This is very, very unpleasant. A staph infection outbreak in Los Angeles that’s got its own name— the Scourge of Skid Row. And it’s one reason why public health, including the real basics like housing, clean water and access to medical care affects everyone—not just those without it.
I’m up at Spot-on talking about Six Dirty Little Health Care Secrets. Comments back here if you like….
With no lurid sex scandal this week and apparently little public interest or Congressional caring about what’s going on overseas, ABC News and USA Today have turned to the health care system to fill some air time and column inches. As you may have heard, ABC’s even been wise enough to ask a couple of bloggers – yes, I’m one of them – to chime in on the debate.
They were asking for solutions to the health care crisis. But asking
for that’s pretty much a waste of time. Americans may hate their health
care system, but they apparently like their health care providers and
even think that their costs are OK. Or at least that’s what one survey
said. But suveys don’t tell the whole story – they serve as a kind of
cover for the real reasons it’s so hard to change the system we live
under. Continue …
After the previous three times, I don’t think I can bear it. This time David Leonhart has written a NYT article saying that the reason we spend more here is because of American culture. This may be the most moronic sentence of the whole series of articles:
We Americans tend to treat any rejection of a health claim as some conspiracy by insurance companies, the government, doctors and the pharmaceutical industry. In other countries, people have arrived at a better understanding that health care necessarily involves economic triage — that $10,000 spent on quixotic care is $10,000 that can’t be spent more usefully.
“We Americans” are somehow are magically controlling the spending, apparently over the objections of “insurance companies, the government, doctors and the pharmaceutical industry”
He’s supposed to be the economist. Does he have no idea who controls health policy and health care spending in this country? For chrissake, the government here more or less represents the “insurance companies, the government, doctors and the pharmaceutical industry” and their interest is in spending more, not less. “We Americans” did not get a seat at that table, unless you count patient groups that also have an interest in higher spending and are co-opted by industry. Any high school senior doing a basic political science class who read the cliff notes on Stigler’s theory of capture can tell you how that works. But apparently you get to miss that class, or Econ 101 if you want to write on health care for the NY Times.
And via HWR, young punk Jason Shafrin, at the Healthcare Economist has a just excellent article about why P4P isn’t enough and impicitly why we need budget and supply constraints to get health care costs under control. (Hint, it isn’t always possible to tell when the curve is flat or heading downhill).
Even though I’m “starring” on their site I can’t say I’m a regular viewer (or actually ever watch) ABCNews — unless it’s being replayed on The Daily Show or Colbert Report. But I’ve been watching some of the videos, and reading the blog from their week long series on health care. And it appears that their health correspondent Dr Tim Johnson is a raving commie. Or at the least he’ll have his AMA card taken away any minute.
He thinks that the plight of the uninsured is terrible and that we need a national, government universal health care system—and that we’ll get pressure for it within a couple of years. He was asked in one video how to tell if a doctor delivered good care. He said that they needed to a) have information tech on their desk and be using an EMR, and b) it helped if they were part of a big integrated system that checked up on them—and specifically mentioned the VA and Kaiser! I can feel Eric Novack grimacing a state away!
Now all my devotees over here know that that’s perfectly sensible. But Johnson works for the Mouse! Now a more typical employee is John Stossel who dives off a cliff that surely even the Cato guys wouldn’t follow him over by suggesting that health insurance itself is a bad idea. Well we wouldn’t expect a coherent argument from Stossel but he’s lots of fun. (On a quick re-read that’s a little unfair—voluntary high-deductible plans are OK apparently) . But do you really think he turns down his Disney-provided insurance?
But given that GE’s MSNBC unit fired Phil Donahue for being too left wing, and chief Mouse guy himself Walt was a rabid anti-communist, I think Johnson will have to watch his back at those county medical society meetings and at work too!
CODA: Canada-basher David Gratzer is mentioned in Stossel’s report. I’ve read his book (and he’s at least selectively read the Commonwealth Fund studies, if apparently none of Bob Evans’ work). I’ll be interviewing him in a couple of days…should be fun. And to give David a hint, a certain recent speech by a consvervative politician might just come up.
I finally got to the article on spine surgery in USA Today. Exactly what you’d expect. Massive practice variation all over the place—although to be fair we’re not exactly sure that too much is bad here, as no one has a clue how to make back pain go away. (Unlike lots of other types of interventions, as Eric Novack will tell us). But there’s a killer quote from Mark Chassin at Mt Sinai.
“The U.S. health system does a great job in developing new and innovative treatments, but it does not do a good job in thoroughly and rapidly evaluating those innovations to find out when they work and when they don’t,” he says
Someone should tell Mark McClellan that he was generally respected by everyone and that now that he doesn’t work for the White House there’s no need to become a Republican shill. But that’s what he’s doing by saying that Medicare drug costs are going down. There are two basic porkies in the statement. The first is that the cost he’s comparing it to is the inflated projection that was come up with well after the MMA was passed–not what Congress was told it was going to be. (I’ve written about how that number changed plenty before, but suffice it to say if you change it up enough and then it comes in lower, that’s not "savings"). If his optimism is correct, we’re back near the original projection, which was still way more than a proper drug benefit should have cost, and was based on more people being covered.
Second, claiming that premiums for seniors in Part D have gone down is not true, as Pete Stark’s office pointed out. Premiums have gone down on average only if you count Medicare HMO/Advantage premiums with those for Part D standalone plans. Medicare Part D standalone premiums have in many cases gone up. Joining a Medicare HMO is a much different thing than adding a Part D standalone plan–just ask anyone who was kicked out of their Medicare HMO in the late 1990s. And of course the HMOs were given a huge subsidy in the MMA legislation separate from the drug coverage part of the legislation, and that’s the money that they are using to reduce their premiums. And we’ve seen this movie before too, including the part when the subsidy is reduced and the private HMOs give up. Just ask anyone who was kicked out of their Medicare HMO in the late 1990s
By the way, you can tell what McClellan is saying here is a lie because Karen Ignagni agrees with him! No need to bother actually researching it, she’s that good a barometer of avoiding the truth! Here’s her quote, if you care:
"There’s no doubt that Medicare is providing valuable benefits for
seniors, and costs are far less than what was expected at the time
legislation passed" creating the new drug benefit, Ignagni says.
Finally, where did Medicare Part D really fall down on the job? It was in failing to enroll low income seniors who would actually have benefited from it. That’s because it was a confusing "market-driven" voluntary program, not a compulsory extension of traditional Medicare. And are low income seniors able to make sensible "market-driven" choices? Apparently not!
NEW YORK, Oct. 13 (UPI) — U.S. seniors with low incomes or no
prescription coverage are less likely to use generic cardiovascular
drugs than more affluent seniors, a study finds. Researchers at
the Mount Sinai School of Medicine in New York say that seniors with
low incomes or no prescription coverage were less likely to use generic
cardiovascular drugs than more affluent seniors and those with
prescription-drug coverage.The study, published in The American
Journal of Managed Care, is the first nationally representative study
that examines the association of income and prescription drug coverage
with generic medication use by Medicare beneficiaries, according to
lead author Dr. Alex D. Federman. Federman and colleagues
examined generic cardiovascular drug use in a nationally representative
sample of elderly Medicare beneficiaries with hypertension. The
findings showed that older patients with cardiovascular diseases often
used costly brand name drugs when equivalent but lower cost generic
versions are available. "The patients that we were concerned
about are low-income and underinsured seniors," said Federman. "Our
findings show this group in-particular are missing opportunities to
save money on prescription drugs without sacrificing quality of care."
But if we had put all seniors into a guaranteed drug benefit program that ensured that they got the best pricing on all drugs (a la VA) and actively managed them so that they were given generics where relevant, then both they and the taxpayer would have been better off. And don’t even start me on the subject of how much the whole benefit would have cost the taxpayer if it had been designed sensibly rather than by PhRMA and AHIP.
I just hope that now he’s out of the Administration McClellan can go back to realizing that there are many shades of gray.
This is long but well worth a read. Modern Healthcare ran a roundtable on health care in New Orleans post Katrina with 2 health care execs and 2 consultants who did a study on the state of play. Essentially because the Oschner clinic was on slightly higher ground than the rest of the city, and stayed open, it’s had its financial ass handed to it on a plate. And despite the $90 billion rescue package (or whatever it was) no one is helping. It’s basically having to suck up the loss. And is the city ready for another hurricane? No prizes for guessing the answer.
So today is the day that the U.S. population hit 300 million which will make all those percentage divisions we’re always doing easier. But we’ve also seen unmarried households become a majority of the 110 million households, which confirms that social policies designed around a 1950s nuclear family, like employment-based health insurance, need to become more sophisticated for a more complex world.
Small beer by the standards of this corrupt Administration (Halliburton anyone?) but given that former F.D.A. Chief Crawford is going down in a conflict of interest scandal, I can safely assume that at least one THCB reader is quietly smiling over his cornflakes today!
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