Monday, October 31, 2005

Toys o' the present

I was over babysitting for the neighbors this afternoon when lo and behold, there sits a miniature "play" bottle of water on the floor before me.

Are you kidding me!? Play bottles of water!? The toy food sure seems different from when I grew up. Then again, my generation is to blame for Cabbage Patch Kids.

Big Bad Deductibles

From Jonathan Cohn
According to a survey of large employers released just two weeks ago by Hewitt Associates, the consulting firm, out-of-pocket medical expenses alone is costing workers an average of $1,366 this year, up from $708 in 2000. And that figure is just the average. People who use a lot of medical services this year will likely pay more--in some cases, a lot more.
Italics mine

These stats -- not the sob stories that accompany them -- are the more convincing reasons to be solidly against CDHC (Consumer Directed Health Care) and all the nifty cost shifting devices that accompany it. Honestly -- a 93% increase in four years. Someone want to enlighten me as to what percent of Americans see their salaries increase 93% in four years? I can tell you this -- the median US household income was unchanged for at least two of those years of increase -- 2002 and 2003.

I just don't see how any of these "directives" are anything resembling a solution if they just price people out of health care altogether. I'm sure demand for all that expensive innovative technology will be sky high if hospitals start emptying because no one can afford health care.

Boo!

Happy Halloween Epiphanites!

Wanna know something scary? At least eight pharmaceutical companies were involved in the UN Oil-for-Food Scandal (via Health Care Renewal)....bwhahahaha

And don't forget the Scalito Alito nomination!

Spooky stuff, indeed.

Thursday, October 27, 2005

FDA blogging

Not really. FDA columning! That's right, column number three is up, and let's just say your Plan A should be to go read it.

Wednesday, October 26, 2005

Non health care blogging

I'm sorry to get all live journal on you guys tonight. But I've got a pretty hilarious development at home, and I just have to post pictures.


My dog, due to her self-inflicted nasty ass sore (see above) has gotten her first cone!



It's just too funny. She keeps running into corners (now that her head has inexpicably increased its circumference five fold).

In other news, I have a new top fifteen (I just can't choose ten) favorite movie. Mad Hot Ballroom. This film is incredible. It's a documentary following New York City P.S. fifth graders as they take their required ballroom dance class and the resulting competition. But the children are amazing. So many of them are beautifully wise beyond their years, eloquent, and fabulous dancers. And they're 11! They dance so much better than I ever will. But I'm okay with that because they are such awesome kids!

Seriously though, you should see the film. My cheeks hurt because I smiled through the whole thing. It's inspiring. Go see it! What are you still hanging around this ol' site for?

One more thing: Go read Ezra's post on Wal-mart over at Tapped. I was going to make pretty much the same point, but why waste your time when Ezra does it way better than I would have?

Thanks for indulging this of "epiphanies: live journal edition". I promise to temper these types of posts.

Tuesday health numbers

Not Via the New York Times,

Via The Wall Street Journal
Just 66% of private full-time workers now have employer-sponsored health insurance, down from 80% in 1989, according to the Bureau of Labor Statistics. Though the U.S. economy has created 3.5 million jobs since 2000, the number of people with commercial health insurance hasn't budged.

Ouch.

Monday, October 24, 2005

monday health stats

I did some more research after all my smart commentors took issue with the graphs from last week. Here's Kaiser's answer:
Changes in the private market impact the cost-effectiveness of premium assistance programs. Recently, there have been sharp increases in private coverage premiums, and private market costs have been increasing more rapidly than Medicaid on a per-capita basis. If private premiums continue to increase faster than Medicaid, and workers are asked to share a larger percentage of the growing cost, the calculation of whether it is cost-effective for states to buy families into private coverage becomes less and less favorable. States can limit their costs by capping their subsidies, but this shifts the risk of added costs to enrollees.
I think the experts do a better job proving my point.

In other news, anyone know some good articles/sources for Plan B (aka the topic of my next health care column)

Saturday, October 22, 2005

Saturday Sick-bed Blogging

And by sick bed I mean my parents comfortable couch, watching Finding Neverland, which I must admit I'm unimpressed by so far. It's too sentimental; they're trying too hard to contrive moments of childhood bliss (I mean, really, have you ever babysat four boys? They are far from this consistently sweet and charming.) Oh, here's Kate Winslet coughing -- she must have bronchitis too! (Sorry to the film's fans, I know that's not funny)

I finally made it to the doctor after not improving for the fourth day straight, and found out I've got a nasty case of bronchitis. Joy. But I can't stop thinking about the excessive urgent care copayment my insurance company demands.

Under my plan, apparently all urgent care outside of your PCP requires a $50 copay. It being Saturday, and my PCP's office being closed, I had no choice but to use urgent care. I had a pretty bad case of bronchitis (I'd been hoping it was a cold -- I went to urgent care as a student one too many times when feeling awful to discover there was nothing to do about it but wait). The doctor told me if I'd waited until Monday I probably would have developed pneumonia.

So this $50 copay strikes me as a perverse incentive. This wasn't an out-of-network office; my insurance contracts with them to provide urgent care. If I'd waited to see my PCP on Monday, my illness could have progressed to pneumonia, which carries a risk of hospitalization -- much more costly than going to urgent care. So why would the insurance company employ this disincentive to seek care when postponing could easily bring much greater costs? I guess I'm lucky I can afford the $50. The last thing I need while waiting around for my leg surgery is to be hospitalized with pneumonia.

In other news, the doctor who treated me was a self-described "flaming liberal" in favor of national health insurance. It's always encouraging to meet doctors on board for reform. Along with her reformist ideas, she was a huge supporter of managed care (which is quite unusual these days). She claimed it "leveled the playing field" in that it gave the same care to her poor patients as her wealthy patients, all for a small copay. My reply was "only if your employer provides affordable insurance!" I disagree with her conclusions on managed care, but it was an interesting exchange.

I'll close with my health stat o' the day, courtesy of my chief information source, the New York Times (I swear I'll be diversifying soon!):
From 2000 to 2005, employees in the most common type of insurance plan, known as preferred provider organizations, saw their premiums for individual coverage rise 76 percent, to $603 from $342, while their deductibles - the amount they pay out of pocket before insurance kicks in - rose almost 85 percent, to $323 from $175, according to the Kaiser Family Foundation. By 2003, a survey by the Center for Studying Health System Change estimated, 20 million American families had trouble paying their medical bills. Two-thirds of these had health insurance.
Which makes me wonder... what was my urgent care copay in 2000?

Friday, October 21, 2005

TGIF Health Stat

Via Matthew Holt, some encouraging poll numbers for the weekend from the Wall Street Journal:
The poll also showed high support for policies or practices that are considered more controversial. Eighty-seven percent of those polled say they support funding of international HIV prevention and treatment programs, while 75% favor universal health insurance, compared with 17% who oppose it. Another 70% support embryonic stem-cell research, compared with about 19% who oppose it.


So, encouraging public opinion polling. Not that it's new -- public support for national health insurance, especially in the last five years, has always been overwhelming positive. Just good to see it's still there.

I've been battling a nasty cold the past couple days, and I expect it'll keep my blogging under the weather this weekend. The posts shall come more freely once I can breathe out of my nose again.

Thursday, October 20, 2005

The Sad Reality of Repeating Our Mistakes

Yesterday I mentioned the Not-So-Sad History of Medicare Cost Containment as Told in One Chart", which illustrates the remarkable difference in administrative costs between Medicare and Private administrative costs. Private costs (11.5%) are more than 3 times those of Medicare (3.6%). It's not only due to the lower administrative costs, but to the huge bargaining power of the government, and the efficacy of government regulation. Let's compare.

Here's the chart for overall Health Care Cost Containment:



The Medicare Cost Containment chart is below:



Keep in mind, that's percent change in spending per year. Click on either image if you want a closer look.

Striking as these images are alone, more impressive is the Bush Administration's willingess to apply the zig-zag method for Medicaid. The New York Times reports today that Florida is undertaking a major restructuring of its Medicaid care delivery.
The Florida program, likely to be a model for many other states, shifts from the traditional Medicaid "defined benefit" plan to a "defined contribution" plan, under which the state sets a ceiling on spending for each recipient. . . The Florida plan says, "The state will set aside a specific amount of money for each person enrolled in Medicaid," based on the person's medical condition and historic use of health care.
Essentially, the state is privatizing Medicaid. Enrollees will now be put in private plans, which will receive payments from the state and fed.

What exactly does that mean? Take it from an expert:
Joan C. Alker, a senior researcher at the Health Policy Institute of Georgetown University, said: "Florida's proposal is one of the most far-reaching and radical proposals we've seen to restructure Medicaid. The federal government and the states now decide which benefits people get. Under the Florida plan, many of those decisions will be made by private health plans, out of public view."
This is actually a pretty big deal, considering the government recently scaled back Medicaid enrollees' rights to sue for treatment. I'm assuming that isn't going to change here just because private insurance is in charge of delivery.

The real question, however, is why are we using the failed private market (see cost containment chart above) to reign in costs when the government (see Medicare chart above) is obviously doing a superior job? And as the system prices more and more people out of their employer sponsored (or lack of) insurance, why are pretending that the same ineffectual system is a magic antidote? The worst part is that this isn't even a new idea! There is not a single shred of novelty in the way care is delivered here -- it's just putting Medicaid enrollees into the same kind of sytem most of the U.S. has. Health care just can't seem to escape the cycle of touching the hot stove, burning and disfiguring its hand, then coming back in five years and forgetting that stoves are hot.

And that's all these "been there, done that" measures will do. They burn people and disfigure our ability to deliver health care. I guess this is just one more step, along with so-called consumer directed plans until our system becomes unrecognizable, and sweeping reform can emerge. I just wish it didn't involve so many scars along the way.

Wednesday, October 19, 2005

Health Stat of the Day

I'm going to try a new series -- Health Stat of the Day -- which is to say most days I will be attempting to do so.

Today's stat comes from a nifty little essay called "The Not-So-Sad History of Medicare Cost Containment as Told in One Chart", by Thomas Bodenheimer, which brings us an equally nifty stat:
... Private insurance administrative costs continue at their 11.5% rate while Medicare is administered at 3.6%


That's in 2002.

Later today I'll post on the charts.

Monday, October 17, 2005

Blame Canada!

Last week a little post of mine on frustration with US health care made some noise here and here. I have to admit I was taken by suprise that my bitching got so much attention.

Much of that attention demanded that I give proof for my accusations! Well, if you read the post closely you'd see I wasn't making any claims except the simple fact that our health system has its problems, waiting being one of them. But today I'm going to give all those naysayers some satisfaction by debunking another huge myth about the perils of Canadian medicine: that many thousands of desperate Canadians cross the border every year seeking medical care because of unsatisfactory care at home, be it long waits, lack of new technology, or [insert appropriate false claim about Canadian care here.]

Three years ago, long before this blog came into existence, Health Affairs ran an article on Canadians seeking care in the US. The authors used some nifty methodology, including surveying numerous US hospitals along the border, as well as institutions generally regarded as "America's Best Hospitals". On the Canadian side, they used the National Population Health Survey (which literally asks, "In the past twelve months did you receive any health care services in the United States?" and "Did you go there primarily to get these services?"), as well as querying insurance companies on the Canadian side about the popularity of policies that cover US institutions.

Before I pull back the curtain to reveal their astounding findings, let's make a couple things clear. Many Canadians travel in the US every year. It is expected that this fact will show up in statistics. Further, I assume there are some very wealthy Canadians who will always say "No thanks" to waiting lists, and hop over to the US. I believe that is a reasonable assumption, and a fact of life that I'm comfortable with.

So what did the authors find?

In terms of hospitals along the border offering advanced treatments or special diagnostic technology (i.e. CT scans and MRIs), about 640 Canadians were seen, along with 270 for procedures like cataract surgery. They compare this to about 375,000 and 44,000 similar procedures in the region of Quebec alone during the same period. If you divide the total number of Canadians seeking those treatments in the US, divided by the number in Quebec alone that's about 0.09%. Not even a tenth of a percent.

But the most striking stats come from the Canadian National Population Health Survey (NPHS). From the article:
Only 90 of 18,000 respondents to the 1996 Canadian NPHS indicated that they had received care in the United States during the previous twelve months, and only twenty had indicated that they had gone to the United States expressly for the purpose of getting that care.

Only 20 of 18,000 sought care in the United States. I can't believe how many people are coming over here! Their system but be truly awful.

But let's give this number some context. We've all heard about seniors getting their prescriptions from Canada. (Hell, even driving to visit my sister at college in rural Kansas, I saw a billboard for "Canada Drug of Topeka!") But how many seniors really do that? Is it exaggerated, like the claims of Canadians coming stateside?

Polling data from 2003 (approximately a year after the Health Affairs article) indicates that 8% answered YES to the following question:

"Have you ever bought prescription drugs from Canada or other countries outside the United States in order to pay a lower price?"

If 8% of the 18,000 Canadians polled in NPHS had expressly sought care in the United States, that would be 1,440. Not 20, as the survey showed.

In other words, we have 72 times the number of Canadians seeking care in the US going to Canada (or at least calling there) to get prescriptions.

Honestly, what's really wrong with this picture?

[Source: Katz, Steven J et al. "Phantoms in the Snow: Canadians' Use Of Health Care Services In The United States." Health Affairs May/June 2002.

Friday, October 14, 2005

That's EBCR0089, bitch

Continuing its fascinating health care series, the New York Times bring us a piece on health care billing that makes you want to tear your hair out just reading it. It's chock full of quotes like this:
There were so many envelopes - some of them very thick - that at first, Mrs. Klausner, 77, could not bring herself to open them, and she stored them in large shopping bags in her Manhattan apartment.

When she finally did open some of the envelopes, there were pages filled with dozens of carefully detailed items, each accompanied by a service code: "Partial thrombo 2300214 102.00," "KUB Flat 2651040 466.00."

On the 15th page or so of each bill, a "balance forward" line listed amounts in the tens of thousands of dollars. One totaled $77,858.04.


Ouch. But that's just some old lady in the New York Times. I mean, how realistic can this situation be? Let's hear from my commentors:
I had decided against the operation and so the bill was a measily $220; which an insurance phone rep had promised to pay, but then refused to pay until I harrassed them for two whole years.

They kept telling me that they would research it and for me to call back the next month, but when I'd call back, they wouldn't know anything either, and we'd start all over again. And somehow, all my letters kept getting lost, though each phone rep insisted that the letters couldn't get lost, and that I must have sent it to the wrong place. They also insisted that they didn't make mistakes; as did the ortho clinic. And the whole time, I was being harrassed by the clinic. They even sent me to a collections guy, who I finally paid.

And even after the insurer paid, the clinic insisted for four more months that they hadn't been, and wouldn't reimburse me (for some reason,the insurer refused to reimburse me directly). And the clinic eventually ripped me off for the $40 that they had paid the collections people to collect my money. So basically, I paid a collections guy to harrass me for money that I didn't really owe. And the whole time, both the insurance company and the ortho clinic acted as if I was some jerk trying to rip them off; rather than acknowledging that they had ripped me off. I never got an apology from anyone.

And to top it all, I still have the bone chip in my elbow! But I'd rather have the bone chip than the large bills I would have gotten, had I elected for the surgery.


Hmm...maybe there are people other than old ladies with this trouble. Wait, what's this?
"I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do," said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. "I can't figure out what care it was related to or who did what."


Oh my God. When I do finally have this surgery, I'm screwed.

Luckily I've been down this road before. It took me a year (in 2003) to get my insurance company to actually pay for physical therapy visits that they approved in the first place.

But hey, it's the best system in the world, I mean, I'm totally satisfied, aren't you?

Wednesday, October 12, 2005

Navigating the health care system

Well, this morning I'm full of complaints, so reader beware.

You know, when people complain about wait lists in Canada it really gets my proverbial panties in a knot. That's not because there aren't wait lists in Canada -- there are. That's not because I don't think things could be improved over there -- they could.

It's this idea that our health care system is so flawless, that we can just go into the doctor here and set up surgery. And that couldn't be further from the truth if you have anything out of the ordinary.

I have to have complex and unusual surgery on my femur (thigh bone). I found this out August 31st. I've been trying to arrange surgery since then, and I've gotten almost nowhere. First, trying to even figure out which surgeons specialize in what I need is a nightmare. I need a pediatric orthopedic surgeon. That shouldn't be too hard, right? Try finding a pediatric surgeon that will still operate on someone over 18!

Next, in the extremely slow communication world of over-worked nurses, it takes a week emailing back and forth to even approach answers to my questions.

What's this? Finally a doctor in KC who might be able to see me?! Oh, yes, he can help you but his next availabe appointment is February 16th!

Okay great.

I need to have this surgery, which I fully expected to have by now, and I'm just finding that any type of plans I make keep being smashed to pieces before my eyes. It's been such a frustrating ordeal, not in the least because I'm just sitting around, waiting for news, unable to plan what the next however many months of my life are going to be like. I don't think I've ever been so frustrated in my life, and all I can do is wait. And the waiting is hell.

Column #2

My second column is up over at Campus Progress. Go check it out!

Monday, October 03, 2005

I've done it!

Eegads, I've done it!

By which I mean I set up the wireless connection in my home, and now I can happily blog from any place in my house. This is much preferred to sitting in our terribly insulated playroom, which is either hot and humid or freezing depending on the unpredictable KC weather.

The best thing is the Kansas City weather prediction for the next three days:

Monday
Partly cloudy. Chance of showers and thunderstorms in the late morning and afternoon. Highs in the upper 80s. South winds 10 to 20 mph. Gusts up to 30 mph in the afternoon. Chance of precipitation 30 percent.

Tuesday
Partly cloudy. Highs in the upper 80s. South winds 10 to 20 mph. Gusts up to 30 mph in the afternoon.
Tuesday Night
Partly cloudy. Chance of showers and thunderstorms after midnight. Lows in the lower 60s. South winds 10 to 15 mph and gusty. Chance of precipitation 50 percent.

Wednesday
Mostly cloudy with chance of showers and thunderstorms in the morning...then partly cloudy in the afternoon. Breezy. Much cooler. Highs in the upper 60s. Northwest winds 15 to 25 mph with gusts to around 35 mph. Chance of precipitation 30 percent.

Yes! Chance of thunderstorms every day! Thunderstorms are my absolute favorite, and after four years in coastal California, with a grand total of three thunderstorms...let's just say I'm liking the forecast.

In other news, I'm off to figure out who the hell this Harriet Miers is. I heard something about being a lawyer? And thinking that the president was the most brilliant man she had ever met. Yeah, something like that.

Sunday, October 02, 2005

No Spam, thank you ma'am

So my comments are being spammed. Much as I want to know about "cancer uterine" and "camera spy gadgets", I'm not sure you all share my enthusiasm! Anyone know a solution?

Thanks!