February 8, 2008
Book Quiz: Just for Fun on a Friday
Here is fun Book Quiz by BluePyramid for you to take to learn which book best represents you and your future. It is only six questions.
I ended up as, "The Lion, The Witch and the Wardrobe," by CS Lewis (a book that I greatly enjoy). I am not so sure about my future though . . .
You were just looking for some decent clothes when everything changed quite dramatically. For the better or for the worse, it is still hard to tell. Now it seems like winter will never end and you feel cursed. Soon there will be an epic struggle between two forces in your life and you are very concerned about a betrayal that could turn the balance. If this makes it sound like you're re-enacting Christian theological events, that may or may not be coincidence. When in doubt, put your trust in zoo animals.
10 Ways to Change our Health Care System
LiveSmarter has an interesting post detailing ten different ideas to help improve our health care system from 10 experts. Here is a brief selection:
1. Mend the medical schools
Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC), thinks the country needs more medical schools and that doctors, nurses, vets need to learn together. Beginning their education at once, Gerberding says, can encourage healthcare professionals to cooperate and develop a shared mission.
“If we are seriously thinking about building a health system, then we need to be training professionals in a collegial and collaborative manner,” Gerberding told reporters at the annual meeting of the American Veterinary Medical Association earlier this year.
2. Single-payer insurance
Dr. Michael Ozer, a San Antonio-based pediatrician and a member of Physicians for a National Health Program (PNHP), says that the country needs to expand health coverage and lower its costs at the same time. The only way to do this, he asserts, is through single-payer national health insurance, or NHI. The approach is similar to healthcare programs in Canada and Britain.
According to PNHP estimates, U.S. insurance companies spend more than a third of health care dollars on administration and marketing, which subtracts money from patient care. A national system, Ozer states, would facilitate long-term cost controls on the pharmaceutical industry to ensure that new benefits are sustainable. Such a system would equal overhead savings possibly to the tune of as much as $350 billion a year. He goes on to cite federal legislation currently under consideration in Congress called the United States National Health Insurance Act (HR 676) which, if passed, would extend Medicare to more people.
3. Individual, not company, plans
Michael F. Cannon, director of health policy studies at the Cato Institute and co-author of the forthcoming 2nd edition of Healthy Competition: What’s Holding Back Health Care and How to Free It, says market forces bear no consequence on rising healthcare costs. Doctors and insurance companies get away with charging high prices because government programs encourage employer-controlled insurance. More people could benefit if they kept the same insurance plan even if they didn’t keep the same job.
The government is at least taking a step in that direction, Cannon says. President George Bush and GOP presidential candidate Rudy Giuliani have endorsed reforms that would extend the tax break applying to employer-controlled coverage to individual coverage. Those measures could result in families controlling more of their healthcare money and the expansion of coverage to 7 million people, according to the Congressional Budget Office.
4. Divert the dollar to the doc
Orthopedic surgeon and sports medicine specialist Neil Thomas Katz, on the other hand, says that the dollar needs to go to the doctors, not the patients, the insurance companies or the government.
“The solution is simple. Doctors and hospitals need to be paid at least as much as it costs to take care of you. We should not be losing money,” Katz states.
America’s healthcare funds, he claims, go toward paying high executive salaries and to maintaining insurance company staff whose primary job is “to find ways not to pay for your healthcare.” In addition, workers’ compensation and no-fault premiums create a cycle of litigation against doctors and employees. The current system enables a government health bureaucracy to thrive.
5. Pay for the care of populations, not events
Donald Berwick, a Massachusetts pediatrician and the president of the Institute for Healthcare Improvement, touches upon several ways to transform healthcare. One area he focuses on involves making healthcare a pattern, not a response to a particular occurrence.
Berwick thinks that individuals rely on random health events like hospital stays and office visits for care. A better system would treat patients on a regular basis and aim for high quality preventive care. This method would address “the real needs of patients over time and place, guiding them through the technological thicket of modern medicine, and making sure that they get exactly what they want and need, exactly when and how they want and need it,” Berwick says. . . . .
Thanks to Ezra Klein for the link.
February 7, 2008
Rating Your Doctor: Cost v. Quality of Care
The Wall Street Journal's Health Blog reports on Tennessee BlueCross BlueShield's adoption of doctor rating. Jacob Goldstein reports,
The debate over insurers rating doctors encapsulates a lot of what people are fighting over in health care these days: Who should have access to what information, how to determine quality of care, and the roles insurers and doctors should play. But even as the debate continues, it’s clear that consumers will get more information about their doctors, and insurers are starting to dish it out.
The latest example comes courtesy of the Nashville Tennessean, which reports today that BlueCross BlueShield of Tennessee, the state’s largest insurer, will soon start rating doctors based on whether patients get appropriate tests and treatments. The insurer’s private customers will also be able to get info on how much doctors charge.
The insurer will stop short of recommending particular doctors. And, the article reports, it will follow the rating model established by negotiations between the New York AG’s office and several big insurers. One key element is disclosing the criteria that go into rating doctors, and allowing doctors to appeal their ratings.
Docs have argued that insurers have an incentive to send patients to the cheapest — but not necessarily the best — doctors. Dr. William Edwards, a vascular surgeon who served on an advisory panel to the Blues on the ratings, said that doctors who see sicker patients could be at a disadvantage because their costs would be higher. “If you publish that data, you run the risk that those doctors could become averse to taking on those risky patients because it makes them look bad,” he told the Tennessean. . . . .
Modern Music: Your Parents Were Right!
The New York Times reports this week on the "dangers" of modern music which our children spend hours a day listening today. The story says,
Teenagers listen to an average of nearly 2.5 hours of music per day. Guess what they’re hearing about? One in three popular songs contains explicit references to drug or alcohol use, according to a new report in The Archives of Pediatrics and Adolescent Medicine. That means kids are receiving about 35 references to substance abuse for every hour of music they listen to, the authors determined.
While songs about drugs and excess are nothing new, the issue is getting more attention because so many children now have regular access to music out of the earshot of parents. Nearly 9 out of 10 adolescents and teens have an MP3 player or a compact disc player in their bedrooms. Studies have long shown that media messages have a pronounced impact on childhood risk behaviors. Exposure to images of smoking in movies influences a child’s risk for picking up the habit. Alcohol use in movies and promotions is also linked to actual alcohol use.
Researchers from the University of Pittsburgh School of Medicine studied the 279 most popular songs from 2005, based on reports from Billboard magazine, which tracks popular music. Whether a song contained a reference to drugs or alcohol varied by genre. Only 9 percent of pop songs had lyrics relating to drugs or alcohol. The number jumped to 14 percent for rock songs, 20 percent for R&B and hip-hop songs, 36 percent for country songs and 77 percent for rap songs. . . .
The study authors noted that music represents a pervasive source of exposure to positive images of substance use. The average adolescent is exposed to approximately 84 references to explicit substance use per day and 591 references per week, or 30,732 references per year. The average adolescent listening only to pop would be exposed to 5 references per day, whereas the average adolescent who listens just to rap would be exposed to 251 references per day. . . .
Although music lacks the visual element of film, adolescent exposure to music is much more frequent, accounting for an average of 16 hours each week for music compared with about 6 hours each week for movie images, according to the study authors. But frequency of exposure is not the only factor. Unlike visual media, music is a powerful social force that also taps into an individual’s personal identity, memories and mood.
February 6, 2008
Costly People to Cover -- Healthy People
PLoS Medicine published a study by Dutch scientists whichprovides an overview of how much obesity costs the nation. It has received some (see AP article here) because its conclusions about the cost of the obese are not quite what people expected. It turns out that obese people are not as costly as one might assume - it is those with slighly lower BMIs and a history as a non-smoker who tend to live longer and those consume more health care dollars.
The researchers used their model to estimate the number of surviving individuals and the occurrence of various diseases for three hypothetical groups of men and women, examining data from the age of 20 until the time when the model predicted that everyone had died. The “obese” group consisted of never-smoking people with a BMI of more than 30; the “healthy-living” group consisted of never-smoking people with a healthy weight; the “smoking” group consisted of lifetime smokers with a healthy weight. Data from the Netherlands on the costs of illness were fed into the model to calculate the yearly and lifetime health-care costs of all three groups. The model predicted that until the age of 56, yearly health costs were highest for obese people and lowest for healthy-living people. At older ages, the highest yearly costs were incurred by the smoking group. However, because of differences in life expectancy (life expectancy at age 20 was 5 years less for the obese group, and 8 years less for the smoking group, compared to the healthy-living group), total lifetime health spending was greatest for the healthy-living people, lowest for the smokers, and intermediate for the obese people.
Darn those healthy people - I think I will go eat some more chocolate and consider some unhealthy habits I can adopt just so that I won't be adding to our nation's health care costs.
Climate Change and the Spread of Disease
Slate.com has an interesting piece discussing the what impact, if any, climate change may have on the spread of various diseases. Maria Said writes,
Before the summer of 2007, Castiglione di Cervia, Italy, was known as a quiet village near Ravenna. In July, however, doctors noticed complaints of excruciating joint pain, fever, headaches, and rash. Their patients were experiencing a fever called "chikungunya"; the word originates in the Makonde language in Tanzania and Mozambique and means "to dry up or become contorted." This epidemic had two years previously raged unexpectedly through islands in the Indian Ocean. But it was new to Europe.
And so Castiglione found itself at the center of scientists' efforts to map the effect of climate change on the spread of infectious disease. In December, at a Washington, D.C., conference sponsored by the Institute of Medicine, scientists and doctors wrestled with these questions: Did global warming bring chikungunya to Italy? Will it lead to a return of scourges like malaria, pushed out of Europe and the United States in the mid-20th century? Will epidemics worsen in poorer countries? . . . .
While they readily accept the associations between climate and infectious agents, scientists balk at stating exactly what a change in climate might cause. This reluctance lies both in the complexity of disease and in the nature of science, in the need to build a case incrementally, fact by fact. Asking a scientist to predict the spread of disease is like asking him or her, while standing in the midst of a tornado, to predict how the landscape will change by measuring the direction and amount of debris flying by.
Take the chikungunya debate: Initially hailed as a clear example of how warmer weather can lead to new epidemics, some experts pointed out that it was not global warming but a new mutation of the virus that made the fever increasingly infectious. Others argued that the reasons for the chikungunya epidemic lay in new routes for disease opened up by the global economy; in the 1990s, imported tires carried into Italy a mosquito known as "the Asian tiger," which can serve as a vector for chikungunya as well as dengue fever. . . . .
What is the alternative to endless discussion? Recent editorials in the New England Journal of Medicine and the Lancet call for accepting, even without 100 percent certainty, the accumulating body of evidence that climate change will affect infectious diseases. Doctors regularly make recommendations to patients based on what they think might happen. Gina Solomon, a physician and senior scientist for the Natural Resources Defense Council, points out that not knowing whether hypertension will hurt an individual patient does not stop a doctor from trying to bring his or her blood pressure down.
A different slant, put forth by Peter Schwartz and others at the consulting agency Global Business Network, sidesteps the need for scientific proof. Their "systems vulnerability approach" does not try to predict what will happen to the climate; rather, it identifies existing vulnerabilities in our world that could easily tip a region toward a new epidemic given the additional stress of climate change. A damaged Iraqi town without a clean water source is more vulnerable to a cholera outbreak if waters there warm, as they did in Peru. An unusually hot summer in a sprawling slum in Mexico City becomes the breeding ground for an epidemic of infectious diarrhea. We may not know precisely what causes what. But we don't have to sit back and wait to see what the weather will do.
February 4, 2008
Bush Budget: Cuts for Medicare and Medicaid
The Wall Street Journal's Health Blog provides a concise overview of the Bush budget for Medicare and Medicaid. Ms. Wang writes,
Medicare spending needs to be reigned in, the Bush administration makes clear in its budget proposal for fiscal year 2009. The $3 trillion proposed federal budget cuts Medicare and Medicaid funds by $14.2 billion, reports the Washington Post.
The plan would shave $560 billion from Medicare and Medicaid over the next decade but leaves alone subsidies to insurers totaling an estimated $150 billion, notes the WSJ. The Bush administration estimates the changes will result in a $10 trillion decrease in spending over the next 75 years. . . .
A bipartisan discussion of federal entitlements are being called for by some congressional leaders, says the WSJ, but most think the chasm between President Bush and the Congress is too wide to be bridged.
SEIU Puts Money Behind Universal Health Care
Ezra Klein updates us on the push for universal health care - writing about the recent decision of the SEIU to spend $75 million promoting universal health care (Take that Harry and Louise!). He writes,
It's a really big deal that SEIU has committed to a $75 million campaign for universal health care. More important, by far, than the opinions and strategies of the individual presidential candidates is the strength, commitment, and ferocity of the coalition pushing for reform. Politicians are, at the end of the day, politicians, and they will do only what they believe to be possible given the realities of the moment. SEIU's efforts, along with those of the many other groups I reported on in this article, will shape the moment. And they, not the candidates, are why we actually have a chance.