Category Archives: Healthcare

How We Spend

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?

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.

Caveat Lector

The next time you read, see or hear a news story related to dietary or health study claims you might want to keep remember story titled “I Fooled Millions Into Thinking Chocolate Helps Weight Loss. Here’s How” 

“Slim by Chocolate!” the headlines blared. A team of German researchers had found that people on a low-carb diet lost weight 10 percent faster if they ate a chocolate bar every day. It made the front page of Bild, Europe’s largest daily newspaper, just beneath their update about the Germanwings crash. From there, it ricocheted around the internet and beyond, making news in more than 20 countries and half a dozen languages. It was discussed on television news shows. It appeared in glossy print, most recently in the June issue of Shape magazine (“Why You Must Eat Chocolate Daily,” page 128). Not only does chocolate accelerate weight loss, the study found, but it leads to healthier cholesterol levels and overall increased well-being. The Bild story quotes the study’s lead author, Johannes Bohannon, Ph.D., research director of the Institute of Diet and Health: “The best part is you can buy chocolate everywhere.”

I am Johannes Bohannon, Ph.D. Well, actually my name is John, and I’m a journalist. I do have a Ph.D., but it’s in the molecular biology of bacteria, not humans. The Institute of Diet and Health? That’s nothing more than a website.

Other than those fibs, the study was 100 percent authentic. My colleagues and I recruited actual human subjects in Germany. We ran an actual clinical trial, with subjects randomly assigned to different diet regimes. And the statistically significant benefits of chocolate that we reported are based on the actual data. It was, in fact, a fairly typical study for the field of diet research. Which is to say: It was terrible science. The results are meaningless, and the health claims that the media blasted out to millions of people around the world are utterly unfounded.

Here’s how we did it.

You really should read the whole thing to see exactly how easy it is to game the science journalism field. And if you want to be happy you should also embrace the strategy of believing the studies that purport to show the health benefits of eating/drinking whatever you want and ignoring those that claim those same habits are unhealthy.

Works for me.

Long-term Recovery

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

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.

Wake Forest Lab Developing Frankenweenies

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?

Billions Left on the Table

North Carolina is one of the states that didn’t expand its Medicaid program after the passage Obamacare. According to this little item from the Wonkblog there are a BUNCH of states that are reconsidering their decisions to opt out:

Money talks: Medicaid expansion makes headway in Republican states. “Two things have led to a change of heart for some Republican politicians. Most of the 27 states that are already expanding the program have begun to reap billions in federal subsidies for insurers, hospitals and healthcare providers, putting politicians elsewhere under intense pressure to follow suit. As demonstrated by Pennsylvania’s deal with Washington, the Obama administration has also proved willing to accept tweaks that give the private sector a greater role in providing healthcare and place new responsibilities on beneficiaries. All of that has got as many as nine states talking to the administration about potential expansion terms.” David Morgan in Reuters.

According to the Reuters article referenced above, North Carolina is one of the states looking at what it can do:

Some states with Republican governors, such as Indiana, are negotiating with Washington for agreements that could pass political muster with conservatives back home. Others such as North Carolina, South Dakota and Wyoming are exploring options.

One of the reasons that North Carolina’s leaders said they didn’t want to opt for expansion is that they feared the Feds wouldn’t pick up the vast majority of the cost as they’d promised (I’m paraphrasing). Now that they’re seeing what kind of money they’re leaving on the table they seem to be second guessing their decision, but they’re likely going to slow-play their hand because things might change in November.

According to the Reuters article if the Democrats lose control of the Senate then the wave of Republican states reconsidering their Medicaid expansions might ebb. Here’s the irony for North Carolina Republicans, many of whom might benefit from Medicaid expansion: on this particular issue they might be better off if Dem. Senator Kay Hagan wins reelection. And if you think the only Republicans who might benefit are those who are eligible for Medicaid then you’re forgetting all the Republicans who work in the health care industry. Just look at the projections for Pennsylvania:

A study by the RAND Corp predicted a $3 billion economic boost and the creation of 35,000 jobs – big advantages for a state that has struggled for decades to make up for jobs lost from the decline of the coal and steel industries.

Unfortunately for the Democrats this kind of issue is far too complex to make an effective campaign tactic. After all, this is a country full of people who said things like “Keep the government’s hands off my Medicare” when Obamacare was being debated. You can’t possibly expect them to back a candidate out of enlightened self interest when they don’t even know what their self interest is.

North Carolina’s $51 Billion Gamble

Brad DeLong has some thoughts about Obamacare and here in NC this one bites:

The willingness of state-level Republican politicians to hurt their own people–those eligible for the Medicaid expansion, those who would benefit from a little insurance counseling to figure out how to take advantage of subsidies, those hospitals who need the Medicaid expansion to balance their finances, those doctors who would ultimately receive the subsidy dollars–is, as John Gruber says, “awesome in its evilness”. The federal government has raised the money, and all the state has to do in order to get it spent is to say “yes”. Especially in contrast with the extraordinary efforts state-level politicians routinely go through in order to attract other spending into their state, whether a BMW plant or a Social Security processing center, this demonstrates an extraordinary contempt for a large tranche of their own citizens. And when I reflect that a good third of that tranche reliably pull the lever for the Republican Party year after year…

To that point, here’s some encouraging news about North Carolina’s non-participation in Medicaid expansion:

North Carolina’s decision not to expand Medicaid coverage as part of Obamacare will cost the state nearly $51 billion in federal funding and reimbursements by 2022, according to research funded by theRobert Wood Johnson Foundation

It notes that North Carolina stands to lose $39.6 billion in federal funding between 2013 and 2022…

“States are literally leaving billions of dollars on the table that would support their hospitals and stimulate the rest of their economies,” says Kathy Hempstead of the Robert Wood Johnson Foundation.

The report notes that for every $1 a state invests in Medicaid, it will receive $13.41 in federal funds.

And here’s the real kicker:

The decision not to expand Medicaid coverage will leave 6.7 million U.S. residents uninsured in 2016. That includes 414,000 people in North Carolina.

Of course Obamacare isn’t perfect and Medicaid isn’t the end-all, be-all of health care insurance — DeLong himself says in his thoughts about Obamacare that “Where the Medicaid expansion has been allowed to take effect, it has taken effect. People are going to the doctor more, people are finding doctors to go to, and the only minus is one that we already knew: that Medicaid is not a terribly good way to spend our money in treating people with chronic conditions” — but it is still a better option than nothing and an improvement over the Emergency Room as primary care provider system that we’ve had.

What’s truly frightening to consider is where we’ll go from here. Without the funds our doctors and hospitals will be missing out on literally billions of dollars of reimbursement, almost 1/2 million citizens will be uninsured and will continue to use the emergency room as their primary caregiver, the hospitals will have to eat the cost and downward we spiral.

Measuring Success

There are many ways to measure success and/or failure, and it’s important to keep that in mind when you assess hot-button issues. For instance, this article in the Greensboro News & Record about Obamacare’s affect on insurance coverage in North Carolina:

In North Carolina, 16.7 percent of residents are now uninsured, compared with 19.6 percent before the onset of the ACA, according to a study conducted by the social network WalletHub.

 

North Carolina ranked 33 among states for its number of uninsured residents.

The Tar Heel state also ranked fourth among states with the most net new private insurance enrollees per capita.

WalletHub used data from the Kaiser Family Foundation, the Centers for Medicare & Medicaid Services, the U.S. Department of Health and Human Services and the Census Bureau to make its projections.

Those who supported Obamacare will likely tout this statistic as proof that Obamacare is working. On the other hand, those opposed to Obamacare can ask the question, “But at what cost?” That’s the crux of the issue: we can all probably agree that more people having health insurance is a good thing, but we’d probably have lots of heated debate over how much to pay for it, how to pay for it and how to structure the program. Does the phrase “socialized health care” ring any bells.

Quite frankly I think it’s far too early in the process to declare Obamacare a success or failure, but I’d say these numbers show a positive trend towards getting more people health insurance coverage. Long term who knows whether or not Obamacare will be a net success, but at a minimum we’ve seen thousands of North Carolinians moved off the roles of the uninsured and that’s a step in the right direction.

 

Health Care Rights

Have you heard about the SCOTUS decision in the Hobby Lobby case? If you live in American and haven’t heard about it then you might live in a cave, but here’s the gist of it:

The U.S. Supreme Court has upheld a decision whereby closely-held companies can request exemptions the Patient Protection and Affordable Care Act (ACA) coverage provision for some contraceptives because of the corporations’ founding family’s religious beliefs…

Much of the controversy over today’s decision derives from the fact that Hobby Lobby and Conestoga are not in the business of conducting religious services or overseas humanitarian missions as their primary business. They are for-profit companies. The ruling allows the corporations to refuse coverage because of the religious beliefs of individual leaders.

Beyond selectively singling-out women’s reproductive care, the decision raises the question of whether corporate leadership elsewhere might refuse coverage of other drugs due to religious beliefs.

A lot of the reaction I’ve seen online has focused on a couple of points: the weirdness of bestowing religious rights on closely held corporations using the argument that the corporation is an extension of the owners (that’s simplistic but I think gets to the heart of it); that the religious rights of the corporation/owners trumps the reproductive rights of their female employees.

I’d like to focus on the second point for a minute because I think the argument is a bit off and, quite frankly, misses the larger point. While it is regrettable that employers like Hobby Lobby would refuse to pay for insurance that covers all of their female employees’ contraceptive choices it doesn’t mean that those same employees can’t go out and get those contraceptives if they’re willing to pay for it themselves. Thus they aren’t denying them anything, they’re just not paying for it. That might seem like semantics, but I think it’s important because what it exposes is that corporate health insurance in this country is not a right for anyone.

Health insurance as we know it came into being in the World War II era as an incentive companies used to attract and retain employees who were in short supply at the time. As such, health insurance was never a “right” but was a benefit that came to be so commonplace that most employees started to view it as a right. Then something funny happened – companies realized they could shift the cost of health insurance back to employees and not suffer too many dire consequences and so they starting jacking up premiums and co-pays or simply doing away with health insurance all together. The result is a growing percentage of our population without access to health insurance, which means they forego preventive care and rely on ERs when they get sick, helping drive up health care costs for everyone.

The Clinton administration’s effort to deal with the rising health care problem twenty years ago was a notorious failure. ObamaCare started out as an ambitious plan to provide health care coverage for everyone, fought the “socialized medicine” stigma, went through a negotiation phase involving the health insurance cabal that resulted in the imperfect system being fought out in the courts today. You’d be hard pressed to find anyone happy with the system, except maybe for the millions of people who had NO access to health insurance pre-Obamacare and now at least have the option to buy it.

Long story short, while it’s easy to get hung up on the reproductive and religious rights arguments raised by the Hobby Lobby case, it would be a mistake to limit the scope of the conversation. The bigger question is why we can spend so much time and energy talking about our religious rights, women’s reproductive rights, our right to bear arms, etc. but we never seem to debate whether we should have a fundamental right to affordable, adequate health care and whether or not relying on private companies to provide it is the best way to approach it.