Happy birthday Medicaid! (and Medicare)

IMG_2373Today is the day that we celebrate Medicaid’s birthday (and Medicare’s too). On July 30th, 1965, LBJ signed Medicare and Medicaid into law.

Recently, I went to the Medicaid museum (also known as the LBJ Presidential Library) and got a chance to see the pens that were used to sign these programs into law and the first ceremonial Medicare cards (to Harry and Bess Truman).

IMG_2369A lesser known fact is that the Trumans were not in fact the first Medicare beneficiaries.

Lillian Grace Avery of Naperville, Illinois was the first to have her hospital bills paid by Medicare. She received Medicare on July 1, 1966. The Chicago Tribune did a story last year on it last year and how Medicare’s battles relate to the Affordable Care Act.  It’s worth a read.

Well, happy 49th birthday to two wonderful programs!



What do we do with research? A crisis in the making.

photo (1)As a fun packing activity I stacked some of my health policy reports and journals (no books or CFRs). Quickly, gravity (the pull from the earth, not the Hollywood blockbuster) took over and I had to stop stacking. My pile reached 4 and a half feet. (Keep in mind- I’ve only been in this business for a few years.)

But what does one do with all of this research? Go back to school to get a PhD? OK. Read it? Who actually does that?

I made an excel spreadsheet as I was reading the articles but it would take me many more years to read these 4 years worth of reports and people keep writing! Not to mention people have been writing for years.

While, I’m hungry to read everything about Medicare, Medicaid and insurance markets- how exactly should one filter to get the best and fullest picture of what health care research looks like? I’ve been told I should focus. I can’t count the times I’ve been told, “become a Medicaid person.” I like Medicare too. And Marketplaces are fun. I want to be an expert in everything health policy. Surely that’s possible.

Are we getting to a point that publishing research is just a way to gain clout? Has it been that way for years? Will anyone read what I write in the future?

Maybe that’s what this blog is for.

Public health advocates rejoice – helmets!

This summer, I took a tour of America and stumbled upon this program in a couple of cities: Bicycle Benefits. The concept is bike users put a sticker on their helmet and participating restaurants and stores give discounts and free items to consumers that bring in their helmet and show the sticker. Boston and a couple of other city bike-share programs provide a sticker with the membership.

One major criticism by public health advocates of bike-share programs is the increased rate of biking without helmets. Incentives like this sticker system may increase helmet use- but I doubt a lot of people are studying it (free idea grad students!). This system also seems to benefit businesses by bringing in additional consumers and benefits everyone by taking cars off the road. The only losers seem to be anti-bikers.

Japan as a model

The cost of in home long-term services continues to rise and the future costs are only expected to increase at an even higher rate. Several articles have looked to robotics as a way of taking care of the elderly and disabled and profiled Japan recently.  This weekend, the New York Times had an interesting piece:

Last year in Japan, where robots are considered “iyashi,” or healing, the health ministry began a program designed to meet work-force shortages and help prevent injuries by promoting nursing-care robots that assist with lifting and moving patients.

Robots are fascinating and while this technology continues to develop, it reminds us that Japan has innovated beyond mechanically in their health care system. Japan uses all payer rate setting to control the cost of health care and for all intensive purposes, their system has maintained a low rate of growth.  See below:

Country Health Care Percent GDP in 2000 Health Care Percent GDP in 2008
Japan 7.7 8.5
US 13.7 16.4

Naoki Ikegami and Gerald F. Anderson wrote an interesting Health Affairs article in 2012 about their rate setting policies. While the health care system in Japan has a fee-for-service model which typically drives usage, the rate setting is keeping costs down. In order to revise the fee schedule the government looks at overall rate of increase paying special attention to drugs and devices then takes into account item by item revisions. The government doesn’t do global rate decreases because that would be politically impalpable. Interestingly, Japan combines their hospital and physician fees for inpatient care which makes sense and reduces overbilling.

Medicaid is the Best: Part 2

This is part 2 of the ongoing series in Medicaid posts to pursued the minds of all internet users that Medicaid is indeed the best.  

People love Medicaid.

For instance, Belhaven, North Carolina Mayor Adam O’Neal. This week, O’Neal started a 273 mile walk to Washington to protest the closure of the hospital in his area. The hospital sites anticipated reductions to Medicaid uncompensated care payments as reason for closure. These future cuts were designed to be offset by new payments from the the new Medicaid expansion population. North Carolina decided not to expand Medicaid to those under 138% federal poverty.

O’Neal is a Republican.

While O’Neal’s protest should be directed to the state rather than the federal government, his actions join a growing cacophony of local protesters fighting for Medicaid expansion.



Screenshot 2014-07-15 17.20.35I hope that you all are regularly reading the Journal Sentinel if not, you may have missed that a month ago they had great analysis teaming up with the Pittsburg Post-Gazette for a story by Lillian Thomas entitled “Hospitals, doctors moving out of poor city neighborhoods to more affluent areas.” Jaclyn Cosgrove (follow her!), who does some killer reporting out in Oklahoma, directed me to the Oklahoma City breakdown of metro regions that the Journal did.

What’s going on in Oklahoma City? The blue dots indicate hospitals that have recently opened and they are clearly primarily located in higher income neighborhoods.  Red dots indicate the hospitals that have closed.  The darker orange shows a higher percent of the population below the poverty level. Play around with the tool yourself here.

Playing around with the map feature a bit Oklahoma City is one of the clearer examples of cities that are closing hospitals specifically in poorer neighborhoods.  Hospital consolidation has been a concern for decades but where this consolidation is occurring and how it impacts access could be more troubling. Recent research by Alan Sager at Boston University also suggests that the hospitals closing are more efficient than the ones remaining open.

So, what is causing the closures? Most closures are attributed to financial strain. It makes sense that those serving low-income areas would see lower payments and high uncompensated care. As hospital systems continue to grow in the hospital landscape financing mechanisms with DSH payments and other financial incentives for hospitals serving low-income populations should ensure these hospitals stay open.

An interesting fact

I’m currently rereading The Social Transformation of American Medicine by Paul Starr.  Amazon tells me there are only 19 copies left! Yikes!

Here is an interesting fact from that book:

The total investment necessary to enter medical practice in 1850, including direct expenses and opportunity costs probably ranged between $500 and $1,300, depending on the degree of schooling.

Starr does some calculations in order to come up with this estimate including looking into the average costs of a horse and buggy at the time ($200-300) and estimations of the opportunity costs of the schooling and apprenticeship.

Last year, CBS news estimated that it costs on  average $1 million to become a doctor today.