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Cost Containment

Junk Food is Not an Accident

By Brian L. Grant, MD

Every so often a book is published that impacts how we live or at least how we see our world.

The new book “SALT SUGAR FAT, How the Food Giants Hooked Us”, by Michael Moss may be one of them.

Like “The Jungle” by Upton Sinclair, that exposed the abuses of the meatpacking industry on immigrants in 1906 or “Fast Food Nation” by Eric Schlosser, that helped expose the abuses of factory farming of animals that help make today’s fast food – this new book by Moss describes how the fast food industry has succeeded in creating products that compel consumption, contributing to our current obesity epidemic.

Moss is a reporter for the New York Times. Excerpts of his book appeared in the New York Times Magazine on February 24. In addition, we have included the recent review of his book from the New York Times, and a link to the Amazon description, author interview and reader reviews.

Marketing and research work. We are persuaded to consume, to embrace styles and brands, and otherwise spend our money based upon real or perceived values and needs, informed by marketing efforts. In most cases the only damage is to our wallet if we consume goods or services that we don’t need. And many times what we get is quite useful and valuable.

The food industry faces a challenge. The success of food marketing requires food consumption. The more successful the marketing is, the more food is consumed. This consumption, especially of the sorts of processed foods that the global giants create, is a driver for obesity.

To quote the review:

“…that is the nub of Mr. Moss’s case: By concentrating fat, salt and sugar in products formulated for maximum “bliss,” Big Food has spent almost a century distorting the American diet in favor of calorie-dense products whose consumption pattern has been mirrored by the calamitous rise in obesity rates. Entire food categories were invented to support this strategy (Mr. Moss is particularly fascinated by Kraft’s near-billion-dollar line of Lunchables snack trays), as processors bent the American appetite to Wall Street’s will.” Read More…

Read the article, the reviews, and the book. After doing so, you may never enjoy Cheetos or Dr. Pepper quite as much.

Could IBM’s “Watson” Be a Healthcare Game Changer?

When we think of breakthroughs in our healthcare system, we often place our hopes in miracle drugs, cutting-edge research, or new legislation.  But IBM has something entirely different in mind to change the medical playing field.

Using the same supercomputer that competed and beat two Jeopardy champions in 2011, IBM is developing Watson to digest complex information and make medical recommendations more efficiently than humans.

The Atlantic article, “The Robot Will See you Now,” presents a detailed look into the revolutionary machine and how it could be an effective tool in the health care industry.

In order to help train Watson for medical purposes, researchers at the Memorial Sloan-Kettering Cancer Center in New York have been developing fictional cases to demonstrate Watson’s ability to absorb complex cases and “natural language” and make intelligent medical diagnosis.

Unlike any other machine, Watson is able to process up to 60 million pages of text per second, whether the information is in the form of unstructured physician notes or complex medical jargon.  Researchers have also found that the longer Watson is exposed to real cases,  it gets better at figuring out medical problems and ways of treating them. The article states, “Watson even has the ability to convey doubt. When it makes diagnoses and recommends treatments, it usually issues a series of possibilities, each with its own level of confidence attached.”

“Watson fills in for some human limitations,” Kohn told me in an interview. “Studies show that humans are good at taking a relatively limited list of possibilities and using that list, but are far less adept at using huge volumes of information. That’s where Watson shines: taking a huge list of information and winnowing it down.” Read more…

But the notion of having a robot make serious medical recommendations and decisions poses many questions. Just how much can we rely on artificial intelligence and could it replace human doctors?

An Overview of a Sick Health Care System

By Brian L. Grant, MD

This very detailed, long, and comprehensive report from Time  states the obvious to many who have paid attention to the debacle of our health care system.

It is long, but the best summary I have seen making the case for a need to revamp and disrupt the U.S. health care system. The article, “Bitter Pill: Why Medical Bills Are Killing Us,” details how:

“In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.”

A response to the article in Slate criticizes the article on giving doctors and their pay a pass.

Obviously this hits close to home for this writer and many readers of MCNTalk. It actually hits home for every American.

It will enlighten and disturb most. Readers may even learn a new word: Chargemaster. Learn what this means and why it is important to you.

What is clear is that virtually every interest group invested in health care stands to lose a lot if the system truly rationalizes itself structurally and functionally in a way that addresses the major dysfunctions in the current U.S. system.

If the 18+ GDP being currently spent in the U.S. were to decrease to a level consistent with other industrialized countries, that means the spend will be less and the income of impacted stakeholders in our present system may decrease.

This article ought to make readers angry and concerned, enough to do their own analyses rather than accept the rhetoric designed to polarize. Simply put, our health care system is indefensively abusive to society.

Any system that charges those who can least afford to pay, the uninsured, many times that charged to Medicare patients and double that paid by private insurers, is wrong.

Any system that costs us as a society one out of five dollars – twice what other countries with systems equal in quality to ours – when it comes to major measures of health is wrong. Any system that abuses its nonprofit status, holds charity balls to cover the 1% or so that it may give away, while ending up with 12% or more of untaxed profits, paying its key executives in the many millions each – is wrong!

The article says little about the unnecessary nature of much of the care received by patients and the excesses in care with respect to labs, medications, therapies and other interventions. There are no health care bills when one does not receive care that is not needed or when one is healthy in the first place. And preventative care should be evidence based, not automatic.

This writer is in the medical business, as a physician, patient, employer, and in a role with a business that every day analyzes and reviews care received or proposed. I know a train wreck in process when I see it.

The political divisiveness and partisanship that surrounds the health care debacle is not accidental. It is carefully calculated and brilliantly executed by political operatives on behalf of those who stand to lose.

How fascinating that many of those who suffer the most in the current system, most revile the president and party who have proposed solutions that might mean a few less folks would need to declare bankruptcy from their medical bills.

At some point in the relatively near future, change will be forced by political will and those who have been tricked into opposing change will see the errors of their ways. Those businesses who are footing ever increasing bills for private insurance will also decide that they are fed up.

Changes will be fought hard, with desperate claims to maintain the status quo. It is in the interest of those most impacted to be part of solution rather than have it be imposed on them.

In the interim, pray that you, your friends, and loved ones never show up at a hospital with none or inadequate insurance. And welcome the day you are eligible for Medicare.

We invite readers’ responses to this article. We would especially like to hear counterpoints to the main points raised in the article.

 

Should California Workers’ Comp Cover Pro Athletes from Any Team?

Workers’ Compensation has a clear place in society.

Professional athletes, especially football players, often sustain chronic injuries from their play.

The Los Angeles Times article, “Athletes Cash In On California Workers’ Comp,” addresses how many California workers’ compensation judges have held that any professional athlete who plays in the state is eligible to receive benefits from employers.

“Over the last three decades, California’s workers’ compensation system has awarded millions of dollars in benefits for job-related injuries to thousands of professional athletes. The vast majority worked for out-of-state teams; some played as little as one game in the Golden State.

All states allow professional athletes to claim workers’ compensation payments for specific job-related injuries — such as a busted knee, torn tendon or ruptured spinal disc — that happened within their borders. But California is one of the few that provides additional payments for the cumulative effect of injuries that occur over years of playing.” Read More…

California’s particular workers’ compensation regulations appear to have created coverage for players from any team that played in California during their career. Is this good policy?

Are Your Health Benefits Cutting Your Pay?

This thoughtful and depressing article from the New York Times describes the actual health care costs to individuals in graphic terms; how it impacts their salary and how the political process ensures that the high costs continue.

The author closes with a modest proposal on how the system might change by only insuring for unexpected, catastrophic illness – leaving the remainder to individuals to self-insure.

Clearly such a suggestion would be resisted by most everyone. We currently consume health care in the context that we expect routine and affordable treatments such as teeth cleaning, eyeglasses, and contraception be paid for by someone else.

Most of us will drive a mile to save a couple of  cents on gas. If our car insurance paid for gas,  which it would if health insurance behavior applied to cars, not only would we go to the closest station, but the price of the gas would not be posted. Read More…

Will Self-Insurance Plans Drive Up Costs for Others?

A New York Times article addresses the self-insurance trend as some companies with relatively young and healthy employees decide to opt out of the health insurance marketplace.

Though it is unclear whether employers  are deciding to self-insure as a response to the Affordable Care Act, companies have found they can avoid the laws’ minimum coverage standards and save money by doing so.

“The new health care law created powerful incentives for smaller employers to self-insure,” said Deborah J. Chollet, a senior fellow at Mathematica Policy Research who has been studying the insurance industry for more than 25 years. “This trend could destabilize small-group insurance markets and erode protections provided by the Affordable Care Act.”

However, this change could drive up costs for employees at other companies because commercial insurers and insurance exchanges will be left with disproportionate numbers of older and sicker people who are more expensive to insure. This could drive up premiums for uninsured people seeking coverage in the exchanges and since the federal government subsidizes that coverage, it could face higher costs as well.

The Challenge with Accountable Care

Noted business professor Clayton Christensen and colleagues discuss the challenge that new health regulations face in the context of physician and patient behaviors that may remain unchanged.

The article, “Christensen, Flier and Vijayaraghavan: The Coming Failure of Accountable Care,”  hints at the major challenge in engaging stakeholders in meaningful change, when custom, economic drivers, and human nature do not reinforce the changes enacted. Perhaps we will end up with a two-tier system, not based upon economics, but based upon compliance and attitude.

The Everett Clinic, as described in the article, has told Medicare patients that they must change to Medicare Advantage – which promotes preventive care and disease management – or seek care elsewhere, in the old fee-for-service model.

The article states that Accountable Care Organizations (ACO’s) are on the hook for patients who don’t comply with recommended treatment or lifestyle changes. In other words, there is a misalignment of interests.

In the old fee-for-service model, hospitals and physicians are paid more for caring for the sick, including those whose problems are of their own making based on lifestyle decisions and avoidance of preventative measures. A system that has one-sided economic sanctions against physicians based upon patient outcomes may induce doctors and even hospitals to deny non-emergent access to certain patients in favor of those who engage in healthier behaviors. The ethics of such care denial have been challenged in this article. Ultimately, the development of ACO’s may limit care access to those who need it the most.

The 5 Most Common Workplace Injuries

Every year thousands of employees are injured in the course of their employment.

Injuries in the workplace are costly and while it is nearly impossible to prevent every single exposure and injury in the workplace, it is important to proactive identify those that are most common in order to find possible solutions.

According to the 2012 Liberty Mutual Workplace Safety Index, the top five leading causes of workplace injuries drive 73%  of the nation’s direct workers’ compensation costs.

The study found that the top five injuries were:

1. Overexertion: Injuries from excessive lifting, pushing, pulling, holding, carrying, throwing, which accounted for $13.61 billion in costs.
2. Fall on same level: a slip, trip, or a fall in which the worker impacts either the surface or an object at the same level on which he/she is standing. This injury drove $8.61 billion in costs.
3. Fall to lower level: Which accounted to $5.12 billion in costs.
4. Bodily reaction: Injuries from bending, climbing, reaching, standing, sitting, and slipping or tripping without falling, which drove $5.28 billion in expenses.
5. Struck by object: Which accounted for $4.64 billion in costs.

The Liberty Mutual study is available here.

 

 

 

The Rising Need and Cost of Dialysis

The Seattle Times article, “The Dialysis Dilemma: Urgent Need vs. Overtaxed System,” gives an excellent historical account of the development, impact, and moral hazards involved in treatment of kidney failure.

In the early 1960s, dialysis became a long-term treatment option for select few. At $20,000 per patient, the three machines could treat nine patients. But money wasn’t the only issue.

Because of the limited number of machines available, a committee dubbed “The God Committee” or “The Life or Death Committee” was formed to decide who would be treated.

The committee members — a surgeon, a pastor, a lawyer, a banker, a state government official, a labor leader and a “housewife,” plus two physician advisers — were white. All but one were male.

Most patients they picked were well-off, white and male. Patients had to be able to pay for the treatment — $30,000 for three years, about $229,000 in today’s dollars. The committee also considered net worth, number of dependents, education and ‘future potential.’

Patients less than 25 or older than 45 generally weren’t eligible, nor were those with other illnesses.

Though our nation has seen significant progress in treating end-stage kidney disease since the “The Life or Death Committee, ” roughly 600,000 U.S. patients are affected by the disease and the costs are high.

In 2010, for each patient with end-stage renal disease on hemodialysis — the most common dialysis method — Medicare paid $87,561 on average, counting medications and other medical expenses. For those who dialyze at home, it was $66,751 per year, and for those who received a transplant, $32,914. Read more…

This once fatal disease has become survivable with dialysis and transplants. But the costs are high for society and the human lives involved very real.

America’s Health Care System: It is Not a Jobs Program

In a New York Times op-ed article, “We Can Be Healthy and Rich,” Ezekiel Emanuel writes about the impact of the health care system on our larger economy and points out that there are many vested interests in the status quo of high health spending.

These high health costs are not geared toward the public good, but rather the economic impact of the massive spending.

He rightly states:

“Health care is about keeping people healthy or fixing them up when they get sick. It is not a jobs program.”

According to the Council of Economic Advisers, reducing health care costs by just 1 percentage point every year would lead to a 4 percent increase in G.D.P. by 2030. In today’s dollars, that would mean an extra $600 billion for our economy and an extra $7,000 for the average family.

Various comments by readers illustrate many views on his article and a number of additional perspectives.