Category Archives: Health Care

Spirit of the Law? Hospitals Don’t Give a Fu%$

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If you look under the “Categories” archive of this blog you’ll notice that over the years I’ve posted 52 times under “Health Care” and 71 times under “Healthcare.” Ignore the fact that I should have figured out a long time ago which one of those is correct; the point is that I care deeply about health care (healthcare?) and a primary reason for that is how much it has cost me and my family over the years.

I’ve spent my entire career working for very small companies or being self employed, and so I’ve never had access to what you’d call a “Cadillac” health insurance package. I’ve also been responsible for evaluating and choosing an insurance plan every year, whether for my own family when I was self-employed, or for my employer, for the last 25 years. To say that I’m sensitive to how much health care and health insurance cost would be the understatement of the century.

That’s why this story in the Wall Street Journal about hospitals using code to hide the pricing on their website. Here’s an excerpt:

Hospitals that have published their previously confidential prices to comply with a new federal rule have also blocked that information from web searches with special coding embedded on their websites, according to a Wall Street Journal examination.

The information must be disclosed under a federal rule aimed at making the $1 trillion sector more consumer friendly. But hundreds of hospitals embedded code in their websites that prevented Alphabet Inc.’s GOOG -1.24% Google and other search engines from displaying pages with the price lists, according to the Journal examination of more than 3,100 sites.

The code keeps pages from appearing in searches, such as those related to a hospital’s name and prices, computer-science experts said. The prices are often accessible other ways, such as through links that can require clicking through multiple layers of pages.

“It’s technically there, but good luck finding it,” said Chirag Shah, an associate professor at the University of Washington who studies human interactions with computers. “It’s one thing not to optimize your site for searchability, it’s another thing to tag it so it can’t be searched. It’s a clear indication of intentionality.”

Among websites where the Journal found the blocking code were those for some of the biggest U.S. healthcare systems and some of the largest hospitals in cities including New York and Philadelphia…Some regional systems also had such code on their websites, including Michigan’s Beaumont Health and Novant Health in Winston-Salem, N.C.

Lovely to see the system that has a hospital I can walk to, Novant, on the list.

Technically they’re complying with the rules, but in the same way that printing legal disclaimers in 2 point font would be. While that looks and smells bad, I think it would be a mistake to focus on the sliminess of this approach. In my mind it’s far more important to stay focused on how the continued efforts of the health care industrial complex to keep their pricing opaque, and their systems complex and antiquated, prevents any substantive system improvements from developing.

Years ago the insurance program we had was a Health Savings Account (HSA). The way it worked is that we set up an account kind of like an IRA with a bank. We contributed pre-tax dollars to it and it and then used those funds for any health care expenses. It was tied to a catastrophic insurance plan that featured a very high deductible and low premiums, so anything that wasn’t a major health event that would cost over $10,000 in a year we would pay out of pocket via the HSA. Sounds good in theory, but then you have to get an MRI and when you try to find out how much it will cost you find it next to impossible. As a result you pay $1,900 for a scan that took 30 minutes from parking the car to getting back in it, and find out later that you could have had the same procedure done a 10 minute drive away for much less.

That’s a true story, and in full transparency part of the problem was we were used to our old insurance system where we just went to wherever the doctor sent us without question because the insurance was gonna cover everything except our co-pay and deductible. It literally didn’t occur to us that we could ask, although we learned from this experience that we could.

I came away with a valuable insight after our year spent with the HSA and it was this: Our supposedly market-based health care system is lacking an important element – an informed and empowered consumer base. The complexity and opacity of our system virtually guarantees that it will be inefficient and provider-centric, which is great for the providers in the short term, but in the long term will make that bogeyman of “socialized medicine” look more and more appealing by comparison. If that happens they’ll have reaped what they sowed.

1NT: Flu Down

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One fairly predictable side effect of the COVID-19 pandemic: cases of the flu are down drastically this year. From the Wall Street Journal:

Clinical laboratories tested 22,474 patient samples, mostly nasal swabs, for influenza during the week ended Dec. 5, and only 40, or 0.2%, came back positive, according to data from the CDC. During the same period last year, more than 11% of over 41,000 samples were positive.

The number of positive flu samples at U.S. public health labs is also lower than in years past, according to the CDC data. These labs are currently processing more patient samples than in previous years because of the explosion of testing for Covid-19...

In the Southern Hemisphere, Covid-19 precautions practically wiped out the flu this year, offering hope for a lighter flu season in the U.S. and Europe. It wasn’t certain whether the season in the U.S. would follow suit, but influenza’s spread in the country appears to be following a similar pattern.

Obviously, it isn’t sustainable to shut down our public gathering places every flu season, but hopefully this is the evidence we need to change our adjust our behavior in public, especially during flu season. In other words, maybe wearing masks, diligently washing our hands, and coming up with ways to greet each other besides shaking hands should become our cultural norm.

1NT: Spit on COVID-19

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Don’t feel like having a big Q-tip shoved up your nose to be tested for COVID-19? Want to be tested from the comfort of your own home? Well, there is an at-home saliva test available from multiple sources, including Costco and Vault Health. The negative is that it will likely run you about $120 and it could take a few days to get results, but given the wait times for swab tests lately it might be worth considering.

How We Spend

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It’s tax filing time, which in our home means it’s time for the annual “How the hell did we spend so much on THAT?” ritual. Maybe that’s why I found this snapshot of how the average American household spends its money so interesting:

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Source: Digg.com

Apparently, the average household has 1.3 earners, 0.6 children and 0.4 seniors, which explains why there is Social Security included in income. What I found most surprising is the health insurance number at $3,414 per year. That works out to $285.50 per month which, quite frankly, I find almost unbelievable. Here’s why:

My wife and I have been married for 27 years and for almost all of those years we’ve both worked for small companies or been self-employed. As a result, we’ve not had access to large group health insurance or, better yet, the health insurance available to government employees. If I were to make a conservative estimate, without having the numbers in front of me, I’d say that we have averaged $8,400 per year ($700/month) in health care premiums alone. Throw in co-pays and deductibles and we were almost always in the $10,000/year range.

Now, we have three kids so that obviously put us beyond the average, but health insurance isn’t necessarily linear so you can’t draw a direct corollary between the number of kids (people) and premiums. If you’d asked me to guess what the average household spent before I’d seen this data I would have said something like $5,000-$6,000 a year. That just shows how my own experience has skewed my perception of what health insurance costs, and perhaps why I felt more strongly than many of my peers that the ACA (Obamacare), as imperfect as it was, was at least an effort towards reining in the exploding costs of health insurance and health care.

As for the other numbers? Well, let’s just say this time of year also features the annual “We eat out too much” ritual self-flagellation.

Is BMI Worse Than Worthless?

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The statistical gurus at FiveThirtyEight have looked at the ubiquitous body mass index (BMI) and come to a conclusion that many of us suspected: it stinks as a measure of health. In fact I’d argue that it might be worse than useless, in fact might even be harmful, because it misleads people into thinking they are not at risk of negative health effects because they have a BMI in the “normal” range.

Taken alone as an indicator of health, the BMI is misleading. A study by researchers at UCLA published this month in the International Journal of Obesity looked at 40,420 adults in the most recent U.S. National Health and Nutrition Examination Survey and assessed their health as measured by six accepted metrics, including blood pressure, cholesterol and C-reactive protein (a gauge of inflammation). It found that 47 percent of people classified as overweight by BMI and 29 percent of those who qualified as obese were healthy as measured by at least five of those other metrics. Meanwhile, 31 percent of normal-weight people were unhealthy by two or more of the same measures.2 Using BMI alone as a measure of health would misclassify almost 75 million adults in the U.S., the authors concluded…

The researchers analyzed the health data for 15,184 adults who were part of the National Health and Nutrition Examination Survey. Their results,published in the Annals of Internal Medicine, were pretty surprising: They showed that midsection obesity was a killer, even among people with normal BMIs. For example, a man with a BMI of 22 (putting him firmly in the normal range) but too much belly fat according to his waist-to-hip ratio had an 87 percent higher mortality risk than a guy with the same BMI and a healthy waist-to-hip ratio.

What’s more, a man with a normal BMI and disproportionately big belly had more than twice the mortality risk of a man who was overweight or obese by BMI but not by waistline. Among women, those who were normal weight by BMI but had a high waist-to-hip ratio had a 48 percent higher mortality risk than those with a similar BMI but a healthy waist-to-hip ratio, and a 32 percent higher risk compared with those who were obese according to BMI only.

This is the kind of thing that leads me to think BMI has more in common with phrenology than mainstream health care practices.

Long-term Recovery

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Friend Kim Williams has written an important opinion piece for the Winston-Salem Journal and I highly recommend you check it out. Here’s just a snippet:

Being an addict means so much that is negative in our lives. Lies, stealing, distrust – we wrap addicts in all of these things. However, I would like to believe that that is only part of the truth.

One of the major obstacles to recovery is public stigma. The stigma comes, in part, from the way we talk and think about recovery. Addict. Junkie. Druggie. These terms carry with them the Hollywood scenes and dramatic memories of the underbelly of alcoholism and addiction. These words cause us to ignore the people like myself who are living in recovery. These words and prejudices cause us to objectify the addict and the alcoholic. We can then easily place them in the box with the “town drunk” as too often incurable. As a result, when I sought help, the help that was available to me existed only in church basements, amid bad coffee, smoke-veiled doorways and broken stories of destruction and carnage…

According to the 2012 National Survey on Drug Use and Health, 23.1 million people ages 12 and older needed treatment for an illicit drug or alcohol use problem last year, but only 2.5 million received treatment at a specialty facility. About one-quarter of those who need treatment but do not receive it lacked insurance, according to the article…

There are an estimated 23 million people in the United States who are living in long-term recovery. I am an addict, but I’d prefer to say something different. I am a person in long-term recovery. What that means to me is that I haven’t had alcohol or other drugs since July 10, 1999. This has allowed me to become a better person, a loving father, grandfather and husband. I have established myself as a productive member of my community and a successful business leader.

Kim’s focus here is on the price that individuals pay for their addiction and the lack of resources many of them find when they look for help, but we should also keep in mind the impact that the lack of resources have on the rest of us. Our prisons are full of people put there for drug crimes, we have foster homes filled with children who are a product of homes broken by addiction and we have friends and families who suffer the agony of watching their loved ones kill themselves slowly and abuse those around them in the process. In one way or another addiction takes a tremendous toll on everyone, not just the addicted, and we long ago passed the point where we need to change how we address the issue.

You should also check out Kim’s blog and his ebook Wishful Preaching.

A Tale of Two Forsyth Counties

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If you set up a Google news alert with the keywords “forsyth county” you’ll get a lot of news about two different places – Forsyth County, NC (where I live) and Forsyth County, GA. Today I saw a story about each from their local news outlets with the following headlines:

  1. Forsyth County Remains Healthiest in Georgia (GA)
  2. Forsyth County Slips Again in Health Rankings (NC)

If you read the articles you’ll see that Forsyth County, GA ranks first in its state and Forsyth County, NC ranks 29th in its state. So is my home county significantly less healthy than its counterpart in Georgia? If you look at a comparison of the two (see table below) using data from the countyhealthrankings.org you can see that Georgia has better numbers in many categories, but they really aren’t that far apart when you take into account the population size of each county. According to the US Census North Carolina’s Forsyth had 360,221 in 2013 and Georgia’s had 195,405 so even if you looked at some raw numbers that look pretty bad for NC, the population difference changes things. For instance:

Premature Deaths: NC 7,218 vs GA 4,234 but if you adjust for population size you see that NC’s is 2% of its population and GA’s is 2.16%. Still a decent difference but not as stark.

Then there’s this number:
Sexually Transmitted Infections: NC 755 vs GA 91

No amount of adjusting for population makes that better for NC (and gross!), and as you can see we in Forsyth of NC fare worse than GA based on our behaviors in general. Luckily we’ve got an awesome doctor/resident ratio to help deal with the consequences of our sins:

Ratio of primary care physicians to population: NC 945:1 vs GA 2,506:1
Ratio of dentists to population: NC 1,657:1 vs GA 2,677:1
Ration of mental health providers to population: NC 406:1 vs GA 2,246:1

Probably the biggest difference between the two counties, and a huge contributor to the health differences, is that Forsyth, GA appears to be far more affluent than Forsyth, NC.  In addition to the numbers in the chart below (NC’s child poverty rate 3x greater, single parent homes 2.5x greater violent crime 2x greater per capita) you have this data from the US Census: median household income (2009-13) in Forsyth, GA is $86,569 and in NC it’s $45,274.

Money may not buy love, but it sure does help on the health front.

Fighting Anecdotal Fire With Anecdotal Fire

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This article in Slate, written by a woman whose mother did not have her vaccinated and thus suffered through mumps, measles, rubella, etc., is an excellent piece of thinking about the current hubbub related to vaccinations. I like this part in particular:

I find myself wondering about the claim that complications from childhood illnesses are extremely rare but that “vaccine injuries” are rampant. If this is the case, I struggle to understand why I know far more people who have experienced complications from preventable childhood illnesses than I have ever met with complications from vaccines. I have friends who became deaf from measles. I have a partially sighted friend who contracted rubella in the womb. My ex got pneumonia from chickenpox. A friend’s brother died from meningitis. 

Anecdotal evidence is nothing to base decisions on. But when facts and evidence-based science aren’t good enough to sway someone’s opinion about vaccinations, then this is where I come from. After all, anecdotes are the anti-vaccine supporters’ way: “This is my personal experience.” Well, my personal experience prompts me to vaccinate my children and myself. I got the flu vaccine recently, and I got the whooping cough booster to protect my son in the womb. My natural immunity—from having whooping cough at age 5—would not have protected him once he was born.

(Bold emphasis mine)

There are a lot of things that frustrate me about the vaccination debate, not the least of which is that someone else’s decision to ignore science and logic might adversely affect other peoples’ health, but what really gets my goat is the trend the author points out of people refuting evidence with anecdote.

Recently I saw a post on Facebook in which someone shared an information piece of dubious origin that said something like: “Number of deaths from measles last year: 0. Number of deaths from measles vaccines: 106” There are so many things wrong with this, but here are the most obvious:

  • First of all, if you’re going to share this kind of data then please share the source so it can be verified as legitimate.
  • Second, if it is legitimate then please share whether or not that’s in the US or the world. Why? Because if it’s the world then I can flat out tell you it’s BS. From the World Health Org.:
    WHO warned today that progress towards the elimination of measles has stalled. The number of deaths from measles increased from an estimated 122 000 in 2012 to 145 700 in 2013, according to new data published in the WHO Weekly Epidemiological Report and the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. The estimated number of measles deaths in 2013 represents a 75% decline in mortality since 2000, significantly below the target of a 95% reduction in deaths between 2000 and 2015.
  • Third, if it IS true and it is just the US then use percentages rather than raw numbers. One reason so few people would have died from measles is because so many people were vaccinated! What percentage of people who got the vaccine died? Vanishingly small. And while the percentage of people who die after contracting measles would also be vanishingly small, that doesn’t mean the disease doesn’t wreak havoc by making people very sick.

So here’s the point, and I’m going to type it really slowly so the anti-vaxxers can keep up: You are entitled to your opinion. You are also entitled to ignore science and generally do stupid things. Your entitlement ends where others’ well being begins, thus if you decide to not vaccinate your children then your family should NOT be allowed to partake in any public activities or enjoy any other societal benefits that would put you in direct contact with the vaccinated population. No schools, no restaurants, no stores, no swimming pools, no movie theaters, no malls, no amusement parks, no public parks and no places of business (okay, maybe Walmart). Nada. Nothing. Don’t want to participate in 21st century public health programs? Fine, then don’t participate in 21st century public gatherings.

Some Things Shouldn’t Be Left to the Market

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North Carolina’s freshman senator, Sen. Thom Tillis, is getting some pretty bad press today for saying that he has no problem with restaurants not being required to make their employees wash their hands after using the bathroom. Of course that’s the headline version that’s grabbing everyone’s attention, but when you see it in context it’s not quite that bad. Here’s what he said:

Tillis said his interlocutor was in disbelief, and asked whether he thought businesses should be allowed to “opt out” of requiring employees to wash their hands after using the restroom.

The senator said he’d be fine with it, so long as businesses made this clear in “advertising” and “employment literature.”

“I said: ‘I don’t have any problem with Starbucks if they choose to opt out of this policy as long as they post a sign that says “We don’t require our employees to wash their hands after leaving the restroom,” Tillis said.

“The market will take care of that,” he added, to laughter from the audience.

In that context the quote’s not nearly as bad as the headlines and social media posts would lead you to believe, but even so his stance is terrible public policy. First of all, just because you require a sign doesn’t mean it’s going to be seen. More importantly, how do you propose to deal with all the people who get sick or die before the word gets out that a restaurant is toxic?

I’m all for letting the market decide in many areas of our lives, but public health ain’t one of them.

Wake Forest Lab Developing Frankenweenies

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Not sure how this escaped the local press, or if it didn’t escape the local press how I missed it when they covered it, but it seems that Wake Forest’s Institute for Regenerative Medicine has graduated from creating lab-grown bladders to lab-grown penises:

Penises grown in laboratories could soon be tested on men by scientists developing technology to help people with congenital abnormalities, or who have undergone surgery for aggressive cancer or suffered traumatic injury.

Researchers at the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina, are assessing engineered penises for safety, function and durability. They hope to receive approval from the US Food and Drug Administration and to move to human testing within five years.

While it is fun, in a very immature way, to play word games with this story it really is serious science that will mean a lot to the men it helps. It’s also quite cool that it’s happening here in Winston-Salem.

FYI, they’re working on a LOT more than bladders and penises:

Atala’s team are working on 30 different types of tissues and organs, including the kidney and heart. They bioengineered and transplanted the first human bladder in 1999, the first urethra in 2004 and the first vagina in 2005.

Finally, a random fact for you: the plural of penis can be either penises or penes. Who knew?