CBS This Morning Report on UPMC

CBS This Morning ran a story on profiteering at UPMC today.  For those of you who couldn't see it it can be seen here.  Also there is a profile of Julie Sokolow and Scott Tyson in the Journal Healthcare Financing News. 

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Legislature Polarization and Single Payer Prospects

I came across this chart while looking at Kevin Drum's blog at Motherjones.com.  It summarizes the results of a study measuring the amount of political polarization in all 50 state legislatures compared to the US Congress. They looked at the roll call voting record of each legislator from 1996-2009 for both houses (and Nebraska which has a unicameral legislature) to see how polarized their record was and ranked each member within their party.  The difference in the polarization between the members ranked in the middle of their party determines the polarization scores of the legislature. 

The US Congress, which has left John Conyers' HR 676 single payer bill in committee has a score of 1.2.  California, which almost passed single payer in 2010, had by far the highest polarization score at 2.5 while Vermont which did pass a single payer bill in 2011 has a score of 1.3.  Montana and Hawaii which are considering bills have scores of 1.6 and 0.9 respectively.  Our state, Pennsylvania of course, has a score close to the US Congress at 1.1 (I'm extrapolating from the graph for these numbers).  Louisiana had the lowest polarization at 0.5.

So what do these numbers mean for single payers prospects in the PA legislature with our new economic impact study?  As the film Lincoln artfully demonstrates raw numbers of votes are most important.  California, though polarized, had a large democratic majority which almost passed the bill.  Vermont is less polarized and passed their bill. 

Polarization in legislatures can fluctuate over time but averaged across years and houses can remain relatively stable.  Their original study plus the raw data can be downloaded here.

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Medicaid Expansion Battle Moves to the State Legislatures

Via: The Advisory Board Company 

The Maine legislature has passed Medicaid expansion that Gov. Paul LePage R says he will veto.  The Medicaid expansion map from the advisory board company has now filled up with 26 states saying they will participate (in dark blue above), 1 (New York) saying they are leaning toward participating, 4 in light blue saying that they are pursuing alternative forms of implementation, 5 in light red saying they are leaning toward not participating, and 14, including Pennsylvania and Maine, saying that for now they are definitely not participating.  

The Texas legislature has voted with Gov. Rick Perry in refusing Medicaid expansion though an estimated 26% of it's population has no insurance.  The Pennsylvania Health Access Network has been lobbying the PA legislature to reverse Gov. Tom Corbett's decision on expansion much as Healthcare for All PA has been pushing a single payer solution for Pennsylvania.  

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The Wall Street Journal has a report on how employers are looking at bare bones insurance plans to control costs  (subscription needed to read online) that they are required to provide under the Affordable Care Act (aka Obamacare).  This comes as little surprise to Single Payer advocates who know that a nonprofit healthcare system is most efficient at providing care and controlling costs as our economic impact study shows.  Canadian Ellen Page eloquently defends her country's healthcare system against right wing critics below.  This is our 150th post.

The Daily Show with Jon Stewart
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In a follow up to Jon Stewart's extended interview with Steven Brill of Time Magazine on health care costs, Stewart did this one on other media following up on Brill's piece.   HealthCare for All PA has an economic impact study which projects that a single payer system could save the state about $17 billion per year.  Past Pennsylvania Public Health Association President Walter Tsou discusses the study at length below.

This Saturday the SW PA chapter will have a meeting to discuss how to promote the study and the Single Payer bill (SB 400) this Saturday, May 18 at 10 AM.  It will be at the Murray Ave office.  See the Contact Healthcare for All PA/PUSH tab above for directions.




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Julie Sokolow Has a Video Entered Into a Competition at Challengepost

Julie Sokolow of Healthy Artists has produced a three minute video titled A Healthy Democracy which can be seen above.  She has also written many blog posts on Michael Moore's website on healthcare.  Her video is entered into a competition at challengepost.com

You can vote for her video and watch other submissions by clicking here.  Voting ends next Thursday May 16. 

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Big News From Oregon--Not All of It Good

There is study in progress with a randomized control group design—the gold standard of evaluation research—to evaluate the effects of Medicaid expansion in Oregon. The second wave of results from that study were published yesterday. To summarize briefly, Oregon wanted to expand Medicaid but didn't have enough money. They invited anyone who was eligible to apply, and 90,000 people applied. They then randomly selected 10,000 of them to receive Medicaid, while the others became eligible for the control group. The first wave of results, with about 6000 adults in each group, showed that the Medicaid recipients were more likely to rate themselves in “good” or “excellent” health, were less likely to report a recent decline in their health, had more doctor and hospital visits, more preventive care, and fewer unpaid medical bills.

Unfortunately, the second wave study, published in the New England Journal of Medicine, is gated, so I am relying on the abstract and a summary by Aaron Carroll and Austin Frakt in The Incidental Economist blog.

The corporate media are spinning the second wave study as showing Medicaid expansion to be a failure. For example the New York Times says:

It found that those who gained Medicaid coverage spent more on health care, making more visits to doctors and trips to the hospital. But the study suggests that Medicaid coverage did not make those adults much healthier, at least within the time frame of the research . . .

Later the article notes that Medicaid expansion under the Affordable Care Act will be costly. “Health economists anticipate that new enrollees to the Medicaid program will swell the country's health spending costs by hundreds of billions of dollars over time,” it warns. If you go online and check the comments following any article about the study, you'll find that it has unleashed a torrent of criticism from the political right claiming that providing health care for the poor is a waste of money. The study is certain to be used by Republicans such as Pennsylvania Governor Tom Corbett to justify their opposition to Medicaid expansion.

So what does the second wave study actually show? First, the bad news. The three objective indicators of physical health, blood pressure, cholesterol and blood sugar level, were all lower in the Medicaid group than the control group, but the differences were not statistically significant. Here are the data. (HDL is “good” cholesterol, so the fact that there are fewer people with low HDL cholesterol in the Medicaid group is a good outcome. High hemoglobin A1c is high blood sugar.)

Now the good news. Medicaid reduced the incidence of depression by 30%, which was statistically significant. It also significantly increased preventive care, including a 50% increase in cholesterol monitoring, a doubling of mammograms, and an increased likelihood of being diagnosed with diabetes.

Finally, the economic news. Health care spending was 35% higher in the Medicaid group. Of course, Medicaid practically eliminates catastrophic medical costs. As a result, the Medicaid recipients were significantly less likely to report borrowing money or skipping other bills in order to pay medical expenses.

There are several reasons we should not accept the conservative rush to judgment that this study shows that Medicaid is not helpful.

• Medicaid recipients were healthier on all three measures of physical health. The problem is that the differences were not statistically significant. There are several reasons why that might be the case, but the most likely is that the sample sizes were too small to detect the effect. The authors state:
  
  
  [O]ur power to detect changes in health was limited by the relatively small numbers of patients with these conditions; indeed, the only condition in which we detected improvements was depression, which was by far the most prevalent of the four conditions examined. The 95% confidence intervals for many of the estimates of effects on individual physical health were wide enough to include changes that would be considered clinically significant . . .
  
  
• These data were collected only two years after the program began. The significant differences in preventive care suggest that greater differences in health might emerge in later waves of the study.
  
  
• Mental health is also health, and significant differences in depression should not be dismissed as unimportant. Financial hardship also matters, and its absence may be related to the lower incidence of depression in the Medicaid group.
  
  
• There is no comparable study of the health effects of private health insurance, so these data should not be used to infer that Medicaid is any more expensive or less effective than private insurance.
  
  

Let's do a thought experiment. Suppose you had a private health insurance policy, researchers did a study to evaluate its health effects that was comparable in size, duration and design to the Oregon study, and obtained identical results. That is, the policy holders' health was better, but not significantly better than people without insurance. Would you cancel your policy? One of the reasons people buy health insurance may be that they think it will make them healthier, but it is my guess that the primary reason people in this country buy health insurance is to guard against the financial consequences of catastrophic illness.

You may also be interested in:

Tom Corbett to PA's Working Poor: “Drop Dead!” Part 1. Medicaid improves Health and Saves Lives.

Tom Corbett to PA's Working Poor: “Drop Dead!” Part 3. What Medicaid Expansion Would Mean to Pennsylvania

Medicaid Expansion Update