All posts by Greg Scandlen

Greg Scandlen is the founder of Consumers for Health Care Choices, a non-partisan, non-profit membership organization aimed at empowering consumers in the health care system.
Health Care Costs

Evidence-Based Medicine

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A paper by Twila Brase, RN, PHN, president of the Minnesota-based Citizens Council on Health Care, and published by ALEC, explains the dangers of relying solely on “evidence based medicine” (EBM) to determine appropriate treatment for an individual patient. The problems are too long to list here, but they include:

  • Researcher bias when the researcher conducting the study has a preference for one form of treatment over another. Sometimes this may involve financial incentives, but that is not the only or even the major source of bias.
  • Conflicting results. This happens all the time in research. One study contradicts another, and neither may be completely accurate.
  • The expense, and therefore the rarity, of conducting randomized clinical trials. Very little medicine would be conducted if these trials controlled what could be done.
  • Comorbidities. Clinical trials focus on only one condition at a time, but few patients present with just one issue. There is a little information available about how multiple conditions and multiple treatments interact.
  • Special interest pleading. Well-organized interest groups are able to influence what topics are researched and how the research is conducted.
  • Lack of real-world testing. What works in the lab may break down on the battlefield of real life. Continue reading Evidence-Based Medicine →
Health Insurance

Blue Cross Survey

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The Blue Cross Blue Shield Association has released its 2008 survey of member experience in CD Health plans. There is a lot of information here, not all of it positive:

  • 70% of consumers report that an HSA-eligible product is (now) available to either them or their spouse/partner.
  • Blue Cross Blue ShieldApproximately 25% of consumers who are given a choice of plans choose an HSA-eligible product, but the percentage choosing an HRA has dropped from 23% in 2007 to 12% in 2008.
  • There is very little difference between those who choose a CDHP plan and those who choose a non-CDHP in terms of age, income, or health status.
  • People in HSAs are far more likely to be concerned about the cost of care, to track their expenses, and to choose lower-cost options for treatment. They are also more likely to participate in wellness programs.
  • Both groups are equally likely to comply with treatment for prevention and for chronic care, but people in CDHPs saved a lot of money due to reduced utilization – $616 per member for those who had a choice of plan and $1,074 per member in a full replacement group.
  • The percentage of people in an HSA-eligible program who do not plan to open an account has grown from 29% in 2007 to 46% in 2008. Nearly half of them (48%) say they don't see the value in having an account and 30% say they can't afford to make a contribution.
Health Insurance

Empowered Patients Form Social Network

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Newly empowered patients are creating social networking sites that enable them to run their own clinical trials.

Joined HandsHumberto Macedo in Brazil who has ALS heard of some success in Italy of ALS being slowed by the use of lithium. “No company would be willing to finance a confirming trial of a drug that went off patent decades ago, against a disease that strikes only 4 to 8 people per 100,000. So Macedo stepped up, proposing to fellow PatientsLikeMe members that they test it themselves.”  250 ALS patients participated, keeping track of their experience on a detailed spreadsheet. As it turns out, using lithium did not slow the progression of the disease, so in this case the experience debunked a theory. But isn’t that how science progresses?

New Health Care Law

What People Think

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Harvard's Robert Blendon continues his superlative work in measuring public opinion around health care issues in a new study of the attitudes of Massachusetts residents about that state's health reforms. [link]

One of the findings is how opinion changes once people are made aware of the costs and consequences of a reform proposal. Mr. Blendon tested attitudes towards various reform ideas in 2003. He found that 82% of respondents favored "expanding existing state programs," but when told that "these programs would require raising taxes to pay for the cost" support dropped to 55%.

Continue reading What People Think →

Health Insurance

Good News on the HSA Front

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HSA PiggybankWellPoint has a new report on consumer directed health plans (CDHPs):

  • Employers who adopted a CDHP in 2006 saw their cost decline, while the cost for non-CDHPs rose between 7% and 10%.
  • People in a CDHP were more likely to have a choice of plan.
  • The CDHP was more likely to be chosen by families with children.
  • People enrolled in CDHPs were more likely to use preventative care than people in non-CDHPs (3.1% higher for women and 8.8% higher for men).
New Health Care Law

Mark Pauly on the Candidates’ Health Plans

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Writing in Health Affairs, Mark Pauly of the Wharton School of Business at the University of Pennsylvania makes a case for a hybrid plan between what Obama and McCain have proposed in their campaigns. He seems to like McCain's tax credit:

(A uniform tax credit) would not inappropriately push people into or away from group insurance, or bias choices for or against high-deductible insurance. Rather, it would push choices toward insurance that the consumer judges to be worth its true (unsubsidized) cost. This neutrality is important because group insurance is usually less administratively costly than individual purchase, and sometimes managed care is better than high cost sharing to limit overuse. However, individual insurance can give different individuals the coverage they want, and managed care makes some people angrier than high deductibles. Neutrality allows these trade-offs to be made properly. Continue reading Mark Pauly on the Candidates’ Health Plans →

Health Insurance

Blue Cross Survey: CDHC Plans Working

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Blue Cross Blue Shield Association has unveiled the results of its latest survey of Consumer Driven Health Plans (CDHP). This year’s presentation reveals that:

  • BCBS enrollment in CDHPs has grown 50% in the last year, with 2.9 million in HSA programs and 1.5 million in HRAs.
  • Distribution of age and income matches very closely with the distribution for non-CDHP enrollment.
  • People who choose a CDHP want to have more control over costs and utilization.
  • Compared to people in a non-CDHP plan, people with HSAs are far more likely to ask their doctor about the cost of a recommended treatment (52% to 33%), choose a lower cost option (36% to 23%), and use mail order for buying Rx (43% to 30%).
  • They are also far more likely to track their health care expenses (72% to 40%), estimate future expenses (38% to 22%), and discuss expenses with their doctor (38% to 27%).
  • They are about 50% more likely to participate in wellness programs.
  • They are slightly more likely to use preventative services and equally likely to receive necessary services and comply with prescribed treatment.
  • Savings due to reduced utilization equal $1,074 per member in full replacement groups and $615 for multiple choice groups.
  • Still, this year for the first time, CDHP enrollees are somewhat less likely to recommend the coverage to others (38% to 45%).
Medicare

Johnson Introduces Medicare “Freedom to Choose” Bill

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Congressman Sam Johnson (R-TX) has introduced legislation (HR 7148) that would allow so-called private contracting under Medicare and enable people to decline to enroll in Medicare without forfeiting their Social Security. It would also allow people who are otherwise eligible for Medicare to continue contributing to an HSA. Mr. Johnson, who is a member of the Health Subcommittee of the Ways & Means Committee, said in a press release, "If Warren Buffett wants to pay for his own medical care, I say we should let him."

The private contracting issue means that Medicare beneficiaries could see a private physician and pay directly for the service, without requiring the doctor to opt-out of Medicare altogether, provided there is a written contract between the physician and the patient and they do not attempt to bill Medicare for any part of the service.

At the same time, a lawsuit has been filed on this very issue. (See previous post.)

In an op-ed on this issue, Heritage president Ed Feulner, says "You'd expect those who run entitlement programs to jump at any chance to trim expenses and save money (but) you'd be wrong."

Health Insurance

The Tipping Point is Here

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The annual survey of the Centers for Disease Control finds that 20.3% of all people under age 65 have a high deductible health plan (HDHP) – more than the number covered by public programs (19.4%). The HDHP is defined as having a deductible of at least $1,100 for an individual or $2,200 for a family. Over one-fourth of this number also had a dedicated account (HRA or HSA).

Source: CDC report on NHIS Survey.

httpv://www.youtube.com/watch?v=-D9S48A81os

Bob Dylan singing "The Times They Are A-Changin'"

Health Insurance

Good News: Health Care Inflation Down; Employers Offering Insurance Up (But You Won’t Hear It Anywhere Else)

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The Kaiser Family Foundation has released its annual survey of employer benefit plans. Gary Claxton, John Gabel and others summarized the findings in an article published in Health Affairs. There is a wealth of interesting information here.

Starting with overall trends, the study finds that employer health care costs rose a mere 5% from 2007 to 2008, and that the percentage of employers offering coverage rose from 60% in 2007 to 63% in 2008. In fact, the rate of cost increases has been dropping every year since 2003 to the point that it is very close to the rate of increase in overall inflation and workers earnings in 2008. And the percentage of employers offering coverage is the highest since 2004.

These are both very good news, worthy of banner headlines. Continue reading Good News: Health Care Inflation Down; Employers Offering Insurance Up (But You Won’t Hear It Anywhere Else) →