That Beloved Hospital? It’s Driving Up Health Care Costs – NY Times

It’s not just us local critics of our expensive hospital talking about the rising costs, but a national discussion. Journalist and physician brings up some sobering thoughts and why we are unlikely to see any change in this situation.

Data shows that hospitals are by far the biggest cost in our $3.5 trillion health care system, where spending is growing faster than gross domestic product, inflation and wage growth. Spending on hospitals represents 44 percent of personal expenses for the privately insured, according to Rand

A report this year from researchers at Yale and other universities found that hospital prices increased a whopping 42 percent from 2007 to 2014 for inpatient care and 25 percent for outpatient care, compared with 18 percent and 6 percent for physicians.

Shocking statistics for Jefferson & Clallam Counties in opioid database from Washington Post.

In the battle to determine who is to blame for the opioid epidemic that has killed more people than Viet Nam, it turns out that not only was West Virginia a capital of opioid prescriptions, but Clallam County was also. Between Jefferson and Clallam Counties, in a six year period both counties received and distributed over 43 million opioid pills!

According to the Washington Post that reformatted the data into searchable form, from 2006 to 2012 there were 5,817,030 prescription pain pills, enough for 28 pills per person per year, supplied to Jefferson County, Wash. Safeway was the largest distributor, selling 2,331,220 pills. Don’s pharmacy came in at 1,367,550 pills distributed, behind second place QFC in Hadlock.

But even those numbers were dwarfed by Clallam county, who distributed 37,838,060 prescription pain pills, enough for 76 pills per person per year.

•18,067,280 of the pills in Clallam County were distributed by McKesson Corporation and 19,907,900 were manufactured by SpecGx LLC.

JIM’S PHARMACY, PORT ANGELES pharmacy received the highest number of pills. They distributed 5,280,190 pills. But Chinook Pharmacy in Forks was not far behind with over 4.6 Million pills distributed.

It is clear to anyone following this story that a number of people are at the root cause of this human tragedy. Let’s count the ways:

  • There is clear evidence now that the pharmaceutical companies lied to the public and the government. Lawsuits underway have established that fact. Their salespeople spread misinformation about the products.
  • The Federal government, lawmakers, FDA and others, blindly took the word of the drug companies as to the safety and efficacy of these drugs.
  • The medical community bought the medical findings and the pharmaceutical sales peoples pitches. This included the medical providers at our local hospital, Jefferson Healthcare. This can be seen as a damning indictment of the the medical providers there, along with the administration of the hospital and it’s hospital commissioners. Who was watching the amount of pills being provided to patients? There were clear signs that there were problems with opioid prescriptions much earlier than 2012. What was Jefferson Healthcare doing to monitor their staff?
  • At the same time the medical professionals at JHC were writing all these prescriptions for opioids, they were well aware of problems with them,because Dr. James Kimber Rotchford was treating many of their patients for abuse of these same pain killers at his independent clinic, Olympic Pain and Addiction Services . It was widely known within the local medical community and a number of these providers were quite dismissive of Dr. Rotchford’s efforts. Dr. Rochford’s clinic was raided by the DEA in 2010 but was cleared of any wrongdoing. The basis for the raid was never uncovered.
  • The pharmacies ignored clear warning signs that vastly too many pills to make sense were being sold for their communities.

The outcome was a trail of broken lives, broken communities, massively enriched sales people and companies, many of whom then recycled these gains into political candidates campaign chests.

Read the whole story

https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/?utm_term=.9591a96b0d8e

Supplements and diets for heart health show limited proof of benefit. NY Times

It’s always interesting to see that many of the supposed benefits of these supplements are once again debunked by scientific study.

www.nytimes.com/2019/07/08/well/eat/supplements-and-diets-for-heart-health-show-limited-proof-of-benefit.html

“People who are taking these supplements for the sake of improving their cardiovascular health are wasting their money,” said Dr. Safi U. Khan, an assistant professor at West Virginia University School of Medicine and the lead author of the new study.

In win for hospitals, Supreme Court rules DSH change violated law – Healthcare Dive

The Supreme Court temporarily have saved hundreds of hospitals from losing substantial benefits to help Medicaid and uninsured patients. Justice Neil Gorsuch,writing for the majority, ordered Health and Human Services to go back and get written comment from the public.

This is the outcome of voters electing a Republican Congress and President who are only out to slash costs regardless of the outcome to hospitals and patients. If this goes through, look for even more critical care hospitals to shutdown.

https://www.healthcaredive.com/news/in-win-for-hospitals-supreme-court-rules-dsh-change-violated-law/556054/

Many Hospitals Charge Double or Even Triple What Medicare would pay – NY Times

While our PT hospital is not named in this study, this article is relevant because Jefferson Healthcare is *allowed* to charge much higher rates that competing hospitals, since we are deemed “rural”. Yes, it’s strange that a hospital only 60 miles from a gigantic urban center could be considered rural, but that is what it is. And given the experiences that myself and others I’ve interviewed have shown, JHC is significantly overcharging for many of it’s procedures. The medical staff (doctors, PAs etc) are not aware of the pricing, as it’s all done by the billing department. But the watchword is that if you are going to go in for any kind of procedure that allows you the time to shop around, do so. I have been quoted $500 for a three view x-ray, and Sequim quoted me $250 while Poulsbo quoted me $150 and I ended up paying less than $50.

It is important to note that Medicare does *NOT* pay enough to make many hospitals profitable, or even break even. There is a very real threat to JHC if the Medicare For All proposals of Bernie Sanders and others are actually put into law, without government funding for hospitals that care for high Medicare/Medicaid populations, such as Jefferson County. We could lose our hospital under a badly implemented M4A.

The Measles Moms – Medium

A very good short read on the people making the decisions on not vaccinating their children and how the medical community (and non medical community) might reach out to them. Written by Jessica Valenti.

The leaders of the anti-vaccination movement — both at home and on the national stage — are women. (Specifically, women in <a href="https://www.sciencedaily.com/releases/2017/10/171003111108.htm&quot; data-href="https://www.sciencedaily.com/releases/2017/10/171003111108.htm&quot; class="markup–anchor markup–p-anchor" rel="nofollow noopener noreferrer" target="_blank" style="background-color: transparent; color: inherit; text-decoration: none; -webkit-tap-highlight-color: rgba(0, 0, 0, 0.541176); background-image: url("data:image/svg+xml; utf8, “); background-size: 1px 1px; caret-color: rgba(0, 0, 0, 0.843137); font-family: medium-content-serif-font, Georgia, Cambria, “Times New Roman”, Times, serif; font-size: 21px; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: -0.06300000101327896px; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px; -webkit-text-size-adjust: none; -webkit-text-stroke-width: 0px; background-position: 0px calc(1em + 1px); background-repeat: repeat no-repeat”>affluent areas.) They’re <a href="https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/women-and-job-based-health.pdf&quot; data-href="https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/women-and-job-based-health.pdf&quot; class="markup–anchor markup–p-anchor" rel="nofollow noopener noreferrer" target="_blank" style="background-color: transparent; color: inherit; text-decoration: none; -webkit-tap-highlight-color: rgba(0, 0, 0, 0.541176); background-image: url("data:image/svg+xml; utf8, “); background-size: 1px 1px; caret-color: rgba(0, 0, 0, 0.843137); font-family: medium-content-serif-font, Georgia, Cambria, “Times New Roman”, Times, serif; font-size: 21px; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: -0.06300000101327896px; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px; -webkit-text-size-adjust: none; -webkit-text-stroke-width: 0px; background-position: 0px calc(1em + 1px); background-repeat: repeat no-repeat”>disproportionately the family members who make medical decisions about kids, they’re the most active in chat rooms, and they’re the most recognizable public faces of the anti-vaccination movement.

https://medium.com/s/jessica-valenti/why-women-lead-the-anti-vaxx-movement-13bb6ff6ae5c

We don’t need government-run healthcare to get affordable, universal coverage – Washington Post

A very interesting opinion piece (that dovetails with the last post of mine discussing that a large amount of lobbyists are out to kill the idea of Medicare for All). I don’t think that Third Way is a lobbying arm of the healthcare industry, but I would love to get some feedback by my readers as to what they think of this proposal. It does merit a good debate, I believe. It might even be possible to get a great many Americans on board with this, since they get to keep their doctor, it doesn’t put every medical professional into having to accept the uneconomic reimbursal rates of Medicare/medicaid, it eliminates medical bankruptcies, and it covers everyone in a way that is easy to implement. Thoughts? Am I missing something here?

From the article:

America can insure everyone without changing anyone’s existing health coverage. It won’t require replacing Obamacare with a single-payer, government-run system. Instead, we can build upon Obamacare with two simple, game-changing features: a universal cap on premiums and out-of-pocket expenses, and an automatic coverage system that places the uninsured in a plan they can depend on and afford.

UPDATE: After thinking about it, here’s my, and a medical friend’s thoughts:

A missing element in this is that it doesn’t change the issue that not everyone with insurance gets the coverage they need. Some providers don’t take more than one or two of the ACA options. Some don’t take any. Many things docs want to do arent covered by Obamacare, Medicare or independent insurers. If your doc says you need an MRI, and the ACA people say no, what then? Why is an insurance bureaucrat more knowledgeable about your care than your doctor? The devil is in the details in the current ACA & in this one too. In Canada, everyone who walks in the clinics or hospitals gets the same care. This proposal at least in the article, does not achieve that. Reimbursements in the ACA often barely cover the cost of treatment. That’s why some docs won’t take them. What about the caps? Meaning some programs only allow you to see a doc 4 or 5 times a year, then you are out of luck and out of pocket. Will it cover all needed coverage? So much missing in this article. Would love to have the authors point us to more indepth overviews of this. Interesting to read some of the comments, which seem to say that Third Way is a tool of the Right, some say it’s a tool of the Left. Wonder what the reality is? 

https://www.washingtonpost.com/opinions/2019/02/19/we-dont-need-government-run-health-care-get-affordable-universal-coverage/