Latest Blog Posts & Articles

Coolest Nudge Ever!

I love behavioral science. I love public policy. And I am obsessed with music. So you can see why I think the nudge pictured below may be the coolest thing on the planet! It encourages drivers to drive at an appropriate speed, so they can hear music created by their passage over the road:

Coolest Nudge Ever Musical Road Japan

I have no idea if this works. And of course I’m not sure I’d hear the road over the typical blare of my stereo when I drive. But who cares? This is absolutely brilliant.

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Is This the PR Campaign Vaccines Need?

Here is a public service advertisement, promoting vaccines. (Thanks to Michelle Meyer for making me aware of it.) It harkens back to a day when vaccines weren’t yet available for diseases like polio:

PR Campaign Vaccines NeedDo you think it will work?

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Health Insurance Trends in One Picture

Here is data from the CDC, on the percent of Americans without health insurance. It shows that Obamacare, for all its strengths and weaknesses, is definitely addressing one major problem in the US:

Health Insurance Trends in One Picture

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A Self Control App?

The MacOS has a new self control app called, straightforwardly, SelfControl. The app has an ominous icon, which looks like a cross between a poker game gone wrong and the warning symbol on a bottle of poisonous chemicals:

Self Control App

The app gives users the ability to temporarily block websites, which they know they are wasting too much time on. If you decide, for example, that you keep checking out your Facebook feed rather than finish that important project, you can tell the app to deny you access to the Facebook website for the next, say, four hours.

All of us have limited willpower. And even the act of avoiding Facebook can be exhausting for those people who are addicted to it. This kind of app takes over willpower responsibilities for us, allowing us to use our energy for better purposes.

I’m in favor of the idea, as long as people aren’t spending too much of their time blocking!


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My New JAMA Article, On Value Promotion in Healthcare

Here is the opening of an article I recently published in JAMA, available now online, in which I raise concerns about misguided congressional efforts to promote the use of high-value healthcare services, without doing anything to reduce the use of low value ones.

Health care systems around the world are under pressure to restrain health care expenditures. In response, many health care leaders have embraced the idea of promoting health care value, with value defined “as the healthcare outcomes achieved per dollar spent.”1 For instance, some experts have urged third-party payers to adopt value-based insurance designs, whereby the amount patients pay out-of-pocket for health care services varies not as a function of the cost of those services but, instead, as a function of their value.2

The US Congress also has expressed support for value promotion, with both the House and the Senate passing legislation requiring the Centers for Medicare & Medicaid Services to pilot test value-based insurance designs in Medicare Advantage plans (the private insurance plans that contract with Medicare to provide enrollees with health care benefits).

Although advocates of value-driven health care may embrace the idea of value-based insurance designs, the proposed Medicare Advantage pilot is likely too asymmetrical to create many savings. The bills promote the use of high-value health care services without creating strategies to reduce the use of low-value ones. Unless value-based insurance programs in particular, and value promotion more generally, are balanced, they are unlikely to restrain health care expenditures.

To understand the hazards of this asymmetry, it helps to clarify how value-based insurance programs differ from the design of some traditional insurance benefits.

To read the rest of the article, please visit JAMA.

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Finally: Something Republicans and Democrats Can Agree On

The United States Medicare program is forbidden, by law, from negotiating with pharmaceutical companies. This was part of a negotiation that was reached at the time that the government, under the leadership of George W. Bush, created Medicare Part D, to cover prescription benefits for Medicare recipients. The pharmaceutical industry was quite worried that government involvement in prescription coverage would lead to price-fixing. So they lobbied for language that would forbid such actions, and that would even limit the government from negotiating prices with Pharma companies.

The US public doesn’t support that policy. According to a Kaiser Family Foundation poll, the vast majority of people – Democrats, independents and Republicans – want to see such negotiations:

Finally Something Reps and Dems Can Agree On

Now we will see who our elected representatives actually represent!


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Republicans Hate Obamacare so Much, They Refuse to Benefit from It?

Here is a chart from the Washington Post, showing the percent of people lacking health insurance over the last few years. For a long time now, a higher proportion of Democrats have been uninsured than Republicans, with low income and minority communities experiencing a disproportionately high uninsurance rate. But since Obamacare has come into effect, a lot of Democrats have signed up for health insurance who never had it before. But Republicans have lagged behind, and now it looks like they might be experiencing higher uninsurance rates than Democrats:

Republicans Hate  Obamacare So Much

To their credit, at least Republicans aren’t being hypocritical!



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Obamacare Going into a Death Spiral?

Obamacare Going in a Death SpiralFolks around the country are signing up for health insurance right now on the Obamacare exchanges, and some are seeing a very confusing set of options, with price hikes, or maybe not price hikes, and with subsidies, or maybe not such generous subsidies. Here is a great take on what’s happening in NC:

Obamacare Customers Look for Better Deals as Prices Rise

Cathy Allen pays less than $5 a month for health insurance through Obamacare’s Health Insurance Marketplace. But to keep her plan next year, her costs would have skyrocketed to $150, said her husband, Richard Allen.

Then the Allens got a call from Cumberland HealthNET, a local health care nonprofit, as the staff checked back with people they initially had helped enroll.

“I was glad they did,” Allen said. “She called me and told me to come in and they would try to help us find a better plan.”

After sitting down with a marketplace navigator, the Allens were able to find a plan that would meet her needs for about a dollar more each month.

This is a common scenario for people who already are enrolled in Obamacare plans, say local application counselors and health insurance navigators.

The prices for some Obamacare plans have gone up by double digits, in large part because not enough healthy people have enrolled to help offset the costs of older, sicker enrollees. Some experts see that as a challenge to the long-term viability of the controversial health insurance program.

Most marketplace customers will automatically be re-enrolled in coverage if they don’t actively update their application or change plans by Tuesday. Those who let that date slip by without double-checking their plans may be paying a higher premium come Jan. 1.

“Many people think they are stuck with it,” said Diasmil Pena, a navigator at Cumberland HealthNET. “They don’t know their options.”

In some instances, said Megan Epert, another navigator there, such customers will cancel their plans altogether because they don’t believe they can afford it. Others, she said, get the renewal letter from their health insurance company but assume it will automatically renew at the same rate.

“We’re advising consumers to come on in, check that out, go on the marketplace, to ensure that they’re getting the insurance they want for the premium they want,” said Francine Chavis, a navigator with Legal Aid in Robeson County. Often, there are comparable plans for a lower price, she said.

Janel Lewis, a certified application counselor with Stedman-Wade Health Services, said she’s had success helping existing customers avoid large premium increases.

“We’re seeing that with everyone who brings a notice to us, we’re able to input their information and end up walking out paying less,” she said.

Last year, she said, many customers favored the flexibility afforded by PPO plans offered by Blue Cross and Blue Shield of North Carolina, the only provider to offer plans in every county during the first year of enrollment.

“That made the difference for some people,” she said.

But this year, she said, Cumberland County residents are flocking to United Healthcare.

“You don’t really have as much to choose from,” she said.

Many consumers really like their insurance company, Pena said, “but it’s just unaffordable for them, so they had to end up switching plans.”

For Cathy Allen, an affordable plan meant sticking with United Healthcare. She’ll now have co-payments for doctor appointments, but “it’s better than not having health care at all,” Richard Allen said.

At 57, Cathy Allen has cirrhosis of the liver and other chronic health problems, and before the Affordable Care Act, she had been uninsured, he said.

“If it weren’t for the Affordable Care Act, she’d probably be dead by now,” her husband said.

“Now she’s got it under control.”

Market ‘in flux’

Marketplace consumers are not alone in the seemingly constant change they experience.

“This is a market in tremendous flux,” said Peter Ubel, a Duke University professor specializing in health policy and economics.

“It’s a market that ultimately depends on everybody being in it.”

But many healthy people have been staying away from Obamacare.

“That leaves insurance companies with very expensive enrollees,” he said.

“And so they raise their premiums, and more people wonder if they should buy insurance.”

Blue Cross and Blue Shield of North Carolina, the largest insurer in the state, requested marketplace rate increases averaging nearly 35 percent.

To read the rest of the article, please visit The Fayetteville Observer.

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Are Device Manufacturers Playing Bait-And-Switch with the FDA?

Are Device Manufacturers Playing Bait and Switch with the FDA Charlie Brown

The problem with the FDA is that if often requires so much proof of safety and effectiveness that the time it takes to bring a new product to market can grow by 3, 4, or even more years. FDA delays into the time that companies have to exclusively produce and sell their products.

In recognition of this problem, the FDA sometimes grants marketing approval to innovative new devices through a Pre-Market Approval Pathway, or PMA. Under this pathway, companies are allowed to bring their products to market more quickly – with less than optimal evidence on safety and effectiveness – as long as they promise to continue collecting such data through post-market surveillance.

According to a study in JAMA, device manufacturers often fail to keep up their side of this bargain.

In the study, Vinay Rathi and colleagues looked at all 28 new high risk devices receiving PMA approval in 2010 and 2011. They found that FDA approval was often based on scant data – studies of less than 300 patients with no blinding and limited follow-up. (With blinding, clinicians measuring patient outcomes do so unaware of which patients have received which interventions. Without blinding, such outcome measures can be biased by clinicians’ expectations.)

Given the small number of patients studied prior to market approval, it is that much more important that manufacturers continue to collect data once their products come to market. Unfortunately, most devices are not well studied once on the market. According to authors of the JAMA study: “Most devices have been or will be evaluated through only a few studies, which often focus on surrogate markers of disease in small numbers of patients followed up over short periods of time.” In fact, almost half of post-market studies are funded without support from the manufacturer.

Why are manufacturers being so lax in conducting post-market research?

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

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Graphs Made Easy, by Monty Python

I recently blogged about a study showing that the same information, when presented in a graph, is more credible to people. One of my friends pointed out that Monty Python figured this out a few decades ago.

“In this graph, this column represents 23% of the population. This column represents 28% of the population, and this column represents 43% of the population. Telling figures indeed.”

Photo Credit:

Photo Credit:

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