Tag Archives: health care

September 2017 in Review

Most frightening stories:

  • Fueled by supercharged sea temperatures, the 2017 hurricane season was a terrible, terrible season for hurricanes devastating coastal regions of the United States. One reason is that these storms not only were powerful and hit densely populated areas, but they set records for rapid intensification. Beyond all the human suffering, one thing I find disturbing is that I feel desensitized at this point when I think back to how I felt after Hurricane Katrina. The first major city destroyed is a shock, but later you get numb to it if you are not actually there. Then finally, a remote island territory is all but wiped out in what should be shocking fashion, and the public and government response is decidedly muted. This is what the age of climate change and weapons proliferation might be like, a long, slow process of shifting baselines where the unthinkable becomes thinkable over time.
  • In a story that U.S. media didn’t seem to pick up, China seemed to make a statement in its  official state-run media that it would defend North Korea in case of an unprovoked attack by the U.S. and its allies. John Bolton  and Lindsey Graham made comments suggesting they think any number of Korean dead would be a price worth paying for an unprovoked U.S. attack. The Trump administration is openly using Nazi propaganda.
  • During the Vietnam War the United States dropped approximately twice as many tons of bombs in Southeast Asia as the Allied forces combined used against both Germany and Japan in World War II. After the Cold War finally ended, Mikhail Gorbachev made some good suggestions for how to achieve a lasting peace. They were ignored. We may be witnessing the decline of the American Empire as a result.

Most hopeful stories:

  • It’s possible that a universal basic income could save the U.S. government money by replacing less efficient assistance programs.
  • There are also workable proposals for a U.S. single-payer health insurance program, although this one would somewhat obviously mean the government spending more money, which it would have to collect in taxes. People would come out ahead financially if the taxes were less than the premiums they are paying now, which doesn’t seem that hard, but of course this is politically tough given the incredibly effective propaganda the finance industry has used to kill the idea for the last 50 years.
  • Utility-scale solar energy cost dropped 30% in one year.

Most interesting stories, that were not particularly frightening or hopeful, or perhaps were a mixture of both:

  • The FDA has approved formal trials of Ecstasy to treat post-traumatic stress disorder.
  • I learned that the OECD Science, Technology and Innovation Outlook named “ten key emerging technology trends”: The Internet of Things, Big data analytics, Artificial intelligence, Neurotechnologies, Nano/microsatellites, Nanomaterials, Additive manufacturing / 3D printing, Advanced energy storage technologies, Synthetic biology, Blockchain
  • In automation news, Tesla is testing automated truck platoons. And there’s a site that will try to predict whether robots will take your job.

the Sanders single payer plan

Bernie Sanders, Elizabeth Warren, and others have introduced a “Medicare for All” bill. Introducing a bill doesn’t mean it will become law any time soon, but it may be a good sign that something seen as politically unviable in the past is now at least being seriously discussed by mainstream politicians.

The universal Medicare proposal released this week extends health insurance coverage to every single American free of copays, premiums, and deductibles — and has long been viewed as a direct threat to highly profitable health-related industries and providers.

The bill calls for gradually expanding Medicare coverage, starting with the young and phasing in other segments of the population. The plan would cover all essential services, including routine doctor visits, emergency room care, mental health, dental, outpatient care, and forms of treatment.

Sanders’s office also released a statement this week laying out various financing methods for the bill, including an employer tax, closing tax loopholes, and a variety of progressive income-based taxes.

Taxes are unpopular of course, but we have to remember that workers and employers are all paying enormous health insurance premiums, much of which either gets eaten up by the enormous inefficiencies of the health care industrial complex, or goes into the pockets of insurance and drug companies as profits.

FDA has approved trials of Ecstasy to treat post-traumatic stress disorder

This is according to Science:

In people with PTSD, a small sensory trigger such as a sound or a smell can bring a traumatic memory rushing back. “The disabling element of PTSD is the fact that when the memory starts, the emotions completely override you and overwhelm the brain,” Nutt says. Studies suggest that MDMA can dampen the emotional response to the memory, allowing people to relive their trauma and work through it, he says. The MDMA-treatment consists of several sessions of psychotherapy, some conducted while the patient is under the influence of the drug…

A small U.S. study that first suggested MDMA could help treat PTSD was published in 2011. Since then, researchers in Canada, Israel, and the United States have jointly carried out larger phase II trials funded by MAPS; their results, which remain unpublished but have been reviewed by the FDA, were very good, says Doblin. Overall, 107 participants who had suffered from PTSD for an average of 17.8 years were treated in the phase II trials, Doblin says. Of the 90 patients who were available to be studied 12 months later, 61 no longer had PTSD.

In late July, says Doblin, MAPS and FDA agreed on how the coming phase III trials—usually the last hurdle before seeking a drug’s approval from regulators—should be conducted.

July 2017 in Review

Most frightening stories:

Most hopeful stories:

  • A new cancer treatment genetically modifies a patient’s own immune system to attack cancer cells.
  • Shareholders of big fossil fuel companies are starting to force some action on climate change business risk disclosure.
  • Richard Florida offers five ideas for solving poverty and what is wrong with cities: taxing land based on its improved value, massive investment in public transportation and public education, ending the mortgage interest tax deduction, and guaranteed minimum income.

Most interesting stories, that were not particularly frightening or hopeful, or perhaps were a mixture of both:

  • Technology is marching on, whether or not the economy and human species are. The new thing with satellites is to have lots of small, cheap ones instead of a few big, expensive ones. Even if the coal industry were to make a comeback, today’s coal jobs are going to data analysts, remote control machine operators, mechanical and electrical engineers, not guys underground with pickaxes and headlamps. But the coal can be produced with a lot less human effort (i.e. jobs) than it used to be. Iris scans like in Minority Report are now a thing.
  • Ecologists have some new ideas for measuring resilience of ecosystems. Technologists have some wild ideas to have robots directly counteract the effects of humans on ecosystems. I like ideas – how do I get a (well-compensated) job where I can just sit around and think up ideas?
  • Isaac Asimov says truly creative people (1) are weird and (2) generally work alone.

Some combination of the Trump news, the things I see every day on the streets of Philadelphia, and events affecting friends and family led me to question this month whether the United States is really a society in decline. Actually, I don’t question that, I think the answer is yes. But the more important question is whether it is a temporary or permanent decline, and what it means for the rest of the globe. I am leaning slightly toward permanent, but maybe I will feel better next month, we’ll see. Maybe I need to get out of this country for a little while. Last time I did that I felt that the social glue holding Americans together is actually pretty strong compared to most other places, even if our government and its approach to other governments have become largely dysfunctional. We need to get through the next couple years without a nuclear detonation, hope the current vacuum of leadership leads some quality leaders to emerge, and hope things have nowhere to go but up. There, I talked myself off the ledge!

 

June 2017 in Review

Most frightening stories:

  • The Onion shared this uncharacteristically unfunny observation: “MYTH: There is nothing mankind can do to prevent climate change. FACT: There is nothing mankind will do to prevent climate change”. It’s not funny because it’s probably true.
  • Water-related hazards including flood, drought, and disease have significant effects on economic growth.
  • There were 910 deaths from drug overdose in Philadelphia last year. Interestingly, I started writing a post thinking I might compare that to car accidents, and ended up concluding that the lack of a functioning health care system might be our #1 problem in the U.S.

Most hopeful stories:

Most interesting stories, that were not particularly frightening or hopeful, or perhaps were a mixture of both:

  • Tile is a sort of wireless keychain that can help you find your keys, wallet, and those other pesky things you are always misplacing (or your significant other is moving, but won’t admit it).
  • Fleur de lawn” is a mix of perennial rye, hard fescue, micro clover, yarrow, Achillea millefolium, sweet alyssum, Lobularia maritima, baby blue eyes, Nemophila menziesi, English daisy, Bellis perennis, and O’Connor’s strawberry clover, Trifolium fragiferum.
  • Traditional car companies are actually leading the pack in self-driving car development, by some measures.

single payer

What is there really left to say about single payer? It works well, almost everywhere except the United States, where it is deemed too expensive and politically impossible.

On the quality of our system, here are some stats from the Commonwealth Fund:

Adults in the U.S. are more likely than those in the 10 other countries to go without needed health care because of costs. One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill a prescription because of costs. This percentage is down from the 2013 survey (37%). As few as 7 percent of respondents in the U.K. and Germany and 8 percent in the Netherlands and Sweden experienced these affordability problems.

Fourteen percent of chronically ill U.S. adults said they did not get the support they needed from health care providers to manage their conditions. This was twice the rate in Australia, Germany, the Netherlands, New Zealand, and Switzerland.

Although the U.S. has made significant progress in expanding insurance coverage under the Affordable Care Act, it remains an outlier among high-income countries in ensuring access to health care. The authors point out that all of the other countries surveyed provide universal insurance coverage, and many provide better cost protection and a more extensive safety net.

So the self-proclaimed “greatest country in the world” appears to be somewhat sick and poor compared to its peers at similar levels of wealth and development.

Our health care system is expensive because the finance and health care industries pay politicians to write the rules in ways that stifle competition, use cynical propaganda campaigns  and scare tactics to convince the public they are engaged in competition, keep information away from consumers that would allow them to make reasonable cost-effectiveness choices, and generally maximize their short term profits at the long term expense of public health and the economy. Hillary Clinton had a very succinct way of summarizing this:

In the past, the health insurance industry has deployed sophisticated propaganda efforts to divide single payer proponents and weaken any political support for the idea. Former Democratic presidential nominee Hillary Clinton once considered such a system, but wondered, “Is there any force on the face of the earth that would counter the money the insurance industry would spend to defeat it?”

Like I said, our health care system, including all the public and private elements, is off the global charts insanely expensive both in terms of total spending relative to our economy, and in terms of the value we get in return for that spending. Shifting any portion of this expensive system from private to public funding would mean that the government would be paying more of the price tag, and government revenues would have to go up to pay for that. In other words, yes, we would be paying higher taxes in place of the high insurance premiums, co-pays and out-of-pocket payments we are making directly to the finance and health care industries now. Cynical politicians, who remember are bought and paid for by these industries, purposely confuse voters by equating the portion of the bill paid by the government with the total cost of health care, as in this Washington Post article:

But the government’s price tag would be astonishing. When Sen. Bernie Sanders (I-Vt.) proposed a “Medicare for all” health plan in his presidential campaign, the nonpartisan Urban Institute figured that it would raise government spending by $32 trillion over 10 years, requiring a tax increase so huge that even the democratic socialist Mr. Sanders did not propose anything close to it.

Single-payer advocates counter that government-run health systems in other developed countries spend much less than the United States does on its complex public-private arrangement. They say that if the United States adopted a European model, it could expand coverage to everyone by realizing a mountain of savings with no measureable decline in health outcomes, in part because excessive administrative costs and profit would be wrung from the system.

In fact, the savings would be less dramatic; the Urban Institute’s projections are closer to reality. The public piece of the American health-care system has not proven itself to be particularly cost-efficient. On a per capita basis, U.S. government health programs alone spend more than Canada, Australia, France and Britain each do on their entire health systems. That means the U.S. government spends more per American to cover a slice of the population than other governments spend per citizen to cover all of theirs.

But they go on to point out that the reason these costs are so high is that “A big reason [the government] does not clamp down now on health-care spending is that it is hard to do so politically.”

It’s almost impossible to even try to tackle these problems unless and until we have constitutional reform making it clear that big business ownership of politicians is not the same thing as free speech by individual members of the public. And our elected officials who are owned by big business are not going to give us this constitutional reform. It’s a conundrum that seems almost impossible to solve – if the 2007 financial crisis did not whip up enough public anger to counteract and overcome industry propaganda, it is hard to imagine a crisis that would.

So we would have to get that constitutional amendment (somewhat blandly called “campaign finance reform”, which understandably does not spark the public imagination) done. If we did that, we could look at some incremental reforms to move us toward either single payer or a more efficient public-private system. One idea seems particularly attractive to me. The state exchanges under the Affordable Care Act are an attractive idea because they encourage insurance companies to compete against one another for consumer health care dollars. The ACA also established a pretty uniform set of minimum coverage requirements that make it clear what we are paying for. Understanding what you are buying, and then having some choice of providers of that service, is the basic foundation of a functioning market system. The market should be able to set reasonable prices under these conditions, in theory. The insurance companies have the bargaining power and incentive to take on the health care industry over price and drive prices down.

So this all sounds pretty good. Where it is clearly failing, it is because some insurers are choosing to pull out of the exchanges, leaving buyers without any choice and destroying that link between supply and demand. What would make sense to me is to figure out what the premium would be for people to buy into Medicare and/or Medicaid directly, and then require these Medicare and Medicaid options to be available on the exchanges in a given state if at any time the number of private insurers competing on the exchange drops to less than 3 (or maybe 2, but 3 seems better). That way the insurance industry has complete control over whether they choose to shoot themselves in the foot or not. This won’t happen without the constitutional amendment first.

A shorter-term incremental measure that could help without the constitutional amendment would be to create some kind of common platform for all insurance companies to share price and outcome with consumers. Some insurers already have their own systems for doing this, and we have the system of common procedure codes, but it is all way too confusing. The government could force the insurance and health care industries to get together, come up with a crystal clear communications strategy, and put it all on a common platform. They would be required to provide you with this crystal clear information at the beginning of every doctor, hospital, and pharmacy visit. All without the government paying a dime more of people’s health care cost or providing any more price controls than they do now.

April 2017 in Review

Most frightening stories:

Most hopeful stories:

Most interesting stories, that were not particularly frightening or hopeful, or perhaps were a mixture of both:

  • I first heard of David Fleming, who wrote a “dictionary” that provides “deft and original analysis of how our present market-based economy is destroying the very foundations―ecological, economic, and cultural― on which it depends, and his core focus: a compelling, grounded vision for a cohesive society that might weather the consequences.”
  • Judges are relying on algorithms to inform probation, parole, and sentencing decisions.
  • I finished reading Rainbow’s End, a fantastic Vernor Vinge novel about augmented reality in the near future, among other things.

An American Sickness

The New York Times has a review of a new book called An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. Here’s an excerpt from the review:

Rosenthal thinks the health care market is different, and she sums up these differences as the “economic rules of the dysfunctional medical market.” There are 10 — some obvious (No. 9: “There’s money to be made in billing for anything and everything”); some humorous (No. 2: “A lifetime of treatment is preferable to a cure”) — but No. 10 is the big one: “Prices will rise to whatever the market will bear.” To Rosenthal, that’s the answer to Scalia’s question. The health care market doesn’t work like other markets because “what the market will bear” is vastly greater than what a well-functioning market should bear. As Rosenthal describes American health care, it’s not really a market; it’s more like a protection racket — tolerated only because so many different institutions are chipping in to cover the extortionary bill and because, ultimately, it’s our lives that are on the line…

The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. In every country where people have access to sophisticated medical care, they must rely heavily on the clinical expertise of providers and the financial protections of insurance, which, in turn, creates the opportunity for runaway costs. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.

In the United States, such counterpressure has been headed off again and again. The industry and its elected allies have happily supported giveaways to the medical sector. But anything more, they insist, will kill the market. Although this claim is in conflict with the evidence, it is consistent with the goal of maximum rewards to (and donations from) the industry. As a result, Medicare beneficiaries have prescription drug coverage (passed by Republicans in 2003), but Medicare administrators have no ability to do what every other rich country does: negotiate lower drug prices. In January, President Trump said drug companies were “getting away with murder” because they had “a lot of lobbyists and a lot of power,” insisting he would get Medicare to bargain. Should we really be surprised that the dealmaker in chief dropped the subject after meeting with pharma executives earlier this year?

At the individual level, there are really only two things I can think of to do. One is to attempt to shop around for health care. If you call your doctors office or hospital and ask for the price they charge for a particular service you are considering buying, which is how every other market works, they are likely to laugh at you. Your insurance company might actually help though. I have tried this with Blue Cross Blue Shield with limited success, but it definitely takes time and effort. The second option is to go abroad for checkups, lab work, and elective procedures. It’s not that hard to combine a vacation with a doctor or dentist visit. Insurance companies will generally cover it, because it will almost always save them money, but you definitely have to talk to them in advance. Foreign hospitals (I have experience in Singapore and Thailand) will sometimes bill U.S. insurance companies provided you have a letter form the insurance company up front. Otherwise you might have to front the cash and do the paperwork for reimbursement when you get back.

Like I said, all this takes time and effort, but there are significant savings to be had. So why aren’t third parties stepping into the vacuum to make comparison shopping and medical tourism easier for the masses?

breaking the 90 barrier

 

The Lancet has an open-access article on projected life expectancies in 35 industrialized countries by 2030. A few interesting findings are that South Korea seems to have some of the longest life expectancies and some of the largest gains in life expectancy among both sexes. South Korean women are projected to be the first to break the barrier of an average life expectancy of 90, with a 50% probability of this happening by 2030. The USA is consistently below the middle of the pack. The good news is that life expectancy is projected to increase in all countries studied, and the gap between men and women is projected to narrow. The graphics in this article are really interesting – I have picked just one below.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32381-9/fulltext

Figure 3 from Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble

self-healing teeth

Teeth – I have always thought they are one of the weakest links in our evolution, and an example of how nature does not always come up with an optimal design. They just don’t make any sense. Why make them out of substances that dissolve in acid when most of our food is made of acid? They just don’t last as long as most of our other body parts, and they cause us tremendous pain and suffering. Maybe in the future we will just have them all pulled out at some point and replaced with titanium or something else durable. Something I didn’t know, though, is that teeth actually have the ability to heal themselves at a slow rate, and this ability could maybe be accelerated using drugs.