Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

“Unintended Consequences” Of Cheaper Generic Drugs?

There’s an article in the New England Journal of Medicine entitled the “Unintended Consequences of Four-Dollar Generic Drugs.“ Ever one to hone in on unintended consequences of all stripes, I quickly clicked through. Oh, dear! What bad could possibly come of making drugs significantly more affordable?

Were more people demanding prescriptions for drugs they didn’t really need now that they were so cheap? (Dream on. I’m still twisting arms to get my high-risk cardiac patients to take their generic statins.) Were pharmacies going out of business, no longer to make ends meet without massive markups on brand name drugs, contributing to skyrocketing unemployment and otherwise adding to the country’s general economic malaise? Were cardiologists’ incomes plummeting because of sagging rates of coronary disease now that everyone could easily afford their beta blockers, ACE inhibitors, and statins?

Or maybe it was something good. I guess, technically, “unintended” doesn’t automatically equal “bad.” What could it be? So I read. And what did I discover? Read more »

*This blog post was originally published at Musings of a Dinosaur*

Accountable Care Organizations: Additional Barriers To Success

Accountable Care Organization(ACOs) are not going to decrease the waste in the healthcare system. Waste occurs because of:

1. Excessive administrative service expenses by the healthcare insurance industry which provides administrative services for private insurance and Medicare and Medicaid. A committee is writing the final regulations covering Medical Loss ratios for President Obama’s healthcare reform act. The preliminary regulations are far from curative

2. A lack of patient responsibility in preventing the onset of chronic disease. The obesity epidemic is an example.

3. A lack of patient education in preventing the onset of complications of chronic diseases. Effective systems of chronic disease self- management must be developed.

4. The use of defensive medicine resulting in overtesting. Defensive medicine can be reduced by effective malpractice reform.

A system of incentives for patients and physicians must be developed to solve these causes of waste. A system of payments must also be developed to marginalize the excessive waste by the healthcare insurance industry. Patients must have control of their own healthcare dollars.

By developing ACOs, President Obama is increasing the complexity of the healthcare system. It will result in commoditizing medical care, provide incentives for rationing medical care, decrease access to care, and opening up avenues for future abuse.

The list of barriers to ACOs’ success is long and difficult to follow. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Health Insurance: New Survey Reveals Record Number Of Uninsured

Last month the U.S. Census Bureau released its annual survey on health insurance coverage. The results were startling, yet few politicians seemed to take notice:

– The number of people with health insurance declined for the first time ever in almost two decades. In fact, as reported by CNN this is the first time since the Census Bureau started collecting data on health insurance coverage in 1987 that fewer people reported that they had health insurance: “There were 253.6 million people with health insurance in 2009, the latest data available, down from 255.1 million a year earlier.” The percentage of the population without coverage increased from 15.4 percent to 16.7 percent.

– Almost 51 million U.S. residents had no health insurance coverage at all, a record high, and an increase of almost five million uninsured from 2008.

– Fewer Americans received health insurance coverage through their jobs, continuing a decade-long trend. The number covered by employment-based health insurance declined from 176.3 million to 169.7 million, reports the Census Bureau. Based on the Census numbers, the Economic Policy Institute observes that “the share of non-elderly Americans with employer-sponsored health insurance declined for the ninth year in a row, down from 61.9% in 2008 to 58.9% in 2009, a total decline of 9.4 percentage points since 2000.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Obamacare Saved By The Health Insurance Industry

Why Big Health Insurance Supported Obamacare, Part IV

In the past few posts (in particular, here and here), DrRich has shown why the health insurance industry embraced Obamacare, and indeed, took extraordinary steps to assure that Obamacare became the law of the land. This, of course, is especially interesting in light of the common perception that Obamacare constitutes a major defeat for the greedy health insurance industry.

But the fact that big health insurance gave critical support to Obamacare is far more than merely interesting. It has major implications both to supporters of Obamacare, especially the ones who hope for an eventual single-payer outcome, and to opponents of Obamacare, many of whom hope to repeal it after the 2010 mid-term elections.

For the health insurance industry to have supported Obamacare, especially in the manner that it did, leads us to three conclusions. Read more »

*This blog post was originally published at The Covert Rationing Blog*

Health Insurance And “Medical Loss Ratio” Foolishness

Like Ezra Klein, smart people keep saying foolish things about the health insurance business. This time it’s a pair of bloggers talking about the largest expense that health insurers face — their “medical loss ratio.”

According to Richard Dale at the Venture Cyclist:

[W]hy do they call it Medical Loss Ratio? Why is looking after me (or you) called “Medical Loss,” when the whole point of a healthcare system is to look after me (or you)?

(Sigh.)

Alan Katz, one of the leading health insurance bloggers, surprisingly links to this with approval, saying “words matter.” The problem? The word “loss” is probably one of the four oldest words in the insurance industry. I’d say the others are probably “premium,” “commission,” and “profit.” Should we start outlawing these words, too? Read more »

*This blog post was originally published at See First Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »