Articles Posted in Health Care Reform

mitchAt a time when Americans experience high anxiety and financial insecurity due to medical costs — with more than 20 percent of those with health insurance experiencing trouble paying for necessities, more than a quarter of them saying they had bills in collection, and 13 percent forced to borrowed money as a result of illness — politicians and special interests are closing the midterm campaigns as if they can prank voters. Just how gullible do they think the electorate can be?

Republican congressional candidates, after howling about the Affordable Care Act and campaigning unsuccessfully to repeal it in dozens of votes for years, including in the first of the Trump Administration, now are claiming to constituents that they support key parts of Obamacare.

Even as GOP state attorneys general argue in a pending federal court case to gut ACA protections on preexisting conditions, minimum benefits, and lifetime limits, Republican candidates are telling voters, counter factually, how much they embrace and support those Obamacare components. They’re trotting out sad tales about their own relatives’ illnesses to claim to support a position that they opposed in legislative votes and actions just weeks ago.

deduct-300x190As various news organizations reported, anxious Americans will vote in less than a month with health care as a dominating concern. A new annual report shows why: Medical costs keep rising, as does the cost of health insurance, notably the coverage most of us get from our employers. Companies keep pushing on to workers higher premiums and deductibles that race ahead of inflation and devour wage growth.

Deductibles — the out-of-pocket costs that patients must pay before their coverage kicks in and benefits them — have skyrocketed since 2008, growing by 212 percent. That’s eight times faster than wage growth, and 12 times faster than inflation, according to the latest research by the Kaiser Family Foundation.

The average deductible, $303 a decade ago, now has hit $1,573 for single coverage.

Medicare-logo-650x250-300x115Critics may want to carve it up and make it tougher to join, while proponents would expand it and add more money to it. But what could the U.S. health system overall learn from real, rigorous research on Medicare, the major health coverage method for tens of millions of Americans age 65 and older?

Politico, the politics- and Beltway-focused news web site, has renewed attention on the work of Ph.D. economist Melinda B. Buntin, a professor who heads Vanderbilt University’s health policy department. She and her colleagues have spent years digging into the money flowing into Medicare, a program that in 2017 paid out $700 billion in benefits, compared with $425 billion in 2007.

As Politico reported, the research shows a surprise beneath the big, aggregate, and problematic Medicare cost: “One of the best-kept secrets in American health care might be that Medicare spending — in important ways — is going down.”

theater-228x300What’s an internist to do when an 81-year-old patient, already in failing health with advanced emphysema, seeks a second opinion because he’s been told his prostate specific antigen (PSA) levels are unacceptably high? This senior also has been advised to schedule a prostate biopsy urgently to determine if he has cancer. Can this discussion with both a scared patient — and his bright, concerned personal doctor — be any tougher?

For Andrew Lazris, who is also a geriatric specialist practicing in Maryland, this was a hard, complicated case because it involved his dying dad.

It also exemplified for him the work that he has undertaken with Eric Rifkin, an environmental scientist and adjunct researcher at Johns Hopkins University, in ensuring that patients retain their fundamental and critical right to have a say in their care. And, in doing so, they have developed what they argue is a clear, comprehensible way to help patients grasp and deal with the inevitable uncertainties, risks, and complexities of the array of medical treatments they can get overwhelmed with by doctors, hospitals, Big Pharma, medical device makers, and others in health care.

Bundle-300x151Federal regulators may be forced to reconsider their plans to curtail a cost-containing experiment that affects some of the most commonly performed surgeries — knee and hip replacement procedures that hundreds of thousands of seniors undergo annually through their Medicare coverage at a cost to taxpayers of billions of dollars.

Under the Affordable Care Act, doctors and hospitals were pushed to adopt a new and different way to think about and to bill for these surgeries, which, by the way, aren’t risk free. Instead of patients getting flooded with bills from each provider involved — the lab, radiologist, anesthesiologist, surgeon, hospital, and so forth — Obamacare got all the parties together and told them they would get a single, “bundled payment.” Hospitals, typically, then acted as the chief point of contact, getting the providers to figure their fair share, billing patients (once), and collecting reimbursements and distributing them appropriately.

The system seemed to work: costs declined, the quality of care went up, and patients expressed relief that their mailboxes weren’t jammed with a blizzard of the usual incomprehensible medical bills. But doctors, hospitals, and insurers kept grumbling. The Trump Administration and Republicans in Congress, as part of their relentless and counter-factual assault on the ACA (more on that in a second), took aim at bundled payments and talked about changing and eliminating this approach.

Nursing homes, by scrimping on their staffing to maximize their profits, put their residents at grave risk for infections that too often have grisly and deadly results. Low-rated facilities run by Uncle Sam to care for elderly veterans also may be concerning. And those oft-pricey assisted living facilities may have their own response to dealing with difficult to care for elders — putting them out on the street.

Kaiser Health News Service, the Chicago Tribune, USA Today, and the Boston Globe all deserve credit for their digging into problems at facilities caring for the old, focusing on issues that should be at the fore for regulators, policy-makers, and politicians as the nation grays.

chriscollins-300x201At a time when prescription drug prices keep skyrocketing and Americans pay hundreds of billions of dollars for medications that account for as much as 15 percent of all U.S. health care spending, federal law enforcers provided a rare and jarring sight with the public arrest of a congressman on charges he engaged in insider trading involving an Australian drug maker.

Chris Collins, a Republican who represents a western New York district and was among President Trump’s earliest and most vocal supporters in Congress, insists he committed no wrong. He says he will be exonerated, but he has pulled the plug on his plans to seek reelection in November.

The sordid details of his financial dealings, as laid out in news stories and a damning indictment, however, may keep front and center not only the charges against him but also troubling questions about members of Congress and their private investing, corporate board roles, and especially their tenacity as Big Pharma lapdogs, instead of being watchdogs on behalf of besieged, too often bankrupted American patient-consumers.

krumholzIn many parts of the developing world, families play a big part in patients’ hospital care. They not only sit for long hours with loved ones, supporting and encouraging their recovery. They also may help with direct services, bathing and cleaning patients, tending to their beds and quarters, and even assisting with their medications and treatments.

Such attentiveness from loved ones— once common in this country, too —  may be deemed by many now as quaint and unnecessary, what with the rise of big, shiny, expensive American hospitals.

But think again: As Paula Span reported in her New York Times column on “The New Old Age,” care-giving institutions across the country have become such stressful, disruptive places that seniors, especially, not only heal poorly in them but also may be launched into a downward cycle of repeat admissions.

MRI-300x142The health policy wonks and those who purport to “reform” the U.S. health care system may be long on academic and other fancy credentials. But they also persist in demonstrating they can be short on old-fashioned common sense, especially about the way most of us lead our lives.

That’s a point emphasized in a recent column in the evidence-based “Upshot” feature of the New York Times, written by Austin Frakt. He directs the Partnered Evidence-Based Policy Resource Center at the VA Boston Healthcare System and is an associate professor with Boston University’s School of Public Health and an adjunct associate professor with the Harvard T.H. Chan School of Public Health.

Frakt looked at some recent research to dissect a question that occupies many experts: Could Americans cut their health care costs by shopping around more for medical services? This is a fond notion held by a slice of health care “reformers,” whom Frankt proceeds to disabuse.

cpidrugs-300x182Uncle Sam long has allowed states to set the rules governing how Medicaid works, and a dozen or so of them have decided, with the purported goal of increased fiscal rectitude, to impose harsh rules to force poor, sick, disabled, and aged program participants to work more or to seek employment.

But taxpayers might be better served if the frugal-minded turned greater attention to Big Pharma’s insidious role at the state level in causing Medicaid costs to skyrocket, threatening budgets and creating conflicts in funding other public programs like education and transportation.

The Center for Public Integrity (CPI) and National Public Radio deserve praise for investigating how corruptive, drug-maker money has overwhelmed state officials’ efforts to corral soaring costs of prescription medications covered by Medicaid and governed by a patchwork of rules in each of the nation’s 50 states.

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