Tag Archives: Kaiser Family Foundation

Poll: Most Want the Mandate Nixed. Do You?

As the Supreme Court prepares to take on challenges to the Affordable Care Act, new data suggests that Americans remain divided on the constitutionality of the law’s requirement that all Americans purchase health insurance. Little more than half of Americans (54%) think the individual mandate should be ruled unconstitutional and that the Supreme Court will likely agree (55%), according to a recent poll by the Kaiser Family Foundation. The poll was based on telephone interviews with 1,206 adults in the United States from. Jan 12-17.

Courtesy Kaiser Family Foundation

The poll also found that more than half (59%) of Americans think the Supreme Court Justices will base their ruling on their own opinions.  That sentiment is being echoed by the conservative interest group Freedom Watch, which recently filed its second petition to request Justice Elena Kagan to recuse herself. Supporters of the petition take issue with Justice Kagan’s former position as Solicitor General and close adviser to President Obama while the law was being written.

If the mandate were ruled unconstitutional, it’s not clear if the rest of the law would remain solvent. According to the poll, 55% of American thought remaining provisions of the law would survive but 30% said it would mean the end of the law entirely.

Courtesy Kaiser Family Foundation

Further, the Kaiser poll shows that Americans are split on their own opinions of the ACA. According to the poll, 44% are against the law, 37% support the law, and 19% are unsure.

However, a majority (67%) oppose the mandate because it forced American to do something they don’t want to do (30%) or because health insurance is unaffordable (25%). An additional 22% just don’t like the idea of paying a fine for not having insurance.

Those who do support the mandate (30%) said it guarantees that everyone needs health coverage (32%) and that the mandate can guarantee that (17%). Some also said the mandate could control costs (15%).

Do you agree with these findings? Tell us more.

— Frances Correa (FMCReporting)


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Filed under Health Policy, health reform, IMNG, Polls, Practice Trends

Experts Call on Docs to Lead Cost Control

Doctors must play an integral role in reducing health care costs, health policy experts say. At the annual conference of consumer group Families USA, Dr. Atul Gawande and Dr. Ezekiel J. Emanuel said that doctors participating in reducing costs will have a greater affect than the health care law itself.

Dr. Atul Gawande / Frances Correa/ Elsevier Global Medical News

“Washington will not be able to save the costs. They’ll provide the framework, but in your communities, that’s where you’ll do it,” said Dr. Gawande, a health policy researcher and endocrine surgeon at Brigham and Women’s Hospital in Boston. Dr. Gawande said that the Affordable Care Act will provide the data for doctors to identify where to trim costs. Both Dr. Gawande and Dr. Emanuel said doctors can take a leading role in cost control by focusing on the sickest 5% of patients. According to a 2009 report from the Agency for Healthcare Research and Quality, the sickest 5% of patients account for 50% of national health care expenditures.

Dr. Gawande cited the work of Dr. Jeffrey Brenner. By analyzing medical billing data from practices in Camden, N.J., Dr. Brenner, a primary care physician, was able to map out the most impoverished areas with the highest health care costs. With a focused approach that included home visits and the help of social workers, Dr. Brenner decreased one patient’s inpatient hospital time from 7 months in one year to 3 weeks. While under his care, the patient lost 200 pounds, and quit smoking, drinking, and using cocaine. At the same time, the patient’s hospital costs decreased by 60%. Dr. Gawande wrote about Dr. Brenner’s strategy in a January 2011 article in the New Yorker.

Dr. Emanuel, a recognized expert on health and chair of the department of medical ethics and health policy at the University of Pennsylvania, Philadelphia, said rising health care costs threaten many aspects of American society, particularly education, workers’ wages, and the nation’s position in the world, as well as by putting an economic squeeze on middle class. Dr. Emanuel also served as special adviser for health policy to the director of the White House Office of Management and Budget from January 2009 to January 2011, where he helped craft the Affordable Care Act.

Dr. Ezekiel Emanuel / Frances Correa/Elsevier Global Medical News

“If you care about how our kids are going to educated in the future, you have to care about heath care costs,” Dr. Emanuel said, adding that increased health care costs directly affect tuition rates. For example, from 2001 to 2011, employer contributions to health insurance increased by 113%, according to the Kaiser Family Foundation. Meanwhile, tuition for public universities increased 72% over the past decade, according to the College Board. Dr. Emanuel projected that, as health care costs continue to rise, states will be forced to take the money from other programs, leaving education and health care at the greatest risk.

“We can reduce costs without sacrificing access … [doctors] have to be committed to doing that,” Dr. Emanuel said.

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Filed under Family Medicine, Health Policy, health reform, IMNG, Practice Trends, Primary care, Uncategorized

Inner-city Teens Get Asthma Messages by MP3

Ask a teenager what he or she did today, and you’ll probably get the universal adolescent answer: “Nothing.” Turns out that a whole lot of that “nothing” involves using electronic media. Some innovative pilot studies tapped into those habits to get inner-city teenagers to improve their use of asthma medications, Dr. Giselle Mosnaim reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI).

Image of iPod Shuffle by flickr user aliciat80 (Creative Commons license).

She became frustrated when she kept seeing the same teens in the emergency department in acute asthma crisis over and over again. The messages to use their asthma medications were not getting through to them, so she looked for potentially better ways to reach them.

In a large survey study by the Kaiser Family Foundation, youths aged 8-18 years reported that their use of media (TV, music, computer, video games, print, or movies) in 2009 increased to 10 hours and 45 minutes per day, up from 8.5 hours in 2004 and 7.5 hours in 1999. How is that even possible? They’re multitasking 29% of that time, compared with 26% of media time spent multitasking in 2004 and 16% in 1999. Even accounting for multitasking, they were exposed to media 7 hours and 38 minutes per day in 2009.

In that same time span, cellphone ownership increased in this age group from 39% to 66%. The proportion that owned an iPod or other MP3 player increased from 18% to 76%.

Dr. Mosnaim (Photo by Sherry Boschert)

So Dr. Mosnaim designed a pilot study in which 27 inner-city teenagers with asthma received free cellphones and could choose music to listen to via the phones, but they had to  hear messages from celebrities urging them to take their asthma meds before they could access the music. That study bombed. (Not as in, “You’re the bomb!” but as in, “Fail!”)  Medication adherence did not improve, and the teens found a way around safeguards on the cellphones to run up hundreds of dollars in calls that they weren’t supposed to be making, said Dr. Mosnaim of Rush University Medical Center, Chicago. Plus, they didn’t think much of the celebrity messages.

So she tried again, this time using iPod Shuffles. Four teens in the second pilot study were allowed to download 10 profanity-free MP3 songs per week. They met weekly in coping/peer-support groups, where they recorded their own take-your-asthma-meds messages, and those were mixed in with the tracks on the iPod Shuffle. I don’t have permission to post audio of some of those messages here, but suffice it to say that their creativity outshines most rappers and DJs. The investigators attached a device to each teen’s inhaler to objectively measure medication adherence.

Hearing their own voice on the “asthma track” proved to be a hit. And it seemed to work. Medication adherence increased to 70% in 8 weeks, a “clinically significant treatment target,” Dr. Hosnaim said.

The idea is now graduating from pilot studies to a randomized, controlled trial with 90 participants. The control group will get the iPod Shuffles and follow the same protocol as the intervention group, but the voice on the asthma messages will be Dr. Mosnaim.

Not too long ago, I might have ended this blog post by saying, “Stay tuned.” That’s so last century. When the study’s results drop, you’ll get them here first. Are you subscribed?

— Sherry Boschert (@SherryBoschert on Twitter)

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Filed under Allergy and Immunology, Emergency Medicine, Family Medicine, IMNG, Internal Medicine, Pediatrics, Primary care