Larry Levitt

Why Health Insurance Literacy Matters

progressed, a placental abruption may occur or a prolapsed umbilical cord drop through the cervix. Although such complications affect only 1% to 1.5% of pregnancies, if you don’t have the capacity to deal with them, it’s catastrophic for the fetus,” said Lawrence, who has delivered 7000 babies. Mairi BreenRothman, CNM,MSN,who has a home birth practice in the Washington, DC, area and is a board member of the AmericanCollegeofNurse-Midwives,agreed that rare complicationsarehandled faster in ahospital. “But therearealso risks in thehospital that don’t exist at home—a hospitalacquired, antibiotic-resistant infectionor an adverse reaction to regional anesthesia,” she wrote in an email.

Drug advertising: the right or wrong prescription for our ailments?

As the cost of health care — particularly prescription drugs — is rising at a rate that has not been seen in a decade, the United States finds itself once again searching for new solutions to what has, until now, been an intractable problem. Drug advertising, which has almost become part of the social fabric in the United States, is an appealing and visible target. Critics point to pharmaceutical companies boosting profits by pitching pills, whereas advocates talk of empowering patients with information. With a topic that is so dominated by money and politics, it is sometimes hard to tell who is correct.

Of SCOTUS and chicken.

JAMA: Evidence-basedmedicineoncewas criticized as “cookbook medicine.” Do you still encounter thatkindofcriticism,and if so, how do you counter it? DR GUYATT: One of my favorite talks to give is that evidence-based medicine is patient-centered medicine, so there are a number of things to point out. Perhaps most important is that evidence itself never tells you what to do, never. It’s always evidence in the context of values and preferences. In other words, a person with one set of values and preferences will say, “Yes, it’s the right thing.” Another informed individual would say, “No. For me, the undesirable consequences outweigh the desirable consequences.” Evidence-based medicine has highlighted the fact that so often decisions are value and preference sensitive. To do the best for the individual patient, you need to take into account their values and preferences, ideally in the context of shared decision making.

Is the Affordable Care Act Imploding

President Trump has said on various occasions that the Affordable Care Act (ACA) is imploding, exploding, or collapsing.

Reports of Obamacare’s Demise Are Greatly Exaggerated

Recent developments have once again prompted some to declare that the insurance marketplaces developed as part of the Affordable Care Act (ACA) are unsustainable and collapsing. And once again, these reports are overstated. What has prompted this latest round of recriminations is the report that UnitedHealthcare, the nation’s largest health insurance company, will be pulling out of the ACA’s marketplaces except in a “handful of states” in 2017 (http://bit.ly/1NRi5ab). The company cites financial losses in its plans sold to individuals as the impetus for its withdrawal. The insurer is still quite profitable overall, earning

The Partisan Divide on Health Care

3 billion in operating profits in the first quarter of 2016 (http://bit.ly/1SJ1ucR).

Understanding The Managed Care Backlash

1945 and 1965 had been screened for hepatitis C, with 7400 new infections identified nationwide in 2015 alone. Morgan’s region is one of several across the country that have created hepatitis C dashboards featuring information from patients’ electronic medical records that is updated daily. The tool allows Morgan and colleagues to sort through patients by hepatitis C genotype, extent of liver disease, treatment status, and other factors. Last year, the Long Beach VA system used it to identify veterans with hepatitis C and advanced liver disease who hadn’t yet been treated and send a letter inviting these veterans to come in for potentially curative therapy. “If they don’t call, we call them,” Morgan said. During the previous 2 years, nearly 40% of veterans treated for hepatitis C at the Long Beach medical center had been diagnosed with advanced liver disease. Nationally, that figure is 21% of the 174 842 veterans within the VA health system who have been diagnosed with hepatitis C. More than 76 000 of these veterans have already received treatment, and more than 60 000 have been cured. Educating Veterans Once veterans are in treatment, managing their need for ongoing monitoring and education about hepatitis C is yet another challenge. In San Francisco, a solution is monthly group visits, where 4 to 8 veterans have their blood drawn, pick up a 30-day supply of medication, talk about their latest test results, and provide each other with peer support. A psychologist is typically present to deal with emotional issues that accompany treatment and hope for a cure. Veterans with drug or alcohol addiction aren’t automatically excluded from treatment at the VA, nor is there any specified abstinence requirement. But they won’t be offered antiviral therapy if adherence problems are suspected, Ross said. The VA has extensive experience in treating veterans with HIV infection who also struggle with substance abuse, and the agency understands the need to address social and psychological issues that can complicate medical treatment, he noted. As many as 1 of 10 Vietnam veterans have chronic hepatitis C—a rate 5 times that of the general population—and Vietnam Veterans of America has begun holding educational sessions around the country to encourage them to get tested and seek care if necessary. All are in the age group the VA is targeting, but the hepatitis C virus wasn’t identified until 1989, years after the war ended. Meanwhile, the American Legion has also begun testing veterans for hepatitis C at community events through a partnership with AbbVie, which markets the Viekira Pak hepatitis C medication and has a financial interest in seeing more veterans treated for the disease. Addressing the stigma associated with hepatitis C—which is closely associated with injection drug use and found disproportionately in people who are homeless and other marginalized populations—is an important part of these discussions. “When they came home, Vietnam vets were widely viewed as drug addicts or lazy good-for-nothings, and they haven’t forgotten,” said Berger. “Most of us were not involved in IV drug use; that’s not how we acquired hepatitis C. But that’s one of the reasons why so many of our people don’t get tested, because of the stigma.”