This graph is from a great blog, “The Incidental Economist”.
The graphic demonstrates what are the average life expectancies in different countries (the up and down axis) and the amount spent on providing health care (the left to right axis).
Two striking things about this column is that the United States spends more on health care than other industrialized nations and we have some of the lowest life expectancies. (US life expectancies are equivalent to those in Chile and Poland. The majority of other industrialized countries have much better expectancies.)
The other thing that I find remarkable is the fact that we are so far out on our own. NO other nation spends at much as we do and no other industrialized nation has such short life expectancies.
Says a lot about the United States having the “best healthcare in the world”.
For a detailed analysis check out the full post at http://theincidentaleconomist.com/wordpress/life-expectancy-and-health-care-spending/
The recent bungled roll out of the healthcare.gov website has those in opposition to the Affordable Care Act wagging their fingers in righteous indignation. This will give further support to those in opposition to expanding Medicaid in Florida. This coming year the Florida Legislature will again consider the possibility of expanding the Medicaid program to an estimated additional 1.4 million residents. The overwhelming majority of the expansion would be paid for by the federal government and would extend health insurance to those making 138% of the federal poverty level. By extending Medicaid in Florida many healthcare economists estimate it will drive healthcare costs down, create jobs and help to sustain our healthcare infrastructure. In human terms the expansion would provide 1.3 million Florida families with the security of healthcare access.
Unfortunately our leadership in Tallahassee continues to oppose the expansion. Those in opposition use primarily two arguments against expanding Medicaid in Florida. The first, and most divisive, is that it would extend Medicaid to “able bodied adults”. The implication here is that the state would provide health insurance to underserving masses that chose not to work or accept responsibility for their own healthcare. This argument misrepresents the truth and works to demonize those who would benefit from Medicaid expansion. Those newly covered under the Medicaid expansion will predominantly be the working poor. These are the individuals who bag our groceries, serve our food and bus our tables at restaurants and perform other jobs that pay close to the minimum wage. These individuals, and their families, go largely without health care simply because they do not earn enough to pay for healthcare but make to much to presently qualify for Medicaid assistance. These are hard working individuals who struggle to survive economically from day to day because we choose to not pay a truly livable wage. These are the families that pay the price of our inexpensive foods and services.
The second argument made is that we cannot trust the federal government to produce the funds to pay for the expansion. Those in opposition imply that the federal government will suddenly stop the funding and the state of Florida will be on the hook for tens of billions of dollars. It strikes me strange that these same legislators have no reluctance to rely on the 500 billion dollars our state receives annually from the Federal government, but these funds tied directly to the Affordable Care Act cannot be trusted. We continue to expand education, roads and security based on the promise of federal dollars, but providing healthcare to those most in need is somehow different and irresponsible?
The arguments and actions in opposition to the Medicaid expansion are neither economically prudent nor socially responsible. These are political actions intended to obstruct the Affordable Care Act and gain favor from a political base. These same actions do direct and irreparable harm to Florida’s families who struggle to survive. As a Nurse Practitioner I have seen the faces of these individuals who work 2 or more jobs to survive and then are forced to come to the emergency room because they have no where else to turn for healthcare. I have witnessed lives devastated, and lost, because of the lack of healthcare. Our political leaders have the opportunity to provide our brothers and sisters the small security of healthcare. As a fair and just society it is unethical to perpetuate a system that takes advantage of the working poor and denies them the security of healthcare access. It is my hope that our political leaders gain the wisdom to move beyond their parochial and partisan interests to take action in the best interest of our state and it’s citizens.
FOR MORE INFORMATION
Florida Center for Fiscal and Economic Policy
Analysis of impact on small employers
Who benefits from Medicaid expansion
Medicaid expansion fact sheet
Updated: Sep 19, 2013 @ 14:01:15
United States Speaker of the House has declared “victory” in passing bills that would defund ObamaCare and dramatically cuts funding to foodstamps. The result of the Republican victory will be millions of american citizens who will go hungry and be denied access to healthcare. The bill also continues the current sequestration cuts to federal spending. The vote in the House was strictly along party lines.
The intention of the house may have been to fiscally responsible, however it appears that the majority of the pain will be born by low and middle income families.
It will be interesting to see how this action impacts the next election.
Posted: Sep 19, 2013 @22:02:13
Let us consider the fictional character of Jane Smith.
She is a single mother with two children. To make ends meet she has two part time jobs that bring in an annual income of $30,000 per year. Because she only works part time she is unable to get health insurance from her employers and she makes to much money to qualify for medicaid. When she or her children are ill she depends on the health department, free care clinics or emergency departments. She ignores her health needs because of it’s cost and has not had a PAP smear, breast exam or mammogram for many years. Her children have not had a dental exam or vision exam in many years because she cannot afford it. Jane knows her children need health care, and she wants to do it, but she simply cannot afford it.
Unfortunately Jane Smith isn’t fictional! There are millions of Jane Smiths in our country who are struggling to survive without access to real, affordable primary care services.
The good news is that this January things will get dramatically better for Jane. Under the Patient Protection and Affordable Care Act (ObamaCare) she will be able to shop for health insurance online at the health insurance exchanges. She will be able to select the health insurance that meets her needs and her monthly cost will be approximately 4% of her annual income. The federal government will be pay the remainder of the health insurance premiums. The Insurance she gets will be health insurance that meets criteria that the law requires and covers certain minimum healthcare. Under ObamaCare all preventative care (immunizations, PAP smear, Mammogram, etc) will be covered 100% by her insurance. Her children will have full health insurance and have dental and vision care. If she, or one of her children, has a chronic illness they cannot be denied health insurance or have to pay more. If you go to http://kff.org/interactive/subsidy-calculator/ you can calculate if you qualify for federal assistance and what level of assistance you would qualify for.
The bad news for Jane is that the United States House of Representatives has passed a bill that would defund ObamaCare. The Republicans in the house have threatened a government shutdown as a means to pressure the president to stop his landmark legislation. The Republican leaders claim that this is not political, but is conservative fiscal policy. They declare they act because the american public demand it and out nation needs it!
Unfortunately the facts show that this is purely political gamesmanship without any consideration of how low and middle income families will suffer because of it. The actions of the House leaders are neither nor or fiscally conservative. This is politics, pure and simple!
Consider the follow claims by republican leaders…..
“The Majority of americans oppose the affordable care act!”
-According to polling conducted by The Kaiser Family Foundation 42 % of americans do oppose the Affordable Care Act, while 37% support the law. A large proportion (20%) of americans have no opinion because they are unsure of what is in the law. A key survey conducted by the Kaiser Family Foundation shows that 67% of americans oppose defunding the affordable care act, a clear majority. ( http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-august-2013/)
“By defunding ObamaCare we will decrease the defect.”
In a recent letter from the Congressional Budget Office Director to Congressman Paul Ryan he estimates that the federal defect will increase by approximately 109 billion dollars over 10 years if ObamaCare is defunded. (http://www.cbo.gov/sites/default/files/cbofiles/attachments/hr45.pdf?elq=75fe64eb88e94f999417bb144c231e95&elqCampaignId=2031) This may not to seem to make sense based on the amount of federal subsidies to help individuals buy insurance and enrolling low income families in Medicaid. To understand this you must understand that the federal government pays billions of dollars to fund free care clinics, provides billions of dollars in grants to provide preventative care and pays hundreds of billions of dollars to compensate hospitals for uncompensated care. Much of this funding is no longer necessary if more individuals have health insurance. And as we improve the health of americans we also decrease the amount of money we spend to treat chronic illness.
Also consider that the major source of increases in healthcare spending for the federal government come from people who receive health care and cannot pay for it. (http://www.rwjf.org/en/research-publications/find-rwjf-research/2010/01/health-care-spending-under-reform.html) By controlling these costs the rate of growth for health care spending should slow.
“There aren’t enough providers to care for all the new enrollees.”
ObamaCare includes billions of dollars for educating more physicians, nurses and other healthcare providers. Defunding ObamaCare will result in decreasing the number of individuals to provide healthcare.
“The solution to the healthcare crisis should be market driven and not come from the government.”
Under the present health insurance system there is no competition. Individuals cannot “shop” for health insurance, they can “apply” for health insurance and the insurance companies can cherry pick who they want to insure. Most states have large insurance monopolies that control the market and control their rates. Under ObamaCare the health insurance exchanges will provide a place where individuals can shop for the health insurance they want, see what they will be charged in advance and know in advance what services will be covered. Under ObamaCare insurance companies cannot be denies coverage because of preexisting condition nor pay more for preexisting conditions.
I admit that there are problems within ObamaCare, but these problems can be fixed by simply amending the law. Unfortunately the House of Representatives has voted 32 times to repeal the law, but have never attempted to “tweak” the law. The objective has been, and continues to be, purely political. I will not conjecture if this is racial, partisan or short sightedness. I will state that the actions of the congress will do direct and serious harm to american families that are already struggling to survive.
It is time the grown ups within our political leadership step forward and take the reins. There are real and effective solutions to the crisis facing out nation. Immature, partisan and destructive actions such as those taken by out house of representative are not those solutions!
A recent study out of Australia demonstrates approximately 156 tests or procedures that are commonly performed and do not have any real benefit. The link below takes to the the appendix that lists the data.
This list is representative of the failure of the modern health care system to follow the basic “evidenced based practices” that we subscribe to. If the evidence does not support the procedure what is the motivation for doing it?
Stopping unnecessary tests and procedures are a simple partial solution to the burgeoning cost of health care in our country.
A recent article that appears in the peer reviewed journal “Health Affairs” found that recent regulation changes that financially penalizes health care facilities for complications following surgeries will have a negative revenue consequence for the majority of hospitals.
The paper postulates that this negative income will likely result in decreased hospital days for patients and increased attention to reduce surgical complications. My concern is what I have seen over many years of being a front line health care provider and that is the reaction of Chief Financial Offers to look at the bottom line and reduce full time employees. These reductions will likely come from nursing staff in the operating theatre and replace them will less trained and skilled technicians.
I applaud the regulation and it’s intent, but am concerned about it’s implementation. The faster, and easier solution, for health care facilities is not to reduce reduction but to reduce cost to compensate for the revenue loss. The regulations should have included provisions to ensure the safety of the patients in the operating theatre
Florida is at the center of the Medicaid Expansion debate. The Affordable Care Act greatly expanded the criteria that would allow individuals to qualify for Medicaid (a federal/state program of providing health insurance to poor and nursing home patients.) Although the federal government picked up the lions share of the cost, states would have to assume some of the expense. This led to debate and courts challenges. The supreme court finally ruled that the federal government could not force the expansion on the states and the expansion was optional.
Florida has decided to opt out of the expansion. This decided is applauded and derided by various groups. The challenge is deciding what are the facts free of the rhetoric.
Dr. Aaron Carol and Dr. Austin Frakt did a succinct analysis of the pros and cons. Below is a small excerpt from their blog but I suggest you check out the complete post at:
- State elected officials are politically constrained in their choices. Antos is quite explicit on this (“If you choose the latter [Medicaid expansion in your state] you stand a good chance of being thrown out of office the next election.”) We discuss politics at the end of our paper, concluding that it is not our job to look after the political fortunes of state officials. That they will (or won’t) expand Medicaid and that they should (or should not) are separate matters.
- Expanding Medicaid is not free for the states. Reading Antos’s paper you might think we dispute that, but we don’t.
- Antos makes a direct appeal to the virtue of choice. We don’t take that up in our paper, but we do not dispute that there is value in choice.
- The Medicaid expansion was a lower cost means of increasing coverage. Antos and we acknowledge that private coverage costs more, as would increasing Medicaid payment rates to providers.
- States may be able to use the Medicaid expansion as a bargaining chip, to extract favorable waivers from the Center for Medicare and Medicaid Services (CMS). We wrote that, and Antos seems to agree. We also probably all agree that this is among the most important unsettled areas to watch in terms of health policy.
We are in the final days of the 2012 election season, and a great deal of finger pointing is going around. Both parties are claiming the other will destroy Medicare/Medicaid/Private Insurance. If you listen to either Romney or Obama their opponent wants to do horrible things, take away your health care or destroy health care market!
The rhetoric unfortunately obscures the proposals the candidates have made, and finding an analysis of the impact of the proposals on television news media is nearly impossible. (But they will give you an analysis of how they look, the cloths they wear and how many times they scratch their nose….all the important information!)
Thankfully the Journal of the American Medical Association (JAMA) has published a free, online analysis of the candidates proposals compiled by Aaron E. Carroll, MD, MS and Austin B. Frakt, PhD and how it will impact on the health insurance market in the United States. You can view and download the analysis at: http://jama.jamanetwork.com/article.aspx?articleid=1379004. (Please note that JAMA has a tradition of nonpartisan analysis. Any doubts to the authenticity of the data are addressed at Dr. Carrol’s blog.)
You can also find a commentary by Dr. Carroll, one of the authors at his blog.
However, if you are one of those people who just want the facts in a simple to digest visual format, here it is courtesy of Drs. Carroll and Frakt:
There has been a great deal of confusion and misinformation regarding the AFFORDABLE CARE ACT, what many have come to call “Obamacare”.
The Kaiser Family Foundation, a nonpartisan non-profit health advocacy agency have developed this explanatory video That I believe explains the law in a clear and concise fashion.
With the importance of the pending election and the expected complete roll out of the Affordable Care Act in 2014 educating ourselves and our neighbors is extremely important on this issue.
Oct 18, 2o12 AANP AND ACNP MERGER ANNOUNCED
The American Academy of Nurse Practitioners and the American College of Nurse Practitioners have announced they will be merging to form a new combined entity to represent advanced practice nurses in the United States. The new organization will be called THE AMERICAN ASSOCIATION OF NURSE PRACTITIONERS.
The two organizations will merge functions and the organizations ensure that the transition will be seamless.
For individuals who are accredited by the ACNP will not see any changes. Accreditation by the ANCC is still under negotiation.
For more information visit: http://www.aanp.org/about-aanp/aanp-acnp-merger/85-about-aanp/1106-merger-faqs
Oct 17,2012 260 FLORIDA SITES RECEIVED CONTAMINATED STEROID INJECTIONS
The Florida Department of Health is reporting that a suspected 260 pain management sites may have received contaminated steroid injections from New England Compounding Company that is causing the epidemic of fungal meningitis across the state.
To get the latest news on the outbreak you can visit http://newsroom.doh.state.fl.us.
Who is at Risk?
Individuals who received epidural steroid injections from one of the affected pain management centers. Individuals with compromised immune symptoms (advanced age, diabetes, multiple co-morbidities, HIV) are at greater risk of developing the infection.
What are the symptoms?
Warning signs include headache, stiff neck, lower-than-normal temperature, nausea or vomiting, sensitivity to light, and hallucinations.
Unlike viral or bacterial meningitis, which tend to cause symptoms within hours of infection, the fungal form has an incubation period that can be as long as 43 days or more.