[on the Affordable Care Act] HealthNewsReviews.org Guest post: Bewitched, bothered and bewildered

 

Reblog from 7 August 2012 article at HealthNewsReview.org

The following is a guest post submitted by Harold DeMonaco, MS, one of our expert story reviewers for HealthNewsReview.org.  The opinions stated are his.

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I, like many, read the internet version of my local newspaper.  And in doing so, I am provided with an opportunity to view the comments of my fellow residents on topics of importance.  My local newspaper is a bit right leaning and as a result, the vox populi is as well.

Many of those who post thoughts on current events do so with great fervor and some with great frequency.  The tone and tenor of the “discussions” can vary but were at their most vitriolic when writers could use pseudonyms.  Many of the most vocal appear to have departed when a requirement was made to self identify posts to the site.  Several continue to provide the rest of us with the fruits of their years and breadth of experience as well as their keen intellect.

Given the right leanings of the newspaper and the most vocal of the vox populi, it is not surprising that the Affordable Care Act (presumably a four letter word for many) is viewed in a somewhat negative fashion.  This is somewhat surprising since presumably the writers are either the beneficiaries of then Governor Romney’s surprising insight into healthcare or to the workings of President Johnson’s Great Society and Medicare.  Massachusetts has managed to insure just about every citizen in the state and has now enacted legislation to better control health care costs.  While there is work to be done to develop an ideal healthcare delivery system in Massachusetts and control costs, near universal access has been accomplished.

Why then do people object so strenuously to Obamacare?  Is it their fear of government control?  If so, the objectors should rightfully refuse Medicare, a pay as you go, government run insurance program managed by the Centers for Medicare and Medicaid.  I suspect that the underlying reason is really rooted in economics.  In essence, it is a zero sum game. If you win something, I must lose something.

The Blue Cross Foundation of Massachusetts periodically publishes updates on the Massachusetts experiment.  Here are the latest findings:

• 439,000 more Massachusetts residents have health insurance coverage than did before reform.
• Massachusetts has the highest rate of insurance in the country with 98.1 percent of residents insured.
• There has been no evidence of subsidized coverage “crowding out” employer-sponsored insurance, and employer offer rates have grown from 70 percent to 77 percent since implementation of reform.
• Public support for Massachusetts health reform has remained strong with two out of three adults supporting reform.
• Most employers believe health reform has been good for Massachusetts and 88 percent of Massachusetts physicians believe reform improved, or did not affect, care or quality of care.
• The cost of health care and the annual rate of increase in health care spending remains a challenge.  With no intervention, per capita health care spending in Massachusetts is projected to nearly double by 2020.

Given the intensity of the debate around Obamacare, I would have assumed that more news stories would provide readers with more information about the Massachusetts experience.  More often than not however, readers are provided with partisan arguments for and against the Affordable Care Act.  While there is a good deal of noise, there often is little in the way of real information.

 

 

The following is a guest post submitted by Harold DeMonaco, MS, one of our expert story reviewers for HealthNewsReview.org.  The opinions stated are his.

——————————————————————————————

I, like many, read the internet version of my local newspaper.  And in doing so, I am provided with an opportunity to view the comments of my fellow residents on topics of importance.  My local newspaper is a bit right leaning and as a result, the vox populi is as well.

Many of those who post thoughts on current events do so with great fervor and some with great frequency.  The tone and tenor of the “discussions” can vary but were at their most vitriolic when writers could use pseudonyms.  Many of the most vocal appear to have departed when a requirement was made to self identify posts to the site.  Several continue to provide the rest of us with the fruits of their years and breadth of experience as well as their keen intellect.

Given the right leanings of the newspaper and the most vocal of the vox populi, it is not surprising that the Affordable Care Act (presumably a four letter word for many) is viewed in a somewhat negative fashion.  This is somewhat surprising since presumably the writers are either the beneficiaries of then Governor Romney’s surprising insight into healthcare or to the workings of President Johnson’s Great Society and Medicare.  Massachusetts has managed to insure just about every citizen in the state and has now enacted legislation to better control health care costs.  While there is work to be done to develop an ideal healthcare delivery system in Massachusetts and control costs, near universal access has been accomplished.

Why then do people object so strenuously to Obamacare?  Is it their fear of government control?  If so, the objectors should rightfully refuse Medicare, a pay as you go, government run insurance program managed by the Centers for Medicare and Medicaid.  I suspect that the underlying reason is really rooted in economics.  In essence, it is a zero sum game. If you win something, I must lose something.

The Blue Cross Foundation of Massachusetts periodically publishes updates on the Massachusetts experiment.  Here are the latest findings:

• 439,000 more Massachusetts residents have health insurance coverage than did before reform.
• Massachusetts has the highest rate of insurance in the country with 98.1 percent of residents insured.
• There has been no evidence of subsidized coverage “crowding out” employer-sponsored insurance, and employer offer rates have grown from 70 percent to 77 percent since implementation of reform.
• Public support for Massachusetts health reform has remained strong with two out of three adults supporting reform.
• Most employers believe health reform has been good for Massachusetts and 88 percent of Massachusetts physicians believe reform improved, or did not affect, care or quality of care.
• The cost of health care and the annual rate of increase in health care spending remains a challenge.  With no intervention, per capita health care spending in Massachusetts is projected to nearly double by 2020.

Given the intensity of the debate around Obamacare, I would have assumed that more news stories would provide readers with more information about the Massachusetts experience.  More often than not however, readers are provided with partisan arguments for and against the Affordable Care Act.  While there is a good deal of noise, there often is little in the way of real information.

 

 

 

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States Crack Down on Mental Health Prescriptions

 

From the 14 August 2012 edition of Stateline

n the past two years, Illinois has done just about everything it could to reduce the amount it spends on prescription drugs for mental health. It has placed restrictions on the availability of 17 medications used to treat depression, psychosis and attention-deficit disorder. Doctors now have to explain to Medicaid why the drugs are necessary before a patient can get access to them. Then in July, as part of an effort to cut overall Medicaid spending by $1.6 billion, the state capped the number of prescriptions for Medicaid recipients to four a month, even if they previously were taking a broader cocktail of behavioral medications.

In financial terms, there is no question that it has worked. Last year, the state’s Medicaid mental health drug spending budget was reduced by $112 million. The new cap on prescription drugs is expected to save another $180 million.

Up until 2011, behavioral health drug spending made up about a quarter of Illinois’ Medicaid prescription drug costs. The state spent about $392 million that year on drugs for treating mental health patients. In fiscal 2012, the state spent $280 million on mental health drugs.

But what are the implications for quality of care? Some physicians argue that they are disastrous. “It’s a mess,” says Dr. Daniel Yohanna, a psychiatrist at the University of Chicago Medical Center.  “People who were stable on some drugs have been unable to get them. It has created a significant problem.”

Michael Claffey, of the Illinois Department of Healthcare and Family Services, says the state is aware of the complaints from the mental health community, but adds, “we don’t have unlimited funds. We need doctors to work with us…If a patient needs a drug, they will get approval.”..

..

About half of Medicaid mental health patients had difficulty accessing at least one medication, and about a quarter of them then stopped taking their medications, according to a Psychiatric Services report in 2009 on physicians’ experiences in 10 state Medicaid programs. Physicians reported that many patients experienced an adverse event, such as hospitalization, homelessness or even suicide because they couldn’t get their drugs.  Another study, reported in the May 2008 issue of Health Affairs, showed that between 2003 and 2004, Maine’s prior authorization program for atypical antipsychotics (drugs that treat serious psychoses) resulted in a 29 percent greater risk that patients suffering from schizophrenia would fail to follow their treatment protocol.

Competing studies, on the other hand, suggest that mental health drugs aren’t being properly prescribed, particularly to those under 18, and that imposing restrictions can improve quality of care by requiring physicians to reconsider why they are writing a prescription. I..

…

In Illinois, Yohanna says he has seen examples of inappropriate prescribing of psychotropic drugs and agrees that “prior approval can help with that.” But he thinks that requiring all doctors to get approval for drugs “is just throwing a blanket on things without really dealing with the worst offenders.” He says a policy like Washington State’s second opinion program would be a good idea, as well as setting up a system where there are fewer restrictions on doctors who had responsible prescribing patterns. Currently Yohanna says, it can take two to three days to get a drug approved.

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