When the question about healthcare overhaul is simply: 'What about me?'

"The most common question people have about health reform is 'How will I be affected?' The answer, of course, depends on the individual, as different demographic groups will be affected very differently." So begins a series of briefs from the Robert Wood Johnson Foundation.

The briefs, released Tuesday, analyze the expected impact of the healthcare overhaul on young adults, children, older people and (sort of) people who buy insurance on the individual or small-group market. The latter is a bit too complex to easily distill, it seems. 

The summaries are not what you would call light reading (and can we have a motion to ban the abbreviation PPACA?), but they are informative. And, of course, brief

(PPACA stands for Patient Protection and Affordable Care Act -- what most people call the health overhaul or health reform law -- and it's likely something of a deterrent to consumers looking for straightforward, easy-to-understand information.)

-- Tami Dennis

Photo: Overall, the nation's seniors will see prescription drug coverage improve, the analysis says. But some will also see the premiums increase. Credit: Mark Boster / Los Angeles Times

Black and Latino males twice as likely to have poor health

Given the inequality in healthcare in the United States, it's no surprise that some groups of people suffer far worse health outcomes than people with better resources. But if there is one group that has been especially overlooked in this equation, it's black and Latino boys. The major factor in their poor health, according to a new report by the California Endowment, is where they live. Growing up in poor and stressful neighborhoods with limited healthcare resources leads to poor health.

According to the findings in the report:

• The odds of poor health outcomes for boys and men of color are more than two times higher than for white boys and men in California.
• Latino boys are 4.1 times more likely than white boys to suffer from post-traumatic stress disorder.
• African-American boys are 2.5 times more likely.
• Latinos are 3.1 times more likely to have limited access to health care and 4.8 times more likely to lack health insurance.
• Asthma disproportionately affects children who live in poorer neighborhoods.
  Black young men have a homicide rate 16 times greater than that of young white men.
• African-American and Latino children are 3.5 times more likely to grow up in poverty compared to whites.

Poorer neighborhoods mean less access to stores selling health foods, fewer parks and safe places to run and play in and fewer social networks to promote health and safety.

The California Endowment has launched a 10-year initiative, called Building Healthy Communities, to improve the health of men and boys of color by making strategic improvements in the communities and neighborhoods in which they live. In the report, the group identifies a handful of successful programs to improve the lives of men of color already in place in the state that could be applied on a larger scale -- and why implementing these programs statewide cannot wait.
 
-- Shari Roan

Photo credit: Carlos Chavez  /  Los Angeles Times

Patients denied weight-loss surgery don't get any healthier

Not all health insurance companies cover weight-loss, or bariatric, surgery -- especially if the patient's obesity isn't considered "severe" enough. A study released Thursday, however, offers a glimpse of what happens to people who want weight-loss surgery but are denied it.

Within three years of being denied surgery, patients developed a range of obesity-related diseases compared to a group of similar patients who received surgery. Researchers from Gundersen Lutheran Health System in La Crosse, Wis., examined the records of 587 patients who had laparoscopic gastric bypass with 189 patients who were medically eligible (meaning they were obese enough according to medical guidelines) but whose insurers denied the surgery. The average body mass index of the patients in both groups was 48. A BMI of 30.1 or higher is considered obese; a BMI of 35 to 40 is called Class II obesity and over 40 is considered Class III obesity.

After three years, the average BMI in the surgical group had dropped to 30.5 and less than 1% of patients had developed new obesity-related conditions. The patients who did not have surgery had BMIs that were, on average, unchanged. However, 40% had gone on to develop hypertension, 34% developed obstructive sleep apnea and 20% developed gastroesophageal reflux disease. Others developed diabetes or high cholesterol.

The research was presented Thursday at the annual meeting of the American Society for Metabolic & Bariatric Surgery.

"It is well-known that bariatric surgery treats obesity-related disease," the lead author of the study, Dr. Shanu N. Kothari said in a news release. "Our study now shows that it can prevent new diseases from occurring."

Only about 1% of Americans who are clinically eligible for bariatric surgery because of morbid obesity undergo surgery.

-- Shari Roan

Image credit: T: Joseph Daniel Fiedler / For the Times

U.S. is No. 1 in a key area of healthcare. Guess which one ...

Australia, Canada, Germany, the Netherlands, New Zealand, Britain — all are outperforming the United States when it comes to most aspects of healthcare. Again. But we're still tops in one area: spending.

Take that, Netherlands.

The assessment is from a new Commonwealth Fund report, released Wednesday, ranking healthcare systems on quality, access, efficiency, equity and healthy lives.

After pointing out that the other countries have universal health coverage (perhaps you'd heard?) and that the access picture should change as the health overhaul is implemented, the summary of the report states:

"But even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures. ... It is apparent that the U.S. is lagging in adoption of national policies that promote primary care, quality improvement, and information technology."

The report notes that various legislative remedies (read: funds) are now being administered to mitigate these symptoms as well.

But money doesn't necessarily buy quality, as the assessment emphasizes, and it would appear we have a long way to go in improving key elements of our healthcare system.

Here's today's L.A. Times article on healthcare: Obama proposes interim health protections ... "The regulations, all outlined in the healthcare overhaul bill, include barring insurance plans from denying coverage to children with preexisting conditions. Republicans call the rules a sales job."

— Tami Dennis

Photo: A patient undergoes robotic surgery in Florida. Credit: Roberto Gonzalez / Orlando Sentinel

 

Become a fan of our Facebook page and get a steady stream of health-and medical-related news, musings and the occasional oddity.

Just how many people have preexisting health conditions? About 1 in 5.

The unabashedly pro-healthcare-overhaul organization FamiliesUSA recently offered a look at the number of people in the U.S. with diagnosed preexisting health conditions. Those people will be among the Americans most dramatically affected by the upcoming changes in the health insurance market. On Tuesday, the organization offered a look at California's numbers.

The national report, Health Reform: Help for Americans with Pre-Existing Conditions, stated that 57.2 million non-elderly Americans have a condition that could jeopardize their ability to get insurance in the current insurance market. ("Current," of course, won't be "current" for long.) That amounts to more than 1 out of 5 people younger than 65.

California's numbers are similar, with almost 6.5 million non-elderly adults having a preexisting health condition. Again, that's about 1 in 5. The report offers age, ethnic and income breakdowns.

If the numbers neither shock nor compel you, head over to the organization's exploration of how the recent healthcare overhaul will affect the middle class, small businesses, the uninsured .... The information may not be overly reader friendly, but it is indeed thorough.

Here's recent Times coverage of impending healthcare changes.

— Tami Dennis

Photo credit: Associated Press

Maybe someday, the cost of medical procedures won't be such a mystery

Good luck figuring out how much that knee surgery might set you back. But with healthcare consumers starting to ask more questions about what they're actually getting for their medical money, and trying to predict how much they might have to spend, that might be changing.

As Los Angeles TImes reporter Duke Helfand writes in the article "Healthcare Providers Experiment With Lump-Sum Pricing":

"Wildly different prices for the same medical procedures, sometimes in the same towns, are prompting doctors and hospitals across the nation to experiment with new ways to cut unpredictable healthcare spending that often leaves consumers bewildered and financially ruined.

In one closely watched test beginning in August, several of California's best-known healthcare providers — including Cedars-Sinai Medical Center, the UCLA Health System and Hoag Memorial Hospital Presbyterian in Newport Beach — will begin charging lump-sum fees for hip and knee replacements." Read full story.

Here's Time magazine columnist Barbara Kiviat lamenting the current status quo, "Can price shopping improve healthcare?" 

"I recently went to a doctor and asked how much my office visit and X-ray would cost. Staffers told me that they didn't know and, since I have insurance, I shouldn't care. I should care, though. In fact, I do." Read full column.

It would seem that we all should.  

-- Tami Dennis

Surveys on health reform show more support than expected

Healthcare reform has divided the nation, according to much of the media coverage of the passage of the landmark bill. Two national surveys released Thursday affirm the partisan nature of opinions on reform. But the polls also offer more details about consumers' reactions, suggesting there is substantial support for many provisions of the law yet still a lot of confusion about how the new rules will affect individuals on a personal level.

One poll, from Indiana University's Center for Health Policy and Professionalism Research found nearly four in 10 people want the law repealed and new legislation enacted. But when asked about specific aspects of reform, such as prohibiting insurers from withholding coverage to people with pre-existing conditions, the majority of respondents favored such action. What people don't like, it appears, is the mandate requiring Americans to purchase insurance.

"When we looked at the responses of those who said they wanted to repeal the law and start from scratch, with the exception of the requirement that all Americans purchase health insurance, most of the things that they wanted are already written into the law," Dr. Aaron Carroll, director of the Center for Health Policy and Professionalism Research, said in a news release. "It appears that the mandate requiring Americans to buy health insurance may be the one thing they stringently oppose, and that may be the main motive for the push to repeal the legislation."

The poll, of 600 adults throughout the nation, also found -- surprise -- that 59% of people supported the idea of a public option, which was not contained in the bill.

Additionally, the Kaiser Health Tracking Poll, also released Thursday, found that 55% of Americans surveyed expressed confusion about the bill, and 56% said they did not have enough information about it. Forty percent viewed the bill unfavorably, compared with 46% who viewed it favorably and 14% who were undecided.

Still, many people said they still supported specific reforms contained in the bill, especially those that will be enacted this year. These include providing tax credits to small businesses that offer coverage to employees and allowing children to stay on their parents' insurance until age 26.

The Kaiser poll surveyed 1,208 adults nationwide.

-- Shari Roan

Graphic: Indiana University Center for Health Policy and Professionalism Research

 

Last call for Medicare Part D

Attention, seniors: If you meet the age and income requirements for Medicare, Thursday (just two days away) is the last day to pick a drug plan that works for you. Given that plans change their pricing and restrictions from year to year, it's vital to do a little bit of research to find the best fit.

When the Medicare window opened in November, Your Money/Your Health columnist Francesca Lunzer Kritz gave a helpful guide on picking a drug plan and navigating the enrollment process. "Don't just check the out-of-pocket price for a drug; figure out the plan's total charges for it," she wrote. "Here's why: Medicare adds up the plan's costs and the beneficiary's costs to determine how much has been spent on medicines. If you and the plan together spend $2,830 or more (up from $2,700 last year), you'll find yourself in the so-called doughnut hole, paying the full cost of your medications until your out-of-pocket expenses reach $4,550, up from $4,350 in 2009."

Consumer Reports also provides a quick rundown of the pros and cons of Medicare and Medicare Advantage, and the Medicare Rights Center answers a range of questions, from paying for healthcare costs that Medicare doesn't cover to caring for a senior who uses the healthcare plan.

And, last but not least, there’s the Medicare website, where you'll be able to compare plans and sign up for one all at the same time.

-- Amina Khan

Demise of Botox tax brings applause from AMA leader

As Senate Democrats look to close debate on the healthcare bill, an epic battle that has drawn in pharmaceutical companies, the insurance industry and ordinary Americans bearing personal horror stories, American Medical Assn. President-elect Cecil B. Wilson applauded a concession on the left's part: to drop the "Botax" from the bill. 

It almost sounds too Jerry Springeresque to be part of this months-long political saga, but it's true. Plastic surgeons and Botox manufacturer Allergan beat back a 5% levy on breast implants, face-lifts and other types of cosmetic surgery. Tanning salons, hit with a 10% tax, were not so lucky: indoor salons made for easy pickings, reports said, because of the link between ultraviolet radiation and cancer.

Forget Medicare, insurance premiums or the ill-fated public option. Clearly our representatives and medical professionals have their priorities straight, and our best interests at heart.

-- Amina Khan

For fraudsters, Medicare provides a tempting target

What do Tiger Woods and Medicare have in common? Neither of them needs any more bad press right now.

Yet that's exactly what the healthcare system got when federal agents nabbed 26 people in Florida, New York and Michigan on Tuesday on suspicion of committing a collective $61 million in Medicare fraud. The raid comes as Congress is wrestling with healthcare reform. The crimes took many forms. Dr. Fred Dweck of Miami, along with 14 colleagues, was accused of referring nearly 1,300 Medicare patients for expensive and unnecessary treatments. Suspects in Detroit found patients who pretended to be sick to justify costly testing. 

The scary part about Medicare fraud isn’t its $60-billion price tag; it's that it can take advantage of the sick and elderly, who may not be best equipped to defend themselves against it.

If you want to know what the warning signs are, here's some info from the FBI on spotting all kinds of scamminess. Scroll down for Medicare. Here's another article on protecting yourself (or a loved one) and how to report fraud if you encounter it.

— Amina Khan