The NYtimes details the newest weapon in the fight against cancer– a $100M+ particle accelerator straight out of Star Trek, which appears to have gargantuan impact– but more to hospital bottom lines than cancer patient survival (to date, the evidence appears, well, as theoretical as the focus of this equipment to date).
Some experts say the push reflects the best and worst of the nation’s market-based health care system, which tends to pursue the latest, most expensive treatments — without much evidence of improved health — even as soaring costs add to the nation’s economic burden.
The machines accelerate protons to nearly the speed of light and shoot them into tumors. Scientists say proton beams are more precise than the X-rays now typically used for radiation therapy, meaning fewer side effects from stray radiation and, possibly, a higher cure rate.
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Mark Cuban has an interesting take on the power of transparency in general, in response to Warren Buffett’s suggestion that the rich should pay more in taxes:
And I want 1 more thing. I want transparency. The way the government publishes information on money it spends ,receives and owes is a joke. No one in this country has any real knowledge of how much our country really owes. There are so many hidden and unpublished liabilities that if our country were a public company, someone would go to jail.
The accounting data of this country is public domain information. There is no reason why it can’t be published if not in real time on a government website, than at least quarterly. Money coming in . Money going out. Money that is owed to us and from us. It is currently being recorded somewhere , and someone has responsibility to collect it or pay it. So it can be published.
Then every quarter, our federal government can publish an Income Statement and Balance Sheet according to GAAP principles. It wont be perfect, but it will be a hell of a lot better than what we have today.
Without complete transparency, politicians will do what politicians always do. They find ways to play with our hard earned tax dollars and to put a lien on our current and future earnings, and that of our kids and grand kids just so they can get elected and re-elected. That’s just wrong.
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Is there truly a piece of mind over matter in creating healthy people?
The NYtimes has an an interesting piece where a couple of Harvard psychologists turned awareness of healthy behavior into meaningful improvement in health metrics.
At the start of the study, Langer and Crum quizzed 84 maids at seven carefully matched hotels about how much exercise they got. Fully a third of the women said they got no exercise at all, while two-thirds said they did not work out regularly. Langer and Crum took several measures of the women’s basic fitness levels, which indicated that they, indeed, had the poor health of basically sedentary people. Then just over half the women were told an unfamiliar truth: cleaning 15 rooms daily — pushing recalcitrant vacuum cleaners, scrubbing tubs, pulling sheets — constitutes more than enough activity to meet the surgeon general’s recommendation of a half-hour of physical activity daily. The researchers even provided specifics: 15 minutes of scrubbing burns 60 calories, 15 minutes of vacuuming burns 50. The basic message and the details were then posted in the maids’ lounges in the hotels where the 44 women worked, to serve as reminders, while a control group was left in the dark.
A month later, Langer and Crum checked back with the women to find, as they reported in the February issue of Psychological Science, remarkable results. The average study-group maid had lost 2 pounds, while her systolic blood pressure had dropped by 10 points; by all measures the 44 women “were significantly healthier.” Yet there were no reported changes in behavior, only in mind-set, with the vast majority of the women now considering themselves regular exercisers.
This has some interesting correlations to other stories of expectation, notably the Pygmalion in the Classroom example of a teacher with high expectations for a “gifted” class of randomly selected students ended up with a group of high achievers at the end of the year.
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Kudos to the Happy Hospitalist for pointing out a great piece of research by AHRQ on actual use of the health system.
For those who want an executive summary, my major point is that the median expenditure for medical care in the US in 2002 was ~$700. The vast majority of individuals in the US can afford health care. The shift to the premium-based insurance model that spends a disproportionate share on the very sick is what is making healthcare unaffordable today. Moving away from that model is the only way to ensure good healthcare for all (vs. ridiculously high health expenditures for the few). Its odd to find all the liberals (and less odd to find the health insurance execs) looking to supplement the head of the Pareto curve.
Their findings are as follows:
Theo Francis’s article in the WSJ called “Medicare offers overhaul of hospital reimbursing” contains a number of statements that reflect what side of the carrot/stick equation Medicare’s “solutions” for provider quality will fall.
Medicare proposed sweeping changes to the way it reimburses hospitals, outlining a plan that would essentially redistribute cash by reducing payments across the board and then giving providers a chance to “earn back” money by meeting quality-of-care thresholds.
Its not surprising to see individual providers opting away from Medicare patients with reimbursement not tracking to inflation, and with a 10% punitive Medicare reimbursement cut hanging over their heads, and noise about further requirements for installation of EMRs making their economics look even worse.
Unfortunately for hospitals, demographics dictate that a large portion of their patient population and revenue is tied to Medicare, where these unilateral decisions can be made. (Medicine and Economics blog has a great post on government’s difference from corporations and charity being the ability to use force, Covert rationing blog has a great post on how Medicare/insurance contracting is non-negotiable, and therefore monopolistic and potentially illegal)
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Much as people have separated church from state, the private life of an employee used to be sacred ground outside of work. Health advocates are beginning to encroach on those rights– and the end of days for employer-based comprehensive health insurance has come upon us.
In an effort to motivate workers to kick unhealthy habits, U.S. companies are hitting them where it hurts: in their wallets.
Employers who provide health insurance often use financial incentives, such as contributions toward premiums, to encourage workers to participate in wellness programs like smoking-cessation courses.
Now some employers are wielding a stick as well as a carrot. Employees at some companies who are overweight, smoke, or have high cholesterol, for instance, and who don’t participate in supplementary wellness programs, will pay more for health insurance. In extreme cases, employees’ insurance deductibles could rise by $2,000.
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The focus on insurance as a solution to rising medical costs is somewhat inane. Its the costs, stupid.
Are we getting good value for what we’re paying. And, as this article in the WSJ highlights, the answer is clearly no, and everyone knows it.
One day in late July, Jim Dawson happily returned home. He had spent the previous five months in the hospital battling an infection that nearly killed him. The phone rang shortly after Mr. Dawson and his wife, Loretta, entered their house.
It was the hospital. California Pacific Medical Center was calling to remind the Dawsons that they owed it $1.2 million.
So how exactly does an individual with health insurance rack up $1.2M? The bill looks pretty similar to the DoD’s $12,000 toilets and $900 nails:
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