Author: cmh

Haves and Have-Nots: A Look at Children’s Use of Dental Care in California – CHCF.org

Haves and Have-Nots: A Look at Children’s Use of Dental Care in California – CHCF.org:

“The burden of oral disease continues to fall more heavily on children from poor, minority households. And despite growing awareness of the life-long effects of poor oral care, nearly one quarter of California children have never been to a dentist, including half of all children under the age of five.

Using the most recent data available from the 2005 California Health Interview Survey, this snapshot found that uninsured children were least likely to have had a recent dental visit and most likely to have never visited the dentist. Denti-Cal beneficiaries were least likely to have ever seen the dentist compared to those with other types of insurance.”

I’ll tag this with dental care so you can follow to a couple of other posts on this topic…

Another country heard from…

The Jewish Week News: “But when she makes the move, she’ll be practicing in a country where doctors earn only a fraction of what they do in the United States. In fact, most Israeli doctors have to have second jobs just to make ends meet.

“Doctors don’t move there because of a lucrative salary,” Rosner said. “We’re going because it’s the Jewish homeland, and this fellowship is making the move more doable.

“We know we are going to live a less lavish life than in the U.S., but we are not going to starve.””

OK, maybe this a bit extreme, even for me. But, on the other hand, if private school is only $150 a month, makes you wonder what college costs…

Tax Cuts Don’t Boost Revenues – TIME

Sorry, not directly a single-payer post, but I have to keep track of this stuff somewhere!

Tax Cuts Don’t Boost Revenues – TIME: “If there’s one thing that Republican politicians agree on, it’s that slashing taxes brings the government more money. ‘You cut taxes, and the tax revenues increase,’ President Bush said in a speech last year. Keeping taxes low, Vice President Dick Cheney explained in a recent interview, ‘does produce more revenue for the Federal Government.’ Presidential candidate John McCain declared in March that ‘tax cuts … as we all know, increase revenues.’ His rival Rudy Giuliani couldn’t agree more. ‘I know that reducing taxes produces more revenues,’ he intones in a new TV ad.

If there’s one thing that economists agree on, it’s that these claims are false. We’re not talking just ivory-tower lefties. Virtually every economics Ph.D. who has worked in a prominent role in the Bush Administration acknowledges that the tax cuts enacted during the past six years have not paid for themselves–and were never intended to. Harvard professor Greg Mankiw, chairman of Bush’s Council of Economic Advisers from 2003 to 2005, even devotes a section of his best-selling economics textbook to debunking the claim that tax cuts increase revenues.

The yawning chasm between Republican rhetoric on taxes and even informed conservative opinion is maddening to those of wonkish bent. Pointing it out has become an opinion-column staple. But none of these screeds seem to have altered the political debate. So rather than write yet another, I decided to find out what Arthur Laffer thought.”

He found out that Laffer still believes reagan’s tax cuts paid for themselves in spite of subsequent evidence and recantments.

Implications of UPMC’s ethics policy far-reaching

Implications of UPMC’s ethics policy far-reaching:

“As he delivered a typical $120 lunch order to a doctor’s office last week — three chicken or salmon entrees, three appetizers, a chicken sandwich and four salads — Robert Bishop was mindful that his business, Mobile Menus, soon would be filling fewer orders.

On Friday, he expects to lose the deliveries he makes to doctors affiliated with the University of Pittsburgh Medical Center.

A new UPMC conflicts-of-interest policy will take effect that day aimed at making doctors’ decisions free from influence created by gifts or improper relationships with the drug or medical device industries.
Among other provisions, the policy bans gifts such as pens, note pads and food provided by industry representatives as they work to present information about their products at doctors’ offices.

Losing that food business for the UPMC doctors he visits, Mr. Bishop said, will cut his $5,000 weekly sales by about 20 percent. He said nearly all the lunches he provides to doctors’ offices are paid for by drug industry representatives.”

Good on UPMC…

When Self-Interest Isn’t Everything – New York Times

Not exactlydirectly related to the subject of single payer, but sort of…

When Self-Interest Isn’t Everything – New York Times:

“Researchers at the intersection of economics, psychology, sociology and other disciplines have had interesting things to say about the anomaly inherent in collective action. Albert O. Hirschman, an economist at the Institute for Advanced Study at Princeton, was one of the first to grapple seriously with it. In his 1982 book “Shifting Involvements,” he acknowledges that self-interest indeed appears to be the dominant human motive in some eras. But over time, he argues, many people begin to experience disappointment as they continue to accumulate material goods. When consumption standards escalate, people must work harder just to hold their place. Stress levels rise. People become less willing to devote resources to the public sphere, which begins to deteriorate. Against this backdrop, disenchanted consumers become increasingly receptive to appeals from the organizers of social movements.

Eventually, Mr. Hirschman argues, a tipping point is reached. In growing numbers, people peel away from their private rat race to devote energy to collective goals. The free-rider problem ceases to inhibit them, not only because they now assign less value to private consumption, but also because they find satisfaction in the very act of contributing to the common good. Activities viewed as costs by self-interest models are thus seen as benefits instead.”

The article ends with a description of Milton Friedman’s dismissal of JFK’s “Ask not” sentiments. Not being an economist, I’ve not read Friedman, and, apparently haven’t missed much…

JAMA — From Waste to Value in Health Care, February 6, 2008, Boat et al. 299 (5): 568

JAMA — From Waste to Value in Health Care, February 6, 2008, Boat et al. 299 (5): 568:

“The United States ranks among the worst of industrialized countries for indicators of health such as infant mortality and life expectancy,1 despite spending $2 trillion annually on health care,2 more than any other nation per capita. However, higher health care spending does not correlate with higher quality of care or better patient outcomes.3-5 These sobering indicators suggest that an opportunity exists to close the value gap in the day-to-day delivery of health care by eliminating actions that impede optimal systematic performance, which result in less than perfect outcomes, extra work, or corrective work, otherwise described as waste.

Patient falls and decubitus ulcers represent waste in the form of ‘never events’ that create more costs and result in systemic dissatisfaction. Waste is illegible and incomplete prescriptions that consume technician, nurse, and pharmacist time and, at worst, risk the life of the patient. Waste is acute care hospitalization of patients with diabetes who received inadequate preventive care. Waste is failing to adopt evidence-based care. Waste accounts for 30% to 50% of health care spending.6-7

Over the last 20 years, quality has become a widely shared mantra in health care but with few efforts to systematically define the exact size and nature of the opportunity to improve value. This situation is somewhat analogous to when a physician determines that a patient is ill but does nothing more to diagnose or treat the patient. A better or more accurate approach to taking advantage of the opportunity would be to produce detailed problem statements that permit a locally driven but nationally connected set of interventions to close the value gap.”

More about QI than cost, but they do mostly go hand in hand…

AlterNet: 10 Myths About Canadian Health Care, Busted

AlterNet: 10 Myths About Canadian Health Care, Busted:

“2008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning — and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.

I’m both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I’m in a unique position to address the pros and cons of both systems first-hand. If we’re going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.

To that end, here’s the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they’re made of.”

Read on…

CA: As State Bill Dies, Activists Turn to Single Payer Bill

Berkeley Daily Planet:

“Advocates of single payer health insurance in California are saying that the collapse of the Nuñez-Perata-Schwarzenegger health care bill is a good thing and are moving forward with reviving their own single-payer legislation.

“We were opposed to the Nuñez bill,” Vote Health representative Kay Eisenhower said by telephone this week. “We considered it a step backwards.” Vote Health is an Alameda County-based health care activist organization.

Eisenhower said statewide single-payer health care advocates will be holding a two-day conference in Los Angeles later this month to talk about ways to put State Senator Sheila Kuehl’s (D-Santa Monica-Los Angeles) SB 840 single-payer health care bill back on track. “SB 840’s not dead,” she said. “It’s only on ice.”

Two years ago, it seemed dead. After SB 840 passed the state legislature in 2006, Gov. Schwarzenegger vetoed it.

Kuehl revived her single payer bill a year later, and the bill passed the Senate on a 23-15 vote and the Assembly Health Committee on a 12-5 vote last summer, but it stalled in the Assembly Appropriations Committee as attention in the Assembly turned to a compromise bill being put together by Assembly Speaker Fabian Nuñez.

The bill’s summary says it “would establish the California Universal Healthcare System (CUHS) under which all California residents would be eligible for specified health care benefits. The CUHS would, on a single-payer basis, negotiate for or set fees for health care services provided through the system, and pay claims for those services.””

NEJM — Market-Based Failure — A Second Opinion on U.S. Health Care Costs

NEJM — Market-Based Failure — A Second Opinion on U.S. Health Care Costs:

“Relentless medical inflation has been attributed to many factors — the aging population, the proliferation of new technologies, poor diet and lack of exercise, the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand, excessive litigation and defensive medicine, and tax-favored insurance coverage.

Here is a second opinion. Changing demographics and medical technology pose a cost challenge for every nation’s system, but ours is the outlier. The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system.

Markets are said to optimize efficiencies. But despite widespread belief that competition is the key to cost containment, medicine — with its third-party payers and its partly social mission — does not lend itself to market discipline. Why not?”

Read on…

Lawmakers take on single-payer health care backers at rally: Rutland Herald Online

Lawmakers take on single-payer health care backers at rally: Rutland Herald Online:

“But as the crowd grew more raucous (some began interrupting lawmakers and insulting legislative staff), Rep. Patricia O’Donnell, R-Vernon, staged her own interruption as she came to the front of the room and asked people to treat their lawmakers with respect.

‘If you want to be listened to, you have to be respectful,’ O’Donnell, a member of the House Health Care Committee, told the crowd before a chorus of people yelling ‘sit down’ and ‘shut up’ sent her out of the room, the door slamming behind her.

Maier told the crowd the criticism for legislative staff — who have researched aspects of the hospital plan for lawmakers — is off base. He added that while he doesn’t ‘enjoy being yelled at, it is our job to listen and to ask the tough questions and to dig down.’

‘If we don’t ask these kinds of questions we would be irresponsible,’ he said. ‘It’s not our job to pass ideas and concepts.’

Racine also told the crowd that their anger is misplaced and suggested that attention should also be focused on state and elected officials who do not support universal health care. He cited the new proposed budget from Gov. James Douglas, which he said underfunds Medicaid and will result in ‘$5 million in new co-pays and price increases’ for Vermonters.

‘I know the system is not sustainable. It’s a national crisis,’ Racine said. ‘If some folks have ideas on how to make this work, I’m all ears.'”

Going “Colonial” in Vermont…