhD, Sunita Sah, MD, PhD, & Daylian M. Cain, PhD.

The Journal of the American Medical Association

Conflicts of interest, both financial and nonfinancial, are ubiquitous in medicine, and the most commonly prescribed remedy is disclosure. The Medicare Payment Advisory Commission and the Accountable Care Act impose a range of disclosure requirements for physicians, and almost all medical journals now require authors to disclose conflicts of interest (although these requirements may be imperfectly heeded). Given that some relationships between physicians and industry are fruitful and some conflicts are unavoidable, can disclosure correct the problems that arise when economic interests prevent physicians from putting patients' interests first?

Given that some relationships between physicians and industry are fruitful and some conflicts are unavoidable, can disclosure correct the problems that arise when economic interests prevent physicians from putting patients' interests first?

Disclosure has appeal across the political spectrum because it acknowledges the problem of conflicts but involves minimal regulation and is less expensive to implement than more comprehensive remedies.

More importantly, even if disclosure is rarely seen as providing a complete solution to the problem, it is broadly perceived to have beneficial effects.

There are, however, reasons that disclosure can have adverse effects, exacerbating bias and hurting those it is ostensibly intended to help.

<snip>

ENHANCING THE EFFECTIVENESS OF DISCLOSURE

Despite its potential pitfalls, disclosure is almost certainly a good thing.

It should be a patient's right to know whether his or her physician is receiving financial benefits from prescribing a particular drug or will personally benefit if the patient accepts recommended tests or procedures.

The question for policy should not be whether to disclose but how to ensure that disclosure has its intended effects.

Research has revealed ways of making disclosure more effective.

<snip>

Even if disclosure is crafted in a fashion that increases effectiveness and minimizes potentially adverse consequences, it is no panacea.

Disclosure is simply not applicable to many serious conflicts of interest affecting medicine in the United States.

Although payments from pharmaceutical and device companies have received most of the attention in the literature on disclosure, other conflicts, such as financial arrangements that give physicians (and their institutions) incentives for providing high-cost services of dubious value, may be more consequential.

It is difficult to imagine how disclosure could even be applied to, let alone undo, those problems.

However, perhaps the most significant likely pitfall of disclosure is not its effects on the quality of advice received by individual patients or its inapplicability to many serious conflicts of interest, but the likelihood of a kind of moral licensing on the part of the profession as a whole--the rationalization that, with disclosure, the profession has dispensed with its obligation to deal with conflicts of interest.

Conflicts of interest, including fee-for-service arrangements, are at the heart of the astronomical increases in health care costs in the United States, and transparency is no substitute for more substantive reform.

The entire article is here.

Special thanks to Ken Pope for this information.

U.S. to Force Drug Firms to Report Money Paid to Doctors

By ROBERT PEAR
The New York Times - Money and Policy
Originally published 1/16/2012

WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Federal officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The entire article is here.

Mentally Ill flood ERs as States Cut Services

By Julie Steenhuysen and Jilian Mincer

Reuters

Originally published December 26, 2011

On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.

"He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.

Sullivan said the man kept repeating that he wanted to kill himself. "It seemed almost as if he was interested in being admitted."

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies - attempted suicide, severe depression, psychosis - as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll.

This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

"These are people without a previous psychiatric history who are coming in and telling us they've lost their jobs, they've lost sometimes their homes, they can't provide for their families, and they are becoming severely depressed," said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Visits to the hospital's psychiatric emergency department have climbed 20 percent in the past three years.

The entire story is here.