policy

The Literal Price of Health Care

With all the dialogue on Obamacare, Trumpcare, the ACA, and the AHCA, Dr. Fizzy briefly reflects on the cost of health care.  Recently my daughter sprained her ankle. Because she’s a bit of a drama queen, I took her to urgent care after she refused to put weight on it for a day. The x-ray didn’t show a fracture and they gave her a crutch and an Aircast, which she used for exactly one day before she was better. A couple of months later, I got a bill for $150 for the crutch and Aircast that we barely used. Because of large deductibles and other reasons, we end up paying a lot of our outpatient healthcare expenses out of pocket. But the problem with that is that you have no idea what you’re going to pay until the bill actually arrives. If they had told me it was going to be $150 for that stuff, I never would’ve taken it. Think about how crazy it is. You would never go to a furniture store, buy a sofa, and just wait a few months until the bill comes to see how much you ended up paying for it. But that’s what I’m constantly doing with my healthcare bills. I can give multiple other examples. Recently, my own doctor ordered a lab test which I didn’t think was entirely necessary, but...

The American Health Care Act and its Effects on Healthcare

Repeal and replace has been the ongoing motto of the current administration with regards to the Affordable Care Act. Repealing has remained the easy task, but replacing is the hard part, the one filled with frustration of a system that is can swallow you whole.   While the Affordable Care Act is not without its shortcomings, it was a success in several ways. Mark Hall, JD, one of the leading scholars in the areas of health care law and public policy at Wake Forest University, made three clear points about the ACA at a town hall in Winter 2017: 1) it was never written to provide universal coverage; 2) most Americans have no idea that the uninsured rate is the lowest in decades; 3) the insurance laws were changed so that no one was uninsurable.   However, the American Health Care Act (AHCA), the replacement for the ACA, seems less likely a repeal and replace, and more like a repeal with no clear strategies to on improvement. And when it comes to health and lives of millions of Americans, an inadequate replacement is not good enough. The House Energy and Commerce and Ways and Means committees initially introduced the AHCA in March 2017, where it failed to pass. This bill as it stood in March would have repealed tax penalties for those without insurance, reduced Medicaid spending, incentivized states...

Trumpcare Is Bad For Mental Health Coverage

On May 4, the House of Representatives narrowly passed the Republican regime’s new health plan, known as the American Health Care Act (AHCA), or Trumpcare. This is a win for Republicans, many of whom promised their constituents that they would finally repeal Obamacare. The AHCA is different from Obamacare in many ways, and NPR does a great job of breaking down the main provisions of the new health care bill. One of the ways the AHCA is so different from Obamacare is by how it addresses mental health.   One of the provisions of the AHCA permits states to apply for waivers that allow insurers in their state to eliminate Obamacare-required “essential health benefits” from their plans. The removal of required essential health benefits, which include mental health and addiction services, will likely lead to cheaper, and therefore more affordable, health plans. But, of course, it comes at a cost—while these cheaper plans seem like a good deal for consumers, they actually provide barebones coverage that excludes mental health care. The sad thing is that many consumers aren’t fully aware of the barebones coverage their more ‘affordable’ plan provides. This isn’t necessarily the consumer’s fault, considering how complicated insurance language is….but, that’s a story for another day. The exclusion of behavioral health care is crippling, considering 1 in 5 adults experience mental illness within a given year. The loss of...

Medicine’s Gender Pay Gap is Huge

  A new survey conducted by Doximity, a social media site for physicians, shows that female physicians make an average of 26.5% (or $91,000) less than male doctors. The self-reported data—which was gathered from 36,000 licensed physicians and controlled for factors such as hours worked—shows that the pay gap exists in all medical specialties and in every U.S. city.   The largest wage gap is in neurosurgery, where female neurosurgeons are paid, on average, $93,000 less than males. One of the smallest pay gaps is in preventive medicine, where females still make $35,000 less on average. Meanwhile, in terms of geography, the largest wage gap exists in Mississippi, where female physicians make, on average, $118,000 less than males. The smallest gap is in Hawaii, where women make $45,000 less.   Medicine’s gender pay gap is especially concerning considering many medical specialties rely greatly on female physicians. For instance, specialties such as Pediatrics and Obstetrics & Gynecology are predominantly female, but male physicians in these specialties still make an average of 21% more than their female counterparts. These specialties, among others, will likely see more females in coming years as close to half of the graduates from U.S. medical schools are women. In fact, female graduates outnumbered males in states such as Pennsylvania, Illinois, and Washington. Furthermore, research suggests that female doctors perform better than males—a recent Harvard study showed...

An Update on Healthcare Reform

In March, Republicans failed to repeal Obamacare and replace it with the American Health Care Act (AHCA). It was a troubling moment for a new Republican regime that, for years, had promised to repeal Obamacare.   The AHCA was a flawed bill. It attempted to appease varied conservative interests, but it ended up being a convoluted mess that only alienated hard-line and moderate Republicans. Far-right conservatives thought the bill was Obamacare-lite, while moderates were concerned the bill failed to protect the interests of both their lower-income and sicker constituents.   According to Politico, Republicans have come to a tentative agreement that would appease the conflicting interests of their party. The conservative Republicans have agreed to reinstate Obamacare’s Essential Health Benefits, which was stricken from the original AHCA. According to this provision, all health plans must provide health benefits such as mental health and addiction treatment, preventive services, ambulatory care, and more—all with no limit. This appeases moderate Republicans who were worried about their constituents, as the provision prevents insurers from providing bare-bones coverage. In exchange for this, moderate Republicans have agreed to permit states to opt out of Obamacare’s community rating provision—this means that insurance companies can charge higher premiums to individuals with pre-existing conditions. This is a win for fiscally conservative Republicans because it’ll theoretically lower health insurance prices, at least for healthy individuals.   The compromise does...

Can Punishing Medical Errors Make Hospitals Safer?

In January, Medicare cut federal payments to 769 hospitals, continuing a program of punishing hospitals for errors and avoidable complications, such as blood clots, falls and bed sores. For the first time these penalties also included hospital-acquired antibiotic-resistant infections. Mandated by the Affordable Care Act, Medicare is required to penalize the bottom 25% of the worst performing hospitals, even if they’ve shown a reduced rate of incidents from year to year. In the years since the penalties took effect, they had the unintended consequence of disproportionately reducing funding in teaching hospitals and for patients in low-income areas with limited access to services. This prompted congress to legislate a socioeconomic adjustment when evaluating hospital performance.   While the federal Agency for Healthcare Research and Quality (AHRQ) estimates that hospital-acquired conditions have declined 21% from 2010 to 2015, there were still an estimated 3.8 million hospital injuries in 2016: 115 injuries for every 1,000 patient stays. Specialized hospitals, such as those for children, rehabilitation, cancer, veterans and psychiatric treatment are exempt from the financial penalties.   Reporting by the Kaiser Family Foundation has found that readmission rates started falling in 2012 and have continued, suggesting that more hospitals have taken up preventative measures for hospital acquired infections and preventable readmissions, and that overall the impact of the penalties is less than 1% of the reimbursable amount for a re-admission.   Image:...

Would You Google a Patient?

With social media permeating our lives, the lines between professional life and personal life often become blurred. Going on a first date? A quick Google search can give you a glimpse into your date’s life and potential conversation topics. Taking a class with a new professor? Google will give you a heads-up as to his or her professional interests or recent publications. Have an appointment for a check-up with a new doctor? Many websites will give you patient reviews and ratings of the practice.   …But what if your doctor is Googling you right back?     Researchers have had the better part of two decades to figure out if doctors could use social media to the benefit of their patients, but there still seems to be a wary skepticism among med school students and practicing physicians of all ages that prevents investigation of potential benefits. After all, knowledge is power, but it often comes with an ethical dilemma.   Research from James Brown et al at the University of Sydney found that 1 in 5 doctors surveyed had received a “friend request” from a patient. A similar survey from Bosslet et al found that 93.5% of medical students surveyed used social media in their everyday lives, but it was practicing physicians who were more likely to have looked up the profile of a patient or patient’s family members...