For someone with a PhD in economics, you would think that Goodman realizes that the emergency department is the most expensive way to access health care in this country. Moreover, treatment for a disease is almost always more expensive at later stages, and is definitely more expensive than preventing the disease in the first place. I can’t imagine telling diabetics to just sit tight and come to the ER when they have a crisis — that’s taking a problem that can be managed with relatively little expense if managed regularly and turning into a single episode of care that could cost tens of thousands of dollars.

Here’s exactly what was said:

“So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American — even illegal aliens — as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

“So, there you have it. Voila! Problem solved.”

Yeah, problem solved, all right.  Thanks for making the world’s least efficient, most inequitable health care system even more expensive and dysfunctional. Or, as Steve Benen of CBS news puts it:

“In other words, the man responsible for crafting McCain’s healthcare policy effectively described the most inefficient system of socialized medicine ever devised.”

Post from: EveryJoe

The “ER” Health Plan?

But new data suggests that the flu shot doesn’t actually reduce deaths among the elderly. This contradicts a study published in 2007 that suggested that influenza immunization can actually reduce deaths in community dwelling elders. If the flu shot doesn’t save lives, is it still “worth it” to spend on promotion and delivery of the flu vaccine to the elderly, and for Medicare to pay for that vaccine? I admit, not covering flu vaccine would be a bit radical, and it might save the cost of an associated hospitalization and illness, but should we be actively trying to get every American over 65 to get a flu shot every year?

If flu shots are neither cost effective nor life-saving, is there a good argument for why we should recommend flu shots for everyone 65 and older? After all, other vaccines, such as the HPV vaccine that can protect against the virus that causes cervical cancer are coming under fire for their huge price tags and questionable ability to reduce death.

By the way - here’s an interesting read on why flu shots are not cost-effective in working adults.

Post from: EveryJoe

Flu shots for the elderly – are they worth it?

As an expert in cancer care and how that care is delivered to patients, I can categorically say that access to an emergency room is not the same as “access to health care.” If you’re a cancer patient, what you need is access to expensive pharmaceuticals, experienced physicians, and expert oncology nurses who will actually hook up your chemotherapy IV and treat you for the disease. I’ve never seen someone get their cycle of AC+T chemotherapy at the emergency room (which isn’t to say it’s never happened, but I’m having trouble thinking it might).

An emergency department can’t turn you away if you’re in need of “immediate” care, but what if you’re just fatigued and feeling bad, or experiencing fevers that come and go… these are symptoms of cancer, but I think you’d have trouble getting care from the emergency room unless something else went terribly wrong to send you there in the first place. And if you have to have a mastectomy for breast cancer, is the emergency room going to help you get reconstructive surgery afterwards? I doubt it.

The problem of the uninsured is real, and it’s not going away. Instead of ignoring the problem, we need to find ways to tackle it in this country.

(and if you’re interested in reading about the economics of health savings accounts, which I’ll post about another day, try this first — one of the best articles I’ve ever read on health or medical savings accounts and how they work.)

Post from: EveryJoe

In the “You Can’t Be Serious” category… Does McCain’s Health Care Advisor “not believe in the uninsured?”

She mentioned health care 7 times in her speech at the Democratic National Convention — the same number of times she mentioned Iraq and one of the most frequent themes running throughout her appearance.

Do you think Hillary as a health care reform leader would be able to surmount the shadow hanging over the “Hillarycare” of the past, or would she be able to reinvent herself as a health care reformer for the 21st century?

Post from: EveryJoe

Would Obama make Hillary a Health Care Czar?

Are you struggling with debt or dealing with a pile up of bills because you are uninsured? Or, are you insured, but for some reason have found that your insurance doesn’t cover your medical expenses

I wonder what people who are struggling with medical bill debt think about reforming the U.S. health care system.  Do they support universal health care, or are they more in favor of a private health insurance system.  Perhaps the growing number of people in medical debt (and the growing medical debt issue overall) is yet another symptom of how private health insurance might be a failing proposition for many American families.

Post from: EveryJoe

Nearly Half of Working Americans in Medical Debt

Both 23andMe and Navigenics made news on Wednesday when a California court judged that they may continue to offer their services in that state. Prior to the ruling, the California Department of Public Health had issued “cease and desist” letters to thirteen companies offering similar services, but none as prominent as 23andMe or Navigenics, which have benefited from buzz and PR in recent months both within and outside of the health care industry and health care information worlds. The letters asserted that the companies were not authorized to operate as laboratories and that genetic testing required a physician’s order. However, both companies have now satisfied California’s requirements — for example, a physician at Navigenics routinely reviews customer orders, and the companies send samples out to laboratories that are licensed for the actual testing. The companies act as coordinators for the service and ensure customer privacy, among other things.

So, how much does it cost to get the complete picture of your genome? 23andMe will send you a kit for $999 — you send it back after taking a saliva swab.

Post from: EveryJoe

Want to map your DNA? You can, for a price.

The article states that:

 Growing numbers of women are opting for double mastectomies, even when they have cancer only in one — even when they lack the risk factors of women like Applegate. Among women with cancer in one breast, the risk of developing a tumor in the other breast is less than 1% a year, says Isabelle Bedrosian of Houston’s M.D. Anderson Cancer Center.

If you were in the same situation, what would be the reasons for or against having a double mastectomy? What about women who have not yet developed breast cancer but are at high risk due to genetic or other risk factors? Considering that for many patients, survival rates are the same whether the patient has a lumpectomy or a mastectomy, are physicians doing a disservice to patients who opt for the more drastic procedure?

Post from: EveryJoe

Would you choose a double mastectomy?

The exercise classes are supported by many leading cancer centers in their localities, such as Memorial Sloan-Kettering in New York and Fox Chase Cancer Center in Philadelphia. For example, in Philadelphia, Fox Chase is working with the gym Curves to see if breast cancer patients can stick to an exercise routine during treatment.

While people undergoing treatment for cancer often have to be careful about exercising too vigorously or jumping into a routine especially if they have not been active for a while, the programs are not only a means of exercise, but could be a valuable source of social support from people who may not want to participate in a support group. Of course, anyone undergoing treatment or with a chronic condition should speak to their doctor before starting an exercise program. But with millions of cancer survivors in the United States, gyms are smart to try to capture this growing and unique audience.

Post from: EveryJoe

Gyms tailor offerings to cancer patients

These results aren’t that surprising, but what concerns me the most is the cost-saving potential of getting the correct test ordered, completed, and reported to both physician and patient in a short period of time. We waste a huge amount of money in our health system because test results are often not available or are vague (for example, the physician sends the patient a note with the words “positive” or “negative,” or otherwise lacking clarity, such as “within normal limits.”) If that patient must go to another provider or if the patient lands in the emergency department, that facility must redo the test, even if the patient can say “hey, they told me that my count for [insert test here] was a little bit high.”

Part of this problem is the lack of electronic medical record (EMR) implementation across the board.  If the only copy of your lab results is sitting in a manilla folder at your primary care physician’s office, the ER doctor will never know that your cholesterol is dangerously high. Part of the problem is also patients. The idea of a Personal Health Record, or PHR, that would contain this information is still a bit pie-in-the-sky… although companies such as Microsoft, with HealthVault, and Google Health are promising an EMR/PHR revolution through their products.

Regardless of the technology barriers, the physician ordering a test should have the responsibility for getting the result back and contacting the patient as soon as possible, whether by telephone or mail (or another secure avenue). Not only is it poor customer service to leave patients hanging (or to not ever tell them their results, letting many assume they are fine when there might be a problem), it’s poor business practice, and it can lead to overspending and overtesting.

Post from: EveryJoe

Family Physicians — Testing Positive for Lab Result Errors

While the NAIC should be commended for recognizing that lack of insurance contributes to people skipping doctor’s visits or not filling prescriptions to save money, more research needs to be done to quantify how many Americans with insurance are cutting back on health care service consumption as well. Even the insured may be subject to large deductibles, co-payments, or co-insurance amounts on top of premiums that fewer employers are sharing. Also, many of the insured are now discovering they are “underinsured” for conditions that are serious and expensive, such as cancer. Many policies have instituted lifetime maximums or maximums for particularly expensive diseases, and while a $1 million maximum may seem high, it can be reached in a short amount of time when multiple treatments costing more than $100,000 per year are involved.

Do you know anyone who is reducing their use of health services to save money? Apart from skipping having a prescription filled, is there any other method you have used to save health care money, such as getting a prescription filled at a cheaper pharmacy or switching to generics? What about changing your doctor to one who is in-network or even changing to a cheaper insurance policy?

Post from: EveryJoe

Americans reduce use of health services to save money