Checking Up On Health: July 15, 2014

Health Policy News and Views
Compiled by Benita M. Dodd



Don’t believe the middleman makes a huge difference in health care? Listen carefully the next time you’re at the doctor. I’ve become a believer in direct primary care. It’s a little like a health club membership, where you sign an agreement to use the facility’s services. Unlike the elite concierge doctors of the USA Network show, “Royal Pains,” this affordable model is also called “concierge care for the little guy.”

The difference health insurance makes in the price point was reinforced after my recent visit to an imaging center. The assistant offered me the option to file a health insurance claim or pay $130 up front. My plan is a health savings account (HSA), so I opted for the health insurance, which, of course, pays in full for annual mammograms.

Imagine my surprise when I received the explanation of benefits from my health plan. The imaging center billed the insurance company $599! Lesson learned. Next time I’ll pay up front.

It’s our own fault, of course. Instead of using health insurance like auto insurance – paying premiums out of our own pockets, with a deductible that discourages us from using it for small dings and routine maintenance – we use it for vaccinations, coughs, colds and routine checkups. We aren’t actively involved in the financial transaction — it’s OPM —  so we don’t feel the pain. That’s why individual responsibility is important and why patients need to become savvy consumers of health care.

With direct primary care, the patient and the physician contract directly for a package of services, bypassing the additional costs involved in filing with insurance companies.To learn more about this affordable health care option, listen to one practice owner, Dr. Lee Gross, when he spoke to the Georgia Public Policy Foundation at

Here’s another, description of how it works. Start watching at about the 20-minute mark.

Believe me, you’ll be hearing a lot more of this approach for Georgia as an alternative to a costly expansion of Medicaid under the so-called Affordable Care Act.

Up, up and away: According to a new paper from Gov. Bobby Jindal’s think tank, Americans have faced a cumulative $6,388 higher premium costs per individual, and $18,610 per family, under President Obama’s policies. Health insurance premiums have continued to rise every year President Obama has been in office. Compared to a baseline year of 2008, the year Obama was elected, the average family premium for employer-sponsored coverage rose by more than $2,500 – $3,671, to be precise. “Individually, ever-rising insurance premiums place a tremendous squeeze on a hollowed-out American middle class – but collectively, these costs amount to a massive weight on an American economy struggling to grow. All told, the American people have faced $1.2 trillion in higher health insurance premiums due to ObamaCare’s failure to deliver.” Source: Heartland Institute

The woodwork effect: Georgia may not have expanded Medicaid, but the state still expects a surge in enrollment as people who are eligible for Medicare or PeachCare but not enrolled come out of the woodwork. (That’s why it’s known as the woodwork effect.) It must be quite a surge: Georgia Health News reports that the Centers for Medicare and Medicaid Services plans to review Medicaid eligibility and enrollment processes in Georgia and six other states due to “a substantial backlog of pending applications.” A new Georgia Public Policy Foundation paper examining alternatives to Medicaid points out the challenge:

The Urban Institute estimates there are 159,000 adult, low-income Georgians who are currently eligible for Medicaid but not enrolled. The Georgia Department of Community Health assumes fewer than 25,000 (a little over 15 percent) of these Georgians will sign up for Medicaid; this is referred to as the “woodwork effect.” But what if they are wrong? Millions of dollars are being spent around the nation to encourage individuals to sign up for health insurance. If the signup rate is closer to 75 percent, that is more than 119,000 new enrollees and additional annual state costs. In addition, the state estimates only about one-third of the 176,000 children who are currently eligible for Medicaid will enroll, which could also be a low estimate.

How valid is that study? Is coffee good for you or bad? How about butter? Wine? Don’t be too quick to accept the results of studies, judging by  a couple of unnerving op-eds in The Wall Street Journal. In “The Corruption of Peer Review Is Harming Scientific Credibility,” Hank Campbell, founder of Science 2.0, points out, “We need to get away from the notion, proven wrong on a daily basis, that peer review of any kind at any journal means that a work of science is correct. What it means is that a few (1-4) people read it over and didn’t see any major problems. That’s a very low bar in even the best of circumstances.” And in, “Confessions of a Computer Modeler,” a former employee of the Environmental Protection Agency who was tasked with creating computer models notes, “I realized that my work for the EPA wasn’t that of a scientist, at least in the popular imagination of what a scientist does. It was more like that of a lawyer. My job, as a modeler, was to build the best case for my client’s position.”

You can learn a lot from your dog’s doc: Physician Suneel Dhand, who has dealt with his fair share of pet ailments recently, says, “I have to say that I’m embarrassed sometimes when I observe how veterinary medicine works compared to human medicine.” He seems surprised at one of his observations about vets: “They really like animals!” He suggests that physicians could learn from vets, who keep owners updated at all times; have a welcoming customer service environment and never seem to rush through the visits. I hope doctors don’t resort to scratching me behind the ears, though. I’m ticklish that way. Source.

Tired of waiting at the doctor’s office? Here are some tips to avoid long waits, from pediatrician Justin Smith: Arrive ready with everything. Don’t request peak times during the day, week or year. (Hint: Mondays are always busy.) And speaking from personal experience: Make your appointment for early in the day or immediately after lunch. That way, the office hasn’t had an opportunity to build up delays yet. Source:

Don’t kill the messenger: You’d like to blame the physician, but all too often the reason you’re not healing as quickly or as well as expected is entirely your own fault. Why finish the antibiotics when you’re feeling better already? Who’ll know if you cut the at-home therapy short? How much difference does it make if you don’t take the medication on schedule? Do you have to make that follow-up visit? Dr. Thomas Guastavino points out the problems: “The last straw is currently being thrown on providers’ back in the form of reimbursements tied to nebulous quality measures. Those of us who have been in practice for many years have discovered that outcomes are more often than not dependent on factors over which we have little control.” He points out, “The more complex medical issues tend to occur in those patients who are the most uncooperative, cause you the most stress, take up most of your time, have the most comorbidities, most litigious, and least likely to have adequate insurance. Add to this the added new burden of these patients being the most likely to give you poor quality marks and you have a recipe for disaster.” How are they dealing with it? “I recently read another in a long list of studies trying to explain why more complex patients are being transferred to tertiary care hospitals when it is felt they could be treated locally. The conclusion always seems to be that more studies are needed.” Oh, look at that: Frustrated physicians are passing the buck. Expect more of the same. Source:

Unfunded mandates: Several pharmaceutical groups have asked a federal appeals court to overturn an Alameda County, Calif., ordinance that requires drugmakers to fund the county’s drug take-back programs. The law would place an unnecessary burden on out-of-state drugmakers to handle a local waste-disposal problem, the groups argue. When industry lawyer Michael Carvin said the county was illegally shifting its costs to interstate producers, Judge N. Randy Smith replied that the ordinance “shifts the costs to all producers. It just so happens that the majority are in other states.” California’s never done that before, have they? Source: San Francisco Chronicle

Social media overreach: Elizabeth Nolan Brown of the Reason Foundation reports that some social media posts led the Food and Drug Administration to send a warning letter to Zarbee’s Naturals, which is a line of cough syrup, sleep aids, and seasonal-allergy remedies. Zarbee’s products rely on active ingredients such as buckwheat honey, Butterbur leaf extract, and the sleep hormone melatonin. Brown reports, “The FDA scolded Zarbee’s for saying its products treat conditions such as coughs and congestion, as treating these conditions would ‘cause the products to be drugs.’ That’s right – if your all-natural product does the same thing as a drug that makes the product a ‘new drug’ to the FDA. ‘New drugs may not be legally introduced or delivered for introduction into interstate commerce without prior approval from the FDA,’ the agency warned Zarbee’s”.

Upcoming cancer treatments hold promise: The global market for cancer immunotherapy will reach almost $9 billion in 2022, compared with $1.1 billion two years ago, a Decision Resources report predicts. France, the United States, Spain, Germany, Britain, Japan and Italy will experience the fastest growth. Expected new treatments include four novel immune “checkpoint inhibitors” and five novel therapeutic vaccines, according to the research.

Quote of Note

“It is second nature for us to hang our hat on a simple cause-effect relationship. We see it all of the time in the real world. Yet we do not see the moving parts behind what it takes to go from A to B. Coincidentally, a patient is vaccinated (in the case of MMR, usually at 12 months of age) and then developmental regression or delay is noted. Parents out of fear, frustration, confusion or a severe case of toddler logic syndrome (TLS) are deciding to delay or outright refuse vaccines. There’s no wonder there have been multiple recent outbreaks of measles, mumps and pertussis in the United States.” – Dr. Justin Morgan

“With each additional regulation limiting free speech in marketing, producers are under more pressure to refrain from any advertising at all for fear of harsh repercussions for inadvertently crossing an invisible line. When drug and device manufacturers are afraid to use the latest and most popular technologies to market their products, companies and patients both pay the price.” – Brittany La Couture, American Action Forum