Showing posts with label Commerce and Health. Show all posts
Showing posts with label Commerce and Health. Show all posts

June 11, 2018

The Reason for US Life Expectancy To Have Gone Down {Inequality}

This statement should answer any question about the "inequality" on the title:
Who gets the best health care in this country(US or any country)? the ones that have all the money, not the best insurance. Insurance does not pay a Doctor to cure you but only to try not to hurt you and he/she most medicine you. You have to keep coming back to make this system keep going. Along the way, a particular congress paid by Insurance companies and an ignorant president decided the Insurance companies were not making enough money because there were too many people insured; So they even started to kill this system.

Living in the US increasingly looks like a health risk. Average life expectancy here dropped for the second year in a row, according to recent data from the Centers for Disease Control and Prevention. The grim trend stems from a toxic mixture of more drug- and alcohol-related deaths and more heart disease and obesity in many parts of the country. And it puts Americans at a higher risk of early death compared to their counterparts in other wealthy countries.
But what’s often lost in the conversation about the uptick in mortality here is that this trend isn’t affecting all Americans. In fact, there’s one group in the US that’s actually doing better than ever: the rich. While poor and middle-class Americans are dying earlier these days, the wealthiest among us are enjoying unprecedented longevity. 
So when we talk about life expectancy slipping, what we should also talk about is the growing problem of health inequality in America. And it’s an increasingly urgent discussion, health researchers are warning, because of policy changes on the horizon that are poised to make the mortality gap even wider. 
Some of these policies will hamper access to medical care (such as failing to fund CHIP, the health insurance program for low-income children) but others that aren’t even directly related to health care — like tax cuts — may have even more insidious effects on the American mortality gap. 

America’s alarming life expectancy gap 

The rich have long-enjoyed more longevity than the poor, but the gap in life expectancy has been widening in the US over the last few decades, along with other types of social and income inequality here. 
The CDC’s Division of Vital Statistics, which tracks mortality in the US, uses death certificates as the data source and doesn’t collect family income data. But we do have good data on the mortality gap and income from a study published in JAMA in 2016.  A group of researchers, led by Stanford University economist Raj Chetty, analyzed income data for the US population from 1.4 billion tax records between 1999 and 2014. They then compared it with mortality data from Social Security Administration death records. They found that, from 2001 to 2014, the richest Americans gained about five years of longevity, while life expectancy for the poor didn’t budge: 

Changes in race- and ethnicity-adjusted life expectancy by income group, 2001 to 2014.


 They also found that men who were among the top 1 percent of income earners lived 15 years longer than men at the bottom 1 percent. For women at the extremes of the income distribution, life expectancy differed by 10 years. At Vox, we broke their data down by state, and you can see that wealthier Americans are living longer than poorer Americans all across the country. (Here’s the data on men, but the same trends hold for women.)   his life expectancy divide between rich and poor Americans has been growing for decades. A report from the National Academies of Science looked at life expectancy by income groups between 1980 and 2010. In 1980, the richest cohort of middle-aged American men could expect to live until about 83 and the poorest, to 76. By 2010, the richest American males had gained six years in life expectancy, living to 89 on average, while life expectancy for the poorest men hadn’t improved. (The Washington Post has nice visualizations of the data in the report here.)

“Because we have widening income inequality and there’s a bigger gap between the haves and have-nots,” said Steven Woolf, a researcher at Virginia Commonwealth University who has been researching income and mortality. “We are seeing a bigger divide in mortality.” 

Tax reform and other Trump-era policies are expected to make the gap worse

This growing gap should be “a dramatic reminder of what actually affects our health,” Woolf added. 
We often think about health status in terms of access to doctors, hospitals, and medicines. But access to health care only accounts for about 10 to 20 percent of our health outcomes. Far more influential on our health is our socioeconomic status and certain health behaviors, like smoking, eating healthfully, and getting exercise.  
In Chetty’s study, for example, the researchers found that life expectancy among the poorest individuals was “significantly correlated” with health behaviors like smoking, obesity, and exercise. Poorer people are more likely to be overweight, smoke, and drink compared to their wealthier counterparts. Interestingly, these effects seemed to be mitigated in places that had enacted policies to curb poor health behaviors — such as anti-smoking laws or trans fat bans in cities. 
Right now, there are several policies on the horizon that are not only expected to hamper health care access but exacerbate income inequality — and widen the life expectancy disparity, David Blumenthal, president of the Commonwealth Fund, says. Blumenthal has written about the potential effects of the tax bill, which passed through the Senate in December, on low- and middle-income Americans in particular, and how it’ll disproportionately ding them while rich Americans and corporations will enjoy tax breaks:
Blumenthal told Vox, “We can expect ... to see the gap in life expectancy and health care outcomes between low- and high-income Americans grow in coming years if gaps in income increase.” 
Vox’s Dylan Scott and Alvin Chang have also argued that the tax bill — because of its tax breaks for the rich — “takes the wheel of America’s already-dramatic income inequality and presses the accelerator.” It’ll also repeal Obamacare’s individual mandate, resulting in an estimated 13 million fewer Americans with health insurance. That’s not to mention Congress’s failure to fund CHIP and its proposed cuts to Medicaid — health insurance programs for low-income American children and adults — both moves that have been endorsed by the Trump administration, 
So instead of just focusing on the overall decline in life expectancy, we need to start talking about these links between policy, and worsening income inequality and its relationship to the growing mortality gap. If we don’t, Woolf warned, we’ll fail to see the solutions to America’s early death problem.

August 9, 2015

The Secret Outfit Messing with Your Meds


Adam Pierno, a 40-year-old ad exec in Scottsdale, Arizona, was heading to his local CVS not so long ago, intending to refill a prescription. Quick errand, or so he thought. Upon arrival, he heard his insurance was suspended. But wait! When he called his insurer, Blue Cross Blue Shield, they said there wasn’t a problem and they’d put the scrip through if he wanted — but first, wouldn’t he like to hear how he could save money by switching to a mail-order pharmacy run by Express Scripts? “It was a nasty tactic,” Pierno says.
Americans love to hate their health insurers; these gatekeepers barely edge out the post office and cable companies in customer satisfaction rankings. But it turns out there’s a related industry that people might like even less — if they knew about it. Outfits like Express Scripts go by the terrible name of “pharmacy benefit managers” — PBMs, in insurance lingo — but all you really need to know is that they make a business of inserting themselves between you and the medications your doctor prescribes. (The Federal Trade Commission estimates that PBMs handle 95 percent of U.S. prescriptions.)
Middlemen like PBMs may be dying off everywhere else, but they’re alive and well in the economic hairball of U.S. health care.
PBMs say, with some justice, that they’re playing an important role in the health care system by keeping drug costs down. The industry says it cuts prescription costs by 35 percent, a figure in line with older estimates by the federal Medicare program. That’s a lot of dough in a U.S. drug market that was worth almost $400 billion in 2014, according to the IMS Institute for Healthcare Informatics. But critics argue those savings come at a big cost. Companies like Express Scripts, they say, essentially act as enforcers for insurance companies, telling you what prescriptions you can and can’t use, deciding how much you’ll pay, and even sometimes steering you toward their own mail-order pharmacies.
Middlemen like PBMs may be dying off everywhere else in the modern economy, but they’re alive and well in the economic hairball that is U.S. health care, which turns everyone into a middleman. Drug companies, for instance, don’t sell their meds to doctors or patients — they just spend enormous sums convincing doctorsto prescribe the pills that insurance companies will ultimately pay for. Insurance companies hate that and fight back with coverage restrictions and other bureaucracy. Under such circumstances, the capitalist magic of business competition can’t do much to improve service and lower costs. Instead, the warring sides wage costly but inconclusive trench warfare, occasionally creating new weapons like PBMs in hopes of breaking the stalemate.
Trouble is, patients sometimes get stuck in no-man’s land. Lindsay Kearns, a 24-year-old food and nutrition marketer in Denver, found her recent attempt to pick up a migraine prescription hijacked by her insurance company, UnitedHealth Group. But Kearns didn’t get a soft sell; she says the insurer told her she could either switch to a mail-order pharmacy run by UnitedHealth’s in-house PBM, OptumRx, or pay the full — i.e., uninsured — price. UnitedHealth referred queries to OptumRx, which responded with a boilerplate statement touting its “92 percent customer satisfaction score” and the benefits of home delivery. Blue Cross Blue Shield and Express Scripts said they couldn’t comment on the specifics of Adam Pierno’s case, although Express Scripts noted that, in general, insurers sometimes require home delivery of certain prescriptions “for added convenience, safety and cost savings.” (Both Pierno and Kearns ultimately switched to home delivery, saying they couldn’t afford to pass up the lower prices.)
PBMs first arose in the 1990s as IT-savvy firms that could connect insurers to CVSes and Walgreens across the country, according to Patricia Danzon, a health care management professor at the Wharton School. PBMs were so good at that, insurers eventually handed them the keys to their prescription-drug benefits — thus their name — even letting them make huge decisions over which drugs to cover and how. Suddenly, PBMs had the clout to squeeze Big Pharma but good. “They go to the [drug] manufacturer and say, ‘If you give us the lowest price, we will structure our [benefits] to steer patients towards your drug,’” Danzon says.
Once you start squeezing, though, it’s hard to stop. PBMs soon hit on the notion of running their own mail-order operations to cut local and chain pharmacies out of the picture. While mail-order medicine sounds like it should be as convenient as Amazon, that’s only true when it works — and it sometimes doesn’t. Jesse Smith, an HIV-positive physics student at San Francisco State, had his antiviral prescription switched to OptumRx’s mail-order pharmacy in 2012. Only twice did his meds arrive on time, he estimates; once, he paid for a two-day supply out-of-pocket at more than $100 a pill. Similar stories from other HIV or AIDS patients led to lawsuits; some are settled, while others are ongoing. Those settlements, however, are strictly limited to HIV and AIDS patients, leaving out cancer patients or others with chronic illnesses.
PBMs, which routinely argue they’re playing a vital role in the health care industry, are certainly doing well as a result. Express Scripts, generally considered the largest independent PBM, reported a $2 billion profit last year, up 9 percent from the previous year, even though its overall revenue declined. These companies are also getting bigger. UnitedHealth just paid almost $13 billion for a PBM called Catamaran, which it intends to merge with OptumRx to create the third-largest PBM in the world. According to research from Trefis, UnitedHealth will eventually manage more than 1 billion prescriptions when this deal goes through.
You may not even notice, of course. As Jerry Flanagan, a Consumer Watchdog lawyer involved in the HIV/AIDS lawsuits, says: “No one knows what a PBM is, as long as they’re not screwing with you.”
LILY ALTAVENA                                        


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