The study, released Monday, compares what the government anticipates the country will spend on health care through 2019 in its forecast released in 2015 versus what was expected through that period in 2010. The more recent forecast numbers take into account the actual spending from 2013, as well as the legislation passed by Congress in 2015 to permanently fix a major gap in Medicare funding. They also reflect how sequestration, the stunted economic recovery and a Supreme Court ruling that made Medicaid expansion optional for states affected overall health care spending. . .
Archive for the ‘Healthcare’ Category
Nina Martin reports in ProPublica:
Back in January, as the Supreme Court was preparing for its most important abortion case in a generation, some four dozen social scientists submitted a brief explaining why they believed key portions of Texas law HB2 should be struck down. The brief was a 58-page compendium of research on everything from the relative dangers of abortion vs. childbirth to the correlation between abortion barriers and postpartum depression. “In this politically charged area, it is particularly important that assertions about health and safety are evaluated using reliable scientific evidence,” the researchers declared.
Six months later, the material they submitted clearly helped shape Justice Stephen Breyer’s majority opinion in Whole Woman’s Health v. Hellerstedt, which found critical elements of HB2 unconstitutional. Less noticed, the decision also handed a resounding victory to private donors who’ve spent more than a decade quietly pouring at least $200 million into the scientists’ work, creating an influential abortion-research complex that has left abortion opponents in the dust.
The research initiative dates back at least to the early 2000s and became more urgent after the high court suggested in 2007 that in cases of “medical and scientific uncertainty,” legislatures could have “wide discretion” to pass laws restricting abortion. Since then, a primary objective of abortion rights supporters has been to establish a high level of medical certainty — both about the safety of the procedure and about what happens when a woman’s reproductive options are drastically curtailed or eliminated.
There’s little or no publicly funded research on this controversial topic in the U.S., so for years basic information was lacking — from how often patients have complications to what happens to women who want abortions but can’t obtain them.
Into this breach stepped the Susan Thompson Buffett Foundation, named for the late wife of one of the richest men in the world. Established in the 1960s, the philanthropic behemoth (it ranked fourth among family foundations in 2014 in terms of giving) is known for its focus on abortion access, training and more recently, prevention. It’s also known for its secrecy, often appearing under grant acknowledgements only as “an anonymous donor.”
The Buffett Foundation helped financethe development of the abortion drug RU–486 back in the 1990s. From 2001 to 2014, it contributed more than $1.5 billion to abortion causes, including at least $427 million to Planned Parenthood worldwide and $168 million to the National Abortion Federation — a track record that led one foe to call Warren Buffett the “sugar daddy of the entire pro-abortion movement.” In the past 15 years, it has also made research a core part of its strategic efforts, funding such organizations as the Guttmacher Institute, a policy think tank and advocacy group that tracks demographic and legislative trends ($40 million), and Gynuity Health Projects, which focuses on medication abortion ($29 million), as well as work by academics abroad. Other foundations supporting research on a smaller scale have included the William and Flora Hewlett Foundation, the David and Lucile Packard Foundation, the John Merck Fund, and the Educational Foundation of America. (Hewlett is also a funder of ProPublica.)
Buffett’s main academic partner (receiving at least $88 million from 2001 to 2014) has been the University of California, San Francisco, a medical research institution with a strong reproductive-health infrastructure. . .
Extremely interesting article (and chart): Availability of medical marijuana greatly reduces use of addictive opioid p
Christopher Ingraham writes in the Washington Post:
There’s a body of research showing that painkiller abuse and overdose are lower in states with medical marijuana laws. These studies have generally assumed that when medical marijuana is available, pain patients are increasingly choosing pot over powerful and deadly prescription narcotics. But that’s always been just an assumption.
Now a new study, released in the journal Health Affairs, validates these findings by providing clear evidence of a missing link in the causal chain running from medical marijuana to falling overdoses. Ashley and W. David Bradford, a daughter-father pair of researchers at the University of Georgia, scoured the database of all prescription drugs paid for under Medicare Part D from 2010 to 2013.
They found that, in the 17 states with a medical-marijuana law in place by 2013, prescriptions for painkillers and other classes of drugs fell sharply compared with states that did not have a medical-marijuana law. The drops were quite significant: In medical-marijuana states, the average doctor prescribed 265 fewer doses of antidepressants each year, 486 fewer doses of seizure medication, 541 fewer anti-nausea doses and 562 fewer doses of anti-anxiety medication.
But most strikingly, the typical physician in a medical-marijuana state prescribed 1,826 fewer doses of painkillers in a given year.
These conditions are among those for which medical marijuana is most often approved under state laws. So as a sanity check, the Bradfords ran a similar analysis on drug categories that pot typically is not recommended for — blood thinners, anti-viral drugs and antibiotics. And on those drugs, they found no changes in prescribing patterns after the passage of marijuana laws.
“This provides strong evidence that the observed shifts in prescribing patterns were in fact due to the passage of the medical marijuana laws,” they write.
In a news release, lead author Ashley Bradford wrote, “The results suggest people are really using marijuana as medicine and not just using it for recreational purposes.”
One interesting wrinkle in the data is glaucoma, for which there was a small increase in demand for traditional drugs in medical-marijuana states. It’s routinely listed as an approved condition under medical-marijuana laws, and studies have shown that marijuana provides some degree of temporary relief for its symptoms.
The Bradfords hypothesize that the short duration of the glaucoma relief provided by marijuana — roughly an hour or so — may actually stimulate more demand in traditional glaucoma medications. Glaucoma patients may experience some short-term relief from marijuana, which may prompt them to seek other, robust treatment options from their doctors.
The tanking numbers for painkiller prescriptions in medical marijuana states are likely to cause some concern among pharmaceutical companies. These companies have long been at the forefront of opposition to marijuana reform, funding research by anti-pot academics and funneling dollars to groups, such as the Community Anti-Drug Coalitions of America, that oppose marijuana legalization.
Pharmaceutical companies have also lobbied federal agencies directly to prevent the liberalization of marijuana laws. In one case, recently uncovered by the office of Sen. Kirsten Gillibrand (D-N.Y.), the Department of Health and Human Services recommended that naturally derived THC, the main psychoactive component of marijuana, be moved from Schedule 1 to Schedule 3 of the Controlled Substances Act — a less restrictive category that would acknowledge the drug’s medical use and make it easier to research and prescribe. Several months after HHS submitted its recommendation, at least one drug company that manufactures a synthetic version of THC — which would presumably have to compete with any natural derivatives — wrote to the Drug Enforcement Administration to express opposition to rescheduling natural THC, citing “the abuse potential in terms of the need to grow and cultivate substantial crops of marijuana in the United States.”
The DEA ultimately rejected the HHS recommendation without explanation.
In what may be the most concerning finding for the pharmaceutical industry, the Bradfords took their analysis a step further by estimating the cost savings to Medicare from the decreased prescribing. . .
I just watched the movie Spotlight, which is excellent and shows how the Spotlight team at the Boston Globe works. Just yesterday Spotlight began a new series on how the government has failed to provide care and support for the mentally ill, a vulnerable population that has been abandoned.
The article begins with some effective graphics, so I urge you to click the link and compare what the Spotlight team is finding in Massachusetts and how that might compare to what they would find in your own state. The article notes, “This story was reported by Michael Rezendes, Jenna Russell, Scott Helman, Maria Cramer, and Todd Wallack. It was written by Rezendes.” (Rezendes was played by Mark Ruffalo in the movie.) The text begins:
Nancy Chiero was making a cup of mint tea in the kitchen of her Uxbridge home that January morning.
It was a small, characteristically kind gesture toward her 35-year-old son, Lee, who had always worried her, and sometimes scared her, too. Also, unfathomably, it was a fatal one.
Lee’s life had been ruled by severe mental illness, the pattern of his repeated unravelings devastatingly familiar to his mother and family. A psychotic episode would send him to an emergency room. Once released, he would refuse to take his medications, the delusions would return, and the cycle would repeat. And repeat again.
Through it all, Nancy had remained devoted and unimaginably patient with him. There was no one else who would. He had been living in a basement bedroom of her home; he had nowhere else to go.
The cycle was repeating again now, in 2007, she could see, and in even more alarming form. Lee had been videotaping his conversations with her, suspecting her in a plot against him.
He suspected everyone. Lately, Lee had disconnected computers and even the electric power in the house to prevent his imagined enemies from spying. He made his mother drive him hours from home for grocery shopping to elude his pursuers. He’d come to believe he’d been abducted by aliens and abused by animals, and feared he would be again.
Finally, just before Christmas, Nancy had Lee rushed by ambulance to Boston’s Tufts New England Medical Center at the urging of his primary care doctor, who agreed that he had become dangerous. But at the hospital, Lee insisted he was fine and a Tufts psychiatrist released him after four days, concluding that he “did not seem to present a danger to himself and others.”
Now, alone in her kitchen, Nancy faced her son’s fevered imaginings armed only with a cup of tea. Mint is soothing, she said, adding that even animals took pleasure in the fragrant herb.
With little warning, Lee lunged at her, knocking her down the basement stairs, convinced that her casual comment referred to the animals that would sexually assault him after his abduction.
He pulled out the knife he carried for protection and began stabbing his mother in the eyes, demanding she confess.
“That’s what you get for following me around,” he said, ranting on, with his camcorder running.
Then, it was over.
In the sudden quiet Lee began to doubt that Nancy was really part of the conspiracy that had taken control of his life. She hadn’t confessed. And if the house was bugged, if his every move was being watched, why hadn’t anyone intervened? Why hadn’t anyone stopped him? Why was he suddenly so alone in the overwhelming silence of his mother’s home?
In the instant of her death at the hands of her son — a deeply troubled man discharged without restrictions from hospital care — Nancy Chiero wasn’t merely failed by the state mental health care system. She was her son’s mental health care system — or at least the only one he could rely on.
In a state that prides itself on leadership in human services and compassionate government, it has come to this, a Spotlight Team investigation has found: threadbare policies, broken promises, short-sighted decisions, and persistent underfunding over decades. As a result, the seriously mentally ill, including those at greatest risk of harming others or themselves, are far too often left in the care of parents, police, prison guards, judges, shelter workers, and emergency room personnel — almost anyone, in fact, but professionals trained to deal with their needs.
Families of these sufferers find themselves up against obstacles that earlier generations didn’t have to face. Fifty years ago, Lee Chiero might have been treated — and locked away — in one of the public psychiatric hospitals that once dotted Massachusetts.
Today, nearly all of those institutions have been bulldozed or boarded up — and many had to be, having evolved into inhumane asylums for people who are, in the great majority, no threat to anyone. But the hospitals were not replaced with anything resembling a coherent care system, leaving thousands of people with serious mental illness to navigate a fragmented network of community services that puts an extraordinary burden on them to find help and to make sure they continue getting it.
Even those beset by the most ferocious inner demons, such as Lee Chiero, are routinely pinwheeled from hospital to hospital, therapist to therapist, court to court, jail to jail, then sent off into the world with little more than a vial of antipsychotic medications and a reminder to take them. Chiero was hospitalized at least 10 times in a half-dozen hospitals over two decades before he killed his mother.
“I can’t tell you how many emergency rooms we visited to try and get him in,” said his sister, Gina.
This is the choice Massachusetts has made, a choice with deadly consequences. . .
And yet the public (at least, the public not directly affected) and the legislators have deliberately ignored this situation and shirked the state responsibility to support the most vulnerable.
Dave Philipps has a long and interesting article in the NY Times on a particular instance of a very familiar military phenomenon: The refusal to acknowledge something that went wrong, including lies, even though what happened was harmful to the troops. The article begins:
Alarms sounded on United States Air Force bases in Spain and officers began packing all the low-ranking troops they could grab onto buses for a secret mission. There were cooks, grocery clerks and even musicians from the Air Force band.
It was a late winter night in 1966 and a fully loaded B-52 bomber on a Cold War nuclear patrol had collided with a refueling jet high over the Spanish coast, freeing four hydrogen bombs that went tumbling toward a farming village called Palomares, a patchwork of small fields and tile-roofed white houses in an out-of-the-way corner of Spain’s rugged southern coast that had changed little since Roman times.
It was one of the biggest nuclear accidents in history, and the United States wanted it cleaned up quickly and quietly. But if the men getting onto buses were told anything about the Air Force’s plan for them to clean up spilled radioactive material, it was usually, “Don’t worry.”
“There was no talk about radiation or plutonium or anything else,” said Frank B. Thompson, a then 22-year-old trombone player who spent days searching contaminated fields without protective equipment or even a change of clothes. “They told us it was safe, and we were dumb enough, I guess, to believe them.”
Mr. Thompson, 72, now has cancer in his liver, a lung and a kidney. He pays $2,200 a month for treatment that would be free at a Veterans Affairs hospital if the Air Force recognized him as a victim of radiation. But for 50 years, the Air Force has maintained that there was no harmful radiation at the crash site. It says the danger of contamination was minimal and strict safety measures ensured that all of the 1,600 troops who cleaned it up were protected.
Interviews with dozens of men like Mr. Thompson and details from never before published declassified documents tell a different story. Radiation near the bombs was so high it sent the military’s monitoring equipment off the scales. Troops spent months shoveling toxic dust, wearing little more protection than cotton fatigues. And when tests taken during the cleanup suggested men had alarmingly high plutonium contamination, the Air Force threw out the results, calling them “clearly unrealistic.”
In the decades since, the Air Force has purposefully kept radiation test results out of the men’s medical files and resisted calls to retest them, even when the calls came from one of the Air Force’s own studies.
Many men say they are suffering with the crippling effects of plutonium poisoning. Of 40 veterans who helped with the cleanup who The New York Times identified, 21 had cancer. Nine had died from it. It is impossible to connect individual cancers to a single exposure to radiation. And no formal mortality study has ever been done to determine whether there is an elevated incidence of disease. The only evidence the men have to rely on are anecdotes of friends they watched wither away.
“John Young, dead of cancer … Dudley Easton, cancer … Furmanksi, cancer,” said Larry L. Slone, 76, in an interview, laboring through tremors caused by a neurological disorder.
At the crash site, Mr. Slone, a military police officer at the time, said he was given a plastic bag and told to pick up radioactive fragments with his bare hands. “A couple times they checked me with a Geiger counter and it went clear off the scale,” he said. “But they never took my name, never followed up with me.”
Monitoring of the village in Spain has also been haphazard, declassified documents show. The United States promised to pay for a public health program to monitor the long-term effects of radiation there, but for decades provided little funding. Until the 1980s, Spanish scientists often relied on broken and outdated equipment, and lacked the resources to follow up on potential ramifications, including leukemia deaths in children. Today, several fenced-off areas are still contaminated, and the long-term health effect on villagers is poorly understood.
Many of the Americans who cleaned up after the bombs are trying to get full health care coverage and disability compensation from theDepartment of Veterans Affairs. But the department relies on Air Force records, and since the Air Force records say no one was harmed in Palomares, the agency rejects claims again and again.
The Air Force also denies any harm was done to 500 other veterans who cleaned up a nearly identical crash in Thule, Greenland, in 1968. Those veterans tried to sue the Defense Department in 1995, but the case was dismissed because federal law shields the military from negligence claims by troops. All of the named plaintiffs have since died of cancer.
In a statement, the Air Force Medical Service said it had recently used modern techniques to reassess the radiation risk to veterans who cleaned up the Palomares accident and “adverse acute health effects were neither expected nor observed, and long-term risks for increased incidence of cancer to the bone, liver and lungs were low.”
The toxic aftermath of war is often vexing to untangle. Damage is hard to quantify and all but impossible to connect to later problems. Recognizing this, Congress has passed laws in the past to give automatic benefits to veterans of a few specific exposures — Agent Orange in Vietnam or the atomic tests in Nevada, among others. But no such law exists for the men who cleaned up Palomares.
If the men could prove they were harmed by radiation, they would have all costs for their associated medical care covered and would get a modest disability pension. But proof from a secret mission to clean up an invisible toxin decades ago has proved elusive. So each time the men apply, the Air Force says they were not harmed and the department hands out denials.
“First they denied I was even there, then they denied there was any radiation,” said Ronald R. Howell, 71, who recently had a brain tumor removed. “I submit a claim, and they deny. I submit appeal, and they deny. Now I’m all out of appeals.” He sighed, then continued. “Pretty soon, we’ll all be dead and they will have succeeded at covering this whole thing up.” . . .
Interesting how much better Louisiana is doing now that Bobby Jindal is no longer governor and the office is occupied by a Democrat. Tierney Sneed reports for TPM:
Since June 1, the first day Louisianans could sign up for the expanded program, more than 201,000 people have enrolled. The state is well on track to meet its 375,000-enrollee goal, which will save Louisiana an estimated $184 million in the next year.
Those numbers are even more remarkable given the obstacles facing the Edwards administration, namely the refusal of the GOP legislature to fund even one new employee to ease the transition to the expanded program.
“They say that necessity is the mother of invention,” Rebekah Gee, the secretary of Louisiana’s Department of Health and Hospitals, told TPM in an interview last week. “We certainly have had to think long and hard in the first weeks of the administration about how we were going to do it given that it was made clear to us that we were not going to have additional resources.”
Without any additional funding for the roll out — meaning no new state employees, no eligibility workers, nor any other new administrative tool to ensure that Louisianans were taking advantage of the expanded coverage — the state had to depend on the infrastructure of existing social service programs, whose participants were eligible for the Medicaid expansion.
The tactic had the dual advantage of saving the state money while creating an application process that was minimally burdensome for users and administrators alike. It was that creative approach, along with the assistance of non-governmental entities, that likely helped Louisiana achieve the numbers that it did. . .
Patrick G. Lee reports in ProPublica:
Mergers have become commonplace as hospital mega-chains increasingly dominate the American health-care market. But these deals often go unscrutinized by state regulators, who fail to address potential risks to patients losing access to care, according to a new report released today.
MergerWatch, which analyzes the hospital industry and opposes faith-based health care restrictions, surveyed health care statutes and regulations in all 50 states and the District of Columbia. It found that only 10 states require government review before hospital facilities and services can be shut down. Only eight states and the District of Columbia mandate regulatory review when hospitals enter into more informal partnerships rather than full-scale mergers, closing a loophole that exists in other states for deals to pass with minimal state oversight.
Smaller, local hospitals often agree to merge with larger chains in order to survive. The goal is to cut overlapping services, negotiate better deals with insurance companies and share in the cost savings. But without state protections, local residents can see health services disappear, sometimes without a chance to weigh in.
“In a number of states, there is no oversight at all. So hospitals are just doing what makes business sense for them,” said Lois Uttley, one of the report’s co-authors and the director of MergerWatch. “Someone needs to be looking out for the patients and the community.”
Sometimes the loss of services is ideological: As ProPublica and Mother Jones have reported, the expansion of Catholic hospitals in Washington State has led to restrictions on women’s health services and end-of-life counseling. Other times it’s just the bottom line: Expensive services such as pediatrics, obstetrics, emergency room and neo-natal intensive care may be downsized when a non-profit hospital is taken over by a for-profit one, according to the report.
Even when state regulatory programs exist, they often fail to protect consumers from reductions in health-care services. That’s because state oversight programs were largely written in the 1960s and 70s when hospitals were expanding and the main fear was duplication of facilities and services. Today, however, the opposite is happening: . . .