healthcare
lborkowski | December 23, 2010United States Senator Bernard Sanders, Independent of Vermont, received this year's Paul Wellstone Award at the Activist Dinner on 7 November in Denver, during the annual meeting of the American Public Health Association. Dr. Anthony Robbins presented the award "for his principled support for a universal comprehensive health care system..."
Senator Sanders prepared this video for the activists who attended. During his 10-minute address (skip to 0:40 for the start of remarks), Senator Sanders focuses on the new healthcare law and explains why he voted for it, what it does for prevention and…
lborkowski | December 14, 2010Yesterday a federal judge struck down the new healthcare law's individual mandate, which requires everyone to have health insurance. (Actually, the mandate doesn't apply to everyone: those who'd have to spend more than 8% of their income on coverage are exempt, as are undocumented immigrants - and if you don't have coverage, you pay a fine.) US District Judge Henry E. Hudson ruled that the individual mandate is unconstitutional, but he did not strike down other portions of the law or issue an injunction against its implementation. Two other district court judges have found the mandate…
lborkowski | December 3, 2010A few of the recent pieces I've liked:
Robin Fields at ProPublica: In Dialysis, Life-Saving Care at Great Risk and Cost
Timothy Noah at Slate: McSurance on Trial: A Senate committee puts the spotlight on the crap health insurance given fast-food workers
EPA Administrator Lisa Jackson in the WSJ: The EPA Turns 40
Kristen Lombardi and John Solomon at The Center for Public Integrity: Big Polluters Freed From Environmental Oversight by Stimulus
Jonathan Chait in The New Republic: How Chipotle is Like the Federal Government
mikethemadbiologist | November 5, 2010Paul Krugman, in a recent column, asks the following regarding the bogus claim by former Blue Dog Democrat and current corporate lobbyist (nice retirement plan) Evan Bayh that Democrats were too focused on healthcare:
After all, are people who say that Mr. Obama should have focused on the economy saying that he should have pursued a bigger stimulus package? Are they saying that he should have taken a tougher line with the banks? If not, what are they saying? That he should have walked around with furrowed brow muttering, "I'm focused, I'm focused"?
Regarding Bayh and the rest of the…
lborkowski | October 28, 2010At the Millennium Development Goal summit last month, one of the sessions addressed the issue of the global healthcare workforce. We don't have enough healthcare workers to deliver needed care to the world's population, and until we address this problem it'll be next to impossible to meet the goals of reducing child mortality, improving maternal health, and combating diseases like AIDS and malaria.
One major challenge is simply that there aren't enough trained healthcare professionals, but the distribution of the existing healthcare workforce is also a pressing issue. At the global level,…
mikethemadbiologist | October 28, 2010Maryn McKenna has a good article about a new strain of methicillin resistant of Staphylococcus aureus, ST239, aka The Brazilian Clone (as far as I know, no bikini wax is involved...). ST239 is troubling since it's not only resistant to methicillin, but also resistant to other antibiotics, including clindamycin, tetracycline, cotrimoxazole (also known as Bactrim), moxifloxacin, and gentamicin. While cotrimoxazole and tetracycline are old drugs, they have proven to be reasonably effective against many MRSA. So spread of a multidrug resistant MRSA means that we really only have one drug that…
lborkowski | October 7, 2010If you feel like you could use an overview of the new healthcare law - the Patient Protection and Affordable Care Act - head over the the Kaiser Family Foundation's website and watch their nine-minute animated video. Cokie Roberts narrates, explaining the problems the law's designed to address and its major provisions.
If you want more details, check out KFF's Implementation Timeline, which lists and briefly summarizes the various provisions that will be taking effect each year (including several that were implemented last month).
And for a more irreverant look at dysfunction of the status…
mikethemadbiologist | September 17, 2010I've decried before the lack of natural history in economics, and I'm thinking Mark Thoma, with whom I usually agree, seems to be doing just that. Thoma on the ongoing recession:
There are different types of recessions, and this one can be termed "a balance sheet" recession. It had a big impact not just on bank balance sheets, but on household (and, for that matter firm) balance sheets as well. Households were particularly hard hit due to declines in stock prices and declines in the value of housing. These losses were large, they upset plans for things such as retirement, and households…
gregladen | August 27, 2010The question is being asked, Will Cardiovascular Disease Prevention Widen Health Inequalities? in a Policy Forum essay in the OpenAccess Journal PLoS Medicine.
Here is the executive summary from the article:
The primary prevention of cardiovascular disease (CVD) is dependent on the effective reduction of the major risk factors for CVD, particularly tobacco control and a healthier diet.
The high-risk approach to prevent CVD typically involves population screening. Those exceeding a risk threshold are then given lifestyle advice and/or tablets to reduce blood cholesterol and blood pressure.…
lborkowski | August 5, 2010If you haven't already, go read Atul Gawande's New Yorker article "Letting Go." As a surgeon, Gawande knows how doctors tend to death with terminally ill patients, both because of their training and their ordinary human tendencies. As a writer, he knows how to weave together personal stories and explanations into a seamless portrait of our medical system's dysfunctional approach to death. Here's one of his snapshots:
Recently, while seeing a patient in an intensive-care unit at my hospital, I stopped to talk with the critical-care physician on duty, someone I'd known since college. "I'm…
lborkowski | July 20, 2010Last year, Atul Gawande wrote an interesting New Yorker piece that compares present-day efforts to control healthcare costs with early 20th-century efforts to increase US farming productivity. The quest for more farming productivity succeeded not because of any grand, sweeping reform, he explains, but because the government, through the USDA, invested in pilot programs, scientific extensions, and provision of information to farmers. Gawande summarizes the recipe for success:
The government never took over agriculture, but the government didn't leave it alone, either. It shaped a feedback loop…
lborkowski | June 24, 2010If you haven't already, go read Katy Butler's powerful New York Times Magazine piece about her aging father's years of decline and the hard decisions she and her mother had to make about his care. Butler's father suffered a stroke at age 79, and she writes of its effect:
His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member. ... Even though a capable woman was hired to give my dad…
mikethemadbiologist | June 18, 2010Or more precisely, why do some patients not follow their doctors' orders even when it is blindingly obvious that they should do so? In Monday's NY Times there was an interesting article about patients who are being paid to take their medicine in a reliable manner. I was going to write about the payment issue as it raises all sorts of questions, but I've become fixated on something in the article: ignoring obvious incentives to take care of yourself.
For example, once a juvenile diabetic (someone who can't manufacture his or her own insulin) takes a lot of insulin before eating a meal,…
lborkowski | June 9, 2010President Obama has nominated Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services, and he sounds like a great guy for the job. Julie Rovner reported for Morning Edition earlier today that Republicans are stalling his nomination, which isn't out of the ordinary these days. But the part of her story that really pissed me off was this snippet from Senator Pat Roberts (R-Kansas), who said, "Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care."
I would really, really like it if everyone who gets involved in the…
lborkowski | May 27, 2010A New York Times article by Jane Gross highlights a costly healthcare problem: avoidable hospital readmissions, which affect one in five patients and account for $17.4 billion of the current $102.6 billion Medicare budget. (When people talk about readmissions, they're generally referring to an admission within 30 days of the previous admission for the same condition.)
When patients end up back in the hospital, it's often because their care didn't continue appropriately when they were first discharged. Patients leaving the hospital should receive detailed instructions about what they need to…
mikethemadbiologist | April 23, 2010By way of Echidne, I came across this article about WellPoint's cancellation of insurance policies belonging to women with breast cancer (italics mine):
Shortly after they were diagnosed with breast cancer, each of the women learned that her health insurance had been canceled. There was Yenny Hsu, who lived and worked in Los Angeles. And there was Patricia Reilling, a successful art gallery owner and interior designer from Louisville, Kentucky....
The women paid their premiums on time. Before they fell ill, neither had any problems with their insurance. Initially, they believed their policies…
mikethemadbiologist | April 21, 2010"Will these be enough chickens for an angioplasty? No. Ok, then. Can I get a couple of weeks of chemo then?"
(from )
Sadly, I'm not kidding. Republican candidate for Nevada's senate seat Sue Lowden thinks bartering farm animals is a way to control healthcare costs. No, really:
A couple weeks ago our Eric Kleefeld came up with video showing Nevada Senate candidate Sue Lowden suggesting that "bartering" for medical care would be a good way to rein in spiraling health care costs.
I mocked her with the headline: "I bid three chickens for that MRI!" But I sort of figured she'd rethink that…
mikethemadbiologist | April 20, 2010One of the best ways to deal with the problem of antibiotic resistance is infection control in hospitals. That is, if patients aren't getting infections, whether those be sensitive or resistant to antibiotics, then there's less of a problem. Massachusetts has released its annual report on hospital infection rates. The report currently looks at two major causes of hospital acquired infections: central venous catheter blood stream infections (CLABSIs) and surgical site infections (SSIs).
The good news is that, compared to the nation as a whole, MA does no worse or even better than the…
gregladen | April 19, 2010Are you going to be finishing all of that mastodon meat?
Cost of Modern Medicine, Insurance Reform, and Death in the Paleolithic
Two months ago, I fell on the ice, was taken to the hospital in an ambulance, got emergency surgery, and two/three days later was released from the hospital. The paperwork I waas handed on my release indicated that the costs to that point were $20,000 US (all covered). I estimate that this injury will cost, medically speaking only, about another ten grand, so the total cost of this injury is going to be, let's say, $30,000.
A few weeks later, a tooth crown that I…
mikethemadbiologist | April 10, 2010I'm skeptical. Floyd Norris, who usually is smart enough not to join the 'Pain Caucus', claims it is in The NY Times:
The federal government is now starting to build the institutions that will try to reduce the soaring growth of health care costs. There will be a group to compare the effectiveness of different treatments, a so-called Medicare innovation center and a Medicare oversight board that can set payment rates.
But all these groups will face the same basic problem. Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care.
Managed care…