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Let the mutherfuker burn!
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yellojktJust a collection of recent health care news. Posting it now before it gets stale.
Great essay from a hospitalist on end-of-life care in last weekend’s Washington Post Outlook section. What was really interesting was the idea that advances in modern medicine are not the driver of the improvement in life expectancy. According to the the CDC, “a person who made it to 65 in 1900 could expect to live an average of 12 more years; if she made it to 85, she could expect to go another four years. In 2007, a 65-year-old American could expect to live, on average, another 19 years; if he made it to 85, he could expect to go another six years.” The increase in life expectancy was caused by a vast improvement in the child mortality rate that was the result of improved sanitation, nutrition and advances in delivery. He makes the point that interventions are really so family members can say “we did everything we could” when, instead they should be saying “we sure put Dad through the wringer those last few months.” Particularly damning was a quote from a retired nurse: “I am so glad I don’t have to hurt old people any more.”
(Another essay worth reading by a doctor on how doctors die. — Mike)
RAND is out with a study on the individual mandate. Dropping it would not cause a “death spiral” according to the report. Instead about 12 million would not be covered an premiums would go up about 9.3 percent. However, when you look at premiums by age group, the increase is only 2.4 percent. Also, there’s another group that’s opposed to the mandate: Single Payer Action, a physicians organization that opposes it on policy grounds that the mandate is not needed to regulate health care, filed a brief with SCOTUS. “It is not necessary to force Americans to buy private health insurance to achieve universal coverage,” said Russell Mokhiber of Single Payer Action. “There is a proven alternative that Congress didn’t seriously consider, and that alternative is a single payer national health insurance system.”
GAO is reporting that just because Medicare covers a preventive service, doesn’t mean that beneficiaries are using them. “Despite Medicare’s expanded coverage and the removal of financial barriers for certain preventive services, research suggests that use of some preventive services may not be optimal.”
KHN and WaPo on the last trend at the ER. Show up at the ER with a non-emergent problem? It might be like some gas stations. Pay first. Usual suspects trot out usual complaints about barriers to care.
The HHS budget-in-brief is a great way to get an overview of what Obama has planned for FY 2013 for the department. You can read by agency.
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All Things in Moderation 
NoVA:
Hope you don’t mind that I stuck in another link to an essay about doctors dying.
[Not at all. I see this as a link dump – NoVA]
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Thanks NoVAH [and Mike].
I think we knew that infant mortality was the statistical biggie. But it is significant from my perspective that my statistical life expectancy seems to be @19 instead of @12. My medically predictive life expectancy is probably about 19, too, because I have no health problems at 68 and my parents’ and grandparents’ deaths clustered around 87 [94, 88, 87, 86, 82, 71]. Add in my mother’s brother [87] and my father’s brother [93] and sister [80] and the cluster still seems to be 87. The outlier was my paternal grandmother who had pancreatic cancer and died when I was 6. My guess is the statistic was drawn just for me.
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From NoVA’s HHS budget link, I just wanted to point out BHO’s NIH budget is flat, but includes a $64M increase for “translational sciences,” a euphemism for preclinical development of drugs/vaccines, and a $48M decrease for “general medical sciences,” which is the institute that usually funds very basic biological research.
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Mike, isn’t cutting “pure” in favor of “experimental” or “developmental” research typical in tight times? Short sighted, of course, but the optimist in the WH probably thinks we can get back to pure research “later” while not interrupting the flow of technology “now”.
Is that oversimplified, or off the mark?
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Mike:
From NoVA’s HHS budget link, I just wanted to point out BHO’s NIH budget is flat, but includes a $64M increase for “translational sciences,” a euphemism for preclinical development of drugs/vaccines. . . .
Faculty in my department (OTs and PTs) are lately having success with “translational” grant submissions, in our case meaning putting together collaborative teams to include our folks, physicians, prosthetists, basic scientists, etc. Our research certainly is not about drugs/vaccines, but rather about developing or improving clinical procedures. I guess I misunderstood what “translational” meant based on experience in my limited world. I’ll have to check it out.
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Mark:
Oh, I think it is based in politics. If the NIH can help foster along some drugs into the Pharma pipeline, then the NIH budget can be justified and perhaps expanded when the economy recovers. The optics are good. And Troll can tell you how long it takes to get a drug to market, especially since 99% of drugs fail at some point during testing, so it is a bit more corporate welfare as well.
Okie:
The “translational sciences” was shorthand for the new National Center for Advancing Translational Sciences (the former NCRR whose mission was changed by the NIH director), which is focused mostly on drug and/or target development. Everyone uses the word “translational” in their grants now because it is sexy and because we think it will help us get funded. But I was talking specifically about funding for NCATS.
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From the Great Essay – “But I’m not always lucky. The family may ask me to use my physician superpowers to push the patient’s tired body further down the road, with little thought as to whether the additional suffering to get there will be worth it. For many Americans, modern medical advances have made death seem more like an option than an obligation. We want our loved ones to live as long as possible, but our culture has come to view death as a medical failure rather than life’s natural conclusion.”
I don’t want this person as my doctor. Reading this and the rest of the psychobabble he spouts throughout the article makes me sick to my stomach. I have just recently (in the last 3 weeks) gone through my mother-in-laws death after a long continual decline. I realize I might be tainted by my recent experience but it is not his goddamn choice or preferance – it is the person and the families… We were under no illusions that my MIL would get better or that the doctors were working on miracles. We were all aware that death was and always is immenent. We were aware of her quality of life. We were, like most people in this situation, doing what we thought best based on the wishes of my MIL and the feelings of the family members. The doctor simply needs to provide the family with the knowledge required to understand what their decisions mean. I think if a doctor informs you about their superpowers or lack thereof, the people who actually have a vested interest can make the decisions necessary and appropriate for them. This arrogant ass can take his stethescope and stick it as far as I am concerned. Suffice to say, I disagree with NoVa and don’t think this is a great essay.
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Thanks for the essay links mike & nova. Thought provoking stuff.
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Dave!
I’m very sorry for what you’ve gone through with your MIL’s recent death. I’m still really, really lucky in that I haven’t had to face anything like this with any of my close family members yet, so I have no idea of what a roller coaster it must be.
I’m going to disagree, though, and say that I thought both of those essays were wonderful; I can certainly see where you’d have the response that you did, though. Thanks for a great (and timely) post, NoVA!!
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Interesting that the ACA is being attacked on the left by a group of doctors. I presume that they are a minority voice in the debate, but some see overturning the individual mandate as a step towards single payer.
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