Insurance

October 11, 2018

Congrats on the raise. Too bad it’s gone already. For health insurance.

As 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.

October 9, 2018

Congress approves 650-page bill to attack opioid crisis, as doubts abound

by Patrick A. Malone

Congress has approved a major new push to deal with the opioid crisis that kills tens of thousands of Americans annually. Voters can expect President Trump to sign the big bill, passed easily and with rare bipartisan support in the House and Senate, just in time for politicians in the mid-term elections to campaign on their drug-fighting initiatives. But critics say it won’t be enough.

The opioids legislation covers 650 pages, and, in brief, the Washington Post reported, would:

Require the U.S. Postal Service to screen packages for fentanyl shipped from overseas, mainly China. Synthetic opioids that are difficult to detect are increasingly being found in pills and heroin and are responsible for an increase in overdose deaths.

October 3, 2018

As partisans scuffle, Medicare surprises by reducing per-patient spending

by Patrick A. Malone

Critics 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.”

October 2, 2018

Battle is on to bring down sky-high costs of emergency medical transport

by Patrick A. Malone

Even as District of Columbia officials gave a cautious, interim report on their push to reduce with nurses’ help the expensive misuses of the 911 emergency system, a news organization’s story on a sky-high medical transport bill has underscored why regulators and lawmakers need to fix a pricey part of the health care system: Why can’t sick and injured patients get to treatment, quickly but without breaking the bank?

In the nation’s capital, it will take special nurses more time to settle in, overcome excess caution, and better help emergency dispatchers decide: When can they avoid sending expensive EMS vehicles and teams and when can patients with less urgent medical complaints be helped to get to care with cheaper commercial options, like app-based ride-sharing services Uber and Lyft, D.C. Fire Chief Gregory Dean has said.

The data from the first 90 days of the $1-million “Right care, right now” program to tap nurses’ expertise to divert non-emergency medical care out of the 911 system may offer modest cause for optimism, as the Washington Post reported:

August 8, 2018

Shift-and-shaft: Why is it always patients’ burden to hunt for affordable care?

by Patrick A. Malone

The 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.

July 31, 2018

Patients? We’re just profitable bit$ and byte$ to Big Pharma and insurers

by Patrick A. Malone

Big Data may be a business buzzword that puts most consumers into a big sleep, but big alarms are sounding for Americans about Big Brother intrusions into their lives via the collection and analysis of vast amounts of highly personal information. Of course, Big Pharma and medical insurers are at the fore of invasive practices — some of which patient-consumers themselves are helping, likely without knowing they’re doing so.

Millions of Americans may be little aware, for example, that they’re now working for GlaxoSmithKline, a global pharmaceutical conglomerate with $9 billion in revenues in just the most recent quarter. GSK just struck a $300-million deal with 23andMe, the company that has persuaded roughly 5 million consumers to spit in a test tube to get a glimpse of their genetic information, notably information about their ancestry and purportedly some of their genomic health risks.

Firms like 23andMe, with promotions at events like Baltimore Ravens pro football games, also have amassed highly personal genetic and medical data on millions of patient-consumers, promising to protect the information but also offering, casually and by the way, that this vital information could be shared — ostensibly for the betterment of public health.

July 20, 2018

When Big Pharma dives for dollars, crises erupt but dire needs go unanswered

by Patrick A. Malone

Americans should be wary lest they get in between Big Pharma and a buck.

That’s what investigators for a U.S. Senate subcommittee showed when scrutinizing how industry middlemen inundated the Show Me State with more than a billion doses of powerful prescription painkillers, making big profits but asking few questions how so many opioid drugs could be taken by so few patients.

It’s also what patients might see as drug makers retreat from research to develop needed new antibiotics and therapies for Alzheimer’s and Parkinson’s.

July 10, 2018

Summer’s discontent: Evidence defies partisans on ACA, Medicaid expansion

by Patrick A. Malone

The evidence accumulates that partisans’ persistent attacks on the Affordable Care Act and Medicaid run counter to their constituents’ needs and wishes, but will Republicans course-correct or will voters soon force them to?

It may be inconvenient in these polarized times for public policy to be rooted in research and fact, rather than bluster and shouting. But the New York Times and Washington Post have posted not one but several stories that raise questions about recent actions by the Trump Administration and the Republican-controlled Congress affecting health care access.

Aaron E. Carroll, a professor of pediatrics at Indiana University School of Medicine and health care policy analyst, wrote for the New York Times’ evidence-based “Upshot” column about research on the ACA-driven expansion of Medicaid. It has prompted publication, he reported of “77 studies, most of them quasi-experimental in design … They include 440 distinct analyses.” Of these works:

July 2, 2018

High-deductible nightmares: the health insurance crisis partisans ignore

by Patrick A. Malone

While political partisans pound without pause for extreme changes in the Affordable Care Act, Medicare, Medicaid, and other government programs that seek to assist the poor, sick, children, and others with access to health care, they’re ignoring the medical nightmare that’s afflicting ever-rising numbers of middle- and upper-class Americans who get their health coverage at work: high-deductible health insurance.

Families long have been staggering under sudden and sizable medical expenses they may be forced to bear because they need health insurance and only can afford their employers’ offerings by reducing their monthly premiums with high-deductible policies. They’re betting they won’t be hit with thousands of dollars in out-of-pocket medical costs.

They’re losing that wager. Often. A lot. And dealing with dire consequences. As Bloomberg News Service reported:

June 28, 2018

No surgery is free of risks or complications, as breast reconstruction study reminds

by Patrick A. Malone

Cancer and surgery — it’s little wonder that even the most resilient patients can buckle a bit when their doctors talk to them about these two issues together and urgently. That’s why new research may be valuable to women with breast cancer, providing them with better evidence-based insight about challenges in their reconstructive options.

The information, which experts said surprised them and may change their views on frequently performed procedures, yet again underscores that surgery can carry significant risks and complications.

In fact, 1 in 3 women who undergo cancer-related breast reconstructive surgery develops a postoperative complication over the next two years, 1 in 5 requires more surgery, and in 1 in 20 of cases, reconstruction fails, the New York Times reported of the published findings of medical researchers, most from the University of Michigan.