The newest edition of Health Wonk Review is up on Managed Care Matters.
There, host Joe Paduda calls attention to an eye-opening post by The Health Business Group’s David E. Williams.
Williams reports on what oncologists say about cancer drugs in “The Price of Drugs for Chronic Myeloid Leukemia (CML); A Reflection of the Unsustainable Prices of Cancer Drug.” The article, which was published in the journal, blood, includes candid comments from more than 100 experts They tell us that:.
- Many costly treatments aren’t worth the money
- New treatments with tiny orno benefits often cost a multiple of existing therapies
- Despite their reputation for penny-pinching, health plans are often not aggressive in negotiating price
- Patients are already suffering mightily from high costs –and it impacts quality of life and survival as well as financial health
- Society as a whole cannot afford to pay the high prices charged for so many of the new therapies
(I’m reminded of “A Very Open Letter from an Oncologist published on HealthBeat in 2009.) It’s encouraging to see more oncologist stepping forward to telll the truth about cancer drugs..)
.As Williams observes these insights “come from people who know what they’re talking about and who have traditionally been sympathetic to drug makers and unperturbed about costs.”
But now, the companies that make these drugs have taken greed too far.
Paduda also highlights Health Affairs just-released research indicating that the decline in inflation could result in a reduction of $770 billion (yup, that’s “billion” with a B) in public program health care costs over ten years. “
But is the trend sustainable? John Holahan and Stacy McMorrow of the Urban Institute are “cautiously optimistic.” Paduda agrees: “there’s no question there are fundamental changes occurring that are affecting care delivery, pricing, and reimbursement.”
Posting on Health Affairs Blog, John Roehring is less optimistic. His in-depth analysis of health care spending and economic cycles is rigorous. But is it relevant?
Something extraordinary has happened in the past few years: The U.S. finally has passed health reform legislation that aims to provide universal access to high quality care. The legislation recognizes that in order to do this, we Must bring down costs.
Passage of the legislation was all but inevitable.
After years of over-spending, we were heading for a wall. Healthcare spending cannot swallow 25% of GDP. And what can’t happen, won’t. We must become more efficient.
Thus, the past may not tell us much how health care spending will respond to an economic recovery this time around. The Affordable Care Act marks a turning point—and there is no going back. We are in a truly different era.
Roehring is not as hopeful as I am, but he acknowledges that “Some portion of the slowdown is permanent but some will be given back during a recovery”.
Over at The Hospital Leader, Dr. Brad Flansbum writes a provocative post about “Successful Home Management and the Hospital Bottom Line”:
“Care management done right and transitions executed properly keep folks out of hospitals and reduce profits,” he observes. ”If HQP gives a glimpse of the future, the exponential growth of our field will flatten, if not fall.”
In other words: “We receive our salary from the beast we wish to slay. Sucks for us and I cannot help but think of Upton Sinclair’s quote:
‘It is difficult to get a man to understand something, when his salary depends upon his not understanding it!’”
That may be, but these days, more and more physicians are deciding that in the battle over healthcare they would rather be Knights than Knaves or Pawns. (Hat tip to the National Physicians’ Alliance for coming up with these categories.
Signs of the times: Oncologists are telling us that many of our priciest cancer drugs aren’t worth the money. Urologists are no longer recommending PSA testing.
Increasingly, these physicians are looking past their salaries, and asking: “What would be best—not for the hospitals, not for the doctors– but for the patients?”
“Being in a hospital” clearly is not the answer.
This brings us to the question of reducing readmissions. Paduda notes that in response to “a recent WSJ opinion piece assaulting Medicare’s new hospital re-admissions reimbursement policy; the John Hartford Foundations’ Chris Langston presents a clear-eyed, point-by-point rebuttal that shows why the program is a necessary and important step to improving health for older adults.” I would add that, as Langston points out, hospitals will not be penalized for readmitting some patients. The penalty applies only if Medicare sees a pattern showing an unusual number of patients bouncing back into hospital beds. .
Over at Health News Review, Gary Schwitzer highlights an innovative way to market a product to doctors that involves Hooters. I don’t spoil the surprise—just go to Paduda’s Health Wonk Review, and click on the link to Schwitzer’s story.
Will there be a “train wreck” in Colorado when the state opens its Exchanges? Louise Norris of Colorado Health Insurance says “No.” They’re ready—and they’re not alone.\
Will there be enough insurance products available in the Exchanges to give consumers choices ? Writing on HealthInsurance.org. Wendell Potter says there will be plenty. In a few months, we’re likely to be complaining about how hard it is to compare so many plans. Moreover, the notion that you need a dozen companies competing to keep prices down is a myth. In Vermont, he points out, just two companies vying for Exchange business, and premiums are not going up.
How much do you think UnitedHealth’s CEO earns? On Health Care Renewal, Roy Poses will tell you. Brace yourself.
Recently, the state of Oregon compared the the health of citizens who made the cut for the state’s Medicaid program, to those who didn’t. (They qualified, but there were not enough spaces.)
The comparison revealed that, after two years on Medicaid, patients in the program had not made much progress in lowering blood pressure or cholesterol. Diagnosis of diabetes went way up, and the use of medicine to control diabetes also went up, but, again, there wasn’t much difference on the relevant blood tests
John Goodman sees this as damning indictment of Obamacare; “a new study finds that (as far as physical health is concerned) there is no difference between being in Medicaid and being uninsured.”
By contrast,Health Wonk’s Ezra Klein points out that depression rates for patients on Medicaid fell by 30%. This is huge. If you think about the damage that depression does to our bodies and our minds—as well as the links between depression, smoking, drug abuse and alcoholism—these patients were clearly better off. My guess is that they no longer felt as isolated as they had in the past. They had someone to talk to. (To learn more about the connection between poverty, loneliness and poor health, see this briliant PBS documentary, “Unnatural Causes.”
At the very least, their diabetes had been diagnosed, making it much less likely that they would go blind, or face amputations down the road. (If this isn’t good enough for Goodman . . .)
Finally, here’s my take on what the study showed:
1) People on Medicaid are poor.
2)There is a limit to what healthcare can do for people who have been born into poverty and have been poor for most of their lives.
The stresses and deprivations of poverty take an enormous toll. As Dr. Steven Schroeder pointed out in a landmark Shattuck lecture in 2007: “When compared to poverty, medical care plays “a relatively minor role” in premature deaths.” Scroll down to the pie chart in his article, and you’ll see what he is talking about.
I’m not at all surprised that after two years on Medicaid, complicated problems like hypertension and high cholesterol had not been resolved. They still may die sooner than many of us, but clearly the quality of their lives has improved.
Note– This was a rich edition of Health Wonk Review, and these are just highlights. I would urge you to read the whole post.