News Analysis - With or Without Health Reform, We Pay for Others’ Bad Habits - NYTimes.com

News Analysis - With or Without Health Reform, We Pay for Others’ Bad Habits - NYTimes.com:

As a cardiology fellow, I once took care of a young man with severe congestive heart failure. We were supposed to start him on a blood thinner early in his hospitalization, but it got overlooked. Fed up with the delays in getting his blood sufficiently thinned, he left the hospital against medical advice. He said he had to go home to care for his toddler.

He came to the clinic a week later looking very embarrassed. He had left without prescriptions, so he had been taking no medications since he left, leaving him short of breath. To compound the problem, he had been eating cold cuts, cheap and readily available, which made his condition even worse. But the attending physician refused to give him prescriptions. She said that he had to go to a walk-in clinic. She said he had to learn personal responsibility.

Healthy living should be encouraged, but punishing patients who make poor health choices clearly oversimplifies a very complex issue. We should be focusing on public health campaigns: encouraging exercise, smoking cessation and so on. Of course, this will require a change in how we live, how we plan our communities.

“It’s the context of people’s lives that determines their health,” said a World Health Organization report on health disparities. “So blaming individuals for poor health or crediting them for good health is inappropriate.”

- Sent using Google Toolbar

Sphere: Related Content

Taking Responsibility for Death - NYTimes.com

Taking Responsibility for Death - NYTimes.com:

My mother drew up her directives in the 1980s, when she was a volunteer in the critical care lounge of her local hospital. She once watched, appalled, as an adult daughter threw a coffeepot at her brother for suggesting that their comatose mother’s respirator be turned off. Because the siblings could not agree and the patient had no living will, she was kept hooked up to machines for another two weeks at a cost (then) of nearly $80,000 to Medicare and $20,000 to her family — even though her doctors agreed there was no hope.

The worst imaginable horror for my mother was that she might be kept alive by expensive and painful procedures when she no longer had a functioning brain. She was equally horrified by the idea of family fights around her deathbed. “I don’t want one of you throwing a coffeepot at the other,” she told us in a half-joking, half-serious fashion.

There is a clear contradiction between the value that American society places on personal choice and Americans’ reluctance to make their own decisions, insofar as possible, about the care they will receive as death nears. Obviously, no one likes to think about sickness and death. But the politicization of end-of-life planning and its entwinement with religion-based culture wars provide extra, irrational obstacles to thinking ahead when it matters most.

As someone over 65, I do not consider it my duty to die for the convenience of society. I do consider it my duty, to myself and younger generations, to follow the example my mother set by doing everything in my power to ensure that I will never be the object of medical intervention that cannot restore my life but can only prolong a costly living death.

- Sent using Google Toolbar

Sphere: Related Content

Budget battle pits atheist Ayn Rand vs. Jesus, say liberals - USATODAY.com

Budget battle pits atheist Ayn Rand vs. Jesus, say liberals - USATODAY.com:

More than 6,000 people have signed a petition asking {Budget Chair Paul] Ryan to put down Rand and pick up a Bible, according to Kristin Ford of Faithful America, a left-leaning online group.

"Ayn Rand's philosophy of radical selfishness and disdain for the poor and struggling is antithetical to our faith values of justice, compassion and the common good," the petition reads.

...

"Rand, more than anyone else, did a fantastic job of explaining the morality of capitalism, the morality of individualism," Ryan says in a 2009 Facebook video excerpted in the ad. "It's that kind of thinking, that kind of writing that is sorely needed right now."

Ryan's spokesman, Kevin Seifert, said the congressman "does not find his Catholic faith to be incompatible with his feelings for Ayn Rand's literary works. ... Rand is one of many figures and authors that Congressman Ryan has cited as influencing his thinking during his formative years."

 If one can not find the incompatibility between Catholicism (or any major religious tradition, for that matter or even secular humanism) then one is clearly actively refusing to look!

- Sent using Google Toolbar

Sphere: Related Content

Contra David Brooks on ObamaCare - Blog of the Century

Contra David Brooks on ObamaCare - Blog of the Century:

This last point highlights aspects of political economy which Brooks prefers to ignore. He writes that there is no way planners can know]”how Congress will undermine any painful cuts the executive branch does make.” Brooks finds this a powerful insight regarding (say) single payer. The very same point applies to his own preferred solution: the extremely complicated and politicized mechanisms required for premium support. The firms which operate Medicare Advantage serve the healthiest segment of retirees with little apparent savings to show for it. Indeed these firms have been able to lobby Congress for wasteful additional subsidies beyond those required in traditional Medicare.

Brooks is right to worry our health system’s administrative complexities and its political vulnerabilities to special-interest lobbying. He’s wrong to believe that a centralized approach to health policy created either problem. He’s also wrong to believe that health reform has made these problems worse. He might ponder, for example, why so many privileged interests from the insurance industry on down dislike or oppose the new law, and are so keen to destroy measures such as the Independent Payment Advisory Board.

As Paul Starr notes in his essential Remedy and Reaction, our overly fragmented, overly incremental approach to politics is the real culprit here. It makes our resulting health policies too complex, too costly, too vulnerable to special interest pleading.

Hamilton and his friends created an amazing political system which served us well for 200 years. That system does not always serve us well today.

Well said. I like to think of the scene in Animal House (when they walk out and say they're not going to listen to anyone badmouth the US of A) whenever I hear someone argue that we cannot match the quality and efficiency of our European cousins, particularly those in Germany and France. Consider that they are having serious debates about how they are spending too much - while covering everyone and getting better results with no waiting times, mind you - when they are spending a third to half less of their GDP on health care than we are!

Finally, listening to the SCOTUS today, the catastrophic illness and ER visits kept coming up as the talking points about the need for insurance. As anyone in health care knows, the other key to having access is to PREVENT catastrophes and ER visits and maintain health and reduce costs for everyone!

Sphere: Related Content

Ryan Plan May Lead to Single-Payer Health Care - Bloomberg

Ryan Plan May Lead to Single-Payer Health Care - Bloomberg:

Instead, they’ve opted to apply their old policy framework -- the one the Democrats stole -- to Medicare. That has left the two parties in a somewhat odd position: Democrats support the Republicans’ old idea for the under-65 set, but oppose it for the over-65 set. Republicans support the Democrats’ new idea for the over-65 set, but oppose it for the under-65 set.

This isn’t quite as incoherent as it seems. Democrats say they would prefer Medicare-for-All for the under-65 set, but they’ll take whatever steps toward universal health insurance they can get. Republicans say they would prefer a more free- market approach for the over-65 set, but that a seniors’ version of “Obamacare” is nevertheless a step in the right direction. For both parties, it’s the direction of the policy, rather than the policy itself, that matters.

There’s an added complication for Republicans. They have assumed huge savings from applying the exchange-and-subsidies model to Medicare (USBOMDCR). But they don’t assume -- in fact they vehemently deny -- that those same savings would result from the identical policy mechanism in the Affordable Care Act. The Democrats haven’t assumed significant savings from the exchange- and-subsidies model in either case. If the concept works as well as Ryan says it will, then the Affordable Care Act will cost far, far less than is currently projected. There’s no compelling reason to believe competitive bidding will cuts costs for seniors but fail among younger, healthier consumers who, if anything, are in a better position to change plans every few years and therefore pressure insurers to cut costs.

- Sent using Google Toolbar

Sphere: Related Content

Hurray for Health Reform - NYTimes.com

Hurray for Health Reform - NYTimes.com:  Paul Krugman

We all know how the act’s proposal that Medicare evaluate medical procedures for effectiveness became, in the fevered imagination of the right, an evil plan to create death panels. And rest assured, this lie will be back in force once the general election campaign is in full swing.

For now, however, most of the disinformation involves claims about costs. Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when — as was the case with the latest report — the document says on its very first page that projected costs have actually fallen slightly. Nor are we talking about random pundits making these false claims. We are, instead, talking about people like the chairman of the House Republican Policy Committee, who issued a completely fraudulent press release after the latest budget office report.

Because the truth does not, sad to say, always prevail, there is a real chance that these lies will succeed in killing health reform before it really gets started. And that would be an immense tragedy for America, because this health reform is coming just in time.

As I said, the reform is mainly aimed at Americans who fall through the cracks in our current system — an important goal in its own right. But what makes reform truly urgent is the fact that the cracks are rapidly getting wider, because fewer and fewer jobs come with health benefits; employment-based coverage actually declined even during the “Bush boom” of 2003 to 2007, and has plunged since.

What this means is that the Affordable Care Act is the only thing protecting us from an imminent surge in the number of Americans who can’t afford essential care. So this reform had better survive — because if it doesn’t, many Americans who need health care won’t.

- Sent using Google Toolbar

Sphere: Related Content

High health care costs: It’s all in the pricing - The Washington Post

High health care costs: It’s all in the pricing - The Washington Post: Ezra Klein

...the International Federation of Health Plans — a global insurance trade association that includes more than 100 insurers in 25 countries — released more direct evidence. It surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor’s visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we’re paying quite a bit more. The exception is cataract surgery, which appears to be costlier in Switzerland, though cheaper everywhere else.

The PDF of the PowerPoint (of the trailer of the film...) from IFHP is here.

- Sent using Google Toolbar

Sphere: Related Content

Meme-busting: Tort reform = cost control - The Washington Post

Meme-busting: Tort reform = cost control - The Washington Post:

If the pie represents our total health-care spending, then the blue wedge is defensive medicine. Not as big as you thought, likely. But the red sliver, which I pulled out for easier viewing, is what we could expect to see in savings from tort reform.

- Sent using Google Toolbar

Sphere: Related Content

3 Economic Misconceptions That Need to Die - DailyFinance

3 Economic Misconceptions That Need to Die - DailyFinance:

3 Economic Misconceptions That Need to Die

Misconception No. 1: Most of what Americans spend their money on is made in China.

Fact: Just 2.7% of personal consumption expenditures go to Chinese-made goods and services. 88.5% of U.S. consumer spending is on American-made goods and services.

Misconception No. 2: We owe most of our debt to China.

Fact: China owns 7.6% of U.S. government debt outstanding.

Misconception No. 3: We get most of our oil from the Middle East.

Fact: Just 9.8% of oil consumed in the U.S. comes from the Middle East.

You can follow the link for the details and explanations...

- Sent using Google Toolbar

Sphere: Related Content

Medicare Payment Reform — Proposals for Paying for an SGR Repeal — NEJM

Medicare Payment Reform — Proposals for Paying for an SGR Repeal — NEJM:

The Medicare Payment Advisory Commission (MedPAC) has been recommending SGR repeal since 2001 but, until now, has never identified a way to cover its cost. On October 6, MedPAC voted 15-to-2 to recommend replacing the SGR with a “predictable 10-year path of legislated (physician) fee-schedule updates” and paying for the repeal by reducing Medicare payments to various providers and suppliers. Specialists' fees would be reduced by 5.9% for each of 3 years and frozen for the next 7 years. Fees for primary care services delivered by geriatricians, internists, family physicians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants would be frozen for all 10 years. MedPAC estimated that the lower provider payments would save Medicare about $100 billion over 10 years, although Medicare spending on physician services would almost double during that period — increasing from $64 billion to $121 billion — because Medicare's population would expand and the volume and intensity of delivered services would continue to increase. The estimate is based in part on 73% growth of Medicare spending for physician fee-schedule services between 2000 and 2010 (from $37 billion to $64 billion) — a much faster growth rate than that of payment updates or practice costs (see graphGrowth in Medicare Spending for Physician Services, 2000–2010.). Other organizations would face the following payment cuts over 10 years: pharmaceutical companies, $75 billion; post-acute-care facilities, $45 billion; hospitals, $25 billion; clinical laboratories, $10 billion; durable medical equipment makers, $13 billion; and health plans, $13 billion. Medicare beneficiaries would be subject to increased cost-sharing requirements and, for those who carry supplemental coverage, a Medigap excise tax ($33 billion).

- Sent using Google Toolbar

Sphere: Related Content