In a new state-by-state study of price reporting provisions for medical services in America, over half of all U.S. states receive a failing grade. The report, which was compiled by two major American health care consulting firms, judges states based on both their price reporting laws and the availability of that information to the public — for instance, a state that requires providers to report the costs of every inpatient and outpatient procedure on a public website would get high marks. But as the following figure from the report shows, only New Hampshire and Massachusetts have any semblance of strong price reporting laws on their books, and the vast majority of states don’t even meet minimal standards:

In a letter at the beginning of the report, Health Care Incentives Improvement Institute Executive Director Francois de Brantes notes that as employers increasingly shift the cost of health care onto their workers by offering coverage through high-deductible health plans, “it is only fair and logical to ensure that consumers have the necessary quality and price information to make informed decisions about where to seek health care.”

Unfortunately, this transparency simply does not exist in the American health care industry, allowing providers to price gouge and leaving patients in the dark about why their care costs what it does. A recent Time investigation into price opacity in U.S. medical services revealed that a lack of strong public reporting provisions and consumer protections allows providers to charge their patients arbitrary and staggeringly inflated prices for their medical services, contributing heavily to rising health care costs.

They swap out bed pans, tend to wounds, and assist with every facet of day-to-day life — sometimes even living with their patients. They’re home health care aides, and they are a crucial resource in caring for America’s sick, elderly, and disabled — and they do it all for an average wage of $9.70 per hour, less than the mean hourly compensation for lifeguards, food servers, and dry cleaners.

That reality will continue to affect more and more Americans, as growth in this particular portion of the health care industry has been fast — and it’s only going to get faster. Job growth in the American health care sector doubled from January to February, led by strong gains in ambulatory care givers, hospital workers, and home health aides. And as CNN Money points out, an uptick in America’s elderly population — fueled by aging Baby Boomers — will lead to an explosion in demand for such workers’ services.

But due to a loophole in labor protection laws, home health aides often make less than minimum wage, earning about $20,000 per year. And that’s just the full-time workers. Part-time health aides, who make up most of the profession, make even less and don’t receive benefits — leading to a sadly ironic situation in which health workers are often forced to forgo their own health care and turn to government safety net programs:

Under these conditions, it’s no surprise then that about 40% of home aides rely on public assistance, such as Medicaid and food stamps, just to get by.

“What you have is a situation here where the people that we count on to care for our families cannot take care of their own, and that’s got to change,” said Ai-jen Poo, director of the National Domestic Workers Alliance. [...]

A recent study by the Institute for Women’s Policy Research estimates immigrants make up 28% of home health care workers, and of those, one in five are undocumented.

The Census Bureau has found that 53% of home health aides are minorities. By their calculations, it is the single most common job for black women, who alone represent nearly a third of the entire profession.

This is part of the reason workers are undervalued and underpaid, say worker advocates like Eileen Boris, a professor of feminist studies at the University of California, Santa Barbara.

The fact that the populations who are already disproportionately affected by poverty and poor access to essential services are turning to such low-wage, low-benefit jobs is a sad reflection on both America’s economic recovery and holes in the social safety net. In fact, most of the jobs added to the U.S. economy since the recession ended pay low wages.

Under Obamacare, home health aides will serve as essential foot soldiers in the fight to make America’s health care system more efficient. The Obama Administration has been pushing to revamp labor protections for home health aides, but that effort has not enjoyed much success so far.

Spurred by thousands of American women who were being injured due to faulty IUDs, President Gerald Ford signed the Medical Device Amendments of 1976 into law, granting the Food and Drug Administration (FDA) greater regulatory oversight regarding the safety and effectiveness of medical devices intended for widespread distribution. It was a historic consumer protection law intended to preserve public health and safety — but the legislation was also riddled with regulatory loopholes, particularly with respect to products that were already out in the market. Now, almost forty years later, Americans are still feeling the impact of the incomplete legislation as they encounter a multitude of common medical devices, including lethal products, that haven’t undergone adequate testing.

As The Atlantic reports, the medical device regulation bill contained lax provisions for classifying the safety of devices that are similar to products already available on the market, meaning that many contemporary devices do not have to undergo thorough testing simply because they were considered safe enough back in 1976:

The legislation created varying safety standards for devices that the FDA would deem as low, medium, and high risk. Medium-risk products, like surgical stitches, could be sold without first being tested on people under most circumstances, provided the device was “substantially equivalent” to one already on the market. For high-risk devices, like artificial hearts, companies were generally required to test their products in people and demonstrate to FDA that the products were safe and effective.

The law applied immediately to new types of devices and directed the FDA to retroactively classify existing ones, with one caveat: Products that were already on the market when the law passed would effectively be regulated as medium-risk until FDA officially classified them. The unfortunate result has been that some high-risk devices have won approval without being tested in people.

This interim solution was not supposed to last 37 years. Yet nearly four decades since Congress passed the Medical Device Amendments, the FDA still has not classified some of the temporarily “grandfathered” devices. As a result, potentially high-risk devices are continuing to reach the market without ever being tested in people.

The contemporary high-risk products that still have not undergone human testing due to the loophole include aortic balloons for heart surgeries and automated external defibrillators (AEDs). After thousands of faulty hip replacements caused a public health outcry over the last several years, Congress finally took action in 2012 to give the FDA more authority to re-classify the so-called “grandfathered” products. But while the FDA has taken action to re-label hip replacements, “19 grandfathered device types remain unclassified.”

Unfortunately, congressional procrastination on public health and safety measures is depressingly standard, as the FDA’s regulatory powers consistently lag behind until a crisis erupts to force lawmakers to make a change. Last year’s deadly deadly meningitis outbreak stemming from lax standards at a Massachusetts-area compounding pharmacy illustrates the trend perfectly. Lawmakers eventually responded to that crisis by introducing legislation to give the FDA more power to oversee the largely unregulated compounding pharmacy industry — but only after the outbreak resulted in the deaths of over 30 Americans, and the FDA director Margaret Hamburg begged a Senate health committee to give the agency more oversight.

President Obama’s health care reform law takes big strides to eliminate the gender disparity in health costs, particularly by prohibiting most insurance companies from “gender rating” — the practice of charging women more for their coverage simply based on their gender. But that provision doesn’t apply to long-term care insurance, an area in which women may soon be charged higher premiums than their male counterparts for the exact same type of coverage.

Even though Obamacare will put an end to gender discrimination in the vast majority of insurance plans, the long-term care insurance industry isn’t required to cease the practice. And the industry is beginning to take advantage of that. Kaiser Health News reports that the nation’s largest long-term care provider has announced it will begin setting its prices by gender as early as this spring, a move that move may encourage the rest of the long-term insurance industry — which has already been hiking up its premiums over the past several years — to do the same:

Women’s premiums may increase by 20 to 40 percent under the new pricing policy, said Jesse Slome, executive director of the American Association for Long-Term Care Insurance. The average annual premium for a 55-year-old who qualified for preferred health discounts and bought between $165,000 and $200,000 of coverage was $1,720 last year, according to the association.

Experts say they expect other long-term-care insurers will soon follow suit.

Long-term-care insurance provides protection for people who need help with basic daily tasks such as bathing and dressing. It typically pays a set amount for a certain number of years — say, $150 daily for three years — for care provided in a nursing home, assisted living facility or at home. Never a very popular product with consumers, many of whom found it unaffordable, in recent years the industry has struggled and many carriers have raised premiums by double digits or left the market.

Women typically live longer than men — and often end up becoming the primary caregivers for their husbands, which reduces those men’s need for long-term insurance care. But when women’s health eventually devolves, they often don’t have a partner who can provide that type of care for them, and they’re stuck relying on insurance coverage. That’s why women typically have much higher claims for long-term care services, and why insurance companies want to be able to charge them more.

But women also tend to have fewer economic resources than men do, since an enduring wage gap accumulates over time to leave older women with significantly less wealth. Over the course of a 40-year working career, the average woman loses out on an estimated $431,000, and the annual wage gap jumps to about $14,352 in the five years before retirement. Requiring women to pay more for health care in the final years of their life could be a significant drain on their resources, particularly for single women, and ultimately prove unaffordable.

And ultimately, charging women more won’t address the fact that the country’s long-term care industry is currently an unsustainable model. The health care reform law originally included a provision to help address the long-term care crisis in the United States — but the Obama Administration decided the Department of Health and Human Services didn’t have enough authority to implement it, and the GOP has simply pushed to repeal it rather than working to craft a better policy. The fiscal cliff deal finally did away with it for good, but lawmakers still haven’t worked out a better system for taking care of Americans’ long-term care needs — in an equitable way that’s affordable for both women and men.

The quest to improve patient care, maximize medical efficiency, and curb wasteful spending by digitizing Americans’ patient records, insurers’ claims, and providers’ treatment requests just gained a powerful new ally: “Watson,” IBM’s revolutionary data-mining supercomputer that made national waves when it defeated reigning Jeopardy! champion Ken Jennings at his own game.

American Medical News reports that health insurance giant WellPoint has struck up a deal with IBM and Memorial Sloan-Kettering Cancer Center in New York to use the supercomputer — which has spent its post-Jeopardy days amassing and “learning” massive amounts of data about the American health care, insurance, and public health industries — for two pioneer programs to automatically process, review, and pre-authorize medical claims and treatment requests, as well as a third program dubbed “Interactive Care Insights for Oncology” that will “identify individualized treatment options for cancer patients, starting with lung cancer” in order to advise oncologists on the latest and most effective treatment regimens by incorporating up-to-the minute longitudinal medical studies and cancer data into its suggestions.

In an email to ThinkProgress, Cindy Wakefield, a Regional Director for Public Relations at WellPoint, pointed out that the new technology has the potential to have a big impact on the health care industry. “We believe the IBM Watson technology can improve the efficiency and quality of treatment, potentially eliminating unnecessary testing, enhancing the consistency of actions, and accelerating the time to treatment via expedited decision-making processing,” Wakefield explained. “We are continuing to train Watson, and we are teaching Watson by ‘feeding’ it information such as our medical policies and clinical guidelines.”

Using Watson’s technology to automate claims processes could be a potent catalyst for a more efficient American health care industry — which is often bogged down by poor inter-provider communication, incomplete and non-centralized data, and archaic paper records. The supercomputer could also advise providers on the most efficient and appropriate use of treatments based on each individual medical claim, patients’ specific insurance benefits, and patients’ medical histories by analyzing health care data from across the country.

Interestingly, if Watson concludes that a physician or provider’s treatment request is not the most effective one based on a patient’s history and medical benefits, the computer can register its disagreement — but as Wakefield explained to ThinkProgress, it cannot override the provider’s decision or deny treatment requests. Instead, a human nurse would have to review Watson’s alternative suggestion, and then make a judgment call along with the provider on whether or not to comply with it.

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69-year-old Rebecca S. Tomczak suffers sarcoidosis, a condition that leads to lung scarring and can devolce into a terminal disease if left untreated. The doctors told her that without a full lung transplant, her prognosis would be dire — and while Tomczak could have qualified for transplant lists at several hospitals, she had to scour through several providers before finding one that would take up her case, since she’s a practicing Jehovah’s Witness. Her adherence to her faith prevents her from receiving blood transfusions, which are typically necessary for transplant surgeries.

As the New York Times reports, Tomczak was finally able to track down Dr. Scott A. Scheinin of the Houston-based Methodist Hospital, who agreed to treat her on her own terms. The hospital had conducted several successful bloodless lung transplants before — specifically tailored towards Jehovah’s Witnesses — and had developed an innovative, seemingly safe medical approach to treating these patients while also respecting their closely-held tenets. As Dr. Scheinin put it, “At the end of the day, if you agree to take care of these patients, you agree to do it on their terms.”

Critics might balk that tailoring medical procedures towards a patient’s religious beliefs is impractical and costly. But the new system that the doctors at Methodist developed was more cost-effective than regular transplant procedures — and arguably more safe, as there has been some evidence that blood transfusions may actually be risky in certain cases:

The economy is also helping the blood management movement. Processing and transfusing a single unit of blood can cost as much as $1,200, and many hospitals are trying to cut back. Administrators at Methodist said their bloodless lung transplants typically cost 30 percent less than other lung transplants, partly because careful management of hemoglobin levels before surgery has resulted in fewer complications and shorter stays.

Experts say they are beginning to see a measurable impact on blood usage, although the data to support it are not yet available. Dr. Richard J. Benjamin, the chief medical officer of the American Red Cross, predicted that the numbers would show the first decline in use since the AIDS scare began in the 1980s, perhaps by one million units.

“We’re changing this culture, this knee-jerk transfusion reaction,” Dr. Scheinin said. “And I think that’s been a good thing for all our patients.”

While Tomczak’s story is intriguing for its implications on medical innovation and reducing health care costs, it also highlights a positive way to reconcile the tensions between modern medical technology and religious dogma. Rather than being a case in which a doctor imposes his or her conscientious biases on a patient — such as the Irish medical team that incited global outrage after denying a life-saving abortion to a woman who later passed away — Tomczak’s experiences are an example of a doctor keeping his patient’s health at the forefront while also respecting that patient’s ethical choices through creativity and innovation. That may not be achievable in every single case — but this particular story shows that it certainly is possible.

Avik Roy — who advised Republican presidential candidate Mitt Romney on health care policy — and Doug Holtz-Eakin published an op-ed for Reuters earlier this week in which they outlined their vision for a “free market” approach to health care reform. It’s a serious proposal, albeit one that makes the same fallacious argument as Whole Foods CEO John Mackey’s assertion that Switzerland’s health care is more “entrepreneurial” than Obamacare is. Unfortunately, that claim is simply the least worrying aspect of a plan that is riddled with benefit cuts and shifting health care costs onto consumers.

First of all, mentioning Switzerland in the piece at all is essentially a red herring, as the duo’s proposal doesn’t actually shift American health care in the direction of the Swiss system — quite the opposite, in fact. While Switzerland shares important aspects with Obamacare, particularly its federally-subsidized health insurance marketplaces — a fact that Roy and Holtz-Eakin acknowledge, to their credit — the country’s health care program can hardly be described as a less regulated system, since it actually provides more generous insurance subsidies, requires insurers to offer at least one “nonprofit plan” akin to a public option, and imposes stricter price controls and negotiations between the government, drug makers, and health care providers.

Instead, what Roy and Holtz-Eakin want to see is a modified, and far more regressive, version of the proposal that Sen. Ron Wyden (D-OR) and former Sen. Michael Bennett (R-UT) proposed first in 2007 and then again in 2009 during the health care reform debate. Under Roy-Holtz-Eakin, Medicaid and Medicare beneficiaries would be shifted away from public insurance into private plans on Obamacare’s insurance marketplaces, consumer protections and regulations governing the marketplaces would be rolled back to encourage “innovation,” federal insurance subsidies would be limited to Americans up to 300 percent of the federal poverty level (FPL) instead of the Obamcare-mandated 400 percent FPL, and the Medicare eligibility age would be raised by three months every year indefinitely.

These are really poor ideas that would shift costs onto consumers and force many to forgo care, cut Americans’ health benefits by depriving them of Medicaid’s unique benefits, and create costlier private insurance premiums by siphoning seniors out of Medicare — all while doing absolutely nothing to lower the actual cost of American health care, which is the only real way to reduce national health expenditures.

Roy-Holtz-Eakin also caps federal insurance subsidies at 300 percent FPL rather than 400 percent FPL in an effort to contain government expenses. In the op-ed, the authors implicitly justify this by citing the example of Massachusetts — the birthplace of Obamacare — where reform has been working pretty well. But that ignores the fact that Massachusetts is a relatively wealthy state with unemployment and poverty below the national average. For the rest of the country, that cap would be pretty devastating, pricing millions of Americans out of the health care system. Roy and Holtz-Eakin also do not want subsidies to increase faster than inflation, even though that provision is meant to address the well-established reality that health care inflation tends to accelerate faster than regular inflation.

Although Roy-Holtz-Eakin may be an honest proposal for curbing costs, it is largely based on the dishonest notion that relinquishing more responsibility — a euphemism for shifting costs — onto consumers and making them pay more for their care will somehow magically curb the cost of health care. It won’t — but it will make Americans avoid receiving treatment, leading to a form of self-rationing that is particularly ironic given Roy and Holtz-Eakin’s goal of preventing government rationing of health care.

Universal Orlando, a theme park resort in Florida that generates more than $1 billion dollars in annual revenue, plans to drop insurance coverage for its part-time employees at the end of this year — a tactic to avoid providing its workers with adequate health benefits under Obamacare.

The health care reform law attempts to put an end to several predatory insurance practices, and requires employers to provide their workers with sufficient insurance plans that don’t put limits on essential benefits. Universal would be required to upgrade to a more comprehensive insurance plan under Obamacare. But instead of extending better benefits to its part-time employees, the company would rather drop those workers’ health care altogether:

Universal currently offers part-time workers a limited insurance plan that has low premiums but also caps the payout of benefits. For instance, Universal’s plan costs about $18 a week for employee-only coverage but covers only a maximum of $5,000 a year toward hospital stays. There are similar caps for other services.

Those types of insurance plans — sometimes referred to as “mini-med” plans — will no longer be permitted under the federal Affordable Care Act. Beginning in 2014, the law will prohibit insurance plans that impose annual monetary limits on essential medical care such, as hospitalization, or on overall spending. [...]

Critics of mini-med insurance plans say they ultimately provide little protection for workers, with meager payout limits that are nowhere near enough to cover medical emergencies. Supporters argue they are a realistic option for low-paid, limited-hour workers who can’t afford better plans. [...]

Universal’s announcement has angered some employees, who say the resort can afford to provide more-comprehensive health insurance for its part-time workers. Universal Orlando’s immediate parent company, Universal Parks & Resorts, generated approximately $950 million in operating cash flow last year, up 10 percent from a year ago.

Universal has about 17,000 workers, making it one of the largest employers in Central Florida. Company officials say that only a small percentage of its employees would be impacted by the move to drop part-time coverage, since most of Universal’s part-time workers are covered under a parent’s or spouses’s insurance plan. Still, about 500 people are enrolled in Universal’s “mini-med” plan and can expect to lose all of their current health benefits after December 31st.

The resort isn’t the only hugely successful company to balk at the prospect of providing basic health benefits for its low-wage employees — who typically don’t earn enough to be able to afford to purchase insurance on their own. Wal-Mart dropped health coverage for its part-time employees two years ago. And a wide range of businesses in the restaurant industry — including Applebee’s, Olive Garden, Denny’s, and Wendy’s — have also used Obamacare as an excuse to pass the cost of health care onto their low-wage workers.

An Oklahoma state Senate committee rejected a measure that “would have repealed a 1987 law that prevents cities and towns from enacting tobacco use restrictions stricter than that of the state” by a 2-6 vote on Monday — drawing sharp rebukes from public health advocates who see the legislation’s failure as a political concession to Big Tobacco, and even drawing the ire of the state’s GOP Gov. Mary Fallin, who has called on lawmakers to pass legislation aimed at curbing Oklahoma’s smoking-related public health care costs.

“This is a victory for tobacco lobbyists and the tobacco industry,” said Alex Weintz, Fallin’s communications director. “It’s a defeat for the state of Oklahoma and anyone who cares about improving our health.”

As OKNews reports, the debate over SB 36 revealed a clear correlation between the state senators’ votes and the amount of money they received from the tobacco lobby:

The debate on the measure turned into a showdown between Sen. Frank Simpson, R-Ardmore, the only senator to sign a pledge to refuse all contributions, meals and gifts from the tobacco industry, and Sen. Rob Johnson, who is listed as the No. 1 recipient on a website that tracks legislators receiving money from tobacco lobbyists.

Johnson, R-Yukon, received about $11,295 in campaign contributions and gifts from those who were identified as tobacco lobbyists since 2006, according to the website tobaccomoney.com, which was started last year by Doug Matheny, the former director of tobacco prevention at the state Health Department. [...]

“From the tobacco companies themselves, I don’t think I’ve received that much comparatively to other interests,” he said. “It has absolutely nothing to do with it. I’ve taken max contributions from somebody and completely have been opposed to an idea they’ve had.”

Johnson and his fellow reform opponents implied that SB 36 would be a burden on businesses, since it would discourage Oklahoma residents from patronizing establishments that don’t allow smoking. But that logic completely ignores the very real — and very significant — costs of the state’s smoking epidemic. National smoking-related medical costs amount to $200 billion in preventable spending every year, and studies have confirmed that states making small investments in smoking cessation policies see massive economic returns. In Oklahoma specifically, where about 5,800 people die each year from smoking, every household pays an estimated $556 annually in state and federal taxes to cover smoking-caused medical costs.

Ultimately, the measure’s defeat is a reminder of the outsized influence that Big Tobacco continues to enjoy. Fallin has vowed to continue her fight to encourage anti-smoking efforts in Oklahoma, and will potentially call for a popular referendum on SB 36 — but if she does, the people of Oklahoma can expect a titanic statewide lobbying campaign by the tobacco industry.