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Posts tagged as “health care”

First take/insurance

From a report by the Census Bureau:

Between 2013 and 2014, the majority of metropolitan areas saw an increase in the percentage of people covered by health insurance, according to statistics released today from the U.S. Census Bureau’s American Community Survey, the nation’s most comprehensive information source on American households. The 2014 American Community Survey provides statistics on over 40 social, economic and housing topics for U.S. communities with populations of 65,000 or more.

Between 2013 and 2014, all 50 states and the District of Columbia saw an increase in the percentage of people covered by health insurance.

“American Community Survey statistics inform us of how communities evolve and change, allowing us to see the effects of everything from natural disasters to new laws and policies,” Census Bureau Director John H. Thompson said. “Each new year of statistics provides fresh information for the public to use and compare with the year before, helping to tell America’s story and that of communities from Boston to Honolulu and everywhere in between.”

The percentage of people with private health insurance increased in 18 of the 25 largest metropolitan areas between 2013 and 2014. The Miami metro area, which had one of the lowest rates of private health insurance, had one of the largest percentage point increases from 50.5 percent in 2013 to 54.7 percent in 2014. On the other hand, the Boston metro area, which had one of the highest rates, saw a 1.1 percentage point decrease from 76.7 percent in 2013 to 75.6 percent.

Between 2013 and 2014, 22 of the 25 largest metro areas saw an increase in the percentage of people covered by public health insurance. The largest change was in the Portland, Ore., metro area with a 5.6 percentage point increase from 27.1 percent in 2013 to 32.7 percent in 2014.

Below are highlights of the local-level health insurance, income and poverty statistics that complement the national-level statistics released Wednesday from the Current Population Survey. For more information on the topics included in the American Community Survey, ranging from educational attainment to computer use to commuting, please visit census.gov. (photo/Robert Kauffman)

First take

An impressive group, including a couple of former national secretaries of Health and Human Services (Mike Leavitt and Kathleen Sebelius) and a roomful of medical professionals, turned up at the Idaho Healthcare Summit at Fort Hall this week. The idea was to educate Idaho officials on the subject of health care, and a few leading Idaho officials - Senate President pro tem Brent Hill, House Democratic leader John Rusche (a physician) and House health committee chair Fred Wood (also a physician), among them. They were among the Idaho legislators who probably were least in need of the education; according to news reports, just one other legislator (Representative Julie VanOrden, R-Pingree) showed up. The facts apparently didn't matter to many others Today's editorial in the Idaho Falls Post Register suggests, "As for the rest, we can only assume they are content to remain uninformed, place greater stock in talking points than actual data, and continue to appease GOP primary votersby tossing around perjoratives such as 'Obamacare' while lamenting 'federal dependency.'"

Not all of the "Patriot Act" (you have to know there's something wrong when legislation is wrapped in the flag like that) is bad; it included a number of needed updates and upgrades in the law. But the bad stuff, such as the authorization of mass surveillance, was really bad, and support for it has diminished over the years, both on the left and right. Now, on Monday, it may be wiped out - sunset. And that could be important, because simply reauthorizing what's already on the books may be a lot different, politically, than specifically authorizing a new bill. A new, cleaner, better proposal might still pass. But at least a lot of the garbage soon may be taken out.

New: 50 Meds for a Sick Health System

50 Meds
ORDER IT HERE or on Amazon.com

More about this book by Randy Stapilus

One or two won't do. Most books (articles, speeches) about fixing America's health care mess address two or three very real problems and corresponding solutions. But they don't cover the waterfront, and the problem areas are too many to be cured by only a single silver bullet or two. This book for the first time compiles an extensive list of changes, some of them simple and some complex, that could cut costs and re-wire our system so it works better for all Americans. 50 ideas in a short and easy read - just 168 pages packed with solutions that can work. Available now from Ridenbaugh Press, $13.95

The Mac not-quite attack

wu in mac

Outside the Wu town hall, McMinnville/Stapilus

As the McMinnville town meeting by Representative David Wu broke up, one man in the front row flipped open his cell phone and delivered a call, apparently to his wife - it was a call of reassurance: "Well, it's over. No automatic weapons."

Not a bad summation, as these things go. After reports about disruptive congressional town halls around the country, with anti-health reform protesters shouting down congressmen and anyone else who disagreed with them, you can understand why so many nerves and such trepidation accompanied this one. Some congressmen have bagged out on public events, and some (Representative Brian Baird for one) have resorted to telephone-only halls. This event was Wu's first town hall of the break back in district (several more are scheduled to follow), and both sides in the health care debate were primed for action.

That may have helped defuse it.

The pro-reform side was alerted to the prospect of being swamps by the anti's, so they moved quickly. We were told both sides (a local Democratic group on one side, and a protest group led by a former county Republican chair on the other) wit with police and Wu officials, and ground rules set. An escalating set of pre-town hall events was loosely planned, but the situation developed this way: A line formed about four hours before the event outside the meeting room, and most of the early arrivals were pro-reform people.

From there, over four hours, the line and participation swelled to somewhere upwards of 700 people, certainly one of the larger political gatherings ever in Yamhill County. (A typical town hall by Senator Ron Wyden, by comparison, typically might draw 100 people, which under normal conditions is considered pretty good turnout.) The crowd appeared well split between sides, the pro-reform people probably in a majority but likely not by a lot. (more…)

A Utah prescription

utah

Utah Health Care Initiative

Several readers of the recent post here on health care and costs have pointed to a just-delivered speech at the Boise City Club by Utah physician Joe Jarvis, of the Utah Health Care Initiative. The speech is available online.

The speech is called "Too much market, not enough care," and Jarvis' points overlap greatly with those that have been made here. Have a listen. There's a lot of useful material here: "Medicine has once again become a business opportunity. Our body politics has become paralyzed by a market oriented health policy."

From the initiative's web site: "The conventional wisdom about health care is that we should fear socialized medicine (the name offered by those with a proprietary interest in the status quo health system for anything that might threaten their business model) and instead embrace market-based medicine (the notion that health care is a commodity and that unfettered market forces can improve health care delivery). The conventional framing of the health reform debate is bogus. The pretense of a market makes wasteful spending due to a combination of inefficient financing and poor quality care inevitable. What should be feared is not the 'socialization' of American health care. No one, not even the most liberal advocate, is proposing government owned and operated hospitals and clinics in the US. Instead, fear the effects of poor quality health care. The fifth leading cause of death in the US is preventable hospital associated injury. Fear the loss of needed revenues through corporate welfare paid by the taxpayer into the coffers of for-profit insurers and pharmaceutical firms. It is time to change the debate about American health system reform. Rather than worry about coverage, we need to focus on waste. Waste elimination is politically difficult, but essential if sustainable health system reform is ever to happen."

We're en route, just now, to a congressional town hall where the topic do jour is expected to be health care.

Your money or your life

Political speech on health care, quite a bit of it, doesn't match up well with reality on the ground.

Some of the most critical votes in Congress when time comes, presumably some weeks hence, to vote on health care, will be those of the more skeptical Democrats. One of the Democrats most reluctant to accept the various health plans pushed in recent weeks through committees has been Idaho's Walt Minnick.

He's made a number of statements on health care; one (arriving in email) that seemed to need clarification was this: "Third, no 'socialized medicine.' The health care system of insurance must be private – not run by the government." In Minnick's use of the term (exact definitions can vary by person), what does socialized medicine mean? His press secretary responded:

He is firmly opposed to a public option. We of course have Medicare and Medicaid, and while people who use those services like having the benefits of some healthcare, most people very clearly do not like the process associated with those programs. So that partially informs his thinking.

The other key thing to understand is the reasoning by most proponents of a public option. The proposed plan and its proponents on Capitol Hill very much want a single-payer, single-provider system of health insurance – that is a poorly kept secret in Washington, D.C. They view the public option as a way to not just compete with insurance companies, but drive them out of business. The public option would so effectively kill competition in the marketplace, that the proponents would likely be successful in that endeavor.

For Walt, competition is at the heart of this part of the healthcare discussion. A public company would not have to pay taxes, it could bond without restriction, it could go into debt without being beholden to banks or shareholders and would not have to worry about losses. It could just add those losses to the national debt. Most importantly, it would not have any real incentive to drive down costs, because it would quickly become the dominant, overwhelming force in the marketplace. It would be the largest insurance company in the country, run by the federal government and subsidized by taxpayers at enormous cost. That is socialized medicine.

Walt said something interesting the other day as an off-the-cuff way to oversimplify and explain this. Let’s say you sell bikes. And the bike industry is an absolute mess due to poor standards, a lack of accountability, out-of-control costs which are due to a wide variety of complex factors, and wide spectrum of regulations differing from state to state, etc. The government decides it is critical that the industry be reformed so the cost of bikes stops spiraling out of control. Is the way forward for the government to start its own bike company?

Fairly clear as explanation of philosophy. Now, an explanation of how the matter looks as a matter of governing philosophy, from here:

We have laws, generally accepted across the philosophical spectrum, that prohibit someone from walking into your house (or your convenience store), pointing a gun at your head and demanding "your money or your life."

That is what our health care system is doing to us, right now, and on an immense scale. It is extortion at the least, robbery at the most. Governmental activism is needed to stop it.

That may sound harsh or extreme. It isn't. That way of looking at American health care today could be backed up by any number of statistics or studies, but, as Minnick drew on his experience to inform his take on health care, let me draw on some personal events that occurred about 13 months ago. Individual experiences differ widely, of course, but here's some of what informs my thinking on this: (more…)

Merkley on health options

Following up on yesterday's post on the lightly-mentioned state-run insurance funds - which do provide some health insurance for employees - it turns out that a mention of them was made yesterday by Oregon Senator Jeff Merkley. (And, his staff says, not for the first time.)

Appearing on Fox news, Merkley made a number of useful points. (The insurance fund reference, toward the end, was relatively brief but hit a mark.) The trillion-dollar cost of one current proposal gets batted around a lot, but seldom in the context - which Merkley provided - of overall projected health spending during that time of $40 trillion. And the highly useful point that many of the fiscal benefits of the proposal, especially in the area of preventive care, haven't been "scored" by federal budget analysts because no firm numbers for them exist - although there's little doubt those benefits would be substantial.

Not a long interview (and cut off by the Fox interviewers with a slice of unwarranted snark at the end) but a useful listen,

The less you make, the more you pay

It's expensive to be poor, especially when it comes to health care costs. Hold a good, solid, full-time, upper-income job with good health care benefits, and such things as preventive care and earlier physician intervention are practical things. Hold the other kind of job, part-time with lower pay and benefits, and most likely you'll be stuck putting off health care until time has come for the emergency room - which is just about the most expensive kind of health care around.

You can see why some of this develops (and it is an increasingly common approach in both private and government organizations), and there is some reason behind at least some of it. Give full benefits to a part-time employee who at least in theory might be able to work part-time somewhere else too, and - in the zero-sum game that is personnel budgeting - you're limiting what you can provide a full-timer. Except, of course, that in this economic environment, what's really happening is that the part-timers are being shut out of health insurance and, until emergency room time, health care altogether.

Hence the controversy in Idaho, outlined in an Idaho Statesman story today, about a change in state personnel policy requiring, in essence, those state employees who earn the least will have to pay the most for health insurance and related benefits, likely soon kicking them out of the system.

The story clarifies some of this in the case of state employee Zack Gonzales:

Gonzales works 20 hours to 40 hours a week at the Idaho State Emergency Medical Service Communications Center in Meridian.

He pays about $30 a month for health insurance. That's what all qualifying state workers insuring only themselves - not family members - now contribute for the health-plan option Gonzales has, whether they're full-time or part-time. But beginning this fall, his share of the premium will rise to $302.50, a 900 percent increase, or most of one of the two paychecks he gets from the state every month.

Gonzales and his companion rely on Gonzales' check for the mortgage on their home. So Gonzales, 23, will choose the mortgage over health insurance. That means medicine he pays only a few dollars for now will cost him $200 a month.

We sent an inquiry about this policy shift to the governor's office a couple of weeks back. Never got a reply.

The other Wyden health bill

While the battle rages over who provides health insurance and how it's funded (check out the dueling ads to the right), the senator caught up in this particular battle - Oregon's Ron Wyden - is also working on another health care bill that may be just as significant but has gotten a lot less attention. We didn't even register it had been introduced until wandering through the Wyden press releases for this month.

This particular measure is the "Empowering Medicare Patient Choices Act" (S 1133), introduced in the Senate (in standard bipartisan fashion) by Wyden and New Hampshire Senator Judd Gregg, and in the House by Oregon Representative Earl Blumenauer. Getting at its significance requires stepping back a moment to consider why health care is so expensive and why so many dollars in our economy are being swallowed by it.

The truth is, there isn't any one reason to account for it. Many of the best-known prospective culprits - the greedy insurance companies, malpractice, high drug costs, archaic paper records - are without doubt real culprits that do add cost, but the biggest problem seems to be more systemic and directly involved in health care itself: Massive overtreatment.

Jeff Kropf

A terrific book we strongly recommend everyone read (seriously, and right now) is Overtreated by Shannon Brownlee, which makes a totally convincing case that "Each year, our medical system delivers an enormous amount of care that does nothing to improve our health or lengthen our lives. Between 20 and 30 cents on every health care dollar we spend goes towards useless treatments and hospitalizations, towards CT scans we don’t need, towards ineffective surgeries—towards care that not only does nothing to improve our health, but that we wouldn’t want if we understood how dangerous it can be." A great piece in the current New Yorker ("The Cost Conundrum," by physician Atul Gawande) makes a similar case and expands on why much of this is happening, and argues: "Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse." And much of this actually can be mapped, because Medicare costs are tracked by county, and in some counties the costs are massively higher than in others, with no improvement (and sometimes diminishment) of outcomes.

Then there's the decades of study at the Dartmouth Atlas of Health Care, which this year reports: "Huge inefficiencies in the U.S. health care system are hamstringing the nation's ability to expand access to care, according to a new analysis of Medicare spending by researchers of the Dartmouth Atlas Project, published February 26, 2009 in the New England Journal of Medicine. Many experts have blamed the growth in spending on advances in medical technology. But the differences in growth rates across regions show that advancing technology is only part of the explanation. Patients in high-cost regions have access to the same technology as those in low-cost regions, and those in low-cost regions are not deprived of needed care. On the contrary, the researchers note that care is often better in low-cost areas."

The new measure, S. 1133, is aimed most directly just at Medicare, but the principles in it could easily be extended - and might be, with national exposure - through much of the rest of the health care system. (The Dartmouth Atlas people have endorsed it.) What it does, according to Wyden:

"The bill seeks to open up avenues for conversation between physicians and patients so that patients fully understand their treatment options when there is more than one clinically appropriate treatment. Doctors would be reimbursed for the extra time spent counseling patients. . . . The legislation creates a three-step phase-in of patient decision aids which are informational videos and other educational materials about the patient’s treatment options into the Medicare program. Phase I is a three-year period allowing ‘early adopting’ providers to participate in the pilot, providing data and serving as Shared Decision Making Resource Centers. Phase II is a three-year period during which providers will be eligible to receive reimbursement for the use of certified patient decision aids. The final stage requires providers to use patient decision aids for certain conditions as a standard of practice."

Not an ultimate solution, but a thoroughly useful start. One of the most useful things to do with cut medical cost while encouraging beneficial outcomes, which is the prerequisite for doing anything else.

Wyden, Specter and health

Some of the news reports out yesterday about the switch of Pennsylvania Senator Arlen Specter from the Republican to the Democratic caucus mentioned his quick hallway meetup, apparently immediately before the formal announcement, with Oregon Senator Ron Wyden, who greeted him with a big smile and words of welcome.

That came to mind when, today, this passage from a Heritage Foundation (the conservative group) blog post came across:

This is important on policy grounds for a few reasons. One issue that will be dramatically affected is Health Care. Senator Ron Wyden of Oregon told CQ: “I think his decision is transformative. . . . This makes a very significant difference in the health care reform discussion.”

Wyden is correct. It will change the debate dramatically, because Senator Specter was one of the chief opponents of so called Hillary-Care during the Clinton Administration and now will be on the other side of the aisle for the debate on comprehensive health care reform. Democrats will have a 60 vote majority and will not have to negotiate with the minority party when crafting a package of health care reforms.