Why is Healthcare so Expensive? Blame the Lobbyists!

American healthcare is ridiculously expensive. I even wrote a book recently laying out a host of reasons for such high prices, such as the historical connection between insurance and hospitals, the lack of price transparency, and the belated involvement of our federal government in healthcare policies.

But mainly it comes down to the power of hospitals, physicians, and the rest of the healthcare industry to co-opt almost a fifth of our economy. Recent data on healthcare lobbying perfectly illustrates just how much power I’m talking about.

The data comes from an article in JAMA Internal Medicine written by Olivier Wouters, a London-based researcher who I have to imagine is bewildered by the insane cost of American medical care. Based on his article, 4 of the top 7 industry lobbyists in the United States come from healthcare.

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

Promoting Exercise through Gamification – Making Physical Activity More Fun?

I don’t know how many coaches told me “no pain, no gain.” I can tell you that as a child and young adult, it was never the pain part of exercise that encouraged me to be active. It was the fun— chasing down a deep ball to left field, juking the other team’s point guard with my (lame) crossover move.

So I was excited to see a JAMA article led by Mitesh Patel (a fantastic researcher and physician at the University of Pennsylvania) demonstrating that people exercise more when their experience is “gamified”.

I love the study. But the results are underwhelming, and I have a feeling I know why. Their idea of gamification was not as much fun as it ultimately needed to be.

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

How Hospital Stays Resemble Enhanced Interrogation

Ken Mishark is a hospitalist at the Mayo Clinic who formerly served as a physician in the military. Early in his career, he interviewed for a job in the CIA. That experience might explain why he paid attention when the CIA declassified a manual it had developed on how to conduct “enhanced interrogations”. As he perused the manual, he couldn’t shake the notion that the methods of enhanced interrogation create an experience for CIA prisoners that closely (and unintentionally) resembles that of many hospitalized patients. With Holly Geyer and myself, Mishark published an essay in the Annals of Internal Medicine exploring some of these parallels.

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

Employers Are Doing a Terrible Job of Covering the Cost of Pregnancy

If you get insurance through your employer, you don’t have to worry about whether insurance will cover maternity care. The company is required to do so by law.

But that doesn’t mean the insurer will be very generous. Because in the United States, having coverage doesn’t mean you’re well-covered. Employers are increasingly corralling their employees into high out-of-pocket insurance plans, with deductibles, copays, and co-insurance exposing them to crippling out-of-pocket expenses.

Consider an analysis publicized in Health Affairs exploring trends in out-of-pocket spending among pregnant women with employer-based health insurance.

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

American Physicians Lack Diversity— Here’s One Way to Change That

African Americans make up 13% of the country’s population, but only 4% of American physicians are black. This lack of racial diversity in the profession is tragic, denying this prestigious career to many worthy people and undermining the health of many African Americans, who are more likely to receive important medical services when they’re cared for by black physicians.

There is a slew of reasons for this dramatic underrepresentation of African Americans in the physician population. From preschool through college, Americans climb up a ladder whose rungs are constructed very differently for different people. Even medical school contributes to this problem, with the prohibitive cost of such an education discouraging many lower-income aspirants from pursuing a medical education. Medical schools have begun to address this last problem by offering need-based scholarships. But there is still another rung missing from this metaphorical ladder: it’s hard to receive medical school scholarships if you can’t afford to apply to medical school.

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

Pandemics and Overdoses: COVID-19 May Worsen Our Opioid Epidemic

The novel coronavirus has decimated our economy at the same time as it has directly threatened our health. As if that weren’t bad enough, the economic damage Covid-19 is causing could have an indirect impact on our health. Consider what we already know about economic downturns and opioid overdoses.

A research team led by Atheendar Venkataramani found a creative way to study this connection between employment and opiate use. They looked at communities in the U.S. with automotive assembly plants and explored what happened in places where the assembly plant was closed compared to those where it stayed open.

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

A Matter of Life-or-Death: The Type of Nurses Your Hospital Employs

Good medical outcomes often depends on good nursing care. When hospitals cut back on nursing care, patient mortality rates climb.

If you want a good hospital, pick one that doesn’t skimp on the nurse-to-patient ratio. You should also look at the education level of nurses a hospital employs. Because not all nurses are equally skilled.

A recent study explored the chance that a patient will survive after experiencing a cardiac arrest while in the hospital. The chance of survival was strongly associated with the percent of nurses in the hospital that held at least a Bachelor of Science degree. Some hospitals utilize many lesser-trained nurses, people with associate’s degrees, for example.

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

Income Inequality is Killing Us

It’s easy to think of good healthcare as being the key to a long, healthy life. But socioeconomic circumstances often play a far bigger role in life expectancy than access to high-quality healthcare. Consider the strong relationship between socioeconomic circumstances and life expectancy in Norway, a place where healthcare access is universal.

Let’s start with money. People who make less money live shorter lives, a relationship that is especially strong for men.

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

It is Possible to Shop for Healthcare Bargains if You Can Access Them

Are you one of the many Americans facing potentially high healthcare costs? If you have a high deductible health plan, or even a medium deductible one; if you are expected to fork over substantial copays for medical care—I’ve got good news for you. There are potentially a lot of healthcare bargains out there, if you’re willing to dig around for them.

Consider the state of Massachusetts, a relatively high cost place to get healthcare. A recent study in Health Affairs showed that there was substantial variation in healthcare prices across the state for privately insured patients.

To read the rest of this piece, please visit Forbes.

Oncologists Were Paid to Prescribe Generic Chemotherapy (Here’s Why It Didn’t Change a Thing)

Brand-name chemotherapy is often incredibly expensive, in excess of $100,000 per patient. Sometimes there are excellent generic alternatives, but many oncologists are hesitant to prescribe generics because such prescriptions cost them money. For many medicines, you see, oncologists receive a 6% markup, meaning when they infuse a patient with a $10,000 monthly course of chemotherapy, their practice yields an extra $600. By contrast, if the practice treated that patient with a generic chemotherapy, they’d be out most of that extra money.

A private insurer, UnitedHealthcare, tried to incentivize oncologists to prescribe generic chemotherapies by giving them financial bonuses for doing so. For example, a generic medication that would have previously been accompanied by a $12 markup now received a $500 one. That’s a lot of money; but, from the insurer’s perspective, it would have been more than made up by the savings accompanying the use of the generic drug. (In this case, the brand name drug costs $7,000 more than the generic equivalent.)

Fantastic idea, yes? Unfortunately, it didn’t increase generic prescribing one iota.

To read the rest of this piece, please visit Forbes.

PeterUbel