Doctors Address the “800 lb Gorilla” In Health Care Reform

There is no doubt that doctors are among those most affected by health care reform in the United States. The proposed changes to the infrastructure of the medical system and health insurance affect not only their businesses and salaries, but the way that they can prescribe, diagnose and treat their patients. In the March 2011 edition of The American Journal of Medicine are four published articles written by doctors who voice their concerns about the current state of health care and the proposed and implemented changes to the system.

“The 800-Pound Gorilla in the Healthcare Living Room”
This editorial article was written by the journal’s Editor-in-Chief Dr. Joseph Alpert. He argues that the new health care reform did nothing to address tort reform, which he refers to as the “800-pound gorilla.” Tort reform is the proposed change in the legal system which could potentially limit the amount of frivolous and expensive lawsuits brought against the health care community. Some argue that the constant pressure of potential lawsuits is what drives many providers to order unnecessary testing and procedure. This excessive use of diagnostics are expensive and contribute to the rising cost of health care. According to Dr. Alpert, doctors are taught to be conservative in their diagnostics and treatment practices. However, because of this pressure doctors “Order a huge array of test, including radiographic imaging, to rule out every conceivable clinical condition including very unlikely diagnostic entities.” He expresses his concern that this was not addressed in the health care reform and that if it remains ignored the entire health care system will eventually fail.

“On the Critial List: The US Institution of Medicine”
Written by Dr. Salinder Supri and Karen Malone, MA this article addressed the current state of the US health care system. They argue that the system, which was once the best in the world, has become “fragmented, haphazard and broken” as a result of the lack of cohesiveness. Rather than the health care system being run as one unit, there are competing bodies within the system such as health insurance companies, Health Maintenance Organizations, corporate hospital chains and pharmaceutical companies who only look out for their own best interests. Each of these large institutions have set their own “rules of the game” which include restricting coverage, overcharging insurance companies, limiting patient choices, and excessive expenditure on testing and procedures. The authors say that the only way to end this exploitation of the system is to identify who is making the rules and correct them through targeted health care reform.

“The Affordable Care Act: Facing Up to the Power of the Pen and the Purse”
In his article, Dr. Eli Y. Adashi reviews the political and financial challenges facing the Affordable Care Act (ACA). As of now, repeal measures have been taken against the ACA in 40 states. However, Adashi says that they will likely fail due to the Supremacy Clause of the US Constitution which places federal authority above all other laws. He also notes the likelihood that Obama will use his presidential veto against any action by Congress against ACA. In other words, not much can be done to stop the current health care reform from going forward. However, Adashi also predicts that the widespread opposition in addition to efforts to block funding will likely result in the inability of the government to enforce the ACA.

“Medical Bankruptcy in Massachusetts: Has Health Reform Made a Difference?”
Massachusetts was the first state to enact universal medical insurance, a program which is almost identical to the new national health care reform. It was expected that the new universal coverage would reduce the amount of people filing for bankruptcy due to medical expenses, since more people would be covered by health insurance. However, the results of the study showed that the increased coverage had no effect on decreasing bankruptcies. The articles authors, Dr. Davd U. Himmelstein and Dr. Steffi Woolhandler said that “Reform expanded the number of people with health insurance but did little to upgrade existing coverage or reduce costs, leaving many of the insured with inadequate financial protection”. The outcome of this study, they argue, is evidence to the fact that it is not just expanded coverage that the US needs but improved insurance to provide income support for families and caregivers.

2011
04/18
CATEGORY
Affordable Health Insurance
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US Inmates Suffer From Poor Access To Health Care

The nation’s inmate population struggles with high rates of serious illness and poor access to care, according to the first nationwide study of inmate health and health care.

The research, conducted by physicians from Cambridge Health Alliance and Harvard Medical School and published today by the American Journal of Public Health, analyzed data collected from U.S. inmates in the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities.

Nationally, over 800,000 inmates – 40% of the total prison and jail population – reported a chronic medical condition, an illness rate far higher than other Americans of similar age. Over 20% of these sick inmates in state prisons, 68.4% of jail inmates, and 13.9% in federal prisons had not seen a doctor or nurse since incarceration.

The authors also analyzed mental illness care among inmates, both before and during incarceration. While about a quarter of inmates had a history of chronic mental illnesses such as schizophrenia, bipolar disorder, depression, or anxiety, two-thirds of them were off treatment at the time of their arrest. Only after incarceration did most of these people receive treatment.

Other key findings include:

– Compared to other Americans of the same age, the 1.2 million state prison inmates are 31% more likely to have asthma, 55% more likely to have diabetes, and 90% more likely to have suffered a heart attack.

– Access to care was worst in local jails and best in federal prisons; one quarter of jail inmates who suffered severe injuries received no medical attention, vs. 12% in state prisons and 8% at federal prisons.

– Inmates with medical problems like diabetes that require drug treatment often had vital medications stopped after their incarceration, including one quarter of chronically ill state prisoners and 36.5% of ill local jail inmates.

Study co-author Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and a primary care physician at Cambridge Health Alliance, stated, “The U.S. incarcerates more people per capita than any other nation. For many of them, treatment of their mental illness before their arrest might have prevented criminality and the staggering human and financial costs of incarceration.”

“A substantial percentage of inmates have serious medical needs yet many of them don’t get even minimal care,” said lead author Dr. Andrew Wilper, who currently teaches at the University of Washington School of Medicine. “These prisoners are denied their constitutionally guaranteed right to care.”

Improved management of chronic conditions in prisons and jails may have important implications for community health and the reduction of health care disparities, explained Dr. Wilper. “Twelve million Americans are released from incarceration each year. These individuals and the communities to which they return suffer as many carry with them the costs of untreated illness and preventable disability. Inmates are over-paying their debt to society when they are denied access to health care.”

2011
04/05
CATEGORY
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Health Insurance Reform to Help 30 Million Women

The Commonwealth Fund has issued a report in which it claims that over the next 10 years, 30 million women in the United States will benefit from the changes in health insurance laws, making insurance more affordable. Health reform reportedly will both stabilize and reverse the disadvantages regarding health insurance that women have faced over the decades.

Women have health care needs that often leave them more susceptible to high medical costs related to a lack of health insurance. This includes the fact that women of reproductive age are considered a higher risk than men of a comparable age because of pregnancy and related health issues. Thus women not only have had more difficulty getting individual health insurance and are charged higher premiums if they do get coverage, but most individual policies do not even cover pregnancy.

Karen Davis, president of The Commonwealth Fund, noted that historically, women have also had much difficulty covering their medical bills because of lower incomes. The new study believes millions of women will now benefit because health reform will subsidize health insurance for up to 15 million women who are now uninsured and boost existing coverage for 14.5 million who now have inadequate insurance.

“This report provides good news to all women, who will be more likely to get the care they need, with reduced risk of incurring the unaffordable medical bills that have affected so many Americans,” said Davis. The report, entitled “Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010,” is just one of a series of reports planned by The Commonwealth Fund that will provide information on how health reform is expected to affect different populations.

Under the new law, women who live in states that have higher than average uninsured rates will benefit the most. These include Texas and New Mexico (29% uninsured in 2008), Florida and Louisiana (24%), and Alaska, Arizona, Arkansas, California, Georgia, Idaho, Kentucky, Mississippi, Nevada, Oklahoma, and West Virginia (at least 20%).

The bad news? Women will have to wait until 2014 before they can appreciate most of the benefits from the health reform package. Only a few items begin in 2010, such as bans on rescissions of insurance policies, bans on lifetime limits on benefits, and being eligible for a new health insurance plan if you have a pre-existing condition.

Beginning in 2014, uninsured women who earn too much to qualify for Medicaid will be able to buy an insurance policy through a state-run exchange. Women who earn less than 400 percent of poverty, or $88,000 for a family of four, will be eligible for government subsidies to help offset their premiums and out-of-pocket expenses. An estimated 7 million uninsured women may be eligible for subsidized coverage through insurance exchanges.

Also beginning in 2014, health insurers must accept everyone who applies for insurance, and they cannot charge higher premiums based on a person’s health status or gender. All health plans sold through the new state insurance exchanges in both individual and small group markets will be required to cover maternity and newborn care as well.

The Commonwealth Fund report assures millions of women that better days are coming: that their health insurance options will not only be more plentiful, but that they will also provide a wider range of health care. The fruits of this promise of benefitsare still four years away, and for many women, that’s four years too long.

2011
02/09
CATEGORY
Health Insurance
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Age When Marijuana Used Affects Bone Health

Researchers at the University of Edinburgh have found that the effects of cannabis on bone health may vary greatly depending on the age of the Marijuana user. It seems that young users may lose bone strength, while older user may gain protection against osteoporosis.

The researchers noted that a molecule found naturally in the body, the type 1 cannabinoid receptor (CB1), can be activated by cannabis and is key to the development of osteoporosis. It was known that when CB1 comes into contact with cannabis it had an impact on bone regeneration, but this study published in the Cell Metabolism looked at whether the drug has a positive or negative effect.

The study used mice that lacked the CB1 receptor. Using compounds similar to those in cannabis which activated the CB1 receptor, they found that compounds increased the rate at which bone tissue was destroyed in the young.

However, the same compounds decreased bone loss in older mice and prevented the accumulation of fat in the bones, which is known to occur in humans with osteoporosis.

Stuart Ralston, Professor of Rheumatology at the University of Edinburgh, said: “This is an exciting step forward, but we must recognize that these are early results and more tests are needed on the effects of cannabis in humans to determine how the effects differ with age in people”

Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.

Osteoporosis is estimated to affect 44 million Americans, or 55 percent of the people 50 years of age and older. Osteoporosis affects up to 30 per cent of women and 12 per cent of men at some point in life.

Prevention of osteoporosis begins in childhood. About 85-90% of adult bone mass is acquired by age 18 in girls and 20 in boys. It is important for children, teens, and adults to get the recommended amounts of calcium and vitamin D. Weight-bearing and muscle –strengthening exercises are important.

2011
01/19
CATEGORY
Health
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Recessions may be good for your health

The recession itself may be difficult on us psychologically but a study suggesting the current recession may improve health.

Unemployment, home foreclosures, bankruptcy, and constant worry apparently never killed anyone. That is what the study at the University of Michigan discovered. The U.S. life expectancy increased by 6 years between 1929 and 1932, from 57 to 63 with the increase occurring for both men and women. They also discovered that the death toll from disease, accidents and infant mortality during the Great Depression also fell. Does this mean the recession is good for your health?

“The finding is strong and counter-intuitive,” said researcher Jose Tapia Granados from the university’s Institute for Social Research. “Most people assume that periods of high unemployment are harmful to health.”

In one groundbreaking study in 2000 on the impact of joblessness, for example, Christopher Ruhm, an economist at the University of North Carolina at Greensboro, examined statewide mortality fluctuations in the U.S. between 1972 and 1991 and found that a 1% rise in a state’s unemployment rate led to a 0.6% decrease in total mortality.

Stephen Bezruchka of The University of Washington School of Public Health suggests the results could be explained by the fact that people cannot afford to smoke or do excessive alcohol consumption or overeat as a way to save money. People also tend to spend more time with family and friends and sleep, which can all be good for your health.

“The idea that hard work never killed anyone is one of those maxims that turns out not to be true,” Bezruchka tells TIME. “One of the characteristics of a rapidly expanding economy is that people try to garner as much income as they can, working long hours and even multiple jobs. Spending time with friends and family is good for your health.”

Adam Coutts of Oxford University, one of the authors of the Lancet study, believes that recessions have other harmful social effects not directly related to health and that measuring an economic downturn’s overall health impact is a problematic undertaking. “It is true, for instance, that mortality rates reduced significantly during the Great Depression, but that era also saw the rise of fascism, followed by a world war,” he says. “So there’s no simple way to measure the impact of recessions on a population’s welfare.”

More studies will have to be concluded as far as recessions may be good for your health. What we do know is the death toll seems to be less effected by rescission.

Materials from the USA Today and Time are used in this report.

2011
01/14
CATEGORY
To your Health
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2011
01/14
CATEGORY
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