Blue Mass Group

Reality-based commentary on politics.

“Sobering realities of health reform in MA” (with poll)

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This Slate article caught my eye.  

On paper, the experiment was a resounding success. According to an Urban Institute estimate, the number of uninsured residents quickly fell from 13 percent to 7 percent following the law’s passage.

And yet, something strange happened. Despite having health insurance, roughly one in 10 state residents still failed to fill prescriptions, ended up with unpaid medical bills, or skipped needed medical care for financial reasons.

Hundreds of millions of dollars were spent to insure more Massachusetts citizens, but many people still weren’t getting necessary care. What happened?

The article aligns with what I thought was a dicey MTF analysis featured on BMG declaring our state’s plan a success.  

Still, I don’t know of many people in MA who bemoan the reform…most folks simply kept their coverage, not much changed.  

Politically, it seems a safe way for the President to move forward.  It’s just not going to help us much in the long run.  

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  1. We’re only addressing the healthcare payment system in all the hullabaloo about healthcare “reform”. That’s only the tip of the iceberg; the real problem is healthcare costs. We have a very expensive healthcare system, and not the most effective one either. Most industrialized countries have better life expectancies, lower childhood mortality rates, and beat us on most other measures of health.

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    p>We have more expensive specialists and technology, and use them more, than other countries. Those expensive specialists and technology are not necessarily, as we’re being led to believe, emblematic of the world’s best healthcare system. They are expensive. High quality? Who lives longer?

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    p>Our diet and lifestyle: high sugar, high salt, low fiber. More factory food and less real food. More guns. Less exercise. We drive more and walk less. Childhood obesity (sorry that is not a genetic change in just 30 years) and diabetes. As diets change, so do health indicators.

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    p>I’ve been to other countries, so have many of you. Did the people there look diseased, malnourished, deprived? Probably not, at least not in an industrialized country. How much do they pay for health? Who lives longer?

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    p>Expensive does not necessarily equal quality. Ask Cadillac. Or Lincoln.

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    p>Look around Boston. Our fabled teaching hospitals have more technology than some whole countries. Are we healthier? If the amount of technology and the number of specialists and teaching hospitals correlated with high quality healthcare we here in Massachusetts would have biblical life expectancies. We don’t.  Pittsfield, Springfield, the Cape any sicker because they don’t have a teaching hospital within walking distance? Bostonian’s health isn’t any better than anybody else’s.

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    p>I worked in one of those teaching hospitals for a long time, still have family and friends that work in them. They do provide great care. But is that where the care should take place? Is it the right care at the right time? Are there other systems that might have avoided that – expensive – care, yet produced comparable or better outcomes? Who lives longer?

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    p>It doesn’t really matter whether we have 1, 2, 3, 30, 40, or 1000 payors. It doesn’t matter who pays for health insurance. What matters is what we get for our money, and if can we do it cheaper and better. That’s where healthcare reform lies, in driving the cost out of the system.

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    p>That’s why the AMA has always fought healthcare reform, they know that it will drive out expensive specialists in favor of more general practitioners. But who lives longer?

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    p>As we argue about who pays for healthcare we need to also address how much we spend for health, and who gets the money.

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    p>Just my .014 euros

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    p>

    • Sure there are ways to drive down the cost.  

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      p>But at some point, the issue who decides when we get LESS care, right?  

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      p>You’re willing to forego technology in your care.  

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      p>Lots of folks aren’t.  

      • People are not willing to forego technology that they think might help. People would be willing to forego technology that their doctor doesn’t recommend. Doctors likely would not recommend technology that’s been proven not to work, or not to work better than some simpler, cheaper technology. That is indeed less care.

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        p>That’s why we need comparative effectiveness research.

        • technologies are needed for life threatening disease diagnosis.  But often the high cost care and specialists are used when not needed, even when the patient questions the need for more services.
          It’s true there is a fear that tests and referrals won’t be given when truly needed, but in a healthcare setting, you would expect that you are being treated by reasonable and caring individuals who will tell you the truth about what your needs are, and not just send you off for this test and that for no other reason but the payout.

      • More appropriate care, maybe.

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        p>The question remains we have all this expensive technology and people, but are we healthier?

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        p>Are you healthier?

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        p>All those expensive machines and buildings on Longwood Ave. would pay for lots of prenatal care, vaccines, checkups, and other stuff that we know improves health and wellness for a lot of people. Not saying the fancy stuff isn’t needed or that people don’t benefit from it. Just saying we might have too much of that stuff and not enough of other resources.

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        p>We mistake expensive care for higher quality care, and that’s not necessarily true. Less expensive care might produce similar or better health.

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        p>Other countries have less of this stuff and better health indicators.

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        p>Just sayin’ might be something to that. Who’s healther, us or the Canadians, Japanese, Singaporese, Europeans? Or the 41 other countries with longer life expectancies?

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        p>Here’s some stuff (couple years old, but still relevant (WaPo article here:http://www.washingtonpost.com/wp-dyn/content/article/2007/08/12/AR2007081200113.html)

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        p>

        Americans are living longer than ever, but not as long as people in 41 other countries.

        For decades, the United States has been slipping in international rankings of life expectancy, as other countries improve health care, nutrition and lifestyles.

        Countries that surpass the U.S. include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands.

        “Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries,” said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.

        A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.

        Andorra, a tiny country in the Pyrenees mountains between France and Spain, had the longest life expectancy, at 83.5 years, according to the Census Bureau. It was followed by Japan, Macau, San Marino and Singapore.

        The shortest life expectancies were clustered in Sub-Saharan Africa, a region that has been hit hard by an epidemic of HIV and AIDS, as well as famine and civil strife. Swaziland has the shortest, at 34.1 years, followed by Zambia, Angola, Liberia and Zimbabwe.

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        p>Worse:

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        Forty countries, including Cuba, Taiwan and most of Europe had lower infant mortality rates than the U.S. in 2004. The U.S. rate was 6.8 deaths for every 1,000 live births. It was 13.7 for Black Americans, the same as Saudi Arabia.

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        p>To sum:

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        p>

        Murray, from the University of Washington, said improved access to health insurance could increase life expectancy. But, he predicted, the U.S. won’t move up in the world rankings as long as the health care debate is limited to insurance.

        Policymakers also should focus on ways to reduce cancer, heart disease and lung disease, said Murray. He advocates stepped-up efforts to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar.

        “Even if we focused only on those four things, we would go along way toward improving health care in the United States,” Murray said. “The starting point is the recognition that the U.S. does not have the best health care system. There are still an awful lot of people who think it does.“

        (emphasis mine)

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        p>Not seeing how the world’s “less” care is worse than our “more” care. It’s not how much you spend, it’s what you spend it on.

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        p>Another .014 euros

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  2. The Republican bemoan the $1T over 10 years to cover the rest of the citizens, but ignore that we are paying $2.3T per year now, with an escalation well above inflation.

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    p>Get that 16% of GDP down around 10% with all citizens covered and keep it there!

  3. Massachusetts-style reform is part of what Obama is doing, but the key piece in Obama’s plan is a public health care option for everyone.  Massachusetts only has a sort-of-public plan, Commonwealth Care, which is administered by private health insurance companies, and even that is only available to people under 300% of poverty.  So the state pays for it and acts as middleman, but it’s not really a public plan and it’s not for everyone.

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    p>What Obama should do is what he said he’d do and what he’s advocating for now.  It’s not the same as what we did in MA.

  4. in healthcare.  The cost. The way doctors and hospitals do business. Healthcare reform did not cut the cost of healthcare at all.  One problem that I am seeing more and more is referrals to specialists for the most minor of issues.

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    p>Let’s take the case of acne. A treatable and non-life threatening illness. A child presents to his pediatician with small bumps on the chin. The child is 10 years old.
    Pediatrician states, “it looks like acne, but I’m not 100% sure”, and refers patient to dermatologist.  Parent asks doctor if we can just treat for acne to see if it goes away. Pediatrician says no.  Parent takes child to dermatologist. Diagnosis–acne. Patient is treated.

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    p>There is absolutely no reason why the pediatrician could not have prescribed the cream needed to treat what she was almost certain was acne.  If it didn’t work, the child could then have been referred to a determatologist. Instead,there was an additional $300 doctor visit, which was paid partly by the insurance company.

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    p>During a physical exam, the doctor states patient should eat low fat diet because of high cholesterol  Then charges $50. for nutrition counseling. And that’s above and beyond the $350. charge for the Complete Physical Examination.  It seems to me a few words about nutrition could be included in the charge for the CPE.

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    p>So I think the issue of how healthcare is provided and charged for needs to be addressed as well as reforming the health insurance system.

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    p>I really have not done that much research on the Mass Healthcare mandate, because I already have coverage. There needs to be an overhaul of the healthcare system, not just on the insurance side, but on the provider side. The system is driving the price way out of reach for any reasonable person, insurer, or government to afford.

  5. Low wage workers who work for employers that provide health insurance are required to pick up the company insurance as long as the employer pays a certain share of the premium (I think the minimum is 50%).

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    p>So if you make $12/hour you’re stuck with a serious expense that is very difficult to afford, even if your employer pays 75% of the cost of the premium.  And because your employer offers this health insurance, you have no access to the subsidized Mass Connector plans.

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    p>One example I know of is a plan that costs employees $117.75/mo for individual coverage and $308.86/mo for family.  Try paying that on $12/hour.  And that’s only 25% of the premium costs and is before any copays/deductibles (the plan has a $1000 inpatient deductible).  

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    p>Of course there are cheaper plans but they have significantly higher deductibles.  And I’m sure there are much worse stories.  

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    p>All of this is arguably better than having no health insurance, but it’s still a tough assignment.

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    p>

    • and have lived it also.  The premiums are so high, and can eat nearly a whole paycheck.  I hear many woman say they work only for medical benefits for the family, because once they pay for child care, and then the health insurance premium, they come home with nearly nothing in there paycheck.  

      • is that many of those have high deductibles and co-pays. After they finish paying the insurance, they have no money left over to see a doctor.

  6. When looking at life expectancies across the globe, do the statisticians exclude death by homicide? The US has more homicide than most EU countries and that could skew the life expectancy data. I would be curious to see the data without homicide.

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    p>Also, the US is just different from a lifestyle perspective vs most other countries. In scandanavian countries a new employee receives 6 weeks of vacation on day one. Here, you would need to work for about 10 years for one ocmpnay to have 6 weeks of vacation. Hours worked also skew health stats, the US is the most productive workforce in the world, working alot can have a negative impact on health. There is no doubt the care in the US is the best in the world, without it our life expectancy rates would be even lower. To save real money in health you need to spend less at the end of someones life and spend more on the next child being born. I know a man about to have bypass surgery at the Brigham who is 95 years old, why would you do that to a man, the complication he could have will be tremendously painful and for what gain? The reason he is having it becuase the system is set up to deliver on demand, the patient has a “right: to the same care as a 41 year old, the surgoen makes more money if he does more surgery, the hospital makes more for more complicated patient. The only way to save money is to “Just say no” to surgery, to chemo, to hip replacement, then you save billions that could be used to give free healthcare to anyone you like.  

    • the United States used to have the best medical care in the world.

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      p>According to our own Central Intelligence Agency, we are not near the top; we are a distant dead last among industrialized countries, (2009)

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      44th in infant mortality, between Cuba and the Faroe Islands.
      50th in life expectancy between Wallis and Futuna and Albania.

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      p>Kaiser Foundation Study (2005) lists Maternal Mortality

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      48th between Singapore and Suriname

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      p>http://www.globalhealthfacts.o…

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      p>We are dead distant last among the 19 industrialized countries analyzed for preventable deaths due to treatable medical conditions:

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      Preventable deaths due to treatable conditions per 100,000 pop, (US Health Foundation 2008):
      US 101
      Australia 71.3
      Japan 71.2
      France 64.8

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      p>The US is sending 1.5 million “medical tourists” abroad for surgery and procedures this year, far surpassing any other nation.

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      p>The US developed the #1 health care delivery system in the world and then failed to modernize and make improvements. This would be like driving around in a 1937 Ford and insisting it is the best car in the world.

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      p>Would voters find it acceptable if our military was ranked #50? If we had not modernized and improved our military systems since the 1960’s, we might be transporting our soldiers by boat.

      • a. our treatment system

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        p>or

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        p>b. lots of fat people

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        p>i suppose you could try to argue that if we pass obama’s health care plan, we’ll see a significant reduction in obesity.

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        p>but i’d bet against it!  

        • its not likely to reduce obesity.

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          p>But it will lower maternal and infant mortality, decrease preventable deaths, and increase life expectancy.

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          p>Those countries that adopted universal health care started out behind the US and then moved ahead of the US. Wouldn’t you love to see those results repeated in our country?

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          p>The added benefit of lowering costs:
          insurance overhead per capita
          US $553 (2008)
          Australia $93 (2006)
          Canada $147 (2008)
          Germany $185 (2006)
          Netherlands $190 (2006)
          Switzerland $195 (2006)

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          p>And finally making American business more competitive in a global market, by removing health insurance costs from their overhead.

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          p>The explosion of obesity and asthma and allergies, kind of follows the timeline of deregulation of the US food supply….at the same time the rest of the world was tightening their food safety regulations. Why do you think this epidemic seems to be affecting the US?

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          p>

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