Monthly Archives: October 2012

No Matter Who Wins, We’re Still Heading for A Cliff

By Julie Rovner, Kaiser Health News

(Su-Lin: Flickr)

(Su-Lin: Flickr)

Whatever the outcome on November 6th, officials in Washington will still have to deal with a looming “fiscal cliff” before the end of the year.

What’s coming is a perfect storm of expiring tax cuts, scheduled budget cuts, and various other spending changes scheduled to take place Jan. 1 unless Congress and President Obama (who, no matter what, will still be president until next Jan. 20) agree on a way to avert them.

As two of the largest spending items in the federal budget, the Medicare and Medicaid health programs are expected to play a role in how the deal gets done. Under the provisions of the law that created the budget deal Congress will attempt to undo, Medicare is subject to a two percent cut in provider payments, while Medicaid is exempt.

But two new studies and a proposed class action lawsuit settlement suggest a lot of dollar signs could change as lawmakers start to think about how to address the impending mess. Continue reading

Quick Read: 1.2 Million Californians Lost Employer Health Benefits Since 2009

Many of those who lost insurance enrolled in the state’s Medi-Cal or Healthy Families programs. About seven million people in California are uninsured, just over 20 percent of the population.

About 1.2 million Californians lost employer health benefits during the recession while enrollment surged in government insurance programs, a new study finds. The number of people getting health insurance at work has been steadily declining for years in the Golden State, but those losses accelerated from 2009 to 2011, when the Great Recession took a heavy toll on many businesses, according to the study by the UCLA Center for Health Policy Research.

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Seven Factors Driving Up Health Care Costs

By Julie Appleby, Kaiser Health News

There is no one villain in the battle against rising health care costs.

Currently, the United States spends more on health care services than any other country, exceeding $2.6 trillion, or about 18 percent of gross domestic product. Most years, medical spending rises faster than inflation and the economy as a whole. Many factors — and nearly everyone — contributes to those increases.

Here are seven ways you or your medical providers play a role, based on a recent report from the Bipartisan Policy Center, a think tank in Washington, D.C.

1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.

Most insurers — including traditional Medicare — pay doctors, hospitals and other medical providers under a fee-for-service system that reimburses for each test, procedure or visit. Coupled with a medical system that is not integrated, this encourages overtreatment, including repetitive tests, the report says. New efforts in the federal health law and among some private insurers aim to move payments toward a flat rate for a specific condition, such as a knee replacement, or for a patient’s entire episode of care, in order to streamline costs. Medical systems and doctors are also looking to electronic medical records as a way to improve coordination and reduce unnecessary, repeated tests.

2. We’re growing older, sicker and fatter.

As we get older, we tend to need more medical care. The baby boom generation is heading into retirement, with enrollment in Medicare set to grow by an average of 1.6 million people annually. Additionally, nearly half the U.S. population has one or more chronic conditions, among them asthma, heart disease or diabetes, which drive up costs. And two-thirds of adults are either overweight or obese, which can also lead to chronic illness and additional medical spending.

Continue reading

State Accused of Denying Seniors Day Care Access

By Mina Kim

66-year-old Esfandiar Asbagh is waiting to learn if he is eligible for state adult day care services.  (Mina Kim: KQED)

66-year-old Esfandiar Asbagh is waiting to learn if he is eligible for state adult day care services. (Mina Kim: KQED)

Golden State Adult Day Health Care in San Francisco serves seniors primarily from Russia, Ukraine and other Eastern European countries. As I walked in, I saw immediately that I was underdressed. All around were seniors pushing walkers, and they were wearing glittering sweaters, fur hats or chiffon skirts.

“This is mostly clothes from fifty years ago,” Center Director Katya Hope says. “But you look like you’re going to the opera because in fact, this is the major chance to socialize.”

Socializing is why 83-year-old Berta Vekhman says she loves it here.

“We cannot stay alone. When we are alone, we are dead,” Vekhman says. “because we stay alone and nobody at home you cannot talk to somebody. You forget how to talk.”

The prospect of being home alone is hard on her. “I cry all day, all day.”

Vekhman suffers from diabetes, Parkinson’s Disease and needs help using the bathroom. She is prone to depression which she says has worsened since January. That’s when state officials deemed her — and 2,000 other seniors — ineligible for services.

Vekhman was receiving care through the Adult Day Health Care program. Through the program, independent centers, like Golden State, provided physical therapy, mental health treatment and a chance to socialize. Continue reading

Quick Read: Steroid Meningitis Echoes Local Incident

California tightened up its pharmacy rules dramatically after a contamination at a Walnut Creek compounding pharmacy cost lives. Still, tainted injections from the New England Compounding Center reached four California pharmacies and some 600 patients received injections, though none has yet developed meningitis. Now California’s pharmacy board is considering tightening regulations again.

The nationwide meningitis outbreak linked to contaminated steroid injections made in a Massachusetts specialty pharmacy bears chilling similarities to the case of Doc’s Pharmacy in Walnut Creek. In this latest case, the New England Compounding Center in Framingham, Mass., has been linked to a growing meningitis outbreak that has killed more than 20 people and sickened about 300 in 16 states.

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Quick Read: U.S. to Study Cancer Risks Near 6 Nuclear Plants

The last time cancer risks near nuclear plants was measured was in 1990. That was a study by the National Cancer Institute. Researchers then determined that health risks — if any — were too small to be measured. But more recent studies in Germany and France show that children who live near nuclear reactors have double the leukemia risk.

The U.S. Nuclear Regulatory Commission announced plans Tuesday to launch a pilot epidemiological study of cancer risks near six nuclear power plants, including San Onofre Nuclear Generating Station in north San Diego County. The commission is acting out of growing concern that using uranium to produce electricity may be dangerous even without accidents at nuclear plants.

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Sorry, There Is No Silver Bullet

Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)

Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)

If a medical study shows that a treatment has a big effect, how much should you trust it? According to a provocative report published today, not very much.

A group of researchers from across the country — including Stanford Medical Center — and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a “very large treatment effect,” defined as a five-fold difference in people who received the intervention versus the control group.

But here the rub: more than 90 percent of the time, those “very large effects” don’t hold up after further research.

Dr. John Ioannidis at Stanford led the study, which is published today in the Journal of the American Medical Association. In an interview he told me, “Most of the time … these very large effects largely evaporated, they became substantially smaller. It’s not that they necessarily went away competely, but they were much, much smaller than the initial study.” Continue reading

Three ‘Reagan Democrats’ Talk About Medicare

By Sarah Varney, Kaiser Health News

(Opus Penguin: Flickr)

(Opus Penguin: Flickr)

Of those voting this year, count in the so-called Reagan Democrats — that group of once loyal left-leaners who crossed party lines in 1980 and helped the former California governor relocate to the White House.

Some of those Reagan Democrats were in their late 30s or early 40s then. Today, they’re older and on Medicare, a program that the GOP wants to alter dramatically. Do they fear for Medicare? Or do they still hold true to the Gipper’s smaller government ethos, even if it might mean big changes to the program for seniors and the disabled?

Kaiser Health News tracked down three Reagan Democrats, who have each landed in a different place on this question: Cheryl McNamara, John Crowe and Penny Lockhart.

Cheryl McNamara was 35 years old in 1980 and a registered Democrat. Asked what she remembers most about that period, she says the one thing that jumps to mind is inflation: “I could see it was just killing my father, for example, who worked for a much smaller company and who couldn’t afford to raise their prices to match inflation. So he couldn’t afford to give the raises to people to match inflation, so the value of my father’s income was eroding.”

McNamara, now 67, lives in Willowbrook, Illinois and thinks she’ll vote for Mitt Romney. She remembers thinking Reagan could put the brakes on inflation and stop the government from meddling with prices. Continue reading

Presidential Debate: Health Care Excerpts from Both Candidates

From Kaiser Health News

Even when the questions aren’t about health care, many of the responses are. Here’s what President Barack Obama and his Republican opponent, former Mass. Gov. Mitt Romney had to say Tuesday night about contraception, Medicare and the health law. A transcript follows.

BARACK OBAMA: Katherine, I just want to point out that when Gov. Romney’s campaign was asked about the Lilly Ledbetter bill, whether he supported it, he said, “I’ll get back to you.” And that’s not the kind of advocacy that women need in any economy. Continue reading

Voucher Program Could Raise Medicare Premiums Across Country

If the program had existed in 2010, Californians would have paid in excess of $100 more per month, study finds

By Jordan Rau, Kaiser Health News

The type of proposal championed by Republicans to overhaul Medicare by giving beneficiaries a fixed amount of money to purchase insurance could lead to significant increases in premium costs in some parts of the country, according to a new study.

If the plan had been in place in 2010, six in 10 Medicare beneficiaries—about 25 million people both in traditional Medicare and in private Medicare Advantage plans —would have faced higher premiums if they didn’t switch to a cheaper plan, according to researchers at the Kaiser Family Foundation. (The foundation is not affiliated with Kaiser Permanente).

The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.

The new study estimated how the plan would have worked in 2010 by looking at the cost of traditional Medicare and private Medicare Advantage plans around the country. The study’s authors emphasized that their model was not an exact replica of any existing proposal for a variety of reasons, including that most plans, among them Ryan’s, wouldn’t phase in for a decade and even then would affect only new Medicare beneficiaries.

The study found that 59 percent of Medicare beneficiaries would have paid higher premiums in 2010 unless they shifted into a cheaper plan. In California, Michigan, New Jersey, Nevada and New York, average extra premiums would exceed $100 a month, and in Florida they would exceed $200 a month, the study calculated. Continue reading