Category: Health Care Access

There is a Market for Human Organs, Whether You Like It or Not

The buying and selling of human organs was in the news this weekend, via an investigative report in the New York Times. People tend to be moved when they learn about someone donating an organ to someone else who needs it, but they also tend to be disgusted by the notion of a market where people can sell their organs to strangers. Naturally enough, this market consists of high-income patients and low-income donors.

The NYT profiles an Israeli woman who bought a kidney from a Costa Rican donor, for a total cost of $175,000. A donor gets about $5,500. The rest goes to middlemen and medical staff. It doesn’t sound like a great deal for the donor, does it?

Wal-Mart Shakes Up Primary Care — and the Whole System

Wal-Mart has a new take on retail clinics. These newly launched clinics will charge patients $40 for a visit — but only $4 for Wal-Mart associates. Anybody, with or without insurance, can go into one of these clinics and be seen by a qualified health professional, without the usual paperwork. Although the mega-retailer has operated clinics in its stores for a few years now, the new ones are different in a couple of ways.

First, Wal-Mart’s previous clinics were collaborations with local hospitals, which had “mixed success”. So, it appears to have decided to do it alone. I am not surprised. Can you imagine a company like Wal-Mart, which succeeds in an unregulated industry with ruthless price competition, trying to negotiate a deal with hospital executives? The communications challenges must be almost insurmountable — sort of a Mars and Venus situation.

Medical Auction Website Puts Patients in Charge of Prices

MedCity News has profiled Medibid, a business that connects patients to physicians who compete on price, through auctions, to treat them:

Francisco Velazco couldn’t wait any longer. For several years, the 35-year-old Seattle handyman had searched for an orthopedic surgeon who would reconstruct the torn ligament in his knee for a price he could afford.

Out of work because of the pain and unable to scrape together $15,000 — the cheapest option he could find in Seattle — Velazco turned to an unconventional and controversial option: an online medical auction site called Medibid, which largely operates outside the confines of traditional health insurance. The four-year-old online service links patients seeking non-emergency care with doctors and facilities that offer it, much the way Priceline unites travelers and hotels. Vetting doctors is left to prospective patients: Medibid does not verify credentials but requires doctors to submit their medical license number for patients to check.

VA to be Rewarded $17 Billion for Failing Vets

A few days ago, we saw a headline we wished we hadn’t seen, in which a VA official testified to Congress that the VA would need over $17 billion to “fix” the problems that have been denying veterans access to care. Well, it looks like he’s going to get it.

The New York Times reports that a bipartisan bill has been negotiated, that hands $17 billion more dollars to the failed agency. Lawmakers from both sides of the isle hope to pass the bill before the August recess. $10 billion will be allocated to get veterans appointments with private doctors and hospitals when they cannot access the VA system. However, that is not the good news it appears to be.

This looks like it is meant to solve the problem that private providers are increasingly unwilling to see VA patients, because the VA does not pay its bills adequately or timely. So, the solution would be to give vouchers directly to vets, right? No such luck:

OxyContin Abuse: Stopping the Dealers Helps; Suing the Drugmaker Does Not

One of the biggest challenges with the regulation of prescription drugs is how to prevent the abuse of addictive ones. OxyContin, a powerful painkiller is probably the best known example. There are two ways to reduce the abuse of OxyContin: Punish the inventor and manufacturer of this valuable medicine; or go after those to take advantage of addicts who need help.

HSAAlthough OxyContin is widely prescribed by physicians and valued by patients who need powerful pain relief, trial lawyers decided that the medicine, not the addiction, was the problem. Years ago, the decided they could make some money by suing the manufacturer, Purdue Pharma. Back in 2008, Heartland Institute’s Lawsuit Abuse Fortnightly reported on the cost of this effort:

If anyone doubts tort claims are a burden on American drugmakers, consider the fees for Purdue Pharma L.P.’s defense of 1,400 lawsuits in 32 states, alleging that OxyContin, its prescription painkiller, is addictive.

Absurd? Online Appointments for Hospital Emergency Rooms

Readers of this blog know that we don’t think that ObamaCare will do anything to reduce ER overcrowding. Indeed, we think ObamaCare will increase the burden on ERs.

The latest absurdity: Booking ER appointments online. According the San Francisco Chronicle, a woman recalled seeing:

Dignity Health television commercials featuring a woman sitting in a hospital waiting room and then cutting to the same woman sitting on her living room couch as words come up on the screen: “Wait for the ER from home.”

Dignity isn’t the only network employing the strategy. In an era of increased competition driven by the nation’s Affordable Care Act, hospital executives around the country are hoping online appointments will attract patients eager to avoid long waits in a crowded and often chaotic environment.

Understanding Waiting Times for Health Care

In Sunday’s New York Times, Elizabeth Rosenthal discusses evidence that waiting times for medical care in the U.S. do not always compare favorably with those of other developed countries:

“I fully expect wait times to be going up this year for Medicaid and Medicare and private insurance because we are expanding access to care, but we’re not really expanding the system of providers,” said Steven D. Pizer, a health care economist at Northeastern University in Boston.

Unfortunately, the article evolves into an apologetic for waiting times as a good thing. I would also quibble with Ms. Rosenthal’s description of U.S. health care as “market-based” which it certainly is not. I don’t think I’ve met anyone, pro- or anti-ObamaCare, who does not expect waiting times to increase as long as ObamaCare exists. So, we better get used to them. How to explain them?

There is no Patient Privacy

Dr. Deborah Peel is probably the nation’s foremost advocate for patient privacy. The Texas psychiatrist has worked tirelessly to include privacy protections in all of the health reform ideas of the past twenty years.

She recently gave a presentation at TEDx where she informed the geek community of how extensive medical data breaches have become. Not just extensive but perfectly legal and even encouraged by our government. Bottom line ― there is no medical privacy anywhere in American health care.

Does Public Health Coverage Augment Private Coverage or Crowd It Out?

Expansion of government health care programs like Medicaid is sold with the explicit argument that expansion will cover the uninsured. However, expansion may also cause people who are already insured to cancel their insurance or let it lapse so that they can take advantage of a less expensive to them government program. Academic studies of the size of the crowd-out effect arrive at a variety of conclusions ranging from Lo Sasso and Buchmueller’s estimate of a 50 percent crowd-out rate for SCHIP to an 8 percent rate for Dague et al.

Wisconsin runs its own population survey of health coverage. It samples from all Wisconsin households with landline phones (weights adjusted to represent what is known of the cell only population). The response rate is 47 percent, and 2,462 households were interviewed in 2011.

Here are two graphs showing what the survey has found over the last decade. What is most striking is that if the overall rate of coverage has increased, the increase is small. The increase in public coverage of children of about 25 percentage points mirrors a similar loss in private coverage; and the same effect ― but slightly smaller ― is observed in working-age adults.



ObamaCare Subsidies for Illegal Aliens?

Health Affairs is a reliable barometer of the direction of mainstream health policy. The following is from the abstract of a May 2014 article:

iStock_000004348658XSmallUndocumented immigrants were excluded from the health benefit Marketplaces created by the Affordable Care Act partly because of claims that they contribute to problems such as high costs and emergency department (ED) crowding. This article examines the likely health care use and costs of undocumented immigrants in California in 2009-10. Using data from the 2009 California Health Interview Survey (CHIS), we developed a model that estimated the state’s adult and child undocumented immigrant population…We found that undocumented immigrants in California, and the uninsured among them, had fewer or similar numbers of doctor visits, ED visits, and preventive services use compared to U.S. citizens and other immigrant groups. Allowing undocumented immigrants to purchase insurance in the Marketplaces and ensuring receipt of low-cost preventive services can contribute to lower premiums and reduce resource strains on safety-net providers.