Which hospital in the United States charges its patients the highest bills for common medical procedures? It turns out that the nation’s most expensive hospital is located in Bayonne, NJ, where you’ll pay nearly $100,000 dollars to treat your case of chronic lung disease — five times as much as what others hospitals charge for the same procedure.

Last week, the Center for Medicare and Medicaid Services (CMS) released first-of-its-kind data detailing the prices that hospitals charge for common procedures. The new numbers revealed that there’s a huge range of price fluctuations between different hospitals, with no good reason for why some places are charging so much more than others. Bayonne Medical Center topped the list, billing at a rate more than four times the national average for the 100 most common types of medical treatments.

Does that mean that, since patients at Bayonne are paying extremely well for their time in the hospital, they’re receiving particularly good care? Not really. The New York Times points out that Bayonne Medical Center ranks about average in terms of the quality of its care, no better or worse than most other hospitals in New Jersey. That fits into the broader national trends regarding health costs and health quality — spending more on care isn’t actually correlated with better treatment.

The Obama administration, which is encouraging greater price transparency in the health care industry as one of the central tenets of Obamacare, hopes that making hospital costs public could help encourage Americans to shop around. If New Jersey residents decide they’d rather not receive the particularly expensive care at Bayonne Medical, maybe they’ll decide to go to a different hospital in the area — and maybe that will force Bayonne to lower its prices to stay competitive.

But addressing the United States’ sky-high medical costs isn’t just about better educating patients. In fact, there’s evidence that teaching doctors more about the actual costs of the procedures they’re recommending can also help. Studies have shown that doctors are less likely to order unnecessary tests and procedures when they know how expensive they are. And, in order to further continue to cut down on wasteful medical spending, the U.S. needs to do more research on which specific types of health spending could be pared down without sacrificing the quality of Americans’ health care.

Cancer patients are much more likely to go bankrupt than Americans who aren’t faced with a cancer diagnosis, a new study finds. Even the Americans who have access to health insurance aren’t necessarily safe from bankruptcy, since the high cost of treating cancer can still put an untenable strain their finances.

A team of researchers in Washington state collected data from nearly 400,000 adults, evenly split between those who had been treated for cancer and those who were cancer-free. After checking to see which of those adults had filed for bankruptcy between 1995 and 2009, the researchers found that cancer patients were 2.5 times as likely to go bankrupt in that period.

Although the study didn’t specifically look at insurance coverage, previous research has demonstrated that the Americans who cite major health issues as the reason they filed for bankruptcy are actually often insured. One 2006 study found that more than 60 percent of bankruptcies in the United States are due to high medical bills, and in those cases, three-quarters of those Americans had insurance when they got sick. NBC News interviewed one cancer patient who found herself in this situation, even though she was employed and insured when she first got her diagnosis:

That rings true for Janet Literski, 57, who had purchased health insurance as an independent contractor working in sales. When she was diagnosed with non-Hodgkin’s lymphoma in 2008 Literski discovered her insurance covered only part of her surgical costs and none of her diagnostic tests. Then there were co-payments and deductibles. By the time she was diagnosed with pancreatic cancer two years later, she was about $150,000 in medical debt.

In 2011, no longer able to work, Literski and her disabled husband filed for bankruptcy. “It was a gut wrenching decision because you feel like a personal failure, and that makes me angry because I had tried to do everything right,” Literski says. “I had health insurance, I was working.”

Literski is now covered by Medicaid and receives disability payments and though she hasn’t been told she’s in remission, she says she is “healthy enough.”

[The study's lead author, Dr. Scott Ramsey,] says cancer centers need to do a better job of assessing each patient’s financial status, offering credit counseling, and managing patient care.

Even bigger disparities emerged when the researchers broke down the cancer patients in their study by different demographics. The younger groups were up to 10 times more likely to go broke than the older patients, and non-white women were the most likely to run out of money.The cancer that is associated with the highest risk of bankruptcy is thyroid cancer — likely because that disease mostly affects younger women. On the other hand, older men with prostate cancer are the least likely to reach financial rock bottom.

Ramsey and his researchers first presented their research in 2011, and their final findings were published in the Health Affairs journal this week. The timing of the study’s release coincides with some recent pressure to help lower the cost of cancer drugs. Last month, a group of over 100 doctors criticized Big Pharma companies for making “life-saving” cancer drugs too expensive for Americans to afford. The doctors asserted that the “unsustainable drug prices” were “causing harm to patients,” and urged reforms in this area to ensure that cancer patients don’t have to go without the treatment they need.

Cancer patients have also been recently caught up in the budget battles resulting from sequestration. At the end of April, cancer clinics blasted Congress for taking legislative action to restore the sequester cuts that were causing airport delays rather than working to address the cuts that are undermining Americans’ chemotherapy treatment. As a result of the automatic budget cuts, some Americans are being forced to delay their chemotherapy, and some cancer clinics may even be forced to close their doors.

Doctors are reluctant to give nurses more authority to treat patients, according to findings in a New England Journal of Medicine study released on Wednesday. But doctors’ skepticism about nurses having expanded roles isn’t based on the facts — and it ignores the reality that nurse practitioners must take on such responsibilities if health care reform is to succeed.

The new study finds that many doctors don’t trust nurses to lead patient-centered “medical homes,” with only 17 percent of surveyed primary care physicians viewing it positively. “Medical homes” are arrangements encouraged by Obamacare in which nurses, doctors, pharmacists, and specialists work together to provide patients with better and more efficient care in a unified setting.

There is also a striking chasm between doctors and nurses on the issue of nurse practitioners’ ability to provide safe, quality patient care:

When researchers asked whether they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.

Doctors also overwhelmingly disagreed with many nurses’ position that they should receive the same level of pay as doctors for performing similar services.

But this position is an untenable one in the era of Obamacare, with more than 25 million Americans expected to gain health coverage in the coming decade. Since the bulk of these Americans are expected to consume primary care — rather than specialty — services, it’s important that the U.S. medical system have enough medical workers to serve them. And there simply aren’t enough primary care doctors to tackle that burden on their own.

Instead, nurse practitioners will have to take on additional responsibilities. There’s no reason to suspect that this will compromise patient care quality — in fact, multiple studies have shown that the quality of care that nurse practitioners provide for acute primary care is on par with doctors. One randomized trial comparing nurses’ versus doctors’ ability to manage complex care regimens for HIV-positive patients receiving antiretroviral therapy also found no evidence of professional inferiority. As David Hebert, CEO of the American Association of Nurse Practitioners, told Kaiser Health News, “[N]urse practitioners have been practicing safely and providing great outcomes for decades.”

Doctors — and patients — would be well served by an expanded role for nurse practitioners. Primary care doctors tend to be concentrated in urban areas, creating a major barrier to rural and isolated communities’ access to basic medical services. But nurses are more numerous and could have greater access to such populations, making them ideal candidates for heading medical homes and seeing to the day-to-day aspects of patient care.

In light of Republican-led states’ entrenched opposition to Obamacare’s Medicaid expansion, safety net hospitals around the country have expressed fears that they could go bankrupt as their government funding gets cut. On Monday, the Center for Medicare and Medicaid Services (CMS) announced that it would help these embattled hospitals by paring back planned cuts to their federal reimbursements.

In an attempt to cut government health expenditures, Obamacare included fairly deep cuts to so-called “disproportionate share” hospitals’ (DSHs’) — safety net facilities that cater mostly to the poor and uninsured — reimbursement payments. These cuts were intended to be offset by an influx of newly-insured Americans covered under the states’ expanded Medicaid programs.

But since the Supreme Court ruled the expansion optional, red states with a large number of low-income and uninsured residents have largely refused to take part in the Medicaid expansion, thereby creating a disastrous funding problem for safety net hospitals in these states. The CMS’s new proposed regulations represent an effort to avert those disastrous cuts as states get their acts together:

The Centers for Medicare & Medicaid Services proposed on Monday that for the next two years, the DSH dollars be reduced based partly on a state’s percent of uninsured residents (states with the lowest percent of uninsured receive larger reductions). CMS also seeks in the proposal to protect state DSH funding that is used to increase coverage under Medicaid demonstration waivers. [...]

“… since some states have yet to decide whether to expand Medicaid, this proposed rule will not discourage expansion, nor will it penalize hospitals in those states that have yet to make a decision,” [Rick Pollack, executive vice president of the American Hospital Association,] said.

However, CMS’s new proposal is a funding band-aid, not a permanent fix. The far more responsible and efficient way to take the heat off of America’s safety net hospitals — while securing low-income Americans’ medical and financial well-being — would be for highly uninsured states to accept the health law’s generous funding to expand Medicaid.

In fact, that’s exactly why some GOP governors such as Arizona’s Jan Brewer and Florida’s Rick Scott have reversed course and decided to endorse the Medicaid expansion — because hospital associations in their states have been warning that noncompliance in the face the upcoming payment cuts would cost them tens of billions of dollars and possibly force them out of business, leaving millions of America’s poor without recourse for medical care. Unfortunately, not all Republican state leaders and legislators seem to be swayed by that argument, forcing the CMS to take action and stave off safety net hospitals’ fiscal ruin.

But seeing as even the GOP governors who have endorsed expansion are struggling to convince skeptical legislators in their own party, the temporary fix is crucial to making sure that safety net hospitals — and the millions of poor Americans who rely on them — don’t end up as the collateral damage of a political fistfight over Obamacare. Arizona, Florida, Texas, and Louisiana — four GOP states that appear increasingly unlikely to expand Medicaid this year — have close to 12 million uninsured residents alone, approximately half of whom live below 138 percent of the Federal Poverty Level (FPL) and would likely gain Medicaid coverage under the expansion.

For the first time in decades, U.S. prescription drug spending dropped last year — a phenomenon largely stemming from the fact that, faced with spiraling health costs, Americans are being forced to cut back on their care wherever they can.

According to a new report from IMS Institute for Healthcare Informatics, the nation’s total spending on prescription medications dropped from $329.2 billion in 2011 to $325.8 billion last year. Similarly, the average amount that each American spent on their medications in 2012 fell to $898, representing a decline of $33. This is the first time the IMS has recorded a drop in drug spending in the 58 years that the institute has been monitoring the data.

Part of the decline is due to more cheaper, generics drugs entering the market, a positive trend that helps Americans better afford their medication and ultimately lowers health costs. But that’s not the whole story. According to the IMS’ director of research, Michael Kleinrock, many Americans are skipping out on their prescriptions because they’re struggling to afford all of their medical costs, and are therefore being forced to ration their health care:

IMS found affordability of health care remains a big problem for many Americans, with growing out-of-pocket costs forcing people to go without needed doctor visits, medicines and other treatments.

For some, that was because they lost jobs or homes during the worst recession in decades. But higher costs also are hitting many employed people who have health insurance.

Employers have been raising health costs for their workers well above the inflation rate, through higher copayments, premiums and deductibles. Many commercial insurance plans now have annual deductibles — the amount a patient must pay before insurance kicks in — that exceed $1,000, Kleinrock said. [...]

“Even patients with insurance are feeling the pinch and have been reducing their use of health care,” Kleinrock said.

IMS’ findings are consistent with other studies that have found that low-income Americans are forgoing their medication because they can’t afford it. One out of every five Americans has asked their doctor to prescribe a cheaper medication in order to lower their prescription costs — and, compared to wealthier people, poorer patients are more than twice as likely to avoid taking their medication as directed in order to save money.

Of course, as Americans continue to struggle to afford their prescription drugs, Big Pharma is reaping the benefits. The 11 largest drug companies’ profits have been soaring for the past eight years, and they raked in almost $85 billion in 2012.

Unfortunately, profiting at the expense of workers isn’t exclusive to Big Pharma. As Kleinrock notes, even the Americans who currently have insurance are now being forced to cut back on their care, since their employers continue to shift more of their health care costs onto them. Across the country, employees’ contributions to their health insurance plans have skyrocketed at the same time as those workers’ wages have stagnated. That’s especially true for the low-wage workers who are employed by large chain companies in the restaurant industry, whose CEOs have repeatedly complained about the cost of providing adequate health benefits under Obamacare — and keep attempting to find unscrupulous ways to circumvent the health reform law.

Looks like Obamacare is more “on track” than “train wreck.”

In a striking illustration of the promise that the health law holds for consumers, two Oregon private insurers vying to sell coverage on the state’s Obamacare insurance marketplace this October are reevaluating their opening bids for the plans’ monthly premiums. The reason? A side-by-side regional comparison of all proposed 2014 premiums for Oregon marketplace plans became public on Oregon’s marketplace website Thursday, and showed that the two insurers’ planned monthly premiums were far higher than other proposals. That raised fears among the companies’ officials that their plans wouldn’t be competitive on the market later this year, leading them to proactively request a rate reduction — and as more of Obamacare is implemented, state insurance commissioners expect that trend to continue:

“Posting rate comparisons company-by-company is a taste of what is to come,” says Cheryl Martinis of the Oregon Insurance Division.

Judging by the reaction, there’s already an impact.

Providence Health Plan on Wednesday asked to lower its requested rates by 15 percent. Gary Walker, a Providence spokesman, says the “primary driver” was a realization that the plan’s cost projections were incorrect. But he conceded a desire to be competitive was part of it.

A Family Care Health Plans official on Thursday said the insurer will ask the state for even greater decrease in requested rates. CEO Jeff Heatherington says the company realized its analysts were too pessimistic after seeing online that its proposed premiums were the highest.

“That was my question when I saw the rates was, ‘Can we go in and refile these?’” he said. “We’re going to try to get these to a competitive range.”

Although some insurers have been using Obamacare as an excuse to hike premiums despite record profits, such rate hikes have been rarer — and less extreme — since the law’s passage. And to emphasize, this is all happening before the state has had a chance to review and approve initial plan rates — much less launch the actual marketplace. After the exchange opens up, consumers will have even more detailed information about marketplace plans, including the ability to compare — not just rates — but actual benefits offered on the plans side-by-side.

That’s particularly significant because much of the current variation in health plan premiums stems from rampant health care price opacity and wildly divergent benefits offered on different health plans — a status quo that won’t last in the Obamacare era since the law requires qualifying insurance plans to offer a base level of ten “essential health benefits,” including prescription drug, mental health, and maternity services. That means that Americans will be able to go online and figure out whether a plan costs more because it actually provides more robust benefits, or because an insurance company is just trying to gouge prices and maximize profits. Insurance offered on the marketplaces will be separated into Bronze, Silver, and Gold plans based on how generous their offered coverage is, making consumer comparisons between similar health plans simple.

As Thursday’s development shows, that public information empowers consumers by forcing insurers to compete with one another to attract customers. Or to put it another way — and contrary to conservative fear-mongering about the law — Obamacare is working exactly as it was intended to. And with 24 million Americans expected to gain coverage through the marketplaces by 2016, that’s great news for Americans’ pocketbooks — as well as their health.

One of the most important ongoing stories in the realm of budgets and health care economics is the remarkable drop in how much health care costs are projected to grow over the next decade. Back in March, David Cutler and Nikhil Sahni released some preliminary work arguing that, thanks to this slowdown, projections of government spending on health care for the next decade were overshooting by hundreds of billions of dollars. Now they’ve released a more complete paper (gated) with a specific number: if the lower growth rate continues, the federal government could save $770 billion by 2021. Furthermore, Cutler and Sahni concluded that as much as 55 percent of the slowdown has been driven by factors other than the recession.

That last point is especially important. If the slowdown in growth is due to the recession, then it’s temporary. Health care costs will once again rise at their previous rate once the economy recovers, driving health-related spending to ever greater heights and further straining the budgets of both the government and American families. But if the slowdown is due to deeper, structural changes in health care markets, then at least some portion of the slowdown may be long-term. And the government’s projections of future debt and deficits rely heavily on those previous assumptions of high health care cost growth. So if the slowdown sticks, the outlook for America’s fiscal future could improve radically, all without lawmakers cutting a dime.

Here’s Bloomberg with a nice summary:

Cutler’s research compared the U.S. government’s growth projections for health spending from 2004 to 2012 with actual increases in the period. It found that the real growth rate was about half of the government’s prediction, leading to a gap of more than $500 billion in 2012 between the projections and spending.

The paper calculates that the recession accounted for about 37 percent of the slowdown in health costs from 2003 to 2011. Declining private insurance coverage and cuts in payments byMedicare, (USBOMDCR)the government health plan for the elderly and disabled, accounted for another 8 percent and the remaining 55 percent is “unexplained,” Cutler wrote. That’s where the structural changes come in, he said.

If the current lower-than-expected rate of growth continues, the country may reap savings of as much as $770 billion through 2021, the research found.

As always, there’s a lot of uncertainty built in here. Another recent study by Kaiser, for instance, suggested that as much as 77 percent of the slowdown is a temporary result of the recession. Also, there’s a lot of complexity in the category of “structural” changes. Some of it’s improvements in the efficiency of health care delivery, quite possibly thanks to reforms in Obamacare that encourage providers to change the way they do business. Other parts of it may be one-time shifts in the market, such as the rise of generic drugs to replace more high-cost brand-name medicines.

The broader point, however, is that there are more ways to balance the budget than just slashing the aid and benefits Americans need to buy. A better-designed health care system could very well deliver lower and more efficient government spending than austerity ever could.

The Center for Medicare and Medicaid Services (CMS) released highly-anticipated data on Wednesday that outlines what hospitals across America charge for common inpatient medical services. The takeaway from the new numbers? There is no rhyme or reason to what different hospitals charge for the same procedures across geographic regions (or even within the same region), and prices can fluctuate by over $100,000 in the most extreme cases.

The CMS data is comprised of charge records from over 3,300 hospitals spanning 306 localities, and detail the costs of many of the most common inpatient procedures, such as treatments for heart failure, chest pain, respiratory infections, and lower limb replacements. The Huffington Post has a helpful graphic mapping the prices that hospitals throughout the New York and New Jersey areas charge patients for treating chronic obstructive pulmonary disease (COPD), which helps illustrate just how significant the disparities can be:

These numbers confirm a recent Time Magazine investigative report that found much of the same trend throughout the U.S. And the biggest victims of this rampant price variation — and apparent price-gouging — are the poor, the uninsured, and the underinsured. Public entitlements such as Medicare are relatively protected, since the government has the power to negotiate blanket prices and reimbursement rates for specific services. But private insurers — and, of course, the uninsured — don’t have that same capacity, making them subject to the whims of the hospitals they do business with. In essence, that means that poor people’s medical and financial stability are left up to pure luck, dependent on whether or not the hospital they visit charges reasonable rates.

As Obama Administration officials explained, there isn’t any feasible economic reason for this cost variation — and reformers are hoping that the publication of the data will shame hospitals into changing these practices and acting in good faith:

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A new study published in the Journal of the American Medical Association (JAMA) Internal Medicine raises a provocative question: can patients’ religious faith — and the spiritual support given to them by their caregivers — influence their decisions on end-of-life medical services and health care spending? The short answer, according to researchers’ findings, is yes — with some caveats.

Dr. Tracy Balboni of Dana-Farber Cancer Institute in Boston led the new study, which tracked 343 Americans with advanced cancers from its launch in 2002 up through their deaths. The results were striking. Compared to those who reported a lower level of spiritual support, the 43 percent of study participants who reported “high spiritual support” from religious communities were about a third as likely to receive end-of-life (EoL) hospice care, over two and half times more likely to to receive some form of aggressive — and expensive — EoL service (like being put on a ventilator or pursuing additional chemotherapy), and five times more likely to die in a hospital ICU in their last week of life.

Furthermore, patients who self-reported the highest levels of “religious coping” during their final days were 11 times as likely to receive aggressive EoL treatments and 22 times more likely to die in the ICU compared to those with lower levels of religious coping. Those numbers were also elevated for minority populations, particularly African Americans, who are among America’s most religious ethnic groups.

So what’s at the root of these notable trends — and what lessons do they hold for doctors who want to provide their patients with the best care while also reducing the number of unnecessary procedures they must undergo in their last days? Researchers speculate that the numbers may have something to do with religious Americans’ belief in a higher power and the prospect of God working through medical professionals. “One possibility is that religious people consider medicine to be a primary means of divine intervention,” wrote Balboni and her colleagues. They also mused that strong religious community support could foster the desire to “persevere” through “hope found within suffering” — in essence, the mettle to refuse to call it quits.

But as the study’s findings on these religious community-supported patients’ ICU death rates shows, channeling that faith-based will to live into aggressive medical care isn’t necessarily effective — and, to be blunt, it contributes to wasteful health care spending by Americans and public entitlement programs such as Medicare. EoL hospice care isn’t a huge proportion of total health care spending — but aggressive medical interventions for chronically ill elderly Americans on the cusp of death is, with the top five percent of such patients accounting for over $600 billion in health spending every year.

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Ever since the Supreme Court gave Obamacare its constitutional blessing last summer, few Obamacare provisions have elicited as much ire from conservative critics and some in the business community as the requirement that large employers provide health coverage to all employees who work for 30 hours or more per week. Employers are now engaged in a concerted effort to force Congress to ease this worker protection, essentially presenting lawmakers with an ultimatum: loosen the relevant Obamacare rules, or we’ll continue to slash workers’ hours to avoid paying for their health coverage. In fact, this policy battle underscores the innate risks of America’s system of employer-sponsored health coverage.

First, it’s important to note that retail and service-sector employers such as Denny’s and Olive Garden — while making some of the biggest splashes about the Obamacare requirement — are not alone in their frustrations. Citing cost concerns, nonprofits such as charities and city and state governments have also joined the push to change the health law’s mandates for hourly waged workers (although the vast majority of large employers in general plan to keep providing health coverage after Obamacare implementation).

To be clear, these Americans will still be able to access insurance coverage under Obamacare regardless of their employers’ actions, either through Medicaid (if their state decides to participate in the reform law’s optional expansion) or by receiving federal subsidies to purchase insurance on Obamacare’s statewide exchanges. For instance, a part-time worker earning $15,000 per year would only have to pay $300 in annual premiums, with the remaining $2,718 covered by government tax credits. Still, reducing such part-time workers’ hours amounts to a pay cut for low-income Americans, giving employers formidable leverage in their dealings with Congress. And that very leverage — as well as employers’ generally outsized influence over their workers’ health care — is a direct consequence of employer-sponsored insurance (ESI).

American health care didn’t always work this way. In fact, a 2009 NPR foray into the history of ESI found that the modern system took root through a series of historical accidents and ad hoc responses to world events. At the turn of the 20th century, medical services were mostly cheap and procurable through cash or bartering — and the average American’s annual health costs were little more than $100 in today’s currency. But as innovation in health care technology began driving care prices up, individuals’ ability to pay for it began to dwindle, leading Americans to only consume care when they got sick while forgoing checkups and preventative services. The advent of medical insurance was born out of hospitals’ efforts to reverse this trend, as Baylor University Hospital began providing Dallas-area teachers with a monthly premium-driven insurance plan that would come to be called “BlueCross.” While this was limited to teachers at the time, the idea caught on — and by the time World War II came around, employers began offering benefits like health coverage as a way to lure workers during an era of sky high demand for good labor.

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