Brad Wright has posted Health Wonk Review: The New Wright on Health Edition. Check it out!
Brad Wright has posted Health Wonk Review: The New Wright on Health Edition. Check it out!
Michelle’s Let’s Move partnership with schools, businesses, and local leaders has helped bring down childhood obesity rates for the first time in thirty years – an achievement that will improve lives and reduce health care costs for decades to come.
This is great news. Of course, the first lady did not accomplish this feat single-handedly, but it’s always good politics to say nice things about your wife.
One last point on financial security. For decades, few things exposed hard-working families to economic hardship more than a broken health care system. And in case you haven’t heard, we’re in the process of fixing that.
A pre-existing condition used to mean that someone like Amanda Shelley, a physician assistant and single mom from Arizona, couldn’t get health insurance. But on January 1st, she got covered. On January 3rd, she felt a sharp pain. On January 6th, she had emergency surgery. Just one week earlier, Amanda said, that surgery would’ve meant bankruptcy.
That’s what health insurance reform is all about – the peace of mind that if misfortune strikes, you don’t have to lose everything.
This is the key contribution of Obamacare, decreasing uninsurance. The Affordable Care Act did so in a way that is likely unaffordable in the long-run without significant changes. At the individual level, however, having health insurance greatly decreases downside financial from serious health problems.
Already, because of the Affordable Care Act, more than three million Americans under age 26 have gained coverage under their parents’ plans.
The ACA allowed children under 26 to be covered by their parents plan. Prior to the ACA, only children under 18 or those enrolled in college could be covered on family plan.
More than nine million Americans have signed up for private health insurance or Medicaid coverage.
Again, coverage expansion is the key to the ACA. However, who will pay for the Medicaid expansion? Initially the federal government will foot the bill, but eventually most of this burden will shift to states. Will they be willing to continue to foot the bill for the increasing number of Medicaid beneficiaries?
And here’s another number: zero. Because of this law, no American can ever again be dropped or denied coverage for a preexisting condition like asthma, back pain, or cancer. No woman can ever be charged more just because she’s a woman. And we did all this while adding years to Medicare’s finances, keeping Medicare premiums flat, and lowering prescription costs for millions of seniors.
Not only does the ACA prevent denying coverage due to pre-existing conditions, but also health insurers cannot alter their rates based on health condition (only based on wide age bands and smoking status). If you are old or sick, this is certainly a good thing. However, it does distort pricing. Health insurers now have an incentive to target customers who are young and healthy. Older individuals are money losers.
Alternative proposals–such as the “Best of Both Worlds“–would allow the market to work freely and insurers can charge whatever price they would like. In this plan, insurers do not have an incentive to target healthy individuals. To counteract the result that health insurance would be prohibitively expensive for the old and sick, the government would subsidize health insurance based on individuals age and health status.
And if you want to know the real impact this law is having, just talk to Governor Steve Beshear of Kentucky, who’s here tonight. Kentucky’s not the most liberal part of the country, but he’s like a man possessed when it comes to covering his commonwealth’s families. “They are our friends and neighbors,” he said. “They are people we shop and go to church with…farmers out on the tractors…grocery clerks…they are people who go to work every morning praying they don’t get sick. No one deserves to live that way.”
Steve’s right. That’s why, tonight, I ask every American who knows someone without health insurance to help them get covered by March 31st. Moms, get on your kids to sign up. Kids, call your mom and walk her through the application. It will give her some peace of mind – plus, she’ll appreciate hearing from you.
I consider this part simply advertising for Healthcare.gov.
As this time of war draws to a close, a new generation of heroes returns to civilian life. We’ll keep slashing that backlog so our veterans receive the benefits they’ve earned, and our wounded warriors receive the health care – including the mental health care – that they need.
Military servicemen have an implicit contract: they risk their lives in combat in exchange for security and health care when they return to civilian life. I agree that providing health care for veterans is an important duty. The cost to improve the healthcare veterans receive will not be inexpensive. Nevertheless, politicians should weight these implicit promises next time the government considers going to war with another nation or rebel group.
I first met Cory Remsburg, a proud Army Ranger, at Omaha Beach on the 65th anniversary of D-Day…A few months later, on his tenth deployment, Cory was nearly killed by a massive roadside bomb in Afghanistan. His comrades found him in a canal, face down, underwater, shrapnel in his brain.
For months, he lay in a coma. The next time I met him, in the hospital, he couldn’t speak; he could barely move. Over the years, he’s endured dozens of surgeries and procedures, and hours of grueling rehab every day.
Even now, Cory is still blind in one eye. He still struggles on his left side. But slowly, steadily, with the support of caregivers like his dad Craig, and the community around him, Cory has grown stronger. Day by day, he’s learned to speak again and stand again and walk again – and he’s working toward the day when he can serve his country again.
“My recovery has not been easy,” he says. “Nothing in life that’s worth anything is easy.”
An anecdote that illustrates the point above.
In many countries with universal public health insurance, the government also provides subsidies for private insurance. Examples of this practice include Australia, Spain and the United Kingdom. Why do they do this? Is it a good idea?
There are arguments on both sides.
One metric to judge the benefit of these subsidies is whether the cost savings from reduced resource use in the public sector offsets the cost of these subsidies. In other words, are the subsidies self-financing. However, people who buy private insurance typically use more private and public health care. Is this due to the subsidy or are people who buy private insurance those who are either sicker, or who have strong preferences for more medical care?
A paper by Cheng (2014) uses data from the Household, Income and Labour Dynamics in Australia (HILDA) survey to answer the question. The paper finds that:
…individuals with private health insurance are more likely to seek hospital care as a private patient compared to those without private insurance. However, the intensity of hospital admissions and length of overnight stay do not differ between the insured and uninsured groups….reducing premium subsidies is expected to generate net cost savings to the public budget. To illustrate, a 10 percent reduction in rebates for instance is projected to lead to an increase in public expenditure that is either not statistically different from zero, or substantially smaller than the cost savings achieved through lower spending on premium subsidies.
Nevertheless, just because these subsidies are not cost savings, they may have value. Having a vibrant private sector is useful not only to increase the competition with the public. Thus, it may increase quality of care. Further, a vibrant private sector helps the public sector determine appropriate pricing for public services. Subsidies for private insurance may not be cost saving, but policymakers should think twice before abandoning them.
Both the stimulus bill (i.e., The American Recovery and Reinvestment Act of 2009 [ARRA]) and Obamacare (the Affordable Care Act [ACA]) contain provisions to increase funding for compariative effectiveness research (CER). According to a Deloitte Issue Brief,
ARRA provided the foundation for the ACA’s newly mandated and immediately effective CER entity, the Patient-Centered Outcomes Research Institute (PCORI). Bysponsoring scientifically rigorous CER studies, PCORI will be responsible for assisting patients, clinicians, payers, and policy makers in making informed health care decisions by advancing the quality and relevance of evidence.
How do different countries use comparative effectiveness research? This chart provides a nice summary.
Is Google going into the optometry business? You’ve probably heard of Google Glass, but recently Google has built a contact lens. The contact lens would not only improve your vision, but it could also monitor your diabetes levels.
From the Google Blog:
We’re now testing a smart contact lens that’s built to measure glucose levels in tears using a tiny wireless chip and miniaturized glucose sensor that are embedded between two layers of soft contact lens material. We’re testing prototypes that can generate a reading once per second. We’re also investigating the potential for this to serve as an early warning for the wearer, so we’re exploring integrating tiny LED lights that could light up to indicate that glucose levels have crossed above or below certain thresholds.
Some industry leaders are claiming that the Google contact lenses will be tied to Google Glass.
But how will the device be powered? How well does it work. The Washington Post reports:
Right now, the company said, it can get a level reading once every second. The lens also features a tiny antenna, capacitor and controller so that the information gathered from the lens can move from the eye to a device — such as a handheld monitor — where that data can be read and analyzed. It will draw its power from that device and communicate with it using a wireless technology known as RFID.
This blog has been a proponent of increased use of nurse practitioners and physician assistants to reduce the cost of health care. However, do they really reduce the cost of care? On the one hand, NPs and PAs cost less than physicians. On the other hand, if patients must visit an NP/PA and then a doctor for most conditions, costs would rise. Also cost would increase if the use of NPs/PAs increased hospitalization rates.
A study by Spetz et al. finds that NPs and PAs are cost saving in retail clinics.
Our results are consistent with prior research that found that retail clinic care was associated with lower total costs, compared to the cost of care received in other settings such as physician offices, urgent care clinics, and emergency departments, and that there was no indication that these clinics increased subsequent hospitalizations, compared to nonretail clinics.
However, some states allow NPs and PAs to practice independently, while other states require that they be supervised by or collaborate with physicians. This requirement prohibiting independent practice has a direct effect on cost.
We also found that when NPs were allowed to practice independently, the cost savings of retail clinic episodes were even greater than when they could not practice independently.
“I have not advocated the single payer model here because our government is too corrupt. Medicare is a large insurance company whose board of directors (Ways and Means and Senate Finance) accept payments from vendors to the company. In the private market, that would get you into trouble.”