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Emergency Room Prices: They Are Outrageous, But I Am Not Blaming ER Clinicians

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Recently I posted a piece, describing research out of Johns Hopkins, showing that when patients come to ERs – either with no insurance or insurance that is out-of-network – they often face charges that are four, six, or even ten-fold greater than what Medicare would pay for the same services.

After the post, I was inundated with angry tweets and emails, mainly from emergency medicine physicians outraged that I would blame them for these prices.

Below, I lay out some of these criticisms. I don’t expect I’ll satisfy all my critics, but I certainly want them to know that I’ve heard them, and that much of their concerns were ones I already shared.

Blaming Doctors:

Physicians told me that I was blaming them for high ER fees. I even received an irate email from an emergency medicine physician working in Europe, saying I had offended her, a strange response given that I was writing about the United States. But I think I know why she was upset. I presented data on physician fees. But when health policy wonks, like me, talk about “physician fees,” we aren’t referring just to what doctors charge for their services. Instead, we are talking about all healthcare charges that aren’t part of a hospital bill. Terrible terminology, I know. But it goes back a long ways, to the separate evolution of Blue Cross insurance plans (set up by hospitals to cover their fees) and Blue Shield plans (set up by doctors to cover other medical bills—hence “physician fees”). This terminology even got carried forward into Medicare when it was formed, with Part A paying hospital bills and Part B paying physician services—including things like outpatient xrays, lab tests, EKGs, and the like.

Here’s the misunderstanding: To Medicare, ER bills are considered physician services, not hospital bills. So when I rightly criticized the high cost of ER care, it sounded like I was blaming physicians.

(To read the rest of this article, please visit Forbes.)

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More Young People Die in America than in Other Rich Countries (Two Pictures Explain Why)

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The average life expectancy of American men is almost four years less than men in Switzerland. In fact, among 17 high income countries, U.S. men ranked 17th in life expectancy. American women die young, too, with a life expectancy five years less than the average Japanese woman. Why is American life expectancy so poor?

In part, it is because too many Americans die at very young ages—30, 40, or 50 years old—compared to peers in other wealthy countries.

Sometimes healthcare pundits point to dismal American life expectancy to criticize the quality of care in the U.S. healthcare system. But it is not healthcare that explains much of the high mortality of young Americans. Consider American men. The number one reason they die at younger ages than men in other rich countries is homicide. The next two most important contributors are injuries, from either transportation (like car accidents) or non-transportation causes (falling off ladders and the like).

To read the rest of this article, please visit Forbes.)

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Think Fast and You’ll Lose Money Quickly (A Behavioral Economics Explanation of Irrational Gambling)

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I have just given you $78. (I’m a generous guy.) Now I’m giving you a choice: you can enter a lottery where you have a 75% chance of losing that $78 and a 25% of keeping it, or you can hold on to $20 and avoid the lottery all together. Quick—tell me what you would choose!

Faced with such a gamble, there’s no right or wrong choice. If you want a sure $20, you’ll avoid the gamble. But if you want a shot at going home with $78, you’ll take the risk. Neither of these choices, on their own, is irrational.

But behavioral economists have identified a strange type of irrationality that influences people’s reactions to these kinds of gambles, and a recent study shows that the faster people think, the more susceptible they are to that irrationality.

I’m referring to the irrational way that people’s decisions are influenced by whether their choices are framed as losses or gains.

(To read the rest of this article, please visit Forbes.)

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The Most Potent Prescription Ever: Take Time for Yourself, As Directed by Your Doctor

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Dr. Norah Neylon was caring for a 50-year-old woman who was overwhelmed with care-giving responsibilities of her own. The woman’s mother was experiencing early signs of dementia. Five of her relatives had died in the past three years. She frequently had to fly back and forth from California to the Caribbean to take care of members of her extended family. Oh yes—and her blood pressure was dangerously elevated at 210/115.

So Neylon gave her a prescription. I’m not referring to the blood pressure pills she prescribed. Instead, I’m referring to another script, which read:

“Permission to put your needs first. Use at least once a day for thirty minutes, do not exceed the stated dose, this is potent medicine.”

Neylon’s patient laughed when she saw the script, and then began to cry. She hadn’t been putting herself first, and her health was suffering as a result.

Neylon relayed this story in a recent JAMA article “The Prescriptions I Write.” It’s a beautiful essay.

Many health problems are self-inflicted: Some of us bring illness upon ourselves by smoking or drinking too much, or sleeping and exercising too little. Other people become sick because they don’t take time to care for themselves.

(To read the rest of this article, please visit Forbes.)

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Obamacare Is Experimenting on Us (Does That Make Us Frankenstein or Fusilli?)

(Photo by Joe Raedle/Getty Images)

Obamacare is a large, unwieldy law. Despite its complexity, most people are familiar with its most important elements. They know it created a marketplace where people can shop for healthcare insurance; many are even aware that the cost of that insurance is subsidized for people with lower incomes. Others realize that Obamacare encouraged states to expand Medicaid. And of course, almost everyone has heard of the now defunct individual mandate which required people to purchase insurance or face a tax penalty.

But most Americans probably aren’t aware of what, in the long run, could turn out to be the most impactful part of the Affordable Care Act. The crafters of the ACA recognized that the science of healthcare delivery hadn’t advanced far enough to identify the best ways to improve healthcare quality while lowering healthcare costs. So, lawmakers set a slew of experiments in motion, designed to test ways of accomplishing these goals.

Results of those experiments have been coming out of the lab lately, raising the question of what kind of creatures Obamacare has been creating—are they like Frankenstein’s monster, terrifying but misunderstood? Are they like Edward Scissorhands, loved by suburban moms until they realize how dangerous he is? Or are they like a less renowned creature—Fusilli Jerry, the pasta stick figure that Kramer made for Jerry Seinfeld on that eponymous 1990s sitcom?

I side with the latter, because I view the Obamacare experiments as a type of pasta-flinging exercise. People at CMMI, the federal agency in charge of running these experiments, have been cooking up a bunch of ideas, throwing them into a pot, pulling them out one at a time, and then flinging them against a metaphorical wall to see which ones stick—which ones are ready for public consumption. Some relatively recent studies serve as a good introduction to what Obamacare has been cooking up for the American healthcare system.

(To read the rest of this article, please visit Forbes.)

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Frank Thomas – Baseball’s ‘Big Hurt’ – Hurts People by Promoting Harmful Supplements

(AP Photo/Kathy Willens)

Frank Thomas is a 6 foot 5 inch hulk of a man, the 7th player in MLB history to retire with a batting average greater than .300 and more than 500 home runs. He was also thought of as a clean player, despite playing in the steroid era, and even advocated for drug testing when the rest of the league was purposely, and lucratively, looking the other way.

So why is he now hawking testosterone supplements?

Frank Thomas, appearing in ads with fans praising him for looking fit enough to still be playing, credits testosterone supplement NUGENIX® (“GNC’s® #1 selling male vitality product”) for his current level of fitness.

(To read the rest of this article, please visit Forbes.)

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Mass Shootings: Tragic for Victims, Great for Gun Manufacturers

In the aftermath of the Parkland High School shooting, we are having lots of debates about the role of the NRA in shaping gun legislation. Politicians who take money from the NRA are said to be in the organization’s pockets. But don’t forget where the NRA gets its money: gun manufacturers. And while no manufacturer celebrates gun violence, the facts are clear: mass shootings are good for their business.

More than 32,000 Americans die each year from gunshot wounds. Few of these people are criminals shot by innocent victims defending themselves or their loved ones. Some gun-related deaths result from criminal violence. A tragic number result from accidents. And a tiny number, less than 1%, result from mass shootings.

Yet it is these mass shootings that dominate the news, and that drive gun sales. The publicity surrounding such shootings scares many people into purchasing guns, in hopes that having a gun on hand will help them stop a shooter before he can do more damage. Mass shootings also lead people to purchase guns because, in the aftermath, some politicians call for gun control efforts, which cause people to purchase guns before they are banned.

(To read the rest of this article, please visit Forbes.)

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The U.S. Healthcare System Is Back to Its High-Spending Ways

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For a few years, U.S. healthcare spending seemed to be under control, rising no faster than the economy as a whole. The proportion of our GDP spent on healthcare was flatter than a Nebraska cornfield in November. Here’s how much we spent on healthcare, relative to the economy as a whole, between 2009 and 2013:

  • 2009: 17.3% of GDP
  • 2011: 17.3% of GDP
  • 2013: 17.2% of GDP

That’s a historically low rate of healthcare inflation. But much of that flattening resulted from the great recession that started in 2008. And now, it looks like healthcare spending is once again on the rise, already equaling 17.8% of GDP.

(To read the rest of this article, please visit Forbes.)

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A Drug to Treat Cancer and Heart Disease (Miracle Cure or Media Hype?)

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In a recent New York Times article, physician-author Siddhartha Mukherjee wrote about a clinical trial that he characterized as “beautiful,” for potentially illuminating a surprising connection between heart disease and cancer. Mukherjee is a justifiably acclaimed writer, who publishes regularly in The New Yorkerand The New York Times, and who won a Pulitzer for his bestselling book The Emperor of All Maladies. But I wonder whether the demands of popular writing have caused him to hype a treatment that, while promising, is far from proven.

The treatment targets inflammation by inhibiting an interleukin molecule. Researchers conducted a huge clinical trial to see whether the treatment would reduce the kind of inflammation that damages arteries. But Mukherjee didn’t write about the drug because of its ability to prevent heart attacks or strokes. Instead, he was excited about the trial because a secondary analysis of the data showed a “drop in all cancer mortality” and a “stark decrease” in deaths from lung cancer.

Mukherjee knows that secondary analyses like this need to be viewed with caution. Measure enough outcomes in a clinical trial, and the statistics of chance predict that the intervention will falsely appear to reduce some kind of medical problem or other. He even acknowledges that this cancer finding needs to be replicated. However, he isn’t content to urge readers to remain in a state of scientific caution, proclaiming that “if the benefit holds up in future trials, interleukin-1-beta inhibition could eventually rank among the most effective prevention strategies in the recent history of cancer.”

Holy moly, that’s a misleading sentence!

(To read the rest of this article, please visit Forbes.)

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Want to Avoid Unnecessary Antibiotics? Be Careful What Time of Day You See Your Doctor

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Too often, people with viral illness leave the doctor’s office with prescriptions for antibiotics. That’s a real problem. Antibiotics don’t treat viruses, often cause side effects, and when taken too often, lead to drug resistance.

So when you have a bad cough and go to the doctor, you should hope to see someone who is careful not to prescribe unnecessary antibiotics. Oh yes, and you should see that doctor early in the morning, or first thing in the afternoon, or you risk the chance that fatigue will cause your physician to prescribe an antibiotic you don’t need to take.

That’s the conclusion drawn by Jeffery Linder and colleagues, after they analyzed data from 23 primary care clinics in the Boston area. Disturbingly, Linder and colleagues found that doctors prescribe unnecessary antibiotics with frightening frequency, almost regardless of the time of day.

(To read the rest of this article, please visit Forbes.)

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