Category: Health Care Access

Dr. Pharmacist Will See You Now

A recent article in the International Business Times outlines how pharmacists are pushing for a bigger role in health care. According to the article, Washington recently became the first state to recognize pharmacists as health care providers, and require that insurers reimburse them for consultations. Beginning next year pharmacists in Washington can bill insurers for appointments just like doctors and nurse practitioners.

Hooray! Cheap Lab Tests Coming to a Walgreens Near You! No Physician Required!

A recent Huffington Post article explains how a 31-year old college dropout wants to alter your relationship with your doctor — but in a good way. Elizabeth Holmes, a self-made billionaire, is in the process of shaking up the stodgy laboratory testing industry. The first of her tests have received clearance from the U.S. Food and Drug Administration, with others to follow.

Direct-To-Consumer Lab Test Works Fine!

Fellow Forbes contributor and health care entrepreneur Dan Munro has taken advantage of Arizona’s new law allowing patients to buy lab tests directly without a physician’s order. It was a positive experience:

The Theranos process really has removed much of the friction I associate with blood tests I have taken in the past. Access is through a familiar retail facility with pharmacy hours. Billing is a typical retail transaction with credit, debit and HSA cards (or cash/check). The lowest price blood test is $2.70 (Glucose) and Theranos advertises that their pricing is at least 50% below Medicare reimbursement rates for all tests.

The highest price test on the Theranos order form was $59.95 ‒ a comprehensive test for Sexual Health. For comparison purposes, RequestATest (which appears to be an online, front-end for using LabCorp locations around the country), charges $199 for a comprehensive STD test and AnyLabTest Now (with 3 locations in the Phoenix metro) charges $229 for a comprehensive STD test.

One Year After Veterans Waiting List Scandal, Doctors Only 2,000 of 23,000 New VHA Hires

I hate to bring this up right after Independence Day, but the Veterans Health Administration appears to have devolved from an expensive and failing bureaucracy to an even more expensive and failing bureaucracy.

We have  already discussed that waiting lists have grown one year after the scandal broke. Now, see what they’ve done with the billions of dollars Congress handed them in the wake of the scandal:

o Bonuses at the most troubled VA facilities ran virtually unabated.
o Out of 23,000 new employees added to the employment counts during the scandal, fewer than 2,000 were doctors. Less than 1 in 12 new hires were doctors.
o At the troubled Hines VA in Cook County, IL bonuses leapt to three year highs, but the number of doctors actually decreased.
o Across the system, the VA cut the number of accountability positions: inspector general, auditors, and quality assurance officers.
o There are only 23,768 doctors in the system, but over 338,297 total employees. It’s still an employment farm, not a medical system.
o Yet, the VA increased the Public Relations Directors total salaries by $3,000,000. Painters, Interior Decorators, and Gardeners also increased in headcount and salaries.

(Open the Books, July 4, 2015)

Veterans’ Waiting Lists Up 50 Percent One Year After Scandal Exposed

Affordable-Care-ActUnfortunately, our predictive abilities at NCPA’s Health Policy Blog appear to be holding up pretty well. Last July, I wrote that giving billions of dollars to the Veterans Health Administration to “fix” the problems of long waiting lists for treatment would be viewed by the VHA bureaucrats as a “reward,” and they would react accordingly.

That is exactly what has happened:

One year after an explosive Veterans Affairs scandal sparked national outrage, the number of veterans on wait lists to be treated for everything from Hepatitis C to post-traumatic stress is 50 percent higher

Ahead of the House Committee on Veterans Affairs budget hearing scheduled for Thursday, VA leaders also warned that they are facing a $2.6 billion budget shortfall. They said they may have to start a hiring freeze or furloughs unless funding is reallocated for the federal government’s second-largest department. (Emily Wax-Thibodeaux, “One year after VA scandal, the number of veterans waiting for care is up 50 percent,” Washington Post, June 23, 2015)

At what point does a government bureaucracy that fails so badly get put out of business? Not very often, and not soon enough.

NCPA’s CEO, Allen B. West, has also written about this scandal.

Drug Shortages Getting Worse

Robin Miller, a 62-year-old oncologist in Atlanta with bladder cancer, was scheduled to receive a potentially lifesaving drug in December. But her doctor’s office called shortly before the appointment to say: “Sorry, we don’t have any. We can’t give it to you,” according to Dr. Miller.

The disruption was due to a global shortage of the drug, BCG, which arose after manufacturing problems at two of the few global suppliers. Without the drug, Dr. Miller feared her cancer would come back and she would have to have her bladder removed, a step she called “barbaric.”

The crisis illustrates the potentially grave consequences of a persistent problem in health care: drug shortages. The number of drugs in short supply in the U.S. has risen 74% from five years ago, to about 265, according to the University of Utah’s Drug Information Service, which tracks supplies. They range from antibiotics and cancer treatments to commodity items such as saline. (Peter Loftus, “U.S. drug shortages frustrate doctors, patients,” Wall Street Journal, May 31, 2015)

The U.S. government’s measures to mitigate this problem have failed because it has ignored NCPA’s conclusion that shortages result from too much, not too little control over the market for these drugs.

The government keeps tightening the screws on manufacturers, and the shortages keep growing.

See Devon Herrick’s testimony to the U.S. Senate in 2011 and my own study published in 2012.

Preventive Care Does Not Want To Be “Free”

One conceit behind Obamacare is that if the government mandates preventive care be “free”, people will use it. The notion should appeal to free-market types, too: As the price of a service drops, the quantity demanded should increase.

However, it is not that simple in health care. Let’s take another dive into the always heated and controversial discussions about preventive care for women (such as our recent entry about mammography).

New research shows that women under 65 are over screened for osteoporosis, and women aged 65 and over are under screened, although older women get screened for “free”:

Draining More Brains: Where Medicine is Heading

Watching the Affordable Care Act roll-out and reading about its gestation in Steven Brill’s book, America’s Poison Pill, makes one very aware that there is a serious brain drain under way in medicine.  Here’s what anyone can see:

Numbers of applicants to medical school, which once was 10 for every place, is now less than 1.  Physicians are telling their children not to go into medicine. There is now more than a 7 foot stack of regulations for the Affordable Care Act. As we all know, the slogan for this whole program has been “the healthcare system is broken.”  (If that is so true, why force feed new people into it?)

Some manifestations:  the adoption of the ICD-10 coding system, which defines conditions needing care in such detail that there is an unacknowledged administrative cost for compliance and a substantial legal and financial risk if there is mis-coding. Another is the forced adoption of Electronic Medical Records, with rules for “Meaningful Use.” This will produce electronic oversight of all medical care, in the guise of supporting “quality of care” and facilitating “Value-based Payments.”  Ultimately, the government regulators expect to have real time access to any person’s care and any physician’s performance.

Certificate of Need Laws Reduce Choice in Health Care

Imagine if you wanted to open a new hardware store and you needed a “Certificate of Need” issued by the state or local authority that your hardware store was needed. Needless to say, incumbent hardware stores would already be well armed with strong arguments that your hardware store was not needed. Crazy? Yes. Un-American? Yes. Unfortunately, these Certificates of Need exists in most U.S. states for hospitals or other facilities.

Scholars at the Mercatus Center have published a new ranking of states’ CON laws, finding that sates with Certificate of Need programs are associated with:

  • 131 fewer beds per 100,000 persons.
  • A reduction by between 1 and 2 hospitals providing MRI services per 500,000 persons.
  • A reduction of 37 percent in the number of hospitals offering CT scans.


Washington, DC: Rich World’s Worst Capital for Infant Mortality

Save the Children has a new report ranking 25 of the world’s richest capital cities by childhood mortality. Washington, DC is the worst. Prague, Stockholm, Oslo, Tokyo, and Lisbon lead.

But I think the international ranking was just to get headlines. The real point of the report is to emphasize differences in infant mortality between rich neighborhoods and poor neighborhoods in these rich capitals:

  • In examining infant deaths in D.C., Save the Children found that in 2012 the infant mortality rate in DC’s poorest neighborhood (Ward 8) was more than 10 times higher than the rate in DC’s wealthiest community (Ward 3).

  • In 2012 the infant mortality rate in ward 8 was 14.9 deaths per 1,000 live births. In contrast in Ward 3, the city’s wealthiest ward, the rate was 1.2 deaths per 1,000 live births.

I suppose that many will use this report to call for increases in Medicaid spending, which has increased relentlessly over the years without eliminating this difference.