Monthly Archives: January 2013

Economist Rekindles Debate over Geographic Differences in Health Spending

By Jordan Rau, Kaiser Health News

An economist at the Federal Reserve has restoked the debate over the causes of regional differences in Medicare spending, and her analysis disputes some of the thinking behind a number of policy changes in the 2010 health overhaul.

The Obama administration and many prominent economists believe that as much as a third of the $2.7 trillion spent on health care may be due to wasteful practices of physicians and hospitals that could be eliminated without hurting patients. This is based on decades of research, principally by the Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire, showing that Medicare spending in some regions of the country is significantly higher than others.

This geographic variation in spending, which the government has also examined, was a motivating force behind a number of government initiatives including changes in Medicare payment to reward hospitals and doctors who provide good care efficiently. Continue reading

Sex Doesn’t Burn Weight and 4 More Popular Myths About Dieting Debunked

Woman's feet on scale.

(Justin Sullivan/Getty Images)

I don’t cover a lot of dieting stories here on State of Health. I figure you get enough of that elsewhere. For example, here are 88 million places I found by Googling “How can I lose 10 pounds?”

But I love evidence-based medicine. So when a group of respected researchers shatter widely-held beliefs about weight loss, I’m there. In Thursday’s New England Journal of Medicine, a group of researchers does just that.

In the review, the researchers categorized as myths those “beliefs held to be true despite substantial refuting evidence.” In other words, people have been repeating these ideas for so long, everyone thinks they’re true. But they’re not.

So, here we go:

Myth #1: Small changes — eating less or exercising more — done over time will yield large weight loss.  This myth comes from the idea that a pound is equal to 3,500 calories. But the short-term studies that looked at burning 3,500 calories to lose one pound were done 50 years ago. More recent research shows that individuals will burn calories differently as they lose weight. So the 100 calories you’re burning in exercise today will affect your body differently than the 100 calories you burned, say 18 months ago, when you started these small changes. Note that it’s not to say that exercising more — or eating less — is pointless (you will see why later in this post).

Myth #2: If you lose a lot of weight really fast, you’ll just gain it back really fast; you’ll have better long-term results if you lose weight slowly. When researchers actually looked at the studies, they found “no significant difference” between the two approaches in relation to long-term weight loss. Continue reading

Quick Read: To Open Eyes, W-2s List Cost of Health Plans

The goal here is to make the average person more cost conscious. Policy types have long said that people think they’re getting health insurance for free. But employers are likely to be paying lower wages because they provide insurance.

WASHINGTON – As workers open their W-2 forms this month, many will see a new box with information on the total cost of employer-sponsored health insurance coverage. To some, it will be a surprise, perhaps even a shock. Workers often have little idea how much they and their employers are paying for coverage.

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For Young Mother, Immigration Program Puts American Dream Within Reach

Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.

San Jose resident Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.

Last year the Obama administration passed a law allowing some undocumented immigrants to apply for work permits. As part of our occasional series called “What’s Your Story?” San Jose resident Ayary Diaz talks about how Deferred Action for Childhood Arrivals is opening doors to opportunities she says she never thought she’d have. We post it here, since there is an intersection between Diaz’ immigration status and her health. The following is a transcript of her first-person radio story.

For 24 years I’ve been forced to live in the shadows because of a choice that was never mine.

I’m an ‘illegal.’ My parents brought me here from Mexico when I was five, and I have been living — undocumented — in the United States ever since. I have two amazing children and a loving fiance but my road has been hard.

I can finally come out of the shadows, stop hiding who I am, and shine in a country that I’ve always considered my home.
When I graduated from high school, I hoped to go to college like my peers. But I needed a Social Security number to apply and, most importantly, to get financial aid. I didn’t have one and began to think that I would have the same poor and unproductive life I’d seen my parents live.

But in 2001, a new California law changed things. Undocumented students could apply to college as California residents if they had graduated high school and had been continuously living in the States for several years. So I went to Foothill Community College and then San Francisco State. It took me eight years, working countless hours as a minimum wage server while going to school fulltime to pay for my tuition in cash. But I had my degree, in international business, the first in my family.

Continue reading

UC Student Health Plan Slips Through Loophole in Affordable Care Act

A UC Berkeley student discovered the limits of his UC student health coverage after a cancer diagnosis.(Studio H (Chris)/Flickr)

A UC Berkeley student discovered the limits of his UC student health coverage after a cancer diagnosis.(Studio H (Chris)/Flickr)

If you are a student at any of the UC campuses — or a family member of one — you might want to pay close attention to the case of Kenya Wheeler at UC Berkeley. A year ago he was “healthy as a horse,” the San Francisco Chronicle reports and biked to school every day.

But everything changed when he was diagnosed with cancer. He had health insurance through the UC Student Health Plan. But as medical bills mounted, he closed in on the $400,000 lifetime cap of the policy — caps that were made illegal under the Affordable Care Act.

Illegal, that is, except for self-funded college health insurance plans, such as the one UC has. In its self-funded plan, UC bears the financial risk of medical coverage. From the Chronicle:

Universities have long offered student health coverage to make sure their students have access to health care. Most college health plans purchase a group policy from a health insurance company and must adhere to the new federal requirements. Continue reading

Quick Read: Think Preventive Medicine Will Save Money? Think Again

It’s so tantalizing and seems like a no-brainer: a focus on prevention will save big bucks. This is “widely misunderstood,” says one economist. While a handful of interventions do achieve a net savings (think childhood vaccinations), many others do not. This article is generating controversy as you will read in the comments section.

Since about 75 percent of healthcare spending in the United States is for largely preventable chronic illnesses such as Type 2 diabetes and heart disease, providing more preventive care should cut costs. If only.

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Are There Enough Medi-Cal Doctors in Kern County? How About Statewide? Who Knows?

People wait in line at Clinica Sierra Vista at the East Bakersfield Community Health Center. Some were waiting before they opened at 7:30am. (Casey Christie / The Californian)

People wait in line at Clinica Sierra Vista at the East Bakersfield Community Health Center. Some were waiting before they opened at 7:30am. (Casey Christie / The Californian)

Once Obamacare is fully implemented in January, hundreds of thousands of Californians will move from the ranks of the uninsured to the insured. That’s the good news. The downside: many California counties already face a shortage of primary care doctors — a shortage that is especially acute in the Central Valley.

How those newly insured — especially those who will be enrolled under Medi-Cal — will access care is an especially pressing question in Kern County, as the CHCF Center for Health Reporting has been exploring under a series, Desperate for Doctors.

“It would be really helpful for policymakers to have an agreed upon set of facts.”

A chief problem is not only the shortage of primary care doctors, but also the question of whether physicians accept Medi-Cal patients. If individuals and families hold Medi-Cal insurance, but can’t find a doctor who will accept it, their new coverage isn’t much help. Continue reading

The Numbers on Sugar

(Uwe Hermann: Flickr)

(Uwe Hermann: Flickr)

Dr. Robert Lustig is perhaps the most outspoken anti-sugar critic out there. His 90 minute video, Sugar: The Bitter Truth, has netted 3.2 million views on YouTube; his latest book Fat Chance, which, among other things, links sugar to obesity and chronic disease, is currently #68 on Amazon’s Top 100 bestselling books.

On Monday, Lustig was a guest on KQED’s Forum and even though he was fighting a bad cold, he was his usual passionate self on many things related to the American diet, especially sugar. Lustig believes sugar is such a dietary menace that it should be regulated, much the same way alcohol is regulated.

He rattled off a lot of numbers during his discussion with Forum host Michael Krasny.

Continue reading

Learning to Live with Guns — Advocates Urge a Public Health Campaign

By Mina Kim

Editor’s note: State lawmakers are expected to hold a joint legislative hearing on guns and gun laws Tuesday. 

Sandra Macias of Fairfield looks at posters she's made over the years for marches and rallies demanding more gun control. In 1995, Macias's 14-year-old son Alex Stasenka was shot and killed accidentally by the brother of a friend of his. (Photo/Mina Kim)

Sandra Macias of Fairfield looks at posters she’s made for marches and rallies demanding more gun control. In 1995, Macias’s 14-year-old son Alex Stasenka was accidentally shot and killed. (Photo/Mina Kim)

Remember those ads from the early 1990s that encouraged people to intervene if a friend who had been drinking was about to get behind the wheel? ‘When friends don’t stop friends from drinking and driving, friends die. Friends don’t let friends drive drunk.’

Researchers believe this type of public health campaign that was successful at reducing motor vehicle fatalities could also be used to reduce the number of gun deaths and injuries, including suicides. David Hemenway is a professor of health policy at Harvard and director of the Harvard Injury Control Research Center.

“What we want to be able to do is figure out a way to live with our guns. Right now we are dying with our guns.”
“It’s the notion ‘friends don’t let friends drive drunk’, ‘friends don’t let friends who are going through a bad patch have easy access to a gun,’” Hemenway said. “If a close friend you can see has just got a divorce, he’s started drinking, he’s started talking crazy, try to figure out a way to get the gun out of the house for a few months until things get better.” Continue reading

Quick Read: Tips for Making Decisions, and Sticking to Them

Two books are coming out in March that look at why we do not make the right decisions — or follow through on a course we’ve set. It’s interesting psychology. Midway through the article is a discussion of how people tend to be overly confident of their own abilities — and a fleeting reference to studies showing that doctors who are “completely certain” of a diagnosis were wrong 40 percent of the time.

How many times has this happened to you? You firmly decide what you’re going to do – whether it be going to the gym or asking your boss for a raise or placing a much-delayed call to a friend.

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