For-Profit Hospitals Poised to Take Market Share From Non-Profits

Non-profit hospitals have been spending, hand-over-fist, on new construction and new wings, adding rooms that most communities don’t need, while investing in the same multi-million dollar medical equipment that five hospitals in a three-mile radius already have. On HealthBeat, I’ve been writing about the investments in hotel-like amenities for more than two years.

Hospitals were borrowing in order to build – interest rates were low; money was available—why not?  Inevitably, the recession would bring an end to all of that. I have predicted that many hospitals would find themselves running out of money in the middle of projects. Other are now saddled with debt, and struggling to hold onto market share.  

Lieberman Defects While Public Support for Medicare E Grows

Joe Lieberman is no Olympia Snowe (R-ME). Many progressives admired Olympia Snowe’s stance (even if they disagreed with her). By contrast Lieberman’s  announcement that he may join the Republicans in a filibuster that aims to block letting the health care reform bill come to the Senate floor is merely vintage Lieberman. He’s an opportunist. I knew him many years ago, back in Connecticut, when a reform candidate was challenging the Democratic machine. Lieberman wavered on the sidelines, waiting to see who was going to win. He didn’t want to risk picking a losing team.

Today, as Lincoln Mitchell points out on Huffington Post: “By wavering between the two parties while never fully abandoning the Democratic Party, Lieberman has made himself far more important than he should be. If he were to formally switch parties, he would suddenly be of little interest to the Republicans as he would be just another member of the minority who would probably be suspect because his right wing credentials would not be strong enough for the Limbaugh-Palin wing of the party.”

Who Would Be Eligible For A Public Option? Far more than “10%” of the Population

Very likely you have heard that only a “tiny group” of Americans will be eligible for the public plan. But if you read the House bill approved by three House committees (HR 3200) carefully, (this is the proposal that provides the most detail on the public option) it appears that 20 percent to 25 percent of all Americans would be eligible to sign up for the public plan in 2013. In the years that follow, the Exchange will be open to all Americans.
 
The notion that only “10 percent of the population” will be eligible to enter the Insurance Exchange and choose between private sector insurance and Medicare for Everyone is fast becoming an urban myth. Some commentators are using the number to minimize the importance of the public plan.

There’s something about Mary…

As debate over the cost of health reform intensifies, it is worth repeating that significant savings will result from making fundamental changes in the way health care is delivered. Here at Healthbeat, we have written extensively about how cutting the waste and over-treatment out of the current health care system will not only reduce the cost of care, but also lead to better outcomes for patients. But there is nothing like a real-life experience to drive this message home.

Recently, my neighbor called and asked if I would walk with her to her internist’s office just two blocks away. Mary is 80 years old and had been feeling dizzy and unsteady on her feet for over a week. Since she has hypertension, she wanted the doctor to check her blood pressure to make sure it wasn’t contributing to her symptoms.

Patient-Centered Malpractice Reform

Below, an excellent Op-ed by Kevin M.D. in “U.S.A Today.” It looks at malpractice from the patient’s perspective. Read the whole piece—the final section explores what we might learn from other countries. Before commenting, be sure to take a look at the NEJM article (see link below).

Any malpractice reforms should put patients first

By Kevin Pho

Whenever the issue of medical malpractice comes up, my fellow physicians and I agree that changes are necessary. Where we disagree is on how to fix the problem. So we all took note when President Obama acknowledged that  medical malpractice reform must be considered. In fact, he proposed pilot projects to study how to improve patient safety and change the way we compensate injured patients.

The Public Option: It’s Not About Politics; It’s About the Economics of Reform

Last week, I argued that the insurance industry had declared war on President Obama’s plans for healthcare reform because industry leaders sensed—or knew-- that support for a federal public insurance option was building. A week earlier,  I told an audience at a San Francisco screening of Money-Driven Medicine that I thought the odds were at least 60/40 in favor of a national public plan. They were surprised that I was so optimistic, and this was a very liberal audience in San Francisco.

At the time, most progressive pundits had declared the public plan moribund. Reading the political tea leaves, listening to “informed Congressional aides,” parsing the administration’s statements, they were convinced that the public plan was, as the Buffalo News put it “the rotting corpse of health care reform.” Why was I still hopeful? Because I continued to believe that, without Medicare E (for everyone) health care reform won’t be affordable.

"I'm sorry but we cannot print the data."

Have  you ever received this message when you tried to post a comment on HealthBeat?

It  happens to me too.

I finally realized that this happens when too much time elapses between the time I started writing the comment and when I try to post it. (Since I often respond to many of your comment in one long comment, I may spend a half hour writing it.)

The solution is simple. Just "copy" your comment, then close HealthBeat.

Open  a new HealthBeat, scroll down to the comments section, paste in, your comment, and send it.  It will be accepted.

I'm sorry for any inconvenience, but this is  just how typepad works .

A Letter from Canada

Below, a letter from a Canadian disputing some of the propaganda that we hear about health care in Canada. (Thanks to HealthBeat reader Lisa Lindell for putting me in touch with Vera Goodman) This is the first in what I hope will be a regular series featuring letters from patients, doctors, nurses and others describing how health care works in their countries.

Since I believe that the best reporting combines stories and statistics, I’ll add some stats, as I have here, in brackets.

The next letter will be from a doctor in Norway who has practiced medicine---and been a patient—both here in the U.S. and in his home country.

Why is Health Care So Expensive in Rural Louisiana?

Most discussions of regional variations in healthcare focus on the nation’s cities. Below, a first-of-its-kind map from a post on the Daily Yonder titled “The Uneven Cost of Rural Health Care.”

Daily Yonder/Dartmouth Health Atlas

This map shows the difference in per capita Medicare costs among 1,845 rural hospital service areas. Green areas have costs below the national average. Brown areas are above the national average. For a larger version of the map, click here.

The map and the post are based on data collected by researchers at the Dartmouth Medical School. Doctors and economists there take a sample of Medicare costs from some 1,843  hospital service areas where a majority of the  people are  living in rural or exurban zip codes.

Mining for Gold in Prescribing Records

Drug companies spent $5.0 billion on marketing prescription drugs directly to consumers last year and, as I have written in the past,  these ads have paid off. Studies have found that every dollar spent on DTC ads generates up to four dollars in additional sales of new drugs that are often only marginally better than far cheaper, generic versions or older drugs.

But as companies cut advertising budgets and introduce drugs that command smaller markets, there are signs that the days of $100 million-plus DTC ad campaigns might be over. A recent report by TNS Media, (a company that tracks media ads) found that DTC drug advertising was down 8% last year. Another survey of pharmaceutical industry marketers found that 58% of them plan to decrease DTC advertising this year, up from 28% in 2008.

One reason for the slowdown, according to the TNS report, is that companies are introducing fewer blockbuster drugs; the newest entries are approved for narrower uses with fewer potential patients and weaker sales projections. The report doesn’t mention that consumers also appear to be fed up with incessant advertising for erectile dysfunction, sleep problems and overactive bladder, and might be tuning out many of these mass-market missives. Drug companies also are facing keener oversight from policy makers who question the educational benefit of some DTC advertising and are examining their roll in increasing health care costs.

So where do drug companies go next to market their drugs? It turns out that many companies are refocusing their marketing efforts on an old, familiar target—physicians and their prescription pads.