A look back at the week's health policy news with a
focus on ACA implementation
Repeal and replace, SCOTUS, enrollment, measles, a data
breach and as always, much, much more. We better get started.
ACA: Opposition
Apparently, Congress has nothing better to do than vote to
repeal the ACA and promise a replacement plan: House
votes to repeal ObamaCare “The GOP House on Tuesday voted for the fourth
time to completely repeal ObamaCare, but this time with instructions for
several committees to replace the healthcare law with new policies. Passage
fell largely along party lines by a vote of 239-186. Every Democrat in the
chamber opposed the measure, and three Republicans, Reps. Robert Dold (Ill.),
John Katko (N.Y.) and Bruce Poliquin (Maine) voted against repeal.” Yes, you read that right, Maine’s new
Congressman from the Second District Poliquin
votes against repeal of Obamacare, one of only 3 Republicans. However, there is less here than meets the eye – he is
still against the law, but he wants to have something to replace it with before
voting to repeal.
As you may recall, this is not the first time Republicans
have promised a replacement plan (20
Times GOP Leaders Have Promised Their Own Obamacare Replacement Plan).
Meanwhile, “President Barack Obama gathered with
beneficiaries of his health care law Tuesday to argue that the persistent
effort to wipe it out “makes absolutely no sense,” as the House was poised to
take the first repeal vote of the new Congress.” (Obama
highlights health law; says repeal makes ‘no sense’)
Will the Republican’s really come up with a replacement plan
this time? It will not be easy: GOP
chairmen to lead task force to develop Obamacare alternative “The House GOP
is seriously split on almost every issue, and it’s an open question as to
whether they’ll be able to coalesce around any plan. Ryan’s involvement in the
group does give Republicans some home — he’s been able to persuade the GOP to
follow his plans on numerous occasions.”
There are competing thoughts as to what the replacement plan
should be. On Thursday, a group announced a plan (very similar to the one they
announced last year: Here’s
how the GOP would repeal and replace Obamacare While this is how some would
replace, this is not the group designated by the House bill passed Tuesday. “The
GOP plan outlined by congressional aides Wednesday is similar to one that the
senators offered last year, which the GOP never united around.”
That said, the plan is receiving a lot of attention, so here
are the basics (edited from the article):
- No more individual mandate
- A pre-existing condition ban, with a catch (if you let your coverage lapse for a couple of months, insurers are allowed to take this into account)
- A cap on tax preference for employer health plans (very similar to Cadillac tax)
- Eliminates the ACA's employer mandate requiring businesses with 50 or more full-time employees to offer health insurance or pay a penalty.
- Less generous subsidies (credits up to 300% FPL, based on age/family status, not cost of premiums)
- Medicaid expansion rolled back, credits available at all income levels. Subsidies vary by age and income, not by price of premiums
- No Essential Health Benefits including no guarantee of maternity care
- Community rating band widened to 5:1
A final note of caution: An
Obamacare 'Replacement?' Don't Believe The Hype “Even though the proposal
is virtually identical to the one that Hatch and Burr issued a year ago with
then-Sen. Tom Coburn (R-Okla.), the duo -- along with Upton -- scored headlines
describing their framework as the Obamacare replacement plan. But remarks from
House Speaker John Boehner (R-Ohio) on Thursday underscore how far
congressional Republicans are from having an actual alternative in place.
“Clearly, our three chairmen have an awful lot of work to do to come up with
our replacement. But I would expect all of this to be part of the discussion --
all of it. Listen, there’s a lot of ideas out there," Boehner said.
"The key is going to be to boil those concepts down to what a real
replacement would look like."”
ACA: Courts
One of the reasons for all the “replacement” talk now is the
theory that having an alternative in place will make it easier for SCOTUS to
find for the plaintiffs and eliminate subsidies on the Federal Marketplace.
Lots of other activity on the subsidy case this week. Here
Tim Jost takes a look at several of the amicus briefs submitted to the court: The
Amicus Briefs Supporting the Government's Position in King v. Burwell. Maine’s
Attorney General signed on to one of them: Keep
health care law subsidies, Maine urges U.S. Supreme Court “The “friend of
the court” brief, signed by Maine Attorney General Janet Mills, was filed Jan.
28 in the “King vs. Burwell” case that’s scheduled to go before the Supreme
Court on March 4 and is likely to be decided this summer.” Most likely this was done without consulting
with the Governor.
Secretary Burwell was on Capitol Hill Wednesday to talk
about open-enrollment. When questioned about contingency planning for the
elimination of subsidies, she once again said “…there is no backup plan to
support Obamacare if the Supreme Court strikes down federal subsidies.” (No
backup plan at HHS if Supreme Court strikes down subsidies Obamacare,
Back at the Supreme Court: Frequently Asked Questions)
Before the case was accepted by SCOTUS, many thought it was
without merit. Given it was accepted, there has been a certain level of
pessimism regarding the outcome. Here is one more optimistic thought on how it
may turn out: Here’s
one way the Supreme Court might save Obamacare “However, it’s also possible
that Justices could decide the case isn’t just about statutory draftsmanship,
and conclude that siding with the challengers would raise serious federalism
concerns, ones involving the role of states as separate, independent
sovereigns. The Justice to watch in this regard, some legal observers think,
may be Anthony Kennedy.”
And on a similar note, this author thinks Overturning
Obamacare Would Change the Nature of the Supreme Court “To reject the
government’s defense of the law, the justices would have to suspend their own
settled approach to statutory interpretation as well as their often-stated view
of how Congress should act toward the states.”
A reminder of what’s at stake as Public
Health Experts Have Estimated How Many Americans Will Die If the Supreme Court
Repeals Obamacare ““Researchers found that, in the first four years of the
[health care reform] law in Massachusetts, for every 830 adults gaining
insurance coverage there was one fewer death per year,” the brief reads. “Using
the national estimate that 8.2 million people can be expected to lose health
insurance in the absence of subsidies on the federal marketplace, this ratio
equates to over 9,800 additional Americans dying each year.”
ACA: Enrollment
As I write this there are only 10 days left to this year’s open
enrollment period. This week’s report showed that “Since Open Enrollment began
on November 15, nearly 7.5 million consumers selected a plan or were
automatically re-enrolled through the HealthCare.gov platform” (Open
Enrollment Week 11: January 24, 2015 – January 30, 2015).
Here is a look at this month’s
numbers here in Maine:
|
Week Ending
|
Cumulative Enrollment
|
Week’s Enrollment
|
|
9-Jan
|
59,126
|
|
|
16-Jan
|
61,964
|
2,838
|
|
23-Jan
|
62,983
|
1,019
|
|
30-Jan
|
64,069
|
1,086
|
Note there was a surge in the run-up to Jan 15, the deadline
for a Feb 1 effective date. This week we saw a slight uptick but that should
explode in these last two weeks.
I’m not the only one expecting a surge: “The federal health
insurance marketplace will have 40% more call center workers on hand starting
Monday to help consumers deal with the final week of Obamacare open enrollment,
the Department of Health and Human Services said Wednesday.” (ACA
sign-ups estimated near 10 million as deadline looms).
Here’s a look at one of the (other) states that’s having
success with enrollment: Why
Florida Is No. 1 In Obamacare Enrollment Despite GOP Opposition ““It is
truly ironic that Florida leads the nation in enrollment … with leadership that
has actively opposed the law,” said Leah Barber-Heinz, executive director of
Florida CHAIN, an advocacy group involved in outreach efforts. “It shows true
commitment on the part of many and it portrays an extremely high need for
affordable coverage. There are other reasons cited for Florida’s robust
enrollment —including intense competition among insurers in several big
counties and the high degree of coordination among the nonprofits and community
groups which received federal grants to sign people up.”
Last week the Kaiser survey showed a significant number of
people who thought they were ineligible for help when they were eligible. This
piece takes a look at how that might have happened: How
subsidy-eligible enrollees got ‘false negatives’ “Millions eligible for
Medicaid or ACA's subsidized exchange coverage concluded they were ineligible.
Here's how it might have happened.” Important reminders as we approach the end
of open-enrollment.
Measles, etc.
We’ve been talking about this since the first reports of the
Disneyland outbreak. This week as the numbers infected continued to climb (There
were more new measles cases in the past month than in all of 2012),
mainstream media caught fire with the story. You probably all know the basics
by now – someone infectious with measles visited Disneyland. Probably because
of a relatively low rate of immunization, the infection spread. This has led to
the public taking a long hard look at vaccination policies and the group of
“anti-vaxers” who don’t want to vaccinate their children.
In order to spare you, I will not include all the 50+links
that I amassed this week on the topic. What I have done below is focus on a few
key issues: 1) Why are we talking about this 2) The politics of the issue 3)
What can/should be done going forward 4) Etc.
1) Why are we talking about this?
Having you child vaccinated does not only impact your child.
As a society, we rely on “herd immunity” to protect those who either can’t be
vaccinated (one group is infants younger than 12 months) or for whom the
vaccine is ineffective (a small percent of those inoculated).
From CA (Baby
contracts measles, closing day-care center at Santa Monica High) to Chicago (Measles
Hits Chicago: Five Infants Diagnosed With Disease) some of those at risk
are catching the disease.
Jon Stewart, in that way that he has, summed it up simply: "Your
choice puts other people in jeopardy"
2) The politics of the issue
On Super Bowl Sunday, in the traditional Presidential game
day interview (did you know that is a thing?) the President said very simply
everyone should Get
your kids vaccinated. What seems like simple uncontroversial message didn’t get
to stay that way, as one of the potential 2016 Republican presidential
candidates, Chris
Christie won’t recommend measles vaccines to parents. Jumping on the inexplicable bandwagon, Rand Paul
says he’s heard of vaccines leading to “profound mental disorders” in children. Something that we know from study after study just isn’t
true.
Then, in a burst of rationality, the
Wall Street Journal editorial page had this to say: Christie’s
Vaccine Stumble: The Governor panders amid an outbreak of preventable disease.
Wall Street Journal editorial taking to task Christie and complimenting Obama.
“The U.S. is experiencing an outbreak of measles and other diseases long
thought to be eradicated, and some politicians aren’t helping as much as they
could. On this score President Obama has it all over Chris Christie.”
More of the 2016 Republican Presidential field joined in on
the side of rationality: GOP
2016ers: We love vaccines! As Rand Paul causes a stir, his potential
presidential rivals praise vaccinations. As did these 7 Republicans
who love vaccines.
So there is reason to be optimistic that we can keep this
from becoming a partisan issue: All
our politicians should join together to end the dangerous anti-vaccination
madness “It’s all-too-easy to see how these issues could become enmeshed in
the culture wars, partisan politics or even the 2016 presidential campaign.
This would be a public health disaster. We will never sustain herd immunity if
Americans’ beliefs and behaviors in the realm of vaccination harden along
cultural or religious or ideological lines.” Some additional thoughts on the
topic: Vaccine
support is bipartisan. Here’s how to keep it that way.
3) What can/should be done going forward
With infants and others being put at risk, and politicians
(and some doctors) encouraging irrational behavior, there is anger out there. This
piece reviews some of the options: Measles
Keeps Rising. Should We Tax Vaccine Deniers, Shame Them -- Or Jail Them?
“How do we get vaccination rates where we need them to be? How do we steer
wayward Americans back into the herd? … I’ve listed out seven much-discussed
proposals to win over vaccine holdouts. Think of these as rational strategies
designed to deal with irrational arguments — and note that every single one of
these tactics is ultimately imperfect.”
While there are already laws in place requiring vaccination,
over time their effectiveness has eroded with the increased use of religious
and personal exemptions. So, to get vaccination rates back up, consider eliminating
those exemptions: Want
More Vaccinated Children? End Religious and Personal Exemptions.
One of only two states that currently do not allow either of
those types of exemptions, Mississippi, had some in the legislature trying to
add them in, that attempt failed this week: Mississippi,
a Leader on Vaccination Rates, Stands By Strict Rules “By a voice vote, they advanced a heavily
amended version of the bill that now calls for only technical changes to
Mississippi’s law, which has been largely untouched since the late 1970s. The
law requires all children in public and private schools to have certain
immunizations, including for chickenpox, hepatitis B and measles. Generally,
children must have the vaccines by the time they are in kindergarten.”
Meanwhile in CA where use of personal exemptions is high,
attempts are underway to scale them back: California
legislators want to make it way harder for parents to opt out of vaccines “California
lawmakers on Wednesday introduced a bill that would require parents to
vaccinate all school children unless a child's health is at risk, the
Associated Press reported.”
And in case you were wondering, it was decided long ago that
Yes,
the Government Can Make You Vaccinate Your Child - The courts agree: It's not a
violation of your constitutional rights “But it’s instructive to remember
that the Supreme Court settled the question of compulsory vaccinations more
than 100 years ago. And just last month, the U.S. Court of Appeals for the
Second Circuit, which sits in Manhattan, cited that century-old precedent in
rejecting a constitutional challenge to a New York law requiring that all kids attending
public schools be vaccinated.”
4) Etc.
Here in Maine there are several bills dealing with
vaccination up before the legislature: Maine
Lawmakers to Weigh in on Vaccination Debate “Maine lawmakers will have a
chance to weigh in on the controversy when they consider a number of
vaccination bills this session.”
And I’ll end with these notes of caution. Even though the
science is crystal clear, 1 in 5
millennials thinks vaccines cause autism “A survey of 1,000 US adults by
YouGov, conducted between January 26 and January 28, found 21 percent of young
adults believe the long-debunked idea that vaccines cause autism, while just 13
percent of all US adults agree.” And
that may be the reason that Young
adults more likely to say vaccinating kids should be a parental choice “A
Pew Research Center report released last week shows that a majority of
Americans say children should be required to get vaccinated. Further analysis
of the survey data reveals significant age differences in views about vaccines.”
There is more education that needs to be done and that
education should go hand in hand with tougher laws removing the option to skip
vaccinations. However, as we were reminded by the Press Herald, there is a
secondary issue regarding making it easier for those parents who want to
vaccinate: Our
View: Too many Maine children lagging on vaccinations: A bill targets the high
opt-out rate, but a much greater number of kids skip some shots.
I’ll end this section with my favorite quote on the topic “The
science is clear: The earth is round, the sky is blue, and #vaccineswork. Let's
protect all our kids. #GrandmothersKnowBest” (Hillary
Clinton loves vaccines and wants you to know about it).
Costs
The President released his 2016 budget proposal this week. While
there is absolutely no chance it will be adopted, it is an important document
as it shows the administration’s position. Here is a look at how the budget
handles ACA funding: Implementing
Health Reform: President Obama’s FY 2016 Budget And The ACA.
Keeping in mind the same qualification that the budget won’t
be passed as submitted, here is a Summary
of Medicare Provisions in the President’s Budget for Fiscal Year 2016 from
Kaiser.
Also included in the budget, Obama
Wants Price Negotiations For High-Cost Drugs “The proposal will surely meet
strong resistance from the pharmaceutical industry and isn't likely to go
anywhere on Capitol Hill. Critics, including Republicans, say price
"negotiations" would actually turn into price controls, given
Medicare's purchasing power, and that lower payments would cut into the
industry's research budgets.”
This week, the Congressional Budget Office released new
spending projections. They show that Obamacare is costing
way less than expected “So even adding all the spending in Obamacare, the
CBO is projecting the federal government will spend $600 billion less on health
care than the agency expected in 2010, when they weren't counting even a dollar
of the spending in Obamacare.”
And while we’re on the topic of budgets, here is an
interesting take on the annual “doc fix” ritual. Maybe it’s not such a bad
thing after all: Doc
Fix: The Budget Gimmick That Actually Isn’t So Bad “The pressure on
Congress to find a way to finance doctors’ pay every year has actually reduced
federal health spending in general and the Medicare budget in particular.”
In response to last week’s announcements regarding
value-based care, some additional pushback regarding exactly how the goals will
be accomplished: The
biggest challenge facing the government’s new plan for better health care
“On its face, it sounds reasonable enough. Who doesn't want to cut waste in
America's $2.9 trillion health-care system and improve the kind of care that
patients get? But actually determining the quality of this care is tough
business.” And speaking of quality
measures: Quality
measures are going through growing pains “Everyone wants high-quality
health care. It’s obvious in the abstract. But how do we know what that is?”
There was also this cautionary note: Beware
vaporware on value-based care “Expanding those programs, assuming the
targets announced last week are met, will encourage the healthcare system's
evolution toward value-based care. But the radical transformation of payment
policy implicit in last week's rhetoric remains, in a word, vaporware.”
With all the talk of an ACA replacement, it’s worth looking
at this piece regarding malpractice insurance. Malpractice insurance reform is
always one of the GOPs talking points about a replacement plan, but the
evidence is just not there to show it would have much of an impact: Barking up
the wrong tree: Non-economic damages caps reduce medical malpractice payments,
but not costs. “Damages caps are arbitrary, limiting financial recovery for
those patients with the greatest losses, and fail to address the bigger issues
of prevention and quality improvement.”
Medicaid
While the marketplaces have a set open enrollment period
(for most people) that’s not the case for Medicaid. So measuring the impact of
the ACA is a little different: Medicaid
and CHIP Enrollment Reaches 10 million More Than the Average Monthly Enrollment
for July Through September 2013 “The most recent Medicaid and CHIP data
shows enrollment reaching over 10.1 million additional Americans as of November
2014. This represents a 17.5 percent increase over the average monthly enrollment
for July through September of 2013, the pre-Marketplace open enrollment
timeframe.”
We’ve seen a few more states adopt Medicaid expansion. Here
is a look at one of the unique ways states are addressing its financing: “Budget
Neutral” Funding for State Share of Medicaid Expansion: Hospital Fees and
Taxes? “One mechanism to reach budget neutrality is to propose a fee or tax
on hospitals within the state to either partially or fully fund the expansion.
Hospitals are willing to consider this option because the benefits to their
bottom lines are so great.”
A reminder today that even when a previously reluctant
governor decides to pursue expansion there is no guarantee his legislature will
go along with him. Haslam
health plan Insure Tennessee is dead “Tennessee will not expand health
benefits to hundreds of thousands of low-income residents, with state senators
rebuking Gov. Bill Haslam's controversial health care proposal.”
At least Arkansas'
1st-in-the Nation Medicaid Expansion Survives “Arkansas'
first-in-the-nation program using federal funds to purchase private insurance
for the poor survived another year after the state House reauthorized the
program on Thursday, despite an influx of new Republican lawmakers elected on a
vow to kill the hybrid Medicaid expansion.”
Medicare
Problems with Aetna’s Medicare prescription drug plans are
being addressed: “More than 400,000 Medicare beneficiaries who may have been
confused or misinformed about the pharmacy details of their 2015 Aetna
prescription drug plans have until the end of this month to find participating
pharmacies or switch plans, according to the Centers for Medicare &
Medicaid Services.” (Medicare
Offers Relief To 400,000 Caught In Aetna Pharmacy Network Mix-Ups)
This week, despite complaints regarding the first released
it was announced that Medicare
Physician Data to be Released Annually “CMS’s decision to release more data
every year is therefore a move in the right direction. Hopefully, the first
Medicare physician payment data release in 2014 served as a starting point and
the future data that CMS is planning to publish will learn from its
limitations.”
Drugs
Supplements are in the news this week as the New
York Attorney General Targets Supplements at Major Retailers “The authorities
said they had conducted tests on top-selling store brands of herbal supplements
at four national retailers — GNC, Target, Walgreens and Walmart — and found
that four out of five of the products did not contain any of the herbs on their
labels.”
So you may not be getting what you pay for, but that begs
the question why are you paying for them to begin with? Americans
are ignoring the science and spending billions on dietary supplements “Researchers
from the same Inspector General's report found that 20 percent of the weight
loss and immune system support supplements they purchased made illegal claims
about their ability to treat and cure disease. A year later, Harvard
researchers found that between 2004 and 2012, there were 237 recalls of dietary
supplements — accounting for more than half of FDA recalls of Class 1 drugs,
which mean the products contain substances that can cause death or serious
health problems. And in October, a JAMA study found most of supplements that
were recalled for containing dangerous banned drugs were still available to
consumers at least six months later.”
There are a few supplements where there is evidence base
showing their effectiveness, this resource can help you figure out which those
are: How
to spot the rare dietary supplement that’s actually legit “But not all
supplements are created equal. Information Designer David McCandless wanted to
know which supplements' claims were backed by scientific evidence, and which
weren't. So after pouring over hundreds of scientific studies, he built a
visualization of which supplements are supported by research, and which aren't.”
But it’s not just alternative medicine where people take
things that aren’t of any use: Doctors
know they shouldn't give antibiotics for bronchitis, do it anyway
“Researchers have known for decades now that antibiotics aren't an effective
treatment for bronchitis. And prescribing them actually comes with a risk:
overuse of antibiotics can speed up the creation of deadly, antibiotic
resistant superbugs. Yet despite years and years of warnings, 71 percent of
bronchitis cases are treated with antibiotics, research published in May 2014
in the Journal of the American Medical Association finds.”
System Transformation
Anthem Data Breach
A huge data break was reported by Anthem this week: Hackers
breach health insurer Anthem “Hackers infiltrated Anthem's information
technology system and gained access to the personal information of about 80
million current and former members. It appears to be by far the largest
cyberattack ever disclosed by a healthcare company.”
“Anthem is Maine’s largest private health insurer, with
roughly 312,000 members across the state. The company provides coverage to
small and large businesses in Maine, as well as to individuals.” (Health
insurer Anthem hit by massive cybersecurity breach, personal data stolen) Late Thursday, word that Anthem
Attack Investigators See Signs of Chinese Hackers “Investigators of Anthem
Inc.’s data breach are pursuing evidence that points to Chinese state-sponsored
hackers who are stealing personal information from health-care companies for
purposes other than pure profit, according to three people familiar with the
probe.”
Medical Care
It’s so important to understand what a potential treatment
could do for you, and how likely it is help vs. harm: How
to Measure a Medical Treatment’s Potential for Harm “We hope that every
therapy has a benefit. The N.N.T. shows us that benefits are often much less
likely than many might think. The N.N.H. can show us how likely we are to have
a harm compared with a benefit. Considering both, especially in light of how
practice often differs from studies, can help us make better decisions about
how to care for ourselves and those we love.”
That extends to screening tests as well as treatments: “We
have to remember that screening matters only if detecting a disease early makes
a real difference in terms of outcomes, and if screening leads to a significant
decrease in the detection of advanced disease. In practice, screening often
doesn’t lead to earlier diagnosis. Additionally, the later development of
better treatments for later-stage disease can mitigate the advantages seen from
screening in earlier studies. What screening often does, though, is cause some
level of harm. Overdiagnosis and overtreatment can have detrimental
consequences. Even the psychological worry from a false-positive result can
have real-world implications.” (JAMA
Forum: How Useful Are Screening Tests?)
Technology
Several fascinating developments on the technology front
this week, I’ll let them speak for themselves:
Athenahealth,
BIDMC to craft records system “The health care technology company Athenahealth
Inc. is teaming up with Beth Israel Deaconess Medical Center to design an
Internet-based system to manage medical records and compete in a growing,
multibillion-dollar market for sales to big hospitals around the country.”
Exclusive:
Apple's health tech takes early lead among top hospitals “The pilots aim to
help physicians monitor patients with such chronic conditions as diabetes and
hypertension. Apple rivals Google Inc. and Samsung Electronics, which have
released similar services, are only just starting to reach out to hospitals and
other medical partners. Such systems hold the promise of allowing doctors to
watch for early signs of trouble and intervene before a medical problem becomes
acute. That could help hospitals avoid repeat admissions, for which they are
penalized under new U.S. government guidelines, all at a relatively low cost.”
Feds
move into digital medicine, face doctor backlash “The Centers for Medicare
and Medicaid Services responded to the criticism late last week, saying it
would ease reporting burdens on doctors in a proposed rule to come this spring.
The rule, however, wouldn't eliminate penalties. … Even most critics believe
electronic health records are the future. But it's unfair to levy penalties at
this stage, they say, while the technology is still so flawed that it takes
time away from patient care, often won't allow information to be shared between
different offices, and can even create safety problems.”
Smartphone
accessory diagnoses HIV and syphilis in 15 minutes “The researchers
estimate that the completed dongle will carry a manufacturing cost of $34,
significantly lower than the $18,450 cost of the equipment runs typical of this
form of diagnostic testing.”
Some
Maine hospitals can predict your next trip to the ER: Here’s how “By
combing through the electronic medical records of nearly all of Maine’s 1.3
million residents and applying sophisticated modeling software, the
computerized tool predicts which patients are most likely to land in the ER.”
U.S.
government releases draft plan for electronic health data “The Obama
administration on Friday proposed a plan to move most doctors, hospitals and
their patients to national standards for handling electronic clinical data by
the end of 2017.”
End of Life Care
There is more of a focus on end of life care than ever before.
But a new survey shows that it hasn’t had much of an impact yet: Study:
Suffering At End Of Life Getting Worse, Not Better “The number of Americans
experiencing pain in the last year of life actually increased by nearly 12
percent between 1998 and 2010, according to a study released Monday in the
Annals of Internal Medicine. In addition, depression in the last year of life
increased by more than 26 percent.”
More reminders that it doesn’t have to be that way:
Dying
on your own terms: A physician’s advice for a better death “To a certain
kind of Washington policy wonk, the trouble with "doing everything"
is that it causes soaring medical costs and billion-dollar financial woes. But
those are not the concerns of Volandes, a Harvard researcher who practices as a
hospitalist. Instead, he sees the extreme end-of-life measures as a tragedy for
patients - a tragedy that could be prevented if only doctors asked patients
what they want. The patients are the ones who must bid farewell to life being
poked and prodded and filled with tubes by strangers in the hospital.”
Dying
Shouldn’t Be So Brutal. “As the end of life approaches, whether death is
welcomed or feared, there is a lot we can do to make the process of dying
safer.”
We
forget to ask patients what their goals are A simple question can make a
huge difference
And finally, a look at the question of how public should
your grieving be. This piece talks about the
loss of a pet, but the
conversation is equally as relevant to a family member. The role that social
media should play is the one you want it to play, there are no wrong choices: #R.I.P.:
Grieving My Dog Offline
Thanks for reading.
All
comments and suggestions are welcome; please let me know what you think. And as
always, thanks for reading!
Funded by support from
the Maine Health Access Foundation
*The title is a tribute to the BBC show, the NBC show and the amazing Tom Lehrer album "That Was The Year That Was"
