There were 16 pilot programs in all. Overall, patients were less happy. Staff was happier. And:
We found no significant overall reduction in costs, though in case management sites there was an overall 9 per cent reduction in hospital costs.
We are already hearing reports of doctors who do not take Medicare patients. In a 2010 survey of 9,000 physicians, the American Medical Association reported that 17 percent of doctors restricted the number of Medicare patients; among primary care physicians, a whopping 31 percent did. With universal Medicare, is the population really going to accept, and would Congress really allow, the continued reductions in prices?…
By some estimates, the Medicare program loses a staggering $60 billion to fraud each year. This amounts to 11 percent of the Medicare budget and would be enough to double Federal spending on primary and secondary education. No private company would ever tolerate this abuse. Imagine the fraud if Medicare covered 300 million Americans.
From Dana Goldman and Adam Leive at the Health Affairs Blog. Entire post is worth reading. See also, my Health Affairs Blog post with Tom Saving, Is Medicare More Efficient than Private Insurance?, and the NCPA study, Health Care Reform: Do Other Countries Have the Answers?
A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims.
Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation – but insurers are responsible only for the first month.
Doctors say the liability might keep many physicians from participating in next year’s program. A single prostate cancer patient’s course of treatment can cost $93,000, they say.
More from Jim Sanders.
The Diagnostic and Statistical Manual of Mental Disorders is often called the “Bible” of psychiatric diagnosis, and the term is apt. The DSM consists of instructions from on high; readers usually disagree in their interpretations of the text; and believing it is an act of faith.
The DSM-II (1968) made homosexuality a mental disorder, a decision revoked by vote in 1973…Narcissistic Personality Disorder was voted out in 1968 and voted back in 1980; where did it go for 12 years? Doctors don’t vote on whether pneumonia is a disease.
The new DSM-5, with its modernized Arabic number, is 947 pages. It contains, along with serious mental illnesses, “binge-eating disorder” (whose symptoms include “eating when not feeling physically hungry”), “caffeine intoxication,” “parent-child relational problem” and my favorite, “antidepressant discontinuation syndrome.” Now psychiatrists can treat the symptoms of going off antidepressants, which is good because the expanded criteria for many disorders allows doctors to prescribe antidepressants more often for more problems. Gone is the “bereavement exemption,” for example. You used to get two weeks after a loved one died before you could be diagnosed with major depression and medicated. Now you get two minutes.
More at the WSJ.
These bacteria, which number around 100 trillion, are living (and dying) right now on the surface of my skin, on my tongue and deep in the coils of my intestines, where the largest contingent of them will be found, a pound or two of microbes together forming a vast, largely uncharted interior wilderness that scientists are just beginning to map.
It turns out that we are only 10 percent human: for every human cell that is intrinsic to our body, there are about 10 resident microbes — including commensals (generally harmless freeloaders) and mutualists (favor traders) and, in only a tiny number of cases, pathogens. To the extent that we are bearers of genetic information, more than 99 percent of it is microbial. And it appears increasingly likely that this “second genome,” as it is sometimes called, exerts an influence on our health as great and possibly even greater than the genes we inherit from our parents. But while your inherited genes are more or less fixed, it may be possible to reshape, even cultivate, your second genome.
Michael Pollan from the NYT Magazine.
Researchers at the Georgia Institute of Technology have developed Cody, a robotic nurse the university says is “gentle enough to bathe elderly patients.” There is also HERB, which is short for Home Exploring Robot Butler. Made by researchers at Carnegie Mellon, it is designed to fetch household objects like cups and can even clean a kitchen. Hector, a robot that is being developed by the University of Reading in England, can remind patients to take their medicine, keep track of their eyeglasses and assist in the event of a fall.
The technology is nearly there. But some researchers worry that we are not asking a fundamental question: Should we entrust the care of people in their 70s and older to artificial assistants rather than doing it ourselves? (NYT)
Americans spent approximately $61.4 billion in 2011 on about 218 million pets, not counting several million fish. HT: Timothy Taylor.
Miami hospital tells what buyers actually pay. HT: Sarah Kliff.
Unions not happy with health care reform law.
While most of the media are fixated on Benghazi, the IRS abuses, and the DOJ’s interest in reporters’ phone calls, the biggest scandal of all may be Kathleen Sebelius’ shakedown of health care companies to pay for activities Congress has refused to fund.
It is illegal for government officials to solicit money from companies they regulate, according to Sarah Kliff from The Washington Post. She writes –
Federal regulations do not allow department officials to fundraise in their professional capacity. They do, however, allow Cabinet members to solicit donations as private citizens “if you do not solicit funds from a subordinate or from someone who has or seeks business with the Department, and you do not use your official title,” according to Justice Department regulations.
That should be a no-brainer. But Ms. Sebelius has violated the law before. Michael Cannon of the Cato Institute reminds us that in 2012 –
…the U.S. Office of Special Counsel concluded that Sebelius violated the Hatch Act by campaigning for President Obama and other political candidates while traveling on official business, an offense for which other federal workers are fired.
This paper proposes new measures of the business cycle that incorporate monetized changes in health of the population. In particular, we incorporate in GDP the dollar value of mortality, treating it as depreciation in human capital analogous to how NDP measures treat depreciation of physical capital. We examine the macroeconomic fluctuations in the United States and globally during the past 50 years, taking into account how depreciation in health affects the cycle. Because mortality tends to be pro-cyclical, fluctuations in standard GDP measures are offset by monetized changes in health; booms are not as valuable as traditionally measured because of increased mortality, and recessions are not as bad because of reduced mortality. Consequently, we find that U.S. business cycle fluctuations appear milder than commonly measured and may even be reversed for the majority of “recessions” after accounting for the cyclicality of health. We find that adjusting for mortality reduces the measured U.S. business cycle volatility during the past 50 years by about 37% in the United States and 46% internationally.
NBER paper by Mark L. Egan, Casey B. Mulligan, Tomas J. Philipson.
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