Wonkblog: Health Care

How’s That New Obamacare Plan Working Out?

Six million Americans got new health insurance on Jan. 1 because of the Affordable Care Act, and we want to know how it's going for you. Please let us know what it's been like trying to use that shiny new insurance card -- or if you've encountered any bumps along the way. You can fill out the form below or e-mail us at sandhya@washpost.com and sarah.kliff@washpost.com.

Doctors are using electronic records more - but liking them less

Doctors are using electronic records more - but liking them less

Doctors’ use of electronic health records has gone up in recent years — and so has their dislike for the digital record keeping.

There’s a lot of enthusiasm in the health policy community for electronic health records and how they could improve patient care, by being available anywhere, while also lowering costs. Doctors’ use of electronic health records has grown in recent years.

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Why one health insurer won’t extend Obamacare’s benefits

Why one health insurer won’t extend Obamacare’s benefits

Insurers promising to uphold some of Obamacare’s benefits, even if the Supreme Court overturns the law, looks to be all the rage in health policy this week. UnitedHealth is doing it. Aetna is doing it. Humana, too.

But one of the Affordable Care Act’s biggest supporters refuses to jump on the bandwagon.

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We think surgeons make 600 percent more than they actually do

We think surgeons make 600 percent more than they actually do

That’s according to a new study in the Journal of Arthroplasty. The study had 1,120 knee and hip replacement patients take a guess at how much the surgeon who performed the procedure had made. They also had patients suggest what they thought the surgeon should have been paid for the procedure. Here, in chart form, is what they found:

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One rural doctor decides to close shop: ‘It’s just not sustainable’

A day in the life of Dr. Marc Shiffman can go something like this: Leave home at 7:45 a.m. Drive 40 miles through rural Colorado to Summit Internal Medicine, the clinic he founded in 2007. Start seeing patients at 8:30 a.m. Stop seeing patients at 5:30 p.m. Do paperwork—forms that need to be sent to insurers, bills that need to be looked over—until 9:15 p.m. Make the 40-mile drive back home. Arrive around 10 p.m. Repeat.

Shiffman is the only internist in Summit County, a rural area of
(Matt Cardy - GETTY IMAGES)
Colorado about 72 miles west of Denver. He founded his own clinic in April 2007, after a long career working in large doctor groups and hospitals. At the end of this month, on June 30, Shiffman will close his clinic.

“In a word, I’d say running a solo, primary care practice in rural America is impossible,” Shiffman said. “Rural America is not well-served, and the prospects for the future are gloomier.”

A century ago, half of Americans lived in rural areas, as did 41 percent of their physicians. Since then, Americans have migrated out of rural areas and their doctors have done so at an even quicker pace. Nationally, the United States has 191 physicians for every 100,000 people. In rural areas, that ratio can be as low as 52.3 doctors for 100,000 patients. An American living in a non-Metropolitan area is four times more likely to live in an area with a primary care shortage.

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Reports of Medicare’s death are greatly exaggerated

Around this time last year, Americans got a dire warning: Medicare was heading into the red, quickly. “Medicare to go broke in 2024,” one headline proclaimed. “We know,” Sen. Kelly Ayotte (R-N.H.) told Fox News, “that Medicare is going broke by 2024.”

Those predictions of Medicare’s impending doom came from the 2011 Medicare Trustees Report, an annual look at the entitlement program’s finances. The dense, 267-page tome is never much of a page-turner. Most of it is obtuse, economical analysis and endless charts — not, of course, that there’s anything wrong with endless charts. But there’s one figure that always gets a lot of attention: The date by which, if things stay on current course, the Medicare trust fund will become insolvent.

At 12:45 p.m. today, the Medicare Trustees will release their 2012 report. It’s likely to elicit a similar round of headlines. Before that happens, it’s worth understanding why projections of the fund’s insolvency actually say very little about whether Medicare is going bankrupt. Reports of Medicare’s death are, as Mark Twain would put it, greatly exaggerated.

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Should Warren Buffett’s cancer get treated?

Should Warren Buffett’s cancer get treated?

When Warren Buffett’s doctor recently administered a test for prostate cancer — a test that came back positive — he went against long-established medical guidelines. He also, perhaps unknowingly, leapt into a fierce policy debate about unnecessary care.

The U.S. Preventive Task Force says that men over 75 shouldn’t have regular tests, as there’s little benefit to early detection. That’s because prostate cancer is incredibly slow growing; even if caught early, there’s a high chance that it will never cause medical harm. “Early diagnosis,” the Wall Street Journal’s Ron Wilson contends, “can lead to over-detection and over-treatment of disease that will never cause any problems.”

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PDUFA: The most important health policy you haven’t heard of

PDUFA:  The most important health policy you haven’t heard of

Right now, there’s a big health policy battle brewing on the Hill. It’s not about Obamacare. It has nothing to do with repeal — and everything to do with PDUFA, a very important law with a very funny name.

Try and get past the quirky acronym, which sounds more like a children’s cartoon character than a crucial piece of health policy. Because PDUFA is actually quite serious. It stands for the Prescription Drug User Fee Act. It generates the vast majority of the federal government’s budget for reviewing new medications. And so it plays a huge role in determining how safe our health-care system is, and how quickly we get access to new drugs.

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Report: Romneycare no ‘budget buster’

The nonprofit Massachusetts Taxpayers Foundation has run the numbers on Romneycare, which recently celebrated its sixth birthday, and finds that the health insurance expansion hasn’t been the ‘budget buster’ that some expected.

“Additional state spending attributable to the health reform law accounted for only 1.4 percent of the Commonwealth’s $32 billion budget in fiscal year 2011,” the group finds.

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‘I thought, why not pair risk adjustment with Samuel L. Jackson’


(Payment Reform Made Meme)

Attention, wonks: We may have stumbled onto the world’s wonkiest Tumblr.

Payment Reform Made Meme launched yesterday, much to the delight of health-care nerds across the country. If you’ve ever wanted to see Simba and Mufasa from “The Lion King” discuss government regulation of health-care pricing, or see Ryan Gosling whisper sweet nothings about global payments, this would be your chance.

The Tumblr is the brainchild of Ari Fertig of Health Care for All Massachusetts. When I caught him this morning, he immediately described his meme-ifying of health-care policy as “by far the geekiest thing I’ve ever done.”

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‘I always had to call an ambulance to get up.’

‘I always had to call an ambulance to get up.’

The San Diego Union-Tribune is in the middle of a fantastic series that looks at health care’s “frequent fliers”: the 1 percent of Americans who account for 22 percent of national health-care spending. These heavy users tend to be disproportionately lower-income, with less access to health-care services, like the man that John Gonzalez and James Gregg profile:

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‘We should be better judges of when things are futile.’


(Vadim Ghirda - AP)
Last week, a new initiative called Choosing Wisely got a lot of positive attention for gathering nine medical specialty groups and coming up with 45 procedures that even doctors think doctors shouldn’t do. But a new study on end-of-life care suggests that actually implementing those recommendations will be difficult.

Researchers at the Dartmouth Atlas looked at how well cancer treatment facilities, from world-renowned institutions to community hospitals, did at following end-of-life care guidelines. The guidelines were drawn up by the National Quality Forum, in consultation with stakeholder groups, and include avoiding chemotherapy treatment in the last two weeks of life and reducing intensive care unit admissions. The new parameters were largely meant to respond to numerous studies showing that, at the end of life, cancer patients tend to want less aggressive treatment.

So these are, in other words, treatments that patients don’t think doctors should do. But they get done anyway.

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Forty-five procedures doctors don’t think doctors should do


(Christopher Furlong - GETTY IMAGES)
Doctors have many difficult conversations, whether they’re delivering a poor diagnosis or hashing out the best course of treatment. But one of the most challenging discussions, according to physician Lawrence Kosinski, is telling a patient “no.”

There’s a growing consensus that patients and their doctors need to have that conversation more frequently. Wasteful medicine costs the health care system an estimated $700 billion each year, and each unnecessary procedure comes with its own set of health risks. It was those factors that got Dr. Kosinski, who works with the American Gastroenterologists Association, involved in a new initiative called Choosing Wisely, which has partnered with nine medical speciality groups to identify procedures that doctors should not be doing. Each group was tasked with coming up with five specific items they would deem unnecessary.

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Dartmouth Atlas’s Skinner on high-cost hospitals

Dartmouth Atlas’s Skinner on high-cost hospitals

On Tuesday, I wrote about a new Massachusetts Institute of Technology study suggesting that more expensive hospitals in New York provided higher-quality health care. Those results seemed to contradict findings from the Dartmouth Atlas of Health Care, which has produced a stream of research suggesting that more spending doesn’t correlate with better-quality care. So I reached out to Dartmouth’s Jon Skinner, a researcher with the Atlas, to get his take.

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How Wall Street feels about Obamacare’s future

The Atlantic’s Matt O’Brien had the smart idea of looking at how Wall Street reacted to this week’s Supreme Court hearings on the health reform law. And it seems that markets are betting on one of two outcomes — either the law will be allowed to stand or be repealed entirely.

Insurance companies have predicted that one possible outcome — in which the court strikes the mandate, but allows the rest of the law to stand — could lead to doomsday. If there was no penalty for not buying insurance, the thinking goes, only those who expect high health care costs would buy policies. That would likely mean the cost of health insurance would spike. More expensive premiums would, for insurance companies, likely mean fewer customers and less revenue.

Coming out of this week’s argument, however, health insurance investors actually look incredibly bullish on the Affordable Care Act’s future. O’Brien points out that Aetna’s stock soared in the 24 hours since oral arguments wrapped up. And that actually looks to be true for the five largest health insurance companies, all while the Dow Jones average has remained pretty flat:

This could, as O’Brien points out, be really good news for Obamacare — or really bad.

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Obamacare ruling won’t affect Romneycare

Obamacare ruling won’t affect Romneycare

Reader Robert Howard asks, “If ACA’s individual mandate is repealed, could Romneycare be challenged/repealed as well?”

The short answer is: No, it couldn’t. The question in front of the Supreme Court is whether the federal government can require most citizens to carry health insurance. Even if the justices decide the federal government cannot do that, Massachusetts will still have a law on its books requiring all Bay State residents to buy coverage. That law will not be touched by a Supreme Court decision.

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Health care overhaul’s future depends on ‘wheat, pot, guns’

Politico’s Josh Gerstein has one of the more comprehensive — and more entertaining — run-downs of the case law that the Supreme Court will rely on when it opens oral arguments on the health reform law Monday:

No previous Supreme Court case is a perfect match for the Obama health care law, but a 70-year-old ruling about an Ohio wheat farmer comes closest.

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Don’t call it a primary care comeback

Today is a very big day for medical students: Earlier this afternoon, 38,377 of them found out whether they’d been accepted into one of the country’s 26,772 residency slots. It’s also a big day for the health care system too, as it gives us a sense of what kind of medicine our future doctors are interested in pursuing.

Each year, the National Resident Matching Program releases data on what kind of programs medical students are matching into. Over the past two years, it’s looked like medical students are increasingly interested in pursuing primary care. Between 2009 and 2011, the number of American students matching into primary care residencies increased by about 10 percent each year. That came after decades of declining interest, as you can see in the graph below. That shows the number of American students matching into family practice residencies, one type of primary care.

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In abortion battle, White House defunds Texas Women Health Program


Planned Parenthood President Cecile Richards. (Michael Ainsworth - AP)
After Texas blocked abortion providers’ participation in its Medicaid Women’s Health Program, the White House officially notified the state Thursday afternoon that it will pull all funds from the program, which totalled about $39 million last year.

Twenty-nine states participate in the Medicaid’s Women Health Program, which extends Medicaid coverage for reproductive health services to lower-income women who do not qualify for the rest of the entitlement program’s benefits. In Texas, the program served about 130,000 women, with the federal government footing 90 percent of the bill. About half of the clinics participating in the program would have been disqualified by the new legislation.

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Why isn’t there a Yelp for doctors?

The New York Times’ Ron Lieber asks why, as restaurant and other review sites flourish, nothing comparable has developed for doctors. Part of it has to do with legal complications of such reviews. It also hinges on what information is available:

Perhaps the biggest problem with the ratings is that they are incomplete. WellPoint tracks doctors’ communication skills, availability, office environment and trust, but it doesn’t yet provide information about medical outcomes. While it’s nice to know how long different obstetricians make you wait, it would also be helpful to know how many babies they end up delivering by Caesarean section.

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Poll: Health reform not more popular, but fewer think they’ll be worse off

In a new poll today, the Associated Press finds that fewer Americans believe their health care will actually get worse under the Affordable Care Act.

The Associated Press asked “As a result of the changes to health care that were passed by Congress in March of 2010, do you think it will probably cause you to get better health care, cause you to get worse health care, or not change the quality of health care you get?”

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Sizing up Medicare’s spending slowdown

Sizing up Medicare’s spending slowdown

Many have dismissed a recent slowdown in Medicare cost growth as temporary, a consequence of the economic downturn leaving Americans with less to spend on their medical care. Chapin White and Paul Ginsburg, however, beg to differ. Tracing the health-care spending slowdown back to 2005, they think we could be at the beginning of a more permanent trend:

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Study: CHIP doesn’t crowd out private insurance

The Children’s Health Insurance Program, the state-federal program that covers lower-income children, has expanded eligibility significantly in recent years. Between 2002 and 2009, 13 states increased the income threshold for CHIP to between 200 and 400 percent of the federal poverty line.

But the practical implications of those big expansions, a new National Bureau of Economics Research paper suggests, is actually quite limited. It turns out that the higher income populations targeted by these expansions actually enroll in the program at very low rates:

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