Category Archives: National

Increase in Premiums for those Covered Under Affordable Care Act

By Winston Lie

On October 24 of this year, the Obama Administration announced a significant rise in premiums for those covered under the Affordable Health Care plan for the upcoming year in many parts of the country. This price increase will present financial strains and concerns to many of the more than 20 million adults and 3 million children currently covered by the Affordable Healthcare Act, also known as ACA.

This price increase will present financial strains and concerns to many of the more than 20 million adults and 3 million children currently covered by the Affordable Healthcare Act.

According to a report by the Department of Health and Human Services, there will be an “average increase in 2017 Benchmark Premium for HealthCare.gov States [by] 22%”; this figure was determined from preliminary data coming from 43 states and the District of Columbia. Although the national average of these increases may hover around 22% which may seem relatively small, there will be huge variations in markups according to the region of the country the individual lives in.

In an analysis by the Kaiser Family Foundation Group, a 40-year-old, non-smoking individual living in Phoenix, Arizona who makes $30,000 per year and receives financial assistance will expect to pay $507 in 2017 in comparison to only $207 in 2016. In short, in contrast to the national average of 22% increase, this man will experience a 145% increase. Meanwhile, an individual with the same conditions but residing in Richmond, Virginia can expect only a 7% increase in costs.

Many factors can be attributed to the rising premiums cost. The New York Times noted that many of insurers that partnered with the ACA “mispriced their plans in the early years of the law and have either left the market or had to raise their prices sharply to cover the costs of providing coverage.” Many of the services covered by insurers before the ratification of the ACA are simply too expensive for the premiums to remain as low as they had been. In response to this discrepancy between market costs and government-mandated premium prices, UnitedHealth, Aetna, and even more insurance companies have left their partnership with the Affordable Care Act.

Though these increases are sharp, they will primarily affect individuals who buy their own health insurance. Those whose health insurance is often provided by and managed by employers will not be as affected as those who purchase their own insurance. However, for those who do buy their own insurance there are some actions that can be taken in order to offset any large changes in premium costs. One option would be to research for other health plans that offer similar coverage at a reduced cost on the healthcare marketplace. Another possibility may be to apply for subsidies and other financial assistance to minimize the extra costs, which the Obama administration has encouraged.

Regardless of whether one’s insurance is covered under the Affordable Health Care or not, the increase in health care premiums nonetheless is problematic and reveals issues with the competitive and expensive nature of the healthcare market in the United States, especially for the families and individuals within the middle or low income range. Therefore, it is necessary for the full implications of the ACA be studied in order to alleviate more suffering of American citizens.

 

Citations

Abelson, Reed, and Margot Sanger-katz. “A Quick Guide to Rising Obamacare Rates.” The New  York Times, The New York Times, 25 Oct. 2016, www.nytimes.com/2016/10/26/upshot/rising-obamacare-rates-what-you-need-to-know.html.

Cox, Cynthia et al. “2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces.” 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces, Kaiser Family Foundation, 1 Nov. 2016, kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/.

Marte, Jonelle. “Where Obamacare Prices Are Rising Dramatically.” Washington Post, The Washington Post, 1 Nov. 2016, www.washingtonpost.com/news/get-there/wp/2016/11/01/where-obamacare-prices-are-rising-dramatically/.

Pear, Robert. “Some Health Plan Costs to Increase by an Average of 25 Percent, U.S. Says.” The New York Times, The New York Times, 24 Oct. 2016, www.nytimes.com/2016/10/25/us/some-health-plan-costs-to-increase-by-an-average-of-25-percent-us-says.html.

Pignataro, Juliana Rose. “How To Apply For Obamacare: Open Enrollment Deadlines, Dates And What To Know Before Signing Up For A Plan.” International Business Times, 27 Oct. 2016, www.ibtimes.com/how-apply-obamacare-open-enrollment-deadlines-dates-what-know-signing-plan-2438263

The Reality Behind Preterm Birth

BY NINA RODRIGUEZ

Despite what most people believe, according to the World Health Organization, preterm birth is a global issue. It is not just a concern for people living in countries located in Africa or Southeastern Asia. In fact, the United States is ranked in the top 10 countries with the greatest number of preterm births. However, the U.S. has the resources to care for these premature babies, whereas many mothers across the globe do not have access to basic medical care. Nonetheless, affordable healthcare has the potential to prevent 75% of the 1 million preterm baby deaths that occur every year.

The WHO defines preterm birth as “all births before 37 completed weeks of gestation or fewer than 259 days since the first day of a woman’s last menstrual period.” Every year, around 15 million newborns are born premature. In their 2012 Global Action Report on Preterm Birth, the WHO classified the cause of preterm birth into either spontaneous preterm birth or provider-initiated preterm birth. The most significant risk factors for preterm birth are the mother’s lifestyle, the possibility of infection, the mother’s nutrition, and contraception.

These factors can be managed in order to prevent the death of premature babies worldwide. Although it may seem as though providing medical services for preterm babies is expensive, there are “cost-effective, practical solutions exist to help them survive and thrive. For example, a leading low-cost technique called ‘Kangaroo Mother Care’ involves swaddling a baby against an adult’s chest (usually the mother’s) for an extended period.” Other possible solutions include providing antibiotics to treat infections and better access to contraceptives.

Although it may seem as though providing medical services for preterm babies is expensive, there are “cost-effective, practical solutions exist to help them survive and thrive.

One organization that has advocated improving newborn survival in Bangladesh, Ethiopia, and Mali is Born on Time. This “five-year initiative brings together the expertise and resources of World Vision, Plan International Canada, Save the Children, the Government of Canada and Johnson & Johnson” to help mothers in these countries deliver full-term babies. Born on Time approaches this issue by working closely with the local governments of the communities they are sponsoring.

Born on Time aims at improving health service delivery. Their activities in order to arrive at this goal include training health care providers and community health workers to provide quality care during and after pregnancy. They will also help supply local health facilities with necessary supplies and strengthen the referral systems for high-risk deliveries. Another goal that this group has is to increase the uptake of health services in the communities of Bangladesh, Ethiopia, and Mali by empowering mothers and working with community leaders to raise awareness. Lastly, Born on Time hopes to strengthen data collection on this issue in order to increase knowledge on the issue to prevent future preterm births.

This global issue has various negative consequences on the entire world. So, improving the healthcare situation for mothers abroad strengthens the entire international community.

Whole Women’s Health v. Hellerstedt: Why Does It Matter?

BY ALLISON CHANG

With the recent Supreme Court case regarding abortion, Whole Woman’s Health v. Hellerstedt, the court stands to make an important decision on women’s abortion rights. The legality of abortion laws at both the state and national level has been hotly contested in the Supreme Court since the early 1970s, most notably with the landmark case, Roe v. Wade (1973), which legalized abortion and ruled that states could no longer prohibit abortion, except in late pregnancy after a fetus reaches viability and can live outside the womb. By 1992, however, Planned Parenthood v. Casey overturned the court’s previous ruling that the state cannot have any involvement in abortions before the end of the first trimester and allowed states to enact laws provided that the laws did not create “undue burden” for a woman or place “substantial obstacles” in seeking an abortion.[i]

This ruling led to the viability of TRAP laws, also known as Targeted Regulation of Abortion Providers laws, which many pro-choice groups consider to be a threat to abortion rights by increasing the requirements on abortion without much scientific backing. Texas’s new abortion law, HB2, is considered to be a TRAP law because of the following measures:

  • “A physician performing or inducing an abortion: must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced” – Section 2. Sec. 171.0031[ii]
  • “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under Section 243.010 for ambulatory surgical centers (ASC).” – Section 4 – Section 245.010(a)

Thus, the ruling on HB2 by the Supreme Court is not only significant in making abortion accessible to women in Texas, but also in setting a precedent for the constitutionality of TRAP laws.

After the law was passed, half of Texas’ abortion clinics were closed down for being unable to meet ASC standards, and if the Supreme Court rules in favor of the law, the number of clinics in Texas would likely drop down even more to around ten or fewer clinics in the whole state.[iii]

The central argument of the prosecutors is that the provisions in the HB2 measure create “undue burden” on the right to abortion for women,[iv] a precedent made in the Planned Parenthood v. Casey case in 1992.

Because of the new requirements on abortion clinics and physicians that perform abortions, many of these clinics have been forced to shut down, making it difficult for women who do not live close to abortion clinics to access abortion services. Coupled with other existing Texas abortions laws, such as a law that states all women seeking a medical abortion (an early non-surgical abortion using only pills) must have at least four visits or more to the same abortion facility and physician, women seeking abortions in Texas find themselves having to travel longer distances more frequently than some may be able to.[v] These women then find themselves having to pay high travel costs, sometimes even having to book a hotel room rather than travel back and forth between their home and the nearest clinic, yet another barrier for poor, rural or disadvantaged women.[vi]

The defendants hold that the new requirement for abortion centers to have the same standards as an ambulatory surgical center are designed to protect the health and safety of women seeking an abortion.[vii]

However, one such abortion clinic was forced to close down because it’s hallways were only 3 feet wide, whereas the ACS requirements are 8 feet wide corridors. The ACS requirement was designed to ensure that two surgical gurneys could easily travel through the corridors. In a small-scale abortion clinic, on the other hand, not only are most abortion procedures not surgical and only require taking pills, but there are also few instances where surgical gurneys would be necessary in the first place.[viii] Around 20% of abortions are performed by taking a pill, while around 79% require a dilation and curettage procedure.[ix] The latter procedure simply involves dilating the cervix and then inserting a suction tube into the uterus to remove the fetus, which does not require any post-procedural care other than staying in a recovery area, much less a surgical gurney.[x]

The other main point of the law, which requires doctors have admitting privileges at local hospitals has also been contested as unnecessary, with the American Medical Association and The American College of Obstetricians and Gynecologists stating, “There is no medical basis on which to conclude that women’s health would be advanced by requiring that clinicians obtain privileges. Doing so is inconsistent with prevailing medical practice and imposes unnecessary restrictions on the ability of clinicians to provide abortion care.[xi]

However, what makes Whole Woman’s Health v. Hellerstedt, different from past landmark abortion cases that have been brought to the Supreme Court is not so much the continued battle over constitutionality, but the latest gender distribution of the Supreme Court. There are currently three female justices: Justices Ruth Bader Ginsburg, Sonia Sotomayer, and Elena Kagan. Justices Sotomayer and Kagan are the two most recently appointed Justices, taking their positions in 2009 and 2010, respectively.

Justice Ginsburg is the third most senior member of the court currently serving, and was the second woman to be appointed a Supreme Court Justice, after former Justice Sandra Day O’Conner. The last major Supreme Court case regarding abortion was Planned Parenthood v. Casey (1992), back when the only female Justice was O’Conner.

Thus, the Whole Women’s Health v. Hellerstedt case will be interesting for not only the ruling, but also for the way that the debate is proceeding. It is highly likely that due to the presence of only eight serving Justices, due to Justice Antonin Scalia’s death in February, that there will be a 4-4 split with the three female Justices and Justice Stephen Breyer on the liberal side. The female Justices have been particularly outspoken, even going as far as ignoring conventional court proceedings by continually extending the time limits given to the prosecutors for oral arguments. In the chance that a 4-4 tie does occur, the Texas law will continue to be upheld but have no precedence in terms of constitutionality.[xii]

Furthermore, with no federal mandates, states will be free to debate the question in their own judicial circuits, meaning that women living in pro-life leaning circuits may find their rights increasingly restricted. The ruling on this case doesn’t simply have to do with Texas, but with the legality of other TRAP laws, opening the door to a whole host of opportunities for conservative governments to limit women’s ability to acquire an abortion, as well as blocking those who feel that the TRAP laws are unconstitutional from challenging such laws in their courts.

Sources

[i] “A History of Key Abortion Rulings of the U.S. Supreme Court.” Pew Research Centers Religion Public Life Project RSS. Pew Research Center, 15 Jan. 2013. Web. 30 Mar. 2016.

[ii] Texas (State). Legislature. Assembly. An Act relating to the regulation of abortion procedures, providers, and facilities; providing penalties. … H.B. 2. Texas State Assembly. Web.

[iii] De Vogue, Ariana. “Liberal Justices Critical of Texas Abortion Law.” CNN. Cable News Network, 3 Mar. 2016. Web. 30 Mar. 2016. <http://www.cnn.com/2016/03/02/politics/supreme-court-abortion-texas/>.

[iv] Alter, Charlotte. “Women Supreme Court Justices Question Logic of Abortion Law.” Time. Time, 2 Mar. 2016. Web. 30 Mar. 2016. <http://time.com/4244904/women-justices-rally-to-defense-of-abortion-providers-in-supreme-court-oral-arguments/>.

[v] “FAQ: NEW ABORTION LAWS IN TEXAS.” The Lilith Fund. The Lilith Fund, 2016. Web. 30 Mar. 2016. <https%3A%2F%2Fwww.lilithfund.org%2Fnew-laws%2F%23cani>.

[vi] Epps, Garrett. “Will the U.S. Supreme Court Take Precedent Seriously on Abortion?” The Atlantic. Atlantic Media Company, 29 Feb. 2016. Web. 30 Mar. 2016. <http://www.theatlantic.com/politics/archive/2016/02/us-supreme-court-whole-womens-health-v-hellerstedt/471546/>.

[vii] Bassett, Laura. “Rick Perry Signs Abortion Bill Into Law.” The Huffington Post. TheHuffingtonPost.com, 18 July 2013. Web. 30 Mar. 2016. <http://www.huffingtonpost.com/2013/07/18/rick-perry-abortion-bill_n_3613158.html>.

[viii] LastWeekTonight. “Last Week Tonight with John Oliver: Abortion Laws (HBO).” YouTube. YouTube, 21 Feb. 2016. Web. 30 Mar. 2016. <https://www.youtube.com/watch?v=DRauXXz6t0Y>.

[ix] Pazol, Karen, Andreea Creanga, and Denise J. Jamieson. “Abortion Surveillance — United States, 2012.”Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 27 Nov. 2015. Web. 30 Mar. 2016. <http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6410a1.htm?s_cid=ss6410a1_e>.

[x] White, Cynthia D. “Abortion – Surgical: MedlinePlus Medical Encyclopedia.” U.S National Library of Medicine. U.S. National Library of Medicine, 16 Nov. 2014. Web. 30 Mar. 2016. <https://www.nlm.nih.gov/medlineplus/ency/article/002912.htm>.

[xi] Whole Women’s Health v. Hellerstedt. Medical Associations Amicus Brief. The Supreme Court of the United States. N.d. SCOTUSblog. Bloomberg Law, n.d. Web. 30 Mar. 2016. <http://www.scotusblog.com/wp-content/uploads/2015/10/Medical-Associations-Amicus-Brief.pdf>.

[xii] http://www.slate.com/articles/double_x/cover_story/2016/03/how_the_undue_burden_concept_eroded_roe_v_wade.html

Image Sources

[1] http://www.thenation.com/article/how-much-more-proof-does-the-supreme-court-need-that-clinic-closures-restrict-abortion-access/

Paperwork and Physicians: Medical Documentation in the Information Age

BY MIMI CHUNG

As in many professions, the constant presence of paperwork is an annoyance, but in the medical field, it serves an important and obvious purpose – namely, to protect patients from malpractice and record medical history. Nurses and physicians must keep accurate note of clinical documentation, such as tests, patients’ conditions, and other essential information. Such a straightforward process, however, has paradoxically grown more complicated and bloated in an attempt to make medical records more streamlined.

Medical documentation has been a frustration for physicians for years. A 2002 survey by Powerhouse Cooper, a consulting and research organization, found that documentation made up a significant portion of a physician’s time in clinic, often cutting deeply into patient care time. The most striking results came from some of the most important specialties: the emergency care department reported an hour’s worth of paperwork for every hour spent with a patient. In other words, half of the work time was spent not on caring for the injured or sick, but instead was lost finishing reams of paperwork. Surgery and inpatient acute care fared slightly better, with thirty-six minutes of documentation for every hour of patient care, while skilled nursing care only had thirty minutes.

In other words, half of the work time was spent not on caring for the injured or sick, but instead was lost finishing reams of paperwork.

Over a decade after these problems were identified, after years of technological innovation, and after a large number of new regulations, physicians still find that paperwork impedes their actual job. The most significant current challenge is the introduction and adoption of electronic medical records (EMR) and electronic health records (EHR), a move meant to simplify the process and increase transparency. This move has many potential benefits, yet the actual implementation of the program has been hindered by a slow acceptance in the medical field and a host of legal, ethical, and financial questions.

EMR and EHR can potentially solve extremely salient issues that still plague the healthcare system. Documents can be edited simultaneously by multiple people, providing instant updates on a patient’s health without having to fax or email information. Copying relevant information and disseminating it becomes a trivial concern. Timestamps and alerts can increase accountability for physicians, since the EMR and EHR would provide legal evidence of misconduct or neglect.

However, the implementation of these records have provided an ethical and legal minefield, since technology advances much faster than the court can resolve problems. A key question is liability issues involved with EMR and EHR alert systems. EMR and EHR include alerts for doctors, which are popups warning them of potential health consequences based on certain medications or surgery arrangements. Alerts can range from allergic reaction information to NPO assignments. This alert system provides a check for busy doctors, but worries about alert fatigue have brought this potential benefit into question. Because a large number of the risks pinpointed by the system are fairly negligible, physicians can miss some of the more important alerts, which could provoke substantial problems for physicians.

However, the implementation of these records have provided an ethical and legal minefield, since technology advances much faster than the court can resolve problems.

Further, the sheer volume of information, both provided to and provided by physicians and nurses, has drawn criticism, especially from those working against the clock to find specific information. The ease of copy-paste both benefits physicians while hindering the ease of finding pertinent diagnoses. “Information overload,” a common phrase in today’s oversaturated Digital Age, hides information under all the other data within an electronic file – and if the nurse or doctor can’t find what they are looking for, they face consequences since the information was, technically, right there.

Although 33% of doctors who have implemented EMR said that the system has improved quality of care, according to a survey by the Physicians Foundation in 2012, physicians have voiced frustrations with the system as well. One pointed out that EMR “simply do not work for certain specialties,” such as dermatology, and requested that mandatory adoption be postponed.

Another doctor claimed that the “benefits of an EMR are overstated” since it “do[es] not seem to have been designed with any significant physician input,” resulting in “poor” outcomes. More harshly, some physicians have said the system is “a scam” because increasing the amount of required note taking has led to a decrease in time spent with patients. 34% of those who have not yet implemented EMR have stated that the cost of introducing the system has been the most prevalent concern.

Perhaps the most concerning is the question of privacy. Digitizing medical records increases the risk of privacy breaches, as cases of healthcare hacking has increased exponentially – about one in three Americans have had their records compromised, with criminal attacks on healthcare records increasing 125% since 2010. Medical identity theft is much more serious than financial identity theft: with someone’s complete medical record, hackers can fabricate an entire person, including ordering prescriptions and filing false tax returns. Hospitals and private physicians struggle to provide adequate security for this data due to high costs and lack of innovation.

About one in three Americans have had their records compromised, with criminal attacks on healthcare records increasing 125% since 2010. 

Though EMR and EHR have brought a significant benefit to certain specialities, much more research and development must be done to provide the American people with the best care – and allow doctors to focus on their patients, not their paperwork.

 

 

Sources

Patients or Paperwork? The Regulatory Burden Facing American Hospitals. Chicago: American Hospital Association. 2008. PDF file. http://www.aha.org/content/00-10/FinalPaperworkReport.pdf.

AHIMA. “Integrity of the Healthcare Record: Best Practices for EHR Documentation.” Journal of AHIMA 84, no.8 (August 2013): 58-62. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050286.hcsp?dDocName=bok1_050286

Rouse, Margarent. “Clinical Documentation (healthcare).” SearchHealthIT. http://searchhealthit.techtarget.com/definition/clinical-documentation-healthcare.

Sittig, Dean F., and Hardeep Singh. “Legal, Ethical, and Financial Dilemmas in Electronic Health Record Adoption and Use.” Pediatrics 127, no. 4 (2011): e1042–e1047. PMC. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065078/

Gechlik, Gary. “Electronic Medical Records: Current and Future Challenges.” ABA Health 6, no. 3 (November 2009): n.p. http://www.americanbar.org/newsletter/publications/aba_health_esource_home/Gechlik.html

A Survey of America’s Physicians: Practice Patterns and Perspectives. Physicians Foundation. 2012. PDF file. http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf

Costello, Tom. “Hacking of Health Care Records Skyrockets.” NBC, 13 Feb. 2016. http://www.nbcnews.com/news/us-news/hacking-health-care-records-skyrockets-n517686.

Weisbaum, Herb. “Health Industry Can’t Protect Your Records from Hackers: Report.” NBC, 7 May 2015.  http://www.nbcnews.com/tech/security/health-industry-cant-protect-your-records-hackers-report-n355401

Documentation in Health Care (Practice Portal). Rockville: American Speech-Language-Hearing Association. 2016. http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935365&section=Key_Issues#Legal_and_Ethical_Issues

Frellick, Marcia. “Note Bloat Disrupts Utility of Electronic Health Records.” Medscape, 16 March 2016. http://www.medscape.com/viewarticle/860459

Weir, Charlene R., and Jonathan R. Nebeker. “Critical Issues in an Electronic Documentation System.” AMIA Annual Symposium Proceedings 2007 (2007): 786–790.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655797/

The Possibility of a Zika Invasion in the U.S.

BY BRIAN COSTA

According to a new study from PLOS Currents: Outbreaks that was discussed in the Washington Post, researchers have found fifty cities in the United States that have a suitable environment for the Zika Virus to survive and cultivate.

Understandably, this statistic certainly warrants some kind of concern. According to the same study, the Zika virus traces back to 1947, when it was in fact extracted from primates not mosquitos, in the Ugandan Zika Forest. A year later in that same location, the Zika virus was then found in the Aedes africanus mosquito, which has been pinned as the main transmitter of the outbreak in South America, especially Brazil. In fact, the Zika virus was brought to Brazil in 2015 and would immediately attain international prominence when the World Health Organization declared a “public health emergency of international concern,” according to the CDC. What’s even more concerning is the way in which the virus spread at an unbelievably fast rate to Brazil’s neighboring countries, to the Caribbean, and now across the Pacific and Atlantic, with even South Korea recently receiving its first case, as discussed in greater lengths in BBC News.

How is the Zika virus spread?

According to the CDC, there are several ways in which this disease can be contracted and passed from one person to the next. It could be transmitted through mosquitos. What is also important is the reverse pathway in which mosquitos can contract the virus through infected people. This helps the Zika virus spread at a faster rate. The second way in which a person can contract the virus is for the disease to be passed from the mother to the child. That is, a pregnant mother that contracts the virus, even close to the time of delivering the baby, allows for the possibility of the virus to be passed down to the baby. Thirdly, infected people can spread the disease to others through sexual contact. Cases of transmission though blood transfusion have also been documented in Brazil.

That being said, should the United States be concerned for an explosion of cases in the near future?

In a January interview with BloombergBusiness, Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, predicts that while the Zika virus may come to the United States, it will not spread at explosive rates across the United States the way it had in Brazil and other countries in South America. Osterholm asserts that the United States mosquito control is superior relative to other nations struggling with the epidemic. Nonetheless, especially being that there is no known cure for the disease yet, he advises that people avoid getting mosquito bites as well as, particularly women, to refrain from traveling to countries where the virus is prevalent.

 

Image Source:

[1] https://www.businessinsider.com/image/56aa5304c08a8037018bd4e6/the-us-has-its-first-case-of-sexually-transmitted-zika-virus-related-to-the-recent-outbreak.jpg

Flint Water Crisis: The Response

BY BRIAN COSTA

Water is a necessity that we use, perhaps overuse, for every day activities in the United States. According to the EPA, on average, an American household consisting of four members uses a staggering 400 gallons daily. A major key for the reason that so much water is utilized is that water is easily accessible and safe to use due to safety standards in tandem with the developed public water systems found in the country. As Americans, we usually take water for granted.

However, as many have learned in recent events in Flint, Michigan, U.S. safety regulations and infrastructure do not always work.

According to a Wall Street Journal article, in April 2014, Flint switched their tap water provider away from Detroit’s more expensive water source to the Flint River, which was to be used temporarily until a new piping system was created connecting to Lake Huron. Nothing wrong with that, only the change in water source would ultimately cause the corrosion of lead in these old pipes and would result in the contamination of household tap water.

According to an article from the Washington Post, the state had failed to add mandatory chemicals to the new water source that would have prevented lead from corroding in the piping system. The water treatment is not a particularly expensive task either, especially considering the heavy costs amassed for the error. Most importantly, though, are the horrible health effects that the mistake has had on the people of the Flint community.

To make matters worse, while the problem has been identified, the solution has been elusive and slow. In fact, the local, state, and federal officials are still trying to alleviate the damages to an already distraught city. It took until the end of 2015 for leaders to tell the locals to stop drinking the tap water.

“Nothing wrong with that, only the change in water source would ultimately cause the corrosion of lead in these old pipes and would result in the contamination of household tap water.”

According to an article from the USA Today, Michigan governor Rick Snyder only officially declared Flint to be in a state of emergency on January 5, 2016 and called on the National Guard to help provide bottled water and filters to the distressed families. The Flint water system was also reconnected to the Detroit city water, but residents were still advised not to drink the water as the river had already sparked the pipe corrosion.

President Obama followed with his own declaration of a federal state of emergency on February 16 by activating the Federal Emergency Management Agency (FEMA), which helped cover costs for the struggling city. However, both the state legislature and the EPA fell under criticisms for failing to act quickly after dangerous levels of lead was detected in the water.

Flint’s mayor Karen Weaver would also be inevitably entwined in the debacle. In an NBC News article from February 17, Weaver and Snyder are currently locked in a disagreement over the best way to proceed with fixing the pipeline. Snyder argues that the pipes consisting of the lead should be replaced in a thought-out process. However, Weaver argues that the replacement of pipes should be done immediately, so that Flint residents could have access to safe tap water as quickly as possible.

At this point, the lead contaminated water has already affected many people as the realization that a high concentration of lead was infiltrating the water flow to houses occurred very late. More work must be done in Flint so that the city can have access to clean water without any qualms in the future. A lot of very poor mistakes have been made, but now the priority for policymakers and leaders of the Flint community is to put an end to the nightmare.

 

Image Source:

[8] http://www.rollingstone.com/politics/news/wtf-is-happening-in-the-flint-water-crisis-explained-20160122

Money and (Pharmaceutical) Drugs – the Rise of American Drug Costs

BY MIMI CHUNG

When Turing Pharmaceuticals increased the cost of a life-saving drug, Daraprim, from $13.50 to $750 last September, the nation was outraged. Daraprim is a drug that treats toxoplasmosis and is often used by people with weakened immune systems. The unexpected increase could put the drug out of financial reach for many of its purchasers, including patients with AIDS and those undergoing chemotherapy. Meanwhile, in many other areas of the world, a similar drug costs less than a dollar per pill. A 5,000% price hike of a lifesaving drug and an unrepentant CEO named Martin Shkreli instantly grabbed the headlines.

Yet the circumstances that created this situation run much deeper than one man’s greed. The Daraprim case is simply a manifestation of many American healthcare policy problems. The price jump is perfectly legal – and, more worryingly, similar price increases have been observed for hundreds of other important drugs. Elsevier, a publishing company for scientific and medical information, reported that the price of 222 drug groups out of 4,421 increased by at least 100% between 2013 and 2014. In the most extreme cases, some drugs increased almost 1,000% of the price the year before.

The causes for the price increase are many and varied – some stemming from economic necessities, some from policy changes, and some from pure business profit margins.

The FDA gives drug companies patents for new drugs to incentivize them to research and develop new products. Patents of new drugs therefore help protect drug companies from the high fixed costs of R&D, by guaranteeing a profitable market for the drugs after developed. However, patents can increase the price of healthcare by allowing drug companies to set their own prices by granting them an effective monopoly. The problem arises when pharmaceutical companies exploit these practices to make more money. For example, the drug manufacturer Gilead Sciences, which patented a hepatitis C medication that costs upwards of $80,000 per treatment called Sovaldi, has reported a huge company profit margin of around 30%. For comparison, British energy companies faced intense political and public backlash for a profit margin of 8%, which is less than a fourth of Gilead’s margin. Many analysts question how reasonable it is to allow drug companies to set prices for patented drugs when the profit far outweighs the justifiable cost of production and marketing.

Even generic drugs, which are not under a patent, have seen a steady price increase in recent years. Many companies can product generic drugs, so competition between them drives prices down to around 80-85% of the brand drug. However, many generic drug manufacturers have merged in the years following 2009 to prevent losses. For example, Pfizer stated in November 2015 that it would buy Allergen, which would create one of the largest pharmaceutical companies in the world with around $64 billion in annual sales. Consolidation of these large corporations have decreased competition in the market and increased drug prices.

Corporations alone are not solely responsible for the increase in costs either. Recent difficulties in manufacturing, including new policies and research prices, have required drugs to have a higher sticker price in order to ensure a return for the pharmaceutical company. Research costs for new products, while always the large bulk of expenses, has skyrocketed in recent years. New innovations in creating drugs has brought in a promising number of new pharmaceuticals for refinement and development, but the increasingly difficult process of testing and approval has companies increase prices for fear of losing money.

Higher standards for quality controls set by the U.S. Food and Drug Administration (FDA) also slow production. These new requirements often disproportionally affect older generic drugs, since these pharmaceuticals are more likely to require large-scale changes for maintenance or renovation. On occasion, the FDA has worked to eliminate some of the cheapest generics completely because the drugs started being manufactured before the 1938 Food, Drug, & Cosmetics Act, which set a basic structure for approving new pharmaceutical drugs. Drugs that went through clinical studies would replace these old drugs – which, while undoubtedly safer, also could drive up prices.

If there is anything that be considered positive from this situation, it is that the Shkreli case has ignited a conversation about pharmaceutical drug costs. Under the Affordable Care Act, Medicare is currently unable to negotiate prices with drug companies – however, the shock of this debate has forced Congress and presidential candidates alike to take a serious look at rising healthcare costs due to drug prices. As more attention is focused on this issue, perhaps the United States will discover a treatment to stabilize drug prices. But for now, many Americans still need to decide between the necessity of paying the mortgage and the immediacy of life-saving medication.

Sources:

[1] Anderson, Bill. “Pharmaceutical industry gets high on fat profits.” BBC, 6 November 2014. Accessed 18 February 2016. http://www.bbc.com/news/business-28212223

[2] Berkrot, Bill and Randsdell Pierson. “Pfizer to buy Allergan in $160 billion deal.” Reuters 24 November 2015. Accessed 18 February 2016. http://www.reuters.com/article/us-allergan-m-a-pfizer-idUSKBN0TB0UT20151124.

[3] Golstein, Amy. “Sharp increases in drug costs draw hundreds to government forum.” The Washington Post, 20 November 2015. Accessed 17 February 2016.https://www.washingtonpost.com/news/to-your-health/wp/2015/11/20/sharp-increases-in-drug-costs-draw-hundreds-to-government-forum/.

[4] Hamblin, James. “Pharma Bro Is the Face of U.S. Health Care.” The Atlantic, 23 September 2015. Accessed 17 February 2016.http://www.theatlantic.com/health/archive/2015/09/martin-shkreli-in-the-mirror/406888/.

[5] Herrick, Devon M. What Is Increasing the Cost of Generic Drugs? Dallas: National Center for Policy Analysis. 07 October 2015. Accessed 15 February 2016. http://www.ncpa.org/pub/what-is-increasing-the-cost-of-generic-drugs-part-ii-regulatory-and-legal-reasons.

[6] Johnson, Linda A. “Here are the 6 reasons why prescription drugs are so expensive.” Business Insider, 25 September 2015. Accessed 18 February 2016. http://www.businessinsider.com/ap-multiple-factors-cause-high-prescription-drug-prices-in-us-2015-9.

[7] “Painful Pills.” The Economist, 26 September 2015. Accessed 15 February 2016.http://www.economist.com/news/business-and-finance/21665436-dramatic-rises-price-some-medicines-prompt-calls-action-hillary-clinton-promises.

[8] Pianin, Eric. “The Feds Finally Make a Move on Soaring Drug Prices.” The Fiscal Times, 16 October 2015. Accessed 12 February 2016. http://www.thefiscaltimes.com/2015/10/16/Feds-Finally-Make-Move-Soaring-Drug-Prices.

[9] Surowiecki, James. “Taking on the Drug Profiteers.” The New Yorker, 12 October 2015. Accessed 15 February 2016. http://www.newyorker.com/magazine/2015/10/12/taking-on-the-drug-profiteers.

[10] Trefis Team. “Why Are Generic Drug Prices Shooting Up?” Forbes, 27 February 2015. Accessed 17 February 2016. http://www.forbes.com/sites/greatspeculations/2015/02/27/why-are-generic-drug-prices-shooting-up/#2db693c4377e.

[11] Walker, Joseph. “Gilead’s $1,000 Pill Is Hard for States to Swallow.” The Wall Street Journal, 8 April 2015. Accessed 18 February 2016. http://www.wsj.com/articles/gileads-1-000-hep-c-pill-is-hard-for-states-to-swallow-1428525426.

Gun Violence: A disease?

By David Landeta

Recently, media reports of gun violence incidents have become alarmingly frequent across America. On October 1, a gunman opened fire at Oregon’s Umpqua Community College. Ten people were killed, including the perpetrator, Christopher Harper-Mercer, marking yet another mass shooting on a college campus.

The latest incident that caught media attention was the San Bernardino shooting on December 2, when a progressive community in California was shocked by the actions of a Muslim-American couple, who left fourteen people dead at a social services facility. Yet, citizens responded not just by paying tribute and condolences to the victims, but also by buying more guns for self-defense.

The call for gun regulation and reform has gained support as we see more and more gun violence perpetrations. But one factor has been ignored: the idea of treating gun violence as America’s newest and deadliest epidemic.

The health care industry has been demanding efforts to launch research towards gun reform and if they can indeed treat the gun violence issue as an epidemic for decades. Yet, the Center for Disease Control and Prevention is still banned from conducting research on gun violence. The support of this ban is headed by Appropriations Committee of the U.S. House of Representatives, which rejected the appeal, claiming that “a gun is not a disease.” This proposition gives Congress the ability to allow funding and was rejected once again.

Physicians tried once again to lift the ban of gun violence research by presenting this issue to Congress. On the December 2, the morning prior to the San Bernardino shooting, the Washington Post reported that the non-profit organization called Doctors for America entered Capitol Hill and proclaimed their petition, signed by 2,000 physicians nationwide. The group demanded for the government to “view gun violence as a public health epidemic and research ways to solve it – as the country would with any disease causing the deaths of thousands of Americans each year.” [4] In addition, they are demanding a 20-year lift on banning gun control research.

Hopefully, Congress may finally realize the importance of gun violence research from a health care perspective in the wake of mass shootings that terrorize our society.