Idea #305 for December 20th, 2009: Saving Money In The Long-Run or Paying For Medicaid Patients to Quit Smoking

A change in Medicaid led to a significant drop in smoking among Medicaid patients in Massachusetts, and federal legislators have taken notice. The state began paying for counseling and drugs for smoking cessation two years ago. Since then, the smoking rate among Medicaid patients has fallen by 25%. At the same time, the smoking rate among uninsured patients in that state remained unchanged. Two senators have introduced an amendment to the healthcare bill that would require Medicaid to cover similar anti-smoking treatments. Based on the success in Massachusetts, it’s a sensible step to take in the fight against smoking nation-wide.

Read more about this here.

Idea #304 for December 19th, 2009: The $60 Billion Sinkhole or Stopping Medicare Fraud

With the federal government trying desperately to do something about rising healthcare costs, we sometimes forget about an especially devious way that healthcare dollars are sometimes sucked down the drain. A story in the news today reminds us of this costly ploy: Medicare fraud. Twenty-six people were arrested by federal agents in three states for allegedly committing $61 million worth of Medicare fraud. A Florida doctor and 14 associates were arrested for fraudulently referring 1,300 patients for unnecessary treatments. We shouldn’t lose sight of the fact that Medicare fraud costs us $60 billion a year, and efforts to reform healthcare should address this problem.

Read more about this story here.

Idea #262 for November 7th, 2009: Left Out in The Cold or The Importance Of Medical Insurance For Children

With the direction of healthcare legislation still being fought over in Congress, one thing remains clear. Children in the US who do not have medical insurance coverage are at a disadvantage when it comes to quality of healthcare. Uninsured children with trauma injuries are three times as likely to die than children who do have insurance. This setup is inherently unjust, and Congress must take steps to rectify this problem for their legislation to be considered successful.

Researchers have a few hypotheses as to why uninsured children are much more likely to die from trauma. Without insurance, trauma patients are sometimes transferred from one hospital to another, which eats up valuable time that could be used to treat them. Also, fewer diagnostic tests may be ordered for un- or under-insured children, which can prevent an accurate diagnosis from being quickly ascertained. No matter the true reasons behind it, the statistic itself is alarming. The American public may have objections to universal healthcare, but those objections should end when it comes down to coverage for children — a population that has no control over whether or not it has healthcare insurance.

Read more about this statistic in the news here.

Idea #234 for October 10th, 2009: Abuse of Power or Some Domestic Abuse Victims Struggle to Get Health Insurance

We’ve all heard stories about people being unjustly denied health coverage due to pre-existing conditions, but this story is particularly egregious. A New Mexico woman was denied a policy based on medication and counseling she received after being assaulted by her ex-husband. The insurer claimed she was at high-risk of being admitted to an emergency department in the future. And as bad as that scenario sounds, eight states still allow insurers to use abuse as a legitimate reason for denying coverage.

A 1994 survey found that 8 of the 16 largest insurers weighed domestic abuse history as a factor when deciding on whether to allow a person to sign-up for their plans. While they may not explicitly ask a person about their history of domestic abuse, insurance companies have other ways to find answers. They can look for trends of abuse in medical records, or even scour news articles for mention of abuse and use that to deny coverage. As a result, women in those 8 states may be less likely to speak frankly about abuse with their doctors, considering that information might hurt their chances of procuring coverage down the line.

Attempts to fix this at the federal level have been unsuccessful up to now. Even as recently as 2006, a proposed bill to change the law nation-wide failed in Senate committee. We need legislation to change this, so that victims of domestic abuse aren’t discriminated against when trying to get healthcare coverage in the eight states where that practice is permitted.

Read more about this story from MSNBC.

Idea #212 for September 18th, 2009: Ghostbusting or Journal Editors Try To Stop Medical Ghostwriting

This year we’ve heard about ghostwriting campaigns conducted by major drug makers to hype up their drugs in medical journals. Now some journal editors are taking steps to prevent this activity in the future, the New York Times reports. The editors want journals to adopt more stringent disclosure policies and to investigate potential articles more thoroughly.

The editorial board of Public Library of Science medical journal has called for other journals to find and expunge any ghostwritten article that has appeared in their pages. Also, any author who signed off on the ghostwritten articles should be banned from future publication, and have their activity reported to their institutions, the editorial board suggests. This comes after a senator’s inquiry into the policies of eight major medical journals found that none had ever taken action against an author partaking in ghostwriting, and some even had no policy whatsoever against the act of ghostwriting.

A study in JAMA found a ghostwriting rate of 7% in their own publication, and an 11% rate in NEJM. Since healthcare legislation may put the focus on treatments supported by evidence in research, ensuring that medical literature is free from bias is more important than ever. Effective healthcare overhaul legislation must address the issue of ghostwriting in medical journals before more lives are put at risk.

Read the article about this issue in the NY Times.

Idea #120 for June 18th, 2009: Food for Thought or Changes at the FDA

As blogged about previously, the FDA has a few problems that need to be addressed in their handling of both food and drugs. On the food side, it looks like Washington is moving forward with a plan to plug some of the gaps. Legislation that will improve oversight of food safety is one step closer to becoming law, the Wall Street Journal reports. The bill, which includes giving the FDA authority to order food recalls, setting safety standards, and requiring annual inspections of high-risk facilities, has made been approved by a House committee. A fee imposed on food facilities is expected to help fund the costs associated with the new duties.

In the wake of events like salmonella-tainted peanut products and E. coli in spinach, it’s vital that the FDA be given more authority to police the food industry. As of now, the FDA does not have the power to order recalls of tainted food, which is absurd. Merely suggesting a food recall does not cut it when people’s lives are on the line. Inspections are all-too-often carried out by private auditors, but without upping the number of inspectors under the FDA’s employ, that is unlikely to change. Imposing new civil penalties, as this legislation outlines, could make food producers take safety more seriously though. It’s a positive step forward, but whether this bill passes, and to what extent it will be altered during its passage, remains to be seen.

In the media, see articles by: the Wall Street Journal and the Boston Globe.

Idea #89 for May 18th, 2009: A Healthier Workplace or Paid Sick Days

For about half Americans, taking a sick day means taking a cut in their paycheck. Unlike other developed countries, there is no law in the US requiring employers to pay workers for time off due to illness. A new bill introduced by Democrats is aiming to change that by making employers offer up to seven paid sick days per year.

Many Americans who are not given paid sick days find themselves continuing to work during an illness rather than forgoing a day’s earnings. Not only does this affect their own health, it may endanger the health of others too. A restaurant worker, for instance, is capable of spreading disease to a sizable number of diners. Even workers who don’t deal with customers can just as easily infect their coworkers. A study in California in 2008, for example, concluded that paid sick days in that state could potentially help all residents of the state, as cases of the flu and other contagious diseases would decrease.

There is likely to be resistance to the Congressional bill by business organizations who are concerned that the new law would hurt their bottom lines. Those costs should be considered, especially in this economy. But opponents of the legislation have to realize that businesses are hurt by employees who don’t take time to get well, and that paid sick days can help stop the spread of disease, which will lower the healthcare costs of everyone.

For more, see the NY Times and this opinion piece in the San Francisco Chronicle.

Idea #88 for May 17th, 2009: Enlarging the Fine Print or Requiring Restaurants to Post Calorie Counts

People realize that fast food hamburgers aren’t the healthiest meals, but they are unlikely to know the specific number of calories or grams of fat in their Big Macs. When you buy a bag of potato chips, the nutritional information is listed in a box on the back. But you aren’t supplied with that data when you dine out, and with good reason: the cost of assessing the nutrition of all the dishes would be exorbitant for most restaurants. Cost issues aren’t as big of a factor for large chain restaurants though, especially ones with consistent menus.

A year ago, New York City began requiring large chain restaurants to post calorie counts alongside prices. A survey showed that 25% of New Yorkers take those numbers into consideration when ordering, which accounts for hundreds of thousands of people. Nationwide, Americans consume about a third of their calories outside of home. Now there is an attempt to legislate calorie count requirements at the federal level.

Anything we can do to cut rates of obesity will save massive amounts of money in health spending, but the rights of restaurants have to be taken into consideration too. But if we do move forward with legislation, it does make more sense to do at the federal level so that a national restaurant chain won’t have to change its menu from one state to another, in order to comply with various local standards.

Read more about the legislation in the LA Times and the Boston Globe.