The Health Care Blog – Page 1019 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

A Blueprint for Healthcare Reform by Maggie Mahar

Feb 18, 2008• 8

On this blog, we have often debated these questions: “Why is U.S. healthcare so expensive? Why is it that states like Massachusetts and California just can’t seem to find a way to provide high quality, affordable medical care for all of their citizens?”

In the past, I have suggested that the answer can be found in the work done by Dr. Jack Wennberg and his colleagues at the Dartmouth Medical School. The story that I have posted below provides the narrative behind that assertion, tracing how, over a period of thirty years, Wennberg and his team uncovered the incredible, incontrovertible waste in our health care system.

Wennberg’s work reveals that roughly one out of three of our health care dollars is squandered on unnecessary tests, ineffective, unproven, sometimes unwanted procedures and over-priced bleeding-edge drugs and devices that are no better than the less expensive products that they have replaced.

Only a Luddite would fail to appreciate the wonders of 21st century medical technology. And Wennberg is no Luddite. He is quick to acknowledge that the most expensive, aggressive care that U.S. doctors and hospitals provide is often the most effective care.

But not always. This is what is less obvious. It would seem that by spending so much more than other countries, we would be buying the best care on earth. But the evidence shows that, often, we are not. And therein lies the conflict at the heart of our money-driven health-care system: while more health care equals more profits, it does not necessarily lead to better health.

Where will all the employees go? By Eric Novack

Feb 18, 2008• 15

A quick question: With calls for a substantial increase in government involvement in health care by so many—and, among the major justifications is the claim of high administrative overhead in the private sector relative to government—what do the proposals plan to do with the hard working people currently working in the health insurance industry?The insurance workforce is estimated at close to 2.5 million. It would be not unreasonable to say that 25% of that is health care related. And that does not even include the people working on health insurance related issues on the provider/ hospital end—a number that absolutely exceeds 600,000.So, put another way: what do the reformers plan to do (a) for, (b) with, the potential displacement of over 1 million workers?Just asking, but could it be that the claimed efficiencies will not materialize and they will stay employed? Could it be that the costs of ‘retraining’ and financial support for these families will exceed the ‘savings’ claimed? Which group really will be displaced—will the size of the in-office, and in-hospital administrative workforce even be counted when looking at ‘streamlined’ administrative costs? Will many of the displaced workers simply end up working as government employees in a similar capacity?I would hope that supporters of the Obama plan, the Clinton plan, and the single-payer plan would weigh in here with real specifics—and not ad hominem attacks…Eric Novack

Web Video Statistics: I Smell a Rat by Craig Stoltz

Feb 16, 2008• 5

Craig Stoltz is a web consultant working in the health 2.0 space. He has previously served as health editor for the Washington Post and editorial director of Revolution Health. He blogs at Web 2.0 … Oh really?

The web metrics firm comScore has published a tally of of how many online videos were viewed during the month of December. That number is 10 billion. That’s “b,” as in “freakin’ billion.”

Like Mike Huckabee, I didn’t major in math. But as a journalist I do have an Associate’s Degree in Rat Sniffing. And I smell a big one.

By my primitive calculations, if comScore’s stats are correct, during the month of December 2007 2,237 person-years were spent watching online video. (That’s assuming each of those 10 billion videos was watched for :30.)

Peeling The Healthcare Onion, By George Van Antwerp

Feb 15, 2008• 8

George Van Antwerp is a Vice President at Silverlink Communications where he focuses on developing healthcare communication solutions across the industry with a focus on the pharmacy space. He and I have been conversing back and forth by email for a couple of years (since before he joined Silverlink who are—FD—sponsors of THCB & Health 2.0). He blogs regularly on both topics at Patient Centric Healthcare and today is his first post on THCB

I think an onion is the right analogy for healthcare for three reasons: (1) it can make you cry; (2) every time you pull off a layer you learn more; and (3) what you see from the outside is a lot different than what you see from the inside.

POLICY: Two awful stories

Feb 15, 2008• 10

Just before you get too lost in the wonkiness of health policy, just remember the financial implications of being sick in the wrong circumstancesin this country. Here’s a woman with a sick kid who is going to have her husband take a pay cut so that she can qualify for S-CHIP.

And here’s a benefit tonight in Richmond Virginia, for Kellie Brown, a student who needed an emergency appendectomy and has dropped out of college to pay of the $10,000 she owes. I kicked in a few bucks; if you’re feeling nice you might too.

Think of the economic insanity of these two things–someone dropping out of college, and someone moving to a lower pay grade because of health care costs!And no, this shit does not happen anywhere else in the civilized world.

HEALTH PLANS: I beat Lisa Girion!

Feb 14, 2008• 11

This might be my proudest moment in blogging. Anyone can be ahead of the WSJ by 5 years. But on THCB I connected the dots between LA Times coverage of the dumb public relations of Wellpoint in California, and New York AG Andrew Cuomo’s assault on UnitedHealth Group yesterday afternoon.

That’s at least 6 hours (maybe 7) before Lisa Girion did it in the LA Times. I emailed Lisa to crow about it this morning…..of course she’s probably too busy being the de facto head of health insurance reform in California — and now the US — to email back, admit defeat and come work on THCB instead!

Being serious for one second, Lisa’s work in exposing the behavior of health insurers may be the most important series of work in health care journalism in the last few years—even more so than the series which exposed the problems at King-Drew and Walter Reed. There’s no question in my mind that it will lead to significant legislation which will go some way to cleaning up the health insurance industry.

And it’s not as if Lisa was mailing this in. She found the recission (retroactive insurance cancellation) stories herself, she did the digging in the courts, and she got what at first blush sounds like a very unsexy type of story to be a major issue in California’s most important paper day after day.

To my mind she’s become a national treasure and I hope that the powers-that-be at the NY Times or perhaps Pro Publica are paying attention!

PHARMA: The statin backlash (or WSJ later than THCB by 5 years!)

Feb 14, 2008• 2

Yesterday the THCB hit meter went off the charts. not sadly because of some new genius posting on THCB, but because the WSJ has this article about Lipitor causing memory loss and Google searches are bring up an article from 5 years ago on THCB that I wrote—after reading a piece in Smart Money about the same topic. Here was the key paragraph form that article

Unfortunately the Smart Money article doesn’t give any denominators, so there’s no real evidence other than these anecdotal stories about whether significant numbers of people have had these reactions to Lipitor. So despite the heart-rending stories, you can’t draw any conclusions. Also don’t forget that in the grander scheme of things (if you believe the conventional wisdom that lower cholesterol reduces heart disease), Lipitor is saving thousands of lives for each one it hurts–if it does hurt.

The problem is that increasingly it’s become evident that the statin story is similar to other heart intervention stories—the endpoint which it helps (lower cholesterol in the case of statins, less heart blockage in the case of CABG and stents) doesn’t necessarily reduce overall mortality all that much on an absolute risk basis—and may have other damaging side-effects. Of course the most under-reported side effect from CABGs is also neurological deficiency. In fact there are serious clinicians who believe that use of statins or revascularization prior to a heart attack is clinically wrong.

So it appears that we know far too little about what’s going on before we really should be putting statins “in the water” as the cardiologists use to joke.

Then of course there’s the business interests involved. Pfizer has been roundly criticized for its Lipitor off-label marketing (even if going after Robert Jarvik for his lack of rowing skills is a little silly). But the pressures around a $12 billion franchise are likely to create this kind of behavior.

And worse. Peter Rost (not exactly Pfizer’s best buddy) has been pillorying Schering Plough for the stock trading behavior of its senior execs before recent belated release of data on the failed Zetia trial. And now Congress is joining in there too.

All of which gives me pause to think about whether the whole statin era may be on its way out. It’s looked so obvious for so many years that more people should be on them, but maybe the pendulum of the perception of the evidence is starting to swing the other way.

And when you read a message board like this one at DailyStrength, it certainly gives this 44 year old with borderline high cholesterol pause before wanting to go down the statin path. Still I guess Feb 14 is an appropriate day to be confused about affairs of the heart!

You can take your $15 fee and … ! by Paul Levy

Feb 14, 2008• 13

In the past, I have sometimes used this blog to refer to articles
from medical journals when I felt they had broad public interest.
Sometimes, those articles have not been available to the general public
because they were only available by subscription. From time to time,
commentors to this blog have complained about this. I have let those
comments go by without reply.

But, finally, I have had enough. I
want to state this clearly and directly: When a respected medical
journal issues a press release about a given article that has important
public policy ramifications but does not make available the full text
of the article, it is a bad thing. It inhibits full public
understanding of the issue and makes us beholden to other people’s
interpretation of the article. It is inconsistent with the general
principle of academic discourse and also is counterproductive in
facilitating an informed debate on issues.Here is today’s example, from the Journal of the American Medical Association ("JAMA"). Last week, I received the following email from the AAMC (Association of American Medical Colleges):

The
Feb. 13 issue of JAMA will include an article on a new study examining
the status of institutional conflicts of interest policies at U.S.
medical schools. The study was undertaken by the AAMC and Massachusetts
General Hospital, and provides the first national data on medical
school policies and practices for dealing with institutional financial
conflicts of interest. Susan Ehringhaus, associate general counsel for
regulatory affairs in AAMC’s division of biomedical and health sciences
research, is the lead author on the article.

This topic
is clearly of great public interest and import, and so I asked the
question of whether the full article would be available for reading
upon publication. The answer I received today was, "No." Checking the
JAMA website, I confirmed this. I can read the titles, the authors, and a short abstract.
But I can’t read the article and reach my own conclusions about the
methodology employed, the assumptions made, and the results.

HEALTH PLANS: Insurers getting lambasted

Feb 13, 2008• 5

First, 24 hours after being shamed in the LA Times, Wellpoint has backed down on getting docs to check up on whether their patients should have their insurance recisionned (is that a word?). It’s good to know that someone’s setting insurance policy in this country even if perhaps Lisa Girion wasn’t actually elected to the job!

Then it gets announced that the AG of New York state (traditionally a post filled by a kick-ass hungry Democrat, these days Andrew Cuomo) is going after UnitedHealth sub Ingenix and a whole raft of insurers it works with on price fixing/reimbursement rate manipulation. What particular part of a health plan’s business practices Cuomo is going after it’s hard to tell. There’s usually plenty of choice!

But it is clear that if anything gets done about health care in the next cycle, insurers are front and center in the politicians sights.

And if you think this is just me talking, check out libertarian Arnold Kling, who for some strange reason manages to get his stuff on the op-ed pages of the WSJ. He basically agrees with me.

Let’s All Ask Secretary Leavitt To Explain HHS’ Schizophrenia On Medicare Physician Data – Brian Klepper

Feb 13, 2008• 3

Regular readers will know that, last Sunday, I posted a column that pointed to HHS’ schizophrenic behavior when it comes to the release of Medicare physician data. First they fight the consumer advocacy group Checkbook.org’s lawsuit demanding the release of data in 4 states and DC. (The AMA’s Board Chair has admitted that they lobbied HHS to appeal the court’s finding that they should make the data public.) Then, a week ago last Friday, HHS announced a new program that would identify Chartered Value Exchanges (CVEs) in 14 communities – these are coalitions of employers, payers, providers and consumers – and then hand over the same physician data they’ve been fighting the courts to keep secret so these groups can combine them with data available from the private sector and create physician quality/cost report cards.