Response to Sticker Shock: More Expensive Than What?

From Guest Blogger Cathy Hope of the Georgetown Center for Children and Families.  (See her original post here.)

Whenever I read stories about the sticker shock that may hit some consumers when the Affordable Care Act takes effect, it reminds me that buying insurance can be more mystifying than buying a new car.  There have been so many jalopies being sold in “mint condition” in the wild west of the insurance market for so long that it’s going to take some time for consumers to realize how much better the insurance products will be once the ACA consumer protections take full effect.

They will finally be getting what they are paying for – coverage that will cover essential health needs and won’t disappear when they need it most.  Don’t forget, there will be other important features included in next year’s models (in other words improvements brought about by the ACA market reforms such as the elimination of pre-existing condition discrimination and gender-based rating.)

These sticker price narratives also often ignore the fact that many people won’t be paying the full sticker price because they will be eligible for federal tax credits and/or cost-sharing protections offered by the ACA to offset the cost of insurance.   A new report from the Kaiser Family Foundation found that 48% of people now buying their own insurance would be eligible for a tax credit that would offset their premium. Among the approximately half of current enrollees who will be eligible for tax credits, the average subsidy would be $5,548 per family, which would reduce their premium for the second-lowest-cost silver premium by an average of 66%.

So the next time you hear the refrain that insurance coverage will cost more under the ACA, ask yourself more expensive than what and are the premium tax credits and cost-sharing protections being taken into account?


Health Care Cost Control: Banning Drug Advertising

by Virginia Suarez [vsuareznin@yahoo.com], a  UNC student in public health.

Controversy around heavy advertising of prescription drugs (often called Direct to Consumer or DTC advertising) has been on the rise recently with an increasing number of questions around effectiveness and safety. Just a few examples of recent scandals and drug recalls include:

  • Vioxx linked to serious adverse events including heart risk, stroke and death
  • Accutane linked to birth defects and increased risk for heart and liver damage
  • Ketek linked to liver damage including liver failure and deaths
  • Zelnorm linked to increased heart attacks and strokes
  • Lotronex linked to ischemic colitis and multiple deaths

Consumer advertising spending by the drug industry has more than quadrupled in 7 years. According to a Congressional Research Service report, it increased from $791 million in 1996 to $3.2 billion in 2003, for mostly 50 brand name drugs.  Overall health costs have nearly doubled over this same time period.  Getting this spending under control is a key part reducing health costs both in North Carolina and nationally.

The medical profession agrees.  Doctors overall tend to view DTC advertising negatively. Survey results, published in the Archives of Internal Medicine, concluded that a majority of physicians felt that DTC advertisements increase overall drug consumption (61.9%), do not provide enough information on cost (94.9%), lead to patients’ request for specific drugs (80.7%), do not do a good job of informing patients of side effects (54.8%), do not provide sufficient information on alternative treatments (94.9%), increase patient visit times (55.9%), and need better regulation (68.8%).

The FDA also may slowly be waking up to this situation.  Before the pharmaceutical company Merck pulled Vioxx out of the market in September 2004, Dr. David Graham of the FDA reported that an estimated 88,000-140,000 excess cases of serious coronary heart disease probably occurred in the USA with a 44% fatality case rate.

DTC advertising not only increases cost of prescription drugs but more importantly it puts many people at risk of serious adverse events including death.  Banning DTC advertising is a good first step to start getting costs under control and improving the health of patients.


John Locke Foundation Fumbling in the Cold

by Richard Littlemore (cross posted from his DeSmog blog )

The John Locke Foundation's environmental front EnvironmentNC has this goofy post celebrating record snowfall in Switzerland and cold temperatures in South America as proof that the climate isn't changing.

As even the most rudimentary primer would affirm "global warming" is calculated on the basis of global average temperatures, not on one-off weather events in a single region or country. All theories of global warming also suggest that as the average temperature in earth's atmosphere increases, there will be a corresponding increase in weird weather.

The Locke Foundation either missed this memo or is motivated by some other agenda to try to ignore or deny what is actually happening.


Mr John Hood, writing for the John Locke Society, is too big for his breeches.

I would not tell a lawyer, or an accountant what is ethical in his profession, and it is presumptuous of a lawyer to dictate to doctors. Ethics is too serious a matter to leave to the lawyers. The legislature’s intent might sound noble, but its effect is just the opposite—it perverts medicine’s most cherished rule—PRIMAM NON NOCERE — first do no harm.

Glen Larkin, a retired doctor from Charlotte offers this advice in response to John Hood's opinion piece about the death penalty moratorium published in the Lincoln Tribune. Read Dr. Larkin's comments in their entirety on the Texas Death Penalty Blog. 


A puzzle from Vietnam

Written by Josh Glasser, Fulbright Scholar

I was in Nghi Son Village today, a small fishing village on the Vietnamese coast. It has a small harbor, but otherwise it is very quiet and even depressed economically. It's village leadership are nice enough, but they have received nowhere near the education that one would typically receive at an American university (even if they went to a Vietnamese university, which some may have).

Nghi Son also has a drug problem, which has caused an increase in HIV, which has caused the village to adopt a needle exchange program.

Now, riddle me this. Our legislature has the "best and the brightest" either serving or on staff. It has plenty more resources than your typical Vietnamese fishing village. It has all the time and experts handy to design and explain the program to the public.

How exactly does the village government in Nghi Son have a better public health policy with regard to needles than the State of North Carolina?