Healthcare

[dublinirish]

Do they get a tax refund, or credit if they elect private HC?

no its pretty much a "top up" to the NHS coverage. it would get you into a private room instead of a multi bed ward etc.

 

[koonja]

So what did Koon glean from it?

And reps, gonna take a look at it this weekend.

It depends from country to country, it doesn't point you all in one direction. But I will say that in general, the myths about the struggle members have in other countries certainly seems to be a thing of the past. And the economics of it are very compelling.

If you do watch it, let me know which model you think would work best in the U.S. IIRC, I really liked the German concept, as well as Thailand's.

 

[koonja]

It depends from country to country, it doesn't point you all in one direction. But I will say that in general, the myths about the struggle members have in other countries certainly seems to be a thing of the past. And the economics of it are very compelling.

If you do watch it, let me know which model you think would work best in the U.S. IIRC, I really liked the German concept, as well as Thailand's.

The part that I'll never forget is when Germany considered going private rather than Universal... Their citizens literally protested against it. That's how much they love the universal system.

 

[Irish YJ]

It depends from country to country, it doesn't point you all in one direction. But I will say that in general, the myths about the struggle members have in other countries certainly seems to be a thing of the past. And the economics of it are very compelling.

If you do watch it, let me know which model you think would work best in the U.S. IIRC, I really liked the German concept, as well as Thailand's.

Cool, and will do. I watched a few similar docs 4 or 5 years back, and came away with a feeling that not a lot of what is out there will work for a large country like the US. I believe we already spend more (as a % of fed spending) than for instance the UK and Germany.

Personally, I'm for national HC,,,, but at the same time I want a model that kills the insurance company layer, and one that forces drug companies to charge the US the same as the world. We're getting F'd.. That's why I hated Obamacare. The insurance companies are still taking a cut as an added layer, and the drug companies are still charging us twice what other nations are paying.

 

[koonja]

Cool, and will do. I watched a few similar docs 4 or 5 years back, and came away with a feeling that not a lot of what is out there will work for a large country like the US. I believe we already spend more (as a % of fed spending) than for instance the UK and Germany.

Personally, I'm for national HC,,,, but at the same time I want a model that kills the insurance company layer, and one that forces drug companies to charge the US the same as the world. We're getting F'd.. That's why I hated Obamacare. The insurance companies are still taking a cut as an added layer, and the drug companies are still charging us twice what other nations are paying.

I work for a Fortune-15 Payer, so I'm selfishly for the insurance industry, but I truly believe the Universal system has way more pros than cons. No system is perfect, but which has provides the most "good" with the least "bad".

In a universal system, the elite of the elite in the U.S. would not like it I'm sure. I believe the Germany model allows the top ~10% to opt out, and get private care. They've built in a way to account for that so that it works for the remaining 90%.

Another reason I like this documentary, they give the provider's perspective as well. Because this move would really impact that in U.S., so it's good to understand what that would mean for our providers.

 

[Irish YJ]

I work for a Fortune-15 Payer, so I'm selfishly for the insurance industry, but I truly believe the Universal system has way more pros than cons. No system is perfect, but which has provides the most "good" with the least "bad".

In a universal system, the elite of the elite in the U.S. would not like it I'm sure. I believe the Germany model allows the top ~10% to opt out, and get private care. They've built in a way to account for that so that it works for the remaining 90%.

Another reason I like this documentary, they give the provider's perspective as well. Because this move would really impact that in U.S., so it's good to understand what that would mean for our providers.

Regarding insurance providers, I've had horrible personal and professional experience with them. Based on several issues with family, I think they are some of the most soulless people on the planet. Between steering people to lower cost treatment and medicine, to slow pay and intimidation by red tape, they are scumbags of the highest order IMO.

Professionally, while working for two companies (One Telecom, the other Tech), I spent time with C-levels in both IT/Tech and Marketing at a few providers. Between that, and having a friend in upper management at one of them, I found their message of care and well being to be a thinly veiled means to maximize profit. Nothing more. KP was the worst.

And the drug companies are the same. I have two friends in Pharma sales, and another who is a high end consultant specializing in bringing drugs to market. It's all about the $$.

I'd love to see examples of how a Western country transitioned from private to truly universal. The fallout from kicking insurance providers to the curb, actually negotiating with drug companies, and dealing with the malpractice insurance shit show will be interesting.

 

[Irish YJ]

I would strongly encourage everyone to take 1 hour of their time to watch "Sick Across the World" if they haven't already. It's on Netflix I believe.

It identifies the ~5 different health care systems across the world, and spends ~10 minutes going through what it's like and how it works. Extremely eye-opening IMO.

Hey Koon,
Looked on Netflix, nothing. Googled it, and found a "Sick Around the World", a 90 minute episode from PBS Frontline. The description fits. That it? It's available on youtub, but that will change my viewing strategy a bit lol.

<iframe width="854" height="480" src="https://www.youtube.com/embed/8O2g_srE1Wg" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>

 

[Legacy]

Hospital Billing Transparency

Hospital Billing Transparency

Colorado’s big idea for lowering health care prices is more transparency. Here’s why some think that won’t work.

Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors (in Ohio)

Texas ruling on $11,000 ER bill may have long-lasting effects, experts say

 

[koonja]

Hey Koon,
Looked on Netflix, nothing. Googled it, and found a "Sick Around the World", a 90 minute episode from PBS Frontline. The description fits. That it? It's available on youtub, but that will change my viewing strategy a bit lol.

<iframe width="854" height="480" src="https://www.youtube.com/embed/8O2g_srE1Wg" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>

Sorry I didn't see this until now. Yes, you might have to youtube it, and I can confirm it's a PBS documentary. Sorry about that! Let me know after you see it.

 

[Irish YJ]

Sorry I didn't see this until now. Yes, you might have to youtube it, and I can confirm it's a PBS documentary. Sorry about that! Let me know after you see it.

no worries. will do!
will likely get to it Thursday evening.

 

[Legacy]

Poll: Two-thirds of Voters Say a Candidate’s Position on Pre-existing Conditions is Important to their Vote, More than Say the Same about Drug Costs, ACA Repeal or Medicare-for-All (KFF)

Further Findings from Kaiser’s June Health Tracking Poll: Women’s Issues (KFF)

Proposed Changes to Title X: Implications for Women and Family Planning Providers (KFF)

Community Health Centers and Family Planning in an Era of Policy Uncertainty (KFF)

Abstinence Education Programs: Definition, Funding, and Impact on Teen Sexual Behavior
(KFF)

 

[Legacy]

It’s 4 A.M. The Baby’s Coming. But the Hospital Is 100 Miles Away.

KENNETT, Mo. — A few hours after the only hospital in town shut its doors forever, Kela Abernathy bolted awake at 4:30 a.m., screaming in pain.

Oh God, she remembered thinking, it’s the twins.

They were not due for another two months. But the contractions seizing Ms. Abernathy’s lower back early that June morning told her that her son and daughter were coming. Now.

Ms. Abernathy, 21, staggered out of bed and yelled for her mother, Lynn, who had been lying awake on the living-room couch. They grabbed a few bags, scooped up Ms. Abernathy’s 2-year-old son and were soon hurtling across this poor patch of southeast Missouri in their Pontiac Bonneville, racing for help. The old hospital used to be around the corner. Now, her new doctor and hospital were nearly 100 miles away.

Medical help is growing dangerously distant for women in rural America. At least 85 rural hospitals — about 5 percent of the country’s total — have closed since 2010, and obstetric care has faced even starker cutbacks as rural hospitals calculate the hard math of survival, weighing the cost of providing 24/7 delivery services against dwindling birthrates, doctor and nursing shortages and falling revenues.

Today, researchers estimate that fewer than half of the country’s rural counties still have a hospital that offers obstetric care, an absence that adds to the obstacles rural women face in getting health care. Specialists are increasingly clustered in bigger cities. Clinics that provide abortions, long-term birth control and other reproductive services have been forced to close in many smaller towns.

“It’s scary,” said Katie Penn, who said she was rejected by eight doctors before finding an obstetrician in Jonesboro, Ark., about an hour from Kennett. “You never know what can happen.”

When obstetric services leave town, a cascade of risks follows, according to experts at the University of Minnesota Rural Health Research Center who have studied the consequences. Women go to fewer doctor’s appointments and more babies are born premature, compared with similar places that do not lose access to care. And when women go into labor, they are more likely to end up at emergency rooms with no obstetric care or to deliver outside a hospital altogether.

Families struggle to afford the gas, child care and time off work to drive hundreds of miles for an ultrasound, shots or hospital tests. Women say they have ended up on waiting lists at overwhelmed clinics, or been turned away because they said doctors did not want to take them as patients late into their pregnancies...

Maternal Mortality Is Rising in the U.S. As It Declines Elsewhere

 

[MJ12666]

Maternal Mortality Is Rising in the U.S. As It Declines Elsewhere

[/QUOTE]

The chart is misleading as countries use different standards in determining when a born alive and therefore would go into the numerator of the rate. For example, according to the article linked below:

Low birth weight infants are not counted against the "live birth" statistics for many countries reporting low infant mortality rates.

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies - considered "unsalvageable" outside of the U.S. and therefore never alive - is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.

https://www.americanthinker.com/blog/2011/08/infant_mortality_figures_for_us_are_misleading.html

 

[Legacy]

Maternal Mortality Is Rising in the U.S. As It Declines Elsewhere

The chart is misleading as countries use different standards in determining when a born alive and therefore would go into the numerator of the rate. For example, according to the article linked below:




https://www.americanthinker.com/blog/2011/08/infant_mortality_figures_for_us_are_misleading.html

[/QUOTE]

Not sure what your point is here. The chart is for maternal mortality. Are you saying that
the other countries' classification of live births skewers their maternal mortality rates lower?

National Initiative Aimed at Reducing Maternal Deaths Shows Early Signs of Improvement in Severe Maternal Morbidity (Amer. College of Obstetrics and Gynecoloy) w. links

JAMA Forum: Why Is US Maternal Mortality Rising? (J. Amer. Med. Assoc Forum)

In the first 15 years of this century, the rate of maternal mortality around the world decreased by more than a third. Shockingly, rates in the United States have been rising.

In 2005, 23 US mothers per 100 000 live births died from complications related to pregnancy or childbirth. In 2015, that number rose to 25. In the United Kingdom, the number was less than 9. In Canada, it was less than 7.

Very few wealthy countries saw increases over those years. Many poorer countries, including Iran and Romania, saw declines. But here in the United States, things got worse.

These numbers have been confirmed by independent research. Last year, a study published in Obstetrics and Gynecology found that the maternal mortality rate in the United States had increased by more than 25% from 2000 to 2014. This trend differed by state, however. Although California had shown some declines, Texas had seen significant increases.

Texas in particular has been the focus of much of the news on maternal mortality in the last few years. From 2011 to 2014, the rate doubled. Although we lack good data to tell us why, many have postulated that changes to family planning in the state coincided with this increase. In 2013, for example about half of the state’s clinics that provided abortion in addition to other reproductive health services were closed because of regulations passed against them. In 2011, the family-planning budget was slashed in an attempt to defund Planned Parenthood. Many clinics closed and more were forced to reduce their services.

Family planning matters. About 50% of pregnancies in the United States are unplanned and might lack preventive care that properly planned-for pregnancies might.

There’s more to this story than changes in regulations and family planning. Some of the increase is likely due to the growing prevalence of other chronic conditions. Obesity, diabetes, and heart disease likely contribute to maternal mortality, and trends for many conditions have been increasing over the last decade. Women are having children later in life than they used to, and some have more complex conditions. More women have caesarian deliveries, which can lead to complications. The opioid epidemic may contribute to maternal mortality, as well.

Disparities exist in maternal mortality as they do in other areas of health care. The increases we’ve seen are most noticeable in non-Hispanic black women. The number of deaths per 100 000 live births among black women is more than 3 times that among white women. In fact, for any state, the higher the percentage of black women in the delivery population, the higher its rates of maternal mortality. But racial disparities can only account for so much of the problem. Even if you look only at white women in the United States, the rates of mothers who die is greater than those in other developed countries.

The fragmented nature of the US health care system doesn’t help either. Too many people in the United States go without necessary care, because they lack access to care or avoid it because of cost. This is just as true of pregnant women as it is of everyone else. As many politicians argue that maternity care shouldn’t be considered essential benefits, some worry that coverage might get worse with reform.

It is possible that some of the increase in maternal mortality is due to better record keeping. States have been working to improve how they keep track of maternal deaths, as well as other causes of death, and better reporting would be reflected as increases in prevalence. It’s hard to imagine, however, that this increase in better records has been solely in the United States, and could account for all of the increases. There’s no reason to believe that all other countries would be keeping themselves in the dark. Moreover, the more universal and socialized health systems are less likely to have women, and their deaths, fall through the cracks and be missed.

Pregnancy and childbirth are risky. We don’t like to talk about it, but maternal mortality is the sixth most common cause of death among US women age 25 years to 34 years old. Proper maternal care helps to prevent morbidity and mortality, but that care is difficult when clinics close and insurance lapses. Medicaid can help to close the gap and often does with pregnant women, but even then, both physician services and mother’s finances are strained.

As with many things in health care, a rising tide would lift all boats. Efforts to improve the health of women in general would improve our rates of maternal mortality. Reducing levels of obesity, diabetes, and heart disease would achieve results. So would getting a handle on the opioid epidemic. But we’ve spent the last few years—if not more—focused on efforts to reduce infant mortality. Mothers may need a similar commitment.

 

[Legacy]

Medicaid expansion is on the ballot in three red states - Idaho, Utah and Nebraska. Medicaid expansion was passed in Maine, but the Governor stalled implimentation. The state Supreme Court ordered implementation. Virginia passed expansion. Total currently is 34 states with expansion (including DC, Maine), 14 without, 3 on ballot.

 

[Legacy]

Trump Administration, in Reversal, Will Resume Risk Payments to Health Insurers (NYT)

The Trump administration, in an abrupt reversal, said Tuesday that it would restart a program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act.

The administration suspended the program less than three weeks ago, saying it was compelled to do so by a federal court decision in New Mexico.

But the administration said Tuesday that it would restore the program because otherwise health plans could become insolvent or withdraw from the market, causing chaos for consumers.

In adopting a new rule, the administration essentially accepted the arguments of critics, including consumer groups, health insurance companies and Democrats in Congress, who said that suspending the payments would cause turmoil in insurance markets.

States Attacking ACA Would Suffer Most If Preexisting Conditions Shield Gets Axed (KHN)

 

[Legacy]

Research results on the effect of Medicaid expansion on Americans access to health care and quality of care and improvement in health of enrollees.

Finally, Some Answers on the Effects of Medicaid Expansion (NY Times)

Research suggests that access to care has greatly improved, and that quality of care has generally improved.

What’s the big picture?
These are individual studies. Looking at all the research together might provide a more accurate picture of how the Medicaid expansion is performing. Another study in Health Affairs by Indiana University health services researchers (I was one of them) systematically reviewed the literature to gather all available peer-reviewed evidence.

Since the start of Medicaid expansion, 77 studies, most of them quasi-experimental in design, have been published. They include 440 distinct analyses. More than 60 percent of them found a significant effect of the Medicaid expansion that was consistent with the goals of the Affordable Care Act.

Only 4 percent reported findings that showed the Medicaid expansion had a negative effect, and 35 percent reported no significant findings. Negative effects could include more uninsurance and increased wait times, but none showed decreased quality. It should be noted, moreover, that the few studies with negative outcomes were more likely to employ methodologies that were less likely to be able to show that Medicaid was causing these outcomes.

The majority of analyses looked at access to care, and they showed that after the Medicaid expansion, insurance coverage improved and the use of health services increased. It’s harder to study quality than access, but 40 analyses in 16 studies did so. About half of these reported improvements in quality measures like diabetes monitoring or preventive care screenings.

It has only been a few years since the Medicaid expansion, and clearly we need to follow these results over time. But the evidence to date is — if anything — positive. As Olena Mazurenko, the lead author of the systematic review, wrote to me, “With dozens of scientific analyses spanning multiple years, the best evidence we currently have suggests that Medicaid expansion greatly improved access to care, generally improved quality of care, and to a lesser degree, positively affected people’s health.”

States should keep this in mind as they debate whether and how to accept the A.C.A.’s invitation to expand Medicaid.

The Trump administration has rejected Rep Governors' and HHS administrators' requests to partially expand Medicaid until after the midterm elections. Wisconsin recently was granted a waiver for the state to reinsure their program, which will reduce participants' premiums by 11% from expected increased level in 2019. Minnesota, which was granted a similar waiver to form their own reinsurance, saw premiums for participants decrease by 15% this year from last year's premiums. Last year the Trump administration did not grant Oklahoma's waiver request for reinsurance program, which would reduced premiums there by 20% this year.

Trump’s migrant fiasco diverts millions from health programs (Politico)

The health department has quietly dipped into tens of millions of dollars to pay for the consequences of President Donald Trump’s border policy, angering advocates who want the money spent on medical research, rural health programs and other priorities.

The Department of Health and Human Services has burned through at least $40 million in the past two months for the care and reunification of migrant children separated from their families at the border — with housing costs recently estimated at about $1.5 million per day.

The ballooning costs have also prompted officials to prepare to shift more than $200 million from other HHS accounts, even as the White House weighs a request for additional funding for the Department of Homeland Security — a politically explosive move almost certain to antagonize fiscal hawks in the run-up to the midterm elections.

"We have a public health emergency like Ebola, Zika, hurricanes — except this one is man-made," said Emily Holubowich, executive director of the Coalition for Health Funding, who says HHS should request emergency funding too. "We should not be taking discretionary funding away from programs that need it."

 

[Irish YJ]

Reform and common sense needed, not more money

Reform and common sense needed, not more money

The U.S. spends more on healthcare than any other country — but not with better health outcomes
The U.S. spends more on healthcare than any other country — but not with better health outcomes

In 2015, the United States spent almost three times on healthcare as the average of other countries with comparable incomes, according to data from the Organization for Economic Cooperation and Development, also known as the OECD, a group of 35 countries, the majority of which have advanced economies, that work to promote economic development. And despite spending more, the results don’t necessarily yield better health. Both Italy and Britain, for example, spent at least $5,000 less per person than the United States on healthcare, and yet the population of each of those countries has a higher life expectancy at birth than the United States.

“The U.S. spends more money, but we definitely have worse health outcomes,” said David Squires, president of the Commonwealth Fund, a private foundation based in New York that carries out independent research on healthcare issues.

“It doesn’t appear that people in the U.S. use more healthcare in general. We go to the doctor less often than people in other countries and get hospitalized less, so it’s not like we are making greater use, but we are paying more for the things we do use,” he said.

Despite investing heavily in healthcare, Americans live shorter lives than people in 30 other countries, data from the World Health Organization showed. On average, life expectancy in the United States is 79.3 years, the lowest rate among other advanced economies such as Switzerland, Australia and Canada.

The United States has one of the lowest numbers of hospital beds per capita among all OECD member countries, with 2.83 hospital beds for every 1,000 people, data from the OECD showed.

What's behind high U.S. health care costs - Harvard Study
https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more-for-health-care-with-worse-population-health-outcomes/

In 2016, the U.S. spent nearly twice as much on health care as other high-income countries, yet had poorer population health outcomes.

The main drivers of higher health care spending in the U.S. are generally high prices — for salaries of physicians and nurses, pharmaceuticals, medical devices, and administration.

Contrary to commonly held beliefs, high utilization of health care services and low spending on social services do not appear to play a significant role in higher U.S. health care costs.
In addition, despite poor population health outcomes, quality of health care delivered once people are sick is high in the U.S.

Here's the real reason health care costs so much more in the US
https://www.cnbc.com/2018/03/22/the-real-reason-medical-care-costs-so-much-more-in-the-us.html

The U.S. is famous for over-spending on health care. The nation spent 17.8 percent of its GDP on health care in 2016. Meanwhile, the average spending of 11 high-income countries assessed in a new report published in the Journal of the American Medical Association — Canada, Germany, Australia, the U.K,. Japan, Sweden, France, the Netherlands, Switzerland, Denmark and the U.S. — was only 11.5 percent.

Per capita, the U.S. spent $9,403. That's nearly double what the others spent.

This finding offers a new explanation as to why America's spending is so excessive. According to the researchers at the Harvard Chan School, what sets the U.S. apart may be inflated prices across the board.

In the U.S., they point out, drugs are more expensive. Doctors get paid more. Hospital services and diagnostic tests cost more. And a lot more money goes to planning, regulating and managing medical services at the administrative level.

Why the U.S. Spends So Much More Than Other Nations on Health Care
https://www.nytimes.com/2018/01/02/upshot/us-health-care-expensive-country-comparison.html

Over all, the researchers found that American personal health spending grew by about $930 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion (amounts adjusted for inflation). This was a huge increase, far outpacing overall economic growth. The health sector grew at a 4 percent annual rate, while the overall economy grew at a 2.4 percent rate.

Did the increasing sickness in the American population explain much of the rest of the growth in spending? Nope. Measured by how much we spend, we’ve actually gotten a bit healthier. Change in health status was associated with a decrease in health spending — 2.4 percent — not an increase. A great deal of this decrease can be attributed to factors related to cardiovascular diseases, which were associated with about a 20 percent reduction in spending.

Though the JAMA study could not separate care intensity and price, other research blames prices more. For example, one study found that the spending growth for treating patients between 2003 and 2007 is almost entirely because of a growth in prices, with little contribution from growth in the quantity of treatment services provided. Another study found that U.S. hospital prices are 60 percent higher than those in Europe. Other studies also point to prices as a major factor in American health care spending growth.

The real reason the U.S. spends twice as much on health care as other wealthy countries
https://www.washingtonpost.com/news/wonk/wp/2018/03/13/the-real-reason-the-u-s-spends-twice-as-much-on-health-care-as-other-wealthy-countries/?noredirect=on

“The narrative that has come up, that has developed, is that America spends so much more because Americans demand more health care,” said Ashish Jha, a professor of health policy at the Harvard T.H. Chan School of Public Health. “We have done, through the Affordable Care Act and other policy efforts, almost nothing about prices. To me, that has been the big missed opportunity.”

Nonspecialist doctors in the United States are paid on average $220,000 per year — double the average salary in the other countries. Nurses and specialists were also compensated better. Defenders of doctors' higher salaries often point to the burden of medical school debt in the United States, but one study found that taking into account tuition cost didn't explain the difference in earnings.

Administrative costs were 8 percent of health care spending in the United States, vs. an average of 3 percent among wealthy countries.

The notion that high prices are driving health-care spending isn't new. In 2003, a Health Affairs paper called “It's the Prices, Stupid” made a similar argument, with less comprehensive data.

But prices can be difficult to curb, because one person's high price is another person's profit margin or salary. Hospitals are often among the biggest employers in a region. Pharmaceutical companies offer American consumers big innovation but big price tags — and the debate about how or whether something needs to be done about drug costs has typically fallen apart under the weight of extensive lobbying by the industry. There are two main ways to lower prices, which fall along partisan lines: price-setting or increasing competition.

“I feel like America has figured out how to do the worst of both,” Jha said. “We have, in Medicare, a price-setter that is very weak, and whenever Medicare tries to negotiate or get aggressive on prices, Congress intervenes and holds them back. Most markets are pretty inefficient with a lot of power with providers. Combine a weak price-setter with inefficient markets, and you have the American health care system.”

Jha told a story about a recent trip to Paris, where his briefcase was stolen. A generic beta-blocker that he takes daily, at a cost of about $1 a pill, was in his luggage. He needed a few more pills to hold him over during his trip. He went to a pharmacy to ask if it would be possible to get four pills.

The pharmacist dispensed the medication — the brand name version of the drug — at only 10 cents a pill.

So in short, we need reform and change, not more money. Actually we need something totally new. The ACA creates a money pit on top of an existing money pit. We've paid more than all OECD countries with some of the worst results. Raise taxes? We already spend more per capita and as a % of GDP than anyone else.

Witnessing what my mother has experienced over the last 3 months has been enlightening. Over testing, wasteful visits, wasteful hand offs, wasteful processes, crazy high drug prices, crazy high visit and doctor prices. It's a joke of the highest accord.

 

[Legacy]

A quick reaction. These are good articles, though the caveat is that NY Times article is based on health care spending between 1996 and 2013. If I remember correctly, by the time Congress acted instituting the ACA, the overall health care costs were growing at a 6-7% rate as our population ages, projecting spending growth to eat up an even greater percentage of the overall budget and GDP along with poorer outcomes, more uninsured (less coverage) and with those more patients who initially present to the part of the health care system that is most expensive - ERs.

The Harvard study from the CNBC article determined three factors for the growth in costs all of which require federal intervention. States are ill equipped to manage these.

- The main drivers of higher health care spending in the U.S. are generally high prices — for salaries of physicians and nurses, pharmaceuticals, medical devices, and administration.
- Contrary to commonly held beliefs, high utilization of health care services and low spending on social services do not appear to play a significant role in higher U.S. health care costs.
- In addition, despite poor population health outcomes, quality of health care delivered once people are sick is high in the U.S.

All three require a combination of federal regulation with cost control mechanisms.

I would add, sadly, that Fraud, estimated at 15% of overall spending, and different levels of reimbursement (federal reimbursement is 60% of private payers) are also contributing factors.

Any new healthcare system, which has to be at the federal level, must account for all these factors. Overall, we have settled for a combination of public and private entities in our healthcare system, barriers to spending which also must be overcome.

We are also seeing recent mergers in the private sector in health insurance, decreasing competition. This also gives those five or six major companies more leverage in passing along costs to consumers and with approvals from state regulators in raising rates. Other considerations are federal limitations to negotiating power in drug costs (noted above) and the "gag rule" which prevents pharmacists from informing patients of lower cost alternatives.

Highlighting a quote from the above studies:

...the debate about how or whether something needs to be done about drug costs has typically fallen apart under the weight of extensive lobbying by the industry. There are two main ways to lower prices, which fall along partisan lines: price-setting or increasing competition.

“I feel like America has figured out how to do the worst of both,” Jha said. “We have, in Medicare, a price-setter that is very weak, and whenever Medicare tries to negotiate or get aggressive on prices, Congress intervenes and holds them back. Most markets are pretty inefficient with a lot of power with providers. Combine a weak price-setter with inefficient markets, and you have the American health care system.”

 

[Irish YJ]

If you are going to nationalize any of it, tear it all down. Don't build a new house on a shit foundation. Get rid of the insurance providers and minimize admin, and regulate all costs including drugs. If you privatize, give a mandate of outputs while capping $ that are more in line with the OECD countries.

Health care is an area where I believe capitalism has no place. the ACA is simply a shitty attempt to appear socialist while still ensuring all the big businesses maintain their high profit margins. In effect, costing us double or triple what other countries cost, and still providing an inferior product.

 

[dublinirish]

<blockquote class="twitter-tweet" data-lang="en"><p lang="en" dir="ltr">Anatomy of a “for-profit slaughter” via <a href="https://twitter.com/nytimes?ref_src=twsrc%5Etfw">@NYTimes</a> <a href="https://t.co/wVkDzzT2xr">https://t.co/wVkDzzT2xr</a></p>— Louis Theroux (@louistheroux) <a href="https://twitter.com/louistheroux/status/1024356085895819265?ref_src=twsrc%5Etfw">July 31, 2018</a></blockquote>
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[Irish YJ]

<blockquote class="twitter-tweet" data-lang="en"><p lang="en" dir="ltr">Anatomy of a “for-profit slaughter” via <a href="https://twitter.com/nytimes?ref_src=twsrc%5Etfw">@NYTimes</a> <a href="https://t.co/wVkDzzT2xr">https://t.co/wVkDzzT2xr</a></p>— Louis Theroux (@louistheroux) <a href="https://twitter.com/louistheroux/status/1024356085895819265?ref_src=twsrc%5Etfw">July 31, 2018</a></blockquote>
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While I disagree that the government should require the fox to monitor the hen house, this is an instance where the gov should force new ownership of Purdue Pharma. They have a long history of BS

 

[Legacy]

Report: Boone County leads US in per-capita opioid-related costs
(Charleston Gazette)

The opioid epidemic is costing Boone County’s economy an estimated $206.5 million a year — the highest per-capita burden of any county in America, according to a new report by the American Enterprise Institute.

It’s a staggering cost for a county with 23,645 people in rural Southern West Virginia, a region also struggling with the loss of coal jobs. Boone County’s opioid-related economic cost comes out to $8,734 per person, the AEI study found.

“Quite honestly, I’m surprised that we’re No. 1,” said Kris Mitchell, director of the Boone County Community and Economic Development Corp. “There’s certainly places that struggle as much or more than we do. A lot of the focus seems to be on our problem here, and there’s no denying the state has a problem with opioids, but it’s really a national problem.”

Still, the opioid epidemic has undoubtedly hit West Virginia’s counties the hardest.

According to the study, six of the top 10 counties in the U.S. shouldering the highest per-capita economic cost are located in West Virginia: Boone (No. 1), Cabell (No. 3), Wayne (No. 5), Mingo (No. 7), Summers (No. 8) and Berkeley (No. 9). Those counties also have some of the highest drug overdose death rates in the state.

The study takes into account costs related to the loss of life and decreased productivity in each county, and what’s being spent on health care, criminal justice and substance abuse treatment.

“In West Virginia, the numbers are driven up by the amount of misuse [of drugs] and the amount of fatalities,” said Alex Brill, a resident fellow at the American Enterprise Institute.

If fatalities were excluded, Boone County’s opioid-related economic costs would drop to an estimated $9.3 million a year, according to the study.

Last month, AEI released a state-by-state analysis that concluded the opioid epidemic is costing West Virginia’s economy an estimated $8.8 billion a year. The Mountain State dedicates the largest share of its gross domestic product — 12 percent — to costs associated with the drug crisis. The 12 percent economic hit is more than double that of any other state.

West Virginia has the highest overdose death rate in the nation.

In the study released this week, an additional six West Virginia counties rank among the top 20 in the nation for opioid costs per resident: Hampshire (No. 12), Wyoming (No. 15), Pocahontas (No. 17), Mercer (No. 18), McDowell (No. 19) and Webster (No. 20). Also high on the list were Lincoln County (No. 22) and Mason County (No. 30).

On a total cost (not per-capita) basis, Kanawha County’s economy takes an $854 million hit each year from the opioid epidemic, followed by Cabell County, with an $805 million impact, and Berkeley County, at $740 million annually, according to the AEI study.

I cannot imagine.

Drug firms shipped 20.8M pain pills to WV town with 2,900 people (Charleston Gazette)

Over the past decade, out-of-state drug companies shipped 20.8 million prescription painkillers to two pharmacies four blocks apart in a Southern West Virginia town with 2,900 people, according to a congressional committee investigating the opioid crisis.

Springboro, Ohio-based Miami-Luken sold 6.4 million hydrocodone and oxycodone pills to Tug Valley Pharmacy from 2008 to 2015, the company disclosed to the panel. That’s more than half of all painkillers shipped to the pharmacy those years. In a single year (2008 to 2009), Miami-Luken’s shipments increased three-fold to the Mingo County town.

Miami-Luken also was a major supplier to the now-closed Save-Rite Pharmacy in the Mingo County town of Kermit, population 400.

The drug wholesaler shipped 5.7 million hydrocodone and oxycodone pills to Save-Rite and a branch pharmacy called Sav-Rite #2 between 2005 and 2011, according records Miami-Luken gave the committee. In 2008, the company provided 5,624 prescription pain pills for every man, woman and child in Kermit.

In its letters, the panel also raised questions about Miami-Luken’s shipments to Westside Pharmacy in Oceana, Wyoming County. The committee cited documents that show a Miami-Luken employee reported a Virginia doctor, who operated a pain clinic located two hours from Oceana, was sending his patients to Westside Pharmacy, which filled the prescriptions.

In 2015, more than 40 percent of the oxycodone prescriptions filled by Westside Pharmacy in Oceana were coming from the Virginia doctor, according to the committee’s letter. The following year, the Virginia Board of Medicine suspended the doctor’s license, finding his practice posed a “substantial danger to public health and safety.”

The panel’s letter also mentions Miami-Luken’s suspicious shipments to Colony Drug in Beckley. In a five-day span in 2015, the drug wholesaler shipped 16,800 oxycodone pills to the pharmacy.

“In several instances, Colony Drug placed multiple orders for what appears to be excessive amounts of pills on consecutive days,” the committee wrote.

The House committee questioned H.D. Smith’s painkiller shipments to Family Discount Pharmacy in Logan County. The drug shipper distributed 3,000 hydrocodone tablets a day to the pharmacy in 2008, a 10-fold increase in sales from the previous year, according to the committee’s letter. The pharmacy, located in a town of 1,800 people, was shipped 1.1 million hydrocodone pills in 2008.

Other Gazette articles on the WV DRUG ABUSE

 

[Irishize]

you guys forget the system is two tiered. those who can afford private health can pay for it themselves/through their employers. this level of care is obviously much better than public that everyone gets.

But why? I thougt NHS was “free” healthcare for ALL?!? They should ALL be forced to use it.

 

[dublinirish]

But why? I thougt NHS was “free” healthcare for ALL?!? They should ALL be forced to use it.

So outlaw private healthcare? That's what they do in Canada right?

 

[Irishize]

If you are going to nationalize any of it, tear it all down. Don't build a new house on a shit foundation. Get rid of the insurance providers and minimize admin, and regulate all costs including drugs. If you privatize, give a mandate of outputs while capping $ that are more in line with the OECD countries.

Health care is an area where I believe capitalism has no place. the ACA is simply a shitty attempt to appear socialist while still ensuring all the big businesses maintain their high profit margins. In effect, costing us double or triple what other countries cost, and still providing an inferior product.

Agreed. I just wonder if the US can truly afford to cover all. It’s just one symptom of what’s wrong w/ the U.S. bureacracy. I want to see stiffer regulations on what nationally elected officials get as far as salaries, healthcare, pension. Being an elected senator or rep is now simplay a gravy train. They preach about what all Americans should be given for “free” while enjoying a life w/ minimal financial stress.

I’d love to see them all brought to their knees. Make them where the same suits...like school uniforms. No more $5000 designer suits & Louis Vuiton bags. Sadly, they’d still find a way around any restrictions by using their political clout to curry favor w/ those in position to help them personally.

 

[Irishize]

So outlaw private healthcare? That's what they do in Canada right?

Make them all enjoy the same healthcare that their constituents have. And if they’re caught using their political clout to get preferential treatment....fine them after first offense and remove them from office upon 2nd offense.

 

[Irishize]

There are a number of factors that physicians who would construct the ideal health care program have. They indirectly highlight their difficulties with any current system and proposals and objections. Some factors from an older article:

A National Health Program for the United States: A Physicians' Proposal (1989)

On a single payer system:

Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act
(Addresses the myths of a single payer system, 2016)

Key Features of Single-Payer
(2003)

Special interests who benefit mightily from the current system have vigorously opposed this for decades.

In general, physicians are opposed to all the changes the Reps want to make - eliminating subsidies, decreasing coverage, eliminating Medicaid, block grants to the states, different reimbursement amounts to mention a few. With one out of every four patients on Medicaid, for instance, that indicates the increasing levels of the low income group in the U.S.

The immunological diseases are not hard to treat and there are specific tests and markers that would indicate the diagnosis. Mostly, biologics are used nowadays with good results, but may need follow-up by specialists. Co-existing diseases that may have similar symptoms can complicate the diagnosis.

Perhaps some of the links in the first post on this topic may help for overviews.

So, again, which would you prefer and why?

 

[dublinirish]

Make them all enjoy the same healthcare that their constituents have. And if they’re caught using their political clout to get preferential treatment....fine them after first offense and remove them from office upon 2nd offense.

well the system exists so the wealthy can get preferential and better treatment.

 

[Irishize]

The immunological diseases are not hard to treat and there are specific tests and markers that would indicate the diagnosis. Mostly, biologics are used nowadays with good results, but may need follow-up by specialists. Co-existing diseases that may have similar symptoms can complicate the diagnosis.

You are assuming the physician is practicing medicine as both an art & a science which most, in my experience, do not.

Yes, there are Dx tests & markers but it’s not crystal clear what they diagnose. The test could be slightly w/in the norms on the particular day the patient was tested and the MD will say “test checked out fine...you don’t have (insert condition)” Then the patient sees a second specialist out of frustration. This specialist “thinks outside the box” and realizes medicine is not always “black & white”. He/she decides to treat the “gray area” based on consulting w/ the patient & studying Dx results. Decides to treat the patient’s condition despite test showing the test fall achingly short of diagnosis. Turns out patient starts to see improvement despite what first MD told them. It comes down to the physician’s critical thinking and true loyalty to the Hippocratic oath. Just b/c a person has a photographic memory & wants to live the lifestyle of a doctor, does not make them a physician.