Category Archives: Health Care

The War on Drugs goes viral

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drug-war The perverse damage that federal and state drug prohibition policies impose on American citizens and our neighbors has been a frequent topic on this blog over the years.

In this must-read Reason.com article, Radley Balko reviews how Americaís drug prohibition policies are increasingly being used as a basis for conducting Gestapo-like raids on American citizens:

Last week, a Columbia, Missouri, drug raid captured on video went viral. As of this morning, the video had garnered 950,000 views on YouTube. It has lit up message boards, blogs, and discussion groups around the Web, unleashing anger, resentment and even, regrettably, calls for violence against the police officers who conducted the raid.

I’ve been writing about and researching these raids for about five years, including raids that claimed the lives of innocent children, grandmothers, college students, and bystanders. Innocent families have been terrorized by cops who raided on bad information, or who raided the wrong home due to some careless mistake. There’s never been a reaction like this one.

But despite all the anger the raid has inspired, the only thing unusual thing here is that the raid was captured on video, and that the video was subsequently released to the press. Everything else was routine. Save for the outrage coming from Columbia residents themselves, therefore, the mass anger directed at the Columbia Police Department over the last week is misdirected.

Raids just like the one captured in the video happen 100-150 times every day in America. Those angered by that video should probably look to their own communities. Odds are pretty good that your local police department is doing the same thing.

Meanwhile, after suggesting on the campaign trail that drug prohibition policies needed to be changed, President Obama has cynically and hypocritically retreated and now supports the federal governmentís drug prohibition policy. Meanwhile, the enormous costs of the dubious policy continue to pile up.

Americaís War on Drugs is lost. It is way past time that we require our leaders to acknowledge that and end it. Their war has now become a war on us.

Update: Scott Henson has more.

The Medicaid Contagion

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Medicaid_June 2009-thumb-320x240 (1) This earlier post decried the failure of the Obama Administrationís reform of the U.S. health care finance system to address one of the fundamental problems with the system ñ the over-reliance on third-party payor of health care expenses.

Take Medicaid, which is the foundation of Obamacareís insurance-for-all principle. As the Happy Hospitalist explains, Medicaid is a particularly shaky foundation:

Not accepting Medicaid used to be the in thing for primary care.  Only one internist out of thirty in Happy’s town accepts new Medicaid patients.  That’s nothing new.

However, this Medicaid contagion has now spread to subspecialty care. In a first of its kind for Happy’s community, I learned that some subspecialty surgeons are no longer accepting Medicaid for outpatient evaluations.    Cash is king.  If they are forced to care for a Medicaid patient during ER call, they don’t even bill Medicaid for the care.  The hassle factor outweighs the payment received.

Going to the ER does not guarantee you’ll get a hospital admission which would mandate the physician to see you.  If you aren’t sick enough to get admitted, you may get referred back to the subspecialist doctor  from the ER for an outpatient evaluation.  And the  front desk at the office will tell you  they don’t accept Medicaid and will ask for a cash payment up front for a clinic evaluation.  They may be required to see you.  They aren’t required to accept your insurance.

If a Medicaid patient shows up in the clinic as an outpatient referral from a primary care doctor’s office, the patient is told they do not accept Medicaid and cash is necessary for an evaluation.  There is no where for the patient to go, except to the University Hospital 60 miles away.  The surgical clinic doesn’t  offer cab vouchers like Happy’s hospital does.  This is the current reality of Medicaid.  This is ObamaCare’s cure to health care finance reform. 

Medicaid is not a solution. It’s pollution.  Medicaid is an insult to physicians everywhere. [.  .  .]

A nation of disgruntled patients with all the insurance in the world, and no where to go.  Take it up with your Congressman I would say.  They are the ones that destroyed it.

Yes, but everyone will still have health insurance.

For whatever thatís worth.

The MD Anderson – Anticancer Research Venture

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mdanderson This David Agus/TEDlecture from awhile back emphasized the need for new ideas and approaches in cancer research.

Along those lines, David Servan-Schreiber in the video below announces that he has teamed up with Houstonís MD Anderson Cancer Center in a new research project aimed at enhancing and bolstering cancer research and care. Dr. Servan-Schreiberís website about the project is here.

Dr. Servan-Schreiber is the author of the best-selling book, Anticancer, A New Way of Life (Viking 2009). While serving as a clinical professor of psychiatry at the University of Pittsburgh School of Medicine, Servan-Schreiber underwent chemotherapy and surgery twice for brain cancer. After the second bout, Servan-Schreiber spent years researching a mass of scientific data on natural defenses against cancer. His book is the result of this experience and research.

As this Abigal Zuger/NY Times review notes, there is skepticism in the clinical research community regarding Servan-Schreiberís conclusions and recommendations. So, M.D. Andersonís interest in Servan-Schreiberís approach is somewhat surprising.

Nevertheless, as Dr. Agus notes in his TED lecture, perhaps Servan-Schreiberís ideas are the type that are needed to spur clinical research into better treatment protocols and innovative care procedures for cancer patients.

That health care overhead

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healthcareadmin Following on this post from earlier in the week on the adverse impact that the third party payer system of health care finance has had on controlling health care costs, check out this Catherine Rampell post that passes along the graph on the left and the following startling observation:

ìFor every doctor, there are five people performing health care administrative support.î

And we are about to implement changes in the health care finance system that increases the third party payer element that requires much of this administrative support? While dramatically increasing the number of people covered under such a third party payment scheme with no provision for increased supply of medical services to meet that additonal demand?

What possibly could go wrong?

How we pay for health care

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Health Expenditures by Payer What is the most efficient way to pay for health care?

Proponents of a single-payer governmental system content that patients should not have to pay the cost of their health care decisions and that the government can effectively control costs through top-down mandates.

On the other hand, opponents of such a system maintain that the most effective way to curb costs is to have patients bear a portion of their health care costs — such as routine expenses — and that the government canít efficiently control costs without rationing care.

In a recent JAMA op-ed, Dr. John Ford provided this graph (H/T Jeff Miron) to reflect the increase in third-party payment of health care expenses over the past half-century and the decrease in patient payment of expenses over the same span. Health care costs have skyrocketed over the same period.

Why should anyone believe that reform that continues the trend toward more third party payment of health care expenditures is going to result in meaningful reduction of health care costs?

How will Obamacare ration care?

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homer_beer During the latter stages of the debate over reform of the American health finance system, one of the key issues that seemed to fade amidst the rhetoric was the question of how the revamped health finance system will ration care (see also here). Inasmuch as it is still not clear to me how care will be rationed under Obamacare, this recent Happy Hospitalist post caught my eye:

I’m down in the ER the other day when I see a chief complaint fly by on the radar.  What is that chief complaint you ask? ìRefused by Detox.î

The patient was so drunk, even the community detox center refused them.  So how did this play out?  The patient was taken by ambulance from his home to a small town community ER for altered mental status.  There, he was  booked into the ER and seen by a small town community ER physician family practice resident or PA or NP.  Diagnosis you ask? ìAcute alcohol intoxication. Plan:  Discharge to community detox center.î

The patient was then transported to detox  by a cop where he was promptly refused by detox for being too drunk. Too drunk for detox.  How sad is that.  At this point another ambulance was called and the small town hospital refused to accept him back because he was "too drunk" for them to handle if he became comatose and critically ill.

So the ambulance drove him 75 miles to Happy’s hospital which has to accept him, where he was promptly booked into the emergency department in front of the 28 year old with heart burn, the 19 year old looking to get a pregnancy test and the 14 year old who’s mother brought her in because she just had her first period.  What happened with our drunk?  He was promptly placed in a room where stat lab confirmed what everyone else had suspected.  He was drunk.  The big city ER doctor billing $500 an hour proudly made his diagnosis and disposition plans known to the world: ìAcute alcohol intoxication. Plan: Discharge to community detox.î

By now, the patient’s alcohol level was down to 320 and he was awake, responsive and asking for a samich as the cops show up to take him away. Let’s conservatively add it up:

  • Two ambulance rides $1,000
  • Two ER visits $3,000
  • Two ER physician visits $500

Almost $5,000 to take care of a drunk in which doing nothing would have given you the same result.  And you wonder why Medicaid is going bankrupt.

The Hospitalist goes on to point out how expenses such as the foregoing is eventually going to lead to failure of many inner-city hospitalists. But an equally troubling issue is whether anything will change in regard to future opportunities for misallocation of expenses under an increasingly subsidized health care system?

Frankly, I doubt it.

De Vany on PED’s, Diet and Exercise

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When you have a free hour, don’t miss Russ Roberts’ fascinating EconTalk interview of Clear Thinkers favorite Art De Vany.

Performance enhancing drugs resulted in new records in baseball?

Pure conjecture. More likely the records are simply the result of outliers.

The more exercise, the better?

Nope. Intensity and randomness is the key to an effective exercise regimen. Forget the jogging.

We’re healthier than our ancestors?

Not really, unless you’re fasting frequently and controlling your insulin levels.

Provocative stuff. Don’t miss it.

A stroke of insight

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This is one of the most fascinating TED lectures. Brain researcher Jill Bolte Taylor describes the experience of having a stroke.

Update: Interestingly, a number of neuroscientists believe that Bolte Taylor’s lecture is misleading. See here and here.

Making good on Baylor Med’s bad bet

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27937 The Chronicleís Todd Ackerman and Loren Steffy did a good job in this weekend article of chronicling the series of bad bets that Baylor College of Medicineís Board of Trusteeís made in the wake of the schoolís unfortunate 2004 divorce from The Methodist Hospital. Baylor Medís travails have been a regular topic on this blog, most recently here.

The elephant in the parlor of Baylor’ Medís financial problems is the $600 million in bond debt that Baylor Med incurred in connection with its currently mothballed hospital project. Indeed, the difference between the total bond debt and the value of the underlying collateral would gobble up a large chunk of Baylorís endowment, which is currently a tad under a billion dollars. That was enough to scare off Rice University, although I question whether that was the right long-term decision for Rice.

So, the future is bit cloudy for Baylor. But what Iím wondering is whether there is a local partnership that could bail Baylor out of most of current problems while providing an essential benefit for the Houston community?

The last time I look into the issue, estimates in the Houston metro area has one of the largest percentages of uninsured residents in the U.S. (over 30% versus a national average of about 16%). The Harris County Hospital District ultimately ends up with the issues involved with financing indigent care as well as ensuring that adequate medical facilities exist for local citizens.

Given the HCHDís projected need for facilities to keep up with the growth of the Houston area, it makes sense for the HCHD to engage Baylor in discussions over a partnership in which HCHD would make an investment in the hospital in return for Baylorís agreement to staff the institution as its primary teaching facility.

Baylor and the HCHD already work closely in connection with the staffing of the Ben Taub Hospital trauma unit in the Texas Medical Center. A pure teaching hospital for Baylor would provide a quasi-public, low-cost alternative to the Med Centerís impressive but expensive array of private hospitals.

Sure, the details would have to be worked out, such as management of the facility. But doesnít such an investment by the county make sense, particularly when compared to ones such as this?

David Agus on the state of cancer research

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University of Southern California University professor David Agus provides a particularly lucid 24-minute lecture for the TED conference on the state of cancer research.