Latest Blog Posts & Articles


Christmas Shopping Tip — Your Brain Knows What You Like Better Than You Do

photocredit: Getty

A song comes through your earbuds: good rhythm, clever lyrics, pleasing melody. You know whether you like the song, right?

Maybe not. A series of studies using brain imaging raise the possibility that sometimes we think we like or dislike things, but our brains know better.

I will explain what I mean, by describing one of the studies. In it, teenagers listened to songs while researchers measured their brain activity using fMRI machines. Basically, an fMRI shows how much blood is flowing to various regions of the brain over time; when a pleasurable song pipes into kids’ ears, for example, the pleasure centers of their brains light up. After playing music and scanning people’s brains, the researchers and participants went their own separate ways. Two years later, the researchers looked at how the songs they played for the teenagers that day faired in the ensuing time. Surprisingly, the teenagers’ readings of the songs – of how much they liked or disliked – did not predict subsequent downloads their expressed opinions about the songs were like faulty political polls, failing to predict how they actually felt about the music.

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

Posted in Behavioral Economics and Public Policy

The Insurance Companies That Are Most Likely To Refuse To Pay Doctors

Grunge red denied wording round rubber seal stamp on white background photocredit: Getty

Healthcare reimbursement in the U.S. is frighteningly complex. We have federal payers, like Medicare; state/federal payers, like Medicaid; private, for-profit insurance companies, like Aetna; private, not for profit insurers, like many local Blue Cross Blue Shield networks. Oh yes, and we have private insurance companies managing reimbursement for many Medicare and Medicaid recipients.

This complexity comes with costs. Doctors and hospitals need to hire armies of people to process bills for all those different payers. By one estimate, in fact, physician offices spend 30 billion dollars a year on billing-related costs.

A recent study shows which payers are most likely to reject the bills submitted to them by physicians’ offices. The winner, in case you haven’t guessed it already, is Medicaid, regardless of whether the program is run by the government or private insurers.

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

Posted in Behavioral Economics and Public Policy, Health Policy

Why Telling Your Children They Are Smart Could Turn Them Into Cheaters

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I am not one of those parents who believes kids should win trophies just for showing up for their t-ball games. But I’m also not stingy in praising my children when they do well. When my kids got hundreds on their grade school spelling tests, I told them how proud I was of their accomplishment.

But could praise like this turn our children into cheaters?

I’m thinking specifically about praise for ability rather than for effort. When children do well and we tell them how smart they are, are we making them feel pressure to cut corners to hold on to their “smart” identity?

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

Posted in Behavioral Economics and Public Policy

What Socialized Medicine Would Mean for Your Health

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Americans are not fans of socialized medicine. Sure, some people want socialized healthcare payment, including many people who are fans of Medicare for All. But even most Bernie Sanders supporters probably aren’t in favor of socializing the entire U.S. healthcare system, thereby making hospitals and medical clinics into government property. Americans are proud of the high quality of care offered by non-government providers, from their local community hospitals to places like the Mayo Clinic. Many are afraid that if doctors and nurses become government employees, the quality of their care would erode.

But a recent study of patients with kidney failure highlights the possibility that, at least for some people, socialized medical care is higher quality than private care.

The study looked at military veterans whose kidneys were failing, so much so that they might soon need dialysis. The research team, out of Stanford University, looked at how these veterans fared based on whether they received care in the VA system or at private clinics and hospitals.

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

Posted in Behavioral Economics and Public Policy, Health Policy

Why You Might Get Kidney Cancer If You Move To Florida

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About one in fifty people reading this essay will be diagnosed with kidney cancer at some time in their life. In fact, one out of one people writing this essay has already been diagnosed with kidney cancer. (I had a small tumor removed from my left kidney not long after I turned 50.) But how many people diagnosed with kidney cancer have been overdiagnosed with the condition? And what does moving to Florida have to do with your chance of being diagnosed with kidney cancer?

Let’s start with some facts about kidney cancer. The number of people being diagnosed with kidney cancer is rising dramatically in the United States. Just between 2001 and 2010, the rate of such diagnoses grew almost 20%. Some of that increase is due to the aging of the American population, and some to the increased rate of obesity. But much of it results from the increasing number of people receiving CT scans in the United States, for one reason or another, with those scans revealing suspicious growth in their kidneys.

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

Posted in Critical Decisions, Health Policy, Uncategorized

Is Your Local Hospital About To Close? Here Is How Congress Can Help

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Rural hospitals have been closing at alarming rates, no longer able to bring in enough revenue to serve their communities. Fortunately, there is something both state and federal legislators can do to keep local hospitals open.

State governments: if you haven’t expanded Medicaid, do it now. Under the Affordable Care Act, most of the cost of that expansion will be borne by the federal government. If you don’t expand, then don’t be surprised if your constituents blame you when their local hospitals close. Without Medicaid to cover people’s expenses, hospitals lose money caring for uninsured patients who can’t pay their bills.

The federal government: Congress needs to provide financial help to hospitals that serve large uninsured populations. That’s not an unrealistic expectation. The federal government used to provide such assistance, called DSH (or “dish” payments), but those payments were phased out with the passage of the Affordable Care Act, under the (now false) assumption that every state would expand Medicaid and, thus, there wouldn’t be many uninsured patients.

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

Posted in Health Policy

How Suntanning Both Increases And Reduces Your Chance Of Dying From Melanoma — A Mystery Solved

Female Doctor Examining Pigmented Skin On Man’s Back With Dermatoscope photocredit: Getty

Quick quiz question: two people are diagnosed with melanoma – Sarah Sunburn, an adamant sun-worshipper, and Paula Pale-All-The-Time, a fanatical sun-avoider. Who is more likely to die of the disease?

The answer is pale-faced Paula. Surprised? Let me unpack this mystery and explain why sun exposure simultaneously kills people, while making the cancers they are diagnosed with appear to be less life-threatening.

I will start with what you probably know already. Melanoma is a potentially life-threatening skin cancer. It occurs usually as a result of genetic risk, including fair complexion and sun exposure. (I lost my beloved redheaded aunt to melanoma when she was tragically young.) All else equal, people who spend more time in the sun, or in tanning booths, are more likely to die of melanoma, with people of fair complexion especially at risk.

Now here is the part that you might find confusing: among people diagnosed with melanoma, those with a history of lots of sun exposure and fair complexion are less likely to dieThat’s right: sun exposure makes people both more and less likely to die of melanoma. How can that be?

It’s the difference between the rate of death from melanoma and the death rate of people diagnosed with melanoma.

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

Posted in Uncategorized

A Moderate Republican Plan To Fix American Healthcare: ‘Medicare For All’?

Attendees hold signs while waiting for a health care bill news conference to begin on Capitol Hill in Washington, D.C., U.S., on Wednesday, Sept. 13, 2017. Fifteen Senate Democrats are flirting with a single-payer health-care system that would expand Medicare coverage to all Americans, marking a shift within the party on what was once viewed as a politically treacherous issue that attracted little support from lawmakers. Photographer: Andrew Harrer/Bloomberg

Everyone thinks of “Medicare for All” as a liberal idea, an extremely liberal one embraced by the socialist wing of the Democratic Party. It’s an idea Democrats were hesitant to embrace in the Obama era, for being too far out of mainstream political thought. It was thought of as an idea that was too easy to demonize as socialism.

What everyone seems to be forgetting is that “Medicare for All” could end up being a politically moderate way to bring more market competition to the U.S. healthcare system. Think I’m kidding? Give me a chance to explain myself.

Deciding Whether Medicare is “Socialism”

When we call a healthcare system socialized, we need to clarify what part of the system we are talking about. For example, Canada has a socialized payment system, which they (unoriginally) call Medicare. But Canada doesn’t have a socialized provider system. Instead, Canadian hospitals and clinicians work in private enterprises, billing Medicare for their services.

By contrast, the United Kingdom has a fully socialized system, with payment coming from the government, providers working with government employees, and hospitals and clinics owned and operated by the government.

In keeping with this view of socialism, “Medicare for All” is not the same as a fully socialized healthcare system. Under Medicare, providers are still free to operate as private enterprises, and can decide whether to operate as nonprofit organizations – like the Mayo Clinic – or as for-profit ones – like the Hospital Corporation of America.

Even more important, we can’t even call “Medicare for All” a socialized payment system. I’ll explain more about that in a short while.

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

Posted in Behavioral Economics and Public Policy, Health Policy

Obamacare: Death By A Thousand Advertising Cuts

(HealthCare.gov via AP)

Obamacare is still the law of the land, but the Trump administration and Republicans in Congress are determined to undermine the law in the hope it will cease to function. One of the strategies is to cut advertising funding for ACA insurance plans. If a recent study is any indication, that strategy might work. One of the key components of Obamacare, you see, was creation of a marketplace where people could shop for (often subsidized) insurance plans. The success of this marketplace depends on bringing in enough customers, especially relatively healthy ones, to cover the cost of caring for people with expensive illnesses. Advertising is key in bringing customers to this marketplace. Under the Obama administration, this advertising budget exceeded $100 million a year. President Trump is cutting the budget 90%.

Will less advertising mean fewer customers?

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

Posted in Uncategorized

Measures of Physician Quality Don’t Measure Up

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Physician reimbursement increasingly depends upon measures of healthcare quality. Physicians who fall short on quality measures now face financial penalties. But it might be quality measures, themselves, that are falling short, according to a study conducted by the American College Physicians.

The study involved a panel of people with expertise in evidence-based medicine. Panelists were asked to evaluate the validity of quality measures being used by either Medicare, the National Committee for Quality Assurance, or the National Quality Forum. It is typically measures from these three groups that are used to determine physician quality report cards, and Medicare plans to use its measures to influence reimbursement for individual clinicians.

The panel evaluated the validity of these measures using a modified version of a RAND/UCLA method that has been widely accepted as the best way to assess the strength of evidence for healthcare interventions. That method, developed in the 1980s, combines literature review and synthesis, multiple rounds of expert panel ratings, and retrospective comparison of evidence with clinical records, when feasible. The method isn’t perfect. But its the best we’ve got by a long shot.

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

Posted in Health Policy