Honey, what was the name of that nice couple ... you know, the ones who were always talking about healthcare? The last time we saw them was around the time of the Democratic convention? That couple who switched sides on healthcare reform... You know...
Yeah, Harry and Louise, and they're back at their kitchen table -- and on your TV screen starting this weekend -- calling for a healthcare reform bill.
"A little more cooperation, a little less politics, and we can get the job done this time," says Louise to Harry, after the two banter about the right reform package: one that would allow people to get affordable health insurance regardless of pre-existing conditions and when they change jobs or lose one.
A little less politics? Huh? Isn't this the same Harry and Louise whose 1994 advertisement, aired in the midst of the Clinton administration's efforts to draft a healthcare reform, helped scuttle reform back then? "They choose...," said Harry, referring to the "government bureaucrats" who, a voice-over tells us, would design the healthcare plans into which Americans would be herded. "...we lose," added Louise. Back then, Harry and Louise were brought to us by the coalition of business groups allied against Clinton's healthcare reform efforts.
But by August 2008, Harry and Louise were a bit more open to healthcare reform. "Whoever the next president is, healthcare should be at the top of his agenda. Bring everyone to the table, and make it happen," Louise said in a political ad aired around the Democratic and Republican conventions.
Harry and Louise were on Capitol Hill this morning as well -- part of a campaign of mounting pressure to ensure that healthcare reform gets done this year. They appeared with Sen. Christopher Dodd (D-Conn.) who's shepherding the bill through Congress, and executives of the two organizations that sponsored the advertisement and the media buy that will see it air for at least three weeks on cable and national networks and on the Sunday talk shows. The campaign's cost is estimated at $4 million.
And who are those political bedfellows bringing Harry and Louise into our homes this time? The Pharmaceutical Research and Manufacturers of America (PhRMA) and Families USA, a group that has been active in advocating for universal healthcare coverage. Dodd and others pointed out that when such groups -- typically feuding -- join for a common cause, the consensus behind a reform measure is strong indeed.
This time, however, neither Harry not Louise weigh in on the controversial "public option" -- a proposed government-run plan that Republicans and many in the insurance industry argue will create unfair competition for private insurers, but which Democrats have argued is necessary to ensure universal coverage. A recent survey found that between 68% and 88% of Americans supported some form of government-run healthcare option as part of a reform package.
The actors' names are, in fact Harry and Louise -- hers is Louise Caire Clark and his is Harry Johnson, and yes, they look a little more AARP and a little less "Family Ties" now. They're not, in fact, married to one another. "But they're still pretty good at finishing each other's sentences," said Bob Meissner of Families USA, who spent time with the pair this morning.
Spending on healthcare for obese American adults increased 82% between 2001 and 2006, according to a new government report.
In 2001, expenditures for obese Americans totaled $167 billion compared with $303 billion in 2006. Costs for adults who were overweight rose 36% during that time period while costs for normal-weight adults increased 25%.
Healthcare expenditures for obese Americans accounted for 35% of all costs in 2006, the report noted. During the years of 2001 to 2006, the number of obese Americans increased from 48 million to 59 million people. Obese people are much more likely to suffer from several chronic health conditions.
One hopes the figures, which were compiled by the Agency for Healthcare Research and Quality, will come to the attention of lawmakers and other authorities discussing healthcare reform. Perhaps the top goal of healthcare reform should be preventing obesity, and the myriad of health problems it causes, in our children.
-- Shari Roan
Illustration credit: Michelle Chang / For The Times
For men with prostate cancer, even those with the early-stage type, the urge to treat is undeniable and understandable. The same apparently holds true for their doctors. But sometimes no treatment, at least for a while, is better -- both for men with cancer and for the healthcare system as a whole.
More men -- and, again, their doctors (who are paid by procedure, not by performance) -- need to ask themselves whether less might ultimately provide more. That's the suggestion posed by a smart, making-the-big-picture-personal piece in today's New York Times.
For writer David Leonhardt, the true test of health reform can be summed up with our medical and insurance systems' approach to prostate cancer, specifically the common, slow-growing kind. It's the kind that can often be monitored with what is known as watchful waiting without the risk of side effects that comes with radiation and surgery.
But if the treatments have roughly similar benefits, they have very different prices. Watchful waiting costs just a few thousand dollars, in follow-up doctor visits and tests. Surgery to remove the prostate gland costs about $23,000. A targeted form of radiation, known as I.M.R.T., runs $50,000. Proton radiation therapy often exceeds $100,000.
And in our current fee-for-service medical system — in which doctors and hospitals are paid for how much care they provide, rather than how well they care for their patients — you can probably guess which treatments are becoming more popular: the ones that cost a lot of money.
If you doubt that similar-benefits contention and want an in-depth look at how the treatments compare, there's this report: "Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer" from the Agency for Healthcare Research and Quality.
The report, released last year, concludes:
Published evidence indicates that no one therapy can be considered preferred for localized prostate cancer due to limitations in quality of the body of comparative effectiveness evidence. All treatment options result in adverse effects (primarily urinary, bowel, and sexual) though the severity and frequency may vary between treatments and according to the provider/hospital. Even if differences in therapeutic efficacy exist, differences in AEs [adverse effects], convenience, and costs are likely to be important factors in individual patient decision making. Despite this uncertainty, patient-reported satisfaction with any individual therapy received is high.
Leonhardt is right. This one example highlights the seemingly large and intractable problems of rising healthcare costs (proton radiation therapy isn't cheap) and getting the most effective healthcare for our national dollars.
And, come decision-making time, if less-expensive treatments are as effective as more high-tech ones, perhaps it's time to question some of the recommendations for expensive treatment and screenings.
“No news is good news” seems to be what most patients assume when they're waiting to hear about test results. But for 1 out of 14 of them, “no news” may in fact mean “bad news” that their doctor didn't inform them about, according to a study published in Archives of Internal Medicine on Monday.
The study, led by Dr. Lawrence Casalino of Weill Cornell Medical College, looked at more than 5,000 records of randomly selected middle-age patients from 23 primary care practices.
The patients had received common blood and screening tests, including mammograms, pap smears, cholesterol tests and red blood cell counts. “Abnormal results” that fell well outside the normal range were reported in roughly one-third of patients. But in 7.1% of these cases, practices did not inform — or document that they had informed — patients.
Communication failures like this could have serious, even lethal, consequences, Casalino says. “We weren’t looking for cholesterol levels that were trivially high,” he notes. Some patients weren't informed of total cholesterol levels as high as 318 mg/dL (above 200 mg/dL is considered high). If left untreated, such levels could eventually mean a stroke or a heart attack for some patients.
Adds coauthor Dr. David Meltzer of the University of Chicago, seeing the numbers “would clearly require a doctor at the very least to have a discussion with the patient” — about lifestyle changes, medication or other forms of intervention.
You might think that switching to electronic medical records would be the solution -- but that's not necessarily so: Computerizing a process that is already being done poorly may yield even worse results, Casalino says. Good processes, using either electronic or paper-based methods, seem to be the key to fewer mistakes.
Casalino and colleagues propose common-sense procedures physicians could use to manage test results, including having the doctor sign off on all results and telling patients to call after a certain time interval if they have not been notified of their results.
Making a few simple changes to automate the system could reduce errors without necessarily making costs higher, Meltzer adds. “A great example would be what happens in an airplane cockpit,” he says. “There are certain pieces of information that are only considered transmitted if they are confirmed. When a co-pilot says to the pilot, ‘We’re running out of fuel,’ the co-pilot’s job isn’t done until the pilot actually says ‘I heard you tell me that.’ ”
Until that happens, however, the study’s authors recommend that patients play an active role in their own care. The single most important message: Don’t assume no news is good news. Know which tests have been done, know when to expect them back -- and if you don’t hear anything, call.
“It’s not hyperbole to say it could save your life,” Casalino says.
If you tuned out of the health-reform discussions early on, thinking this whole overhaul thing wouldn't gain traction, it's not too late to do your homework. Here are three new primers to get you up to speed -- or at least not woefully behind:
"Five years from now, there's an excellent chance you won't have the same health insurance you have (or don't have) right now. That's because members of Congress are gearing up to reform the U.S. health care system, and unlike in 1993 when then-first lady Hillary Clinton tried her hand at changing the medical system, this time the important players -- doctors, insurance companies, pharmaceutical manufacturers -- seem to be on board. You heard a lot about health care reform this week, and you'll be hearing even more in the months to come. It's an incredibly confusing, complex issue, so in this week's Empowered Patient, we break it down for you with 10 frequently asked questions about health care reform."
"Universal health care is a cause that comes around every 15 or 20 years in Washington, and Presidents as far back as Woodrow Wilson have tried and failed to make it happen. ... But even amid signs of a new consensus, there are at least five questions that must be settled before there can be meaningful reform:"
"With the Democratic-controlled Congress working on a potentially sweeping health care overhaul, questions abound for consumers, including whether they might have to change their insurance or buy coverage if they don’t have it. Here's a guide to the top issues:"
... Of course, these backgrounders come even as today's L.A. Times carries this story: "Aggressive timetable for healthcare reform hits snag"
Its members began their week by listening patiently Monday (meaning they booed once, but also gave several standing ovations) to President Obama's plans for the nation's health system.
That story: "Obama calls cost of healthcare a threat to economy"
The group has been less than enamored with proposals for a large public health insurance plan, and the president's speech at the annual conference has been much discussed. Here's a synopsis of their differing opinions from Top of the Ticket: "Obama tells AMA about healthcare plans."
But after that arguable high point, the group gamely proceeded with the rest of its annual conference. And its members came up with these notable, though perhaps-not-so-bold, statements:
There was this: "The AMA passed policy today [Monday] that recognizes breast cancer as a condition that affects males as well as females and supports education about the risks, signs, and symptoms of male breast cancer."
And this: "Today [also Monday], the AMA passed policy to inform physicians, policy makers and the public of the current scientific evidence on the use of hormones for anti-aging. Proponents of any hormone or other substance for anti-aging have the responsibility to prove that claims are scientifically valid." I'm with them on this one. The other one too actually.
And this: "Health care organizations, such as medical schools and hospitals, can serve as role models and educators on the importance of adopting a healthier and more sustainable food system. This is according to new policy passed today [Tuesday] at the American Medical Association’s (AMA) Annual Meeting." Again, hard to argue with.
"As the American Medical Association (AMA) works for health reform this year that provides all Americans with affordable, high-quality health coverage, new policy states that the AMA 'support health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.' ”
Whether you agree or disagree, the language is, again, not so bold. But better than a poke in the eye, I suppose.
Here's the Associated Press' take: "Doctors signal they'll work with Obama"
As writer Lindsey Tanner says: "While the Obama administration would have preferred a strong endorsement, the vote by American Medical Association doctors is a victory of sorts for the White House and the group will continue to be a player in the health care reform efforts."
The full transcript of President Obama's speech Monday at the annual meeting of the American Medical Assn. The point: "The cost of our health care is a threat to our economy. It's an escalating burden on our families and businesses. It's a ticking time bomb for the federal budget. And it is unsustainable for the United States of America."
Second, a local perspective on healthcare from L.A. Now:
It begins: "Residents in the poorest neighborhoods of Los Angeles County continue to face living conditions that are significantly more unhealthy than more affluent areas, according to a report released today by public health officials." It includes a link to the full report (much data, many maps).
And finally, a foodie's perspective from the Daily Dish:
It begins: "The Pharmacie, a series of roving, invite-only cocktail parties (more underground than even the Roger Room?), kicked off last Sunday evening."
-- Tami Dennis
Photo: Aspirin might come in handy. Credit: Joe Kohen / Bloomberg News
That finding may not be as notable as the fact that it's still stubbornly true. A report released today by the Kaiser Family Foundation offers a state-by-state look at American women's health. Among the key findings:
--Women of color fared worse than white women across a broad range of measures in almost every state, and in some states these disparities were quite stark. Some of the largest disparities were in the rates of new AIDS cases, late or no prenatal care, no insurance coverage, and lack of a high school diploma.
--For Hispanic women, access and utilization were consistent problems, even though they fared better on some health status indicators.
--Black women experienced consistently higher rates of health problems. At the same time they also had the highest screening rates of all racial and ethnic groups.
Here's a quick by-the-numbers look at California. Of the state's 11.2 million women ages 18-64, 45% are white, 32% are Hispanic, 14% are Asian, Native Hawaiian or Pacific Islander, and 6% are black.
Having employer-backed or private health insurance is obviously a marker of who has relatively easy access to care. Those numbers for California: 78% of white women, 71% of Asian women, 58% of black women and 48% of Hispanic women.
And here's the full report, titled "Putting Women's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level."
The conclusions state: "More than a decade after the Surgeon General’s call to eliminate health disparities, the data in this study underscore the work that still remains."
--Tami Dennis
Photo: Dermatologist Susan Stuart, left, discusses skin cancer prevention with Lucy Chard, 43, of Rancho Bernardo at Scripps Memorial Hospital in La Jolla. Credit: Al Schaben / Los Angeles Times
Nearly two-thirds of those filing for bankruptcy protection in 2007 cite illness and medical bills as having contributed to their financial failure, reports a study published in the American Journal of Medicine. And 77.9% of those bankrupted at least in part by illness and its expenses had private insurance at the beginning of their medical odyssey.
The study, based on a survey of a random sample of 2,314 bankruptcy filings during early 2007, was conducted by researchers from Harvard University's Law and Medical Schools and Ohio University, under a grant from the Robert Wood Johnson Foundation. The researchers then conducted extensive telephone interviews with 1,032 of those filers to detail how illness and medical expenses contributed to their bankruptcy status. Four in 10 of the "medically bankrupt" had lost two or more weeks of wages due to their own or a family member's illness, roughly 35% had spent more than $5,000 or 10% of their annual income in out-of-pocket medical bills, and 43% specifically cited their own or a family member's illness as a reason for filing for bankruptcy.
Two of the four authors of the study, Harvard Medical School Professor Dr. David Himmelstein and Cambridge, Mass., physician Steffie Woolhandler, are co-founders of the group Physicians for a National Health Program. Citing the study's findings, Himmelstein called private insurance "a defective product, akin to an umbrella that melts in the rain." Woolhandler said the findings demonstrated that in the current debate about healthcare reform, proposals to "expand phony insurance -- stripped-down plans riddled with co-payments, deductibles and exclusions -- won't stem the rising tide of medical bankruptcy."
The study follows a 2005 study by the same researchers, who found that between 2001 and 2007, the proportion of all bankruptcies that could be attributed to medical problems rose by 49.6%. While Congress has in the meantime tightened the criteria for those who may file for bankruptcy, the stalled economy has propelled bankruptcies back up to the levels of 2001 -- roughly 1.5 million annually. The data reflected in the current study were collected before the economy had fallen to its lowest levels.
Two-third of those who were termed medically bankrupt were homeowners. Three-fifths had gone to college. In many cases, the researchers found, illness was followed by time lost from work, leading the filer to lose his or her job and, with it, health insurance coverage.
Those filing for bankruptcy due in part to illness averaged $17,943 in out-of-pocket costs. Such costs were highest for uninsured patients, whose medical expenses averaged $26,971. But patients who initially had private insurance but who lost it in the course of their illness were close behind, averaging $22,568 in out-of-pocket costs. Individuals with diabetes and those with neurological disorders such as multiple sclerosis or Parkinson's disease had the highest out-of-pocket costs, averaging $26,971 and $34,167, respectively. Medical expenses for those who suffered injuries ($25,096), strokes ($23,380), mental illness ($23,178) and heart disease ($21,955) also were heavy burdens upon bankruptcy filers.
Medication errors, ventilator problems, improper appendix removal ... so many things can go wrong in the hospital. But the risks posed by cheery get-well-soon bouquets had thus far escaped our attention.
To the rescue is popflowershop.com: "Stale, dirty vase water houses dangerous bugs, water-borne viruses and even risks electric shock near medical equipment. Buds emit harsh respiratory allergens and air-borne disease. The rotting, sulfuric smells of withering bouquets send the elderly into coughing fits. Pop Flower Shop, a company that offers 100% hypoallergenic and fragrance-free bouquets, has seen an increase in demand for their floral alternatives, due to this recent health risk realization."
The e-mail from the company, which offers "everlasting flowers," states that many United Kingdom hospitals have forbidden the fated-to-wilt kind of bouquets. Could this be true?
Maybe we should all check into those hospitals. The staffs there have apparently managed to eliminate medication errors and the like and have moved on to other risks....
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
