Viewpoints: Late hospital bills perplex consumers; Personal health data can 'revolutionize' care

Jun 28 2013

Los Angeles Times: A Bill From The Blue
Flavio de Pecol hit the trifecta after taking his daughter to the emergency room for a horse-riding injury: hours of waiting, a 16-mile ambulance ride to a different facility and bills for more than $40,000. At least, he thought, that was the end of it. But nearly two years (later), ... De Pecol, of Newport Beach, has received yet another bill, this time for $1,054.53. ... "How can I trust that this isn't a mistake when a hospital takes 21 months to bill me?" De Pecol asked. ... Good questions, and yet another example of the way consumers are at the mercy of the healthcare industry's opaque and byzantine billing practices (David Lazarus, 6/25). 

The Wall Street Journal: 'Unspecified Mental Disorder'? That's Crazy
The American Psychiatric Association released a revision of its diagnostic bible in May, the first major rewrite in two decades. "The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders," or DSM-5, is the official guidebook for diagnosing every conceivable psychiatric ailment. This new edition loosens the rules in a disturbing way (Leonard Sax, 6/26). 

New England Journal Of Medicine: The FDA's Graphic Tobacco Warnings And The First Amendment
In the past, constitutional principle gave the government broad authority to regulate tobacco or pharmaceutical advertising. The state's power to safeguard the public health was strong, and companies' freedom to plug their products was weak. But the Supreme Court has changed course. Whereas it once did not view "commercial" speech as the kind of speech the First Amendment protects, it now gives businesses nearly the same rights to market their goods as it does individuals to speak their minds. And as the Court has broadened corporate freedom to advertise, it has narrowed governmental power to preserve the public's health (David Orentlicher, 6/26). 

New England Journal Of Medicine: The FDA And Graphic Cigarette-Pack Warnings – Thwarted By The Courts
On August 24, 2012, in R.J. Reynolds Tobacco Company v. Food and Drug Administration, the U.S. Court of Appeals for the District of Columbia ruled that the regulations proposed by the Food and Drug Administration (FDA) mandating the inclusion of graphic warnings on cigarette packs violated the First Amendment: they would compel companies to express antitobacco messages on their own dime. Seven months later, on March 14, 2013, the Department of Justice announced that the government would not appeal that decision to the Supreme Court (Ronald Bayer, David Johns, and James Colgrove, 6/26).

The New York Times' Opinionator: Building Networks For A 'Good Life,' Even After the Caregiver Is Gone
Vancouver is home to one of the world's most innovative disability support organizations: the Planned Lifetime Advocacy Network (PLAN), which helps people secure futures for family members with disabilities -; not by providing them with professional services but by showing them how to build resilient and flexible networks of care. ... PLAN helped (family therapist Ted) Kuntz prepare a long-term care plan for (his son)Josh and build up a network of support, which included other parents of children with disabilities (David Bornstein, 6/26). 

Health Policy Solutions (a Colo. news service): The Cost Curve On Health Care – It's Bending
The biggest long-term concern with the American health care system is cost. The affordability of premiums, access to care and the impact of Medicare and Medicaid on state and federal budgets are all linked to the ever-rising costs of health care. Unless we bend the cost curve, the nation's health care system will become increasingly unsustainable. The good news is that, even though costs and spending continue to increase, we have started to see a slowdown (Bob Serno, 6/26).

Politico: How Big Data Can Revolutionize Health Care
Right now, our population-based health care system leads us to draw conclusions for patients based on what we know of others and how we care for them. But Big Data provides us an opportunity to transition to a personal care system. Rather than making assumptions based on what has worked for other people, this personal view would allow us to take data about a patient's genomes, medical history and behaviors to construct a virtual model that would help predict which treatments will be most effective and customize them to an individual -; improving quality of life for the patient and saving the delivery system money. But how do we scale a data-driven, personal health system so access is afforded to everyone? (Eric Dishman, 6/26).

JAMA: New Evidence Supports, Challenges, And Informs The Ambitions Of Health Reform
The principle ambition of the ACA is to cover the uninsured. A major way it would do so is through the expansion of Medicaid. ... A frequently cited reason for not expanding Medicaid is the cost involved. It is widely believed that uninsured persons are sicker than those who are insured. Therefore, expanding Medicaid to cover poor, uninsured Americans would not only increase the size of the program but also make its risk pool sicker, compounding its increase in cost. In principle, few oppose reducing the number of uninsured persons as a goal, but many question the cost-effectiveness of expanding Medicaid. The report ... in this issue of JAMA directly informs this debate and contradicts several widely held beliefs about how uninsured but Medicaid-eligible (under ACA rules) persons may differ from those covered by Medicaid (Aaron E. Carroll and Austin B. Frakt, 6/26).

JAMA: Sorting Through The Arguments On Breast Screening
Views on the benefits and harms of breast cancer screening are sharply polarized and increasingly vocal. Allegations of harming women are flung in both directions. ... But the evidence on breast screening is more extensive than in many other areas relevant to population health. If this is not enough for an independent group, coming fresh to the debate, to reach a reasonable judgment, then evidence-based policy is a good deal more difficult than many would believe (Michael G. Marmot, 6/26).

St. Louis Post Dispatch: More Girls Should Be Getting HPV Vaccine
Most parents would do almost anything to protect their children. Yet many who could do more to save their daughters from cervical cancer choose not to (Dr. L. Stewart Massad, 6/27).