The US health system was already falling short. Then Covid-19 happened.
https://www.vox.com/policy-and-politics/22555949/us-health-care-system-ranking-covid-19-pandemic
Tag: health
Why food and housing assistance is essential for improving America’s health
“There is an underappreciated contributor to the United States’ comparatively poor health: We underinvest in social services that help people live healthier lives and therefore overspend on medical care relative to other developed countries.
The long-term trends in US health care, as I wrote about earlier this week, tell a clear story: Medical outcomes have gotten better, with measures of life expectancy and disease burden improving over the last 25 years, but they haven’t improved as much as they have in other wealthy nations that spend less money on health care than the US.”
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“If you combine social services spending with health spending, the US and its peers spend about the same amount of money (a little more than 30 percent of their respective GDPs). But spending in those other countries is weighted more toward social support — food and housing subsidies, income assistance, etc. — whereas America spends more on medical care.”
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“Eighteen percent of people in the US live in poverty, compared with 10 percent in other wealthy countries. And we know that people with lower incomes face many structural challenges — lack of access to healthy food, clean water, and fresh air, for starters — that lead to worse health outcomes. When they get sick, they have a harder time both finding a doctor and affording their medical care. In general, they also live with more stress and anxiety than people who make more money, which also has deleterious effects on their health.”
With Houston hospitals filled by COVID patients, man shot 6 times 10 days ago is still waiting for surgery
“It’s been 10 days since Joel Valdez was shot outside of a Houston grocery store, and he still hasn’t been able to undergo surgery, due to his hospital being overcrowded with COVID-19 patients.”
Skeptics question if Biden’s new science agency is a breakthrough or more bureaucracy
“The proposed Advanced Research Projects Agency would deliver breakthrough treatments for cancer, Alzheimer’s, diabetes and other diseases and reshape the government’s medical research efforts, by adding a nimble new agency modeled on the Pentagon’s Defense Advanced Research Projects Agency, or DARPA, which laid the groundwork for the internet.
But the way Biden would make “ARPA-H” and its $6.5 billion budget part of the sprawling National Institutes of Health is raising concern within the research community and in Congress about whether it will bring a new approach to old problems or become a duplicative bureaucracy with a lofty mandate.
“Most of us did not support putting this in NIH, for the simple reason that if NIH were capable of doing this, it would have done it,” said one person outside the government familiar with the planning who’s worried NIH’s staid culture and leadership will bog down the effort.
A half dozen individuals both inside and outside the administration who were involved in discussions about the plan told POLITICO there are alternative approaches being discussed, like putting ARPA-H well outside of Washington, to escape some of the Beltway’s inertia and turf battles. More autonomy could, in theory, speed up the way scientific discoveries are turned into drugs and diagnostic tests.
But the prevailing view is that making the new agency part of NIH’s infrastructure will give it a foundation to spring off — and foster communication to head off unnecessary duplication. As Congress prepares for hearings on the first budget proposal, administration officials are expressing confidence ARPA-H can carve out a distinct identity, wherever it is.”
The public option is now a reality in 3 states
“Washington state first approved its public option in 2019 and made it available to consumers for enrollment in 2020. The state now has a year of experience getting the Cascade Care program up and running, and it’s already starting to tinker with the policy design. It’s also offering lessons for Colorado and Nevada (the other state to pass a public option this year, one week before Colorado).
As these states have drawn up their plans, one thing has become clear: The potential value of a public option is in keeping health care costs in check by keeping rates lower than those of private insurance plans. But it still remains to be seen whether a public option can expand health coverage to more people.”
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“None of the states offer a “public” option like the one Congress contemplated in 2009, where the government sets up and administers its own health insurance plan.
“None of them are true public options in that sense,” says Katie Keith, who writes about insurance reform for Health Affairs and consulted with states as they developed public option legislation.
Instead, she compares them with public-private partnerships. States are contracting with private companies to create new insurance options to be overseen, if not run, by the government. States would face practical challenges to doing a “true” public option — namely, building up the financial reserves they’d need to pay out claims — so they’re taking another approach wherein private insurance companies will run the public option under rules set by the government.”
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“The plans will be sold on the ACA marketplaces, alongside ACA-compliant private insurance. Only people who are eligible for ACA coverage through the individual and small-group market can sign up”
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“How much to pay health care providers is the most important issue for any health insurance plan — those prices dictate the premiums charged to customers — and these states are taking divergent approaches in their calculations.”
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“One challenge in trying to set lower provider rates is that doctors and hospitals might simply choose not to accept the public option plan. That was Washington’s experience in its first year: Some hospitals refused to contract with the public plan, and since an adequate provider network isn’t possible without a hospital, the plan has only been available in 19 of the state’s 39 counties.
Washington is trying to correct that issue through recently signed legislation that will, among other things, require hospitals in large systems to participate in at least one public option plan. Nevada and Colorado, having seen Washington’s network-adequacy issues, are setting up their own provider participation requirements from the start.”
How to supercharge vaccine production for the next pandemic
“But it’s one thing to come up with a vaccine, and entirely something else to manufacture it on a mass scale. That’s where the world has stumbled and where concerted planning now can make sure we’re prepared for the future. If we’re to have a better chance to fight the next pandemic — and there will be a next one — the US needs to build on these vaccine tech innovations and make investments to establish permanent facilities producing mRNA and adenovirus vaccines.”
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“that slack won’t arrive naturally.
Weber, the former assistant secretary of defense for biodefense, has pushed for what he dubs a “10 + 10 Over 10” plan to prevent biological threats in the future. It is essentially a big government investment that could enable the kind of infrastructure necessary to have gotten to full vaccine availability in the US in, say, one or two months, not five.
The plan calls for $10 billion in additional annual funding for the Department of Defense, and another $10 billion per year for the Department of Health and Human Services, devoted to anticipating pandemic and other biological risks, for at least 10 years.
With that funding, government could finance the infrastructure for year-round vaccine manufacture.”
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“The key is that these facilities need to be active during non-pandemic times, otherwise their expertise and readiness could deteriorate.”
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“Pharmaceutical companies are not going to go this big on their own, and there’s no guarantee that the government will fund them sufficiently without pressure. In 2020 — during the pandemic — the Trump administration cut the DOD’s chemical and biodefense programs by 10 percent, with much of the cuts going to the vaccine component of the budget. To set this vision in motion, the US needs to not just reverse cuts like that but spend much more, in line with Weber’s $20 billion per year proposal.”
Marijuana and Pregnancy: What Does the Science Say?
“Studies on marijuana use during pregnancy are inconsistent and inconclusive. But cannabis is not known to be teratogenic—that is, to cause birth defects—in humans. The bulk of scientific evidence suggests that risks posed to developing fetuses are relatively minor and babies exposed to marijuana in utero still fall within normal ranges of outcomes.
A 2020 review looked at longitudinal studies on “the impact of prenatal cannabis exposure on multiple domains of cognitive functioning in individuals aged 0 to 22 years” and found that “evidence does not suggest that prenatal cannabis exposure alone is associated with clinically significant cognitive functioning impairments.” Researchers did note some differences—”those exposed performed differently on a minority of cognitive outcomes (worse on < 3.5 percent and better in < 1 percent)" — although "cognitive performance scores of cannabis-exposed groups overwhelmingly fell within the normal range." A 2016 review of studies on potential ties between in utero marijuana exposure and adverse birth outcomes—things like low birth weight and preterm delivery to miscarriage and stillbirth—found "maternal marijuana use during pregnancy is not an independent risk factor for adverse neonatal outcomes after adjusting for confounding factors." Instead, any increases in adverse outcomes appeared "attributable to concomitant tobacco use and other confounding factors."" ... ""The best new evidence on this comes from a 2019 study out of Canada," Oster writes. Matching women who used cannabis with demographically similar women who didn't, researchers did "find evidence of worse birth outcomes among the cannabis users," including "an increased risk of prematurity and NICU transfer. The increases are moderate but statistically significant: preterm birth occurred in 10% of cannabis users and 7% of non-users." An August 2020 study from the same authors found marijuana use correlated with slightly higher incidences of intellectual disability and learning disorders, as well as higher chances of having autism spectrum disorder. "The percent increase is large—about 50%—and significant," Oster points out, though the researchers do note that the overall incidence rate is still small. Though the researchers tried to demographically match participants between groups, it can still be hard to totally compensate for the ways marijuana users may differ from non-users." ... "The biggest problem is that it's hard to isolate specific factors like marijuana consumption. The population of women who not only use marijuana during pregnancy but are also willing to admit to researchers that they do may differ from those who don't." ... "A review of evidence published in February 2020 "points to the possibility of lower birth weight, diminished IQ and more behavior problems among children whose mothers used cannabis during pregnancy, but notes it is very difficult to separate the marijuana use from other demographics or other variables,"" ... " With the limited evidence available, it may make sense for most pregnant women to avoid marijuana to minimize possible risks to their offspring. But the best choice for one woman and her baby won't be the best choice universally. For women who have extreme morning sickness that makes getting adequate nutrients through food and vitamins difficult, and for whom marijuana mitigates nausea, using cannabis might make sense. Likewise, women with certain mental health conditions helped by marijuana may deem it safer than their usual prescription drugs."
The Government Is Making Us Fat and Susceptible to Viruses
“In all the coronavirus coverage, one issue that rarely makes the headlines is the correlation between body weight and the severity of COVID-19’s effects. And one angle that virtually never makes the headlines is how the government funds the unhealthy foods that increase obesity rates, thereby increasing our susceptibility to such diseases.
Last month the Centers for Disease Control and Prevention (CDC) released a study showing that nearly 80 percent of those hospitalized with COVID-19 were overweight or obese. After age, body weight is the second greatest predictor of COVID-related hospitalization and death. Almost three quarters of all Americans ages 20 and up are overweight, and close to half of that group is considered obese.”
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“Not only is the U. S. government not making any efforts to reduce the obesity epidemic, it is actively subsidizing food that contributes to the problem. The U.S. Department of Agriculture recommends that people fill half their plate with fruits and vegetables, yet the vast majority of its food subsidies—$170 billion from 1995 to 2010—go toward the major ingredients of junk food, such as corn, wheat, rice, soy, and milk.”
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“We have the power to make real changes in the way we eat and move. The government could help that process by taking its thumb off the scale and ceasing to subsidize these foods.”
Medicaid for Kids could pay for itself
“examining how the rollout of Medicaid in the late 1960s affected people who were children at the time.
If you got health insurance through the program as a child, he found, you were less likely to die young; you were likelier to be employed and less likely to have a disability as an adult; and all these benefits actually wound up saving the government money.”
Private equity ownership is killing people at nursing homes
“When private equity firms acquire nursing homes, patients start to die more often, according to a new working paper published by the National Bureau of Economic Research.
Private equity acquisitions of nursing homes is a pressing topic: Total private equity investment in nursing homes exploded, going from $5 billion in 2000 to more than $100 billion in 2018. Many nursing homes have long been run on a for-profit basis. But private equity firms, which generally take on debt to buy a company and then put that debt on the newly acquired company’s books, have purchased a mix of large chains and independent facilities — making it easier to isolate the specific effect of private equity acquisitions, rather than just a profit motive, on patient welfare.
Researchers from Penn, NYU, and the University of Chicago studied Medicare data that covers more than 18,000 nursing home facilities, about 1,700 of which were bought by private equity from 2000 to 2017.
Their findings are sobering.
The researchers studied patients who stayed at a skilled nursing facility after an acute episode at a hospital, looking at deaths that fell within the 90-day period after they left the nursing home. They found that going to a private equity-owned nursing home increased mortality for patients by 10 percent against the overall average.”
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“the increased mortality is concentrated among patients who are relatively healthier. As counterintuitive as that may sound, there may be a good reason for it: Sicker patients have more regimented treatment that will be adhered to no matter who owns the facility, whereas healthier people may be more susceptible by the changes made under private equity ownership.
Those changes include a reduction in staffing, which prior research has found is the most important factor in quality of care. Overall staffing shrinks by 1.4 percent, the study found, but more directly, private equity acquisitions lead to cuts in the number of hours that front-line nurses spend per day providing basic services to patients. Those services, such as bed turning or infection prevention, aren’t medically intensive, but they can be critical to health outcomes.”
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“The combination of fewer nurses and more antipsychotic drugs could explain a significant portion of the disconcerting mortality effect measured by the study. Private equity firms were also found to spend more money on things not related to patient care in order to make money — such as monitoring fees to medical alert companies owned by the same firm — which drains still more resources away from patients.”
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“The researchers make a point in their opening to stipulate that private equity may prove successful in other industries. But, they warn, it may be dangerous in health care, where the profit motive of private firms and the welfare of patients may not be aligned”