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Archive for the ‘Healthcare’ Category

The price of inaction: Half a billion dollars from Michigan State. What will USC pay?

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Will Hobson and Cindy Boren report in the Washington Post:

Michigan State has agreed to pay $500 million to 332 alleged victims of disgraced former sports physician Larry Nassar, settling lawsuits filed by the victims, both sides announced Wednesday.
“This historic settlement came about through the bravery of more than 300 women and girls who had the courage to stand up and refuse to be silenced,” said John Manly, one of several attorneys representing victims, in a statement. “It is the sincere hope of all of the survivors that the legacy of this settlement will be far reaching institutional reform that will end the threat of sexual assault in sports, schools and throughout our society.”
The settlement will pay $425 million to the 332 girls and women who have come forward to date, averaging about $1.28 million per victim. Michigan State will set aside an additional $75 million in a trust fund for any victims who come forward in the future.
“Michigan State is pleased that we have been able to agree in principle on a settlement that is fair to the survivors of Nassar’s crimes,” said Robert Young, a lawyer for the university.
The settlement does not apply to other organizations still facing lawsuits over Nassar’s abuse, including the United States Olympic Committee, USA Gymnastics and famed former Olympic coaches Bela and Martha Karolyi.
Penn State University paid out $109 million to 35 victims in the Jerry Sandusky scandal. . .

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So what will USC’s inaction and coverup cost? Jennifer Medina reports in the NY Times:

For decades, medical staff at the University of Southern California complained about inappropriate touching of students during pelvic exams by a gynecologist at the campus health center. On Tuesday, the university admitted it failed to respond to the accusations strongly or quickly enough.

The scandal comes at a difficult time for the university, which was rocked last year by reports that the former dean of the medical school had spent months partying with criminals and using drugs on campus, and was forced to resign.

In 2016, the university conducted an internal investigation, which concluded that the doctor’s pelvic exams may have been inappropriate and that he had repeatedly made racially and sexually offensive remarks to patients. The doctor, George Tyndall, agreed to retire under a separation agreement last summer, a year after he was suspended, U.S.C. officials said Tuesday.

But university officials did not make a report about Dr. Tyndall to the California Medical Board until earlier this year, after he wrote a letter asking the university for reinstatement. Officials now say that was a mistake. The university made the investigation public after it was contacted by The Los Angeles Times, which first reported the complaintsabout Dr. Tyndall on Tuesday.

“In hindsight, we should have made this report eight months earlier when he separated from the university,” C. L. Max Nikias, the president of U.S.C., wrote in a letter sent to all students and staff earlier Tuesday.

Mr. Nikias said that there had been repeated complaints about Dr. Tyndall dating back to 2000, which “were concerning enough that it is not clear today why the former health center director permitted Tyndall to remain in his position.”

In its report, The Los Angeles Times found that Dr. Tyndall was not suspended until a frustrated nurse turned to the rape crisis center on campus in 2016.

In its statement, the university did not directly address the most serious allegations of misconduct unearthed by The Los Angeles Times, which were based on extensive interviews with students and university employees as well as documents. The newspaper reported that Dr. Tyndall often photographed women’s genitals, moved his fingers in and out during pelvic exams, and in one case asked a woman if he could keep the IUD he had just removed from her. In recent years, Dr. Tyndall appeared to be targeting students from China. . .

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Institutions for some reason really, really do not want to recognize internal wrong-doing.

Written by LeisureGuy

16 May 2018 at 9:21 am

Medicaid Work Requirements and the Politics of Whiteness

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Written by LeisureGuy

14 May 2018 at 5:36 pm

3 States Are Pushing Medicaid Reforms That Discriminate Against Black People

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Ed Kilgore writes in New York:

Frustrated in their congressional efforts to “reform” Medicaid by ending its status as a personal entitlement and rolling back the expanded coverage that 32 states have chosen under the Affordable Care Act, Republicans in many states are now seeking to pare back Medicaid eligibility through work requirements that they hope will discourage enrollment. They’ve largely been given a green light by the Trump administration via waivers. But a new wrinkle in the way these requirements are drawn up is driving concerns (and lawsuits) based on suspicion that the idea is to make urban minority folk work while exempting rural white beneficiaries.

Kentucky secured a waiver to introduce Medicaid work requirements back in January, and there the way the new rules are being phased in has already drawn negative attention, as Alice Ollstein explains:

The waiver in Kentucky, the first state to win federal approval for a Medicaid work requirement, will have the effect of exempting eight southeastern counties where the percentage of white residents is over 90 percent. The work requirements will be imposed first in Northern Kentucky, which includes Jefferson, the county with the highest concentration of black residents in the state.

In a pending waiver request from Ohio, and in a bill passed by the GOP-controlled legislature in Michigan, counties with high unemployment rates are exempted from the work requirements entirely. These tend to be heavily white rural areas. Meanwhile, low-income African-Americans tend to be concentrated in large counties where low unemployment in relatively wealthy suburbs keep the inner cities from qualifying for the exemption.

John Corlett, Ohio’s former Medicaid director and the president of Cleveland’s Center for Community Solutions, studied the 26 counties that qualify for an exemption from the proposed Medicaid work requirements and found they are, on average, 94 percent white. Meanwhile, his research found, “most of these non-exempted Ohio communities have either majority or significant African-American populations.”

The same is true in Michigan, where the discriminatory impact of the proposed work requirement has gotten significant national attention, and not in a good way. The Washington Post looked at Medicaid data from the state and found a pretty dramatic disparity:

African Americans make up about 23 percent of that [Medicaid] population, but they would make up only 1.2 percent of the people eligible for the unemployment exemption. White people make up 57 percent of the total potential affected population, but they make up 85 percent of the group eligible for the unemployment exemption, according to an analysis of the state’s data.

The bill is still awaiting action from Michigan’s Republican governor, Rick Snyder. If he signs it, Michigan will get in line for its own waiver from the Trump administration. Based on the Kentucky precedent, the odds are high they’ll get approval.

Writing in the New York Times, two law professors from the University of Michigan suggested that any such waiver could and would be challenged under civil-rights laws. But they go on to address the underlying issue that supporters of Medicaid work requirements keep dancing around:

There’s a deeper lesson here. If work requirements were a good idea, conservative Michigan legislators wouldn’t need to exempt their rural constituents. They’d just offer a tough-love message: If you want health insurance on the public dime, you should move to a place where you can find work.

That’s not the message, though. The message, instead, is that work requirements are good for people who live in hard-bitten cities and bad for those who live in hard-bitten counties. . .

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And to think that some people claim that the US is a racist country!

Written by LeisureGuy

14 May 2018 at 2:25 pm

Americans are starting to suffer from Trump’s health-care sabotage

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The Washington Post editorial board writes:

IT IS a tribute to the resilience of the United States’ public and private institutions that, despite President Trump’s incoherent management, the country has, by many measures, continued to improve, notching its lowest unemployment rate since 2000 in the latest federal employment update. But the effects of the president’s underinformed instincts, enabled by the ideologues in his administration, are beginning to show up in some of the numbers, representing real pain that Americans are suffering for Mr. Trump’s deficient leadership.

The Commonwealth Fund, a nonprofit foundation focused on health-care issues, announced last week that the rate of working-age Americans without health insurance in the group’s annual survey rose to 15.5 percent, up about three percentage points since 2016. Things are worse in the 19 holdout states, such as Virginia, that have refused to expand their Medicaid programs: The rate of uninsured working-age Americans hit 21.9 percent in those areas, up nearly six percentage points over two years. Nationally, the spike has been particularly bad at the modest end of the income scale, rising nearly five percentage points since 2016 for low-income, working-age Americans.

Obamacare critics regularly describe all problems as the inevitable result of a poorly designed law. But the numbers suggest that the critics’ sabotage efforts are to blame. After impressive declines during President Barack Obama’s second term, the fund found that the uninsured rate increased in both of the years Mr. Trump has been in office. During the campaign, Mr. Trump regularly complained that the Affordable Care Act (ACA) left too many Americans uncovered. The result of nearly a year and a half of Mr. Trump’s leadership is 4 million people added to that group.

Obamacare was never perfect. But Commonwealth Fund analysts noted that, rather than fixing the law’s problems, Republicans have done concrete things to worsen them. “These include the administration’s deep cuts in advertising and outreach during the marketplace open-enrollment periods, a shorter open enrollment period, and other actions that collectively may have left people with a general sense of confusion about the status of the law,” they wrote. “Signs point to further erosion of insurance coverage in 2019: the repeal of the individual mandate penalty included in the 2017 tax law, recent actions to increase the availability of insurance policies that don’t comply with ACA minimum benefit standards, and support for Medicaid work requirements.”

Former health and human services secretary Tom Price, an architect of the GOP’s anti-Obamacare campaign, admitted last week that repealing the law’s requirement that all Americans carry health coverage means that “you’ll likely have individuals who are younger and healthier not participating in that market, and consequently that drives up the cost for other folks within that market.” Indeed, the fund found that 5 percent of non-elderly adults plan to drop coverage in response to the mandate repeal. That number may seem small, but if it is younger and healthier people dropping out, it will raise costs for everyone else.

States must do their best to fill gaps. They can  . . .

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Written by LeisureGuy

11 May 2018 at 12:03 pm

Rooney Style 1 Size 1, Phoenix Artisan Honeysuckle, and the Baili BR171

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Extremely nice shave this morning. Phoenix Artisan’s Honeysuckle shaving soap has the fragrance of spring and summer, and the Rooney Style 1 Size 1 seemed to enjoy making the lather—I certainly did.

Three passes of the excellent Baili BR171 left a totally smooth face, happy to receive a good splash to Honeysuckle aftershave splash.

Yesterday was my first real experience with Canadian healthcare, which began with a doctor visit, was resulted in a referral to the hospital ER for a more thorough workup including a CT scan. No problems were found (the presenting problem was intermittent disequilibrium): brain, heart, etc., checked out fine. No sign of a tumor, for example. One reasonable explanation: inflammation or fluid in the middle ear. There was the usual sort of waiting that one encounters in ER visits, perhaps exacerbated by the need for the CT scan. At the end of the day, though, we paid zero. No co-pay, no fees. Well, parking: hospital parking was CDN$3 (US$2.33) for 2 hours. And so far as I could tell, the care was excellent (though I’ve noticed that doctors these days strike me as quite young). And there will be no follow-up paperwork or follow-up arguments with Blue Cross Blue Shield or other insurance company.

Update: Also, no preauthorization arguments, with some clerk at the insurance company trying to override the doctor’s orders. It was very simple: doctor wrote the order, the hospital ER accepted it, and the tests were done. No red tape.

Written by LeisureGuy

1 May 2018 at 10:34 am

Legal Marijuana Dispensaries Appear to Reduce Opioid Abuse

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Kevin Drum notes a Mark Kleiman post:

Does access to legal marijuana reduce opioid abuse? It’s a tricky question to answer, but Mark Kleiman points today to a recent Rand report that tests the effect of medical marijuana laws between 1999-2013 on both opioid deaths and treatment for opioid addiction.

The study finds that medical marijuana laws appear to have almost no effect on opioid use. What’s important, it turns out, is the existence of legally-protected dispensaries. Once those are in operation, the authors estimate that within a few years admission to addiction treatment programs declines 38 percent and opioid deaths decline 25 percent:

It’s worth noting a couple of things. First, these numbers tend to vary a fair amount depending on precisely which years are included in the study and which controls are used. Second, the total distribution of legal opioid painkillers doesn’t decline after legal marijuana dispensaries become active. Taken together, this means that (a) the findings aren’t especially robust, (b) the paper is unable to say why opioid abuse seems to decline after legal dispensaries are opened, and (c) the sample sizes are fairly modest—something that’s inevitable since we’re still in the early days of legal pot dispensaries.

Those are all good reasons not to treat these results as gospel. FWIW, I’d add another: the results seem too large. It makes sense that opioid abuse might decline when a different kind of pain therapy becomes widely available, but it’s a little hard to believe that the effect would be this large within just a few years. For more reasons to be cautious about these results, Kleiman has you covered in his post. However,  . . .

Continue reading.

Written by LeisureGuy

26 April 2018 at 9:05 am

Science hinted that cancer patients could take less of a $148,000-a-year drug. Its maker tripled the price of a pill.

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American healthcare has a serious problem, and it is spelled “g-r-e-e-d.” Carolyn Johnson reports in the Washington Post:

A group of cancer doctors focused on bringing down the cost of treatments by testing whether lower — and cheaper — doses are effective thought they had found a prime candidate in a blood cancer drug called Imbruvica that typically costs $148,000 a year.
The science behind Imbruvica suggested that it could work at lower doses, and early clinical evidence indicated that patients with chronic lymphocytic leukemia might do just as well on one or two pills a day after completing an initial round of treatment at three pills per day.
The researchers at the Value in Cancer Care Consortium, a nonprofit focused on cutting treatment costs for some of the most expensive drugs, set out to test whether the lower dose was just as effective — and could save patients money.
Then they learned of a new pricing strategy by Janssen and Pharmacyclics, the companies that sell Imbruvica through a partnership. Within the next three months, the companies will stop making the original 140-milligram capsule, a spokeswoman confirmed. They will instead offer tablets in four strengths — each of which has the same flat price of about $400, or triple the original cost of the pill.
Just as scientific momentum was building to test the effectiveness of lower doses, the new pricing scheme ensures dose reductions won’t save patients money or erode companies’ revenue from selling the drug. In fact, patients who had been doing well on a low dose of the drug would now pay more for their treatment. Those who stay on three pills a day won’t see a change in price.
“That got us kind of p—ed off,” said Mark J. Ratain, an oncologist at the University of Chicago Medicine who wrote about the issue in the Cancer Letter, a publication read by oncologists. “We were just in the early stages of planning [a clinical trial] and getting it organized, and thinking about sample size and funding, and we caught wind of what the company was doing.”

Research and anecdotal experience of physicians suggests that co-pays can be a major barrier to people staying on their drugs. Stacie Dusetzina, an associate professor of cancer research at Vanderbilt University Medical Center, said that if a patient were taking one of the old capsules each day, their out-of-pocket costs under Medicare would be close to $5,000. Under the new pricing regimen, the patient’s burden of the cost — for the same dosage — would roughly double. The difference in the cost to Medicare would be about $100,000. That does not reflect rebates paid by the drug company to Medicare.
“It’s fascinating and disturbing,” Dusetzina said. “It appears to be a program being implemented, possibly to save some of the profits they’d be losing if dose reductions are really rapidly going to start coming down the pike.”
In a statement, Janssen and Pharmacyclics said the companies began to develop the new single-tablet dosing regimen in 2015 “as a new innovation to provide patients with a convenient one pill, once-a-day dosing regimen and improved packaging, with the intent to improve adherence to this important therapy.” They called the studies on lower dosing “highly exploratory in nature” and noted that patients who take a higher dose of the drug will save money.
But the new regimen could undermine patient safety, Ratain and colleagues argue. People on Imbruvica often need to have their doses adjusted, because it can interact with other drugs. Physicians also may try lower doses when people have trouble tolerating the drug because of side effects, such as extreme joint pain.
The companies said in their statement that a dose exchange program with rapid shipment would allow physicians to make those changes.
Under the old regimen, doctors could adjust the dose immediately by telling a patient to take one or two pills a day, instead of three, then return them to the higher dose when necessary. Under the new regimen, physicians will have to initiate a dose-switching protocol that requires paperwork. The phone number physicians have been given to call is only open Monday to Friday during business hours, several oncologists noted.
“I do share their concerns,” said Jennifer Brown, director of the Center for Chronic Lymphocytic Leukemia at the Dana-Farber Cancer Institute, who was not an author of the Cancer Letter paper. “We frequently change the dose of this drug, in relation to drug interactions in particular, and usually we need to do that basically instantaneously.” . . .

Continue reading.

Written by LeisureGuy

18 April 2018 at 9:42 am

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