The New Health Dialogue

If you’re an average American, you drink 44.7 gallons of pop (“soda” for the coastal readers out there) every year.  Adding in sports and energy drinks, the average American consumes about 50 gallons of sugary beverages a year.

Assuming you are drinking non-diet beverages, you would ingest 46 pounds of sugar, or about 7.3 gallons.

If you need help visualizing that, this picture shows how much sugar you would consume if you drank one 12oz soft drink a day for a year (5 gallons):

Vikas Saini, M.D. is a clinical cardiologist and researcher at Harvard Medical School and Harvard School of Public Health and president of the Lown Cardiovascular Research Foundation in Boston. This article is cross-posted in the Lown Foundation's Prevention India column. For another perspective on avoiding avoidable care, check out Shannon Brownlee's accompanying piece entitled, "Less is More."

We need to reduce overdiagnosis and overtreatment and use the costs associated with them to pay for prevention.

Prevention works, but prevention costs money. Some prevention can be practised at the individual level as is emphasised by the content of this magazine. Much of the prevention opportunity lies at the social level—whether in the provisioning of parks and recreation areas for exercise, or regulation to make food safe and healthy. But all of this, whether at the individual or social level, costs money. In a world of constrained resources, where will the money come from?

Forbes blogger Avik Roy commented during yesterday’s IPAB hearing that “studies show that health outcomes for many Medicaid patients are worse than those who have no insurance at all.” That assertion has been around for a while. Unfortunately for Roy, it’s been frequently refuted, with a new study out of Oregon containing further evidence that patients do, in fact, benefit from Medicaid coverage.

The National Bureau of Economic Research study, released earlier this month, details results from  a study of Oregon’s Medicaid program. Three years ago, the state discovered that it had additional funds for Medicaid and wanted to enroll more people. But there were more eligible recipients than there was money, so the state created a lottery to decide who could apply and who couldn't.   The study, conducted by researchers from Harvard, MIT and other institutions, is the only randomized experiment ever done on the effects of having insurance compared to no insurance.* It compared utilization, health outcomes and self-reported health status, and financial hardship due to medical expenses among people who won the eligibility lottery and those who did not.

One key result: The authors describe an “overwhelming sense from the survey outcomes that individuals feel better about their health.”

Individuals who won the lottery also used more medical services, had improved self-assessed physical and mental health, and reduced likelihood of medical debts being sent to a collections agency. While none of the results directly relate to mortality or other measures of actual health (because mortality among the adult population is extremely low, even without insurance), there is a clear benefit to Medicaid in terms of beneficiaries’ general well-being. (Future papers will present more data on traditional measures of health outcomes.)

So much for the claim that Medicaid makes people sicker.

*The RAND Health Insurance Experiment(the only other randomized trial looking at the effects of insurance) examined the effects of different amounts of insurance, using different cost-sharing arrangements, but did not include any participants with no insurance at all.

In case you missed the excitement, the House Energy and Commerce Committee held its second day of hearings on the Independent Payments Advisory Board, also known as IPAB. The board has been a source of contention since its inception, as some members of Congress have insinuated that it would reduce seniors’ access to medical care. Be sure to follow our live-tweeting of the hearing here, join the conversation with the hashtags #IPAB, and you can watch the (remarkably interesting and entertaining) webcast here.

So what is IPAB, anyway? And more importantly, will it mean I get sent off on an ice floe to die when I turn 65?

Probably not. The Independent Payments Advisory Board was created by the Affordable Care Act as a mechanism for finding cost savings in Medicare, and keeping the per capita growth rate at the levels specified by Medicare's independent actuary. Its recommendations are submitted to Congress, and become law automatically through a "fast-tracked" parliamentary procedure unless Congress achieves the required cost savings by other means.