Dr. Rosenthal was an emergency room doctor before becoming a journalist.
Jan. 21, 2019
“As Donald Trump was fighting with Congress over the shutdown and funding for a border wall, his administration implemented a new rule that could be a game-changer for health care.
Starting this month, hospitals must publicly reveal the contents of their master price lists — called “chargemasters” — online. These are the prices that most patients never notice because their insurers negotiate them down or they appear buried as line items on hospital bills. What has long been shrouded in darkness is now being thrown into the light.
For the moment, these lists won’t seem very useful to the average patient — and they have been criticized for that reason. They are often hundreds of pages long, filled with medical codes and abbreviations. Each document is an overwhelming compendium listing a rack rate for every little item a hospital dispenses and every service it performs: A blood test for anemia. The price of lying in the operating suite and recovery room (billed in 15-minute intervals). The scalpel. The drill bit. The bag of IV salt water. The Tylenol pill. No item is too small to be bar coded and charged.
But don’t dismiss the lists as useless. Think of them as raw material to be mined for billing transparency and patient rights. For years, these prices have been a tightly guarded industrial secret. When advocates have tried to wrest them free, hospitals have argued that they are proprietary information. And, hospitals claim, these rates are irrelevant, since — after insurers whittle them down — no one actually pays them.”
“It’s worth remembering what Republicans said would happen before the A.C.A. went online: that it would fail to reduce the number of uninsured, that it would blow a giant hole in the budget, that it would lead to a “death spiral” of rising premiums and declining enrollment.
What actually happened was a dramatic fall in the uninsured, especially in those states that expanded Medicaid. The budget costs of expanding Medicaid and subsidizing other insurance have been significant, but estimates for 2019 suggest that these costs will be around $115 billion — much less than half the revenue lost due to the Trump tax cut.
What about that death spiral? Premiums on the health exchanges established by the A.C.A. initially came in much lower than expected, then rose sharply when the people signing up for those exchanges turned out to be fewer and sicker than insurers had hoped. But the markets have now stabilized, with only modest premium increases for 2019 and insurers returning to the exchanges.
And while the exchanges are covering fewer people than projected, Medicaid is covering more than expected, so that overall gains in coverage have been surprisingly on target. In early 2014, the Congressional Budget Office projected that under the A.C.A., by 2018 there would be 29 million uninsured U.S. residents. The actual number is … 29 million.”
“D’ashon, a Texas toddler with severe birth defects, needed 24/7 nursing care to keep his breathing tube clean and to prevent him from pulling it out.
His foster mother asked Superior HealthPlan, the insurance carrier that provides Medicaid services to the state’s 30,000 foster children, for additional nursing hours, according to a Dallas Morning Newsinvestigation. Superior said no, even after D’ashon’s doctors and nurses said that it was a matter of life or death.
Bind his arms with a soft splint to keep him from removing his breathing tube when no nurse was on duty, the company suggested to D’ashon’s foster mother. The insurance carrier finally agreed to provide round-the-clock nursing care — after D’ashon choked while no nurse was on duty and lapsed into a permanent vegetative state.”
“When President Trump mused that the mass shooting at a high school in Parkland, Fla., in February might have been prevented if the United States had more mental institutions, he revived a not-quite-dormant debate: Should the country bring back asylums?
Psychiatric facilities are unlikely to prevent crimes similar to the Parkland shooting because people are typically not committed until after a serious incident. Still, a string of news articles, editorials and policy forums have noted that plenty of mental health experts agree with the president’s broader point.
The question of whether to open mental institutions tends to divide the people who provide, use and support mental health services — let’s call them the mental health community — into two camps. There are just 14 or so psychiatric beds per every 100,000 people in the United States, a 95 percent decline from the 1950s. One camp says this profound shortage is a chief reason that so many people suffering from mental health conditions have ended up in jail, on the streets or worse. The other argues that large psychiatric institutions are morally repugnant, and that the problem is not the lack of such facilities but how little has been done to fill the void since they were shut down.”
David Lindsay: Yes, and, here are the two top comments I also recommended:
I didn’t think our relationship would last, but neither did I think it would end so soon.My patient had struggled with bipolar disorder his entire life, and his illness dominated our years together. He had, in a fit of hopelessness, tried to take his life with a fistful of pills. He had, in an episode of mania, driven his car into a tree. But the reason I now held his death certificate — his sister and mother in tears by his bed — was more pedestrian: a ruptured plaque in his coronary artery. A heart attack.Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.
“Last week we learned that Novartis, the Swiss drug company, had paid Michael Cohen — Donald Trump’s personal lawyer — $1.2 million for what ended up being a single meeting. Then, on Friday, Trump announced a “plan” to reduce drug prices.
Why the scare quotes? Because the “plan” was mostly free of substance, controlled or otherwise. (O.K., there were a few ideas that experts found interesting, but they were fairly marginal.) During the 2016 campaign Trump promised to use the government’s power, including Medicare’s role in paying for prescription drugs, to bring drug prices down. But none of that was in his speech on Friday.
And if someone tries to convince you that Trump really is getting tough on drug companies, there’s a simple response: If he were, his speech wouldn’t have sent drug stocks soaring.
None of this should come as a surprise. At this point, “Trump Breaks Another of His Populist Promises” is very much a dog-bites-man headline. But there are two substantive questions here. First, should the U.S. government actually do what Trump said he would do, but didn’t? And if so, why haven’t we taken action on drug prices?”
“It seems that these successes within the department have intensified the ambitions of people who want to put V.A. health care in the hands of the private sector. I believe differences in philosophy deserve robust debate, and solutions should be determined based on the merits of the arguments. The advocates within the administration for privatizing V.A. health services, however, reject this approach. They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.
Until the past few months, veteran issues were dealt with in a largely bipartisan way. (My 100-0 Senate confirmation was perhaps the best evidence that the V.A. has been the exception to Washington’s political polarization). Unfortunately, the department has become entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what’s best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.”
“Ever since the school shooting in Parkland, Fla., law enforcement and other officials have been calling for changes in the Baker Act, a Florida law that allows involuntary commitment for 72 hours of people who are an imminent danger to themselves or others. If the Baker Act had been easier to deploy, they think, Nikolas Cruz, the accused shooter, would have been taken and treated before his horrible act.
However this law may be reformed, it will never be able to get people with serious mental illness the treatment they need.
I know something about the Baker Act. About halfway through my son Matthew’s decade-long struggle with serious mental illness, my wife and I invoked the Baker Act against him.”
Here is the top comment, I recommended:
“President Trump is vowing to return to two of his favorite goals in 2018: a crackdown on immigration and the dissolution of the Affordable Care Act.
When congressional Republicans passed the sweeping tax bill in December, they eliminated the A.C.A.’s health care mandate. But President Trump wants to knock out the entire program.As I have learned in the past four years, immigration and health care in America have an organic relationship that may escape the president and his supporters if they experience health care only from the outside looking in.”
“Those comments matched Mr. Trump’s characterization in January of drug companies as “getting away with murder.” That same day, a dozen Republican senators, including Ted Cruz of Texas, John McCain of Arizona and Mike Lee of Utah, voted for the old liberal idea of letting Americans buy cheaper drugs from Canada.”
“The pharmaceutical and health products industries spent $145 million on lobbying for the first half of 2017, according to the Center for Responsive Politics.
Drug makers gave $4.5 million to congressional campaigns in that period, including six-figure donations to House Speaker Paul Ryan; Representative Greg Walden, a Republican of Oregon who heads the House Energy and Commerce Committee; and Senator Orrin Hatch, Republican of Utah and chairman of the Senate Finance Committee, a Kaiser Health News analysis found.
The drug lobby has spent $28 million so far this year to air six ads depicting heroic researchers about 4,600 times on national TV, according to iSpot.tv, an ad tracker.”
“Drug makers say that high prices reflect heavy investment in innovation and drug development. They reject the notion that the industry wields too much influence in Washington. The top 10 publicly traded United States drug companies made $67.8 billion after taxes last year, regulatory filings show.”
Reform is a disaster, since big money seems to rule. Here are the top comments, which I endorsed.