Category Archives: Healthcare

The Immortal Life of Henrietta Lacks

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This is another book recommended to me by my wife. Her recommendation once again led me to read a fascinating book. However, she continues to recommend books that don’t have a happy story or ending.

This book by Rebecca Skloot introduced me to a subject I hadn’t read about before. The book begins by describing how a doctor treating Henrietta’s cervical cancer shaved samples from cancerous and noncancerous areas. He gave the samples to George Gey, who had built a laboratory out of spare parts and had worked unsuccessfully for years to grow malignant cells outside the body. The cells were taken without Henrietta Lacks knowledge or permission and were labeled “HeLa.” Cells from the cancerous tumor began to replicate at an enormously rapid rate. When Gey finally determined that his lab had grown the “first immortal human cells” he began sharing samples with colleagues. The word spread and Gey was sending samples all over the country and then the world. A huge medical research industry was developed to grow cells and use them in experimentation that has resulted in the cure to many diseases. There is no way of knowing how many of Henrietta’s cells have been grown but it is estimated that there are several tens of metric tons. Continue reading →

Social Security Projections

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The U.S. deficit continues to grow out of control, and there should have been actions taken to address the problem long before now. However, President Obama’s comments that the deficit is not a short term problem indicates to me we won’t do anything about the deficit for the next four years. Much of the problem is caused by “entitlement” commitments, and President Obama said in his inaugural address that he has no intention of doing anything about those either.

I’m baffled how the American people and the media are going along with the “don’t worry, be happy” approach. Looking at Social Security alone is frightening. A recent article by Chuck Saletta on the Motley Fool points out that each new analysis finds that the program will reach “financial unsustainability” sooner than the previous analyses. The Social Security Trustees reported in 2008 that problems would not be encountered until 2041. The date has now changed to 2033, and that is going to continue to move closer.

Money taken from employees and employers is invested in bonds, and bonds that mature must be replaced with new ones. The older bonds were yielding much more in interest than the ones currently available. The program is projected to earn $5.4 billion less in bond interest in 2012. The fact the Federal Reserve has recently said they are going to artificially keep interest rates low until the unemployment rate begins to drop means the revenue is not going to improve. Continue reading →

Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer

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Reviewed by Kathy London

overtreatedThis book by Sharon Brownee documents a frightening and infuriating American health care system. “Politicians are constantly telling us we have the best health care in the world, but that’s simply not the case. By every conceivable measure, the health of Americans lags … other developed countries.” Using both individual stories and formal studies, Brownlee shows that a third of what we spend on health care is not only wasted, it is making us sicker. Money is certainly an issue, but the suffering of patients is more striking to me.

Our current, technology-based system is a modern invention, arising after World War II. Hospitals became “factories whose products were miracles.” I include this quote because most of the book makes me want to hide from hospitals. Unneeded diagnostics and treatments expose patients to all the risks of medical care (Brownlee presents many) without the benefits. Brownlee details the “desperate need in medicine for clearer standards and better evidence of what works” and the need to end a warped financial system that “propels clinical decisions.”

Brownlee presents many stories of injured patients and of doctors who are “absolutely gob-smacked” when presented with proof of overtreatment. For example, two cardiologists brought sophisticated heart procedures to a rural hospital in California. Some local doctors felt they performed excessive procedures. Healthy patients with minor complaints were coming out disabled or dead. Brownlee follows one doctor through his decade-long effort to get someone to act: Medicare, the State, anyone. Finally the FBI investigated and their outside experts estimated half the procedures were “inappropriate”. The hospital paid a large Medicare fraud settlement, and the doctors lost their licenses. What was striking to me was the sincere shock of the errant doctors. One doctor “appeared genuinely devastated by the charges…. He wept…” Continue reading →

Romney Pick of Paul Ryan

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I have seen news reports of hecklers shouting at Paul Ryan in some of his first campaign speeches with accusing words such as “Why do you want to destroy Medicare?” I suppose the origin of that question is from a Democratic ad on the Internet that accuses, “Paul Ryan’s plan would end Medicare as we know it.” The anti-Ryan ads are playing frequently in places such as Florida where the votes of older residents are crucial. I wonder how long it will be before they resurrect the ad that portrays a Ryan look-alike dumping an elderly woman out of a wheelchair over a cliff.

Both ads bring to mind the observation that it is easier to tell a lie than to explain the truth. Mr. Ryan’s proposals are intended to improve the fiscal strength of Medicare. There would be no changes at all for the older people the ads are intended to scare.  People under 55 would have the option enrolling in Medicare or being given a voucher to enroll in a private insurance policy.

So let’s get this straight. The Ryan proposal would not change anything for anyone over 55 and it would give people 55 and under the option to stay on the program or shop for health care coverage. The proposal is in response to the fact that Medicare’s Hospital Insurance Trust Fund will have insufficient funds to maintain benefits in twelve years. Apparently ending Medicare as we know it means that bankruptcy is preferable to fixing the program. My suspicion is that some politicians can’t accept the idea that people might chose to manage their own affairs instead of depending on government.

I want Mr. Ryan to respond to the hecklers “I want to save Medicare!” Politicians who refuse to do anything to fix broken entitlement programs remind me of the meek townspeople in the old Western movies who hide and watch while the hero takes his six shooters out to the street to defend the town. We need fewer politicians who hide and watch while criticizing those who take the risk of proposing changes. The Congressional Budget Office has warned Medicare will go bankrupt without changes. Is proposing changes to make the program better than hiding and watching while it goes bankrupt? I vote yes.

Health Care Outsourcing

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I recently posted a blog about indications some of the technology and call center jobs that had been outsourced to India are being pulled back because of quality problems related to communication problems. Don Lee of the Los Angeles Times has an article describing how some healthcare companies have begun to shift clinical services and even decision-making on medical care to primarily India and the Philippines. The practice is not new, but the health care law commonly called “Obamacare” is encouraging more jobs to leave the U.S. The new law requires that 80-85 percent of insurance premiums to be spent on medical care. That requirement, which I understand was put into the law to control insurance company profits, will have the unintended consequence of insurance companies reducing as many jobs as possible with outsourcing.

Jobs that had been previously outsourced involved medical activities such as reading X-rays and other diagnostic tests. Task now being outsourced include “pre-service nursing” to evaluate patient needs and to determine treatment methods. WellPoint, owner of Anthem Blue Cross, has formed Radian Services as a separate business unit to set up the outsourcing. A WellPoint spokesperson said there had been 925 jobs outsourced. The explanation why the outsourcing was being done through a separate business unit is that “…it has the technical expertise and can ensure compliance with laws.” My reaction to that quote is that the real reason is to protect WellPoint from lawsuits that might or are likely to be filed when someone has problems with their medical care.

The article says that companies can save 30 percent of labor costs by outsourcing jobs to the Philippines. However,  having medical treatment decisions made overseas sounds risky considering that companies are returning call center and computer work for quality reasons.  It isn’t surprising that nursing organizations are cautious. Patient privacy is also a concern because people’s medical information is being sent to other countries. I didn’t find the quote that “…nearly all countries have laws for protecting patient privacy…” to be all that reassuring.

One person who had processed medical claims for WellPoint was laid off after a colleague went to the Philippines to do training on how she did her job. I doubt that person would be too impressed that the part of a new law designed to control insurance company profits contributed to the decision to have the work done more cheaply in the Philippines.

Health Care Law Status

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The legal battle about the constitutionality of the Affordable Care Act, which is commonly called “Obamacare,” has reached the Supreme Court. An article in the Washington Post by Robert Barnes leads with the Obama administration telling the Supreme Court, “Congress was ‘well within’ its constitutional powers when it decided that the way to resolve a crisis in health-care costs and coverage was to mandate that Americans obtain insurance or pay a fine…”  Lower courts have been just about evenly “…split on whether the Constitution gives Congress the power to require individuals to buy something they may not necessarily want.” Two judges wrote, “We are unable to conceive of any product whose purchase Congress could not mandate…” if the individual mandate is ruled constitutional.

There are many who do not believe the Supreme Court will actually rule on that issue at this time of high political drama, and the Obama administration is maneuvering separately to disarm some of the arguments against the law. Robert J. Samuelson wrote in the Washington Post that Health and Human Services secretary Kathleen Sebilius is doing what she can to make Obamacare disappear as a liability for the President. She has decided to delegate the final decision on defining “essential health benefits” for minimum health insurance coverage to the states. That decision is crucial to answering the question of how 35 million Americans who are currently uninsured will receive subsidized health insurance by 2016. Millions more who receive coverage in individual and small group insurance markets also will be affected.

Sebelius has disarmed the criticism that Obamacare imposes “one-size-fits-all” by requiring each state to define “essential health benefits.” However, the question of how broad the coverage that is required has been scattered to 51 debates. The two goals will obviously be broad and affordable coverage, and those two goals are in direct conflict. Broader coverage will increase the cost to government to pay for the subsidies. Many expect that employers could begin to freeze raises and cost of living increases to cover their costs for the new health insurance benefits that will be required.

The states apparently can base their decision on ten existing plans. “The choices include, for example, ‘the largest plan by enrollment in any of the three largest small group insurance products in the state’s small market group’.” I have no idea what that means but hopefully the 51 states have a better understanding of that and the other nine possibilities. The “good news” is that states that can’t figure out what to do can be granted waivers beginning in 2017, and perhaps that would be the best approach.

The best article I’ve read to try to understand this issue is titled “Dissecting the Health Care Case, Election-year debate makes this term a mirror of the New Deal era” by Mark Walsh. I suggest you clink on the link to this article and read the second page. My quick summary is that the Court might (or is likely to) rule that the current challenge is premature. “Under this view, the law’s individual mandate may not be challenged until individuals who refuse to buy health insurance have to pay a penalty.” One Court of Appeals threw out a challenge to the health care law on that basis. The Supreme Court did not take up that ruling, but “…it did accept the Obama administration’s suggestion to consider the Anti-Injunction Act issue.”  The issue will be argued for one hour on March 26.

There are strong opinions on both sides of the issues, and I believe the key is whether Congress can mandate that individuals must buy something. However, as the article describes, there are politics involved beyond what is constitutional. The Supreme Court ruled some of Franklin Delano Roosevelt’s New Deal laws unconstitutional. My personal favorite was a ruling in Schechter Poultry Corp v. United States in which the Court ruled that (simplistically) the poultry processor had not intentionally sold unhealthy chickens. However, the Court began to uphold his programs in 1937 to stave off FDR’s court packing plan to gain friendly rulings.

I believe the best thing government can do is to get out of the way, and laws that sound as if they are based on good intentions are generally destructive. Obamacare has already distracted the country from the most important issue, and that is how to create a better economy that will employ more people. I also believe the law has already been detrimental in discouraging entrepreneurs from having the courage to launch new businesses. I know I would question my sanity if I decided to begin a new business with the uncertainty of both Obamacare and Dodd-Frank standing ready to crush it with both costs and bureaucracy.

Back to the likely outcome of the Supreme Court and Obamacare, Professor Lucas A. Powe Jr., a Supreme Court historian, writes, “I cannot imagine that John Roberts intends to go down in history as the chief justice who struck down one of the most significant statues in American history.” My prediction is that the Supreme Court will avoid such a contentious ruling by accepting that the current challenges are premature. The Anti-Injunction Act requires that a challenge is not allowed until “…individuals who refuse to buy the health insurance have to pay a penalty.”

What does all of this mean? Elections matter and the American people elected a President and dominantly Liberal Congress based on anger and fear in 2008. Laws that were intended to “protect and serve” were passed and signed, and now we must deal with the consequences.