Healthy Policy

Teen pregnancy: it's worse than you think

A new survey has found almost a third of sexually active girls aged 15-19 have gotten pregnant. 

That number really shocked me, although my shock is surely exacerbated by my upper-middle class upbringing.  Sure, I have friends who've gotten pregnant, but not many.

I recently heard the story of a girl and her boyfriend who had been having unprotected sex for over two years and she just now got pregnant.  She's 20.  The idiocy it takes to continue to take the risk of pregnancy for over 104 weeks is unthinkable.  But apparently not unheard of!

Although straight stupidity is sometimes to blame for unintended pregnancy, among teenage girls it is not the chief culprit.   Rather inadequate sex education, which often creates the impression that all birth control is faulty.  This kind of information not only prevents teens from learning the correct ways to prevent pregnancy, but it might also make them think that nothing is truly reliable and therefore worth taking the time to purchase. 

But only 11% of boys in the same age group report being involved in a pregnancy -- which alludes to the fact that most of these girls aren't telling their partners.  If more guys knew they'd gotten someone pregnant, or that their friend had, they'd be more likely to use birth control.

AHP's and the ACS

The American Cancer Society is among the groups protesting Mike Enzi's Association Health Plan Bill.  And they have some sound and not so sound reasons for this:

  In response to the bill, which likely will move to the Senate floor for consideration in May, the American Cancer Society plans to publish print advertisements that warn the legislation could reduce the ability of women to obtain coverage from health insurers for mammograms. Forty-nine states require health insurers to cover mammograms. Dan Smith, vice president of government relations for ACS, said, "Not only would this legislation wipe out guaranteed access to cancer screenings, it would remove coverage guarantees for clinical trials, off-label drug use and smoking cessation services."

The mammogram thing is a great point.  But off-label drug use?  Most Americans don't know what that is or why we should have it, particularly in the case of chemotherapy, and frankly, it's not such a great thing to use a large part of your ad campaign on behavior that is discouraged by the FDA.

Maybe we could talk about prenatal care coverage?  Or any number of other things Americans will immediately understand, that Association Health Plans could wreck?

Remember me?

Read Graham on a woman with an autobiographical memory.  Now there's certainly things in my life (read: the week following my surgery) I'd prefer not to remember that well, but sign me up for this skill!

UMDNJ: Very bad people

This extensive reporting by Health Care Renewal of the problems at UMDNJ makes me very sad. 

Reinhardt responds to Salgo

Everybody's favorite health care economist, Uwe Reinhardt, sent in a letter to the editor responding to Peter Salgo's New York Times Op-Ed "The Doctor Will See You for Exactly Seven Minutes".  Reinhardt takes issue with the blame game:

Dr. Salgo also says that "publicly traded H.M.O.'s, for example, began restricting doctors to an average seven-minute 'encounter' with each customer." I defy him, or any doctor, to produce a memorandum from an H.M.O. to that effect.

During the 1990's, H.M.O.'s did extract discounts from doctors. To keep their income at previous levels, doctors voluntarily shortened visits. The H.M.O.'s were not to blame.

Finally, the average length of hospital stays started declining in the mid-1980's, after Medicare began paying hospitals a flat fee for each admission. Hospitals found it profitable to voluntarily reduce the length of stays.

Another letter echoes part of these sentiments -- that it's not up to patients to enact change, but that doctors need to take more responsibility for the deterioration of the doctor-patient relationship, because they didn't do enough to stop changes in the first place.

UPDATE:  Roy Poses of Health Care Renewal offered some thoughtful comments:

With all due respect, Prof. Reinhardt is quibbling.
Clearly managed care (and Medicare) have periodically either cut reimbursement for office visits, or have failed to raise reimbursement to keep up with inflation. Also, they have imposed ever greater bureaucratic burdens on office practitioners that increase their overhead...See this article that shows that primary care physicians' charges (reflective of patient volume) have increased much faster than their compensation, which has failed to keep up with inflation:
http://www.ama-assn.org/amednews/site/free/bil10920.htm
For Reinhard to call physicians' responses to managed care and government practices "volunary" is sophistry.  Furthermore, I wonder if perhaps Prof Reinhardt's thinking is being influenced by his conflicts of interest?

Teacher! Who's this funny man?!

This story about a childless ER doc visiting a third grade classroom is pretty cute.

National Health Policy Conference

I'm attending Academy Health's National Health Policy Conference in Washington D.C. this week.

I'll fill you all in on the happenings later this week, but I want to apologize for my non-existent posting in the mean-time.

If you're attending the conference, I'm the girl on the crutches.  Come introduce yourself!

2006, a lot like 1606

Via the AP, this is a little Scarlet Letter-esque:

Legislatures sought ways to improve safety on the highways, demanding seat-belt use in taxis and shuttle vans in Oregon, requiring motorists hogging the left lane to move to the right in Florida, and trying to discourage drunken driving in Tennessee by requiring that offenders help clean up state highways while wearing vests emblazoned with the phrase "I am a Drunk Driver" in 4-inch lettering.

How to be a jerk in one dishonest column

What on earth is wrong with the person who wrote (and agreed to publish) this? There's no such thing as ventilator insurance!

Update: Ezra was willing to dive in deeper -- I can't bring myself to discuss such a despicable display of misanthrope with anything but shock.

More Best of '05

Happy New Year everyone!  Since it's still a holiday for most people, and the med blogosphere is particularly slow, it's time for more Best of '05 in Health Care.  This edition, courtesy of Leif Wellington Haase, includes the Worst of '05 (just to rile you up a bit) and some under the radar gems.  We're positive folks here at HP so let's start with the worst and end on a good note.   

The worst in '05?  Well, it's partisanship as usual, with a splash of greed and corruption:

Docs on the take? Needless to say, most physicians are ethical and conscientious—but the commercialization of modern medicine has sent many down the wrong path and put other doctors on the defensive. There’s a rogue’s gallery of unseemly behavior—possible conflicts of interest, dubious clinical trials, and ghostwritten scientific articles—here, here, and here, and in a valuable book-length expose by Jerome Kassirer, the former editor of the New England Journal of Medicine.

Whose moral hazard? Cervical cancer is diagnosed in about 10,000 U.S. women each year and kills about 3700. Merck has developed a vaccine for cervical cancer that targets the virus that causes 7 in 10 cancers and has shown impressive results in clinical trials. The company intends to apply to the Food & Drug Administration by the end of 2005 for permission to market the vaccine. (GlaxoSmithKline is also developing a cervical cancer vaccine.) Amazingly, the Family Research Council and other conservative groups have raised doubts about administering the vaccine to children (where it would be the most effective) because they fear that it will encourage promiscuity and undermine their preferred message of sexual abstinence.

The Medicare Drug Benefit. There’s a lot of potential for good here for low-income Medicare beneficiaries, who get tremendous help under the benefit with prescription drug costs. And it’s hard to criticize the impressive efforts of government officials, state and local volunteers, and private insurers to make sense, on behalf of older Americans, of this needlessly complicated benefit. But the early sign-up numbers don’t seem to be impressive—including, sadly, among low-income seniors and the disabled—and there are lots of minefields both structural and political ahead. To paraphrase Yogi Berra, for the drug benefit, it’s getting late early.

  I'll be the first to admit my proverbial panties are in a knot.  Corruption is screwing patients left and right while the Medicare drug benefit does its best with tax payers. 

But surely there's some good things, right?  From the Best:

Take Care New York. An ambitious, simple, and no-nonsense Web site introduced by New York City Public Health Commissioner Thomas Frieden to improve public health citywide. Thanks to his education efforts and tough anti-smoking legislation, the number of smokers in the city has dropped by an estimated 200,000 over the past three years. Governing magazine rightly named Frieden one of its public officials of the year.

Minnesota hospital systems that have stopped gouging uninsured patients. One of the ongoing scandals of U.S. health care is that uninsured patients frequently have to pay more than patients covered by large insurers for the same procedures. Then they get dunned by bill collectors as they try to dig out of impossible financial holes. Under an agreement with Minnesota Attorney General Mike Hatch, this honor roll of hospitals—Allina, North Memorial, Park Nicollet, and HealthEast Care—agreed that uninsured patients with annual household incomes not greater than $125,000 would pay no more than the large insurer rate for their treatment.

  Civil libertarians bitch and moan about smoking bans, but they work.   And for those of us non-smokers, they make going out a much more pleasant experience.  Public health is getting more attention, especially in relation to preventable illness and its effects on rising health care costs. 

The Minnesota hospital story is particularly interesting.  Many people are completely shocked when they hear that hospitals can charge more for the uninsured.  As Leif points out, even at the normal prices the uninsured get in bottomless financial holes.  It's great to hear some hospitals volunteering to end the punishment. 

I've only excerpted a little, so go read the original for the entire list.  All in all, 2005 in health care has been like the last 9 or so years.  Nothing major has happened, partisanship continues to paralyze any real reform, pharmaceutical companies get in trouble, and costs continue to rise.  Things will remain that way until at least 2008, and the more pessimistic analysts will predict for much longer. 

In the meantime, I'll keep plugging away here at Healthy Policy, preparing for the year when my summation post will go something like, "There's no question what the top health care story was this year.  The implementation of..." (Hey, there's always hope, right?)

Top Health Policy Stories of 2005

The Commonwealth Fund and Kaiser bring you the top health policy stories of 2005:

The leading vote-getters were:

• The number of uninsured continues to grow, hitting nearly 46 million, with another 16 million reported to be "underinsured."

• Hurricane Katrina draws dramatic attention to holes in the nation's health care safety net.

• Registration begins for new Medicare prescription drug benefit, despite widely reported confusion among seniors over the myriad choices for coverage.

• New cross-national studies add to evidence that U.S. health care system, the most expensive in the world, doesn't perform as well as that of several other industrialized nations on various clinical indicators and in reported patient experiences.

• Health care costs continue to increase, putting increased pressure on consumers, particularly the growing number citing trouble paying off medical debt.

I've written on all of them except Katrina, click on the categories links to the right to read more.

Best of '05 -- Health Affairs Edition

The Health Law Prof Blog has the list of the most-read Health Affairs articles of this year. If you've got a subscription, the most-read list is a great resource. Head over to an article outside your usual health angle. For me, that'll be John Holahan and Arunabh Ghosh, "Understanding The Recent Growth In Medicaid Spending, 2000-2003".

UC continues the corruption parade

Via Health Care Renewal, more corruption comes to light in this wrap up of recent problems in the University of California system. The Santa Cruz campus is my alma mater (and one of the bullet points of shady dealings).

Former UC Provost MRC Greenwood was charged with violating conflict of interest policies by hiring Lynda Goff, a friend and business partner, first as an executive assistant, then in academic affairs at a salary of $192 K. In addition, Winston Doby, UC Vice President for Student Affairs, who reported to Greenwood, hired Greenwood's son into a specially created internship position. When these events came to light, the university launched an investigation, but permitted Greenwood to resign her administrative position before it was completed, agreeing to give Greenwood 15 months of leave at her $ 301 K salary (per the San Francisco Chronicle).

This caused major uproar on campus. The "friend and business partner" is actually (or at least was) Greenwood's lesbian partner, and when faculty (especially those non-tenured, who've gotten a bad deal with pay in the last five years) accused her of neoptism and misusing funds, Greenwood returned with claims of homophobia. Needless to say, a bad situation.

Then there's the debate over the salaries of top administrators:

The first was about lavish pay and other compensation given to many top UC administrators, while state support of the system shrunk, and fees paid by students grew. But UC leadership argued that high pay was needed to attract top quality executives.

This I'm actually somewhat sympathetic to. I know a UC administrator well, have stayed at their home and spoken with them at length about their position. This administrator, though well paid, would absolutely be making 2-3 times their salary at a private institution. Further, if you consider the cost of living in the majority of the UC's campuses -- Orange County, West LA, Santa Cruz, Santa Barbara, San Diego, Berkeley -- these administrators need substantial salaries. Now, in the context of budget crises and student fee increases (because I was out of state, my tuition increased 20% every single year), administrator's salaries should be tied to other wage increases. But this problem is part of our current corporate culture. Public universities have the privilege of making that unacceptable -- the rest of the private sector employees do not.

There's also problems with the liver transplant program at UC-Irvine (birth place of Ezra), so head over for the details.

Corruption and Medicine

Via the New York Times, the University of Medicine and Dentistry of New Jersey is in deep:

UMDNJ effectively becomes the first public university in the nation to be placed under federal oversight, according to a Justice Department spokesman in Washington. With its five regional campuses, more than 4,500 students and a $1.6 billion annual budget, UMDNJ is the nation's largest health care university.

If criminal charges had been brought, the university would be disqualified from receiving the federal aid that makes up much of its budget.

For nearly a year, federal agents have been investigating accusations that administrators at the university doled out patronage jobs and tens of millions of dollars in no-bid contracts to their political allies, sometimes for work that was not performed.

Visit Health Care Renewal, who's been following the case for awhile, for more.

In the meantime, I have a question for the seasoned health policy vets: there appears to be a large number of improper conduct events lately -- Vioxx, Guidant, Cleveland Clinic, Aubrey Blumsohn, and now UMDNJ. Are there more incidents than usual, or is this standard corruption fare?