The problem of elderly people taking too many medications is not new, but continues to pose a serious risk to health as well as contribute significantly to rising Medicare costs. The fact is that nearly 20% of adults aged 65 years and older who are not hospitalized take 10 or more medications daily. This number is not the result of shoddy care, but rather achieved when doctors simply follow practice guidelines for several common, co-existing conditions like diabetes, high blood pressure and depression, for example. If you look at all seniors (those both in and out of the hospital) the American Society of Consultant Pharmacists reports that the average 65-69 year old takes nearly 14 prescriptions per year; by ages 80-84 that number averages an astounding 18 prescription drugs per year.

What’s troubling is that instead of improving the health of seniors, evidence is growing that the more medications an elderly person takes, the more likely he is to experience falls, cognitive decline, loss of mobility, depression and even cardiac problems. These adverse drug effects may be mistaken for Alzheimer’s disease or other dementias too. The bottom line: Experts estimate that up to one-third of the elderly in our communities may be over-medicated and some 20% of their hospital admissions are due to adverse drug events. The costs related to over-medication in the elderly are thought to exceed $80 billion each year.

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Prevention is said to be the best medicine, even better than a cure; and as we’ve been told time and again, prevention pays. This is clearly the reasoning behind the health law’s new provision that aims to eliminate financial barriers to preventive services like mammograms and diabetes testing. Health and Human Services Secretary Kathleen Sebelius has said that Americans use preventive services at only about half the recommended rate; studies find that minorities and the poor are far more likely to be barred from these services by high out-of-pocket costs.

The new provision, which went into effect on September 23, requires that insurers provide 45 preventive services to beneficiaries without charging co-pays or deductibles. For now it applies only to new group and individual policies. Many health plans are “grandfathered” in; meaning that that they are exempt from the requirement until they make significant changes to their policies—something that most insurers will likely do before 2013. Medicare and Medicaid plans will have to remove deductibles and co-pays for the designated preventive services by 2011.

HSS estimates that in the coming year some 31 million people in new employer plans and 10 million people in new individual plans will benefit from the prevention provisions under the Affordable Care Act. By 2013, HHS expects some 88 million Americans will see their access to prevention coverage improve.

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Want to eat all of the McDonald’s cheeseburgers, fries and shakes you want without increasing your risk of heart attack? Why not pick up a statin capsule when you stop by the condiment bar to put ketchup on that burger?

This may sound like a spoof commercial for Lipitor or a skit on Saturday Night Live, but it’s actually the recommendation made by the authors of a recent study published in The American Journal of Cardiology. The authors, who are from the Imperial College in London and funded by the British Heart Association, write; “Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments.”

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State attorney generals have historically functioned as advocates for their citizens, especially when it comes to health issues. In 1994, Mississippi’s Attorney General Michael Moore filed the first lawsuit demanding that tobacco companies compensate the state for Medicaid costs associated with tobacco-related illness. More than 40 other state attorneys eventually filed similar lawsuits, leading to the Master Settlement Agreement in 1998 that required the major tobacco companies to pay a total of $206 billion to the states and also led to restrictions in how cigarettes are marketed.

Lainie Rutkow, assistant professor at Johns Hopkins’ Bloomberg School of Public Health, along with coauthor Stephen Teret (also at Hopkins), write in the new issue of JAMA  that state attorneys general are “powerful but underrecognized participants in establishing and refining health policy.” Rutkow mentions other health advocacy efforts undertaken by state attorneys general including preventing pharmaceutical companies from promoting off-label uses of their drugs and investigating improper health claims by food manufacturers. Just last year, New York’s Attorney General Andrew Cuomo investigated the charge that Igenix, a subsidiary of United HealthCare, was instructing insurers to underpay “usual and customary” charges for medical procedures by some 10-28%; resulting in consumers shelling out excessive out-of-pocket medical expenses. Also in 2009, Connecticut’s attorney general Richard Blumenthal began an investigation into “erratic and excessive” pricing of Tamiflu, a drug that can shorten the duration of flu symptoms, just as the recent H1N1 epidemic reached its peak.

With this history of advocacy, it now seems so incongruous that state attorneys general (along with a handful of governors) from 21 states have filed lawsuits charging that the Patient’s Care and Affordable Health Care Act is unconstitutional and are demanding its repeal. The Act, which would cover some 30 million Americans who are currently uninsured and offers relief from medical bankruptcy to millions more, would seem to be squarely in the public’s interest.

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New findings indicate that putting limits on malpractice awards and enacting similar tort reforms are unlikely to do much to curb the nation’s surging health care costs. In fact a new study, published last week in Health Affairs suggests that costs associated with medical malpractice are far less than the $650 billion figure (26% of all money spent on health care) cited by some Republicans who have made tort reform a cornerstone of their vision for “bending the cost curve” in health care. The newly calculated figure, $55.6 billion, represents just 2.4% of health costs.

According to NPR, “Longtime malpractice and patient safety researcher Michelle Mello of the Harvard School of Public Health [one of Health Affairs authors]” said that “some of the figures used during the recent health overhaul debate were ‘quite imaginative.’”

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The news on Monday that one in six Americans are now enrolled in government poverty programs (Medicaid, food stamps, unemployment insurance and welfare) was an unsettling reminder of the economic fix we currently are in. Medicaid, as I’ve written before is now serving 50 million Americans, up at least 17% from when the recession began in 2007.

With a short-term, but ultimately inadequate, fix coming in the guise of Congress' $26 billion grant to states that extends federal increases in Medicaid funding that were part of the stimulus package, imminent disaster may have been averted. But according to Michael O’Grady and Jennifer Baxendell Young, both of whom served in senior positions at the Department of Health and Human Services before becoming policy consultants, it’s time to consider a longer term fix for a fundamental flaw in Medicaid financing. Writing on the Health Affairs blog, O’Grady and Young explain:

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In 2006, when the government began offering prescription drug coverage for seniors through Medicare Part D, the goal was to increase utilization of prescription drugs by the elderly who may not have been able to afford them before, and also to lower the average price of these drugs. The idea was that insurers—representing all the new Medicare Part-D recipients—would be able to use the clout of having this huge market to negotiate price discounts with pharmaceutical companies.

Studies since then—like this one from The Annals of Internal Medicine—have found that Medicare Part D “appears to have led to modest savings and modest increases in drug use by older people.”  With a new provision coming from the Affordable Care Act that aims to help “fill the donut hole” that seniors experience in coverage, these effects should be heightened.

But two new studies have revealed some unintended consequences of Medicare Part D. According to an AARP Rx Price Watch report released today, the retail prices for some of the most popular brand-name drugs sold to seniors increased 41.5% over the last five years, while the consumer price index rose only 13.3%. For example, the drug Flomax (which began facing generic competition this year and is usually prescribed for incontinence due to prostate problems), had the biggest price jump, climbing 24.8% in 2009. Over the past five years, Flomax increased in price by an alarming 92%. Other popular name brand drugs that experienced sharp price increases over that time span include the respiratory drug Advair (40%), the Alzheimer’s drug Aricept (40%), Nexium (28%) and Lipitor (24%)

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Last week I had my first visit with my new primary care doctor. I picked him based on recommendations (plus he’s one of the few that accepts my insurance), and also because he seemed to be an eager adopter of electronic medical records (EMR). On his website, there was a portal for making appointments on-line, asking questions of the doctor and staff by e-mail and once a registered patient, I could also use a secure system to access my medical records. With EMRs being portrayed as key drivers of quality and savings in health reform, I felt encouraged by my new doctor’s embrace of the technology.

But when he greeted me in the examining room, I was surprised to see the medical assistant hand my doctor a pad of paper with my height, weight and blood pressure written on it. As we talked and he examined me, he wrote notes down on the same pad—even though there was a computer in the room. When I asked how he felt about his EMR system, he said it was a great advance for his practice—but unfortunately it had crashed  that morning and the “tech guy” said it might take a while to get it back on track. “By next week or so we should have you in our system,” he sheepishly explained.

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After the House voted this week to approve a $26 billion aid package to states—$16 billion of which will go toward helping keep strained Medicaid programs limping along—Rep. Joe Barton, of Texas, the ranking Republican on the House Energy and Commerce Committee who voted against the measure said; "There is no emergency," "There is no pending financial catastrophe." House Republican leader John Boehner called the aid package a “payoff to union bosses and liberal special interests.”

What alternate universe do Barton, Boehner and many of their fellow Republicans who opposed the aid package live in? States of all stripes—red and blue alike—are facing a deep crisis in their Medicaid programs.Women and children are losing benefits, and eligibility requirements have only gotten more stringent.

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