Tuesday, May 31, 2011

Huge Profits for Health Insurers as Americans Put Off Care - NYTimes.com

Huge Profits for Health Insurers as Americans Put Off Care - NYTimes.com:

"The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care. "

I know, I'm shocked, too.

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Monday, May 30, 2011

Doctors Soften Their Stance on Obama’s Health Overhaul - NYTimes.com

Doctors Soften Their Stance on Obama’s Health Overhaul - NYTimes.com:

There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.

That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.

As I pointed out here many times over the past couple years, doctors support health reform.

Follow the tags with this to find out more.

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Sunday, May 29, 2011

How to Lower Cancer Care’s Costs | The Health Care Blog

How to Lower Cancer Care’s Costs | The Health Care Blog:

In the NEJM last week, two oncology specialists — Thomas Smith and Bruce Hilner of Virginia Commonwealth University — took up the challenge. They created a “top five” list of common oncology practices, which, if limited to situations where they were truly clinically useful, would sharply lower the cost of cancer care. Their lead paragraph noted the need for taking these steps:

Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond. This increase has been driven by a dramatic rise in both the cost of therapy and the extent of care. In the United States, the sales of anticancer drugs are now second only to those of drugs for heart disease, and 70% of these sales come from products introduced in the past 10 years. Most new molecules are priced at $5,000 per month or more, and in many cases the cost-effectiveness ratios far exceed commonly accepted thresholds. This trend is not sustainable.

Look closely at the second to last sentence of that paragraph: “In many cases the cost-effectiveness ratios far exceed commonly accepted thresholds.” It’s worth noting that there are no commonly accepted thresholds for cost of care in the U.S. That’s not true in Great Britain, where the National Health Service, based on recommendations from the National Institute for Clinical Excellence, will refuse to pay for certain drugs when their costs exceed certain levels. But in the U.S., Medicare, which is the primary payer for most cancer care since cancer is primarily a disease of aging, is forbidden by law from taking cost into consideration. If the Food and Drug Administration has approved a specific approach, and the doctor prescribes it, Medicare will pay for it. If the oncologist tries an approach that is not specifically approved by the FDA — either as an “off label” use or combination of approved drugs — the Centers for Medicare and Medicaid Services will still pay for the treatments long as the approach is listed in clinical practice guidelines. And when it comes to most testing and imaging, most insurers including Medicare will pay for whatever the doctor orders, even though the medical literature is loaded with studies suggesting their lack of usefulness in many situations where commonly used.

A good piece exhorting us to begin to address the out of control costs we have built into our care delivery.

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Why Medical School Should Be Free - NYTimes.com

Why Medical School Should Be Free - NYTimes.com:

DOCTORS are among the most richly rewarded professionals in the country. The Bureau of Labor Statistics reports that of the 15 highest-paid professions in the United States, all but two are in medicine or dentistry.

Why, then, are we proposing to make medical school free?

Huge medical school debts — doctors now graduate owing more than $155,000 on average, and 86 percent have some debt — are why so many doctors shun primary care in favor of highly paid specialties, where there are incentives to give expensive treatments and order expensive tests, an important driver of rising health care costs.

I've certainly made this point here before, but now a more respectable pair of opinionators.

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Friday, May 27, 2011

History of Direct to Consumer Advertising via NPR

Selling Sickness: How Drug Ads Changed Health Care : NPR:

But then, in 1986, while designing an ad for a new allergy medication called Seldane, Davis hit on a way around the fine print. He checked with the Food and Drug Administration to see if it would be OK.

'We didn't give the drug's name, Seldane,' he says. 'All we said was: 'Your doctor now has treatment which won't make you drowsy. See your doctor.' '

This was one of the very first national direct-to-consumer television ad campaigns. The results were nothing short of astounding. Before the ads, Davis says, Seldane made about $34 million in sales a year, which at the time was considered pretty good.

'Our goal was maybe to get this drug up to $100 million in sales. But we went through $100 million,' Davis says. 'And we said, 'Holy smokes.' And then it went through $300 million. Then $400 million. Then $500 million. $600 [million]! It was unbelievable. We were flabbergasted. And eventually it went to $800 million.'

Thought I'd posted this before, but better late than never.

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Thursday, May 26, 2011

Critical State of Top Wages at Publicly Financed Hospitals - NYTimes.com

Critical State of Top Wages at Publicly Financed Hospitals - NYTimes.com:

At Bronx-Lebanon, a hospital that exists only by the grace and taxed fortunes of the people of New York State, the chief executive was paid $4.8 million in 2007 and $3.6 million in 2008, records show. At NewYork-Presbyterian, a hospital system that receives nearly half a billion dollars annually in public money, the chief executive was paid $9.8 million in 2007 and $2.8 million in 2008.

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Tuesday, May 24, 2011

Medicare Costs to Seniors Under House Budget Proposal - U.S. Congress Joint Economic Committee

Press Releases - Press - U.S. Congress Joint Economic Committee:

A new state-by-state analysis by the U.S. Congress Joint Economic Committee (JEC) finds that in each state in the country, out-of-pocket health care costs will more than double for residents turning 65 in 2022 under the Republican budget plan passed by House Republicans in April.

The non-partisan Congressional Budget Office has estimated that a typical 65-year-old Medicare beneficiary in 2022 would see their out-of-pocket health care costs increase from $6,154 to $12,513 under the Republican budget. Using that data along with cost-sharing data from the Centers for Medicare and Medicaid Services, the JEC has estimated out-of-pocket costs on a state-by-state basis. While the increase varies by state, residents in all states will see their out-of-pocket expenses more than double when they turn 65 in 2022. Residents in Florida face the largest increase –$7,383.

The report also shows that current Medicare beneficiaries will be harmed by the GOP budget, immediately losing preventive services such as mammograms and facing higher prescription drug costs.

“This new JEC analysis helps to fill in the picture on just how disastrous and costly the Republican Medicare plan is for our older Americans,” said Senator Bob Casey (D-PA), Chairman of the JEC. “If Republicans have their way, traditional Medicare will no longer exist in 2022. Instead, our elderly will get a voucher to purchase private insurance, but the voucher won’t keep pace with health care costs. The result would be a staggering increase in out-of-pocket costs beginning in 2022. In my state of Pennsylvania, someone turning 65 in 2022 would face a $6,300 increase in their health care expenses. Our elderly Americans cannot afford to have their health care expenses double, but that’s exactly what the Republican plan delivers.”

The increased out-of-pocket costs result from older Americans bearing a larger share of health care costs under the Republican plan and the increase in total health care costs that results from shifting from traditional Medicare to a less efficient, more expensive voucher program.

“The Republican Medicare plan doesn’t rein in health care costs,” continued Casey. “Instead, it simply shifts the costs onto the backs of our elderly. The Republican ‘solution’ is providing our elderly with dramatically higher costs and less care. Current beneficiaries will suffer and the next generation will face retirement without Medicare and without the peace of mind it offers.”

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Friday, May 20, 2011

Wendell Potter: Insurance Industry Flack Screws Up, Points Us to Report We Really Should Read

Wendell Potter: Insurance Industry Flack Screws Up, Points Us to Report We Really Should Read:

A major point of the Thomson Reuters paper is that up to $700 billion that we spend on health care in the U.S. is wasted and that a big reason for that waste is our multi-payer system of private health insurance companies.

'Health care providers must deal with dozens of health benefit plans to bill successfully for services rendered,' the report said. 'Health plans must support systems for underwriting, claims administration, provider network contracting, and broker network management... Simplifying our health care system's administration could reduce annual health care costs by almost $300 billion.'

Then there were these bullet points that surely will never appear in a health insurance industry presentation:

• The average U.S. hospital spends one quarter of its budget on billing and administration, nearly twice the average in Canada. American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than Canada.

• In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.

The white paper is here.

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Monday, May 16, 2011

Bible: Caring for and serving the poor

Bible: Caring for and serving the poor:

"What does the Bible have to say about helping needy people -- the poor, the homeless, the orphans, and the widows? Are there Bible passages which say we are supposed to have compassion and to be giving to the less fortunate? What biblical foundations are there for service to others?

How to care for the poor? How are we to provide for the hungry? Here are instructions from the Bible. Looking for slogan for a promotion about helping the needy or feeding the poor? Use a phrase from one of these Scripture verses as a slogan. "

A nice collection of Biblical quotations about helping the poor.

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Sunday, May 15, 2011

amednews: Bill seeks outside review of relative values in Medicare services :: April 11, 2011

amednews: Bill seeks outside review of relative values in Medicare services :: April 11, 2011:

A Democratic lawmaker has proposed changing the way the Medicare program identifies physician services for which it pays too little -- or too much -- by requiring independent contractors to review doctor fees annually.

Since 1992, a panel convened by the American Medical Association and representing a wide range of specialties has recommended thousands of pay changes to the individual services doctors provide to Medicare patients. The bill would add a layer of review on top of the 29-member AMA/Specialty Society Relative Value Scale Update Committee, known as the RUC.

Critics of the committee say it lacks transparency and is responsible for continuing payment discrepancies between primary care physicians and specialists. But supporters, including the AMA, disagree. They say the use of outside contractors would be duplicative and add an unnecessary layer of bureaucracy to the process.

The Centers for Medicare & Medicaid Services is required to consult with health professionals on adjusting relative values for services. Because the process is budget-neutral, any value change that results in Medicare paying more for a service means it will pay less for one or more other services. CMS routinely accepts the majority of the RUC's recommendations, although it is not required to do so.

Rep. Jim McDermott, MD (D, Wash.), introduced the Medicare Physician Payment Transparency and Assessment Act of 2011 on March 30. The bill explicitly would require independent contractors to identify misvalued physician services on an annual basis and recommend adjustments. The national health system reform law already states that the Health and Human Services secretary 'may use analytic contractors,' but the new measure would make this mandatory.

'For two decades now, this panel has been dominated by specialists who undervalue the essential and complex work of primary care providers and cognitive specialists, while often favoring unnecessarily complex, costly and excessive specialty medical services,' Dr. McDermott said. 'The result is clear -- there is a shortage of family doctors, patients don't necessarily get the services they need and medical costs are increasingly driven higher.'

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Saturday, May 14, 2011

John Kenneth Galbraith understood capitalism as lived – not as theorized / The Christian Science Monitor - CSMonitor.com

John Kenneth Galbraith understood capitalism as lived – not as theorized / The Christian Science Monitor - CSMonitor.com:

Government's role

While Friedman never really appreciated the limitations of the market, he was a forceful critic of government. Yet history shows that in every successful country, the government had played an important role. Yes, governments sometimes fail, but unfettered markets are a certain prescription for failure. Galbraith made this case better than most.

Galbraith knew, too, that people aren't just rational economic actors, but consumers, contending with advertising, political persuasion, and social pressures. It was because of his close touch with reality that he had such influence on economic policymaking, especially during the Kennedy-Johnson years.

Galbraith's penetrating insights into the nature of capitalism – as it is lived, not as it is theorized in simplistic models – has enhanced our understanding of the market economy. He has left an intellectual legacy for generations to come. And he has left a gap in our intellectual life: Who will stand up against the economics establishment to articulate an economic vision that is both in touch with reality and comprehensible to ordinary citizens?

A nice and too brief overview of Galbraith v Friedman, by Nobel Laureate Joseph Stiglitz.

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Tuesday, May 10, 2011

Uwe E. Reinhardt: How Efficient Is Private Charity? - NYTimes.com

Uwe E. Reinhardt: How Efficient Is Private Charity? - NYTimes.com: "Although in absolute dollar terms the United States ranks high in that category as well, as a percentage of G.D.P. many European nations outrank us (see Table 1, Annex A, on page 7).

Citizens of other countries may remind us that there is a trade-off between channeling dollars from citizens to charitable or civic activities through the government’s budget and channeling these funds through the budgets of private organizations that we label charitable, whether they truly support charitable or civic activities.

Many charitable or civic activities financed in the United States with private giving are financed elsewhere through government — health care, education and museums among them.

Why do Americans make so different a trade-off between private charity and government than people in most other nations?

One persuasive reason is that through private charitable giving, the donor can direct where his or her funds go. Americans do not trust their government as much as citizens elsewhere seem to. Yet it is not always clear in whose pockets private charitable donations end up.

A second reason is that many Americans have the notion that private charities are more efficient than government can ever be.

My experience is that to many Americans this notion, which is nothing more than a hypothesis, is an axiom, a statement so self-evident that it does not require proof.

The relative efficiency of private “charity” and tax-financed governmental “charity” is an empirical question. The proper criterion is what fraction of our charitable donations actually flows directly to the activities that we seek to support."

I find it strange this article of faith that ALL private operations are inherently more efficient than ALL government ones.  When I hear this, I ask the person if they've ever tried to question their cable bill, or, even worse, tried to change providers!

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Drug Company Payments to Doctors | Dollars for Docs - ProPublica

Drug Company Payments to Doctors | Dollars for Docs - ProPublica: "Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But eight companies have begun posting names and compensation on the Web, some as the result of legal settlements. ProPublica compiled these disclosures, totaling $320 million, into a single database that allows patients to search for their doctor. Receiving payments isn’t necessarily wrong, but it does raise ethical issue"

ProPublica has many more articles on the influence of Pharma money on medicine at this link.

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Financial Ties Bind Medical Societies to Drug and Device Makers - ProPublica

Financial Ties Bind Medical Societies to Drug and Device Makers - ProPublica:

"SAN FRANCISCO — From the time they arrived to the moment they laid their heads on hotel pillows, the thousands of cardiologists attending this week’s Heart Rhythm Society conference have been bombarded with pitches for drugs and medical devices.

St. Jude Medical adorns every hotel key card. Medtronic ads are splashed on buses, banners and the stairs underfoot. Logos splay across shuttle bus headrests, carpets and cellphone-charging stations."

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Coal Cares: Who needs Global Warming?

Coal Cares:

"Why Free Inhalers? Because COAL CARES.

Coal Cares™ is a brand-new initiative from Peabody Energy, the world's largest private-sector coal company, to reach out to American youngsters with asthma and to help them keep their heads high in the face of those who would treat them with less than full dignity. For kids who have no choice but to use an inhaler, Coal Cares™ lets them inhale with pride.

Puff-Puff™ inhalers are available free to any family living within 200 miles of a coal plant, and each inhaler comes with a $10 coupon towards the cost of the asthma medication itself.

This reminds me of the advice Jim Carey gave his client in "Liar, Liar," "Stop polluting the air, a******!"

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