Even More Evidence That Mammograms Have Been Oversold

FiveThirtyEight: “A study published online today by the The New England Journal of Medicine added to a growing body of evidence that for every woman who has been helped by a mammogram screening1 for breast cancer, many more have been harmed.”

“Screening did result in more cancers being detected, he said, but the data suggests that only about 30 of the 162 additional small tumors per 100,000 women that screening mammograms found would ever have progressed to a dangerous stage. That means that 132, or 81 percent, of the 162 extra tumors detected represented ‘overdiagnosis’ — the discovery and treatment of tumors that were never destined to harm.”

More Evidence Expanding Medicaid Increases Emergency Room Visits

Washington Post: “According to the new study, people who gained Medicaid visited the emergency room about 65 percent more often than individuals who did not gain Medicaid in the first six months — and the trend continued out to two years. The estimates of increased emergency department use at 12 months, 18 months and 24 months are ‘similar and, for the most part, statistically indistinguishable from each other,’ the authors wrote.”

“People covered by Medicaid were more likely to both see a physician at a regular office visit and also go to the emergency room, casting doubt on the idea that people were using health coverage to shift their health care to a primary care doctor.”

Does Economic Growth Kill People?

Washington Post: “Everyone wants economic growth, right? It’s part of every politician’s package of promises. Expanding economies make people richer, and study after study shows that the wealthier lead happier, healthier lives.”

“Yet in recent years, accumulating evidence suggests that rising incomes and personal well-being are linked in the opposite way. It seems that economic growth actually kills people.”

“Christopher Ruhm, an economics professor at the University of Virginia, was one of the first to notice this paradox. In a 2000 paper, he showed that when the American economy is on an upswing, people suffer more medical problems and die faster; when the economy falters, people tend to live longer.”

“In other words, there are great benefits to being wealthy. But the process of becoming wealthy — well, that seems to be dangerous.”

Why More Doctors Need to Vote

Dhruv Khullar: “Doctors don’t vote — at least not enough.”

“We’re less likely to vote than lawyers, other professionals, farmers, and the general population. In some recent elections, less than one-third of doctors voted.”

“Regardless of party affiliation, more politically active physicians could add an important voice to our political and social discussions. Health care accounts for the largest share of the economy, at more than 17 percent of the gross domestic product. In the 2012 presidential election, health care was the second most important issue to voters. This year, prescription drug pricing emerged as a major public concern, and both Republican and Democratic voters favor government intervention to help reduce prices.”

Insurance Executives Ask for Changes to Obamacare

The Hill: “Health insurance executives went to the White House on Monday and called for changes to Obamacare that they say are necessary to keep the healthcare exchanges working.”

“The executives discussed a series of their long-running complaints about ObamaCare including tightening up the rules for extra sign-up periods, shortening grace periods for people who fail to pay their premiums and easing restrictions on setting premiums based on someone’s age.”

“The insurance officials called on the administration to enact a system where it checks enrollees’ documentation to make sure they are eligible for extra sign up periods before they sign up, as opposed to after they are already enrolled, industry sources said.”

‘Franken-bugs’ May Be our Best Weapon Against Zika

Reuters: “On Nov 8, the residents of a suburb of Key West will vote on whether to allow scientists to release genetically-modified mosquitoes into their backyards. Inserted into the mosquito’s genetic makeup would be an artificial stretch of DNA that renders them unable to reproduce.”

“As the ‘transgenic’ mosquitoes mate with wild ones, the plan goes, their offspring would die, bringing the local population of skeeters down significantly — by as much as 90 percent, according to Oxitec, the for-profit firm that wants to release the modified mosquitoes. That would potentially reduce the risk to local residents of catching mosquito-borne diseases such as dengue and Zika.”

“Among scientists, opposition to the release of transgenic mosquitoes centers on the law of unintended effects.”

“A lack of answers to questions such as these has prompted some scientists to invoke the precautionary principle: when effects are unknown, it’s best to play it safe. This sounds reasonable, but it is something of a Catch-22. By the precautionary principle, genetically modified crops would never have made it out of the lab, and yet the worst fears about their impact on human health have not been borne out. We know this because lots of people have been eating them for years.”

The States with the Biggest Obamacare Struggles Spent Years Undermining the Law

Los Angeles Times: “As insurers exit Obamacare marketplaces across the country, critics of the Affordable Care Act have redoubled claims that the health law isn’t working.”

“Yet these same critics, many of them Republican politicians in red states, took steps over the last several years to undermine the 2010 law and fuel the current turmoil in their insurance markets.”

“Indeed, eight of the nine states where consumer choices will be most limited in 2017 have rejected Medicaid expansion and taken other steps that have weakened their marketplaces, data show.”

“19 states are still rejecting federal aid to expand their Medicaid programs to poor, childless adults, a group of Americans traditionally excluded from the government safety net.”

“This has been particularly problematic for those states’ marketplaces, research suggests, as many poor – and probably sick – residents who couldn’t get Medicaid have gone into the marketplaces.”


Clinton and Trump Are Both Wrong About Medicare’s Ability to Negotiate Drug Prices

Geoffrey Joyce and Neeraj Sood: “Hillary Clinton and Donald Trump agree that Medicare bureaucrats should be unleashed to negotiate lower prices with drug companies, and predict billions of dollars in savings as a result. In this political era when any common ground between these two adversaries should be venerated, it is a shame that we must point out that they are both wrong.”

“When Clinton and Trump talk about Medicare exercising its clout to drive down prices, they are primarily targeting cancer and other specialty drugs. But Medicare can’t negotiate any better than pharmacy benefits managers with drug companies holding aces.”

“As we write in the Journal of Policy Analysis and Management, better options exist.”


Obamacare’s Four Biggest Problems and How to Fix Them

New York Times: “Here are four key challenges to the program and a survey of some possible solutions.”

One: “Choice is disappearing.”

“Possible solutions: Both President Obama and Hillary Clinton have also revived the idea of the so-called public option, which would be a government-run plan that would either compete with or be a substitute for a plan offered by a private insurer.”

Two: “Prices are rising.”

“Possible solutions: Bring down costs instead of raising prices… the narrow network strategy may be a smart way to start getting different groups to negotiate down on their prices… Another, simpler way to bring down prices would be to get more healthy people into the market, so the average insurance customer costs less, or use other tools to absorb the cost of people with complicated and expensive medical conditions.”

Three: “The market is too small.”

“Possible solutions: Change the incentives, so more people who are currently uninsured buy health insurance. Hillary Clinton has talked about giving out more generous subsidies, so insurance costs less and more people can afford to buy it. Many Republican politicians suggest another way to lower prices: eliminating current requirements that insurance cover a wide array of services. Some policy experts, including Uwe Reinhardt, a Princeton health economist, in a recent interview, have suggested tightening up the penalties for remaining uninsured, so people can’t wait and buy insurance only after they get sick.”

Four: “The rules are complicated.”

“Possible solutions: The insurers that remain in the market — particularly many Blue Cross plans — have a long list of policy requests that would make their business less risky: by making it harder for sick people to buy coverage for short periods of time, by subsidizing the plans’ losses for very expensive patients, and in some cases by charging higher prices to older customers, who are more likely to be sick. But regulators have been cautious about embracing them, because such moves would shift financial risk to taxpayers and make it harder for people who need health care to get insurance.”


How Expanding Medicaid Can Lower Insurance Premiums for All

New York Times: “The Obama administration for years has been pleading with states to expand their Medicaid programs and offer health coverage to low-income people. Now it has a further argument in its favor: Expansion of Medicaid could lower insurance prices for everyone else.”

“A new study published by in-house researchers at the Department of Health and Human Services compared places that have expanded their Medicaid programs as part of Obamacare with neighboring places that have not. They found that, in 2015, insurance in the marketplace for middle-income people cost less in the places that had expanded Medicaid.”

“A substantial body of research has shown that lower-income Americans tend to have poorer health than those who earn more. (Cause and effect isn’t clear: People may be unable to earn a higher income because of health problems.) And that difference may explain why Medicaid expansion may have lowered insurance premiums. Because the states that didn’t expand had more sick people in their middle-class insurance pool, prices went up for everyone, the paper argues.”

Climate Change Is Making Oysters and Other Shellfish Dangerous to Eat

Quartz: “Oyster happy hours are going to be getting sadder in the coming years—and we probably have climate change to blame.”

“The connection comes from a new study (paywall) in the Proceedings of the National Academy of Sciences that links the rapid rise in sea temperatures in the North Atlantic with a surge in Vibrio, a genus of bacteria that thrives in shellfish and teems in coastal waters—and can be fatal to humans.”

“It’s pretty hard to miss the truly alarming thing about the chart above: that the total number of Vibrio infection cases has been climbing steadily for years. And that’s likely due to how climate change is cooking our seas. The new research is significant because it’s the first to link rising ocean-surface temperatures to Vibrio abundance and disease incidence. Since the deadly bacteria thrives in warmer water, climate change is sickening more and more people.”


The Current State of Obamacare

Two new fairly comprehensive Obamacare analyses can be found on Vox.

Is Obamacare failing?

“The marketplaces’ failures to attract a robust group of health plans to many areas suggests that Obamacare’s insurance expansion is on the path to looking like other safety net programs we know, offering limited services to a predominantly low-income population.”

Big insurers have quit Obamacare. That means more shoppers only get one choice.

“Major insurers like Aetna and UnitedHealth have, in recent months, taken major steps to sharply reduce participation in Obamacare’s insurance marketplaces. The result, a new Vox analysis shows, is a spike in counties served by just one health plan — and a precipitous drop in ultra-competitive areas.”

See also “Is Obamacare Sustainable?” from The New York Times, in which health policy experts and leaders debate Obamacare’s future.