About MeI am a physician and behavioral scientist. My research and writing explore the quirks in human nature that influence our lives -- the mixture of rational and irrational forces that affect our health, our happiness, and the way our society functions. (more...)
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The Journal of the Association for Consumer Research (yes, there is such a thing!) had an outstanding issue dedicated to eating behavior recently. Here is a picture from that issue worth sharing:
Want to know why we continue to spend so much more on healthcare than other countries? We have a price problem, one that experts predict will play a huge role in future healthcare spending:
If we want to reign in healthcare spending, we must go after high prices. That means taking on physicians, hospitals, pharma companies, device manufacturers…Any politicians ready to do that?
Money can undermine our morals. If you don’t believe me, look what happened to a group of four-through-six-year-olds who were brought in for a simple experiment. Researchers asked them to sort objects from a box. Half sorted coins, and half sorted buttons. Then they were asked to do one more thing–try to find their way through a difficult maze with no pencil marks crossing lines. Here is the maze. See how easily you can make your way through it:
How do you think playing with money affected people’s persistence on this task?
(To read the rest of this article, please visit Forbes.)
Poverty wreaks havoc on children’s lives, stunting their intellectual development and harming their health. Children raised in poverty experience declines in growth and development, becoming susceptible to numerous otherwise preventable illnesses in the process. Tragically, almost 1 in 5 American children live in poverty:
Republicans and Democrats must agree on the importance of helping American children thrive. They need to focus on bipartisan efforts to address childhood poverty. And when poverty can’t be addressed, they need to find ways to make sure children coming from poor families have affordable access to necessary medical care.
The free market is supposed to be efficient. Yet employers are throwing away hundreds of millions of dollars, by not giving their employees intelligently designed healthcare benefits that encourage them to shop for affordable lab tests.
Right now, when your doctor orders a CBC (complete blood count) and a basic chemistry panel (checking your sodium, potassium and other fun chemicals), you probably walk down a hallway and get your blood drawn, or maybe you go to the nearest testing site. A pleasant nurse draws several vials of blood from your arm, and eventually you and your employer get a bill in the mail for the cost of your tests. You probably don’t shop around for prices. Yet those tests might cost $30 at one laboratory and more than $100 at another. Who pays that extra $70? A good chunk of that tab will be picked up by your employer, which ultimately makes it harder for your boss to give you a raise. And some of the cost might be on you, with a copay or a charge to your deductible.
There’s got to be a better way.
(To read the rest of this article, please visit Forbes.)
This picture shows changes in the cost of treating colon cancer, from 1993-2005. It shows unsustainable growth in these expenditures:
By unsustainable, however, I do not mean unjustifiable. Patients with colon cancer have much better prognoses in 2005 than 1993, in large part due to advances in chemotherapy. Instead what I mean by unsustainable is that the rate of growth in spending can’t continue.
If we continue to grow at this rate, we will overwhelm our ability to pay for such care, even if the care continues to improve. We must keep the unsustainability of the spending trend in mind when we set expectations of pharmaceutical executives – and what we look for in the growth of their annual earnings.
We should keep this unsustainability in mind, also, when remembering that healthcare spending threatens the financial stability of governments, corporations, and individual citizens. We should celebrate improvement in treatment for diseases like colon cancer. But we should remember that at some point in time, spending more on such patients, even if it improves their health, might be beyond our means.
Paul Ryan is “excited” that the American Health Care Act, as Republicans call their bill, will trim the federal budget by several hundred billion dollars over the next decade. The 24 million people who are expected to lose insurance under the AHCA aren’t excited about the bill, which will cut government spending at their expense, with potentially fatal consequences for those who go without timely medical care.
Debates over healthcare reform often ask us to pick our poison. We either save money or we save lives.
But these debates ignore an antidote to this poisonous choice. If we tackle high healthcare prices, we can insure Americans at the same time as we curb healthcare expenditures.
This antidote is not theoretical conjecture. In fact, most developed countries provide universal insurance to their residents while spending far less per capita than the U.S. This affordable coverage exists in countries where healthcare payment is socialized, like the UK and Canada, and where it is privatized, like Germany and Switzerland. That’s because all these healthcare systems work to rein in high healthcare prices. As a result, appendectomies cost half as much in Switzerland as in America; and knee replacements cost 30% less in the UK than in the U.S.
Unfortunately, prices have been largely absent from healthcare reform debates in the U.S., whether those reforms are crafted by Democrats or Republicans. It’s true that politicians from both sides of the aisle occasionally speak out about pharmaceutical prices. Both Donald Trump and Hillary Clinton criticized pharmaceutical CEOs, like smirking Martin Shkreli, who made the news after enacting outrageous price hikes. But after a public scolding or two, discussion of pharmaceutical pricing usually ends.
Meanwhile, politicians rarely debate the often high price of hospital and physician services in the U.S., which constitute a much larger proportion of healthcare spending than do pharmaceutical products. When is the last time you heard a prominent politician question the lofty incomes of cardiologists, orthopedic surgeons or hospital CEOs?
Perhaps Republicans are hesitant to address high healthcare prices, so as not to galvanize special interests against their current legislation. But the American Medical Association already opposes the Republican healthcare plan, citing the harm vulnerable patients will experience “because of the expected decline in health insurance coverage.” The American Hospital Association also criticized the proposal for not “ensuring that we provide healthcare coverage” to the people dependent on subsidies for their insurance.
(To read the rest of this post, please visit Forbes.)
Here is a news article from Canada, experiencing the kind of healthcare inflation that causes them to call experts in the U.S. for advice—people like me, but also some actual credible authorities!
Some see it as an eternal struggle: the goodhearted doctor championing the best treatments, no matter the cost, while doing battle against the tightfisted insurance company denying claims for expensive but life-saving medications.
But when you get down to it, their goals often dovetail: the best care for patients at affordable prices.
After all, even if a plan sponsor or insurer picks up part of the tab, the cost of pricey medications may convince them to increase their deductibles or copayments, which will have an impact on future patients.
But at a time of increased concern about the sustainability of benefit plans, what’s the role of the doctor in helping to contain drug costs?
“I do think that physicians have a duty not just to the patient in front of them but to society at large,” says Dr. Peter Ubel, a professor of business, public policy and medicine at Duke University in Durham,
N.C. Just as he uses the strongest antibiotics only for the worst bacterial infections in order to protect public health, he’ll save expensive tests and medicines for occasions when cheaper alternatives aren’t successful. “I go right to an MRI rather than an X-ray, I’m burning through societal resources and that causes harm,” he says of the drawbacks of not keeping costs in mind.
Doctors should also consider the cost of drugs because unaffordable prescriptions lead to greater rates of non-adherence and, therefore, worse health outcomes. A 2016 study from Statistics Canada found that western Canadians with cardiovascular-related conditions who spend at least five per cent of their household income on drugs were three times as likely not to get the necessary medication as those who spend less than that amount.
“If patients can’t afford the medications, they don’t take them and then they don’t benefit from them,” says Dr. Yousuf Zafar, an oncologist and an associate professor of medicine at Duke University.
And that means they’re more likely to call in sick or, if they do make it to the office, work less productively.
While doctors wouldn’t prescribe a drug without making sure the patient understands the possible physical side-effects, they often don’t discuss the financial impacts with them. “To know what the best pill is for somebody, you need to know what they care about,” says Ubel. “And if they care about their out-of-pocket expenses, that might change what you prescribe.” But few doctors know how much their prescriptions cost, he notes.
To read the rest of this article, please visit Benefits Canada.