Category: Health Care Access

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.

Certificate

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.

 

Is Patient Scheduling Software Valuable to Doctors?

I am a huge fan of entrepreneurs who want to make medical care more productive and consumer friendly. I wish all of them the best of success. Unfortunately, I am concerned that one of the trends attracting venture capital is chasing a shrinking market. That trend is patient-scheduling software in physicians’ offices.

I was at an angel investor pitch off in Arlington, Virginia, yesterday where one such firm was seeking investors. Two great incubator/accelerators, StartUp Health in New York and Rock Health in San Francisco (and, now, New York) have invested in Arsenal Health, inventor of Smart Scheduling.

Firms like this promise algorithms that use data to predict cancellations and no-shows. I suppose this is the flipside of ZocDoc, the remarkably successful business that doctors use to find new patients to fill appointments that have been cancelled.

These are all great ideas. I am just not sure they make sense in the future environment, where there will be surplus of patients and a shortage of doctors. A few years from now, when the U.S. has Canadian-style waiting lists to see specialists, why would a physician invest in technology to manage cancellations and no-shows?

Such technology would be very valuable where there is a surplus of doctors competing for a limited number of patients. But I don’t think anyone anticipates that for U.S. health care. I hope I am wrong.

Churn: Data Lacking on Critical Question

The media and most health policy wonks focus only on the number of insured versus uninsured people. They don’t really care if people are enrolled in Medicaid, Medicare, Obamacare plans, employer-based benefits, or whatever. As long as the percentage insured goes up, they are satisfied.

One of the problems this disguises is “churn” – people moving between different types of coverage, which leads to disrupted care. It is something that Obamacare surely makes worse, by introducing a new type of coverage for people within a certain range of income.

However, the people in charge of the new system are almost completely ignoring this problem, according to Modern Healthcare:

Experts say churn can be disruptive to people’s continuity of benefits and healthcare, particularly if they have medical conditions for which they are receiving treatment. In addition, it can be harder for people to access healthcare providers, particularly specialists, if they switch to Medicaid, which often pays lower rates.

“For a patient under a physician’s care for a condition like cancer or renal failure, changing providers in the midst of chemotherapy or dialysis can be incredibly disruptive,” said Chris Stenrud, executive director of government relations at Kaiser Permanente.

A CMS spokesman said no data on churning between private plans and Medicaid were available for the nearly three dozen states using the federal marketplace. But a committee of health plans selling products on the federal exchange that has been tracking the trend has noted a small but steady exodus from exchange plans. The committee, however, could not determine whether the people exiting the exchange plans were transitioned to Medicaid or employer coverage or became uninsured.

The solution to churn is a refundable, universal tax credit that allows people to buy health insurance of their own choosing, and getting rid of the artificially fragmented market that Obamacare has made worse.

IS FDA Reporting Drug Shortages Adequately?

For a number of years, there have been critical shortages of certain generic drugs for injection. These are often important cancer drugs. In 2012, I wrote a report that concluded over regulation by the Food and Drug Administration (FDA) was the primary cause of the shortages.

The President and Congress acted, but their actions did not result in improvement for over a year.

Today, the FDA claims to have improved the situation. However, an article in Health Affairs points out that the number of drug shortages reported by the FDA and the number reported by the University of Utah Drug Information Service (UUDIS), the leading private source of this data is diverging dramatically:

Access to Health Care Unchanged After Obamacare’s First Year

The Centers for Disease Control and Prevention (CDC) has released early estimates of health insurance and access to health care for January through September 2014. The National Health Insurance Survey (NHIS) is (in my opinion) the most effective survey of health insurance, because it asks people three different but important questions: Are they uninsured at the time of the survey? Have they been uninsured for at least part of the year? Have they been uninsured for more than a year?

As shown in Figure 2, the proportion of long-term uninsured is about the same as it was circa 2000. The proportion of short-term uninsured has shrink a little in Obamacare’s first year.

F2