The Health Care Blog – Page 324 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Lifecycle Theory of Saving For Healthcare Needs

Feb 26, 2017• 1

By DEVON HERRICK

Republicans are bickering over whether to repeal the more costly provisions of Obamacare and allow greater flexibility into the health insurance marketplace. Republican lawmakers were shocked… SHOCKED, to discover net beneficiaries of the Affordable Care Act (ACA) like receiving open-ended subsidies worth thousands of dollars – paid for by other people. Lost in the shuffle are the self-employed, small business owners and individuals whose premiums have skyrocketed – and are no longer affordable – so that others can get a sweet deal.

The status quo cannot go on, of course. Premiums are skyrocketing and insurers are pulling out of the market. HealthCare.gov plans are a bad deal for all except for those receiving subsidies and those with significant health problems. Only about 15 percent of exchange enrollees are those paying the entirety of their own premiums, suggesting consumers don’t consider plans a good value.

In an ideal world, young people would save for retirement, have an emergency fund and save for future health care needs. A mandatory payroll tax dedicated to individuals’ own health care would be the ideal way to fund their future medical needs. Singapore has such a system, called MediSave accounts. Liberals consider personal accounts to be antisocial, since money in one account cannot be diverted to someone else’s medical bills. However, a dose of antisocial behavior would benefit our health care system.

Diversity in SI Swimsuit Issue is Great But Does it Cross the Line?

Feb 25, 2017

By JASON CHUNG

Sports Illustrated’s new swimsuit issue is touted as a “diversity issue” intended to celebrate female models of different ages, ethnic backgrounds and figures. But in featuring plus-size models, does diversity threaten to go too far?

On its face, any movement toward diversity in modelling is admirable – contemporary models of all stripes generally still skew too young, too white and too thin. And where these models are insufficiently perfect, Photoshop exists to make them even more wrinkle-free, fairer and skinnier.

Luckily, there has been a movement in Europe to rectify at least one of these issues. Via “skinny model” legislation, France, Italy, Israel and Spain have banned models from working if they are underweight. In France, penalties for agencies and brands breaking this law range from jail time to hefty fines. French law also mandates a fine for firms if they fail to clearly note within ads if models have been digitally altered.

From a health perspective, European countries appear to be serious in their attempts to rein in advertisers, designers and photographers. This is great news –this year’s rookie Sports Illustrated swimsuit model Myla Dalbesio echoes a concern voiced by many models – that industry-imposed parameters can be arbitrary and demeaning with years of being told that one is “too fat, then too thin”. Movement toward regulating an industry which, for far too long, has promoted eating disorder-derived emaciated looks such as “heroin chic” deserves oversight and regulation.

How to Make HSAs Actually Work

Feb 24, 2017• 8

By FRED TROTTER

First, let me candidly admit that I have no idea if putting Health Savings Accounts (HSAs for short) at the center of the Trump healthcare rework is a good idea. I do, however, have some insights into what made Bush-era HSA plans fail.

Bush-era HSA’s were unavailable to many Americans, because their health insurance companies and employers ultimately made the decision about whether they would be able sign up for an HSA. Many employers elected not to participate in HSA’s by not purchasing health plans that “came with an HSA”.

I was working at the UT School of Biomedical Informatics during the Bush administration’s attempt to deploy HSA’s. I wanted to research and understand how HSA’s would impact the healthcare system, and I knew that the first step was to sign up for one myself.

Is DRexit Next?

Feb 24, 2017• 27

By NIRAN AL-AGBA, MD

Sean MacStiofain said “most revolutions are caused… by the stupidity and brutality of governments.” Regulation without legitimacy, predictability and fairness always leads to backlash instead of compliance.

Here’s a prediction for you: If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable.

Once DRexit begins, there will be no turning back.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is destructive to the physician patient relationship because it prevents physicians from prioritizing patient care. MACRA supporters like to point out this legislation was passed with bipartisan support; in reality, it was passed simultaneously with repeal of the Sustainable Growth Rate Formula.

The Policymaker’s Guide to Options For Replacing the Cadillac Tax

Feb 22, 2017• 1

By CRFB.org

As policymakers debate repealing and replacing the Affordable Care Act (ACA or “Obamacare”), disagreement remains over how to address the ACA’s “Cadillac tax.” Rather than repealing the 40 percent tax on high-cost insurance plans outright, many advocates of “repeal and replace” have proposed replacing it with a limit on the tax exclusion for employer-sponsored health insurance (ESI). Doing so would be a wise choice, and limiting the ESI exclusion would both generate significant revenue to pay for an ACA replacement and help to limit the overall growth of health care spending. In this piece, we discuss some of the options available for replacement.

Vulnerable Patients and Right to Try. Doing More Harm Than Good

Feb 21, 2017• 5

By McFADYEN, HALL & McBRIDE-FOLKERS

The McFadyens in 2010. Gabriel, Ellen, Andrew and Issac, aged 6.

In both the House of Representatives and the Senate, legislators have introduced “Right to Try” bills, which purport to give terminally ill patients access to experimental medications prior to Food and Drug Administration (FDA) approval. Vice President Pence recently met with Right to Try advocates, expressing support for the movement in a tweet. Forbes has published perspectives from both sides on the issue: first, a Right to Try proponent, Nathan Nascimento, defended the legislation, while medical ethicist Arthur Caplan’s response illustrated why Right to Try is – at its core – bad policy. A key voice missing from this dialogue, and the one needed most, is that of the patient.

A Million Jobs in Healthcare’s Future

Feb 21, 2017• 1

By PRAVEEN SUTHRUM

“The Future is Here. It’s Just Not Evenly Distributed.”

It’s true.

Science fiction writer William Gibson said that right. We simply have to look around enough – now – to find out what the future holds.

The future may never be evenly distributed. But it’s surely becoming the present faster.

What would you do when…

Here are a series of what-would-you-do-when questions to think about. Each of these are a reality today, somewhere.

There’s more medical data than insight

Kaiser Permanente presently manages 30 petabytes of data. Images. Lab tests. EHRs. Patient data. Billing. Registries. Clinical trials. Sooner than later, most medical devices (big and small) will become smart. They will have an IP address like a Fitbit and send data over the cloud.

What would happen when medical data expands to exabytes, zettabytes, and may be even a yottabyte (10^24)?

What it means for jobs: Expect a boom in data-related opportunities. Data scientists. Visualization gurus. Statisticians. Mathematicians who can build predictive models. Anyone who can spot wisdom from information.

Genetic programming becomes the new software gig

People interested in programming are well-suited to become biologists of tomorrow because ATGC (the genomic alphabet) can now be tinkered digitally using tools like CRISPR.

[Read: A programming language for living cells]

If you are a developer, you could join a bio hackerspace or create your own. Explore how programming can make foul-smelling E.coli develop the fragrance of bananas.

The Definitive Guide to Repealing & Replacing Obamacare

Feb 20, 2017• 18

By MARGALIT GUR-ARIE

“So how about it, Nash? You scared?”

“Terrified… mortified… petrified… stupefied… by you.” (–A Beautiful Mind)

Fear is now a sign that you are an intelligent, educated, open-minded and caring person. Being scared is incontestable proof that you have a beautiful heart. When it comes to your health, there is palpable terror that soon, very soon, the bad guys will take away Obamacare, which was the source of health care and life itself for many.

Obamacare is Now Officially the Status Quo

Obamacare went into effect only three years ago, but in the age of information technology, years are like decades. Obamacare is deeply and solidly entrenched in the health care landscape. There is zero chance that anybody will be able to dig up its rhizomic growth into the actual practice of medicine, so let’s play along and see what can be done about the large shiny part, visible to the naked eye, namely health insurance.

Population Health Isn’t Working Out Quite the Way They Said It Would. What’s Going On?

Feb 20, 2017• 7

By HILARY HATCH

I hate shots. Every year when flu season rolls around, I think, “what’s in it for me?” The answer is, “it isn’t for me. It’s for the herd.” I am young and healthy enough that I am unlikely to die of the flu but I have children, older people and vulnerable patients I care about it, so I get a flu shot every year.

This is true population health. I get a flu shot for the benefit of others. Population health has been extended to a much larger set of activities that have no communal benefit. One patient with diabetes doesn’t benefit from another getting a foot exam. (Mammograms, colonoscopies, no communal benefit. STD screening, on the other hand, fits in the category of true population health.)

This distinction matters. Here’s why:

People are keenly aware of being told to do things that aren’t for their personal benefit.
People reject recommendations that don’t match their health needs.
People are much more likely to follow recommendations from people they trust. Points 1 & 2 above undermine trust.

Lively discussion with my fellow panelists at upcoming HIMSS17 panel on consumer engagement highlighted my own misgivings about the absence of the patient’s individuality and voice in population health efforts. We all want better health in the population, but are we going about it in the right way?

Population health puts people into categories by conditions (diabetes, hypertension, depression), age, lab results and medical billing data. These categories presume their own importance. When in fact, psychosocial, behavioral and environmental factors determine individual health far more. Patient goals, preferences and barriers to care tell us what stands between that patient and better health. Without this data, population health efforts are undermined.

Dashboards Are For 737 Pilots, Not Physicians.

Feb 20, 2017• 3

By JACOB REIDER, MD

You’re right, Dr Hatch. Nobody’s feels like they’re winning. Last week I was in a room with a group of physicians, and the Chief Medical Officer of an ACO was explaining to them that he could give them all dashboards that they would love.

But the physicians didn’t look like they were dreaming of the same valentines. “What would we do with a dashboard?” Said one. “Is this another Meaningful Use requirement gone bad?” Said another.

The undertone is that “we didn’t sign up for this population health” stuff. Physicians are intellectually challenged by, and find meaning in the personal conversations and diagnostic puzzles that are well represented in caring for individual people. We are not intellectually challenged by the need to remind patients to get a colonoscopy, mammogram or flu shot.