Map of Every Fast Food Burger in the US

This interesting map of US fast food burger joints was put together by the folks over at http://www.weathersealed.com/.  Great work!

Fast food burgers may be delicious once in a while. But what if you lived in a neighborhood that had no other inexpensive food sources?  I'd like to see map of farmer's markets and grocery store chains laid on top of this, to see where fast food restaurants dominate low cost fresh food stores.

http://www.weathersealed.com/2010/02/23/a-disturbance-in-the-force/

The Power of Better Information

In a provocatively written piece "Technology and the power to say no is real health reform" http://bit.ly/9JOZ7v, Dana Blankenhorn writes that real health reform involves saying no to the sellers of useless medical care and no to patients who refuse to make behavioral changes that would improve their health. By saying no, he means that we must stop paying for health care that doesn't work and for health care for people who don't deserve it.  I agree with his first claim and disagree with his second.

What's great about the article is the very strong case he makes for curbing the growth of healthcare costs by attacking it at the source. The growth in health care costs does not originate with the usual suspects - poor prevention, big government or with overpriced health insurance. Our problem originates with the sellers of health care - especially specialist physicians, high tech hospitals, medical device manufacturers and pharmaceutical companies. The sellers of high cost health care have been dipping into our wallets without our permission for many decades, and it is time we figured out how to make them stop.

It's the sellers of high tech health care who are causing the big hikes in health insurance premiums. It's not that we don't need some of the technologies they sell. It's that we have very little information about what we need and what we don't, and they aren't telling. They're too busy selling. 

So we need more information - comparative information - that tells us which interventions work well and which interventions are just dressing on the cake.  The Federal effort to fund better comparative effectiveness research is exactly what is needed. Once we have that information, we need to use it. We need to find the power to say no to some of these useless technologies and interventions. We need to aquire the the power to say no to the sellers of useless health care. We need to eliminate insurance reimbursements for health care that doesn't work. That's what we'll need if we want to see an end to 39% hikes in health premiums http://bit.ly/9uNKw6.

A recent article in the Journal of the American College of Radiology shows that in one large health care system in Washington State, approximately 1/4 or 26% of all referrals for diagnostic imaging services were not necessary. See a story on this study here:  http://bit.ly/a6zmev.  Many of these diagnostic procedures - x-rays, MRIs and CT scans - are very expensive, and we're paying for these procedures in our health insurance premiums. Why are we doing that and why don't we stop? Someone's got to start saying no. Dana's right about that.

That said, I don't agree with Dana that we must also learn how to deny care to overeaters, smokers and drinkers. The worst of our national health behaviors are undoubtedly killing our bodies and our wallets. However, the most effective strategies for defeating these behaviors and their outcomes - obesity among the worst of them - are not known.

We do know that obesity runs in geographic clusters.  In some regions of the country, people are overweight because there is no fresh food to be found, for miles. In these "food deserts," residents dine on fast and convenience foods. Obesity rates have skyrocketed in these areas over the last several decades. Effective strategies are needed to eliminate the deserts, not to penalize the people. To date, however, very little research has been conducted on what can be done and what might work to reduce desert-induced obesity.

Obesity also runs in social networks, and this finding has only been available since the publication of Nichoolas Christakis' groundbreaking article on that subject in the New England Journal of Medicine three years ago:  http://bit.ly/bHUmBL.  More information is needed to understand how social networks can be used to improve diet and exercise.

Interrupting the geographic and social determinants of obesity may be better than penalizing the elderly person who acquires diabetes after a lifetime of cheeseburgers.

But we need better information about what works and what doesn't. That's power.

The CEA Registry Blog: ‘Best practices’ to trim medical costs

The CEA Registry Blog: ‘Best practices’ to trim medical costs

Americans Still Want Health Reform

From a Kaiser Family Foundation poll, released today at: http://www.kff.org/kaiserpolls/8051.cfm

Question: For each element of health care reform I name, please tell me how important it is that this be passed into law. First, how important is (item)? Is that extremely important, very important, somewhat important, not too important, or should it not be done at all?

1. Reforming the way health insurance works. Proportion saying extremely or very important: 76%
2. Providing tax credits to small businesses. Proportion saying extremely or very important: 72%
3. Creating a health insurance exchange or marketplace. Proportion saying extremely or very important: 71%
4. Helping close the Medicare "donut hole". Proportion saying extremely or very important: 71%
5. Expanding high-risk insurance pools. Proportion saying extremely or very important: 70%

And here's an interesting chart:

And another:
 

Nurse Practitioners Push for an Expanded Role in Primary Care

Check out this interesting article about the push by nurses for an expanded role in primary care: http://www.bit.ly/dg7TSL. And check out this review of studies that compares advanced nursing care with physician-directed primary care: http://www.bit.ly/choFHP.

The nutshell? Advanced nursing care is often as good or better than care from a physician. And it costs less.

Although lower cost care is often equally as good or even better for the patient, there are few incentives in place to choose lower cost and lower intensity alternatives. People who are very sick may prefer to modify or even limit the intensity of the health care they receive. But everything in our system - and nearly everyone - points patients toward higher intensity.

This isn't exactly any one's fault. The whole system has us on a treadmill toward higher spending and higher-intensity care. Many insurers and health providers find themselves struggling to keep revenues high, which means the default choice is a physician over a nurse practitioner, a hospital over a community health center and a hi-tech over a low-tech intervention.

Just a little food for thought.

Health Care Stocks Rise on Death of Health Reform

In "Markets Salivate at Prospect of Healthcare Reform's Defeat," Ken Terry hits the nail on the head: http://industry.bnet.com/healthcare/10001627/markets-salivate-at-prospect-of-healthcare-reforms-defeat/ . He reports that "investors are pumping up healthcare stocks in the hope that reform will fail and that the free market will continue to push up health costs- and profits for the health industry." The Wall Street Journal reports separately that Pfizer and Merck stocks rose on investor "hopes for more concessions to be made in health legislation."http://online.wsj.com/article/SB10001424052748704561004575013480490353788.html?mod=googlenews_wsj

Where will these higher health costs and profits come from? Expect health insurance premiums to go up. Expect little help from the government or from the proposed center for comparative effectiveness research. The proposed center, whose intent was to compare alternative treatment regimens and suggest incentives for those that work best, will die with health reform.

I don't think this is what voters in Massachusetts had in mind yesterday. They wanted compromise on health reform, not open season on their wallets. Pharmaceutical and medical device manufacturers, hospitals, some insurers, and many medical specialists can celebrate. Their stocks are on the rise and healthcare markets remain almost entirely in their hands.

Does Brown's Election Signal a Compromise or an End to Health Reform?

I've heard it suggested that Scott Brown's election last night to the US Senate may bring about a new compromise on health reform. There is speculation in the NYT http://bit.ly/8jFTPd about a compromise that could bring Olympia Snowe back into the fold, or perhaps some effort that could bring both Snowe and Brown over to the reform camp. Presumably, Brown has to tack to the left to be elected again in Massachusetts, in less than two years.

But I don't see a compromise happening any time soon. Currently, no Republicans support the reform bills before Congress, and there is little evidence to suggest that the GOP will suddenly get religion.

Brown has suggested that states should be left to do health reform as they see fit. Snowe wants limited and perhaps no additional Federal involvement in the health system after reform. Neither of these positions can bring about reform of our system. Health reform in the US has to be predicated on one major change: everyone has to participate in the health system, at least at a minimum level. Without this change, "reform" isn't reform at all. Call me a pessimist, but I don't see this happening without increased Federal involvement.

If health reform fails to reach nearly every US resident in every market, the private suppliers of high cost health care interventions will continue to carve up markets, charge whatever they want, invent new "interventions" that have little chance of improving health, and over-treat unwitting patients with aggressive and unnecessary care. The "suppliers" I am referring to include (but are not limited to) pharmaceutical and medical device manufacturers, hospital systems and many medical specialists. It doesn't hurt that many patients want unlimited access to new medical technologies, whether they can improve health or not. All of the incentives are pointed in the same direction: toward newer and more expensive health care.

The suppliers of health care thrive on high cost and high tech interventions, interventions that are oversold to the American public. While some patients need new and expensive technologies, not all of us do. We are suffering from a technology binge in every corner of the US health system. Americans spend 16 cents of every dollar on health care, and the suppliers of high cost care won't mind if we spend 20 cents or more in a few short years.

As if on cue, Pfizer and Merck stocks rose on news that Brown had won the election http://bit.ly/6J07tO . Investors went to Pharma "on hopes for more concessions to be made to health care legislation." Concessions to Pharma? Is this what voters meant when they said they wanted more compromise?

I just don't see Brown or Snowe coming over to a health reform package that has any teeth. If a bill survives, it won't be strong enough to achieve anything meaningful. We should expect premiums for a healthy adult to rise well past $1,000 per month in a few years. That's what it will take to fund our voracious appetites for high cost health care.

Health Care Renewal: What the November, 2009, Breast Cancer Screening Argument Obscured

Health Care Renewal: What the November, 2009, Breast Cancer Screening Argument Obscured

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