Maybe it’s because cars are fun and we’re young when we start driving that we slide easily into the habit of paying automobile insurance. Or maybe it’s because cars are dangerous and our parents and/or the state wouldn’t let us drive without it. The metaphor of allowing beneficiaries to buy health insurance as they do car insurance (just this side of hoary when we used it back in 1998: http://tinyurl.com/98-story) left reality in the dust ages ago. It sounds so nice, but it’s still not happening, according to a Kaiser Family Tracking Poll released in April 2015 (http://tinyurl.com/KFF-poll).
This, despite all the talk of transparency and the overabundance of evidence that two providers can charge very different prices for the same procedure in the same town and get the same outcomes. This, despite the continuing shift in costs to beneficiaries. In the poll, 2 out of 3 people say that finding out how much doctors or hospitals charge is too difficult. Only 6% of people use quality rankings to make a decision about an insurer, doctor, or hospital.
In the land of Oz, you can take a pill that makes you lose weight. In the land of Oz, endive, red onion, and sea bass decrease the likelihood of ovarian cancer by 75%. In the land of Oz, acupuncture can help patients stop smoking, lose weight, and even avoid colds.
Mehmet Oz, MD, a national talk show host started his career as one of the best heart transplant surgeons in the world, practicing at Columbia and New York-Presbyterian Hospital.
Now, he’s under fire for allegedly peddling quackery. Ten physicians wrote to Columbia on Wednesday demanding that the school cut ties with the celebrity doctor who, they wrote, “has manifested an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.”
There are few issues that unite the political polarities these day, but there seems to be consensus emerging about this: We dump too many people in prison, including dumping them on a former coal ash landfill, a situation sparking controversy in a corner of Pennsylvania.
Liberals might see overpopulated prisons as resulting from, say, police profiling, while conservatives might believe, for instance, that there are just too many nonsensical laws on the books. The bottom line: The United States imprisons more people than any other country.
State Correctional Institution (SCI) Fayette County in Pennsylvania, housing 2,000 prisoners and opening in 2003, rests on top of a former coalmine and next to a 500-acre coal ash dump in rural Luzerne township. Not good and possibly unconstitutional, charge two human rights organizations, the Abolitionist Law Center (ALC) and the Human Rights Coalition (HRC) in a recently issued study (http://tinyurl.com/coal-prison).
They cite the Eighth Amendment, which forbids cruel and unusual punishment, and building a prison on a “massive toxic coal waste dump” might be just that. Over 40 million tons of coal waste had been dumped on the site “at depths approaching 150 feet in some places.” The study states that, “Ash is regularly seen blowing off the site … and collecting on the houses of local residents as well as the prison grounds at SCI Fayette.”
There’s a gap in the proverbial health care safety net that’s big enough for a whale to swim through.
People who are incarcerated, on probation, or on parole — what a recent study calls the “justice-involved population” — make up 22% of the 13 million newly eligible people.
“The justice-involved population has a higher disease burden than the general population, yet as many as 90% of justice-involved people lack health insurance at the time of their release from incarceration,” says the study, published in Health Affairs. “This disparity between disease burden and access can drive up the cost of health care, result in worse outcomes, and cause patients to seek care later than appropriate and in care settings that are often isolated and lack care coordination.”
Remember when many predicted that accountable care organizations (ACOs) will save health care? A study by the Health Research and Educational Trust (HRET) states that “ACOs are entities willing to be held accountable for the costs and quality of care for a defined population of patients. When the ACA [Affordable Care Act] became law, such would-be organizations were likened by some observers to unicorns — they exist in our imagination, but no one has actually seen one.” (Certainly not Regina Herzlinger, PhD, as we reported here.)
Harsh, perhaps, but a recent study by the Centers for Disease Control and Prevention searched in vain for the cost savings in Medicare ACO pilots. The HRET says that “only 25% of physician practices have joined or formed ACOs, and another 15% plan to do so.”
Health reform means that much of what health insurance plans did is being taken on by providers. An obvious example is the Choosing Wisely campaign, an effort by physician professional organizations to cut down on overtreatment and overtesting.
Everybody else always knew that they weren’t really invincible, and now they seem to be grasping that fact as well. More than 70% of people 30 and younger say that having health insurance is very important to them, according to a poll by the Kaiser Family Foundation (http://tinyurl.com/insured-youth).
New prescriptions were given to 232 patients from April to August 2010 at St. Michael’s Hospital in Toronto. Twenty-eight percent exhibited primary non-adherence at 7 days after discharge; 24 percent at 30 days. Perhaps more surprising is that patients discharged to home had a better adherence rate (26 percent) than those discharged to a nursing home (43 percent). There were no significant demographic differences between the adherent and non-adherent groups. Participants were all 66 or older; the average age was 78.
The appropriate cliché at the appropriate moment can have an impact. For instance, hearing “the right hand doesn’t know what the left hand is doing” in a hospital might be enough to spin you right back out the revolving door. You know the horror stories. Wrong limb amputated. Forgotten utensils cozying up to innards for the long haul. Those are the sensational examples, but care coordination — or lack of it — was and remains a vexing problem.
Many economists wonder if health insurance exchanges will actually perform one of their primary functions when they open in October — increasing the competition among health insurers offering products to millions of new beneficiaries. This according to Stateline, a wire service for the Pew Charitable Trusts (http://tinyurl.com/Pew-exchanges).