Longer looks: Treating Down syndrome?; mentally ill, meds & trials

Aug 5 2011

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

The Economist: Looking To Uncle Sam
Politicians want to lower spending, or at least they say they do. But in all the to-and-fro over raising the debt ceiling, little sensible has been said about lowering spending in the long term. Nothing illuminates this more clearly than health care. A new report, published in Health Affairs on July 28th, paints a daunting picture. Health spending will rise by 5.8% each year from 2010 to the end of 2020, according to actuaries at the Centres for Medicare and Medicaid Services (CMS). In 2020 health care will account for one-fifth of America's economy. The federal government will pay for a greater share than ever before (7/30).

The Atlantic: Beyond Migraines: How Healthy Are The 2012 Presidential Contenders?
In 2008, there was a considerable amount of concern voiced over the health records of the major party candidates … A similar concern is arising in the 2012 presidential primaries, as health records of GOP hopefuls are released with surprising findings, and sometimes, as in the case of Michele Bachmann, not so voluntarily. But how unhealthy is the migraine-sufferer really compared to the rest of a field that includes cancer-survivor Herman Cain and motorcycle-riding Jon Huntsman? To answer these and other questions, we turned to an approach that provides quantifiable, objective comparisons of the health of the former and current White House executives with GOP candidates: a health utility analysis. … The results of this analysis show that, among living politicians, Newt Gingrich, Dick Cheney and Joe Biden have the lowest health utility -- while President Obama and several young, fit GOP candidates have the highest marks (William Padula and Patrick Sullivan, 8/3).

National Review: Stop Cutting Medicare Payments
It is an insult to the intelligence of our elderly to assure them that their Medicare benefits are not being cut while limiting the services these benefits can buy and decreasing reimbursements to the doctors and hospitals that provide those services. ... The cuts proposed in the current budget deal will make Medicare patients less profitable for doctors, who will run, leaving patients holding Medicare cards that don't buy them access to health care. Even before Obamacare began to muddy the playing field, to say nothing of the proposed cuts, an AMA survey revealed that 17 percent of physicians were already restricting the number of Medicare patients they saw. They did this because the rates that Medicare paid for office visits were frozen, even as doctors' office operating expenses rose by more than 20 percent over the past decade (Dr. Marc Siegel, 8/3).

American Medical News: Direct Primary Care Model: Cutting Out The Insurer
A small but enthusiastic minority of primary care physicians believe they have found a practice model that can save money, improve patients' long-term health and drastically reduce administrative hassles: direct primary care. Direct primary care practices are an offshoot of the retainer care model, which provides unlimited or less-restricted access to physicians for a set fee. Under direct primary care, patients pay a monthly fee -- sometimes less than $100 -- for unlimited access to a range of primary care services, possibly as complex as minor surgeries and x-rays. Patients at these practices are encouraged to have basic health insurance to pay for specialist and hospital care, otherwise uninsured patients pay out of pocket for care outside the practice (Doug Trapp, 8/1).

The Connecticut Mirror: Health Insurance Explained, And Animated 
If you've been meaning to learn about health insurance regulation but were turned off by the lack of animated options, the Oregon Insurance Division has just the explainer for you. The 7-minute video provides the division's answers to why insurance costs so much, how premium costs are set, how the insurance division regulates health insurance, and how the rate review process works (Levin Becker, 8/3).

The New York Times Magazine: A Drug For Down Syndrome
Early in the evening of June 25, 1995, hours after the birth of his first and only child, the course of Dr. Alberto Costa's life and work took an abrupt turn. Still recovering from a traumatic delivery that required an emergency Caesarean section, Costa's wife, Daisy, lay in bed, groggy from sedation. Into their dimly lighted room at Methodist Hospital in Houston walked the clinical geneticist. He took Costa aside to deliver some unfortunate news. The baby girl, he said, appeared to have Down syndrome, the most common genetic cause of cognitive disabilities, or what used to be called "mental retardation." … Now Costa has taken the next step: he is completing the first randomized clinical trial ever to take a drug that worked in mice with Down and apply it to humans with the disease, a milestone in the history of Down-syndrome research (Dan Hurley, 7/29).

The Daily Beast: Should He Be Forced To Take Meds?
Nearly three months after he allegedly killed six people and injured Rep. Gabrielle Giffords and 12 others during a January shooting rampage in Tucson, Jared Lee Loughner sat in a Tucson courtroom, where his mental competency to stand trial was being evaluated. … He appeared benign. And then, unexpectedly, he yelled at the judge: "Thank you for the free kill. She died in front of me. Your Cheesiness." …The 22-year-old unemployed community-college dropout, who had just been diagnosed with schizophrenia, was later deemed mentally incompetent to stand trial. … In the past few weeks, courts have ordered Loughner, who does not want to be medicated, to be put on meds, then taken off meds, then put on meds again, as lawyers prepare for yet another appellate-court hearing in late August over his forced medication. ... For doctors "to stand by and not do anything" as a patient "destabilizes" in a "clinical emergency," says Richard J. Bonnie, the director of the Institute of Law, Psychiatry, & Public Policy at the University of Virginia, would be unethical (Terry Greene Sterling, 7/30).

Slate: Sex Selection Happens In The United States, Too—And Doctors Need Better Guidelines For Dealing With It
Sex selection isn't something that only happens in foreign countries like India or China. It happens in the United States, too ... And while these procedures, which can involve fertilizing a woman with only X- or Y-bearing sperm, implanting her with embryos of the desired sex, or aborting fetuses of the unwanted sex, are all legal in this country, there's no consensus among doctors about whether—or when—it's ethical to offer them. Unlike their Chinese and Indian counterparts, who cannot legally offer sex selection, American doctors are left to decide on a case-by-case basis whether to perform these procedures, without any consistent ethical guidelines. ... Reproductive choice and patient autonomy are pillars of American medical practice, after all  (Sunita Puri, 8/2).