Longer looks: A key Hagel mission is to cut military health costs; Medical lessons from a mother's death; How they price - and how we pay for -a $300,000 medicine

Jan 11 2013

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The New Republic: Can Chuck Hagel Cure the Military's Health Care Problem?
As (David) Brooks and (Paul) Wolfowitz and many others have shown, it's easy to frame our messy fiscal conundrum in these simple terms of guns vs. butter, or rather, guns vs grandma's buttery-yellow, super-pricey heart medication. But there's an important detail that gets lost in this apposition: namely, that the most immediate threat to the military budget from rising health care costs is arguably the ballooning cost of the military's own health care programs. The cost of paying for the health care of nearly 10 million home-base military, their families, retirees and dependent survivors has nearly tripled over the past decade, from $19 billion to $53 billion, making it a major factor in the overall surge in the Pentagon's base budget to $525 billion (Alec MacGillis, 1/9).

ProPublica: What a New Doctor Learned About Medical Mistakes From Her Mom's Death 
[Dr. Elaine] Goodman had just finished her first year of medical school when she found herself spending months at the bedside of her 63-year-old mom, who was battling breast cancer in the hospital. One morning she arrived to find her mother's face and hands bloodied. Hallucinating and disoriented, her mom had yanked the cranial staples inserted during a recent procedure from her head. ... She suffered frequent falls and preventable side effects from drugs. And she narrowly missed having an unnecessary brain operation and getting an incorrect drug. "It was really eye opening for me to see the reality of how difficult it was to keep her safe in the hospital," Goodman said (Marshall Allen, 1/9).

The Daily Beast: The Best Way To Reform Health Care-;And Cut The Deficit
[T]here's one way that Obama can keep deficit hawks happy without sacrificing entitlements. It's the least painful way to lower health-care costs, because it actually increases quality. It's bipartisan, because it adopts deregulatory reforms that should appeal to Republicans. ... So what is it? It's defragmenting health care. To explain: the fragmented nature of the U.S. healthcare system is remarkable. Even physicians who practice within the same hospital are typically independent from each other and from the hospital and its nurses. At some hospitals, case managers gamely try to coordinate the physicians working on a given case but have no direct control and little leverage, because the physicians bill separately. Outside of hospitals, the situation is even worse (Einer Elhauge, 1/6).

Forbes: Inside The Pricing Of A $300,000-A-Year Drug
NPS Pharmaceuticals announced that it was pricing Gattex, its drug for short bowel syndrome, at $295,000 per patient per year, about triple what analysts on Wall Street expected. It is the fourth drug approved in 2012 to be priced at more than $200,000 per patient per year. ... How, though, does anyone pay for such a medicine? The answer is that pricing of these rare disease drugs, known as ultra-orphan drugs in the biotech industry, are not paid for the way that most medicines are. Nobody buys them out of pocket, and the manufacturer refuses to grant discounts to insurers or to Medicare. Commercial insurers will usually not pay the whole cost of the drug, asking patients to cover a co-pay that could be 30% of the drug's price. Through what is known as a co-pay assistance program, NPS will cover patients' out-of-pocket costs (Matthew Herper, 1/3).

Fortune: Lloyd Dean: The Medicine Man Of Dignity Health
As CEO of San Francisco-based Dignity Health -- as of early 2012, the new brand name for Catholic Healthcare West -- the 62-year-old (Lloyd) Dean has been working rooms at corporate and civic levels for more than a decade. In his manner and method, Dean has come to stand out as an unconventional leader in a staid, grave industry. Before a dinner crowd he can kid about his "brother-to-brother" relationship with Barack Obama over the past four years. ... To check up on "customer service" at his hospitals, he's been known to put on a sweats-and-sunglasses disguise in the lobby -- the better to hear what they're complaining about. (The No. 1 beef: parking!) When Dean has heard enough, he'll send around JUST THINKING memos to staff, which pretty much amount to JUST FIX it directives. ... Now Dean has entered the national stage (David A. Kaplan, 1/9).

Houston Chronicle: Native Americans Say Health Care Promises Here Not Fulfilled
When her husband was laid off in 2010 from his engineering job and the couple lost his insurance, Anna Edwards said her monthly prescription bill quadrupled to almost $1,200 and she was forced to abandon some medications. "It's like having to play Russian roulette every day and gamble on it and pray," she said. ... But the U.S. government made treaty commitments to provide Edwards, a San Juan Pueblo, and other Native Americans from federally recognized tribes with health care regardless of financial situation. In Houston, it's an unfulfilled promise. Of the 10 U.S. cities with the largest American Indian populations, Houston is the only one without an Indian Health Service facility (Jayme Fraser, 1/6).

Mother Jones: America's Real Criminal Element: Lead
Experts often suggest that crime resembles an epidemic. But what kind? if it's everywhere, all at once-;as both the rise of crime in the '60s and '70s and the fall of crime in the '90s seemed to be-;the cause is a molecule. ... What molecule could be responsible for a steep and sudden decline in violent crime? Well, here's one possibility: Pb(CH2CH3)4 (tetraethyl lead, which was a gasoline additive). ... The biggest source of lead in the postwar era, it turns out, wasn't paint. It was leaded gasoline. And if you chart the rise and fall of atmospheric lead caused by the rise and fall of leaded gasoline consumption, you get a pretty simple upside-down U: Lead emissions from tailpipes rose steadily from the early '40s through the early '70s, nearly quadrupling over that period. Then, as unleaded gasoline began to replace leaded gasoline, emissions plummeted. Intriguingly, violent crime rates [later] followed the same upside-down U pattern (Kevin Drum, January 2013).

The New York Times: Plan To End Methadone Use At Albuquerque Jail Prompts Alarm
For the last six years, the Metropolitan Detention Center, New Mexico's largest jail, has been administering methadone to inmates with drug addictions, one of a small number of jails and prisons around the country that do so. ... In November, however, the jail's warden, Ramon Rustin, said he wanted to stop treating inmates with methadone. Mr. Rustin said the program, which had been costing Bernalillo County about $10,000 a month, was too expensive. ... The New Mexico office of the Drug Policy Alliance, which promotes an overhaul to drug policy, has implored Mr. Rustin to reconsider his stance, saying in a letter that he did not have the medical expertise to make such a decision (Dan Frosch, 1/6).