Monday, May 11, 2015

More embarrassing facts for the shallow thinkers of the Left!  One sometimes wonders if they think at all

We read:

"A study of survival rates in trauma patients following health insurance reform in Massachusetts found a passing increase in adjusted mortality rates, an unexpected finding suggesting that simply providing insurance incentives and subsidies may not improve survival for trauma patients, according to a report published online by JAMA Surgery.

Massachusetts introduced health care reform in 2006 to expand health insurance coverage and improve outcomes. Some previous research has suggested improved survival rates following injury in patients with insurance. But the relationship of insurance to survival after injury may not be well understood. Some might expect that survival after traumatic injury may be unrelated to a person's insurance status because all injured persons have access to emergency care, according to the study background.

Turner Osler, M.D., M.Sc., of the University of Vermont, Colchester, and coauthors conducted a study of more than 1.5 million patients hospitalized following traumatic injury in Massachusetts or New York, a neighboring state that did not institute health care reform like Massachusetts. The study examined the 10 years (2002-2011) surrounding reform in Massachusetts.

The rates of uninsured trauma patients in Massachusetts decreased steadily from 14.9 percent in 2002 to 5 percent in 2011. The authors also found health care reform was associated with a passing increase in the adjusted mortality rate that accounted for as many as 604 excess deaths during four years.

"Fortunately, the increase in mortality among trauma patients following Massachusetts HCR [health care reform] resolved within a few years. It may not be possible to retrospectively reconstruct the causal pathway responsible for the increased excess deaths following HCR and its subsequent resolution. ... There are compelling arguments for providing health insurance to all citizens of the United States but our analysis suggests that simply providing health insurance incentives and subsidies does not improve survival for trauma patients. ... Ours is thus a cautionary tale for health care reformers: successful HCR for trauma patients will likely require more complex interventions than simply promoting health insurance coverage legislatively."

Comment: Taxachusetts was way ahead of Obamacare in giving people that wonderful publicly subsidized health insurance.  So people there don't die for want of insurance any more -- Right?  As we read above, some pesky medical researchers have just reported the evidence on that.  And???  More people DIED under the Massachusetts system.  The outcome was the exact opposite of what Leftists were so sure they could deliver.  Their meddling was harmful, not helpful.  Where have we seen that before? And will we see it from Obamacare?

The researchers describe the change they observed as "transient", meaning that the effect was seen only in the first few years of the new system. But have the Obamacare architects learned from that?  Not that I can see.  They seem in fact to have made the same mistakes. So this report probably means that Obamacare will kill tens of thousands of Americans.

Their report that earlier studies had shown better outcomes for insured people is naive.  People who took out private health insurance in the past would in general have been smarter and richer.  And both smart and rich people are known to have better  health generally than others.  It's one of the most consistent findings in medical research.  And healthier people are more survivable after misadventure.

And I don't have to be as coy as the researchers above in addressing the cause behind the findings:  The increase in the number of insured patients led to an increase in demand for medical services.  It was meant to. What would be the point of the legislation otherwise?  But that increase was not matched by a similar increase in available medical personnel.  So the healthcare system became overstretched, meaning that EVERYONE got worse care, including, sadly, emergency cases.  And Obamacare was similarly implemented.  It has, if anything, REDUCED the availability of medical personnel. If that is not turned around somehow (How?), the avoidable deaths will continue too.

So in their typically short-sighted Leftist way, the Massachusetts and Obamacare legislators did not consider the probable downstream effects of their new healthcare legislation.  But they did get what they wanted out of it -- the warm inner glow of being SEEN to be helping the poor. That they actually harmed everyone was of no concern to them.

Or, as T.S. Eliot rather generously put it over 50 years ago: "Half the harm that is done in this world is due to people who want to feel important. They don't mean to do harm -- but the harm does not interest them. Or they do not see it, or they justify it because they are absorbed in the endless struggle to think well of themselves."

I do still occasionally report my amazement at the follies I see as a result of my frequent readings in the medical journals and this finding certainly justifies that odd hobby of mine.  And it is particularly enjoyable to have a "big dig" at Taxachusetts.  Puncturing hubris is always amusing.  Journal abstract below

Survival Rates in Trauma Patients Following Health Care Reform in Massachusetts

By Turner Osler et al.


IMPORTANCE: Massachusetts introduced health care reform (HCR) in 2006, expecting to expand health insurance coverage and improve outcomes. Because traumatic injury is a common acute condition with important health, disability, and economic consequences, examination of the effect of HCR on patients hospitalized following injury may help inform the national HCR debate.

OBJECTIVE: To examine the effect of Massachusetts HCR on survival rates of injured patients.

DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 1,520,599 patients hospitalized following traumatic injury in Massachusetts or New York during the 10 years (2002-2011) surrounding Massachusetts HCR using data from the State Inpatient Databases.

We assessed the effect of HCR on mortality rates using a difference-in-differences approach to control for temporal trends in mortality.

INTERVENTION Health care reform in Massachusetts in 2006.

MAIN OUTCOME AND MEASURE Survival until hospital discharge.

RESULTS During the 10-year study period, the rates of uninsured trauma patients in Massachusetts decreased steadily from 14.9%in 2002 to 5.0.%in 2011. In New York, the rates of uninsured trauma patients fell from 14.9%in 2002 to 10.5%in 2011.

The risk-adjusted difference-in-difference assessment revealed a transient increase of 604 excess deaths (95% CI, 419-790) in Massachusetts in the 3 years following implementation of HCR.

CONCLUSIONS AND RELEVANCE Health care reform did not affect health insurance coverage for patients hospitalized following injury but was associated with a transient increase in adjusted mortality rates. Reducing mortality rates for acutely injured patientsmay require more comprehensive interventions than simply promoting health insurance coverage through legislation.

JAMA Surg. doi:10.1001/jamasurg.2014.2464 Published onlineMay 6, 2015


U.S. Emergency-Room Visits Keep Climbing

People on Medicaid turn to hospital care when doctor access is limited, new survey suggests

Emergency-room visits continued to climb in the second year of the Affordable Care Act, contradicting the law’s supporters who had predicted a decline in traffic as more people gained access to doctors and other health-care providers.

A survey of 2,098 emergency-room doctors conducted in March showed about three-quarters said visits had risen since January 2014. That was a significant uptick from a year earlier, when less than half of doctors surveyed reported an increase. The survey by the American College of Emergency Physicians is scheduled to be published Monday.

Medicaid recipients newly insured under the health law are struggling to get appointments or find doctors who will accept their coverage, and consequently wind up in the ER, ACEP said. Volume might also be increasing due to hospital and emergency-department closures—a long-standing trend.

Emergency-room visits are climbing, despite predictions that the Affordable Care Act would lead to less traffic. WSJ’s Stephanie Armour joins the News Hub. Photo: Getty
“There was a grand theory the law would reduce ER visits,” said Dr. Howard Mell, a spokesman for ACEP. “Well, guess what, it hasn’t happened. Visits are going up despite the ACA, and in a lot of cases because of it.”

The health law’s impact on emergency departments has been closely watched because it has significant implications for the public. ER crowding has been linked to longer wait times and higher mortality rates.

“As people gain access to affordable, high-quality coverage, they are more likely to get the right care when they need it,” said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services. “For people who have utilized emergency rooms for nonemergency care in the past, we are continuing to work to reach out and provide information on how to best use their new coverage.”

The Affordable Care Act is also making critical investments to train more doctors and nurses, especially in communities that have lacked access to quality, affordable care in the past, he said.

More than half of providers listed in Medicaid managed-care plans couldn’t schedule appointments for enrollees, according to a December report by the Health and Human Services Office of the Inspector General. Among providers who could offer appointments, the median wait time was two weeks, but more than a quarter of doctors had wait times of more than a month for an appointment.

Many doctors don’t accept Medicaid patients because the state-federal coverage provides lower reimbursement rates than many private health-insurance plans. The waits for primary and specialty care by participating doctors appear to be leaving some Medicaid patients with the ER as the only option, according to ACEP.

“We’re seeing a huge backlog in the ER because the volume has increased,” said Ryan Stanton, an emergency-room doctor at Baptist Health Lexington in Kentucky. “This year we already have had to board people in the ER because of the sheer volumes,” he said, referring to a practice of keeping patients in the ER until a hospital room becomes available.

Dr. Stanton said ER volume rose about 10% in 2014 from 2013, and was up almost 20% in the first few months of this year.

The ACEP survey also found that ERs are seeing sicker patients: About 90% of the doctors polled said the severity of illness has stayed the same or gotten worse. That might be explained in part by an aging population, newly insured people with multiple maladies, and people delaying care because they have high-deductible insurance plans.

Nicholas Vasquez, a medical director for an emergency department in Mesa, Ariz., said volume rose 5% in a year, representing about 10 more patients a day. The stress from bigger caseloads prompted some nurses to resign, he said. “Physicians are working more shifts—that pushes them a lot,” Dr. Vasquez said. “If they work too much, they get burnt out. For patients, it means longer waits.”

Some states have been trying to curb ER use by Medicaid recipients by requiring higher copayments for visits deemed nonurgent. Critics have denounced that practice as punitive, and warn that it will dissuade low-income patients from seeking care that may be necessary.

A 2013 study by Truven Health Analytics that examined insurance claims for more than 6.5 million ER visits by commercially insured people under age 65 found just 29% of patients required immediate attention. Twenty-four percent didn’t require immediate attention, 41% received care that could have been provided in a primary-care setting, and 6% got care that would have been preventable or avoidable with proper primary care.

More than 40% of emergency physicians said they expect emergency-room visits to increase if the Supreme Court rules that subsidies provided to people who obtain insurance on the federal exchange are invalid. The court is expected to rule by late June.



Sharpton’s Progressivism is Authoritarian Nationalism

In his call for the nationalization of police forces, Al Sharpton perfectly encapsulates the mainstream left — frequently dead on target in the diagnosis, yet prescribing a remedy that would only exacerbate the infection. The problems Sharpton identifies, persistent police abuse, unaccountability, and distance between the police and the policed, are the results of a forced monopoly system, one in which arbitrary power is concentrated in the hands of a small group of law enforcement and court officials.

Nationalization would compound these problems by even further centralizing power, increasing the distance (both literally and figuratively) between policing decision-makers and policed communities, and eliminating the checks and balances generated by allowing people to “vote with their feet.” Instead of municipal monopolies providing defense services, which have proven themselves dangerous enough, Sharpton would subject Americans to a single federal police force, echoing Barack Obama’s ominous call for a “civilian national security” force back in 2008.

Sharpton’s proposed remedy shows the mainstream left’s true colors, rooted in the nationalistic, essentially fascist politics of the Progressive Era. The invocation of “fascism,” in this context, should not be taken as mere name-calling. Rather, the ideas of the Progressive Era were self-consciously, even proudly fascist, a deliberate reaction against classical liberalism, calling for increased state management of the economy through bureaucratic expert oversight and collusion between political and economic power that blurred the supposedly hard-and-fast lines between the public and private sectors.

Professional police were very much a central feature of Progressive politics. Experts in government believed that professionalizing police, creating a science of policing and separating officers from particular communities, would position officers above the vagaries of politics and place, thereby leading to safer, more effective policing. But reliance on ostensibly impartial expertise, allowing committees in remote seats of government to dictate rules to everyone, is just how we get the culture of impunity we see in police departments today. Held above competition and empowered by the militarization and over-criminalization of the war on drugs, municipal police departments have free rein to abuse the communities that they are meant to serve and protect.

Confronted with systemic problems created by the state’s coercive interferences with and obstructions of human beings’ natural patterns of life, Progressives like Al Sharpton call for more and stronger government. If Sharpton would look just a bit more closely, question establishment reasoning just a bit more critically, he would see that the American government has been the single greatest enemy of the poor and oppressed, especially black Americans.

The problem is not too little government power and centralized control — it’s too much. The authoritarian reflex and its quick fixes are powerful, but they’re neither genuinely progressive nor liberal.



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1 comment:

C. S. P. Schofield said...

"Sharpton’s Progressivism is Authoritarian Nationalism"

Sharpton's entire schtick is brown nosing his fascistic White Masters.