I know we all like to think of medical care as “life-saving.” If we just detect disease early enough, and find the right doctors, they will cure whatever ails us. But I would argue that the primary purpose of medicine is not to prevent death. If it were, one would have to judge the entire enterprise an abysmal failure. No one beats death. Granted, some die sooner, others later. Yet as I will explain, health care is not the major factor that leads to longevity.
Author Archives: Maggie Mahar
Why Reformers Must Forge Ahead
While others seem ready to declare health care reform dead, Henry Aaron explains why reformers must stay the course in the most recent issue of the New England Journal of Medicine. They have everything to lose, and nothing to gain if they abdicate their responsibilities now. More importantly the nation will be left with a health care system that fails society while threatening our economy.
While others flail about, the Brookings Institution Senior Fellow makes his case in calm, lucid prose, reminding us that nothing has changed over the past month. The House and Senate have, in fact, managed to pass two very similar bills. If you explain the legislation to the public, the majority of Americans favor reform. All that remains to be done is to reconcile those bills—which in the end requires a simple majority.
Announcing Screenings of Money-Driven Medicine in February and March: California and Philadelphia
For more information on the film, produced by Alex Gibney, directed by Andrew Fredericks, and based on the book by Maggie Mahar, see www.moneydrivenmedicine.org
These are free public showings. I’ll be doing a Q&A with the audience following each screening and look forward to meeting HeatlhBeat readers in the area.
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Thursday February 18
The South County Partnership of Fremont, California is sponsoring a screening at the Crown Plaza Union City, Alvarado-Niles Road Union City, CA
Refreshments: 4:30 to 5 p.m. Program: 5 to 7 p.m.
To RSVP or for more information, email: southcountypartnershippresents@gmail.com
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Friday, February 19th
Berkeley University will be showing the film at the University Hall Room, 150 on the Berkeley Campus, 4:30 pm- 7 p.m.
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Tuesday, March 10
The Drexel School of Public Health is sponsoring a screening at the Drexel University School of Public Health, Mitchell Auditorium, Bossone Research Center, 32nd and Market Streets, Philadelphia, PA
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Sunday, March 13
National Physicians’ Alliance Conference
Long Beach, California
Details to follow
How Maryland “Broke the Curve”: A Solution For Massachusetts? Part 3
Massachusetts has succeeded in providing health care insurance for all but 2.6% of its citizens. Yet the Commonwealth still struggles to make that coverage affordable. Health care inflation is driving Massachusetts’ system toward a cliff. Total outlays for medical services and products are climbing 8 percent faster than the state’s economy. Unless something is done to rein in the cost of care, health care spending in Massachusetts is projected to nearly double over the next 10 years, hitting $123 billion in 2020. State officials know they must find a way to put a lid on spending so that it grows no faster than the state’s gross domestic product. .
But how?
I’m Sorry . . .
Someone sent me a link to this post written by Chris Dunn on “Words and Light.” It is titled: “I’m Furious,” and it begins: “I’m furious because I have to read this book:
“Money-Driven Medicine” by Maggie Mahar
Photo by Chris Dunn
“I’m in my final undergraduate semester, and only now am I taking my first-ever political science course. The class is Public Policy, and for our first paper, we are to read this entire book and write a book review.
“That’s not (exactly) why I’m furious.
“I’m furious because I’m learning, in detail, about the failures of the American health care system according to one author-journalist.
“I’m furious because I procrastinated in starting this book, which has prevented me from going out and making pictures and blogging a real photo for my first entry in this 30-day series.
“I’m furious because, although I’m far more interested in being a photographer than in being a student, my academics and work schedule this semester are severely limiting the time and opportunities I could have to pursue better photography.”
Somehow, this post made me smile.
I wrote to Chris (who is a senior at the University of Missouri, where she majors in journalism, photo-journalism and photography) to say “I’m sorry” the book is so long.
But U.S. health care is a complicated topic, and I wanted to include both facts and stories. (Numbers alone are too boring. Anecdotes alone are not persuasive.)
I also told her that it’s a nice photo of the book—which it is. And the photo on the top of her home page is outstanding. (My husband, who is a photographer, admired it.)
Massachusetts’ Problem and Maryland’s Solution We Don’t Have to Wait for Washington Part 2
While health care reformers argue about what it would take to “break the curve” of health care inflation, the state of Maryland has done it, at least when it comes to hospital spending.
In 1977, Maryland decided that, rather than leaving prices to the vagaries of a marketplace where insurers and hospitals negotiate behind closed doors, it would delegate the task of setting reimbursement rates for acute-care hospitals to an independent agency, the Maryland Health Services Cost Review Commission.
When setting rates, the Commission takes into account differences in labor markets and how much a hospital pays in wages; the amount of charity care the hospital does; and whether it treats a large number of severely ill patients. For example, the Commission sets the price of an overnight stay at St. Joseph Medical Center in suburban Towson at $984, while letting Johns Hopkins, in Baltimore Maryland, charge $1,555. For a basic chest X-ray, St. Joseph's asks $81 and Hopkins' is allowd to charge $155. The differences reflect Hopkins's higher costs as a teaching hospital and the fact that it cares for generally sicker patients.
Say it isn’t so.
The New York Times’ David M. Herszenhorn reports that, “If Democrats break down their major health care legislation into components that could be approved separately, the first bill up for consideration could be a proposal to end the exemption from federal antitrust laws that insurers have enjoyed since 1945.”
If reformers want to pass just one piece of the reform legislation, this is the wrong piece.
In Massachusetts Elite Providers Drive Health Care Spending; What Does This Say about the Dartmouth Research? . . . Maryland’s Solution. Part 1
Massachusetts Attorney General Martha Coakely has just released a report which reveals that the state’s health care costs are spiraling in large part because he state’s primo hospitals and physician groups –those with brand name recognition– -are demanding exorbitant reimbursements from insurers. Providers who control the market in geographically isolated areas also are insisting on reimbursements that far exceed what other providers receive for the same services.. http://www.mass.gov/Cago/docs/healthcare/Investigation_HCCT&CD.pdf
These providers have market leverage. Patients want both marquee names and providers close to home in their insurers’ network. If these providers are not included, customers will switch to a different insurance plan. Thus, insurance companies have no choice but to pay what the providers demand.
The investigators “found no evidence that the higher pay was a reward for better quality work or for treating sicker patients,” the Boston Globe reports. http://www.boston.com/news/local/massachusetts/articles/2010/01/29/attorney_general_says_clout_drives_up_health_costs/?page=1
“In fact, eight of the 10 best-paid hospitals in one insurer’s network were community hospitals, which tend to have less complicated cases than teaching hospitals and do not bear the extra cost of training future physicians.”
Sometimes hospitals claim that they charge more because they treat poorer patients who are sicker. But the truth is that, often, poorer patients receive fewer services because they have limited access to care. In addition the public hospitals and “safety-net hospitals” that treat indigent patients frequently have fewer resources: shriveled budgets, fewer specialists, less equipment. As I reported in Money-Driven Medicine, often “safety-net” hospitals must ration care.
The new Massachusetts report confirms what many already know about spending on low-income patients: the investigation discovered that hospitals that treat large numbers of poor patients . . . are paid 10 percent to 25 percent less than average by commercial insurers.
Meanwhile, Coakley’s report made me wonder: Maybe Massachusetts should consider Maryland’s solution?
“I Don’t Quit”
In his address to the nation, President Obama made it clear: Jobs are now his #1 priority.
This is what most Americans wanted to hear. They fear that he has spent too much time on health care, and has not paid enough attention to climbing unemployment. This does not mean that they oppose health care reform legislation—it’s just that there are tired of hearing about it. And the need for jobs is more pressing.
It was a strong speech—particularly when the President acknowledged that “The only way to move to full employment is to lay a new foundation for long-term economic growth, and finally address the problems that America's families have confronted for years.” One jobs bill will not solve the problem.
President Obama also opened the door to a college education for many students when he pledged: “let's . . .give families a $10,000 tax credit for four years of college and increase Pell Grants. And let's tell another one million students that when they graduate, they will be required to pay only ten percent of their income on student loans, and all of their debt will be forgiven after twenty years – and forgiven after ten years if they choose a career in public service.”
These are good ideas. But what about health care?
Hours before the State of the Union address, some believed that the President would save health- care reform for the very end of his speech. The pivotal question was this: would health care seem an after-thought or a climax?
The State of the Union–And the Economy: Why We Need Health Care Reform Now
According to the headlines, 10 percent of Americans are unemployed. The truth is that closer to 17 percent of the population cannot find full-time work; this number includes workers who have become discouraged and have given up looking for work as well as those who have settled for part-time jobs because they cannot find the full-time employment that they need.
The situation is not going to change anytime soon. As Princeton economist Paul Krugman recently warned: “We are facing mass unemployment — unemployment that will blight the lives of millions of Americans for years to come.”