Archive for the ‘Healthcare’ Category
Once more we see expectations contradicted by experience. Paul Krugman notes in his blog:
For reference: I count at least six distinct predictions of Obamacare doom made by the usual suspects, not one of which has come true. Here they are:
1. Enrollment will be very low, and
2. Even if people sign up, they won’t pay their premiums.
Reality: Signups exceeded expectations, and the vast majority paid.
3. More people will lose coverage cancelled by Obamacare than gain it.
Reality: Sharp drop in the number of uninsured.
4. Rate shock.
Reality: Like it says, affordable care.
5. Young people not signing up, and death spiral.
Reality: Pretty good demographics.
Reality: Health costs are below anyone’s expectations.
It’s quite an impressive track record, actually. And what’s even more impressive is that none of the usual suspects will even consider admitting having been wrong.
Krugman has a good column today in the NY Times. From the column:
The goings-on at Veterans Affairs shouldn’t cause us to lose sight of a much bigger scandal: the almost surreal inefficiency and injustice of the American health care system as a whole. And it’s important to understand that the Veterans Affairs scandal, while real, is being hyped out of proportion by people whose real goal is to block reform of the larger system.
The essential, undeniable fact about American health care is how incredibly expensive it is — twice as costly per capita as the French system, two-and-a-half times as expensive as the British system. You might expect all that money to buy results, but the United States actually ranks low on basic measures of performance; we have low life expectancy and high infant mortality, and despite all that spending many people can’t get health care when they need it. What’s more, Americans seem to realize that they’re getting a bad deal: Surveys show a much smaller percentage of the population satisfied with the health system in America than in other countries.
And, in America, medical costs often cause financial distress to an extent that doesn’t happen in any other advanced nation.
How and why does health care in the United States manage to perform so badly? There have been many studies of the issue, identifying factors that range from high administrative costs, to high drug prices, to excessive testing. The details are fairly complicated, but if you had to identify a common theme behind America’s poor performance, it would be that we suffer from an excess of money-driven medicine. Vast amounts of costly paperwork are generated by for-profit insurers always looking for ways to deny payment; high spending on procedures of dubious medical efficacy is driven by the efforts of for-profit hospitals and providers to generate more revenue; high drug costs are driven by pharmaceutical companies who spend more on advertising and marketing than they do on research.
Other advanced countries don’t suffer from comparable problems because private gain is less of an issue. Outside the U.S., the government generally provides health insurance directly, or ensures that it’s available from tightly regulated nonprofit insurers; often, many hospitals are publicly owned, and many doctors are public employees.
As you might guess, conservatives don’t like the observation that American health care performs worse than other countries’ systems because it relies too much on the private sector and the profit motive. So whenever someone points out the obvious, there is a chorus of denial, of attempts to claim that America does, too, offer better care. It turns out, however, that such claims invariably end up relying on zombie arguments — that is, arguments that have been proved wrong, should be dead, but keep shambling along because they serve a political purpose.
The chart above, showing the US in its usual dead-last position for healthcare among developed countries, is from this report by The Commonwealth Fund. The first paragraph of the executive summary:
The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).
Emphasis added. It’s too bad that Congress cannot get its act together to improve our national healthcare system. There’s much that needs to be done.
The report is well worth reading, and Lenny Bernstein has an article on it in the Washington Post:
A report released Monday by a respected think tank ranks the United States dead last in the quality of its health-care system when compared with 10 other western, industrialized nations, the same spot it occupied in four previous studies by the same organization. Not only did the U.S. fail to move up between 2004 and 2014 — as other nations did with concerted effort and significant reforms — it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system.
“Although the U.S. spends more on health care than any other country and has the highest proportion of specialist physicians, survey findings indicate that from the patients’ perspective, and based on outcome indicators, the performance of American health care is severely lacking,” the Commonwealth Fund, a New York-based foundation that promotes improved health care, concluded in its extensive analysis. The charts in this post are from the report.
The data for the 2014 report was collected before the Affordable Care Act (aka Obamacare) went into full effect, so that reform may eventually boost the U.S. out of last place by providing health insurance to some of the 50 million people who lacked it. But, according to the study, the problems of our health-care system remain so pervasive that it will take more than better access and equity to resolve them.
Karen Davis, a professor in the Bloomberg School of Public Health at Johns Hopkins University and lead author of the study, said overall improvement “is a matter of accountability, having information on your performance relative to your peers and being held accountable to achieving a kind of care that patients should expect to get.” . . .
This is why government is so important: the government is not profit-oriented, so it can provide products and services without those having to generate (ever-growing) profits, unlike private capitalism industry. Capitalism is no doubt good for some things, but it’s hardly a universal solution. (A moment of silence to allow Libertarians to catch their breath.)
Here’s an excellent example, in a Gizmodo article by Robert Sorokanich:
In the Soviet Union, western antibiotics couldn’t make it past the Iron Curtain. So Eastern Bloc doctors figured out how to use viruses to kill infectious bacteria. Now, with antibiotic-resistant bugs vexing doctors, that eerie yet effective method might come our way. In post-antibiotic world, infection cures you!
The technique actually dates back thousands of years, in a very rudimentary form: people observed that the water from certain rivers could cure infectious diseases like leprosy and cholera. In the early 20th century, scientists figured out that these waters contained very specific types of viruses, which killed the bacteria that caused the infections. No bacteria, no infection.
You already know this from high school biology (of course), but a virus works by injecting its DNA into a living cell, hijacking the cell’s replication machinery to make more viruses. When the cell can’t hold all those replicated viruses any more, it explodes, releasing the baby viruses to continue the cycle again—and of course, killing the cell.
Bacteriophages are a type of virus that targets, you guessed it, bacterial cells. Starting in the 1920s, scientists in both the U.S. and Georgia (the country, not the Peach State) began purifying bacteriophages and using them to treat bacterial infections. But right around WWII, western medicine latched on to the miraculous power of antibiotics, leaving the Soviet Union to perfect what’s now called “phage therapy.”
(Tip: pronounce “phage” to rhyme with “rage.” Or rhyme it with “lodge” if you’re fancy.)
Fast forward to today. Western medicine’s (over)reliance on antibiotics has led to the evolution of new superbugs that can resist even our most powerful bacteria killers. And as Nature reports, that’s got researchers looking into phage therapy:
In March, the US National Institute of Allergy and Infectious Diseases listed phage therapy as one of seven prongs in its plan to combat antibiotic resistance. And at the American Society for Microbiology (ASM) meeting in Boston last month, Grégory Resch of the University of Lausanne in Switzerland presented plans for Phagoburn: the first large, multi-centre clinical trial of phage therapy for human infections, funded by the European Commission.
And there are some serious benefits to phage therapy. While antibiotics work indiscriminately, killing both the disease causing bacteria and the healthy, necessary bacterial bystanders, each type of phage is precisely targeted to one very specific type of bacteria.
The downside is . . .
And the key paragraphs on how capitalism fails for this beneficial treatment:
There are, of course, drawbacks. Isolating, purifying, and storing phages is a much more finicky and time-consuming process than producing traditional antibiotics. And then there’s the most practical of concerns: money. Since phages occur naturally, and their therapeutic use is nearly a century old, it would be incredibly difficult for a drug company to patent a phage therapy cocktail as intellectual property.
Indeed, the U.S. Supreme Court ruled last year that naturally-occurring genes cannot be patented, a law which would likely extend to phages. Like it or not, pharmaceutical companies are unlikely to invest in a therapy when they cannot ensure they’ll make that money back with a patent-protected product that can’t be copied by the competition.
Emphasis added. One can readily understand why companies will not invest in offering treatments that can cure millions if they cannot guard against competition. Despite the name “free private enterprise,” most companies detest free private enterprise, because it leads to competition, which can cut profits. Thus “free private enterprise” turns to the government in order to secure protection against competition by, for example, getting the government to issue patents. (Capitalists rely on government a lot, despite their protestations to the contrary.)
In the case of these therapies, there is clearly a role for the government to develop and produce the phages, since (a) private enterprise will not, and (b) phages are desirable for the general public welfare.
I don’t think government production of phages will happen in the US, however. Corporations and oligarchs have enough control of the government to kill anything that might threaten their profits, regardless of the benefits to the public. Note that the countries that use this (highly effective) therapy are Poland, Russia, and Georgia, all of which are accustomed to a more vigorous government role that the US lately will allow.
This is quite similar to the strong resistance pharmaceutical companies have shown about using marijuana as a treatment for various disorders (epilepsy, MS, PTSD, and so on): although marijuana usage has been demonstrated to be an effective therapy, there’s no money to be made from it—anyone can grow marijuana plants. So Big Pharma really does not want this sort of treatment around because it deprives them of an income stream from selling expensive meds for the same ailments. (Interestingly, Big Pharma also does not allow the government to compare effectiveness of new medications: new medications have to shown to be better than a placebo, but they do not have to be shown to be better than current medications already on the market.)
Bribery and corruption are so much a part of US politics now that they are conducted in the open. Here’s an article by Jim Newell in Salon giving context for the latest example:
Since late 2009, it’s been an untouchable article of faith among Republicans that the Affordable Care Act was passed under such murky, corrupt circumstances that the law itself will never be fully legitimate and wasn’t passed in good faith. Indeed, there was some horse-trading in Congress in order to enact the law. And the most infamous of those side-deals with Democratic senators was the “Cornhusker Kickback.”
Nebraska Sen. Ben Nelson was one of the most difficult holdouts for majority leader Harry Reid in late December 2009, as the Senate was trying to pass the ACA. Nelson was demanding, especially over language regarding federal funding for abortion. Even after a deal was cut on that, he needed something else. And so he got it: a carve-out in the Senate legislation in which the government promised to cover 100% of Nebraska’s Medicaid expansion. In other states, the deal was that the government would cover 100% of the costs for the first few years of implementation and then gradually reduce its commitment to 90%. (Still a good deal!) This secured Nelson’s vote, and the Senate was able to break a Republican filibuster and pass the ACA on Christmas Eve.
The backlash against the “Cornhusker Kickback” — the term of art coined by a proud Senate minority leader Mitch McConnell – was swift. Republicans wielded it as an objection to the ACA as a whole. And Democratic members and governors from other states were upset that they’d be receiving fewer dollars from the federal government than Nebraska. The deal backfired on Nelson, too, who wasn’t greeted so much as a hero at home for his masterful negotiations so much as he was heckled at local pizza parlors for being terrible and corrupt.
That’s why the “Cornhusker Kickback” never made it past the final hurdle into law. After the House passed the Senate bill in March 2010, the Senate passed a package of “fixes” including the removal of the “Cornhusker Kickback.” Even though the provision was eliminated in the end, however, “Cornhusker Kickback” has still served as an opponents’ rallying cry against the law, and the Medicaid expansion, ever since.
But it appears that corruption surrounding the Medicaid expansion is coming full circle. Because for whatever deals the Democrats made (and then later eliminated) to secure the Medicaid expansion, you should see what the other side’s up to now to ensure it’s never implemented.
One of the country’s hottest state legislative battles is in Virginia, where new Gov. Terry McAuliffe is trying to fulfill a campaign pledge to expand Medicaid and bring coverage to a supposed 400,000 eligible citizens. He’s being met with stiff Republican opposition. If an agreement can’t be worked out and a budget deal isn’t cut by July 1, the state government will shut down. Key to McAuliffe and the Democrats’ plans was control of the state Senate, which is split 20-20 but controlled by Democrats since there’s a Democratic lieutenant governor.
But McAuliffe’s plan has suddenly, and shockingly, taken a turn for the worse. As the Washington Post reports, Republicans are poised to take control of the state Senate now through an act of quid pro quo corruption so brazen it would even make John Roberts blush: . .
And here is Laura Vozella’s story in the Washington Post:
Republicans appear to have outmaneuvered Gov. Terry McAuliffe in a state budget standoff by persuading a Democratic senator to resign his seat, at least temporarily giving the GOP control of the chamber and possibly dooming the governor’s push to expand Medicaid under the Affordable Care Act.
Sen. Phillip P. Puckett (D-Russell) will announce his resignation Monday, effective immediately, paving the way to appoint his daughter to a judgeship and Puckett to the job of deputy director of the state tobacco commission, three people familiar with the plan said Sunday. They spoke on the condition of anonymity because they were not authorized to discuss the matter.
The news prompted outrage among Democrats — and accusations that Republicans were trying to buy the Senate with job offers in order to thwart McAuliffe’s proposal to expand health coverage to 400,000 low-income Virginians.
Del. Scott A. Surovell (D-Fairfax) said Republicans were unable to win the policy argument about Medicaid expansion, so they have resorted to other means.
“It’s astounding to me. The House Republican caucus will do anything and everything to prevent low-income Virginians from getting health care. . . . They figure the only way they could win was to give a job to a state senator,” Surovell said. “At least they can’t offer Terry McAuliffe a job. I hope Terry continues to stand up to these bullies.”
Puckett, a senator since 1998, did not respond to calls seeking comment. Other Republicans denied that Puckett was offered the jobs in exchange for his resignation.
This story in the Austin-American is why I have so little patience with those who (like Obama) said that Edward Snowden should have gone through channels. Going through channels is designed to forestall bad information getting out. I am astonished that President Obama is unaware of this, but that does explain why he seems so out of touch. (Cf. Healthcare.gov rollout: they went through channels.) Jeremy Schwartz writes:
Brian Turner, a Department of Veterans Affairs employee who reported fraudulent scheduling practices in Austin and San Antonio, said Friday that VA officials attempted to stop him from speaking publicly, pinned blame on low-level scheduling clerks and conspired to cover up his allegations by falsely telling the media he had recanted.
Turner’s claims, first reported by the American-Statesman on May 6, quickly led to calls for investigations and were a key part of a wave of allegations that ultimately led to Friday’s resignation of VA Secretary Eric Shinseki.
Yet on a day when President Barack Obama called for a change in the culture within the VA, Turner detailed how San Antonio VA officials tried to discredit his allegations and intimidate him into silence.
According to a letter obtained exclusively by the American-Statesman, sent Friday by Turner’s attorney Eric Pines to the House Committee on Veterans Affairs, the problems began soon after he began reporting scheduling manipulation to his superiors in late April.
According to Turner, who works at San Antonio’s North Central Federal Clinic, scheduling clerks in Austin, San Antonio and Waco were regularly told to enter false scheduling information to make it appear that wait times for appointments were far shorter than they really were. In one scheme, he said, schedulers were told to “zero out” wait times by using the actual appointment date instead of the date requested by veterans or doctors.
On April 25, Turner says he was ordered by Marie Weldon, director of the South Texas Veterans Health Care System, through an intermediary to stop emailing or asking about VA scheduling practices.
On May 2, Turner says that Zachary Selover, chief of medical administrative service for the San Antonio VA, convened an unannounced meeting of scheduling clerks. “Mr. Selover forcefully placed pressure on the clerks to take responsibility for the VA’s improper scheduling practices, while claiming that he and other supervisors were unaware of the fraudulent practices,” the letter reads. When challenged by Turner, “Selover began yelling and screaming at Mr. Turner, causing him to incur an anxiety attack.” . . .
GOP members of Congress are, no surprise, that it’s not their fault for cutting funding for the VA. I imagine they were chanting, “Do more with less. Think outside the box. Work smarter not harder—oh, hell, work harder, too.” and so on.
Kevin Drum offers some good insights in the source of the problems and why they showed up in Phoenix first.