Jamie Oliver eloquently discusses the dire impact of our abysmal teaching about nutrition in the U.S. Check out also this lengthy Byran Appleyard/TimesOnline article on Art DeVanyís continuing research on the integration of good nutrition with sound exercise protocols. Good information for increasing the chances of enjoying a healthy life.
Uwe Reinhardt posted this insightful Economix post last week in which he bores in on the key issue to be resolved in reforming the U.S. health care finance system:
I could easily offer every American family a health insurance policy it could afford, simply by varying judiciously the annual deductible, the coinsurance rate, upper limits on items ostensibly covered by the policy and exclusions from coverage of sundry services or products ó for example, mental health services or certain specialty drugs.
The policy might be a sham; but it sure would be cheap.
Health insurance is just a means by which needed health care can be made ìaffordableî to Americans when they fall ill. Therefore the proper target of health policy should be the familyís total outlay on health care, including out-of-pocket spending. That total outlay on ìneeded health careî should be made ìaffordable.î
Which requires us to define concretely, for practical purposes, what we mean by ìhealth careî and ìaffordable,î pedantic as that may sound. Politicians should be forced to be utterly clear about it. [. . .]
President Obama could make this idea practical by using a visual device such as the table [above]. In that table ìdisposable incomeî is defined as all personal income from whatever source minus all personal income tax payments and other government deductions. The numbers are annual. . . .
Professor Reinhardt makes a good point about the disingenuous nature of health insurance. As I noted here, most forms of health insurance ñ particularly the employer-based kind — insulate consumers from understanding the truce cost of their health care choices. As a result, most consumers ñ and virtually all legislators in Washington ñ have no idea on what amount of health care costs are ìaffordable.î Most insureds are pleased that someone else is footing the bill and simply donít want to lose that perk.
Health insurance is largely the product of bad governmental policy (wage controls during World War II) and, as is often the case with such policies, there are unintended consequences that are even worse than the misdirected governmental policy. In this case, we have two generations of Americans who have been largely insulated from needing to know the true cost of some of their most fundamental choices and needs in life.
Such ignorance is now hindering reform of the fractured U.S. health care finance system. But any health care finance reform that does not rely at least in part on reigniting a consumer market to control costs will likely be even more expensive and less satisfying than the current system.
In this clever sketch, That Mitchell and Webb Look channel the mentality behind the legislation discussed in yesterdayís post.
Does anyone really think for a moment that this legislation is going to have any meaningful impact on its intended purpose:
The Obama administration will begin a drive this week to expel Pepsi, French fries and Snickers bars from the nationís schools in hopes of reducing the number of children who get fat during their school years.
In legislation, soon to be introduced, candy and sugary beverages would be banned and many schools would be required to offer more nutritious fare. [. . .]
The legislation would reauthorize the governmentís school breakfast and lunch programs. It aims to transform the eating habits of many of the nationís children and teenagers, . . .
No word yet on whether the legislation is also going to attempt to bar students from going to the neighborhood grocery or burger stand after school and buy the Pepsi, French fries and Snickers that the do-gooders wonít let them buy during school.
On the other hand, an initiative that really might generate some beneficial health changes ñ such as providing each studentís family lower health insurance premiums in return for family members maintaining a non-obese weight ñ remains illegal under applicable governmental regulatory schemes.
We really do find creative ways to waste time and energy, donít we?
So, Rice University last week finally decided to pass on the proposed merger with Baylor College of Medicine.
In theory, the deal makes sense. Both are top-notch academic institutions with campuses within a stoneís throw of each other. Each institution would have given the other something that it needs. Baylor would have gotten the financial support of Riceís multi-billion dollar endowment, while Rice would have landed a strong scientific research and clinical care center in one of the nationís leading medical institutions, the Texas Medical Center.
Although Rice President David Leebron supported the merger, large segments of the Rice faculty and alumni opposed the deal, primarily on financial and cultural grounds. Indeed, my sense is that Leebron quit pushing the Rice Board of Trustees to approve the deal when it became apparent that a consensus of Rice constituencies were opposed to the marriage.
And Baylor clearly finds itself in precarious financial condition, not completely of its own doing. After its 54-year teaching hospital relationship with Methodist Hospital soured in 2004, and a subsequent deal with St. Lukeís Episcopal Hospital did not work out, BCM decided on a plan to go it alone and build its own teaching hospital.
However, the ambitious deal has been pretty much a disaster from the start. After floating almost $900 million in bonds to finance construction of the hospital, Baylor announced last year that it was temporarily suspending construction of the hospitalís interior as it works through its financial problems.
Meanwhile, BCM has lost over $300 million since the split with Methodist. Inasmuch as Baylorís endowment is less than a billion, those kinds of losses have placed BCMís financial condition at risk. Already in in technical default on multiple bond covenants, BCM is now facing the prospect of hiring a bondholder-required ìchief implementation officerî to oversee an overall financial reorganization. That would have been avoided if the Rice merger had succeeded.
Thus, Rice certainly had understandable reasons for passing on the deal.
Nevertheless, I wonder ñ did Rice make the right decision?
Despite its financial woes, BCM remains one of the elite medical and research institutions in the U.S. The merger would have undoubtedly brought a substantial increase in research funds in such fields as bioengineering, neurobiology, nano-biotechnology, stem cell biology and gene therapy. Although Rice would have been subsidizing BCMís financial problems in the short term, my sense is that the increase in research resources flowing to Rice over the years would ultimately make that bailout well worth it.
But even more importantly, Rice passed on an opportunity to take a calculated risk that could well have elevated Rice, BCM, the Texas Medical Center and Houston to the forefront of medical and scientific research in the world.
Despite the risks, that kind of upside doesnít come around very often. Failing to realize that is one of the key reasons why Texas has lagged badly behind states such as California and New York in the development of Tier 1 research institutions and all the benefits that such institutions provide to the state and its communities.
Thus, Rice is keeping its chips and betting that it can develop its scientific research just fine without BCM. But if I were to place a bet on which institution is closer to the cutting edge of such research after the next 25 years, Iím still putting my chips on Baylor.
This interesting Lawrence Altman/NY Times article examines the theory that that an undiagnosed melanoma contributed to the death of President Franklin Delano Roosevent in 1945.
Of course, regular readers of this blog know that another killer disease — the dire implications of which were not well-known in 1945 — was probably the main cause of FDR’s death.
But despite the historical curiosity, the most important point to glean from FDR’s demise is the importance of continued investment in clinical and scientific research.
We sometimes forget that it was the generation of doctors and researchers who came of age after World War II who embraced the optimistic view of therapeutic intervention in the practice of medicine, which was a fundamental change from the sense of therapeutic powerlessness that was taught to these men by their pre-WWII professors. In short, it has not been that long since medical science has understood that it could cure disease and prolong life.
For example, if FDR’s doctors had known in 1945 what specialists in hypertension discovered in the two following decades, then those doctors would never have allowed FDR to be subjected to the stress of the Yalta Conference that doomed Eastern Europe to almost 50 years of totalitarianism and economic deprivation.
Stated simply, earlier discovery of the research into the implications of hypertension could well have changed the course of human history.
In fact, we all tend to under-appreciate the advancements in medicine since World War II. For male babies born in the U.S. in 1960, the life expectancy was about 66.5 years and for female babies a tad over 73 years. By 2005, the live expectancies had increased to over 75 and 80 years respectively. Although medical advances don’t account for all of those gains, newly-discovered drugs and medical devices — as well as enhanced understanding of disease — have had an enormous impact on improving the quality of life of most Americans.
Thus, as Congress considers reforming the U.S. health care finance system, it is important for citizens to understand that American medical care and research remains the hope of the world. The current health care finance system has generated enormous investment in that medical innovation, which has been a crucial and treasured export of America to the rest of the world.
Let’s think hard before radically changing a system that generated the investment that produced those benefits for us and the rest of the world.
This blog has long addressed the enormous cost to American society of overcriminalization generally and particularly with regard to business and risk-taking.
But lest we think that the problem is limited to such things as business and victimless crimes, think again says Bob Wachter:
Along comes another case involving jail time for a medical mistake, this one featuring an Ohio pharmacist named Eric Cropp.
Eric was the lead pharmacist at Cleveland’s Rainbow Babies and Children’s Hospital on February 26, 2006. The pharmacy, understaffed that day, received a rush order for chemotherapy for a 2-year-old girl, Emily Jerry, who was undergoing treatment for a spinal malignancy.
An unlicensed and distracted (by press accounts, she was planning her wedding on the day of the event) pharmacy technician mistakenly mixed the chemo with 23% saline rather than the intended 0.9%. Eric, working in cramped quarters and rushed for time, gave final approval to the mixture, partly because, after seeing a spent bag of 0.9% saline next to the mixed solution, he assumed that it had gone into the solution.
In other words, the case was a classic illustration of James Reason’s Swiss cheese model, in which numerous safety checks failed due to a confluence of systems and human errors. Tragically, little Emily died from the hypertonic saline infusion.
On hearing of the error, a Cuyahoga County DA decided that the case merited criminal prosecution, even though Eric had no history of errors in his pharmacy career and root cause analysis of the case confirmed that its cause was simple human error compounded by systems problems. At trial, fearing even harsher penalties, Eric pleaded guilty to involuntary manslaughter, and was sentenced to 6 months in the state prison, 6 months of home confinement, 3 years of probation, 400 hours of community service, and a $5,000 fine. Moreover, the Ohio pharmacy board permanently stripped him of his license, depriving him of his livelihood – forever. . . .
During last week’s webcast, Mike Cohen described visiting Eric in prison. “Like a scene out of a movie,” he recalled, with Eric in his orange jumpsuit, speaking to visitors through a glass wall, other felons – including violent offenders – milling about. As he related the visit, Mike choked up with emotion, clearly seeing this tale as both powerfully tragic and cautionary.
How has it come to the point where the criminal justice system exacerbates the tragedy of a young girl’s accidental death by ruining a career and inflicting enormous damage on an innocent family? At least the young girl’s family recovered substantial financial damages resulting from the pharmacist’s negligence. Where does the young pharmacist’s family turn for help?
A truly civil society would find a better way.
A couple of interesting health care-related items caught my eye today.
First, I went by my internist’s office for my annual physical and noticed that another group of doctors had leased a much larger office across the hall from my doctor’s office.
I peaked inside the new doctors’ office window and noticed that the reception area was nicely furnished with plush leather sofas and chairs, flat screen TV’s, handsome hardwood flooring and tasteful Persian rugs.
The opulence of the office prompted me to find out what kind of doctors were apparently doing so well, so I grabbed one of the doctor’s cards from the reception area. It read (not the real name):
"John Smith, M.D., Laparoscopic Obesity Surgery"
Meanwhile, this NY Times article reveals the utterly unsurprising fact that New York City regulations requiring fast food restaurants to post the caloric content of their food did not induce obese consumers from eating less:
A study of New York City’s pioneering law on posting calories in restaurant chains suggests that when it comes to deciding what to order, people’s stomachs are more powerful than their brains.
The study, by several professors at New York University and Yale, tracked customers at four fast-food chains — McDonald’s, Wendy’s, Burger King and Kentucky Fried Chicken — in poor neighborhoods of New York City where there are high rates of obesity.
It found that about half the customers noticed the calorie counts, which were prominently posted on menu boards. About 28 percent of those who noticed them said the information had influenced their ordering, and 9 out of 10 of those said they had made healthier choices as a result.
But when the researchers checked receipts afterward, they found that people had, in fact, ordered slightly more calories than the typical customer had before the labeling law went into effect, in July 2008.
The findings, to be published Tuesday in the online version of the journal Health Affairs come amid the spreading popularity of calorie-counting proposals as a way to improve public health across the country.
“I think it does show us that labels are not enough,” Brian Elbel, an assistant professor at the New York University School of Medicine and the lead author of the study, said in an interview.
"Labels are not enough?" Makes one wonder what regulation Professor Elbel will suggest next — maybe governmental rationing of fast food?
The argument in favor of these types of absurd governmental intrusions into our lives is that government subsidizes medical insurance, so government should attempt through regulation to decrease obesity, which unfairly heaps a portion of health-care costs relating to obesity on tax-paying citizens who are not obese.
But putting aside for a moment the debatable notion of whether obesity really increases health-care costs all that much, the far more effective regulation to decrease obesity would be to provide a financial incentive for citizens to lose weight. Namely, reduce the governmental subsidy of medical insurance for those who choose to remain obese.
Fat chance of that happening.
If you read one article health care-related this week, make it this extraordinary Sheri Fink/NY Times Magazine article on the impossible choices that the heroic doctors — including Dr. Anna Pou — faced at the former Memorial Medical Center in New Orleans in rationing limited medical and evacuation services for their patients during the chaotic aftermath of Hurricane Katrina.
Ms. Fink summarizes the issues raised by the issues that Dr. Pou and her colleagues well:
The story of Memorial Medical Center raises other questions:
Which patients should get a share of limited resources, and who decides?
What does it mean to do the greatest good for the greatest number, and does that end justify all means?
Where is the line between appropriate comfort care and mercy killing?
How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them?
Interestingly, after the federal, state and local governments largely failed the doctors, other workers and patients at Memorial in the aftermath of Katrina, get a load of how the government forces acted once the decision was made to arrest Dr. Pou:
AT ABOUT 9 P.M. on July 17, 2006 — nearly a year after floodwaters from Katrina swamped Memorial hospital — Pou opened the door of her home to find state and federal agents, clad in body armor and carrying weapons. They told her they had a warrant for her arrest on four counts of principal to second-degree murder.
Pou was wearing rumpled surgical scrubs from several hours of surgery she performed earlier in the day. She knew she was a target of the investigation, but her lawyer thought he had assurance that she could surrender voluntarily. “What about my patients?” she asked reflexively. An agent suggested that Pou call a colleague to take over their care. She was allowed to freshen up and then was read her rights, handcuffed and ultimately driven to the Orleans Parish jail. . . .
Read the entire article. Whose judgment do you trust more? Dr. Pou and her colleagues? Or that of those governmental officials who decided to arrest her?
