By KIP SULLIVAN

CMS began two Medicare ACO experiments in 2012 – the Pioneer program and the Medicare Shared Savings Program (MSSP). Data on these programs available at CMS’s website paints a discouraging picture of the programs’ ability to cut costs. But two papers published in the last two years in the Journal of the American Medical Association paint a much rosier picture. A paper written by David Nyweide et al. claimed to find the Pioneer ACO program generated gross savings two times more in 2012, and slightly more in 2013, than CMS reported. Similarly, a paper  by J. Michael McWilliams claimed to find the MSSP program saved money in 2014 while CMS’s data says it lost money.

What explains the discrepancy? Answer: The JAMA papers examined simulated ACO programs, not the actual Pioneer and MSSP programs. Moreover, Nyweide et al. neglected to report that shared savings payments would have greatly reduced the gross savings, and both Nyweide et al. and McWilliams ignored the start-up and maintenance costs the ACOs incurred. (JAMA’s editors redeemed themselves somewhat by publishing a comment  by former CMS administrator Mark McClellan which warned readers that Nyweide et al. failed to measure the “shared savings payments to the ACOs” and “the investments of time and money” made by the ACOs.)

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By HANS DUVEFELT, MD

It has been suggested that to improve quality in healthcare we must reduce variability in how diseases are diagnosed and treated.

It has been inferred that clinical outcomes would improve exponentially if doctors would only follow established guidelines instead of their own whims.

I take that to mean if doctors didn’t think for themselves so much, the health of our nation would be better. I take that to mean that we may be overqualified for the simple work of delivering “evidence based care”.

That is the fantasy of the non-clinician creators of our new medical world order.

Doctors spend all these years learning biology, biochemistry and physics. We learn about anatomy, physiology and pathology. Eventually we study diseases. Then we learn how to practice what we were taught. Finally, more than a decade after we started, do we earn the right to practice independently, only to become the obedient instruments of a healthcare system that demands conformity and disciplines those who put their training to use by questioning politically motivated health policies and overly simplistic clinical guidelines.  

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by LYGEIA RICCIARDI

In these first days of the Trump Administration, there is a great deal of uncertainty, but it’s clear that healthcare will remain in the spotlight. Repealing and replacing “Obamacare” is still at the top of the Republican party’s—and President Trump’s—agenda.

Congress and Trump have already taken steps to repeal the Affordable Care Act (ACA), though a replacement for it has yet to be articulated. Trump promises “insurance for everybody” in a form that is “much less expensive and much better,” but has yet to reveal details about how to meet his goals.

While changes in healthcare policy will have ramifications for all Americans, members of underserved populations are likely to be disproportionately impacted because they are statistically less healthy  and are also the least likely to have health insurance coverage. Parts of the ACA address Medicaid, which provides health insurance to 70 million people—by definition among the poorest Americans. Nine million whites make up the largest racial group of people who have gained coverage as a direct result of the ACA, but significant numbers of minorities, including 3 million African Americans and 4 million Hispanics, have also gained coverage. The ACA also helps LGBT Americans by forbidding discrimination due to gender or sexual orientation, and by enabling same-sex families to apply for joint healthcare coverage. According to a report issued by the nonpartisan Congressional Budget Office on January 17^th, if the ACA were to be rolled back without a replacement, 18 million people would lose health insurance in the first year. There would also be significant restrictions in reproductive health services for women.

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By ALLISON BOWLES

Now I have insurance. But I can’t use it. What am I supposed to do? I know this one is long but it’s worth a read if you want to understand issues pertinent to the Affordable Care Act. My personal story illustrates many of the problems with the ACA.

I started taking notes on the Health and Human Services Secretary hearing, and I will share more as I scrutinize the hearing in more detail but let’s start with the breakdowns below and my experience with Obamacare.  Here goes:

These are the breakdowns of who gets what coverage in the United States:

Medicare 18% – 52m

Employer 61% – 178m

Medicaid 22% – 62m

Individual 6% – 18m (exchanges cover 4% of the 6%–these are the people who have been forced onto the Obamacare plans)

Note: this writer is in the BOTTOM of the barrel here (Individual). Most of the individuals in the “Individual” category are either the upper contingent of the working poor, those who work for small businesses like restaurants or family owned grocery stores and the like that don’t provide health insurance benefits (more and more common these days), and/or sole proprietors like myself. Many health care providers are self employed hence we have been forced into the Obamacare exchanges if we are not high earners. High earners won’t buy on the marketplace and will purchase individual plans outside of the marketplace.

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By COURTNEY GILDENGIL and LAURA FAHERTY

On January 10^th, then-President-elect Donald Trump met with Robert F. Kennedy Jr., a vocal skeptic of vaccine safety. Although the details and implications of the session are still unclear, the meeting and several of Trump’s tweets have raised questions among public health experts who wonder what, if anything, Trump might do on the issue as president. A chorus of celebrities and politicians continue to question vaccine safety and propagate a myth linking vaccines and autism, fueled by a fraudulent 1998 article by Dr. Andrew Wakefield that was later retracted.

In 2014, RAND undertook a rigorous and independent systematic review of vaccine safety for all populations, including pregnant women and children. From our review we found that while some vaccines are associated with serious side effects, these events are rare and are far outweighed by the benefits of vaccination. For example, we found evidence that the combined measles, mumps, and rubella (MMR) vaccine is associated with febrile seizures, which are seizures or convulsions that occur when a child has a high fever. But while these seizures are certainly unpleasant and can be frightening for parents to witness, there is no evidence that they cause any long-term harm to children.

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 By YEUNG, MAY and TRUJILLO

How can we gauge whether America is prioritizing health and well-being? Since public attitudes toward health-related topics are widely shared on social media, we gazed into the mirror that is Twitter and tried to answer that question by sifting through 32 million health-related tweets, one of the largest social media samples ever collected for health research.

Posts and conversations on Twitter have the potential to shed light on the public’s views about a seemingly endless array of health-related topics—obesity, exercise and fitness, safe sex, alcohol use, medication adherence and mental health. Accordingly, researchers have turned to social media to better understand these topics.Continue reading…

By ANDY ORAM

Behind many of the economic and political tensions of our time lurks the growing burden of health care costs. Does that claim sound inflated? Consider: when the public complains of stagnating wages, we can put our finger on health care costs as the monster that gobbles up employee compensation. When economists fret over the future burden of Social Security and Medicare (a cry echoed across the world as populations age), we have to recognize the scourge of increased health care costs. Most of the current debates over the Affordable Care Act–a recurring issue during the presidential campaign–touch explicity or implicity on health care costs.

The upward curve in costs became less of a run-away trend during the recession. Although the ACA might take a bit of the credit, most observers attribute the softening of the cost rises to belt-tightening by patients, and perhaps also to lower inflation. Inexorably, though, costs do rise. Small businesses and people on individual plans suffer most–a burden for which the ACA is not responsible, but that it brought to public attention–and the rest of us are bedeviled by rising premiums and deductibles as well. A study found spending increases across the board in 2015 by individual households, businesses, and governments alike. A number of people give up on health insurance because it’s still too expensive and does not end up covering their needs.

Insurers are suffering too, which is why even major companies such as Blue Cross and UnitedHealth are abandoning some markets.

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By NIRAN AL-AGBA, MD

The Mylan EpiPen debacle may have inadvertently weakened the grip Big Pharma on U.S. lawmakers.  Last week, a bill proposed by Senator Bernie Sanders was narrowly rejected by a vote of 52-46.  Unexpectedly, 12 Republicans and 1 Independent voted with Senator Sanders in favor of allowing pharmacists and distributors to import cheaper prescription drugs from Canada and other foreign countries (something typically favored by Democrats.)  The winds of change are starting to blow in the bipartisan direction when it comes to the pharmaceutical industry.    

U.S. Healthcare needs a revolution ; ‘the shot heard round the world’ often refers to the opening shots of the American Revolution in 1775.  The Big Pharma lobby is holding the American people hostage with their exorbitant ransom demands.  Last summer, Mylan Pharmaceuticals, led by CEO Heather Bresch, overplayed their hand.  Mylan came under fire for a 400% price increase in the EpiPen two-pack.  This device is considered life-saving for children and adults with anaphylactic reactions to various food, insect, or environmental insults.  Ms. Bresch insisted the significant price increase ($600-$700 for a medication which costs pennies) was justified due to the more ergonomic appearance of the delivery device and improved safety profile.  Her miscalculation seems to have indirectly incited the war on Big Pharma by angering the public, the media, and the government simultaneously. 

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