Ugly truth: no health insurance, no liver transplant. Lose your health insurance in your 50s for a brief time period and your reward is death and bankruptcy. You cannot read this story without going “that’s not fair”. There may be a rational way to decide who gets a liver transplant, but this is not it.
And as more and more of these stories get out, the pressure for change will continue to bubble. (Hat-tip FierceHealthcare).
Crowd Protests Health Care in China (in the New York Times)
Some 2,000 people mobbed and ransacked a hospital in southwestern China on Friday in a dispute over medical fees and shoddy health care practices……essential medical care was denied the boy until his grandfather, who was taking care of him, could pay for the treatment. The boy died after the grandfather left to raise money, the group said. An official report from the New China News Agency confirmed that a dispute over medical fees erupted at the hospital, but also said doctors there had treated the boy even though the grandfather did not have $82 to pay for the service.
But no one seems to care in the US, in fact it’s fine and legal in the Sacramento Bee
And then one day my husband was in excruciating pain and the morphine we had at home, nothing I could do would relieve his pain, so I called Cedars Sinai to say I’m bringing him in, he needs — he needs something. He needs to be relieved of this pain. And they said I’m sorry Mrs. Christensen you guys are not allowed through these doors anymore, your insurance has capped out, they’re not paying us anymore and your bills are high. And we can’t allow you to come through these doors anymore. So I had to take my husband to an emergency room where he sat for about eight hours, you know, which is the worst place for a cancer patient to be.
KFF has some new reports out. The first is a Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance. Here’s what the press release says:
The first Snapshot examines the differences in costs associated with individual, nongroup insurance and employer-sponsored insurance. Premiums for nongroup health insurance available from online brokers or reported by insurance industry surveys are much lower than premiums observed for employer-sponsored coverage. This is surprising to some because nongroup health insurance has higher administrative costs. The paper uses data from the Medical Expenditure Panel Survey and finds that people covered by individual insurance have much lower health care spending on average than people who have employer-sponsored insurance, but pay a greater share of that spending out-of-pocket. It also shows that those with individual insurance are significantly more likely than those with employer-sponsored insurance to report that they are in excellent physical and mental health. These findings may help explain why premiums for individual coverage are actually lower than group coverage. The analysis suggests that proposals to extend coverage to lower income people through lower cost nongroup health insurance need to account for the higher out-of-pocket costs associated with these policies.
In other words when someone tells you that eHealthInsurance.com is selling a product cheaper than employers buy it for (as the Galen folks and David Gratzer’s book have recently done), you need to understand that they’re not only selling something different (lower benefits) but that they’re refusing to sell it to people who might actually use it.
The second is a little more subtle. It’s about the ratio of sick people to healthy people in an insurance pool, and the impact on the pools overall cost (premiums). Again from the press release:
The second Snapshot examines the sensitivity of health insurance premiums to enrollment shifts by high cost enrollees – a process often referred to as adverse selection. The introduction of high-deductible, consumer directed health plans has raised concern about their potential to attract younger and healthier people away from more traditional insurance plans, which could increase the costs of those plans. The public discussions of this possibility are often phrased in rather extreme terms – for example, that consumer directed health plans attract primarily the young and healthy. The new report shows that extreme selection behavior is not needed to produce real premium differences between insurance pools, and that the shift of even a small percentage of high spenders from one risk pool to another can have a dramatic impact on average costs – and, therefore, premiums – in the pools
In other words, you only need to avoid a very few sick people to make your pool cost much less. This is something that Medicare Advantage plans (and the GAO) as well as those in the individually underwritten market have known for years. And it’s why the only rational policy outcome (note I said rational, not likely) is a single national pool.
CODA: This is too funny. The very next email into my inbox after the KFF one was the charlatans at Consumers for Health Care Choices (Greg Scandlen) promoting a dinner for Pat (loony) Rooney–the guy who founded Golden Rule and pushed HSAs, and basically is more responsible than anyone else for fracturing what was left of the nation’s insurance pool, and causing all the problems that KFF is explaining!
You be the judge!
Ian Morrison is trying to point out to the upper echelon of America’s body politic (i.e. the rich bit of its health care system) that some compromise may be reasonable in order to avoid single payer.
Brian Klepper and Alain Enthoven are pointing out why that compromise is necessary now — not something that a random walk through the unthinking business columns of the NY Times might suggest.
Of course they’re all optimists. As I’ve told all three (all of whom I know and greatly admire), I think the systems will trundles on till the middle of next decade when at the behest of the China central bank (or whoever controls economic policy then) the President will be forced to put AHIP, the AHA, the AMA, PhRMA and their Congressional lackeys in a room and offer them two choices. And single payer will be the more acceptable one.
The Christian Science Monitor has a pretty interesting article about how the healthcare crisis countdown may lead to a big debate in health care politics either 2008 or later. My guess is much later, but it’s a matter of timing. And the later the system players leave it to sort themselves out, the more likely it’ll be that we get an unthinking single payer solution (as opposed to a thinking one).
Meanwhile John Abramson has joined the hate America crowd. Just because he has data and evidence on his side, he thinks he can get away with that stuff?!
I wrote a scathing piece about an astroturf lobbying organziation that is pretending to be something it’s clearly not. My Spot-on editor Chris Nolan didn’t want me to be sued for libel, so the resulting slightly less caustic article is up there called Action and Reaction. My version was subtitled "Taking the piss."As ever come back here to comment.
Back in the day when there was some vague interest from Democrats in fixing our health care system, a kindly millionaire gave a pile of money
to a lobbying pressure group that had quite some influence behind the
ill-fated Clinton Health Plan. Not too much has been heard since from
Families USA and its leader Ron Pollack. Sadly, those of us of a
certain age felt that its day in the sun had come and gone.
But what was interesting about Families USA was that, unlike
other Capitol Hill groups with "friendly" names, it actually lobbied
for things that might make pretty good sense to families, especially
poor ones. Namely national health insurance coverage that couldn’t be
taken away if the breadwinner got sick. Continue
So the Commonwealth Fund is at it again. Notice how “Commonwealth” has the same root as “Communist”? I thought you did.
Why else would they come out with yet another study showing that compared to other parts of the world that spend a whole lot less money, the U.S. Lags in Several Areas of Health Care. But don’t worry. If you get cancer here and have insurance, you might outlive those damn foreigners…or at least that’s what David Gratzer thinks is the main result of those studies.
If you want to see the whole article in Health Affairs, this is the link. But it doesn’t tell you anything we didn’t already know.
Here’s the full transcript from the David Gratzer interview—if you prefer the podcast version I’ve linked to it here. There are lots of comments there too.
Matthew Holt: This is Matthew Holt, and we’re back with another podcast on the Health Care Blog, and today my guest is David Gratzer. David is a psychiatrist who is still practicing psychiatry, but is also, part-time, a Fellow at the Manhattan Institute, and has written a new book called "The Cure", subtitled "How Capitalism Can Save American Health Care." David, welcome to the Health Care Blog.
David Gratzer: Good afternoon.
Matthew: Let me start off, David. Obviously, with your subtitle, you’re a proponent of free markets in health care, but you come at this from a couple of interesting backgrounds. One is that you’re a Canadian who has moved down to the U.S., to practice medicine down here. The other one, which I found was very interesting is, at the very start of the book, in the introduction, you raise the entire issue of what it’s like to be somebody who has a relative, in this case your wife, who has no insurance in the U.S. and needs medical care. You raised the issue of your wife’s treatment, and I hope she’s fine now, without being overly personal about her, how did you end up in the situation that you were in the U.S. without insurance? David: Well, it certainly was an unfortunate circumstance. A lot of people go without insurance for a variety of reasons. I had access to American health care, but not access to American health insurance. My wife had, as you know from the start of the book, injured her back on the bunny trail on a ski trip. She tells the story slightly differently involving a large mountain, gale-like winds, and heroic efforts on her part. But she had ruptured a disc in her back, and she, as a result, needed surgery. And I’d certainly read much about the American health care system, but what came across me then was not just the confusion about pricing, and I talk about the foot-and-a-half-long bill that I had received, which, as a doctor, I could see was completely inscrutable. But also just the issues around quality.
There we were, trying to find a neurosurgeon, and I went to the Internet and found no information. I went about calling neurologists and trying to get their opinions on neurosurgeons in western New York. So I have a greater appreciation of the frustration that millions of Americans, not just those, incidentally, without insurance. I think even if you’re insured, health care is such a black box of uneven quality, of difficulty gathering basic information, and at the end of the day you’re left with ever-rising prices, with inscrutable bills. I wanted to start the book that way because even though I think there’s greatness in American medicine, and I think one should never lose sight of that, and there’s never been a better time to be, frankly, a patient or a doctor than today, I also wanted to emphasize, literally from page one of the book, that there were huge problems with American health care. And, that even though I took a free market approach to looking at reforms, I wasn’t going to undermine that or downplay that. Matthew: And I understand that. Were you living in the U.S. as a resident at the time? David: I was actually, as I am now, dividing my time. I opted not to get health benefits when I joined the Manhattan Institute. To provide the answer to the insurance question, that’s why. Matthew: The reason I raised that is, and to get to the nitty-gritty of it, you’re not going to get any argument from me about the U.S. health care system having many, many problems, but you’ll get an argument from me about the solution to that. But one of the things that I find curious, from those people that are on the right – the thinking libertarians, to tease my colleagues at the Cato Institute about being, and I think you voice a similar opinion in the book, is the solution to the problem of access. There are many different ways you can talk about solving the problem around pricing and transparency, and getting to understand what people are purchasing, and I think people agree that there needs to be more of that, however it comes out. But the question is, how do you get people to not be uninsured? And I think you’re basically suggesting a voluntary solution here. Do you want to say a bit more about what you think the solution is to dealing with the lack of insurance?
Don Kemper from HealthWise essentially invented the concept of information therapy–the idea that every contact between patients and the medical system should come with an actual prescription for information. I think it’s an incredibly important concept, so I talked with Don in this podcast
about how it got started and where we are, as more and more technology becomes available. (Trascript available in a few days)
I’d never heard of EECP as a treatment for heart disease. Apparently it works, according to this UCSF analysis. But Debra Braverman’s letter to the NY Times says it all (other than mistaking the drug industry for the medical device business):
A full course of EECP costs Medicare a fraction of one stenting procedure and offers physicians and hospitals very little and the pharmaceutical industry nothing. EECP does, however, offer patients substantial relief and improvement in quality of life without risk of heart attacks or death, unlike the drug-coated stents in widespread use, despite the little scientific evidence of long-term benefits.
Meanwhile does anyone know if Dean Ornish’s program is routinely reimbursed by Medicare? Because if the tax payer is buying stents that dont really work as advertised, perhaps we should also be funding alternatives.
Meanwhile, apparently the latest wisdom is that angioplasty is essential within a few hours of a heart attack. And where did this inspired piece of medical wisdom come from? It was developed in the socialized health care havens of Denmark and Sweden. But we’re told that patients there are left to die; apparently not necessarily so!
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