Health Policy News and Views
Compiled by Benita M. Dodd
The biggest health story in a while is happening right here in Georgia, as Ebola makes its first official appearance in the United States while nearly 1,000 have died in West Africa.
Two American missionaries infected as volunteers who were treating Africans for the devastating virus have been transported to Emory Hospital in Atlanta to be treated. The questions raised show some ignorance, some fear and some concern for the cost and ramifications of bringing these two patients home. The virus kills 25-90 percent of the people infected, so there’s some justifiable worry.
I have concerns, too. Not just about the two patients now on U.S. soil, but about what a stark reminder this is of the potential for bioterrorism on our soil. We worry about nuclear weapons and bombs, but think about it: All it takes is one infected carrier to intentionally slip in through one of our airports – and Atlanta is the busiest airport in the world. One of my Facebook friends posted, “I couldn’t keep my hamster contained, and it’s a million times larger than Ebola.”
I also see it as a reminder that the Atlanta-based Centers for Disease Control and Prevention needs to concentrate on its core mission of disease control and prevention instead of the mission creep of recent years. There are still deadly and debilitating diseases out there. Many ailments we haven’t seen in years are beginning to pose a threat, both because of the border crisis involving unaccompanied minors – or, as some call them, unaccompanied “children” – and because many parents choose not to vaccinate their children. We can’t afford to lose ground because of one, the other or the combination of these factors.
Meanwhile, a little old-fashioned rough-and tumble and common sense are good ideas. It would behoove parents to quit racing children to the doctor for antibiotics every time they have the sniffles, and to let their children play in the dirt, the way we did as youngsters. Avoid antibacterial soaps. Sterile environments make your children more vulnerable – to asthma, to allergies and to attacks on their immune system.
Carbon emissions, EPA and asthma: I testified about that last week at the Environmental Protection Agency’s field hearing on its proposed carbon regulations. You can read my testimony here, but as I told the EPA panel:
As for using this action to reduce asthma attacks and fatalities: The EPA has highlighted the dramatic improvements in air quality over the past 30 years, despite the increase in population, the economy and vehicles miles traveled. So if outdoor pollution is the problem, why is it that rates of asthma have risen sharply over the past 30 years, particularly among minorities and children ages 5 to 14? Why are asthma prevalence and deaths climbing among lower-income and minority families?
We should be more concerned with the EPA report that, “The average American spends approximately 90 percent of their time indoors.” Also, that “studies of human exposure to air pollutants by EPA indicate that indoor levels of pollutants may be 2 to 5 times – and occasionally more than 100 times – higher than outdoor pollutant levels.”
Concierge medicine: If you think I’m promoting concierge medicine excessively, it’s because I believe in it enormously and don’t believe that Medicaid is the best option for uninsured, low-income Georgians! Sign up here to attend the Foundation’s 5th Annual Legislative Forum to find out about alternatives to Medicaid expansion in Georgia. AtlasMD physician Doug Nunamaker says it best: “We realized that insurance paying for primary care is akin to using car insurance to try to pay for gasoline. It’s something that’s otherwise fairly affordable until you try to pay for it with insurance: My premiums would be much higher because they wouldn’t know how much gas I would need, they would tell me where to get gas, and I’d have to preauthorize trips out of town.” AtlasMD physicians have 600 patients each. Monthly fees: 20 to 44 years – $50 a month, 45 to 64 – $75 a month, 65 and older – $100 a month, children to 19 years – $10 a month. Generic medicines are available at wholesale prices. Read more about the approach here. Source: KevinMD.com
If you think it’s only Detroit’s problem: When Detroit declared bankruptcy last year, many critics blamed its more than $3 billion in unfunded pension liabilities. At that time, however, Detroit reported approximately $6 billion in unfunded retiree health care obligations, the Brookings Institution reminds us. These were health care benefits promised by the city to its employees who retire before they become eligible for Medicare at age 65. Those are obligations government makes, but taxpayers are on the hook! The 30 largest American cities had over $100 billion in retiree health care deficits in 2013, as estimated by the Pew Charitable Trust. New York City showed the most serious retiree healthcare deficits, at $22,857 per household. The state of Georgia’s, meanwhile has liability for retiree health care benefits totaling $19,804,096. That’s just 3 percent funded, and that makes Georgia the 17th BEST funded in the nation! The Government Accounting Standards Board’s recent proposal that that state and city government record these deficits as liabilities on their balance sheets instead of just being disclosed in financial footnotes is likely to hurt the credit ratings for the bonds issued by local governments with large retiree health care deficits, Brookings notes. Read the Georgia Public Policy Foundation’s proposal for reform here: https://www.georgiapolicy.org/ftp_files/GTI/pensions.pdf.
Five great things about U.S. health care: It’s not perfect, but at least you’re in the USA. Suneel Dhand, an internal medicine physician and author, shares five ways in which America excels in health care. Here’s one: “Statistics. A lot of the endemic chronic diseases in society are ironically a consequence of the wealth of the country, such as overeating and lack of exercise (everyone has a car, so why walk?). A case perhaps of your biggest strength also being your biggest weakness. Casting aside the bad statistics, which can certainly improve, did you know that the U.S. has some of the best statistics in the world for surviving a heart attack, stroke, and cancer? According to one study in Lancet from 2007, American women have a 63 percent chance of surviving at least five years after a cancer diagnosis compared to 56 percent for European women. For American men, it’s 66 percent compared to 47 percent for European men.
They’re still physician ASSISTANTS: Physician assistants must practice under the supervision of a physician but their scope of practice varies from state to state. According to Barton Associates, 12 states place some limit on PAs’ prescribing powers. In Georgia, as in many of those 12 states, PAs may not prescribe Schedule II drugs. In the remaining 38 states and Washington, D.C., the PA’s prescriptive power is determined by the supervising physician. Also in Georgia, a physician may not supervise more than four PAs at any one time.
Sudafed law, pseudo results? Because Ephedrine and Pseudoephedrine are used in the illegal production of Crystal meth (a methamphetamine) many states, including Georgia, have banned or restricted their over-the-counter sale. In his blog post, Dr. David Smith questions whether such laws are effective in the long term. Writing about Mississippi’s 2010 law, which requires a prescription for pseudoephedrine, he notes that “Oregon has had a law similar to Mississippi’s since 2006 and then saw arrest rates related to methamphetamine increase by 36 percent from 2009 to 2012.” And he points out that, unfortunately, “while the users of meth now are getting greater access to more potent forms of the drug, consumers are still frustrated with not being able to treat their colds without greater expense and inconvenience, which results in lost productivity at home and in the workplace.” Source: KevinMD.com
Fifty ways to cut your health care costs: Kiplinger has some ideas on how to cut costs, reminding us – as if we needed a reminder – that you’re paying a bigger share of your health-care costs than you used to. “Higher premiums are only part of the picture. Deductibles are rising, provider networks are shrinking, and insurers have been switching from fixed-dollar co-payments to coinsurance, based on a percentage of the cost of care.” Among the suggestions: using super-preferred doctors, staying in your network, using standalone centers, avoiding the emergency room. Some obvious, but it’s definitely worth a read!
What am I bid for this appendectomy? If you haven’t used Priceline, potential travelers select a city and star rating (i.e., quality level) and enter in a price they’re willing to pay per night. Hotels view the bid, and those under capacity can choose to accept the bid (which usually represents a steep discount on regular rates). A health care consultant has brought the same concept to health care with Medibid. Launched in 2010, the Web site lets providers bid on health care services sought by consumers. Source: Becker’s Hospital Review
Sue me: The U.S. House of Representatives passed a resolution 225-201 that gives the House GOP authorization to sue President Obama, accusing him of abuse of authority when he decided to defer the PPACA’s employer mandate, which requires employers with 50 or more employees to provide health insurance coverage. The employer mandate was originally slated to take effect this year, but it will now gradually be implemented through 2016. Find out more about the lawsuit here. Source: Becker’s Hospital Review
Ruling’s impact: Twenty-four states have not expanded Medicaid and also have federally run exchanges or partnership exchanges with the federal government. A 2012 U.S. Supreme Court ruling made Medicaid expansion optional for states. A federal appeals court panel agreed recently in Halbig v. Burwell that the Affordable Care Act allows tax subsidies for the state-run exchanges, but not for the federally run exchanges. If the Supreme Court supported the Halbig ruling, that would “effectively eliminate the Affordable Care Act health-coverage expansion in these states unless their anti-ACA governors and legislatures reversed course and set up state exchanges,” writes Drew Altman, president and chief executive officer of the Kaiser Family Foundation. “Few are likely to do so. Under this outcome, an estimated 10 million people would lose eligibility for tax credits.” Source: Wall Street Journal
Quotes of Note
“It is becoming apparent to all in the industry that data is perhaps the most precious commodity available to digital health and wearable tech firms, and data becomes more valuable when it encompasses multiple perspectives on the same individual.” – Dr. Jesse Slade Shantz “
In 2012, the Congressional Budget Office and Joint Committee on Taxation estimated that the insurance coverage provisions of the PPACA will have a net cost of just under $1.1 trillion over the 2012–2021 period. A great question remains: Is the cost worth the gain?” – Scott Becker, Lindsay Dunn, Molly Gamble