The Incidental Economist

U.S. medical ‘trash’ saving lives abroad, reports Allie Torgan. “Doctors will often prepare for surgical procedures by opening instrument and supply kits that contain up to 100 items. Many of these items, such as scalpels, needles or sponges, go unused; they’re just not needed for that particular procedure. But because of government or hospital regulations in the United States, they are frequently thrown away, even when they are still wrapped.” Aaron’s comment: It’s great to see this “trash” being used to save lives in under resourced settings. But I bet there are parts of America that could benefit from them as well.

Innovative venture between BCBS NC and UNC Health Care opens today, writes David Ranii. The largest insurer in North Carolina and the University of North Carolina health system are opening a joint primary care venture that plans to care for 5,000 patients. Don’s comment: the new venture is called Carolina Advanced and the principals say it was spurred on by the ACO regs put forth in the ACA; their goal is to better coordinate the treatment of heart disease, diabetes and other common ailments. I wrote about it last winter on my old blog. Some other recent blog posts about this local health care market focused on integration/aggregation of market power here and here and here.

The CDC has released a report on prescription painkiller overdoses in the US. “One in 20 people in the United States, ages 12 and older, used prescription painkillers nonmedically (without a prescription or just for the “high” they cause) in 2010… Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008. This is more than 3 times the 4,000 people killed by these drugs in 1999.” Aaron’s comment: I don’t have much to add other than this is a serious problem, and since we’re writing the prescriptions, doctors should be aware.

Farmers contest revised child labor laws, writes Ana Campoy. The new rules would prohibit persons younger than 16 who are not the children of farmers from operating machinery, doing tasks with animals, and working in grain silos. Don’s comment: I was a hired hand on a tobacco farm beginning at age 11-18 and performed many of the tasks that will be banned. I never thought much of it, was given training, and this experience provided me with many good life lessons. However, the statistics on risk to children in farming (esp from tractor accidents) are sobering, and there is no way I would let my 14 year old son do what I did on a farm when I was 14. So, I have mixed feelings, but this seems the correct step.

Health care provision and distribution problems are among “contemporary capitalism’s numerous flaws,” writes Ken Rogoff. The health care market “fails to satisfy several of the basic requirements necessary for the price mechanism to produce economic efficiency, beginning with the difficulty that consumers have in assessing the quality of their treatment. [...] In health care, perhaps more than in any other market, many countries are struggling with the moral dilemma of how to maintain incentives to produce and consume efficiently without producing unacceptably large disparities in access to care. It is ironic that modern capitalist societies engage in public campaigns to urge individuals to be more attentive to their health, while fostering an economic ecosystem that seduces many consumers into an extremely unhealthy diet.” Austin’s comment: Rogoff is right. If you examine our deeds, collectively, and not our words, we clearly want to behave in ways that are bad for health while hoping someone else will pay for the costs of doing so. That Rogoff counts this as a fundamental flaw of capitalism and devoted three paragraphs of a short opinion piece to it is notable.

Two from Igor Volsky:

“IPAB to stay for at least another year: ’Rep. Phil Roe (R-TN) acknowledged that the House simply doesn’t have time to take up his bill to repeal the Independent Payment Advisory Board (IPAB), which Republicans refer to as the law’s “rationing board.”’ [The Hill]” Austin’s comment: The IPAB is forbidden by law to “ration.”

“Enrollment in Medicare Advantage continues to grow: Medicare Advantage continues to surge in popularity among seniors and its premiums continue to fall, contradicting Republican predictions that President Obama’s health care law would halt the program’s recent and rapid expansion.’ [Washington Times]” Austin’s comment: This is just dripping with irony. On the one hand, Democrats are counting it as a success that MA has not decreased in popularity when many of them would very much like to see it do just that. On the other, Republicans may have warned that there’d be a rapid retrenchment in MA availability and benefits and, in time, it is expected there will be. The GAO report the Washington Times references says just that, as does my own research.

The Department of Justice appealed the District of Columbia court ruling that blocked the graphic tobacco warnings. Kevin’s comment: Previous TIE coverage here.

Central banks seek to backstop global financial system, writes David McHugh and Paul Wiseman. Coordinated efforts by central banks around the world seek to make it easier for businesses to borrow money, hopefully forestalling a global recession. Don’s comment: I am not sure if these efforts will work, or even what the definition of what work means, but if the U.S. and the rest of the world slip into a recession, then all of the short, medium and long range fiscal problems discussed on this blog will be even worse as tax revenues fall. Even the scary scenarios a decade out assume some consistent economic growth over the period.

Via Igor Volsky: “Republicans push for greater means testing in Medicare: ’Republicans are proposing means-testing Medicare in order to pay for an extension of the payroll tax cut, The Hill’s Bernie Becker and Erik Wasson report. The idea of reducing federal benefits for higher-income earners was embraced by President Obama during the recent debt negotiations.’ [The Hill]“ Austin’s comment: Means testing already exists in Medicare. AARP opposes more of it.

HIV/AIDS is a neglected disease in the Southeast United States, writes The Chart Blog (CNN). The blog discusses Dr. Vincent Marconi’s work in South Africa and the Southeast, and he notes connections between the epidemic in these divergent locales (link has great map). Don’s comment: My good friend and colleague at Duke Kate Whetten has an interesting book “You’re the First One I’ve Told: The Faces of HIV in the South” that draws many parallels to the HIV/AIDS epidemic in sub-Saharan Africa and the rural South.

Austin is pressed for time, so here’s a special “lightening round” Reflex contribution from him. (Yes, this is faster because I’m not writing my own blurbs. Maybe I should always do it this way.)

The first two are via the KHN First Edition post:

“The Washington Post: Democrats To Attack Republicans For Pushing Medicare Cuts. The Democratic Party will begin a campaign on Wednesday to attack Republican lawmakers for pushing cuts to Medicare benefits during the latest round of failed federal deficit talks, a new turn in a drama that not long ago featured top Democrats expressing a willingness to tinker with the popular entitlement program (Wallsten, 11/29).” Austin’s comment: It’s no surprise that there is more than policy differences at play here (though there is that). There is politics, which is fueled by and fuels a lack of inter-party trust. More on that from me next week (I think).

“Kaiser Health News: Study: Employers Could Dump Sickest Employees On Public Health Care. Elizabeth Stawicki, from Minnesota Public Radio News, filed the following story as part of a partnership with Kaiser Health News and NPR: ‘A loophole in the federal health care overhaul could allow employers to game the system by getting their sicker employees to opt into buying coverage on the health insurance exchanges, according to two University of Minnesota law professors’(Stawicki, 11/30).”  Austin’s comment: The study is here. I’ll read it later. (H/t Dan Diamond.)

And, via Igor Volsky:

“GingRomney care: ’If Republicans are flocking to Newt Gingrich to get away from Mitt Romney’s health care problems, they could end up with a nominee with … awfully similar health care problems. Or maybe worse: While Romney signed a state mandate into law, Gingrich once went a step further and advocated a federal one.” [Jennifer Haberkorn]‘” Austin’s comment: We all know that many conservatives were for the mandate before they were against it. Likely any viable candidate with no record in support of a mandate could also be pinned with the charge of insufficient experience. If you’ve been thinking about health policy for a long time, you probably have some pro-mandate statements in your past.

Dogs detect diabetics’ trouble, writes Kinsey Sullivan. A non-profit called Eyes Ears Nose and Paws is training dogs to assist diabetics. Don’s comment: This group is training dogs to detect dangerously high blood sugar levels, to nudge people to respond, and to summon 911 if they are unable via a canine-rescue phone. The cost of a trained dog is around $20,000. It would be interesting to see a cost effectiveness evaluation of this approach; it is cool in any event.

Seton Hall Law just hosted a terrific symposium on ACOs.  Kevin’s comment: ACOs are a simple concept with exceedingly complex implementation issues. H/t to Frank Pasquale who blogged it here

The doc fix crisis is back (AP). “Unless Congress acts before Jan. 1, doctors will again face steep Medicare cuts that threaten to undermine health care for millions of seniors and disabled people. This time it’s a 27.4 percent cut.”  Austin’s comment: Expect a lot of hand-wringing and proposals for long-term fixes over the next month or so. My prediction: Congress will do what it has done many times before, implement an interim patch.

Cara Wiri Dineen identifies the 8 germiest places in the Mall. Restroom sinks and food court tables top the list. Don’s comment: File this under ‘more good reasons to not go shopping on Black Friday’ or really, any time so long as you can shop online (today is Cyber Monday). Of course, many risked the mall on Friday, breaking a Black Friday record ($52.4 Billion spent).

This post is jointly authored by Don Taylor and Austin Frakt.

The LSE Impact blog has an interesting post on the increasing use of twitter by academics. They find that around 1 in 40 academics use twitter, with 30% of their tweets being related to their scholarship. We at TIE love twitter and the ability to both speak and listen via this important tool. However, the post goes a bit overboard here:

We might do away with journals entirely. The Web can disseminate and archive products for almost nothing. The slow, back-room machinations of closed peer review could be replaced by an open, accountable, distributed system that simply listens in to expert communities’ natural reactions to new work – the same way Google efficiently ranks the Web by listening in to the crowdsourced ‘review’ of the hyperlink network.

The CDC reports on physician assistant and advance practice nurse care in hospital outpatient departments: United States, 2008–2009. “Hospital outpatient department visits attended only by physician assistants (PAs) or advance practice nurses (APNs) increased by 50% from 2000–2001 (10%) through 2008–2009 (15%).” Aaron’s comment: The whole report is worth a read. This is a trend that’s likely to continue. Mid-level practitioners offer a cost-effective solution to the doctor shortage in the United States in many areas.

According to analysis by Avalere, hospitals will be hardest hit by triggered Medicare cuts, reports Sam Baker (The Hill). Avalere’s analysis says Medicare will be hit with $123B in cuts to providers. “[T]he provider cuts break down as follows: 32 percent to inpatient hospital care, 15 percent to Medicare Advantage plans, 12 percent to physicians, 8 percent to outpatient hospital care, 7 percent to nursing homes, 4 percent to home health agencies, 3 percent to a small portion of the Medicare prescription drug benefit not exempt from the trigger.” Austin’s comment: This is all on top of cuts designated by the ACA. Relative to what private insurers pay hospitals and according to the CMS Office of the Actuary, those ACA cuts look like this: 

If you think this is problematic, I agree with you.

Pay cut for docs looms as debt panel flops, report Haberkorn and DoBias in Politico Pro. “If the super committee reports that it can’t reach a deal — or that it has a small deal that doesn’t include a fix — the committees will have only about five weeks to pass a bill to thwart a 27-percent cut called for by the Sustainable Growth Rate.” But the 27% pay cut is unlikely, reports Brittany Davis. “That’s why, most experts say, the chances of Congress allowing the SGR to go into effect are slim. ‘It’s never been implemented and it’s never going to be implemented,’ said Joe Baker, at the Medicare Rights Center.” Aaron’s comment: I think the experts have it right. I doubt that a 27% pay cut is ever going to happen. However, I think the 2% pay cut that the trigger might require is a real possibility.

WakeMed and Rex Healthcare purchase more practices, writes David Bracken. Two physician practices affiliate with rival hospital systems in Raleigh, N.C. Don’s comment: A small, local story, that is just another step toward the aggregation of medical practices by hospital/health care systems. Some of my past blogging focusing on these issues in the Research Triangle part of N.C., here, here, here, a related TIE FAQ on the effect of hospital concentration on prices, and how concentration could be good.