Latest Blog Posts & Articles
I want to share a wonderful blog post with you, written by one of “my” students, Laura Mortimer – a student in the Masters in Public Policy program at the Sanford School at Duke, who also happens to be a talented writer. In linking to her post, and then calling her my student, I of course am trying to grab credit for her accomplishments. What kind of mentor would I be if I didn’t try to do that? Here is her piece:
My right knee started bothering me on a long run a month ago. After weeks of pain, fruitless physical therapy, and no clear diagnosis, I had an MRI scan of my knee. Thankfully, nothing major showed up – just a persistent case of tendonitis. As a competitive runner hoping to compete in the Olympic Trials, I asked my doctor several questions: When will I be able to run again? What kind of cross-training should I do in the meantime? How many times a day should I ice? What can I do to keep this tendonitis from recurring? Should I hold off on buying plane tickets to that big race in December?
I failed to ask one important question, though: How much money will I have to pay for treatment? This failure is especially frustrating and surprising since my year-long Master’s Project focuses on clinical conversations about healthcare costs. I spend hours each week reading, writing, thinking, and talking about how doctors and patients can more effectively discuss out-of-pocket costs. If anybody should have the knowledge and resources to discuss medical costs, I should… (Read more at Sanford Journal of Public Policy)
“Advertising is legalized lying.” – H.G. Wells
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According to the American Action Forum, 43 million American workers will lose access to employer-based health insurance coverage because of Obamacare. Critics of the Affordable Care Act (ACA) have warned that the creation of health insurance exchanges, and federal subsidies for people earning less than 400% of the federal poverty limit, practically invites employers to stop offering coverage to their employees, so the federal government picks up the tab. Some supporters of the ACA even celebrate this possible exodus from the employer-based insurance market, figuring it is prelude to a government takeover of the healthcare industry.
What is missing amidst all these claims and controversies is good old-fashioned data. Fortunately, recent research published in the journal Health Affairs provides some levelheaded evidence about what has been happening to employer-based insurance over the past decade, and what we can expect to happen in the future.
The first article was written by Thomas Buchmueller and colleagues, from the University of Michigan. The Michigan team began by analyzing trends in employer-based health insurance coverage in the United States from 2000 to 2011. Trend number one, illustrated in the picture below, serves to remind us that big companies – with 100 or more employees – have consistently offered health insurance to their employees over this period of time, while insurance coverage has been much more hit or miss for smaller firms… (Read more and view comments at Forbes)
In response to the New England Journal article I published with Yousuf Zafar and Amy Abernethy, Newsweek chimed in this week with a report on the topic, including some thoughtful commentary from other medical experts. I thought it was worth pointing you towards this article, in part to remind you that Newsweek still exists, and also because it is a very nicely written article:
How much bad news is your doctor obliged to give you?
Consider this very depressing scenario: You’ve got colon cancer. Your doctor might tell you there’s some good news, that there’s a powerful and effective drug called Avastin, but warn you about its potentially harmful side effects – it can mess up your heart. But should your doctor also mention another devastating side-effect – that an Avastin regimen could cost more than $50,000, and that a patient who has Medicare but no supplemental insurance might have to pony up $9,000 for this treatment?
We like to pretend doctors are purists who only focus on our physical and mental well-being, but isn’t the health of your wallet also important?
In light of the current, charged debate about unsustainable health-care costs and the Affordable Care Act, Peter Ubel, Duke University professor of medicine, feels it’s time for a cultural shift among doctors. In a New England Journal of Medicine article he wrote with colleagues, Ubel argues that physicians needed to start incorporating the cost of care into their diagnoses. Continue reading here.
Widower Woodrow Wilson fell in love with Edith Galt in 1915. The President’s doorkeeper summarized the situation tersely:
“She’s a looker; he’s a goner.”
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I recently posted a blog showing what television channels are most commonly used to advertise junk food to kids. Here’s a couple other pictures illustrating some fascinating facts about such advertising.
First, the advertisements don’t seem to place as much emphasis on food as they do for adult advertisements:
And why is that? Because they emphasize toys!:
It’s time that we ban toys in happy meals and the use of cartoon characters and toys to advertise junk food to children.
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NPR recently covered my research with David Comerford on effort aversion. Our research gives some insight into how people wind up in boring jobs. You can listen to the NPR Morning Edition segment here.
In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.
Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% of what Medicare pays, nationally, for outpatient physician services. The payment rate varies from state to state, of course. But if 61% is average, you can imagine how terrible the situation is in some locations. Physicians interviewed in the study explained that they felt it was their duty to see some amount of Medicaid patients in their practice. They recognized the moral need to provide care for this population. But they did not want to commit career suicide – they did not want good deeds to bankrupt their clinical practices.
But reimbursement rates were not the only story. Many physicians talk about unacceptable waiting times to receive reimbursement from their state Medicaid programs. To make matters worse… (Read more and view comments at Forbes)