Longer looks: ACOs and job shifts; abortion's racial gap; having a stroke at 33

Sep 26 2014

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The Economist: How To Fix Obamacare
It is now nearly a year since the roll-out of Obamacare. The launch was a shambles, and Obamacare is a totem for every American who hates big government. Republicans will deride it, yet again, in the mid-term elections. Obamacare is indeed costly and overcomplicated. Yet it is not to blame for America's health mess, and it could just contain the beginnings of a partial solution to it. But that will only happen if politicians treat health care like a patient: first, diagnose the disease, then examine whether Barack Obama's treatment helped, and then ask what will make the patient better (9/20).

Vox: How Much Money Do We Waste On Useless Health Care?
It's hard to overstate the importance of the Dartmouth Atlas, a research project begun in the mid-1990s by health-care researchers at (unsurprisingly) Dartmouth College. The 18-year study has shown the incredible variation in American health spending. What Medicare spends on a single patient's hospital care ranges from $5,371 in Utah to $8,937 in Maryland (Sarah Kliff, 9/18).

The Atlantic: Abortion's Racial Gap
In 2005, Renee Bracey Sherman, then 19, sat in the abortion clinic alone. A jumble of concerns ran through her mind. She didn't feel ready for a baby, but still, she worried that her parents would be disappointed in her choice. More than anything, though, she didn't want to be a statistic, another pregnant black teen. "In the moment, you never know who your allies are," Sherman said. "You don't want to take the chance of everyone judging you at a moment when you're so vulnerable. There's a very unfortunate stereotype of women of color, and black women in particular, that we are promiscuous and just have babies. You don't want that to be you." An African-American woman is almost five times likelier to have an abortion than a white woman, and a Latina more than twice as likely, according to the Centers for Disease Control and Prevention (Zoe Dutton, 9/22).

The New York Times: A Mother In Jail For Helping Her Daughter Have An Abortion
On Sept. 12th, Jennifer Whalen, a 39-year-old mother of three in the rural town of Washingtonville, Pa., went to jail to begin serving a 9-to-18-month sentence. Whalen's crime was, in effect, ordering pills online that her older daughter took in the first several weeks of an unplanned pregnancy, when she was 16, to induce a miscarriage. The medication was a combination of mifepristone (formerly called RU-486) and misoprostol. The drugs have been available from a doctor with a prescription in the United States since 2000 and are used around the world to induce miscarriage. Recent research increasingly suggests that early in a pregnancy, women can safely use mifepristone and misoprostol to miscarry at home. But if the medical risk of this kind of do-it-yourself abortion is relatively small, the legal risk still looms large (Emily Bazelon, 9/22).

The New York Times: A Drug Mule For The Medicare Set
My mother has many attributes, but athleticism has never been one of them. She always hesitates before stepping onto an escalator and rarely walks beyond our circular driveway. So when her physician ordered her onto a treadmill last winter, it hardly seemed surprising that her heartbeat jumped dramatically, even when the pace was not brisk. She is 80, after all. To temper her tempo, she was soon prescribed a very expensive heart medication. "I have to take it or I might have a stroke," she told me (a problem for me, as her future caregiver, as well as for her). Luckily, Medicare and her supplemental insurance picked up most of the cost, so a 90-day prescription's worth of pills came to just $135 -; a good rate to pay, I thought, for a good heart rate. But in July, her discount suddenly ended (Jennifer Conlin, 9/19).

Modern Healthcare: ACOs, Other Delivery Reforms Shift Job Roles At Hospitals
Phoenix obstetrician Megan Cheney no longer makes hours of telephone calls on Thursday nights to report routine results of laboratory tests to waiting patients. The calls, however, still get made every week. A medical assistant with experience in obstetrics and gynecology now handles calls involving routine findings. That has freed time for Cheney to draft the lectures she delivers twice a week to her medical resident trainees. The shift in responsibilities may be minor, a matter of hours in a lengthy work week. But it is one of many underway at Banner Health, where the drive to cut costs has triggered an extensive overhaul of employees' roles and patient care (Melanie Evans, 9/20).

The New York Times: To Gather Drug Data, A Health Start-Up Turns To Consumers
For years, Thomas Goetz had been a spirited armchair advocate of the use of digital technology and data to improve health care. At Wired magazine, where he was executive editor, Mr. Goetz assigned and wrote articles on the subject. He organized conferences, lectured and wrote a book in 2010, "The Decision Tree," which hailed a technology-led path toward personalized health care and better treatment decisions (Steve Lohr, 9/23).

BuzzFeed: I Had A Stroke At 33
There was a cascade of input -; triangles and sky and gravel sound and music on the radio and wind and the feeling of rough cloth near my hands. I could not make sense of it all; I did not know the small triangles were trees, the larger ones mountains, the sound tires crunching snow and Snow Patrol, the jacket Gore-Tex, and that my wrists were the things attached to things called my hands. They were colors and shapes and sound and touch and sensation and my brain was no longer sorting these things out. But when I saw the red snowblowers in the parking lot turned 90 degrees and doubled, I finally had a complete thought. I comprehended what I was seeing. Red snowblowers. Sideways. Strange. That was what my stroke felt like: like I was separating from myself. It was Dec. 31, 2006. I was 33 (Christine Hyung-Oak Lee, 9/21).

Pacific Standard: Why Science Won't Defeat Ebola
On Tuesday President Obama announced that the U.S. government will step up its efforts to help fight Ebola in West Africa. Coming six months into the crisis, and more than a month after the World Health Organization said that the outbreak was getting out of control, this major commitment of supplies and personnel by the world's wealthiest country is long past due. The biomedical community also seems to be lagging. Ebola vaccines and drugs exist but are only available in limited quantities thanks to their experimental state. Reading the headlines, it sounds like the researchers and regulators have moved too slowly. The drugs are "still stuck in the lab." There is a new way to quickly make enough drugs to halt the outbreak, "if only the U.S. had the boldness to try it." The most promising vaccine was recently put on an accelerated testing schedule, but it's too little too late (Michael White, 9/19).