T
he NSA collects 200 million text messages a day.
Electronic medical records: They don’t save money and they don’t improve quality, but they do allow hospitals to bill more. HT: Jason Shafrin.
Judge rewrites ObamaCare law to allow people to get tax subsidies in the federally run exchanges. See Background posted by Michael Cannon.
A year old story that’s worth revisiting:
The so-called bodega clinicas that line the streets of Los Angeles’ immigrant neighborhoods blend into a dense forest of commerce. Wedged between money order kiosks and pawn shops, these storefront doctors’ offices treat ailments for cash: a doctor’s visit is $20 to $40, a podiatry exam is $120 and at one bustling clinica, a colonoscopy is advertised on an erasable white board for $700.
County health officials describe the clinicas as a parallel health care system, servicing a vast number of uninsured Latino residents, yet the officials say they have little understanding of who owns and operates them, how they are regulated and the quality of the medical care they provide…
Visits to more than two dozen clinicas in South Los Angeles and the San Fernando Valley found Latino women in brightly colored nurses scrubs handing out cards and coupons that promise everything from pregnancy tests to tubal ligations. Others advertise evening and weekend hours, and, some 24-hour a day operations trumpet that they are “nunca cerramos” — never closed. That all-hours access — and up-front pricing — is critical, Latino health experts say, to a population that often works low-wage, around-the-clock jobs.
Also important, officials say, is that new immigrants from Mexico and Central America are more accustomed to a corner clinica, which is common in their home countries, than to the sprawling medical complexes or large community health centers found in the United States. And they can get the kind of medical treatments — including injections of hypertension drugs, vitamin solutions delivered intravenously and liberally dispensed antibiotics — that are frowned upon in traditional American medicine. (KHN/NYT)
More on the WSJ.
This is from a NBER Working Paper by David Cutler, Kaushik Ghosh, and Mary Beth Landrum:
H
ealth status in the year or two just prior to death has been relatively constant over time; in contrast, health measured three or more years before death has improved measurably…We show that disability-free life expectancy is increasing over time, while disabled life expectancy is falling. For a typical person aged 65, life expectancy increased by 0.7 years between 1992 and 2005. Disability-free life expectancy increased by 1.6 years; disabled life expectancy fell by 0.9 years. The reduction in disabled life expectancy and increase in disability-free life expectancy is true for both genders and for non-whites as well as whites. Hence, morbidity is being compressed into the period just before death.
HT: Timothy Taylor.
Leon McCarthy of Marblehead, Massachusetts, was born without fingers on one of his hands. When Leon was 10, his father Paul learned about the Robohand and purchased a 3-D printer to build one for his son.
Although the hand reportedly costs $500 to make, the printer required currently sells for $2,399. Even so, the Robohand is far less expensive than available finger prosthetics. Many of the Robohand’s parts can be reused when new fittings are printed as children grow. Though it not be as functional as some of the much more expensive creations available, people buying their own prosthetics are willing to trade some functionality for the Robohand’s lower cost.
Would Robohand be covered by Medicaid and Medicare? Probably not.
Medicare and Medicaid require a prescription to purchase durable medical equipment like hand prostheses. Leon did not have a prescription. He probably could not have gotten one since the Robohand is not an FDA approved medical device. His father obviously does not meet Medicare requirements for suppliers of custom fabricated and fitted prosthetic devices.
The next time someone argues that deregulation will do nothing to reduce health care costs, keep in mind Medicare and Medicaid durable medical equipment regulations, regulations that both raise costs and act as a competitive deterrent to people who might have ideas for products like the Robohand.
In the context of what’s at stake in health care, the practice of giving drugs two names, a brand name and a generic name, makes no sense. Is there any other industry in which thousands of component parts are insistently given two dissimilar names, even though people can suffer, be hurt, possibly even die, if a mistake in names is made? Every drug with two names — and that means practically every drug in use — is a medication error waiting to happen. (NYT)
Paying physicians:
By 20
17, physicians will be rewarded or penalized on the basis of the relative calculated value of the care they provide to Medicare beneficiaries.
But is this a good idea?
…[T]he practical reality is that the Centers for Medicare and Medicaid Services (CMS), despite heroic efforts, cannot accurately measure any physician’s overall value, now or in the foreseeable future. Instead of helping to establish a central role for performance measurement in holding providers more accountable for the care they provide and in informing quality- and safety-improvement projects, this policy overreach could undermine the quest for higher-value health care.
