Health care pt5

[kvrdave]

Originally Posted by wildcatlh

There's a very large leap from "the states won't get money for this one incentive program" to "it's forcing states to do this", isn't there? If the program is to adopt alternatives to litigation, a state with caps really wouldn't need that, now would they?

Sure they would, depending on their alternative. They could set up a system of mediation, or a number of things that could still lead to big payouts. But if they dared to cap those, they don't get money.

It isn't any different that the feds saying you don't get any highway money if you don't have a 55 mile an hour speed limit. They aren't forcing any state to have a 55 mph speed limit....they can do whatever they want, right?

[brayzie]

Originally Posted by wildcatlh

You're not lookng at the correct bill. The new bill is HR3962.

The "America's Affordable Health Choices Act" Bill is now HR 3962?

Does anyone know when the vote on this will be? Does this mean that both the Senate and House of Reps will both be voting on it?

[classicman2]

The House will vote on their version.

If passed, the Senate will vote on their version.

If passed, the bills will go to conference.

[Birrman54]

Originally Posted by JasonF

I'm being unitentionally obtuse, I guess.

Information economics holds that people make "better" choices -- in the sense that they increase their utility -- when they have more information.

The data from New York is that when people have more information about nutrition, they make the same choices.

This suggests that information economics is wrong, at least when applied to this specific scenario.

Milton Friedman is a famous economist and proponent of information economics (I assume he is, anyway -- pretty much every economist I'm aware of is a proponent of information economics).

Therefore, there's an irony (however slight) in the juxtaposition of the Friedman quote with the counter-example to the postulates of information economics.

What am I missing?

You're assuming that calorie postings on menu items are accurate and people are interested in making purchasing decisions based on calorie counts.

At a sit down restaurant I doubt that's true for most, it's sort of resting on the assumption that Americans are being tricked into eating fatty foods. I disagree.

[Birrman54]

Originally Posted by orangecrush

I especially like

Were the receipts checked for the 90% of the 28% of the 50%? Or all the people?

I'd be interested to see whether the 11% who noticed the information and said it affected their decisions actually made better choices.

[Birrman54]

Originally Posted by JasonF

In most states, every insurer will bargain with every hospital to set those rates. So Blue Cross will go to a hospital and they'll agree that Blue Cross will pay $5,000 per appendectomy. Cigna may wind up paying $12,000 per appendectomy. It has a lot to do with how many patients are in the hospital's area -- if Blue Cross has 10,000 subscribers in the area and Cigna has 500, the hospital will cut Blue Cross a huge discount to get those 10,000 subscribers in the door and make up for it by charging Cigna a lot. As a result, a lot of insurance companies have pulled out of markets where they are not the top one or two insurers.

Maryland does it completely differently. In Maryland, there's an administrative agency that tells every hospital what to charge for every test, pill, or procedure. It's done on a hospital by hospital basis and varies to account for the different overhead costs (rural hospitals vs. urban, teaching hospitals vs. non-teaching, etc.), but basically, if the commission decides that Johns Hopkins will charge $6,000 for an appendectomy, then that's what Blue Cross pays and that's what Cigna pays, and that's what everyone else pays. They've had this system since 1977.

Here's the bottom line from the article I found on this



The article also notes that this system winds up costing Medicare more than it would otherwise pay (which makes sense, since Medicare has a lot of bargaining power in other states, so can get lower rates than the average insurance company).

http://www.passionforsubro.com/healt...setting-rates/

The other thing this made me wonder is whether this system had any effect on the quality of care in Maryland. So I found this link:

http://www.statehealthfacts.org/comp...?ind=689&cat=8

This is a list of doctors per capita by state. Maryland ranks number three -- behind DC and Massachusetts, and tied with New York and Vermont. Note that these are all liberal states (or districts, as the case may be). Price controls (and, in the case of Massachusetts, universal coverage), don't seem to have caused an exodus from the state.

So ... what would people think of a federal agency charged with setting prices? A federal mandate for states to establish their own Maryland-style rate-setting agencies?

I can look into the Maryland situation some more; my father is a surgeon in Baltimore and on the board at one of the hospitals. I worked in his office when I was younger and I worked IT at one of the hospitals briefly while in college.

I was under the impression they were facing shortages of certain specialties (Obstetrics & General Surgery come to mind). I think these were mostly due to pressures of hours required and changes in insurance costs.

I think the board controlled costs have to do with acute, emergency care only. The pay is pretty small comparatively, but it does allow the hospitals some predictability in their budgeting. I think it's similar to the states with uninsured driver funds.

For the majority of care; scheduled surgeries, office visits, etc - most of the insurance companies took their pay rate cues from Medicare (some % above Medicare rates). So I think that's pretty similar to how most states operate.

I recall the "all patients, insured or uninsured, are charged the same" being an issue. We would have preferred offering discounts to the uninsured, but that was illegal according to state law.

[JasonF]

Birrman, I'd love to see your father's take on this. All I know is what I learned during a passing reference on NPR and the article I linked to, so I'm relatively ignorant on this topic. I was under the impression that all hospital services were covered (not just emergency), but like I said -- I could very easily be wrong.

[Birrman54]

I'll give him a call tomorrow, I remember doing billing for him and the CPT codes had different payment amounts depending on BCBS vs Cigna vs Aetna, etc. This was several years ago, so my memory is imprecise.

[kvrdave]

I was reading an article on Ford and their contract negotiation with the union here http://online.wsj.com/article/SB1000...googlenews_wsj and the last line contained this...

On Sunday afternoon, the Canadian Auto Workers announced its workers at Ford had overwhelmingly ratified a separate labor deal to cut benefits, reduce vacation compensation and add co-pays on health care insurance, all of which were pattern items from earlier agreements with Chrysler and GM.

Can someone explain that? Doesn't Canada have a national health care system, so why would health insurance be part of the benefits?

Also stumbled across this. It makes me laugh at the public option that Obama wants so badly....
http://www.northjersey.com/news/heal...he_debate.html

The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers. It found that the scaled back government plan in the House bill would not overtake private health insurance and might help a little.

The CBO estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65.

Most people would not have access to the public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only one in five would take the public option.

The budget office said "a less healthy pool of enrollees" would probably be drawn to the public option by the prospect of looser rules on access to specialists and medical services.

As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families into private plans.

Those are just a few quotes. Also, our crisis is so bad that the public option won't even be an option until 2013.....because IT'S A CRISIS, PEOPLE!!!!

[JasonF]

Originally Posted by kvrdave

It makes me laugh at the public option that Obama wants so badly....

You can tell he wants it badly by the way he's tepidly endorsed the weakest possible version of the public option.

[kvrdave]

Or you can tell based on what he has said.

I don't think he wants what is being proposed, but will take it if it means he can declare victory.

[MinLShaw]

I'm four or five parts late, so forgive me for not reading through everything already discussed. I'm assuming that most of the debate here has been like it has been everywhere else; "Public option is evil" vs. "Public option is the only thing that will save mankind." I think it's a worthwhile place to start, but there are far more relevant issues for our healthcare situation I haven't heard addressed much at all that I'd like to throw out there.

We're really just debating whose money is going to foot whose bills. Yes, the money is a major part of it, but I can't help but feel it's getting too much attention. For instance, when I was a kid in the 1980s, we had one kid in the entire school with asthma. I distinctly recall class coming to a complete halt for his occasional attacks, and I personally witnessed an ambulance being summoned for him once. It was a very alarming, disturbing thing and it always introduced a very specific discomfort into the classroom atmosphere to have him around.

Today, of course, kids without a respirator could very likely borrow one from a classmate in case of an emergency and their classmates would not be rattled, or even impressed, the way we were because they're entirely more familiar with such incidents.

I remember it was in the 1990s the first time I ever heard of anyone having a food allergy. I thought it was a joke, or at least an exaggeration. I mean, seriously; allergic to peanuts? That meant you couldn't eat a peanut butter and jelly sandwich, and that was simply a violation of all that was decent. And then I came to be aware of just how many children born in just the last decade or so who have not one, but often multiple such inabilities to safely ingest--or even contact--some of the most basic foods in our society. My wife's stepfather and his son have a deathly allergy to chicken, for instance.

Something is going on there, and we need to start doing something about it. I know the popular belief is that our industrialization has so tampered with our environment that our bodies are no longer surrounded by a healthy natural world, and that our food supply is therefore altered from what it once was. To at least some extent, this is certainly true. I remember when I was a kid, again, in the 1980s, and when I poured a glass of milk, I got bubbles. Somewhere along the line, as corporate farms pumped their cows full of more and more things, the bubbles disappeared. I'd forgotten entirely about bubbles in my milk until one day in the 90s, my mom bought a half-gallon of organic milk and when I poured it, voila! Bubbles.

These are simple examples, but I think they're universally recognizable ones. This isn't about red states, "Obamacare" or anyone's agenda. This is about seeing what's right there in front of us and admitting that by any measuring stick, things have gone very far from where they were even just a short while ago. So long as our children continue to emerge less and less healthy, we can continue this healthcare debate to only escalate--in cost, in urgency and in scale.

I have Crohn's disease and was diagnosed at a time when I was uninsured. I've come to greatly appreciate what limited use I've gotten out of the handful of pharmaceuticals that address my digestive woes, so I bear that in mind when I hear about pharma-profits. Research and development of the kinds of specialized things that help folks like me cost money. Proctor & Gamble manufactures one of the 5 ASA drugs, Asacol, that is a staple of treatment for many Crohnies. They were kind enough to provide my prescription to me free of charge (roughly worth about $150 a month, I believe) because of my low income. It was only effective for me for about a year, but that was a year in which I was mostly under control and their generosity made it possible for me to take the medicine on a daily basis, instead of having to choose between filling a prescription or paying a particular bill.

I've tried to return the favor, in the little way I can, by favoring their products over those of their competitors when shopping, even now (two years after I last took Asacol). I think it's important to note this partly to demonstrate that even the lucrative pharmaceutical companies do find ways of being helpful and accessible to needier patients, and to point out that this is just one example of how such a corporation managed to not only do so while continuing to post great earnings, but earned a loyal consumer in the process. I couldn't easily afford Asacol, but I can easily afford their toothpaste and other items. I'm sure there's a tax incentive somewhere for them, but otherwise the government had little to do with this situation. I think my fellow liberals have lost sight of some of the genuine cooperation within the industry, just as I think too many conservatives have mistaken their own personal fortunes for a sign that other people's problems are entirely of their own doing and that they shouldn't come asking for help after the fact. Medical science can't even answer the question of how a patient develops Crohn's disease, and the leading theories all point to genes and nothing within the power of any particular person to alter through choice or behavior. Simply put, there's nothing I could have done differently, and Crohn's disease--despite how loathsome I get over it at times--is hardly the worst of such chronic conditions. Even now as you read this, I'm sure you personally know someone who would roll their eyes at me even bothering to complain about it.

Ultimately, I think what I'm trying to say is that those of us who have characterized this debate as a matter of counting senators and money estimates have missed the forest for the trees. There are reasons that our healthcare costs have exploded, and they're not all due to the baby boomers reaching their golden years or greedy executives. There are things that we've done to our world and ourselves that have put us here, and these are the things that we need to be addressing. Perhaps those companies dumping God-knows-what into the rivers did more damage than we'd realized; maybe hormones for animals are worse than the F.D.A. thought. I don't know what the scope of such an investigation even should be, but I do know that I am disappointed, and at times outraged, that I've heard no meaningful effort to even begin its undertaking.

[DeputyDave]

And yet people are living longer and longer. For every year that passes, one year is being added on to a baby's expected life span, even without those bubbles in their milk.

I think a lot of what you are seeing is colored by your perceptions. Those allergies existed in the 80's, it's just we are now more aware of them do to the media and hypersensitivity.

[JasonF]

Originally Posted by kvrdave

Or you can tell based on what he has said.

I don't think he wants what is being proposed, but will take it if it means he can declare victory.

As long as something passes -- and something will pass -- he will declare victory. But he's been consistent in talking down the importance of the public option and in pushing to weaken it, precisely because he wants to be sure something passes so that he can declare victory.

[mosquitobite]

Originally Posted by DeputyDave

And yet people are living longer and longer. For every year that passes, one year is being added on to a baby's expected life span, even without those bubbles in their milk.

I think a lot of what you are seeing is colored by your perceptions. Those allergies existed in the 80's, it's just we are now more aware of them do to the media and hypersensitivity.

They did exist, but not in the numbers we're seeing today. It's not just media reporting that's causing the increase, ask any pediatrician.

You really remember seeing an asthmatic kid have an attack while you were in school?
You remember seeing a teacher use an epi pen on a kid?
You had an autistic kid in your class?

These are all epidemics that, yes, may or may not impact life span but they do indeed effect the quality of life.

And MinLShaw, one of my personal theories is sunscreen is a big piece to the puzzle. Vit D deficiencies (in children and pregnant mothers) are rampant now and we have no idea the scope of what that means.

[dork]

Originally Posted by mosquitobite

And MinLShaw, one of my personal theories is sunscreen is a big piece to the puzzle. Vit D deficiencies (in children and pregnant mothers) are rampant now and we have no idea the scope of what that means.

I hope the develop a vaccine for that, and soon!

[X]

Speaking of vaccines...

US swine flu vaccine may be too late

Researchers at Purdue University in Indiana say according to their calculations by the time the vaccine arrives in the U.S. it will be too late to prevent H1N1 infections from the current wave of the virus.

Tom Frieden, head of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia said last week that as of October 23 the U.S. had received 27.4 million doses of H1N1 vaccine.

At this time the U.S. should have received 120 million doses reports NewScientist.

The current amount isn't even enough to vaccinate America's 42 million most vulnerable and with President Obama's announcement last week declaring a national emergency the demand for the vaccine will probably increase.

Shelly Towers and Zhilan Feng at Purdue University calculate (pdf)that even though several companies are using a faster growing strain to produce vaccine, it will still be too late to prevent the majority of infections as the new vaccine won't arrive for weeks.

According to their model, about 25 per cent of Americans will get sick from this wave of H1N1, if they are not vaccinated. Since vaccinations will be coming too late for many people, only 6 per cent of those would have protection from the virus as it takes time to build antibodies in people.
Towers says that vaccination is still far from pointless. She says that 2,000 lives could still be saved "and people who get the shot now will have at least partial immunity should H1N1 mutate and cause a pandemic wave next spring," reports NewScientist.

http://www.digitaljournal.com/article/281274

And an interesting article about why the vaccine will be late...

Swine Flu Vaccine--Too Little, Too Late
Long-standing liability issues leave us unprepared for a pandemic
By The Editors

As health care workers in the U.S. gear up for the flu season, they facea paradox: on the one hand, they will have too little vaccine against the novel influenza A (H1N1) strain to protect the entire population; on the other, some people will resist the shots that are offered to them. Sadly, both problems can be traced, at least in part, to the last time “swine flu” loomed. The 1976 national vaccination campaign against a pandemic that never materialized left the public with lingering doubts about whether the inoculations harmed some recipients and spawned lawsuits that cost the federal government nearly $100 million.

Since that episode, both public mistrust of vaccines and vaccine makers’ mistrust of a litigious public have only grown—hampering the nation’s ability to respond to the current, very real, pandemic. The Centers for Disease Control and Prevention expect the virus to sicken up to a third of the population this fall. But the nation will have barely enough vaccine for a third of its residents because methods used to make U.S. flu vaccines have changed little in half a century. Health officials decided early in the summer to stick with slow, egg-based production techniques and to eschew dose-sparing additives that might have tripled the vaccine supply.

In “Boosting Vaccine Power,” Nathalie Garçon and Michel Goldman describe a new generation of ad*juvants—immune-stimulating vaccine ingredients—that take advantage of scientific advances in understanding immune cell interactions. A few years ago the clinical trial of an experimental pandemic vaccine against bird flu containing one of these new adjuvants provided protection using less than a third of the usual amount of virus antigen in seasonal flu vaccines and produced minimal side effects. Another novel adjuvant has been approved for use in European seasonal flu vaccines for more than a decade.

Yet the U.S. does not permit use of the new adjuvants in vaccines, except in emergencies declared by the Food and Drug Administration (which is hardly likely to inspire public confidence). Even procuring a pandemic vaccine using traditional methods required the government to grant vaccine makers immunity from lawsuits and instead take the liability onto itself, as it did in 1976. Without such protections, vaccine makers were unwilling to enter the market. Fear of litigation had already driven most of them to leave the business. In the 1970s 25 companies made vaccines of all kinds. By 2004 only five remained.

In 2002 the SAFETY Act also granted immunity to potential makers of antibioterror vaccines and drugs. But the expedient of blanket immunity in an emergency is hardly a long-term solution to the crisis in vaccine development. In existing legislation, however, we have a model for a mechanism that would give reasonable compensation to victims of unforeseeable vaccine injuries while also shielding manufacturers from unpredictable legal liability for vaccines that work as intended. In 1986, recognizing the possibility that fundamental childhood vaccines could become unavailable if no one were willing to make them, Congress passed the National Childhood Vaccine Injury Compensation Act. It established a no-fault court to handle injury claims, with ceilings on potential damages. The settlements are financed by a tax on every vaccine dose. This system could be extended to all vaccines.

In 1985 an Institute of Medicine report, “Vaccine Supply and Innovation,” advanced several other options for safeguarding vaccine research and thereby vaccine safety and supplies. Few viable alternatives have been offered since. It is impossible to know what vaccine technologies might have been available to meet the challenge of the influenza pandemic of 2009 had vaccine science not been bogged down by liability concerns for so long. But almost certainly one reason the U.S. has too little vaccine going into the fall is that attention to the decades-old issue of vaccine liability has been too late in coming. As policy makers tackle health care reform in the coming months, we call on them to address the problem of vaccine liability—both to restore public confidence in this critical health intervention and to ensure that the best and safest vaccine technologies are available before the next pandemic.

http://www.scientificamerican.com/ar...ne-flu-vaccine

[mosquitobite]

Originally Posted by dork

I hope the develop a vaccine for that, and soon!

[kvrdave]

Originally Posted by JasonF

As long as something passes -- and something will pass -- he will declare victory. But he's been consistent in talking down the importance of the public option and in pushing to weaken it, precisely because he wants to be sure something passes so that he can declare victory.

This is probably a stupid question, but i woke up wondering it. Using CBO numbers that I have read, we are looking at $896 billion over 10 years, The numbers of those taking the public option are 2% and the premiums are suppose to carry it, and that doesn't start until 2013. So what is that $896 billion suppose to pay for? What does it give us? What is in the bill that costs money, especially that much?

[classicman2]

Now - I really don't believe you woke up wondering that.

[spainlinx0]

I get upset when I have a shitty dream about work. I can't imagine how annoyed I would be if I was dreaming about health care reform.

[kvrdave]

Originally Posted by classicman2

Now - I really don't believe you woke up wondering that.

I actually did. It felt like one of those things where you are having some deep thought in the morning, only to wake up more and realize you were talking jibberish. I felt that way, but it didn't go away.

[Dr Mabuse]

I had a dream last night that a hamburger was eating me!

[spainlinx0]

Originally Posted by kvrdave

I actually did. It felt like one of those things where you are having some deep thought in the morning, only to wake up more and realize you were talking jibberish. I felt that way, but it didn't go away.

Is waking up a new euphemism for being stoned?

[MinLShaw]

Originally Posted by DeputyDave

And yet people are living longer and longer. For every year that passes, one year is being added on to a baby's expected life span, even without those bubbles in their milk.

But that's keeping score simply by addressing how long someone is expected to live and ignoring entirely the deteriorating health expectations of those people. Consider the ever-increasing incidents of autism and cancer alone. I don't know what the specific statistics of those two things alone are, but I can tell you that in my firsthand experience, I've seen and heard of more people having to endure them. When I was younger, cancer was something that old people got, typically from years of smoking. Now, the father of a guy I've known most of my life, has had to deal with prostate cancer. And his son, my friend's brother, just had to have some dubious tissues removed from his colon. He's 32, and this was just a year after his mother had colon issues. These are not issues that are acknowledged by life expectancy figures.

I think a lot of what you are seeing is colored by your perceptions. Those allergies existed in the 80's, it's just we are now more aware of them do to the media and hypersensitivity.

Isn't it more accurate (and exceedingly obvious) to say that my perceptions are constructed from what I am seeing? Isn't that true of all of us? And, no, I'm not more aware of these things entirely due to media and "hypersensitivity." I'm aware of them because they're happening more frequently, and more consistently to people right around me, and I happen to have been paying attention.

When I graduated high school in 1997, there was one "special education" classroom that had about five students. They ranged from down's syndrome to far more debilitating conditions. Today? One of my friends's wives teaches in one of two special ed classes at a school in the same county. Don't tell me that over-reacting liberal media is responsible for my perception of things getting of whack.