Health Care Archive
Suppose we say, as I would, that the income physicians earn after practice expenses, working full time caring for patients, should put them somewhere into the top fifth percentile of the nation's distribution of income (meaning 95 percent of families would have a lower annual income). What income level might we then be talking about?
It turns out that an annual income of $250,000 or so would comfortably meet the fifth percentile threshold. Many primary-care physicians -- especially pediatricians -- are considerably below that threshold. Physicians who derive a substantial part of their incomes from procedures -- such as tests or imaging -- are situated much above the threshold. They are comfortably in the top second percentile of the income distribution.
From the perspective of the "just price doctrine," of course, one can easily understand, that against the huge and relatively easily earned incomes of executives in banking and business, physicians feel vastly "undercompensated" -- just as Adam Smith predicted it.
President Obama talks about the importance of prevention in a way that suggests that when people have heart attacks it's their own fault. But my wife, a longtime vegetarian and marathon runner, had a freak heart attack at the age of 37.
It wasn't from too many Big Macs. After some rough patches, she's now doing well, thanks to an obscure and expensive anti-arrhythmic drug called Tikosyn, and an implantable cardioverter/defibrillator. Not too long ago, she'd have been largely bedridden. These medical innovations made the difference between the life of a near-invalid and a life that's close to normal.
My mother had a hip replacement. Her hip didn't break - she basically wore it out with exercise. When the pain got too bad, she got it replaced, and now she's moving around like before, only painlessly. Not too long ago, she would have been chairbound.
My father had prostate cancer; his doctor suggested waiting but on biopsy it turned out to be pretty aggressive. It was treated with radioactive "seed" implants. He's now been cancer-free for several years, without the side effects of earlier treatments -- or, worse, of cancer.
My daughter had endoscopic sinus surgery this spring. She had been sickly and listless, complaining of constant migraine headaches, missing a lot of school, and generally looking more like a zombie than a teenager. Several doctors dismissed her problems, or prescribed antibiotics that didn't help much, until we found one who took the extra step.
A head CT scan done on a fancy new in-office machine showed a nasty festering infection, the surgeon cleaned it out, and now she's like a normal kid again. Before laparoscopy, her condition
would probably have remained untreated, and she would have been another "sickly" kid. Better to be well.
The normal critique of socialized medicine is to point out that people have to wait a long time for these kinds of treatments in places like Britain. And that's certainly a valid critique. I'm sure my mom and daughter would still be waiting for their treatments, while my father and wife would probably be dead.
The key point, though, is that these treatments didn't just come out out of the blue. They were developed by drug companies and device makers who thought they had a good market for things that would make people feel better.
I have the sense that many defenders of an even-more-fully-government-run health care system have a hard time taking this question seriously. But they should. It's just a fact that much of the world's medical innovation comes from the U.S. This goes a good way toward explaining with why survival rates for many potentially mortal health problems are highest in the U.S., and also partly explains why U.S. costs are so high. Indeed, that a certain strata of Americans spend so much, often on stuff that makes no difference, also partly explains the high U.S. level of innovation.
A few weeks ago, Tom Laskawy took issue with my contention that we don't really know how to convince people to eat better. "Junk food--and that includes any processed food that crosses the line from nutritious to purely caloric--has to get more expensive," he wrote. "Period."
The theory behind this is simple, and, on an abstract level, unassailable. If calories cost more, people will consume fewer of them. If the government slaps a $10 tax on every bag of chips, Lays would probably go out of business. But that isn't likely to happen. The question, rather, is whether relatively modest taxes on calories are effective. Are people extremely price sensitive when it comes to food? Or not?
The evidence appears to point toward "not." A recent study conducted by researchers at the RAND Corp. used evidence from the Health and Retirement Study -- which is generally considered to provide very high-quality data -- to estimate the impact of a 10 percent reduction in the cost of all calories (they use a reduction because, well, food prices have been going down, so that's where we can find real-world data on how people respond to price changes in food). The data isn't very encouraging.
Cigs
...it has become lore among cancer researchers that some game-changing discoveries involved projects deemed too unlikely to succeed and were therefore denied federal grants, forcing researchers to struggle mightily to continue.Take one transformative drug, for breast cancer. It was based on a discovery by Dr. Dennis Slamon of the University of California, Los Angeles, that very aggressive breast cancers often have multiple copies of a particular protein, HER-2. That led to the development of herceptin, which blocks HER-2.
Now women with excess HER-2 proteins, who once had the worst breast cancer prognoses, have prognoses that are among the best. But when Dr. Slamon wanted to start this research, his grant was turned down. He succeeded only after the grateful wife of a patient helped him get money from Revlon, the cosmetics company.
Flickr user Andrew Mason
Bellvue Woman Sets AARP Magazine Straight
A local medical technologist recently spotted an error in AARP magazine, and decided to take it upon herself to fix it. She sent a letter to the publication, noting the mistake, and the magazine recently published it.
"They mixed up the good and bad cholesterol on one of their charts," said Mary Jo Bonifas, of Bellevue, Iowa.
Bonifas has been a medical technologist, certified by the American Society of Clinical Pathology, for more than 35 years.
She is currently the manager of Laboratory Services at United Clinical Labs in Dubuque and Dyersville.
The AARP chart incorrectly said low-density lipoprotein (LDL) is the "good" type of cholesterol, and high-density lipoprotein (HDL) is the "bad" type of cholesterol. It should be reversed.
"It helps to remember you want your HDL to be high, and your LDL to be low, like the first letter in each acronym," Bonifas said.
That's an elegant way to remember it. My high school health teacher told us to think of HDLs like rabbits and LDLs like turtles. Somehow it's always stuck with me. I have no idea what it means.
Flickr user Boliston
Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.How does the company translate these insights into cost savings?
Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above (tobacco usage, healthy weight, blood pressure and cholesterol levels) and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.
...we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.
I am hardly a health care wonk, but the argument sure seems compelling on first look. I'd be curious to see what Ezra Klein, one of the most knowledgeable and readable progressive bloggers on health care, would say about this. If seemingly fair risk pricing demonstrably brings down overall costs, isn't it preferable to a much more complicated and costly set of reforms?
Of course, one can see the downside to all this:
Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors.Smoking today. Alcohol, downhill skiing, and premarital sex tomorrow? Pricing unhealthy habits means testing for them in ways intrusive enough to reliably detect them. What are your vices? Do you want your employer or your government determining which vices cost you money?
