We won't be posting for the next week, but not to worry! We're still writing our little behinds off. We're just saving up posts so we can finish August strong. We may still comment on any big news, so be sur to follow us on Twitter and check back in next Monday!
Two weeks ago, American Beverage Association President Susan Neely took issue with Mark Bittman’s New York Times Magazine article, in which he advocated taxes on soda and other unhealthy foods. Bittman’s justification was that raising the prices of those unhealthy foods relative to more nutritious foods would encourage people to eat more healthfully, and so help combat the national obesity epidemic. Neely said in her response, “Obesity isn’t about “good” and “bad” foods. It’s about an imbalance between calories consumed — from all foods and beverages — and those burned through physical activity.”
She’s right, of course: many factors contribute to obesity, but the problem isn’t as simple as “eating bad foods makes you obese.” The thing is, that’s not what Bittman was saying, either. The ultimate goal of his tax proposal is to change the food environment in which we live.
Public health advocates believe that Americans live in an obesogenic environment: not one where anyone is forced to eat unhealthily and become obese, but an environment with forces that encourage overconsumption of calorie-dense, low-nutrition foods.
It might seem like the New Health Dialogue comes down pretty hard on "medical innovation" sometimes. Yes, we are skeptical of the "new" and the "high-tech" -- for example DiVinci robotic surgery or 64-slice CT scanning -- because there is often evidence that the newest invention is really only the most expensive, rather than the most efficacious.
Sometimes though, the latest advance in medical technology simply blows your mind and makes you want to stand up and applaud. That is surely the case with Charla Nash, the newest recipient of a full face transplant. Mauled by a chimpanzee in 2009, Ms. Nash's face was disfigured beyond all recognition.
Today's number is 18.1 percent -- according to new data released today, that's the portion of our GDP going to health spending. That's up from 16.3 percent when the recession began back in 2007. GDP isn't yet back to where it was at the beginning of the recession.
That means that instead of having more luxury cars, education, and infrastructure development, we've spent the minimal economic growth we've had on health care. We're neither adequately slowed cost growth nor addressed the massive amounts of waste in the medical system. Hopefully before the next recession, we'll have decided to stop wasting money on useless diagnostic tests, rather than slashing budgets for things that really matter.
A new study in the Journal the American College of Cardiology finds that doctors at different hospitals vary widely in their assessment of who qualifies as an appropriate candidate for elective coronary angiography (a way to look for clogged coronary arteries). If Jack Wennberg and his daring band of disruptive Dartmouth Atlas docs have taught us anything, it’s that variation marks the spot for the inconsistent -- and often inappropriate -- use of health care services.
According to researchers at Duke University Medical Center, different hospitals use wildly disparate criteria for determining which patients need non-emergency coronary angiography. The authors found that hospitals with a lower rate of positive tests -- meaning they test a lot of people who end up not having heart disease -- tend to be more likely to perform angiography on younger, asymptomatic patients. Out of more than half a million medical records examined, the researchers found some hospitals with rates of positive tests as low as 23 percent.
Hospitals, even nonprofits, are not excluded from federal taxes by default. Rather, each hospital has to qualify individually for its own slice of billions in federal tax exemptions doled out each year. The criteria for qualification are laid out in §501(c)(3) of the Internal Revenue Code -- the same section that lays out qualifications for other exempt organizations like churches, nonprofit charities, educational institutions, etc.
The IRS states that the nonprofit must be operated “exclusively for exempt purposes” in order to qualify. Those purposes include work for “charitable, religious, educational, scientific,” purposes. The charity subset includes “relief of the poor, the distressed, or the underprivileged," and "lessening the burden of government.” The last function, “lessening the burden of government,” is particularly important to this issue. It suggests that nonprofits should be providing services that the government might also provide, and so the tax exemption should provide more benefit to the community through the charity than it would if the government simply collected the tax and provided the service itself.
Part II of our series on non-profit hospitals is here.
There are 5008 community hospitals in the United States. They care for over 35 million patients each year--one in every nine Americans, if distributed equally. Total payments to community hospitals amount to over $650 billion per year. That’s a lot of money: about the same as the entire budget of the Department of Defense, including the wars in Iraq and Afghanistan. It’s nearly a quarter of our total health spending; over four percent of GDP; over $2100 per American. Community hospitals employ 5.4 million people. What’s more, all those hospitals are the training sites for our next generation of doctors, nurses, and PA’s: the very medical practitioners who will push for efficient delivery of health services, or drive unsustainable and destructive cost growth in the coming decades.
But it's not all Justin Beiber-induced time-sink. Twitter keeps us tuned in to the warm, beating heart of the health policy news in D.C. and around the country, besides helping us stay connected to the latest breaking developments in Anatidaean linear progression.
We joined the Twitter party early.* On Februrary 19th, 2009, a program associate named Paul Testa pushed the New Health Dialogue head first into the social media revolution. With a minor de-anglification of our name, the @NewHealthDialog was born.
And now, 2 years, 5 months, 22 days, and 4,376 tweets later...
So a hearty digital thanks to @umtrey, as well as all of our 6,999 other loyal followers. It's been a wild ride, with that whole health reform debate... bill... law... more debate... court challenge... more debate... debt ceiling... and it sure doesn't look to be over any time soon.
Keep tweeting us (we love to hear from you!), and we'll keep bringing you all the live-tweeting and bad-punning you can handle. We've heard this whole debt commision thing might get interesting...
*Not that early... We were actually Tweeter #20,703,914. But to put that in perspective, if you registered for a new Twitter account today, you'd be somewhere in the 340,000,000s! So we beat about 320 million people to the fad.
**And an even bigger thanks to all the tweeters gone by! We're looking at you Paul, Allie, Meredith, Joanne, Thiago, Eric, Andrew, and Logan.
It was pretty hot last week, but the mercury has just kept on rising. Rising even higher has been the quality of work in the health policy community. This week, Joe Padua at Managed Care Matters highlights some of the finest health wonkery this side of the Congressional recess.
If you (like us) are stuck in swampland while our incredibly effective elected policitical leaders skip town for a month, prepare yourself for the fall's rough and tumble health reform fights with the work of this week's Health Wonk Review!
Last week, U.S. Food and Drug Administration Commissioner Margaret Hamburg told the advocacy group Public Citizen that the FDA may loosen conflict-of-interest rules for experts who serve on the agency’s advisory panels. These panels wield considerable power when it comes to FDA decisions about approving drugs and medical devices, and for pulling them off the market when evidence surfaces that they may cause patients harm.
Why loosen the rules? Commissioner Hamburg said the agency is having trouble finding experts to fill its advisory panel slots. In other words, anybody expert enough to be on an FDA panel undoubtedly has a conflict.
Or maybe the FDA just isn’t looking very hard. In 2008, Jeanne Lenzer -- an independent journalist -- and I created a list of more than 100 experts in fields ranging from epidemiology to neurology to emergency medicine, every one of them independent from industry conflicts of interest. We made the list available to our fellow journalists at the website, Healthnewsreview.org, a site that grades health stories. Dozens of journalists from top news outlets, including the New York Times, Bloomberg, and the Wall Street Journal, have requested the list, and used it to find sources for their stories -- or at least we hope they have.