Tagged: Healthcare

If Obamacare works as well as Romneycare does in Massachusetts our death rate will fall


Ezekial Emanuel, one of the architects of both health plans

The death rate in Massachusetts dropped significantly after it adopted mandatory health care coverage in 2006, a study released Monday found, offering evidence that the country’s first experiment with universal coverage — and the model for crucial parts of President Obama’s health care law — has saved lives, health economists say.

The study tallied deaths in Massachusetts from 2001 to 2010 and found that the mortality rate — the number of deaths per 100,000 people — fell by about 3 percent in the four years after the law went into effect. The decline was steepest in counties with the highest proportions of poor and previously uninsured people. In contrast, the mortality rate in a control group of counties similar to Massachusetts in other states was largely unchanged.

A national 3 percent decline in mortality among adults under 65 would mean about 17,000 fewer deaths a year…

Massachusetts is whiter and more affluent than most states, and has more doctors per capita and fewer uninsured people. But researchers said that the state’s health insurance law nevertheless amounted to the best natural experiment the country has had for testing the effects of a major insurance expansion on a large population.

In Suffolk County, which includes Boston, the death rate for adults under 65 dropped by about 7 percent from 2005 to 2010, the study’s authors said.

There have been patchy efforts to boost coverage for the poor in states like Arizona, Maine and New York, but Massachusetts is the only state to fully overhaul its health system to cover almost everybody…

David O. Meltzer, a health economist from the University of Chicago, who was not involved in the study, said one of the study’s strengths was its size. It looked at four million people in Massachusetts — the entire population age 20 to 64 — and compared them with more than 44 million people in control counties…

The biggest declines happened for conditions that are more likely to be deadly if not caught early — for example, infections from complications of diabetes, heart attacks and cancer.

Americans continue to amaze the rest of the industrialized world. The rate at which we catch on to real social and economic benefits truly lags any sort of common sense. Here we are adopting a half-Republican version of the National Health Service folks in the UK have had for over 60 years. My kin in the Great White North have had the more advanced Canadian version for 30 years.

About the only thing we manage to achieve is higher salaries for doctors and hospital administrators. And insurance company executives.

Of course, we have a surplus of priests, politicians and pundits who tell us we are committing an unholy act by improving health care for all. OTOH, when we have the same number of years to evaluate the single payer system starting up in Vermont, I’ll wager we will find the benefits even more cost effective and achieving similar or better results. The rest of us will continue to ignore the naysayers.

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Reaganomics, privatization, brought Swedes crumbling schools, hospitals, booming inequality

Voters…are returning to faith in cradle to grave welfare after eight years of center-right Prime Minister Fredrik Reinfeldt, who cut income, wealth and corporate taxes. Sweden’s tax burden has fallen by four percentage points of GDP – now lower than France.

In the eyes of many Swedes, the welfare state withered. Sickness and unemployment benefits were cut. Private firms started to run tax-funded schools and hospitals. But a tipping point may have come as a September general election approaches – and many now point to a U-turn…

By any standards, Sweden is healthy. Its public debt is around 40 percent of GDP, half of Germany’s.

But Sweden has one of the world’s most generous welfare states – like subsidized child care with up to 480 days of parental leave per child. Its Nordic model depends on keeping to a strict national bookkeeping unusual in much of Europe…

At the same time as demands grow for more spending on schools and hospitals, Sweden’s public finances have worsened. The country may now be heading for years of rising tax burdens if it wants to keep its public finances in order.

Flush from income tax cuts, middle classes have also enjoyed cheap loans and a property boom. As wealth grew – with clusters of Michelin star restaurants in Stockholm – Sweden remained one of the few economies in Europe with the top AAA credit rating. It also has the fastest growing economic inequality of any OECD nation…

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Republicans discover there may be a jobs crisis in the US

The U.S. has been in a jobs emergency since at least 2008. The cause of the crisis…isn’t mysterious, and neither are the solutions. We could invest in infrastructure to create construction jobs. We could give tax breaks to employers who hire new workers. We could restore the payroll tax cut to workers so they have more money to spend. We could help state and local governments hire back some of the employees they laid off during the recession. Macroeconomic Advisers, an economic consulting firm, found that the American Jobs Act, which contained many of these policies, would have created 2 million jobs.

But in recent years, these policies have been either blocked or canceled by congressional Republicans. They fought Democrats to scuttle the American Jobs Act and allow the payroll tax break and long-term unemployment benefits to expire. Creating jobs, they argued, was neither feasible nor affordable.

That’s the proper context in which to view this week’s hysteria about Obamacare. The nonpartisan Congressional Budget Office just released updated estimates for the health law. It found that the disastrous rollout last fall put Obamacare behind schedule — on track to insure 2 million fewer people than projected by the end of 2014. On the other hand, it also found that insurance premiums were about 15 percent lower than projected, and that the law would cost less than previously estimated. It found that the risk corridors designed to safeguard insurance companies from the effects of acquiring too many high-risk customers — which Republicans have been calling an “insurer bailout” — will actually yield $8 billion in net payments from insurers to the federal government.

The finding that made the news, however, concerned the Affordable Care Act’s long-term effect on labor supply. In past reports, the CBO has estimated that the law will, on net, lead some people to drop out of the labor market or cut back on their hours because their health insurance is no longer tied to their job. Imagine a 62-year-old who would like to shift to part-time work but can’t because he can’t afford — or, due to pre-existing conditions, wouldn’t even be sold — insurance on the individual market. Now, because Obamacare has made that insurance affordable and available, he can — and will. As a result, his work hours will be (voluntarily) reduced…

Whether this is good or bad depends on your views about human flourishing. Lower labor-force participation is bad for economic growth. On the other hand, the point of life is not for everyone to work every possible hour until they die. Workers should be able to choose to leave their jobs or cut their hours without worrying that their families won’t survive a medical emergency. In addition, as the Urban Institute’s Donald Marron tweeted, “employers will be competing harder for workers,” which will push wages to rise for everyone remaining in the workforce…

Policies don’t exist in vacuums. By untying the link between employment and health care, the Affordable Care Act reduces the incentive to work. But there are ways to increase incentives to work without making people dependent on their jobs for health insurance. We can help people without taking away their health care.

So here’s a simple proposal. Repeal of the Affordable Care Act would cost hundreds of billions of dollars over the next few decades because of the law’s spending cuts and new revenue. So instead of repeal, how about if Congress devotes that same amount of money to policies to increase employment now. Republicans could even dictate that all the money flow to targeted tax cuts.

Ezra Klein politely suggests the Republicans are hypocrites. He’s wasting politeness on the crudest, least responsible clot of scumsuckers ever seated beneath the moldy dome of Congress.

Republicans denied playing a part in Wall Street’s crash and burning. They tried as hard as possible to avoid any cooperation on essential economic remedies. Every year since the beginning of the worst economic failure since Herbert Hoover was president – their mantra has been “Jobs, jobs, jobs” – while blocking any reasonable attempt to assist jobs creation.

They stuck to dribble-down economics with a 100% record of failure and spent most of their casual time inside the Capitol waging war on women, reproductive rights, working as hard as possible to rescue their mates in the insurance cartels from bona fide national healthcare, committed to every possible delay in the expansion of civil rights. And, of course, hoping to start the occasional war.

Now, once again, they say they are worried about jobs for working class America. If I was a fire-and-brimstone Christian I wouldn’t stand outdoors next to a Republican for fear of being struck by lightning.

Recent study says fastest job growth will be in healthcare


Why, yes – I have a master’s degree in education

The fastest-growing jobs in the United States through 2017 are expected to be those requiring an advanced education, a study released Thursday found.

The report compiled by CareerBuilder and Economic Modeling Specialists International, says job creation will accelerate from 2013 to 2017 compared with 2009 to 2013, gaining 4.4 percent compared with 3.5 percent.

Jobs requiring an associate degree or a master’s degree are expected to grow 8 percent, the report says, while jobs requiring a bachelor’s degree — which generally takes four years and falls between associates and master’s degrees — are expected to grow 6 percent.

Jobs that require “short-term, on-the-job training trail at 4 percent,” the study projects.

In a list of jobs expected to grow 8 percent or more through 2017, personal care and home health aides top the list with growth expected at 21 percent.

Jobs for market research analyst and marketing specialists are expected to grow 14 percent, as are jobs for medical secretaries.

Jobs for emergency medical technicians and paramedics are projected to grow 13 percent, while jobs for software developers are projected to rise 11 percent.

The final job with double-digit growth expected is medical assistants, with growth of 10 percent predicted, CareerBuilder said…

In the 18 jobs categories expected to grow by 8 percent or more, seven are jobs related to healthcare.

The top 18 include, in descending order, registered nurses, network and computer systems administrators, pharmacy technicians, landscapers, and social and human services assistants, all expected to grow 9 percent, and computer systems analysts, management analysts, cooks, insurance agents, nursing assistants, licensed practical and licensed vocational nurses and food preparation workers and servers, including fast-food, the report said.

Middle-aged? Stick to figuring out ways to survive. Sooner or later the cost of living will begin to accelerate to match the increases of those with growing income. If you want longer-term worries consider your kids and grandkids. The quality of K-12 education ain’t especially getting better inside the United States. Compared to other literate nations and competing with them for jobs, we’re in a deeper hole that’s on the way to becoming downright subterranean.

While there’s no shortage of pundits who finished their college years before malaise and a matching decline set in – they continue to praise the value of our advanced education. That will continue to sort out with underfunded public schools getting more and more of the student base and giving back less in return. Or so it seems.

Born in the USA? Costliest birth in the world!

Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.

At a prenatal class in March, she was told about epidural anesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”

Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors…

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

RTFA. It’s long, detailed, and scary.

When Dwight Eisenhower left office as president he warned of the political power of the military-industrial complex. Well, they ended up owning enough of Congress that they suck down the lion’s share of our non-insurance federal budget. That leaves what is now being called the medical-industrial complex. And between insurance companies, pharmaceutical manufacturers, healthcare providers and hospitals they seem bound and determined to take the rrest of that budget – and our life savings.

Doctors urge FDA to restrict caffeine energy drinks

A group of 18 doctors, researchers and public health experts have jointly urged the Food and Drug Administration…to take action on energy drinks to protect adolescents and children from the possible risks of consuming high amounts of caffeine.

“There is evidence in the published scientific literature that the caffeine levels in energy drinks pose serious potential health risks,” the doctors and researchers wrote.In their letter to Dr. Margaret A. Hamburg, the F.D.A. commissioner, the group argued that energy drink makers had failed to meet the regulatory burden placed on them to show that the ingredients used in their beverages were safe, specifically where children, adolescents and young adults are concerned. As a result, the group urged the F.D.A. to restrict caffeine content in the products and to require manufacturers to include caffeine content on product labels…

Less is known about the safe level of caffeine for a young teenager, experts say, apart from the fact that it is considered to be lower than for an adult. In their letter Tuesday to Dr. Hamburg, the group of researchers and scientists also pointed out that makers of energy drinks aggressively marketed their products to young teenagers and urged them to consume the drinks quickly. Including mixing them with booze!

In recent years, the number of reported emergency-room visits in which an energy drink was cited as the primary cause of a health problem, or a contributing factor, has grown sharply. In 2011, there were 20,783 such visits, compared with 10,068 in 2007. Problems typically linked to excessive caffeine consumption can include anxiety, headaches, irregular heartbeats and heart attacks.

Probably overdue. At least until and unless reasonable research indicates otherwise. Think we can count on the FDA to encourage that?

How Medicare Is misrepresented

A common phrase in the current debate over the so-called fiscal cliff is “Medicare needs to be restructured.” The term serves as code for policies unlikely to be appealing to voters, a term that can mean everything and, thus, nothing.

The question is what problem restructuring is to solve in traditional Medicare, which remains one of the most popular health insurance programs in this country. People who use this vague term should always be challenged to explain exactly why and how Medicare should be changed.

Critics of traditional Medicare – even those who should know better – often accuse it of being “fee for service.” It is a strange accusation. After all, fee-for-service remains the dominant method of paying the providers of health care under private insurance, including Medicare Advantage, the option of private coverage open to all Medicare beneficiaries.

Describing Medicare as fee-for-service insurance is about as thoughtful as describing a horse as “an animal that has four legs,” a characteristic shared by many other animals. The practice is particularly odd, given that traditional Medicare as early as the 1970s was the first program to develop so-called “bundled payments” for hospital inpatient care – the diagnostically related groupings, known as D.R.G. – in place of fee-for-service payment of hospitals, an innovation that has since been copied around the globe.

A more descriptive term for traditional Medicare would be “free choice of providers” or “unmanaged care” insurance. These features, of course, would hardly be viewed as shortcomings among people covered by traditional Medicare or their families. Neither term would be a good marketing tool among voters for proposals to abandon traditional Medicare…

A case can be made, on theoretical and sometimes empirical grounds, that properly managed or coordinated care can on average yield superior medical treatments, at lower cost, than completely unmanaged care under classical indemnity insurance.

The problem has been and continues to be that this is not the folklore among patients or doctors. The latter, as noted, generally believe they can manage their patients’ care properly without outside interference into their clinical decisions. Among patients and doctors, the term managed care is still not quite respectable.

This can explain why critics of traditional Medicare delicately but nonsensically prefer to decry it as being fee for service rather than as free-choice-of-providers insurance or unmanaged-care insurance.

I hadn’t seen Uwe Reinhardt on television in a spell when he popped up on Tom Keene’s SURVEILLANCE yesterday morning on Bloomberg TV. I had forgotten his dry wit and political economist’s accurate simplicity of definitions. The folks I can understand the easiest also often make the most sense.

This blog post is one the earliest of his current series on Medicare.

Meanwhile, click the link and RTFA. Education, it’s wonderful.

End-of-life health care is important, folks

Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill after right-wing commentators and Republican politicians denounced it falsely as a step toward euthanasia and “death panels.”

Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.

Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated. Those standard devices have been greatly improved in recent years by adding medical orders signed by a doctor — known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that a patient’s wishes are followed, and not misplaced or too vague for family members to be sure what a comatose patient would want…

With these physician orders, the doctor, or in some states a nurse practitioner or physician assistant, leads conversations with patients, family members and surrogates to determine whether a patient with advanced illness wants aggressive life-sustaining treatment, a limited intervention or simply palliative or hospice care.

The health care professional then signs a single-page medical order telling emergency medical personnel and other health care providers what to do if the patient is incapacitated. In most states, the patient or surrogate must also sign the medical order to indicate informed consent. The orders are conspicuously highlighted in a patient’s electronic medical record and follow patients from one setting to another — such as a hospital emergency room or nursing home — so that any health professional handling the case will know what interventions the patient might want…

No matter what the death-panel fearmongers say, end-of-life conversations and medical orders detailing what care to provide increase the confidence of patients that they will get the care they really want. In some cases, that could well mean the request to be spared costly tests, procedures and heroic measures that provide no real medical benefit.

RTFA for a broad understanding of your rights. It’s easy to drag your feet and put off a living will. The prospect ain’t exactly thrilling. But, do it – pay attention to the suggestions in this article and push your physician to cooperate if they must be pressed. Most are already ahead of you on this question.