Category: Uncategorized

It’s The Prices, Stupid: Why The United States Is So Different From Other Countries:

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An amazingly helpful look into what our disability program has become. Done with the usual attention to humanity and detail as we have come to expect from This American Life.

490: Trends With Benefits

Mar 22, 2013

The number of Americans receiving federal disability payments has nearly doubled over the last 15 years. There are towns and counties around the nation where almost 1/4 of adults are on disability. Planet Money‘s Chana Joffe-Walt spent 6 months exploring the disability program, and emerges with a story of the U.S. economy quite different than the one we’ve been hearing

Trends With Benefits | This American Life

Some good graphics and a chart pack on this topic. There are losers in this – higher income individuals and families who don’t qualify for significant subsidies under the exchanges.

By the end of the first open enrollment period for coverage offered through the Affordable Care Act’s marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund’s Affordable Care Act Tracking Survey, April–June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick.

Are Americans Finding Affordable Coverage in the Health Insurance Marketplaces? – The Commonwealth Fund

An innovative primary care model…

Who and Where A Seattle primary care practice accepting patients of all ages, staffed by internists, family physicians, and nurse practitioners.

Core Innovations In this direct care practice, in lieu of insurance, patients pay an age-adjusted monthly fee for unrestricted, comprehensive primary care. Patients have no copayments for visits. Low overhead allows providers to have small patient panels, giving patients better access and allowing more time per visit. The objective is to shift care away from expensive specialists and hospitals.

Key Results Qliance has established a viable, sustainable business model with low overhead and patient panels about a third the size of those of the average insurance-based family physician. This has allowed patients to enjoy much greater access and clinicians to delve much more deeply into patients’ health issues, do more research on health problems, work more closely with consultants when necessary, and work more intensively with patients on health change, leading to greater engagement of and satisfaction among clinicians.

A Direct Primary Care Medical Home: The Qliance Experience

Why We Must Ration Health Care – NYTimes.com:

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

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Why More, Not Fewer, People Might Start Getting Health Insurance Through Work – NYTimes.com: “The law’s best-known and least-liked provision — the “individual mandate” — is probably causing the trend. For the first time, people must buy insurance this year or be subject to a tax penalty. In Massachusetts, a similar requirement changed the employer-sponsored insurance market in two ways, said Sharon Long, a senior fellow at the Urban Institute, who has studied the state’s experience.

First, it encouraged more workers who were already being offered health insurance to take it — an effect roughly analogous to what Walmart is experiencing. Second, it actually induced more employers to offer coverage to their workers — because, Ms. Long believes, workers began to demand insurance once they were required to have it. Over all, the percentage of Massachusetts residents with employer-based insurance went to 65.6 percent in 2008, when the health care law was up and running, up from 61 percent in 2006.”

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Health costs are growing really slowly. Americans haven’t noticed.

Ask any health economist and they’ll no doubt tell you that health care cost growth is slowing, growing at a low, unprecedented rate.

They can point to the National Health Expenditures report, which shows health care costs now growing at the same rate as the rest of the economy. Or, they can pull up new data out Tuesday from the Kaiser Family Foundation, showing that premiums grew 4 percent in 2013. That’s way lower than growth in the late 1990s and early 2000s.

Ask any American about what direction health costs are moving, and you’ll likely get a completely different story. Preliminary results for a forthcoming Kaiser Family Foundation poll show that most Americans think that health care costs are actually growing faster than usual right now. Fewer than 10 percent say the growth is slowing down.

“We have a very moderate increase this year, but premiums go up each year,” Kaiser Family Foundation president Drew Altman says. “People see what they pay for their premium going up and perhaps more forms of cost-sharing. We’ve been seeing a quiet revolution from more comprehensive coverage to less.”

Altman said that preliminary results from his group’s survey show that 54 percent of Americans think health care costs are growing faster than average. “A tiny number said they were growing slower,” he says. “I think that’s because, if we look at this as a long term trend, health care costs have increased in excess of wages and inflation.”

Fresh off passing a budget that will increase Ohio’s infant mortality rate, Sen. Shannon Jones is touring the state with the Senate Medicaid, Health & Human Services Committee.

In 2009, the Ohio Department of Health formed the Ohio Infant Mortality Task Force (OIMTF) to address our infant mortality rate, which is currently 3^rd-highest in the nation; our infant mortality rate among African-Americans is the highest in the nation. (In 2009, we were the 12^th-highest. Go Team Kasich!)

The OIMTF made a 10-point recommendation to address the problem, but the Ohio budget systematically undermines each of the 10 recommendations. There’s a chart at the bottom of the [link page] with more detail.

They’ll be hearing “the concerns of constituents… regarding infant mortality rates and health disparities.”

That’s convenient. Here are some sample questions to ask Sen. Jones when she comes to town.

• Early prenatal care is the most effective way to reduce infant mortality, but almost half of Ohio women are uninsured when they become pregnant. Expanding Medicaid would mean that all pregnant Ohioans can get immediate prenatal care without seeking reimbursement. Sen. Jones, how you do propose to lower the infant mortality rate without expanding insurance coverage to all Ohioans?
• In 2009, ODH recommended expanding pre-pregnancy gynecological services. The most popular provider of these “family planning” services is Planned Parenthood, which every year sees 1 in 6 Ohio women. Sen. Jones, you just voted for a budget to take away funding from Planned Parenthood, raising the price of these family planning services. Does that mean that you disagree with the recommendation that women talk to a gynecologist before they get pregnant?
• 10 more at the link below…

12 Questions Republicans Need to Answer on Infant Mortality in Ohio

The Dowd and Allison article appeared in Health Affairs,  and fortunately Uwe Reinhardt has analyzed it in a reality-based context. An excerpt:

The view that private markets — whether or not perfectly competitive — ration goods and services in scarce supply apparently is not shared by Dowd and Allison when they write:

“…rationing involves limits on consumption that are (1) set by someone other than the consumer (such as the supplier) with (2) the intent of limiting choices that some consumers otherwise would be willing and able to make.”

So according to Dowd and Allison, rationing occurs only when limits are placed upon choices that some potential buyer of a good or service would otherwise be willing and able to make, and I emphasize here the words “and able.”

For example, if for some reason government intervened in a reasonably price competitive market for some health care good or service that is in limited supply — e.g., a vaccine — to allocate that scare item to members of society on the basis of some criterion other than price and the recipients’ ability to pay, it would be rationing. On the other hand, if that limited supply were allocated among members of society on the basis of price and ability to pay, and on that basis individuals were denied access to that good or service, that might possibly be an “economic injustice”, but it would not be rationing.

Dowd and Allison certainly are free to posit this as their definition of rationing. They should not assume, however, that their definition is universally shared, even among economists, nor should they assume that in the debate on health policy the more expansive definition of rationing, including price-rationing, is abusive.

Unpacking The Meaning Of ‘Rationing’: A Response To Dowd And Allison – Health Affairs Blog

Wed, Mar 6 2013

By Sharon Begley and Robin Respaut

(Reuters) – When the local doctor who had been treating Vicky Hilborn told her that her rare cancer had spread throughout her body, including her brain, she and her husband refused to accept a death sentence. Within days, Keith Hilborn was on the phone with an "oncology information specialist" at Cancer Treatment Centers of America.

Hilborn had seen CTCA’s website touting survival rates better than national averages. His call secured Vicky an appointment at the for-profit, privately held company’s Philadelphia affiliate, Eastern Regional Medical Center. There, the oncologist who examined Vicky told the couple he had treated other cases of histiocytic sarcoma, the cancer of immune-system cells that she had.

"He said, ‘We’ll have you back on your feet in no time,’" Keith recalled.

Vicky’s cancer treatment was forestalled by an infection and other complications that kept her at Eastern Regional for three weeks. In July 2009, when she got back home, things changed. Despite Keith’s calls, he said, CTCA did not schedule another appointment. As his wife got sicker, Keith, a former deputy sheriff in western Pennsylvania, was reduced to begging.

The oncology information specialist "said don’t bring her here," he recalled. "I said you don’t understand; we’re going to lose her if you don’t treat her. She told me I’d just have to accept that."

Vicky Hilborn never got another appointment with CTCA. She died on September 6, 2009, at age 48.

CTCA is not unique in turning away patients. A lot of doctors, hospitals and other healthcare providers in the United States decline to treat people who can’t pay, or have inadequate insurance, among other reasons. What sets CTCA apart is that rejecting certain patients and, even more, culling some of its patients from its survival data lets the company tout in ads and post on its website patient outcomes that look dramatically better than they would if the company treated all comers. These are the rosy survival numbers that attract people like the Hilborns.

Business & Financial News, Breaking US & International News | Reuters.com