I’m Sorry . . .

Someone sent me a link to this post written by Chris Dunn on “Words and Light.” It is titled: “I’m Furious,” and it begins: “I’m furious because I have to read this book:

"Money-Driven Medicine" by Maggie Mahar

Photo by Chris Dunn

“I’m in my final undergraduate semester, and only now am I taking my first-ever political science course. The class is Public Policy, and for our first paper, we are to read this entire book and write a book review.

“That’s not (exactly) why I’m furious.

“I’m furious because I’m learning, in detail, about the failures of the American health care system according to one author-journalist.

“I’m furious because I procrastinated in starting this book, which has prevented me from going out and making pictures and blogging a real photo for my first entry in this 30-day series.

“I’m furious because, although I’m far more interested in being a photographer than in being a student, my academics and work schedule this semester are severely limiting the time and opportunities I could have to pursue better photography.”

Somehow, this post made me smile.

I wrote to Chris (who is a senior at the University of Missouri, where she majors in journalism, photo-journalism and photography) to say “I’m sorry” the book is so long.

But U.S. health care is a complicated topic, and I wanted to include both facts and stories.  (Numbers alone are too boring. Anecdotes alone are not persuasive.) 

I also told her that it’s a nice photo of the book—which it is. And the photo on the top of her home page is outstanding. (My husband, who is a photographer, admired it.)

Massachusetts’ Problem and Maryland’s Solution We Don’t Have to Wait for Washington Part 2

While health care reformers argue about what it would take to “break the curve” of health care inflation, the state of Maryland has done it, at least when it comes to hospital spending.

In 1977, Maryland decided that, rather than leaving prices to the vagaries of a marketplace where insurers and hospitals negotiate behind closed doors, it would delegate the task of setting reimbursement rates for acute-care hospitals to an independent agency, the Maryland Health Services Cost Review Commission.

When setting rates, the Commission takes into account differences in labor markets and how much a hospital pays in wages; the amount of charity care the hospital does; and whether it treats a large number of severely ill patients. For example, the Commission sets the price of an overnight stay at St. Joseph Medical Center in suburban Towson  at $984,  while letting  Johns Hopkins, in Baltimore Maryland, charge  $1,555. For a basic chest X-ray, St. Joseph's asks  $81 and Hopkins' is allowd to  charge  $155. The differences reflect Hopkins's higher costs as a teaching hospital and the fact that it cares for generally sicker patients.

Autism and the MMR: Finally a Retraction

Are we finally ready to close the door on the much-disputed link between the MMR vaccine and autism?

On January 30, Britain’s General Medical Council ruled that Andrew Wakefield, a gastroenterologist, had acted “dishonestly and irresponsibly” in conducting his research that established a link between autism and the MMR vaccine. And yesterday, the British medical journal Lancet finally retracted the resulting 1998 study authored by Wakefield that helped drive MMR vaccination rates in the U.K. down to the point where in 2008, measles was officially declared “endemic” in the country.

The Lancet’s editor, Richard Horton, told The Guardian "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false," he said. "I feel I was deceived."

Medicaid Needs More Than A Short-term Fix

Health reform may be stalled in Congress, but you need only look to the overburdened Medicaid program to find evidence of the continued toll the current economic crisis is taking on Americans’ ability to afford and access medical care.

At the same time that states are experiencing huge budget deficits, more and more of their residents are unemployed; more and more are joining the ranks of the uninsured and clamoring for Medicaid benefits. The result: Even with emergency federal infusions of funding, state safety nets are being stretched dangerously thin.

Say it isn’t so.

The New York Times’ David M. Herszenhorn reports that, “If Democrats break down their major health care legislation into components that could be approved separately, the first bill up for consideration could be a proposal to end the exemption from federal antitrust laws that insurers have enjoyed since 1945.”

If reformers want to pass just one piece of the reform legislation, this is the wrong piece.

In Massachusetts Elite Providers Drive Health Care Spending; What Does This Say about the Dartmouth Research? . . . Maryland’s Solution. Part 1

Massachusetts Attorney General Martha Coakely has just released a report which reveals that the state’s health care costs are spiraling in large part because he state’s primo hospitals and physician groups --those  with brand name recognition-- -are demanding exorbitant reimbursements from insurers.   Providers who control the market in geographically isolated areas also are insisting on reimbursements that far exceed what other providers receive for the same services.. http://www.mass.gov/Cago/docs/healthcare/Investigation_HCCT&CD.pdf

These providers have market leverage. Patients want both marquee names and providers close to home in their insurers’ network. If these providers are not included, customers will switch to a different insurance plan.  Thus, insurance companies have no choice but to pay what the providers demand.

The investigators “found no evidence that the higher pay was a reward for better quality work or for treating sicker patients,” the Boston Globe reports.  http://www.boston.com/news/local/massachusetts/articles/2010/01/29/attorney_general_says_clout_drives_up_health_costs/?page=1  

“In fact, eight of the 10 best-paid hospitals in one insurer’s network were community hospitals, which tend to have less complicated cases than teaching hospitals and do not bear the extra cost of training future physicians.”

Sometimes hospitals claim that they charge more because they treat poorer patients who are sicker.  But the truth is that, often, poorer patients receive fewer services because they have limited access to care. In addition the public hospitals and “safety-net hospitals” that treat indigent patients frequently have fewer resources: shriveled budgets, fewer specialists, less equipment. As I reported in Money-Driven Medicine, often “safety-net” hospitals must ration care.

The new Massachusetts report confirms what many already know about spending on low-income patients: the investigation discovered that hospitals that treat large numbers of poor patients  . . . are paid 10 percent to 25 percent less than average by commercial insurers.

Meanwhile, Coakley’s report made me wonder: Maybe Massachusetts should consider Maryland’s solution?

“I Don’t Quit”

In his address to the nation, President Obama made it clear: Jobs are now his #1 priority.

This is what most Americans wanted to hear. They fear that he has spent too much time on health care, and has not paid enough attention to climbing unemployment. This does not mean that they oppose  health care reform legislation—it’s just  that there are tired of hearing about it.  And the need for jobs is more pressing.

It was a strong speech—particularly when the President acknowledged that  “The only way to move to full employment is to lay a new foundation for long-term economic growth, and finally address the problems that America's families have confronted for years.”  One jobs bill will not solve the problem.

President Obama  also opened the door to a college education for many students when he pledged: “let's  . . .give families a $10,000 tax credit for four years of college and increase Pell Grants. And let's tell another one million students that when they graduate, they will be required to pay only ten percent of their income on student loans, and all of their debt will be forgiven after twenty years – and forgiven after ten years if they choose a career in public service.”

These are good ideas. But what about health care?

Hours before the State of the Union address, some believed that the President  would save health- care reform for the very end of his speech. The pivotal question was this: would health care seem an after-thought  or a climax?

The State of the Union--And the Economy: Why We Need Health Care Reform Now

According to the headlines, 10 percent of Americans are unemployed. The truth is that closer to 17 percent of  the population cannot find full-time work; this number includes workers who have become discouraged and have given up looking for work as well as those who have settled for part-time jobs because they cannot find the full-time employment that they need.

The situation is not going to change anytime soon. As Princeton economist Paul Krugman recently warned: “We are facing mass unemployment — unemployment that will blight the lives of millions of Americans for years to come.”

Some of the Best of Recent Health Care Blogs: Health Wonk Review

Over at the Disease Management Care Blog, http://diseasemanagementcareblog.blogspot.com/2010/01/welcome-to-tree-of-blogs-avatar-movie.html Jaan Sidorov hosts the most recent edition of Health Wonk Review, a round-up of some of the best healthcare blogs of the past two weeks.  I find that the Review is a good way to find out about excellent blogs that I haven't heard about--while also keeping up with favorites.

Sidorov, who is a primary care general internist and former Medical Director at Geisinger Health Plan., highlights some posts which suggest that physicians are thinking about how to reform their own specialties.

Who Voted for Brown in Massachusetts—and Why? Voters Cannot Oppose Legislation If They Don’t Understand It

The media continues to report that the Massachusetts vote was a referendum on health care reform—and that this has the White House worried.

If so, the White House is wrong.

Take a look at polling conducted by Hart Research Associates for the AFL-CIO on the evening of the election, revealing who voted for Brown –and what those voters said.  Then consider separate polling done by the Washington Post together with the Kaiser Family Foundation and Harvard University.  Read both reports, and you’ll have a very hard time believing that Scott Brown’s election represents a mandate on healthcare legislation.

Finally, factor in the eye-opening Kaiser Family Foundation January tracking poll,  and what it reveals about what voters do and don’t understand about health reform legislation.  If most voters have only a hazy idea of what is in the legislation, you really can’t say that they voted against the Senate bill.