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Insurers Expand Primary Care: an Argument for Obama’s Plan
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Maggie Mahar,
The Century Foundation,
1/5/2009
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Imagine appointments with your primary care doctor that last 30 minutes—or longer. What if you could e-mail her when you need a prescription refill? If you have a two-minute question, she encourages you to call; she or a nurse practitioner will come to the phone. If they’re busy, they’ll return your call within a few hours. Continue to blog here.
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Four Health Care Media Myths That Didn’t Go Away in 2008
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Niko Karvounis,
The Century Foundation,
12/31/2008
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No matter how you slice it, health care is complicated—which means that the media has a vital role to play in helping the public navigate the ins and outs of the issue. Unfortunately, more often than not, reporters, commentators, and pundits don’t serve as trustworthy guides when it comes to health care. In fact, 2008 saw the media once again regurgitating myths that obscure the facts surrounding health care in the United States. Here are some of the most egregious offenders. Continue Reading on the Taking Note Blog.
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Alzheimer’s Disease: The Basics
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Niko Karvounis,
The Century Foundation,
12/30/2008
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Earlier this month newspapers reported that Columbo—that is, actor Peter Falk—has Alzheimer’s Disease. Usually, when news breaks that a celebrity is suffering from a serious medical condition, there’s a flurry of coverage discussing the nature of the disease. Hopefully, the pattern will hold in Falk’s sad case—because Alzheimer’s is both a terrifying disease and a greater public health issue than most of us realize. Continue to blog here.
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Ezekiel Emanuel Appointed as Healthcare Advisor
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Maggie Mahar,
The Century Foundation,
12/19/2008
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This is from the Wall Street Journal’s Washington Wire: “Ezekiel J. Emanuel, a prominent bioethicist at the National Institutes of Health–and the brother of incoming White House Chief of Staff Rahm Emanuel–will serve as a senior counselor at the White House Office of Management and Budget on health policy, two Democratic officials said Thursday. Continue Reading.
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Retiree Health Benefits in the Recession
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Niko Karvounis,
The Century Foundation,
12/17/2008
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“Companies are concerned about how their balance sheets are going to look after two down quarters last year, the events of Sept. 11 and the big increases we've been seeing in health care costs,” the U.S. Chamber of Commerce’s Kate Sullivan told the New York Times in 2002. Reading the tea leaves, Sullivan pointed out that “employers are looking at any way they can to shave off some of those costs”—and that one of their biggest targets were company-sponsored health benefits for retired employees. Continue Reading on the Taking Note Blog.
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Irrational Exuberance over Electronic Medical Records?
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Maggie Mahar,
The Century Foundation,
12/17/2008
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When President-elect Obama outlined his economic stimulus package earlier this month, he emphasized the need to invest in the healthcare system’s infrastructure by pushing for electronic health records (EHR), nationwide: “We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year.” Continue Reading.
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A Story of Pallative Care
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Maggie Mahar,
The Century Foundation,
12/15/2008
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The Dallas Morning News has done a wonderful series on end-of-life care. Thanks to
Annie for pointing it out. Here are excerpts from part one, written by Lee Hancock, describing an encounter at a Baylor University Medical School ICU unit between Ms. Patel, a palliative care team nurse, and Dr. Edward Taylor, a 36-year-old trauma surgeon. Continue to blog here.
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Making Use of Comparative Effectiveness Research
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Maggie Mahar,
Niko Karvounis,
The Century Foundation,
12/5/2008
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Last week the New York Times published a story about one of the biggest medical trials ever organized by the federal government, a study that showed that the newest, most expensive drugs used to treat high blood pressure (a.k.a. hypertension) work no better than inexpensive diuretics—water pills that flush excess fluid and salt from the body. Moreover, the research revealed that the pricier drugs increase the risk of heart failure and stroke. Continue Reading on the Taking Note Blog.
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The End of Pharma's Free Ride?
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Niko Karvounis,
The Century Foundation,
12/4/2008
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Yesterday Reuters reported that, in comments at a Financial Times conference in London, a top executive at Roche Pharmaceuticals condemned direct-to-consumer advertising as a disaster. “Direct-to-consumer promotion [of drugs] was the single worst decision for the industry," said William Burns, Roche’s head of pharmaceuticals, to conference attendees. "When industry says we're spending all the money on R&D but actually it's spending it on TV advertising to preserve margins, it doesn't get much credibility,” he continued. Continue Reading on the Taking Note Blog.
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The Good News on Heart Attacks, Strokes, and Breast Cancer
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Maggie Mahar,
The Century Foundation,
12/1/2008
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Assume that you are a 40-year-old man. What do you think the chances are that you will die of a heart attack or stroke in the next 10 years? (Please forgive the morbidity of the question; there is a purpose to this pop-quiz.) The answer: just 4 out of 10,000 according to Drs. Steve Woloshin and Lisa Schwartz, authors of Know Your Chances. Indeed, the chance that you will die in an accident before reaching your 50th birthday are 50 percent higher: 6 out of 10,000. Continue to blog here.
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Censorship, the Media and the Blogosphere
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Maggie Mahar,
The Century Foundation,
12/1/2008
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I recently attended a conference where bloggers and print journalists talked about the pros and cons of their respective professions. I noted that as a blogger, I am never censored. As a print journalist I was told, on more than one occasion; “Maggie, you can’t say that!” (even though I had evidence to back up my facts.) Usually, the editor was concerned that I would “scare the readers” or upset the publisher (and advertisers). Continue to blog here.
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One Simple Stimulus for Both the Economy and Health
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Hummy Song,
The Century Foundation,
11/26/2008
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When President-elect Barack Obama takes office, he will be preoccupied with a broad range of enormous and complex challenges, including a downward spiraling economy and two wars. But some problems that might seem lower on the priority list also present relatively manageable opportunities to make meaningful progress in ways that would greatly benefit the country. One such target for saving money and improving lives is dealing with tobacco—the nation’s number one cause of preventable death and one of its greatest contributors to high health care expenditures. Continue Reading on the Taking Note Blog.
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The Personal Side of Medicine
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Maggie Mahar,
The Century Foundation,
11/23/2008
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Below, a story and a poem from Pulse, a very special online magazine that uses stories and poems from patients and health care professionals to talk honestly about giving and receiving care. Continue to blog here.
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The Front Lines of Primary Care, Part 2
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Niko Karvounis,
The Century Foundation,
11/23/2008
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In my previous post, I discussed how the realities of primary care—the “hamster wheel” of 15-minute visits with sometimes-difficult patients suffering from complex, chronic conditions—can burn out idealistic primary care physicians (PCPs). Increasingly, disillusioned PCPs are leaving the field. A recent survey from the Physicians’ Foundation reports that one-half of PCPs would leave medicine if they thought they could do so. Continue to blog here.
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The Front Lines of Primary Care
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Niko Karvounis,
The Century Foundation,
11/20/2008
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In a recent post, Health Beat described the policy strategies that must be employed in order to address the primary care crisis in the United States. This post focuses on the human side of the primary care crunch by highlighting the personal experiences of doctors. Moving from the policy to the personal adds an all-important qualitative element to our understanding of just why American primary care is in such dire straits. Continue Reading on the Taking Note Blog.
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"Spread the Wealth" Controversy Hits Doctors
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Niko Karvounis,
Maggie Mahar,
The Century Foundation,
11/17/2008
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Last week Senator Max Baucus (D-MT) offered a “Call to Arms” for health care reform by way of a 98 page policy document. Because Baucus’ document was a sweeping, comprehensive look at America's health care problems, media coverage tended to focus on its grand principles rather than specific policy details. But when it comes to health care policy, it's all about the details, among which Baucus includes the following sticking point: a proposal to increase payments to primary care providers at the expense of compensation for specialists. Continue Reading on the Taking Note Blog.
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"Fat": What the Experts Know (Part 1)
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Maggie Mahar,
The Century Foundation,
11/17/2008
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The film opens with a fetching red-head puffing away on a treadmill. She’s perspiring, but she’s smiling gamely into the camera. “It’s not an average work-out, but I wasn’t an average weight,” she explains. “I have to do above and beyond what any of you guys would have to do. I have to try twice as hard, sometimes three times as hard—just to maintain this level of…chubbiness.”
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More Truths About Rising Health Prices
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Maggie Mahar,
The Century Foundation,
11/6/2008
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What is the biggest threat to the U.S. economy? According to Congressional Budget Office Director Peter Orszag, it is not credit famine, the long-term price of energy, competition from China, the loss of jobs overseas, or even a surfeit of Chrysler SUVs. It is, Orszag declared in October, “the nation’s looming fiscal gap — which is driven primarily by rising health care costs.” Continue Reading on the Taking Note Blog.
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Help, I've Fallen Into the Doughnut Hole and I Can't Get Up: The Problems with Medicare Part D
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Beverly Goldberg,
The Century Foundation,
10/28/2008
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Ever since the enactment of Medicare Part D, which pays private insurers to offer senior citizens plans to help cover the costs of their prescription drugs, bitter complaints about the program have been the norm. Most of the complaints have focused on the "doughnut hole," the coverage gap that occurs when someone spends more than the year's covered amount—$2,510 in 2008—on his or her medications. When that cap is reached, because an individual is on multiple medications or extremely expensive ones or both, the costs of medications must be paid for out—of—pocket until the person spends up to a level that is significantly higher than the covered amount—an additional $3,216 in 2008. At that point, the plan again begins to cover needed drugs under a catastrophic coverage provision. Continue Reading Here.
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Download the PDF.
View Press Release.
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Assigning Blame for Rising Medical Costs
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Maggie Mahar,
The Century Foundation,
10/24/2008
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The conventional wisdom about skyrocketing healthcare costs tends to blame someone: patients who demand too much care; doctors who practice defensive medicine because they fear being sued; aging boomers, and finally, everyone’s favorite, “the insurance companies.” Continue on the Taking Note Blog.
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What Makes the Mayo Clinic Different?
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Maggie Mahar,
The Century Foundation,
10/21/2008
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After working at the Mayo Clinic in Rochester, Minnesota for nine years, Dr. Marc Patterson decided to change his life. In 2001, he moved to New York City to take a job as chief of pediatric neurology at New York-Presbyterian Hospital (NYPH).
This year, Patterson returned to the Big House on the Prairie. "Sometimes I miss New York,” he acknowledges, “but working in a system that actually functions is worth it." Continue Reading on the Taking Note Blog.
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The Medicaid Challenge (Part 1)
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Niko Karvounis,
The Century Foundation,
10/9/2008
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In theory, Medicaid ensures that low-income families receive health care. But in practice, the program leaves much to be desired—and serves as a painful illustration that the existence of an insurance program isn’t enough to ensure access to necessary care.
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Is Healthcare a "Right" or a "Moral Obligation"?
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Maggie Mahar,
The Century Foundation,
10/6/2008
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I have to admit I often have found the language of healthcare “rights” off-putting. Yet the idea of healthcare as a “right” is usually pitted against the idea of healthcare as a “privilege.” Given that choice, I’ll circle “right” every time.
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Free Tuition for Medical Students?
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Maggie Mahar,
The Century Foundation,
9/10/2008
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Always a trailblazer, The Mayo Clinic’s Medical School has had a generous scholarship program for the past 20 years that enables about 60 percent of its students to attend school tuition-free. The 50 students who started at Mayo last summer each received $25,000 to use towards tuition of $29,200. Students also are eligible to receive an additional $2,000 to $5,000 a year based on need, said David Dahlen, director of student financial aid at Mayo, based in Rochester, Minn. Continue Reading on the Taking Note Blog.
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Americans Who Have Insurance —But Still No Access To Care
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Maggie Mahar,
The Century Foundation,
9/5/2008
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A friend who lives in Boston complained, not long ago, about not being able to find a physician. In Boston? “Come on,” I said. “This is like claiming you couldn’t find a liquor store.”
“They’re all oncologists and cardiologists,” he grumbled. “Last week I cut my hand badly enough that it needed stitches. I have good insurance. But I couldn’t get an appointment with my family doctor—or any of my friends’ doctors. I didn’t want to spend hours in the ER. So I wound up going to my sister’s house. She sewed it up at her kitchen table.” Continue Reading on the Taking Note Blog.
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Lessons from Massachusetts
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Niko Karvounis,
The Century Foundation,
8/26/2008
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The Massachusetts experiment in health care reform is all about expanding access. But it doesn’t try to control costs. This, in a nutshell, is why it’s running into trouble. The plan didn’t reform health care delivery, just coverage. Granted, in terms of bringing more people in under the tent, it’s been a success: Since the plan went into effect in 2006, 439,000 people have signed up for insurance—a number that represents more than two-thirds of the estimated 600,000 people uninsured in the state two years ago. Continue Reading on the Taking Note Blog.
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The Geriatrician Shortage
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Niko Karvounis,
The Century Foundation,
8/12/2008
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In a 2006 New York Times article, Dr. Amit Shah, a physician at Johns Hopkins, recalled how other doctors looked down on him during his residency because of his chosen field. "The most memorable discouragement came during his residency, from a pulmonologist," notes the Times. 'When I passed him in the hall, [the pulmonologist] would shake his head and mutter, 'waste of a mind,'" Shah said. Continue Reading on the Taking Note Blog.
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Health Care in Singapore
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Niko Karvounis,
The Century Foundation,
7/31/2008
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It’s always worth exploring how health care works in other countries, if for no other reason than that models in other countries give us the chance to see how some of the approaches discussed by American reformers might pan out. What do the experiences of Germany and Netherlands tell us about the possibility of a better mixed public-private system in the United States? How is China’s health care system a cautionary tale of market forces gone wild? Continue Reading on the Taking Note Blog.
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Reforming Medicare: Options, Tradeoffs, and Opportunities
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Jeanne Lambrew,
Henry J. Aaron,
Brookings Institution Press,
7/28/2008
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Everyone agrees on the need to reform Medicare but not on how to do it. Some argue the program is too comprehensive, others that it is not comprehensive enough. Some suggest it pays too much for health care, others, too little. Meanwhile, the financial stakes continue to mount. Medicare spending exceeded $400 billion in 2007, making it more expensive than the entire health systems of most other nations, as well as the largest national public program other than Social Security and national defense.
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Order the book here.
View related event.
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The Managed Care Roller Coaster
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Niko Karvounis,
Maggie Mahar,
The Century Foundation,
7/17/2008
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At a health care forum held last year in Las Vegas, then-presidential candidate Hillary Clinton declared that she was intent on "taking money away from people who make out really well right now” in order to fund health care reform. When asked exactly which fat cats she was referring to, Clinton responded: “well, let’s start with the insurance companies.” Continue Reading on the Taking Note Blog.
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The Trouble With Medicare Advantage
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Maggie Mahar,
The Century Foundation,
7/15/2008
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Everyone understands why Congress was so reluctant to cut physicians' fees. Reimbursements for primary care physicians are very low—so low that 30 percent of Medicare recipients who are looking for a new medical home can't find one. Cut fees, and fewer doctors will take Medicare patients. The AMA, seniors and the AARP are all up-in-arms. Few politicians like to disappoint this trio. Continue Reading on the Taking Note Blog.
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Comparative vs. Cost-Effectiveness
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Maggie Mahar,
The Century Foundation,
6/24/2008
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The idea of “comparative-effectiveness” research has become a hot topic in health care circles. Conservatives are adamantly opposed to it—as are drug-makers, device-makers and even some physicians who have become involved in designing and profiting from new tests and procedures. Continue Reading on the Taking Note Blog.
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As the Army Approaches a Breaking Point
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Maggie Mahar,
The Century Foundation,
2/26/2008
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Since 9/11, one Army division has spent more time in Iraq than any other group of soldiers: the 10th Mountain Division, based at Fort Drum, New York. Over the past six years and and six months, their 2nd Brigade Combat Team (BCT) has been the most deployed brigade in the army. As of this month, the brigade had completed its fourth tour of Iraq. All in all, the soldiers of 2nd BCT have spent forty months in Iraq.
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Will Consumer-Driven Medicine Really Cut Health Care Costs?
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Niko Karvounis,
The Century Foundation,
2/14/2008
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One of the most common justifications for consumer-driven medicine is reduced health care costs. The reasoning here is two-fold:
- Since they’re high-deductible and low premium, consumer-driven health plans require more out-of-pocket spending. Consumers are more cost-conscious when they have to actively shell out for purchases. As a result, they will user fewer health care services—and thus overall health care costs will fall.
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The Snapshot: Americans Agree, Time for Action on Health Care
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Ruy Teixeira,
The Century Foundation,
1/18/2008
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President Bush’s forthcoming State of the Union address will most likely offer no practical solutions to address America’s burgeoning health care woes. That’s too bad because the public is definitely ready for action on this front. Consider these recent data from Gallup.
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The Health Beat by Maggie Mahar Blog
 The Century Foundation fellow, Maggie Mahar discusses today's most pressing health care policy issues in The Health Beat by Maggie Mahar blog. Click here to view.
Getting More Value from Medicare
In “Getting More Value from Medicare,” The Century Foundation, fellow and HealthBeat Blog editor Maggie Mahar points out that past proposals for containing Medicare’s costs, such as putting a cap on physicians’ fees or requiring beneficiaries to pay more for their care, have not worked.
Money-Driven Medicine
 View, Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), a book by The Century Foundation's Health Fellow, Maggie Mahar. |
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A Second Opinion
Dr. Arnold Relman,
PublicAffairs,
The Century Foundation,
4/23/2007
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Medicare Tomorrow
The Century Foundation Task Force on Medicare Reform, Century Foundation Press
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