Category Archives: Health Care

Another Win For Obamacare

New York recently announced that individual plans under Obamacare will save it’s citizens 50%.  This is huge!  Obamacare will cut the premium costs of 6% of America in half!

The rest of us likely won’t be quite as fortunate.  Most states still don’t know how much, if anything, they will save.  New York had the highest premium costs for individual insurance in the country.  This is because of a law that requires insurance companies to cover preexisting conditions.  Without a mandate for its citizens to carry health insurance, as more people with preexisting conditions signed up, the costs of insurance for everyone went up.  This caused healthy people to drop their insurance which caused the costs for those with the preexisting conditions to go up. Obamacare both demands preexisting conditions be covered and that individuals carry insurance under penalty of law.  Thus the very large savings for New York which only had half the formula to save money.

The most important takeaway from this is that what’s happening in New York highlights exactly what Obamacare proponents have argued would happen.  A larger pool that can’t exclude anyone leads to drastically lower premiums for the individual.  In my analogy where Obamacare is a bag of poo left on the doorstep but what we had before was a flaming bag of poo, what’s happening in New York is what put out the fire.

Michael Douglas Is A Cunning Linguist

It’s not often that important news comes from celebrity, but this certainly qualifies.  In a recent interview, Michael Douglas talked about his recent fight with throat cancer.  He reveals that the likely cause of his throat cancer was HPV caused by cunnilingus.

Now, people will snicker, but this is actually really important as far as education goes.  Studies show that 80% of women will contract HPV by the time they are 50.  HPV can cause many, many health problems for women.  As we see from Michael Douglas, it can also cause problems for men.

All of these problems should be immaterial within a generation or two because we have a vaccine for HPV.  The CDC recommends girls get vaccinated around their teenage years, but I’d like it to be taken a step further.  Making this vaccine mandatory for both boys and girls would prevent countless pointless health problems and save many lives.

Unfortunately, America still thinks sex is icky and if people don’t want to get HPV they simply shouldn’t have sex.  They also think that giving kids the vaccine will make teenagers sex crazed lunatics who will hump anything that moves.  Newsflash, they already are.  The only thing the vaccine will do is prevent them from spreading disease.

Men only think of health problems when it affects them.  Maybe Michael Douglas’ bout with cancer will make politicians stop giving women a tongue lashing (ha!) and get on board with vaccinating this easily preventable disease.

The Air Conditioner Story

Healthcare is weird.  The focus is almost entirely on treatment and not at all on prevention.  Billions of dollars would likely be saved if we switch that focus.  And that leads us to the air conditioner story.  The air conditioner story is a story that Oregon Governor John Kitzhaber loves to tell.  It’s pithy and gets to the heart of the U.S. healthcare problem.  Here is the air conditioner story:  There’s this 90 year old woman with a well managed congestive heart condition and she lives in an apartment with no air conditioner.

That’s it.  That’s the story.  The point being that high temperatures are not good for a 90 year old woman with a congestive heart condition.  On a 100 degree day, healthcare will pay tens of thousands of dollars for the ambulance and the emergency room visit and any followups that are required when that woman has a heart event but it won’t pay $200 to get her a window air conditioning unit that would likely have prevented the event.

Pretty awesome story, huh?  Watch Oregon.  Great things are happening to change healthcare for the better.

Department Of Completely Missing The Point

Oregon, for the past two years, has massively increased access to Medicaid.  (Correction: It wasn’t a massive increase, it was a drastic reduction and then more money was found to support 10,000 more participants when 90,000 were still eligible.)  Participants in the expansion were chosen by lottery.  This has led to a unique opportunity to study the effects of wider access to healthcare on the poor.  The results of that study were recently released.

The study is seen as a presage of what things will look like for poor people under Obamacare.  And, besides the ridiculous lottery aspect of it, it is.

The study shows that those added to Medicaid have no better medical outcomes than those that weren’t added to Medicaid.  This has led to a large amount of gloating from people who oppose Obamacare.   Oh noes!  Obamacare is a failure!  We told you it was a giant boondoggle!

Not quite.  First and foremost, Obamacare, like Medicaid, is insurance.  Plain and simple.  Insurance protects you financially.  Period.  And the study shows much better financial outcomes for those on Medicaid.  Expecting better health outcomes because you suddenly have health insurance is like expecting not to get into a car accident because you have car insurance.  It’s ridiculous.

There were also many other benefits associated with being on Medicaid.  These include drastically lowered rates of depression, better diagnosis and management of diabetes, and increased use of health services.

The mental health aspect of the study is enormous.  This cannot be understated.  Those in the Medicaid group had a 30% reduction in the rates of depression.  Depression leads to all sorts of other issues that don’t show up on a health screen.  Economic and social outcomes can be greatly affected by depression.  Being poor is bad enough.  Being poor and depressed can be disastrous.  If the only thing that Obamacare succeeds at is reducing depression by 30%, it will be well worth the money spent.

All in all, the Oregon Experiment is a good study for Obamacare.  Opponents, of course, will continue to pick any little nit they can find and there are certainly plenty of nits worth picking.  But, like I’m fond of saying, Obamacare is a bag of doggie poo left on the doorstep of America, but what was there before was a flaming bag of doggie poo.  Baby steps.

How Effed Up Is Healthcare In The United States?

It is absolutely appalling how much we spend for healthcare in the United States.  What’s even more appalling is that we have absolutely no idea how much we’re going to spend for even basic health services.  It can vary wildly from place to place.  Quick, how much do you think an angiogram will cost you?  If you answered anywhere between $173 and $2,740, you’d be right!  But why the huge disparity and why do we pay so much more for healthcare than other countries.  Well, the disparity has to do with how health insurance pays for healthcare.  Each individual health group bargains with each individual health insurance company to get the best rate.  Two people sleeping in the same hospital room for the same procedure are likely not paying the same price.  As for the reason why we pay so much more than other countries, that’s easy.  Other countries restrict costs and we don’t.

You might want to argue that the United States pays vastly more because we have better health outcomes.  The only problem with that is we don’t.  We don’t even come close to the best health outcomes in almost every category you can imagine.

AIDS Cured In Newborn

A baby in Mississippi appears to have been cured of AIDS!  As with any extraordinary claim, they’ll need to get some backup to see if it’s actually true or not, but what a breakthrough if it’s true!

If it’s true, this will be only the second human to have successfully been cured of AIDS.  The first was a man in Germany who got a bone marrow transplant in 2007 from another man who had an HIV resistant mutation.  Obviously, that needs to be taken with a grain of salt as well.

Some things that I didn’t know.  The United States has been very successful at limiting the transmission of HIV from mother to child through pregnancy and birth.  Thanks to a wonderful prenatal medicine operation, only 200 children a year are born HIV positive in the U.S.  Compare that to the rest of the world where there are more than 300,000.

Prenatal medicine is vastly important.  Medicaid is a primary source of prenatal medicine funding for poor people.  Think about that if you think we should cut Medicaid.

This Is Not The Budget Deficit You Are Looking For

The United States has a long term budget problem.  That problem has nothing to do with too much spending on defense or building bridges to nowhere.  That problem is almost entirely a healthcare problem.  Medicare and Medicaid are, by far, the largest drivers of our deficits.  If anyone tells you otherwise, they either don’t understand large numbers or they are deliberately trying to mislead you.

As the Baby Boomers get older, the costs of Medicare and Medicaid will increase dramatically.  Or will they?  Yes, yes they will.  But!  But, it’s looking likelier that things are not nearly as bad as everybody predicted they would be.

You see, the problem has been that, for decades now, the cost of healthcare has been growing much faster than everything else in the economy.  So, predictions of future costs has always assumed that Medicare and Medicaid would continue to grow much faster than the economy.  For the last few years, that hasn’t been true. Healthcare appears to have started growing apace with the economy.  This changes everything.  Those massive predicted deficits almost disappear.

Of course, the $500 billion question is if healthcare costs growing apace with the economy is a new normal or a temporary adjustment.  I believe that it is a new normal.  It seems economically dubious that healthcare spending would continue to grow faster than the broader economy forever.  I can’t think of another industry that has had this long of a run rising costs for customers.  Healthcare isn’t like other industries, though, so maybe that thinking is flawed.  With Obamacare and the level of governmental oversight that it brings, I’m guessing that healthcare spending will slow down as a greater emphasis is placed on bring costs down.

This Is Why Single Payer Health Care Is So Important

Here are two charts that should be in every health care discussion.  Yet, they are never really talked about by either side.

The United States government spends around 30% more per capita on health care than Canada does.  This despite the fact that the United States government doesn’t cover all of its citizens while Canada does.  For every man, woman, and child in the United States, our government spends close to $4,000 on health care.  For every man, woman, and child in Canada, their government spends close to $3,100 on health care.  The difference is that Canada negotiates for drugs and we do not.  Canada also had a single point of payment for health care bills while we have thousands of them each with their own rules and regulations that providers need to navigate.  There are other savings involved, but these are the big ones.  We’d be wise to implement both of these ideas here.

That’s public spending, but what about private spending?  We in the United States spend around $4,200 per person while Canada spends around $1,300 per person.  We spend over 20% more than Canada on private health care costs!

And how are things going to change under Obamacare?  As Ezra Klein says:

Obamacare will mostly fix the universal coverage problem, but it won’t fix the cost problem. The reason other countries spend less is that their governments set the prices, and they set them low. The reason we spend so much more is largely because our prices are higher, and by leaving private insurers and medical providers in charge of deciding prices, we’re not doing anything about that in Obamacare.

As I have always said, Obamacare is a bag of crap left on your doorstep.  It’s still better than the flaming bag of crap that is our health care system without Obamacare.  Here’s to hoping we get the purchasing power of the Canadian government and its fantastic savings in the United States soon!

OMG! Vaccines Are Eviiiiiiiiillllllll!

Back in the heyday of the Swine Flu pandemic when there was a very distinct possibility that we would have a pandemic of Spanish Flu proportions on our hands, Sweeden and Finland made the choice to speed up approval of an H1N1 vaccine called Pandemrix.  Soon afterwards, they saw a marked increase of narcolepsy cases in children under the age of 20.  Narcolepsy is a pretty rare condition so even a slight increase is noticeable.  It is looking likely that Pandemrix is responsible for this increase.

In hindsight, it was a pretty bad idea to rush Pandemrix.  Remember, though, the 2009 Swine Flu was a pretty scary event.  It had many of the same features of the Spanish Flu.  It attacked and killed healthy young adults, whereas regular flu mainly kills only the elderly and immune suppressed.  It just happened that, for whatever combination of reasons, the Swine Flu never really spread that much.  Only 18,000 or so confirmed deaths were reported.  Compare this to the 250,000 deaths annually from the regular flu.  Sweden and Finland made an educated decision based on the information they had at the time.  That decision just happened to be wrong.

That would be the end of the story if it weren’t for the narcolepsy increase.  Despite the headlines, this increase isn’t that big of a deal.  We are talking about one incident in every 27,800 vaccines administered.  That’s a 0.0036% chance of narcolepsy.  Pandemrix was also used in other European countries, but there isn’t enough data yet to tell if there was also an increase of narcolepsy there as well.

Scientists are now trying to find out how the narcoleptic events occurred.  It could be that Scandinavians have genetics that are more predisposed to narcolepsy.  It could be some environmental factors are in play.  We just don’t know.  All we know is that there is a causal link between narcolepsy onset and the Pandemrix vaccine in children.

Yes, it’s unfortunate that some children are getting narcolepsy from vaccines.  No, that doesn’t mean that vaccines are unsafe.  Vaccines do, sometimes, have severe side effects, though.  The chances of those side effects occurring are exponentially less than the chances of severe side effects from the disease they inoculate against.

Vaccines are safer.  Vaccines work.  Get your vaccines updated today.  You may not be saving your life, but you could be saving someone else’s.

Is There Really A Nursing Shortage?

I have always thought yes.  This article claims that the nursing shortage is actually just a myth.  There are a lot of things in the article that just don’t jibe, though.

One thing that is interesting is that 43% of newly licensed RNs haven’t found a job 18 months after graduating.  This is interesting because it follows the same paradigm that is being reported in almost every other sector in America.  Companies are looking for employees, but they’re not looking for employees without experience even though what they are looking for are entry level positions.  This is likely just a short term correction due to the economy and I wouldn’t worry about this nearly as much as the author of the article seems to be.

The author then makes a claim that, even in the long run, there is not nursing shortage and that projections assume that nurses will perform the same functions that they do now.  He believes that nurses will be replaced by robots.  I have made the same argument when talking about replacing specialists like neurosurgeons, but I find it a bit unbelievable that the same can be said about nurses.  Nursing is mainly about interaction.  A lot can be inferred of a patient’s condition simply by observing and talking to the person.  I believe that, one day, robots will be able to perform such functions as well, but that day is far into the future.

I think, if anything, the nursing shortage is going to be greater than expected for the same reason they author claims there will be no nursing shortage.  The trend is certainly towards giving nurses more responsibilities, not less.  Therefore, the projections, if anything, underestimate the amount of nurses that will be needed in the future.

It is possible, of course, that there is a bit of Dust Bowl economics going on here.  Come to California!  Jobs for all!  Great wages!  Then people go only to find that everyone else had the same idea and the wages are barely livable if you can even find a job.  We certainly recently saw that with law school.  The difference here is that law schools almost certainly knew about the poor job market yet were continuing to inform law students that things were just dandy and the evidence was there if law students did some research.  The evidence seems to suggest that nurses will be in demand for quite some time and, thus, is a safe bet for now.  Chances are that it too will eventually suffer from Dust Bowl economics in the future.  That’s how job booms always seem to end up.