Consulo Indicium - 8/5/19

Information for your Consideration… 

Washington, We’ve Got A Problem – Arash Mostaghimi, MD recently published information in the British Medical Journal on the exploding costs of WHO “essential medicines”.  At present, there are 265 such medications on the list which is used by Medicare Part D.  Among the essential medicines, the growth in spending went from $11.9Bn (2011) to $25.8Bn (2015) or a 116% increase over a four-year period.  Over that same period of time, out-of-pocket expenses by patients totaled $12.1Bn increasing from $2.0Bn (2011) to $2.9Bn (2015 or, a 47% increase.  In addition, the introduction of novel or new drugs accounted for about 58% of the cost increase versus 22% of the increases attributed to existing drugs.  Nonetheless, this is only for the “essential medicines”.  The cost question for drugs – largely because of federal policies which limit Medicare’s ability to negotiate with the drug companies – in an increasing problem.  We need to get much more serious about negotiating drug prices BUT, that’s not the only point.  Costs in Medicare are growing faster than ALL other elements of society’s costs – education, entertainment, transportation – pick your favorite one!!  If we don’t get a handle on the problem, my generation runs the risk of bankrupting the nation BUT, I actually don’t think the Millennials will let that happen.  So, let’s get on with the solutions…

A Distressing Trend – From 1999 to 2016, the rate of suicide in the US has increased by 28%.  It’s now the 10th most common cause of death.  More importantly, it’s a trend that seems to cut across all the demographic although there is an equally disturbing increase among young girls, age 10 – 19, by 70% according to CDC data.  Why?  No one really knows at this point although there is a phenomena referred to as “suicide contagion”.  For example, in the months following Robin Williams’ (“Nanu, Nanu”) suicide in 2014 there was a 10% spike in such suicides across the nation. Economic crisis seem to cause an increase.  But, I’m wondering about our “connectivity” as a society.  Getting together and talking things over was once a group exercise.  Now, the answer always seems to be “online”.  There is a certain disconnect by using online sources.  I remember several years ago I was at the airport awaiting a plane departure – one of my more common activities in those days – when I looked up to the laughter of a group of young people.  But, they weren’t talking with one another.  They were online, engaged in some activity together, heads turned down with all of their stimulus coming from a screen – not through interaction “real time” with people.  I wonder?  Are we becoming disconnected?  Is the technology separating us?  Now, don’t think I’m “old school” because I’m a huge fan of technology but, I’m wondering!  It’s an issue that needs to be considered…

Walking, Walking, Walking – But, It’s More Than Walking – It seems that walking is all the rage these days as a way for getting us sedentary types out of our hibernation cocoons which are attached to computers and other electronic devices – and, someplace where walking at a rapid clip is accomplished.  The earphones are elective.  But, the question is for how far?  And, for how long?  A recent JAMA Internal Medicine article reviewed the literature in an attempt to find an answer.  The data shows that while 10,000 steps is nice there is no cardiovascular improvement beyond the 7500 steps/day quota.  There was step-wise mortality improvement from 2700 to 4400 to 5900 steps but, beyond 7500, improvements leveled off.  And, if a slightly lower number stimulates you to go after it – you’ll benefit.

But, it’s not just walking that’s important.  It’s the use of weight-bearing exercise that involves the large muscles of the legs.  In a recent report, studies show that use of these muscles stimulates the production of stem cells in the brain which are thought to review our neuro-capabilities!  So, not only do we live longer but, we can also think longer.  When this study is replicated and more effectively disseminated, we’ll probably all be out there taking those big steps to lean on those big muscles. After all, without a brain – what’s it all worth?  If you still want to be a pumpkin and sit around, good luck!

Putting Job Stress Aside To Consider Job Security – There was a recent JAMA Network article on the state of the health and health care workforce in the United States. The US Bureau of Labor Statistics recently noted that the demands of an aging population and the increased rate of health insurance coverage by Americans has resulted in a large increase in demand for health care workers. Between 2014 and 2024, the increase in health care jobs will grow by 19% - the biggest increase for any occupational segment in their database. But, while numbers are important – it is equally important to consider how the workforce actually “works together”.  As we move from value-based reimbursement (I am of the opinion that is a “when” not an “if” question), collaboration becomes the watchword of health care teams.  We’re still not training for that outcome.  So beyond, “more” workers, we also need to be including “how” workers work.  

Crossing The Line Into Advocacy:  I’m Appalled! – The pediatricians have spoken and I’m with them!  In findings that were published online in JAMA Pediatrics, the pediatricians stated: “Millions of children stand to lose health and nutrition benefits if…[a]...proposed rule that influences immigrants’ legal status in the U.S. is finalized by the Trump administration.” According to the report, at least 1.3 million children with a least one existing, life-threatening condition such as asthma or cancer risk losing their benefits if the rule goes through in its current form where it designates these kids as “public charges”.  In essence, the new rule states the “public charges” are ineligible for government health benefits like safety-net programs such as Medicaid and the Children’s Health Insurance (CHIP) program.  Researchers note that even families who would not be affected are likely to pull out or not apply out of fear and confusion.  What kind of country are we evolving toward?  So, I would like anyone who disagrees with me to do the following:

  • Go to church or, to synagogue, or to your local community center, or, to your favorite gathering place where friends gather – or,
  • Go to the nearest park where your neighbors commune or, Better yet, go to the office and call a meeting

In each of these situations, I want you to either stand up and explain (no shouting is needed) your position.  Explain it thoroughly so that everyone you know will know your position.  Don’t post it because I don’t want you to hide behind the veil of social media.  Don’t sit quietly by and let those of us who are appalled take the stand and rant and rave. Simply explain – why on earth you would allow such a policy to be made the law of the land.  Make a stand and explain.  Make us listen. You can even send me a message.

Why Children? – We’ve come so very far as a nation but we seem to be backsliding a lot.  When my Great Grandfather emigrated from Bavaria, Germany in 1887 with his wife and two young children (with more on the way once he arrived) because he wanted to avoid conscription for Bismarck’s wars (i.e. he was a draft dodger), there was a paucity of health care services available.  I’m not sure what they did for health care more than a century ago upon arrival in the USA or if we had adopted the policies in place.  However, I’m confident that he had heard about the plaque on the new dedicated “Statue of Liberty” that was positioned in New York’s harbor as a welcome for emigrants from around the world (SEE “Quotes” above). 

So, it was very disturbing to learn that the Administration recently made a proposal that will increase the odds that immigrants will be deemed ‘public charges’ ineligible for government health benefits. The policy will have a hugely adverse impact on an estimated 1.3 million children throughout the nation who will likely become uninsured.  Why?  Because it is highly that many immigrants will simply disenroll their children from safety-net programs like Medicaid and the Children’s Health Insurance Program (CHIP) out of fear – “even those for those whom the rule would not apply.” I know that not everyone will believe my posts on this topics so I encourage you all to review the George W. Bush Presidential Center website on the topic of immigrants.  They provide a fair overview of the problem.  And, taking it out on children is definitely not the answer!!


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