Latest Blog Posts & Articles

One of My Favorite Paragraphs from Being Mortal

Being Mortal Atul GawandeAtul Gawande has received appropriate praise for his new book. Read it if you haven’t. Meanwhile, here is one of my favorite paragraphs from the book, to whet your appetites:

Even as our bones and teeth soften, the rest of our body hardens. Blood vessels, joints, the muscle and valves of the heart, and even the lungs pick up substantial deposits of calcium and turn stiff. Under a microscope, the vessels and soft tissues display the same form of calcium that you find in bone. When you reach inside an elderly patient during surgery, the aorta and other major vessels can feel crunchy under your fingers. Research has found that loss of bone density may be an even better predictor of death from atherosclerotic disease than cholesterol levels. As we age, it’s as if the calcium seeps out of our skeletons and into our tissues.

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How Generously Does Your State Reimburse for Medicaid?

A while ago, I wrote a post on how hard it can be for Medicaid recipients to get medical appointments, because so many physicians limit the number of Medicaid patients they see. They limit the number because Medicaid reimbursement is often, well, crappy! Here is a picture from a recent NEJM piece showing just how crappy reimbursement is in different states:

Medicaid Reimbursement Tennessee
The outlier – Tennessee. Congrats to that state for paying doctors a fair fee for caring for these needy people.

Posted in Health Policy | Tagged , ,

Malpractice Reform Won’t Save Money

Ambulance Chasers II  2004  Linda Braucht (20th C. American) Computer graphicsTwo problems loom large over the American medical care system. First, we spend outrageous amounts of money on healthcare, with too many patients receiving too many services at too high a price. Second, our malpractice system is an international embarrassment, with too many healthcare providers sued by too many patients for too little reason.

Many experts have pointed out that these problems are two sides of the same coin. On the cost side: the high price of medical care makes doctors and hospitals into lucrative litigatory targets. On the malpractice side, litigation drives up healthcare costs by forcing physicians to charge higher fees so they can pay costly malpractice insurance, and by incentivizing these same physicians to order unnecessary tests and procedures to avoid getting sued by patients who expect such interventions. (To read the rest of this post and leave comments, please visit Forbes.)

Posted in Health Policy | Tagged ,

The Hepatitis C Epidemic in One Picture

Hepatitis C has been in the news lately, because of amazing (and amazingly expensive) new treatments that promise to cure their life-threatening illness. While we ought to debate the expense of these treatments, we should also remind ourselves of how much we’ve been spending caring for patients with advanced disease. Here’s a picture showing the rapid rise of hospitalization for Hepatitis C, relative to Hepatitis B and HIV:

Hepatitis C
The cost of such care? $3.5 billion!

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Great Writing through Analogy

Robert Ballard TitanicEvery once in a while on my blog, I like to highlight great writing. In part, I guess, because my own writing has yet to rise to such a level.

Anyways, here’s Robert Ballard in the Smithsonian trying to help readers understand why the topography of the ocean simply can’t be appreciated if you rely solely on satellite imagery:

Even these seemingly precise representations, often based on satellite estimates of ocean depths, are not all that revealing. They’re rather like throwing a wet blanket over a table set for a fancy dinner party. You might see the outlines of four candelabras surrounded by a dozen chairs, perhaps some drinking glasses if the blanket’s really wet. But that’s about it. You wouldn’t see the utensils and plates, let alone what’s for dinner.

That’s not only a brilliant analogy; it also makes me hungry!

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The Power of Free

The Atlantic recently reproduced a figure showing just how much people like things when they are free. Specifically, they looked at health interventions and show that people are more likely to take up these interventions, or products, when they don’t cost anything.

And certainly, free is better than expensive, but free is also a whole lot better than cheap. There is something special about going from any price to no price:

Power of Free

Posted in Behavioral Economics and Public Policy, Medical Decision Making | Tagged ,

Should North Carolina Expand Medicaid?

North-CarolinaMy home state of North Carolina is one of a number of states that refused to expand Medicaid, even though the Affordable Care Act stipulates that the federal government will cover the majority of expenses associated with such expansion. Here is an excellent story in the Fayetteville Observer laying out the issues:

Denise Johnson works six days a week in the laundry room of a hotel on U.S. 301. The 58-year-old Fayetteville resident doesn’t work enough hours to be considered full-time and doesn’t receive health benefits.

Johnson applied for Medicaid at the Department of Social Services, but she was ineligible because she made too much money. Then she tried signing up for subsidized health insurance coverage under Obamacare. Turns out she doesn’t make enough money to qualify for subsidies.

“I’m like, ‘What affordable care?’” she said, referring to the actual name of the health insurance program, the Affordable Care Act.

Johnson falls into a gap in the health insurance program created by the writers of the law, a Supreme Court decision and North Carolina’s Republican-controlled legislature.

When the Supreme Court ruled that Obamacare was constitutional, it also said that the federal government could not make it mandatory for states to accept one part of the law – an expansion of Medicaid benefits to people at 138 percent of the federal poverty level.

When North Carolina’s legislature rejected that expansion, approximately 500,000 state residents were stuck. They earn too much to qualify for Medicaid under the state’s eligibility guidelines. But under the law, they don’t make enough money to qualify for financial assistance to pay for private insurance.

That leaves Johnson, who has a liver disease and eye problems, unable to afford health care.

To read the rest of this story, please visit

Posted in Health Policy, Medical Decision Making | Tagged , ,

What Causes Couch Potatoes To Eat So Many Potato Chips?

Couch Potato
Do you eat when you’re bored? So do I. Then again, I eat when I’m not bored, too. So the real question is: do we all eat more when we’re bored than, say, when we’re highly entertained?

The answer, according to a clever study by Aner Tal and colleagues, is no. In fact, sometimes being energized by your environment may be the worst thing for your waistline.

In the study, Tal sat college students down in front of the TV with an array of tasty treats at their disposal – M&M’s, cookies, carrots and grapes. Tal then measured how many calories students consumed on average during 20 minutes of TV viewing where the students had no idea that their food consumption was being monitored.

When watching 20 minutes of the Charlie Rose Show, a PBS talk show (yawn!), students consumed a bit more than 100 calories of snacks, on average. But other students, picked at random to watch an excerpt from an action movie, The Island, ate twice that amount in the same period of time.

Double your fun and double your calories? (To read the rest of this post and leave comments, please visit Forbes.)

Posted in Behavioral Economics and Public Policy | Tagged ,

How Effective Are Mammograms?

Mammograms have long been touted as a life-saving preventive test. But recently, people have been re-examining the relative harms and benefits of mammography. This re-examination became quite earnest when the United States Preventive Services Task Force recommended against beginning routine mammography before age 50. Even at later ages, experts are beginning to more thoroughly recognize that the benefits of mammography compete against some very serious harms. Consider the following picture, produced by the website 538, summarizing how mammography influences women at various ages:

MammogramsIn short – not a whole lot of lives saved, but a lot of non-cancers cured, even more non-cancers biopsied, and a whole slew of anxiety-inducing false alarms.

Posted in Medical Decision Making | Tagged ,

The Era of Mega-Hospitals Has Arrived

The Affordable Care Act, a.k.a. Obamacare, encourages healthcare providers to join together in what are called Accountable Care Organizations. Prior to the passage of Obamacare, hospitals were already pursuing mergers, in an effort to gain market share and have better negotiating ability with insurance companies. That trend looks like it has accelerated since the passage of Obamacare:

Mega Hospitals MergersThanks to Dan Diamond (@ddiamond) for pointing this out on his twitter feed.

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