Insurers are Starting to Pay for Cross-Border Treatment


In the New Republic, Adam Teicholz and Glenn Cohen discuss insurers whose provider networks run across the border:

conceptBefore dawn on a Wednesday in January, Cesar Flores, a 40-year-old employed by a large retail chain, woke up at his home in Chula Vista, California. He got in his car and crossed the border into Tijuana. From there, he headed for a local hospital, where he got lab tests — part of routine follow-up to a kidney stone procedure. He had his blood drawn and left the hospital at 7:30. He arrived home before 10.

But Flores’s situation isn’t medical tourism as we know it. Flores has insurance through his wife’s employer. But his insurer, a small, three-year-old startup H.M.O. called MediExcel, requires Flores to obtain certain medical treatment at a hospital across the border. In part due to cost-pressures generated by the Affordable Care Act, other sorts of plans that require travel have the potential to expand.

Who’s Your Doctor?


Over at Forbes, Bruce Japsen reports that the Affordable Care Act is boosting demand for primary care providers. As we’ve said before, Obamacare does nothing to boost physician supply. The millions of newly insured will increase their demand for medical care — and someone has to provide it. This has caused a Gold Rush of sorts among medical practices and hospitals scrambling for primary care providers.

Physician staffing firm, MerrittHawkins reports primary care providers — family physicians and internists tops the list. The number of requests for nurse practitioners and physicians’ assistants it’s been ask to recruits is up more than three times (i.e. 320 %). Advance practice nurses and physicians’ assistants didn’t even make the top 20 of most recruited medical practitioners three years ago. Here’s the current list.

In many cases, increased use of nurse practitioners and physician assistants can provide high quality care at reduced costs. I have long advocated increasing these professionals’ scope of practice as an important part of innovation in delivering medical care. On the other hand, this should happen as a consequence of increased consumer-direction of healthcare spending, not as a response to increased government control, as imposed by Obamacare.

Hits and Misses


electronic-medical-recordCall your doctor: CMS says telehealth services should cover annual wellness visits, psychotherapy and psychoanalysis.

A remote control for your birth control.

A simple blood test for Alzheimer’s.

Weight loss: The best medicine for osteoarthritis.

And you thought you were a hoarder: CDC finds smallpox vials from 1950s in FDA storage room.

Poop in a pill: Fecal transplant drug nearing Phase 3 clinical trials.

A problem that self-identifies: Microwave oven that counts calories as it nukes.

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.

Is Crony Capitalism Good Enough for Health Care?


In the Wall Street Journal, Paul H. Rubin and Joseph S. Rubin make an argument in favor of “crony capitalism” as a second-best solution. Their example from health care is Medicare Part D:

Some claim that Medicare Part D, which pays for drugs, was a giveaway to the pharmaceutical industry. But 40 years of research has clearly shown that the Food and Drug Administration’s regulatory process makes drug development and approval unnecessarily and inefficiently expensive. Perhaps, in this environment, supplementing the costs of drugs may move us toward a more efficient drug policy, and bring more life-saving drugs to market.

That’s not quite the way I see it. Medicare is widely accepted in American society, and excluding prescription drugs made no sense because prescription drugs substitute for more expensive treatments, especially hospitalization. Costs are below budget and seniors’ have lots of choices. So, Medicare Part D is a second-best solution, but it is a second-best solution to the socialization of health care for American seniors. It is not a second-best solution to the unnecessary costs imposed on pharmaceutical development by the FDA.

Medicare’s Spending per Beneficiary Increased Twice as Fast as Employer-Based Plans’ in Ten Years


A new study from the American Health Policy Institute analyzes the growth in health spending by different payers over the last decade. In summary, the study found:

  • 1On average, all U.S. employers spent $3,430 per covered life on health care in 2012, up 13.6 percent from 2003 after adjusting for inflation.
  • On average, large U.S. employers (1,000 or more employees) spent $4,990 per covered life on health care in 2013.
  • In 2012, government (federal and state) spent $1.1 trillion on health care, or an average $9,130 per covered life, up from $8,010 in 2003, or 14.0 percent, after adjusting for inflation;

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.

Hits and Misses


chopsticks-6What you shouldn’t eat: Instant noodles drive metabolic syndrome (at least in Korean women).

Who would have thought this was the case: Some bee pollen weight loss products are a…scam.

Don’t watch what your workers eat: Non-diet approach to weight management more effective in worksite wellness programs.

However, you can lose weight eating sour milk: Yogurt intake over long term linked to lower risk of becoming overweight.

Less exercise, not more calories, responsible for expanding waistlines.

Should a pharmacist run your corporate fitness program? Sure, it’s yet another job they are infinitely overqualified to perform.

Health Costs in Canada Increased 2.85 Times Faster Than Inflation in the Last Decade


New research from The Fraser Institute shows that health costs in Canada increased 53.3 percent since 2014. During the same period, consumer price inflation increased 18.7 percent and cash incomes rose only 34.7 percent. And the taxes taken to fund the single-payer system have risen significantly:

Health care in Canada is not “free.” Canadians often misunderstand the true cost of our public health care system. This occurs partly because Canadians do not incur direct expenses for their use of health care, and partly because Canadians cannot readily determine the value of their contribution to public health care insurance because there is no “dedicated” health insurance tax.


Headlines I Wish I Hadn’t Seen


Confident DoctorsObamaCare made me fire my doctor.

As health care law’s employer mandate nears, firms cut worker hours, struggle with logistics.

Insurers on New York’s exchange seeking significant rate increases.

Only 25 percent of patients are offered cost estimates before treatment

Injury, violence are leading causes of death for young Americans.