October 27th, 2008 by Dr. Val Jones in Health Policy
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Fascinating commentary on human nature. Thanks to Grace-Marie Turner at the Galen Institute (this excerpt is part of an article published in the NY Post today):
HAWAII just had a vivid les son in health-care economics, learning that if you offer people insurance for free – surprise, surprise – they’ll quickly drop other coverage to enroll.
As a result, Hawaii is ending the only state universal child health-care program in the country after just seven months.
The program, called the Keiki (Child) Care Plan, was designed to provide coverage to children whose parents can’t afford private insurance but who make too much to qualify for other public programs (such as Medicaid and Hawaii’s State Children’s Health Insurance Program). Keiki Care was free for these gap kids, except for a $7 office-visit fee.
But then state officials found that families were dropping private coverage to enroll their children in the plan. “People who were already able to afford health care began to stop paying for it so they could get it for free,” said Dr. Kenny Fink of Hawaii’s Department of Human Services.
In fact, 85 percent of the children in Keiki Care previously had been covered under a private, nonprofit plan that costs $55 a month.
When Gov. Linda Lingle saw the data, she pulled the plug on funding. With Hawaii facing budget shortfalls, she realized it was unwise to spend public money to replace private coverage that children already had.
Yet Lingle is facing a political firestorm in the state from critics who say that she’s denying children health insurance – notwithstanding the fact that children in Hawaiian families earning up to $73,000 a year are eligible for Medicaid…
The Hawaiian debacle should also be a caution to Barack Obama, who wants to mandate that all children have health insurance. This would plainly not only require penalties for those who didn’t comply but also new programs to help parents get their children covered. The risk of crowd-out will be great.
October 27th, 2008 by Dr. Val Jones in Medblogger Shout Outs, Opinion
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There is nothing concealed that will not be disclosed, or hidden that will not be made known.
– Mat 10:26
The Internet may be fueling the fulfillment of an ancient prophecy – that there will come a day when nothing can be kept hidden or secret. Of course, early adopters of full transparency are regarded as reckless by some (potentially those who have something to hide?) and laudable by others (though they may be afraid to follow suit). In today’s Boston Globe there is an article about my friend and fellow blogger, Paul Levy. Paul is the CEO of Beth Israel/Deaconess, leading the charge to make hospital errors a matter of public record.
Paul writes about the errors made at his hospital (and many other subjects) in his popular medical blog, Running A Hospital. The blog won the “Best Medical Blog of 2007” award, and he is the first (and perhaps only) hospital CEO that has adopted such a high view of transparency. And for that, I commend him.
In my experience, hospital errors are alarmingly common. Read more »
October 26th, 2008 by Dr. Val Jones in Expert Interviews
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Dr. Armstrong
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Genetic testing is all the rage. Thousands of tests are now available over the Internet, costing people anything from $60 to $3000 per test. While some DNA sequences are fairly well understood (like the BrCA gene or the chromosomal anomaly that causes Down’s Syndrome), most of them are only loosely associated with specific diseases and health outcomes. Experts agree that one day we’ll have a better understanding of the complex interplay of multiple gene sequences, but that day is still far off.
A recent post at GigaOM (h/t to KevinMD ) was critical of genetic testing in general, noting its potentially prohibitively expensive consequences:
Somewhere between 10 and 50 percent of autopsies reveal diseases other than the one that killed the patient. If consumers test themselves, then tell their doctors, the medical system could wind up treating 50 percent more diseases than it does today — even those that wouldn’t have killed the patient.
I interviewed Dr. Joanne Armstrong, senior medical director for Aetna, and assistant professor of obstetrics and gynecology at Baylor College of Medicine in Houston, Texas, about the current state of genetic testing. To listen to the full conversation, please click here.
Dr. Val: First of all, could you tell me a little bit about your work, and what got you interested in genetics in the first place?
Dr. Armstrong: I am the head of the Women’s Health division of Aetna, and about 8 years ago when BrCA testing (the test for predisposition to breast and ovarian cancer) became widely available, I began thinking about the educational initiatives that needed to support this testing. I knew that it would become part of mainstream medical practice and wanted to make sure that patients understood the tests and what to do about them.
Dr. Val: In your view, what are some legitimate and appropriate genetic tests?
Dr. Armstrong: There are about 1200 genetic tests available now, and most of them are not medically appropriate or clinically valid. Read more »
October 25th, 2008 by Dr. Val Jones in Celebrity Interviews
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Ben Vereen
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I had the pleasure of speaking with Tony-award winning actor and Broadway star, Ben Vereen about his recent diagnosis of diabetes. Ben has had an extremely accomplished career, including recent guest appearances on NBC’s Law and Order, and ABC’s Grey’s Anatomy. He’ll appear in an upcoming Fox feature with Patti Labelle called, “Mama, I Want To Sing” so don’t miss it.
To listen to a podcast of our interview, please click here.
Dr. Val: Ben, how exactly were you first diagnosed with diabetes?
Vereen: Unfortunately, prior to my diagnosis I didn’t recognize the signs of diabetes and didn’t understand what was causing my symptoms. I had dry mouth, frequent urination, severe thirst, sugar cravings and fainting episodes and didn’t realize they were all caused by diabetes. One day my daughter saw me pass out and she took me to the hospital. It didn’t take them long to figure out that my blood sugar was out of control. They kept me overnight and told me the next day that I had diabetes. I was shocked because I thought I was exercising regularly and eating well – it never occurred to me that I could have diabetes.
Looking back I realize that I had been told once (about 8 years ago) that I had “a touch of diabetes” but I thought it had gone away because of my good eating habits and exercise. I wish I had thought to follow up on that diagnosis and ask my primary care physician to check my blood sugar regularly.
Read more »
October 24th, 2008 by Dr. Val Jones in Friday Funny
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You may have seen this cartoon here before… but it did go for the highest bid (of the two I auctioned) at the National Press Club yesterday so I thought I’d make it this week’s Friday Funny. Enjoy!
