Zane Safrit

Aha! There is perfection in this relative life

And it's lived by hospitals and their staff. In particular, 5 hospitals in New Jersey reported their own perfection for procedures performed during 2007.

But this realm of perfection in our imperfect bodies and world wasn't limited to 5 of 80 NJ hospitals. No, sir. There were hospitals in Pennsylvania that reported they too achieved perfection on this physical plane.

What I see is an epidemic of perfection on this physical plane of existence,  starting with some hospitals on the East Coast. And spreading, despite laws that require those same hospitals to report any preventable mistakes made, like a plague.

And about the public's response to these reports of perfection amongst them?

The NJ Hospital Association says...it wants to keep the reports private for fear:

It may present an unfair picture of what is actually going on . . . when we have some hospitals that are not reporting and other hospitals that are reporting...[mistakes?]

Yes, they're wise to keep silent the rumors of perfected lives among the staff of select hospitals. We all read the news. We all know what happens when french fries appear as a deity's silhouette. Imagine the response when perfection is in 3-D.  The hordes of worshippers could easily distract the faithful with vigils kept curbside...hoping to catch glimpses of the perfected ones.

Link from WSJ: Some Hospitals Don't Report a Single Error, Despite Laws

Health Care: Tops in Costs. Why Not Tops in Care?

Did you know that our health care system carries administrative costs that average more than 30% more than their counterparts whose health care systems are characterized as nationalized, dare I utter the word...socialized, medicine?

Our per capita costs for delivering health care are double the average worldwide?

Did you know that 18% of working adults in 2006 reported not being able to perform work-related tasks because of health-related problems? That's up from 15% in 2004.

Did you know that in 2007 there were 15 million more Americans under-insured or not insured than there were in 2003?

Did you know that as a nation our best in the world health care system last-in-the-industrial-world mortality rates from its health care system?

The Commonwealth Fund offer Results from National Scorecard on US Health System Performance, 2008.

Link from Progressive States September newsletter.

Cost Benefits Ratio

Ads for Chantix, the smoking cessation drug, resume next week on TV.

The ads  are 90-second spots. And 40 seconds are reserved for disclosing the risks...

I haven't seen the ads. But usually these disclaimers are shared by the voice of someone in the throes of smoking cessation desperately reaching for a cigarette at the alloted time, ie, breathless with a pulse way-past safety zones.

Out of a 90-second spot, 40 seconds are reserved for the speed-reader reciting the acknowledge dangers of a drug.

I saw an ad for an asthma drug last week. One of the risks speed-read at the end was the greater risk of death for those with asthma. Seriously.

I'm sure I'll see the ad again; we're in hay-fever and allergy season. (Yes, I know they're not the same. One aggravates the other.)

And this is good? The ad, the drug, our system that nods and winks at the risks of taking drugs with a bum-rush announcement out the door?

I'm just asking.

Link from WSJ: Pfizer to Bring Back Chantix Ad.

Compassion: Too Often Overlooked

Every once in awhile, I'm reminded I may tend to dwell on the outrages of our current health care system. And I do that at the expense of the many great and wonderful people who provide the truly astounding, inspiring, amazing, how-do-they-do-this, level of care.

Personal and professional.

They bring the highest skills and development in those two areas, personal and professional. I'm always left awestruck when you find those people in any industry, but especially in the high-stress arena of critical health care, that not only are incredibly smart, articulate, master of their knowledge, but have somehow been able to maintain their humanity in the form of being able to offer compassion to their patients and their patient's families and connect and communicate and listen to those who turn to them for help.

And they do this every day, seemingly every hour for their colleagues and their families and their patients sometimes who are in one sense mere strangers and on another sense...universal to us all, seeking warmth, understanding, dignity and respect in settings far from conducive for those feelings.

A recent post at Running a Hospital made me pause and reflect and wish I could find more stories like that contained in the post Remembering Bruce.

I know the stories are out there.  Please share them. We need them.

A prescription for a cure to our health care system

Interesting post.

At health care policy blog is a post titled: US Health Care on the Edge: A Prescription for A Cure.

The US Healthcare system has many problems. At its heart are three that prevent better outcomes, waste vast amounts of money and hinder understanding of optimum cost effective treatment: (1) misaligned risk, (2) ineffectual infrastructure, and (3) minimal leverage with the pharmaceutical industry. All three need be changed simultaneously, or in very rapid succession.

If by misaligned risk, he means the undue influence of insurance companies* on doctor's decisions regarding the care of patients, their undue influence in what constitutes adequate and needed care....then his list is complete.

Still, even if not, the post and blog is worth your time if you're interested in solving our health care crisis.

* 86% of doctors feel insurance denials have compromised patient care. - About.com's health insurance blog.

Mandatory Health Insurance for Grad Students

Some of the challenges of mandatory health insurance are touched on with Colorado State University's requirement that all students have health insurance. CSU offers an affordable plan that's required unless your current plan is superior.

The trick is defining who's defining superior and what are the terms.

From Health Insurance Insider.

Link from Managed Care Matters

Pennsylvania: One H[ealth insurance company] Town

Pennsylvania is considering becoming a one h[ealth insurance company] town. It's eerily similar to the story in the earlier post about a one-hospital town.

The two insurance companies looking to merge are both non-profit.  Key executives from both hospitals will remain and see large pay increases. Up to 1200 current employees of the 2 hospitals will be laid off, though. Redundancies are found with employees, not executives.

Any cost-savings won't be passed on to the consumer, though; double-digit increases in premiums will continue.

Links:

Philadelphia Inquirer Story

Philadelphia Inquirer Op-Ed

Health Care in a One H[ospital] Town

WSJ reports on the impact to the costs of health care when it's a one hospital town. And it's a non-profit hospital, too. A few highlights:

* Health insurance costs for the community were the lowest in the state before the hospital's monopoly. They're now the highest.

* Employee health care costs for businesses have risen as much as 50%.

* Costs for standard procedures run 4-10 times higher what's charged at local clinics.

* One day per week at the City General District Court is reserved for civil actions by the hospital against indigent, non-paying customers.  See previous point about price disparity.

* The CEO, whose pay has tripled over the past 5 years, says it's not right to sue and place liens on people's homes when they can't pay for their health care. But...it's the fault of the broken health care system.

* $50 million per year in tax exemptions are received.

* Reporters investigating the hospital were removed from their health care reporting specialty.

There's more. Read the story: Non-profit hospitals flex pricing power.

Link from Health Care Renewal blog

Comparing the Candidates' Positions on Health Care

Families USA, The Voice for Health Care Consumers, has what looks to be an excellent series of posts on the candidates' positions on health care. The Introduction offers an overview of their positions. And at the bottom of the article is a list of 10 questions, each with a link to a page offering a comparison of the candidates' answers. And included are links to the home pages for each respective candidate.

Definitely worth the read.

And MedicalNews has links to more articles on the issue of affordable health care and candidates' positions.

Decline in Numbers of Uninsured: Subtraction from Addition

The numbers of Americans who lack health insurance had declined by over 1 million.

That's the substraction part.

The numbers of Americans, mostly children, who have health insurance through government programs has grown by a similar number.

That's the addition part.

The amounts budgeted for these federal programs has grown. And the numbers of states who have expanded their budgets to accomodate the growing need to provide health insurance to thoes who can't afford it, need it....that too has grown.

That's the addition part.

The numbers of Americans who need such programs has grown....

That's the subtraction part.

Links:

NY Times: A Decline in Uninsured is Reported.

USA Today: Economy May Stall Push for Healthcare

Reuters: Number of Uninsured Americans Declines Modestly

AIDS Reporting: Head-in-Sand Approach Chosen

8 States Cut from System that Tracks Rate of HIV.

Just as we learned that the HIV/AIDS rate of infection is 40% higher than expected....8 states and Puerto Rico were cut from the system used to track those results. 

Health-insurance induced [Retirement]-lock?

[Retirement]-lock is like job-lock with one big difference: You're forced to retired to keep your health care benefits.

Job-lock locks you into a job where you're possibly bored to tears...just for the health-care/health-insurance benefits of your employer.

[Retirement]-lock locks you into retirement where you're bored to tears....just for the health-care/health benefits of your employer.

And both situations result in lost productivity from the poorly applied or not-at-all applied skills and knowledge gained from decades of service.

State Workers Retiring Early Because of Health-Insurance Costs

McCain's Approach Solving Health Care Job-Lock?

I don't know. De-coupling health care from employers is certainly one way to eliminate health care job-lock. William McKenzie at the Dallas Morning News describes job-lock as follows :

Today's "job-lock" phenomenon forces many workers, especially middle-aged ones with families, to stay in a job because that's the only way they can get health coverage. They may be bored to tears and want out, but they aren't about to leave and use their talents more productively elsewhere – not with health costs being what they are.

The key point for our economy is that last sentence:

They may be bored to tears and want out, but they aren't about to leave and use their talents more productively elsewhere – not with health costs being what they are.

A fascinating study would be calculating the costs to our economy from productivity lost from health-insurance induced job-lock.

How much more productive would an employee be if they weren't locked in job, bored to tears?

What percentage of our employees are locked in jobs, bored to tears, solely for the health-insurance benefit.

How many jobs aren't created by small business because they can't offer health-insurance benefit for the talent needed to drive their company to the next stage?

What innovations remain undiscovered because those that would discover are locked into jobs where they're bored to tears?

Mr. McKenzie sees McCain's plan as de-coupling the benefit from employers. That would empower the employees to own this benefit, much like they own their cars to drive to work. Make the benefit affordable, like a car (or car insurance), and then it won't hamper their decisions on where to work.

Mr. McCain would set them free. He would give all individuals the means to buy insurance on their own.

Families would receive a $5,000 tax credit to buy insurance. (Singles would get a $2,500 credit.) Everyone would qualify for the credit, although critics suggest Mr. McCain's $5,000 credit wouldn't help them meet today's average family premium. Fair enough. Hike the credit.

By giving everyone the chance to buy their own policy, Mr. McCain would put Americans in charge of their health insurance. Their plan would be their property right, and they could shop from state to state to find the best deal, just as they do to buy auto insurance.

At first glance, I like it. Make health insurance affordable, for all, and then it's a non-issue for health care, child-development, senior-care and employment. That levels the playing-field for startups, small-business, innovators competing against well-funded but stagnant corporate giants. Unleash that pent-up productivity and innovation in so many of our companies. Start a wave of job-creation.

And the means to do that is removing the pre-tax nature of current employer-sponsored health-insurance and health-care benefits.

Mr. McCain would take away those advantages and give every American the same tax credit to buy insurance. All workers, from Warren Buffett down to the small businessman in Muleshoe, Texas, finally would be on the same playing field.

A little hyperbolic, perhaps (But who'm I to point the finger on that issue?). Warren in Omaha and Small biz guy in Muleshoe, TX will never be on the same playing field.

But I catch his drift.

To do that, he'd have to tax that benefit.

But at what rate?  Would they tax the benefit based on unpaid premiums from participating in a group plan or the same plan but with premiums paid as an individual, outside the group plan? Big difference. Not an insurmountable hurdle, but one to consider.

And while the $5000, per family, (or more) tax credit is an excellent start it's not helpful to those whose incomes can't afford health insurance or health care regardless of the credit. It's just money: The $5000 tax credit is a source of lost revenues for the Federal budget. Paying for, subsidizing health-care/health-insurance benefits, for low-income families is a source of higher costs for the Federal budget. It has the same impact on the deficit. The difference comes down to ideology and compassion.

The article tweaks my interest in McCain's health care plans. God is in the details, like grains of sand. I need to look closer at the details of McCain's health care plans.

At the very least, it's stirring the conversation and this article is one of the first to discuss health care plans with the issue of job-lock.

Signs of Rising Health Care Costs

* Saving Money by Skipping Doctor Visits. 22% of us, your neighbors and families and co-workers, skip doctor visits to save money.

On the front-end, that's understandable. On the back-end, it's more expensive. Minor illnesses become major maladies when left ignored. That adds expenses for your care to those who surround you: friends, families and co-workers.

Links: SF Chronicle, about.com's health insurance blog.

* Medicare Part D Costs 12% Higher in 2009

We're using more drugs; we're using more expensive drugs. So...Medicare drug benefit plan will pass on prices increases of about 12%. And this rate of increase is double the rate of increase for our overall health care industry in 2007. So...we can expect overall prices for health care to increase even faster in 2009.

You know, if there's one thing Big Pharma does well it's marketing. I mean, come on. The rest of the economy (energy sector excluded) is in a recession. And here's Big Pharma siphoning a big chunk of that dwindling economy. Oh wait, maybe the economy's dwindling BECAUSE our household budgets are being spent more on our meds than consumer goods.

Links: USAToday, National Coalition on Health Care.

* Health Care, as Percentage of GDP, Will Increase

The health care industry will consume 25% more of our domestic production in the next 10 years than it does now. In 2007, the health care industry consumed 16% of our GDP. By 2017, that will increase to 20%. I say consume. Clearly it provides jobs and careers, some high-paying. But health care is one of those industries that if it was doing it's job...its percentage of our GDP would NOT be increasing.

Which brings us to the point of why, if we're the best health care system in the world, are our costs the highest, our rates of growth for these costs the highest and...our system's performance compared to 191 countries ranks us...31st. And that's by the World Health Organization.

Links: National Coalition on Health Care, Cover the Uninsured, Paul Krugman, World Health Organization press release.

Marrying & Divorcing for Health Insurance Benefits

In a poll conducted this spring by the Kaiser Family Foundation, a health policy research group, 7 percent of adults said someone in their household had married in the past year to gain access to insurance. The foundation cautions that the number should not be taken literally, but rather as an intriguing indicator that some Americans “are making major life decisions on the basis of health care concerns.” - Health Benefits Inspire Rush to Marry, Or Divorce.

Let's see. If health insurance costs continue to double about every 6-8 years...by 2016, at the latest, we could see 14% of newlyweds with one partner saying "I do" because the other partner says "I can...provide health insurance for you."

Puts a whole 'nother spin on the term arranged marriages.

And then there's those marriages sustained not for appearances, nor for the children...but for health insurance benefits.

And then there's the marriages dissolved when catastrophic health care costs leave unpleasant options like bankruptcy, homelessness or divorcing so one partner qualifies as low-income and can  receive subsidies.

“Nobody should have to make a choice like that,” Ms. Moulton said. “What happened to our country? I don’t remember growing up like this.”

Yeah. Me neither, Ms. Moulton.

Health Care Cost or Coverage: Which comes first?

Ah. The proverbial chicken or egg quandary?

Which comes first: lower health care costs or greater health care coverage?

If you had more people receiving the health care coverage that would allow for more preventative health care and regular doctor visits, and early diagnosis of major diseases, you'd lower the costs for their health care.

And if you had lower health care costs, you'd have more people who could afford that care on the front end, the less expensive end, of their health care programs.

One of you step forward: lower health care costs or greater health care coverage.

It really doesn't matter. You're both missing parts of the  affordable, health care system we're missing.

Otherwise, the proverbial chicken or egg debate will become the proverbial health care system: lower cost or more coverage debate ? And that's not funny.

Links: ChiroEco, National Federation of Independent Business

What's missing in the health care discussion

What's missing in the discussion on our health care system is the impact it's having on our economy. There's more than enough content that documents its failings: FDA/Big Pharma coziness, Big Pharma/University researchers coziness, only the health insurance companies make money, health care industry is the fastest growing industry sector prior to 2008 and the spike in energy costs, health insurance is the most profitable, growing numbers of under-insured/uninsured, budget deficits to large to consider offering to all Americans the same comprehensive health care plan that our elected representatives voted for themselves.

What's the impact of a growing percentage of our nation's GDP being spent on providing health care to an aging, increasingly unhealthy population? What's the opportunity costs? Where are the opportunity costs in the form of missing investments in infrastructure and new industries that create jobs?

What's the cost to small business from not being able to offer health care plans to its employees, current and future? If job growth comes from innovation and the small companies it births, what happens when you can't find the human talent to generate that innovation and drive the companies that take the innovations to market?

What's the impact on our economy from an aging, increasingly unhealthy population that must work longer not to pay for their retirement but to pay for their health care? For a consumer economy, it's not a sign of future growth when any disposable income is spent on health care, not electronics and cars and homes and vacations, etc.

How's our global competitiveness as a nation effected when more of our human talent is directed towards health care of our aging, increasingly unhealthy population? The compassion factor grows; that's good. But...while all else implodes around us?

I'm just saying...if we looked at the real costs of where our health care system is taking us...we might be a bit more interested in its change.

2:1

Systematic reviews indicate that one in seven new drugs is superior to existing drugs, but two in every seven new drugs result in side effects serious enough for action by the U.S. Food and Drug Administration (FDA), including black box warnings, adverse reaction warnings, or even withdrawal of the drug...Princeton Sociology Professor Donald Light.

And how's this possible?

[R]ather than using current approved drugs as benchmarks of efficacy, the existing testing system evaluates the effectiveness of new drugs based on their effects compared to placebos.

[And] pharmaceutical companies frequently design their trails to minimize evidence of toxic side effects. To do so, they sample from a healthier population atypical of patients who will actually take the drug, excluding people who are older, poorer or who have multiple health problems.

So...let me get this right.

The FDA and Big Pharma have worked together to create a fast-track approval process that's created a system where new drugs are twice as likely to be dangerous as helpful.

And they want to hasten this drug approval process.

That would mean...less review by the FDA than is now occurring.

And, we'd continue to turn to the FDA for protection and redress AFTER problems were found with the newly approved drug? And who approved that drug? Oh, right, the FDA.

Link from Gooznews.

Add'l links:

FDA's most embarassing moments from Jim Edwards blog

BNET Industries story, with links to the GAO study of the FDA.

The downside of electronic patient records

The concern with electronic patient records is privacy and limiting proper access to primary care-givers and health care professionals.  The insurance industry is increasingly likely to turn to electronic prescription data when deciding whether to accept an applicant for coverage, and in determining the appropriate premium rate according to Kelly Montgomery at About.com's health insurance blog.

The concern is   that insurers will jump to erroneous conclusions based on the information obtained from prescription drug usage data, and that people may be improperly denied coverage as a result. There are also significant privacy concerns raised by using this data because it is not regulated by current health information privacy laws.

Health insurance companies using confidential patient information to deny them access to affordable health care? Say it ain't so, Kelly.

Do we really have the societal wisdom to put all healthcare data online? And the data would be stored by the likes of Google and Microsoft? Post  by webinformaticsMD at Health Care Renewal blog.

MedPedia

It's like wikipedia, but with a few differences:

1) Focused Content: it's exclusive domain is all things medical.

2) Restricted Contributors: content editors and creators are required to have an MD or a PhD. Unacceptable contributors then are...patients and their families.

2) Funding. Funding for medpedia comes from...CDC, NIH and the ever-dependable, ever-transparent, patient advocate: FDA. (snark)

Effective immediately, patients are strictly forbidden from joining any conversation about medicines or medical care or treatment or issues related therein.

Signed - The experts who've created and benefited the most from our current health care system.

Headsup from HealthCare Economist.