I rarely overtly “get political” at my blog.
However, this seems to go beyond politics to what living in a functional democracy or republic is all about.
I want to clear up a misunderstanding often voiced in the healthcare blog universe: namely, whether health care is a right or a service. Our answer to this question will affect how we approach healthcare reform in the next Congress, so let me say plainly: health care is a civil right.
Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For example, we don’t have a right to vote for any natural reason; we have the right to vote because society is ordered in a way that makes voting both possible and essential to our free and full participation in society. Voting is a civil right.
Health care is a civil right because society is ordered in such a way as to make it both possible and essential to the free and full participation of the sick, injured and disabled — i.e. ‘patients’ — in society. I’m a patient, and I can tell you: lack of health care makes it impossible for me to participate freely and fully in society. Among the reasons …
- I can’t choose my work. Because health care is tied to employment, and not all jobs have benefits, I can’t do things that might be socially useful or personally satisfying but lack benefits. I can never start a business, for example, because I wouldn’t have health insurance.
- I can’t buy the things I need. Patients are denied the free purchase of goods and services by restrictions on the healthcare market: FDA regulations, prescription requirements, doctor licensing, insurance rules. These restrictions help make health care safer and more effective, but they also sharply curb supply of medical goods and increase their price, which is paid disproportionately by patients.
- I can’t participate fully in the political process. I rarely volunteer in my community — dealing with my healthcare takes up most of my free time. I can’t give money to causes or candidates I support, because I don’t have any to spare. Moreover, a sick person is less likely to risk losing employer-provided insurance by organizing a union, whistle-blowing against fraud, or reporting discrimination in the workplace.
None of these exclusions is intrinsic to illness, but due instead to the structure of our society. And each reason is more compelling to the extent illness and injury are produced by pollution, toxic products, and other societal causes. A patient’s basic right to justice requires us to respond to the likelihood that we — as a society — had something to do with their illness.
One of the counter-claims made against this line of reasoning is that nobody is entitled to claim a health provider’s labor as a right. But there are many other professions which are subject to civil rights claims: teachers, firefighters, lawyers, to name a few. Moreover, physicians and other providers are able to do their job effectively in large part due to public investment in research and technology.
Unfortunately, the Affordable Care Act did not go far enough to guarantee patients right to health care. Access to insurance is not the same as access to care, as any patient will tell you. The ACA was a small step in the right direction, but we still need legislation recognizing patients’ right to health care. Whatever the outcome of the election, health care must be acknowledged as a civil right.
Duncan Cross blogs from the perspective of a chronic patient at his self-titled site, Duncan Cross.
- Health Care in European Countries (travelwyse.wordpress.com)
Rational Rationing vs. Irrational Rationing By DAVID KATZ, MD in the 13 September 2012 article at The Health Care Blog
n a system of universal, or nearly universal health insurance such as in Massachusetts, decisions about what benefits to include for whom are decisions about the equitable distribution of a limited resource. If that is rationing, then we need to overcome our fear of the word so we can do it rationally. By design or happenstance, every limited resource is rationed. Design is better.
In the U.S. health care system, some can afford to get any procedure at any hospital, others need to take what they can get. Some doctors provide concierge service, and charge a premium for it. Any “you can have it if you can afford it” system imposes rationing, with socioeconomic status the filter. It is the inevitable, default filter in a capitalist society where you tend to get what you pay for.
That works pretty well for most commodities, but not so well for health care. As noted, failure to spend money you don’t have on early and preventive care may mean later expenditures that are both much larger, and no longer optional — and someone else winds up paying. If you can’t afford a car, you don’t get one; if you can’t afford care for a bullet wound — if you can’t afford CPR — you get it anyway, and worries about who pays the bill come later.
But those costs, and worries, do come later — and somewhere in the system, we pay for them.
By favoring acute care — which can’t be denied — our current system of rationing dries up the resources that might otherwise be used for both clinical preventive services and true health promotion. Fully 80 percent of all chronic disease could be eliminated if our society really rallied around effective strategies for tobacco avoidance, healthful eating, and routine physical activity for all. But when health care spending on the diseases that have already happened is running up the national debt, where are those investments to come from? The answer is, they tend not to come at all. And that’s rationing: not spending on one thing, because you have spent on another.
Nor is this limited to health care. The higher the national expenditure on health-related costs, the fewer dollars there are for other priorities, from defense, to education, to the maintenance of infrastructure. If cutting back on defense calls the patriotism of Congress into question, then classrooms get crowded and kids are left to crumble. Apparently, it is no threat to patriotism to threaten the educational status of America’s future. …
- How Would You Like Your Rationing – Rational, or Irrational? (thehealthcareblog.com)
- U.S. health care system wastes $750B a year (cbc.ca)
- Waste and Promise Seen in U.S. Health Care System (nytimes.com)
Underinsured CVD patients die sooner than patients with private insurance, irrespective of race…
Insurance status is a better predictor of survival after a serious cardiac event than race, and may help explain racial disparities in health outcomes for cardiovascular disease. A new study by Derek Ng, from the Johns Hopkins Bloomberg School of Public Health in the US, and his team shows that race is not linked to an increased risk of death but being underinsured is a strong predictor of death among those admitted into hospital with a serious cardiac event. Their work appears online in the Journal of General Internal Medicine, published by Springer…
g and colleagues looked at whether the risk of early death was associated with insurance status or race. They took into account the potential effects of neighborhood socioeconomic status and disease severity. They analyzed data from a sample of patients admitted to one of three Maryland hospitals for three specific cardiovascular events: 4,908 with acute myocardial infarction (or heart attack); 6,758 with coronary atherosclerosis (or furring up of the arteries); and 1,293 with stroke.
They found that underinsured patients died sooner than patients with private insurance, whereas the survival rates were comparable between whites and blacks. More specifically, underinsured patients had a 31 percent higher risk of early death after a heart attack and a 50 percent higher risk after atherosclerosis. This survival effect was independent of race, neighborhood socioeconomic status and disease severity.
The authors conclude: “Among those admitted to the hospital with an acute cardiovascular event, there was an increased risk of mortality among subjects who were underinsured compared to those who had private insurance. Given the recent changes in health insurance and healthcare reform, these results underscore the need to closely investigate the factors relating to health insurance that may explain these disparities. Indeed, targeting these factors may relieve the burden of mortality disproportionally affecting those who are underinsured.”
- Those who are covered, recover (eurekalert.org)
- Those who are covered, recover (medicalxpress.com)
- Medicaid. Again. (washingtonmonthly.com)
- Every person deserves access to health care (bangordailynews.com)
- U.S. health centers get $11 billion boost (upi.com)
I am very concerned how federal funding for socioeconomic programs is going to be distributed equitably without relevant, current, and reliables statistical information….
The U.S. Senate is expected to vote next month on an appropriations bill that could end the U.S. Census Bureau’s survey of state and local population, income, health and other data. Known as the American Community Survey, the federally funded program continuously samples about 3.5 million households each year to produce crucial data used to divvy some $400 billion in government money to states and localities, according to the Census Bureau.
Medicaid is the biggest federal program that relies on American Community Survey data to shift funding when states’ average incomes rise or fall. At about $270 billion in federal funding and nearly a quarter of state budgets, the federal-state health insurance program for low-income people uses the survey’s income data to determine federal allocations that can have huge impacts on state budgets.
Allocation of education grants, highway money and other social services funding also rely on the data. States also use the information to allocate state money to county and local governments. So far, it is unclear what data the federal government would use to allocate billions in grant money, if the survey is discontinued…
- What Killing the American Community Survey Would Actually Mean (theatlanticcities.com)
- Killing the American Community Survey Blinds Business (businessweek.com)
- The idiotic war on the American Community Survey (modeledbehavior.com)
- The GOP’s anti-research agenda (maddowblog.msnbc.msn.com)
- What Happens When Congressmen Don’t Understand Statistics (alan.com)
- Why the American Community Survey is worth keeping (flowingdata.com)
- A Future Without Key Social and Economic Statistics for the Country (flowingdata.com)
From the excerpt at Full Text reports (with link to report)
This dissertation contains three papers on the health and welfare of the elderly population. Overall, these papers provide insights into the costs and challenges of providing health care to the elderly population. These papers help us understand the effects of obesity on longevity and health care, as well as better understand the benefits of social insurance. The first paper uses a micro-simulation model to estimate the longevity effects of poor health trends among younger Americans, and finds that difference in these trends can explain 92% of the difference between US and European longevity. The second paper estimates the welfare effects of Medicare Part-D from gains in market efficiency and dynamic incentives for pharmaceutical companies. It finds that these gains alone nearly cover the welfare cost of funding Medicare Part-D. The last paper presents and estimates a structural model of health, exercise, and restaurant consumption. It provides estimates for future welfare analyses of programs targeting obesity through restaurants and exercise in the elderly population. It also estimates the long run effects of making policies which make restaurant food healthier. It finds only minor effects of restaurant policies on health for the elderly. Overall, these papers further our understanding of the challenging objective of improving senior health while containing costs.
- Baby Boomers Short on Medicare Knowledge (momentumtoday.com)
- The New Old Age Blog: ‘Elderly’ No More (newoldage.blogs.nytimes.com)
- A good Introduction in order to Medicare in the usa (boldstate.com)
Once a year, employees of the Swiss Village Retirement Community in Berne, Ind., have a checkup that will help determine how much they pay for health coverage. Those who don’t smoke, aren’t obese and whose blood pressure and cholesterol fall below specific levels get to shave as much as $2,000 off their annual health insurance deductible…
…Gone are the days of just signing up for health insurance and hoping you don’t have to use it. Now, more employees are being asked to roll up their sleeves for medical tests — and to exercise, participate in disease management programs and quit smoking to qualify for hundreds, even thousands of dollars’ worth of premium or deductible discounts.
Proponents say such plans offer people a financial incentive to make healthier choices and manage chronic conditions such as obesity, high blood pressure and diabetes, which are driving up healthcare costs in the USA. Even so, studies of the effect of such policies on lifestyle changes are inconclusive. And advocates for people with chronic health conditions, such as heart disease and diabetes, fear that tying premium costs directly to test results could lead to discrimination.
Consumer Tips: Workplace Wellness Plans
More and more employers are tying financial reward and penalties to workers completing a set of medical tests. KHN’s Julie Appleby says the tests can include blood pressure, cholesterol and blood sugar. Watch the video.
Employee reaction has also been mixed….
..Some workers complain the programs are an intrusion into their private lives.
“They portrayed it as voluntary, which it isn’t, because if you don’t participate, they fine you every paycheck,” says Seff, the former Broward employee who is suing over the program. He has since retired on disability with back and neck problems. “I don’t think any employer should do it.”
In an effort to slow rising health care costs, Broward County in 2009 began asking workers to fill out a health information form and have a finger-stick blood test each year to check blood sugar and cholesterol levels, according to court filings. Workers who declined were docked $40 a month.
Those who did participate were offered disease management programs if they had asthma, high blood pressure, diabetes, congestive heart failure or kidney disease. The county stopped docking those who declined to participate Jan. 1, 2011, after Seff’s suit was filed, court documents say.
The lawsuit, which argues the county’s program violates the Americans with Disabilities Act, is likely the first of its kind in the nation, says Seff’s attorney Daniel Levine in Boca Raton, Fla. Without ruling on whether the wellness effort was voluntary, a federal district court judge backed the county in April, 2011, saying the plan fell under provisions of the law meant to protect bona fide benefit programs. The case is now on appeal. Broward County attorneys did not return requests for comment.
Some state lawmakers are also concerned about the potential for discrimination. ..
..Given the available data, it’s hard to parse how much of the reported savings from such programs come from improved health, and how much from the frequent pairing of such programs with high deductible policies, which shift more costs onto workers.
“We just don’t know how effective (incentives) are,” says Volpp. There is pretty good evidence they help smokers quit, he says, but less that they prompt workers to lose weight and keep it off.
Weight gain is partly a function of genes and environment, he says, so programs that tie incentives to achieving a particular weight range are “in essence, penalizing people for factors they can’t control or can only partly control” – either because they’ve failed to lose weight or haven’t participated in the program.
Volpp says the medical literature shows that incentives work best when participants have choices: get below a certain BMI, or lose 5 percent of current body weight, for example. And, he says, rewards should be immediate.
“If you want the employee to do a health assessment or (medical) screening, you should give them the reward right after they do it” he says.
At Jones Lang LaSalle, workers who make a pledge — on the honor system — that they don’t smoke, or will take a stop-smoking class, and achieve a healthy weight, get 10 percent off their contribution toward insurance premiums….
- More U.S. employers tie health insurance to medical tests (usatoday.com)
- Employers Are Now Including More Medical Tests When It Comes to Employee Contributions and Coverage Offered With Health Insurance (ducknetweb.blogspot.com)
- 5 ways your boss is downsizing your health insurance (insurance.com)
- Take care or pay a higher share of your health insurance (insurance.com)
- More workplace wellness plans dangle financial rewards/penalties tied to test results (HealthNewsReview.org)
The Cost of Coercion [Yes, One Can Refuse Medical Procedures and Continue Health Care Insurance Coverage)(via The Health Care Blog)
From The Cost of Coercion (a February 28, 2012 posting at The Health Care Blog)
Dr. John Schumann dispels what seems to be an urban myth – if one refuses a procedure then one is responsible for any hospital charges not covered by one’s health insurance related to the decision to decline the procedure.
The case presented involves a person who did not wish to undergo an invasive (and expensive) medical procedure: cardiac catheterization. The intern told the patient that if she refused to undergo the procedure, “that she would have to sign out ‘against medical advice’ (AMA). To signify this she would have to acknowledge that leaving AMA could result in serious harm or death. In addition, Ms. DiFazio would bear responsibility for any and all hospital charges incurred and not reimbursed by her insurance due to such a decision.”
In the rest of the article, Dr. Schumann explains how he researched this and found quite the opposite – “that the idea of a patient leaving AMA [against medical advice] and having to foot their bill is bunk: nothing more than a medical urban legend.”
- Do patients pay when they leave against medical advice? (eurekalert.org)
- Study Examines Misconceptions Of Who Picks Up Tab When Patients Walk Out (medicalnewstoday.com)
- How to Avoid Insurance Billing Errors (outofpocket.com)
- Do patients pay when they leave against medical advice? (ihafs.org)
Question the price of drugs and medical procedures (Suggestions for Additional Resources Most Welcome!)
- Ways to Manage Your Own Healthcare Without Health Insurance (savings.com)
- A Proposal to Expand Health-Care Tax Credits for Small Businesses (entrepreneur.com)
- Save On Medical Reaches Florida Patient Population Through New Contracts (prweb.com)
- HHS ensures consumers get better value for their health insurance dollar (nvrdc.wordpress.com)
- Preventive Care Services Covered at 100% Under Health Care Reform? (prweb.com)
- Save On Medical Signs Contract With Central Nebraska Imaging in Kearney (prweb.com)
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
I found a recent Associated Press article on an aspect of the new health care law that many of us may have overlooked. It requires consumer-friendly summaries of what insurance plans cover, a provision that now seems to be at risk. The insurance industry is up in arms about implementation costs and added regulatory burdens. (There’s a good story at NPR, which includes a link to an example of what the language would look like.)
My initial thought was what a shame it would be to lose that provision. But then my mind flipped to the e-patient movement and how it’s teaching people to be active participants in our medical care. That means learning as much as we can about our conditions and treatment options and sometimes questioning our doctors’ recommendations.
It occurred to me that when we focus only on doctors, we’re missing a very sizable forest for the trees. One of the overriding concerns of health care reform is getting costs under control. …
This is where I think the “i-patient” needs to step up: “i” for insurance-savvy. We should be demanding to know what insurance companies’ decisions are based on when they deny a claim. My oncologist told me one of his denials was based on the assessment of a general practitioner hired by the insurance company. Without the specialized knowledge of blood markers an oncologist has, this doctor didn’t realize that the normal marker used as a basis for denial wasn’t a good indicator. Where does that leave my oncologist and his decades of experience? Like he told me, “Medicine is not like taking a car to a shop.” Patients need to know about this. When selecting an insurance company, we should know which ones have the worst record of denying claims.
We also should be keeping a close watch on electronic medical records, beyond simply demanding access to our own records. I recently read a fascinating post by Adam Sharp, MD, founder of par80 & Sermo, called “Why EMR is A Four-Letter Word to Most Doctors.” He explained how EMRs were largely a top-down effort, allowing third parties to implement policies by simply removing options from the EMR. “If you can’t select a particular treatment option, for all intents and purposes, it doesn’t exist or the red tape to choose it is so painful that there is little incentive to fight the system.”…
…We need an i-patient movement to make sure our voices are heard and our choices are preserved. We need to ensure those choices are made in partnership with our doctors, not handed down to both of us by some invisible third-party payer. We have a Society for Participatory Medicine (I’m a member); maybe it’s time we had a Society for Participatory Insurance. Because our doctors can’t fight this battle alone.
- The End of Health Insurance Companies (opinionator.blogs.nytimes.com)
- What is an accountable care organization and why should you care? (insurance.com)
- How to avoid HMO gatekeeper problems in medical homes (kevinmd.com)
- Making patients “consumers” is the wrong focus (quinnscommentary.com)
- The Supreme Court ruling: what’s at stake for health care? (forbes.com)
- 5 Important Dates for Health Care Reform (damonhlee.wordpress.com)