Category Archives: Healthcare

Ebola: A Consequence Of Austerity?

Kevin Drum, today, on how “slashing” funding for the NIH has resulted in us not having an Ebola vaccine:

What’s more, even without a vaccine we’d probably be better prepared to react to the Ebola outbreak if we hadn’t spent the past decade steadily slashing funding for public health emergencies. The chart on the right, from Scientific American, tells the story.

There are consequences for budget cuts. Right now we’re living through one of them.

Hey, my fellow Libertarians… We won! We trimmed government to the point where it could be strangled in a bathtub. Taxes are low. Regulation is minimal. Government spending is back at pre-WWI levels. We did it, and now we’re going to have to live without the nanny that we slaughtered. [sadface]

Oh, wait. No, that didn’t happen.

Government has grown by 59% in inflation-adjusted dollars since 1999. It’s grown from 17.6% of GDP to over 21% in the same time.

Clearly, we’re not at a loss for a vaccine because government wasn’t spending money. And whether you’re on the Left, the Right, or even a Libertarian, one can make quite a strong argument that research into cures or treatments for epidemic-level diseases may be a “public good”. It is quite true that shareholders for pharmaceutical companies find a lot more value in helping middle-aged men get erections than staving off the next extinction-level-event*. This sort of pure healthcare research is exactly the sort of thing that the market doesn’t do well, and has such widespread benefit to society overall to be worth it.

So. If we can agree that government’s spending a lot more money in inflation-adjusted dollars, and we can agree that both sides of the aisle view this sort of research as a true public good, worthy of public investment, why is its budget getting slashed?

Simple: science spending doesn’t buy votes.

The truth is that the government has plenty of money. They spend plenty of money. Even beyond this, a lack of money has never been a barrier to them spending money, whether they have to borrow it, or print it, or have the fed print it so they can borrow it from themselves. If something is important to politicians, they’ll find a way to funnel money to it.

In fact, the problem is similar to that of many government programs. They’ll find money for sexy new things like rail line extensions, but suddenly are broke when it comes to maintaining the lines they already have. Oh, and the lack of maintenance mentioned in that story cost more lives than Ebola has in the US.

Apparently the war in Iraq was worth $1T. The stimulus was worth $787B. Obamacare (Apr ’14 CBO estimates) will cost $1.383T over the 2015-2024 period.

Compare that to the NIH, which costs ~$30B/year.

It’s not a question of spending. It’s a question of priorities. Incremental scientific advancements to third-world diseases are important, and worthy of funding. But very few politicians will get credit for voting for that funding, so they let the NIH wither on the vine while they spend money on “important” things. That is the libertarian critique: the NIH could have been fully funded if the government wasn’t distracted–as they always are–by anything shiny.

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Facts Are Stubborn Things, Mr. Reid

Every individual who has told the press that they have had a bad experience with ObamaCare is either lying or are too stupid to know how to use the Internet. This is the latest line by Senate Majority Leader Harry Reid (D-NV), anyway. Perhaps it’s these kinds of accusations that gave one Colorado woman the presence of mind to record her phone call with the “Connect for Health Colorado” navigator due to her own problems with the website.

Rebecca Ryan of Fort Collins has a preexisting condition but until recently, she was covered by a different government healthcare plan called “Cover Colorado.” The reason for changing her plan? As it turns Cover Colorado did not meet the requirements of ObamaCare and some 14,000 plans were canceled as a result. Rebecca liked her healthcare plan but wasn’t able to keep it. Sen. Reid wants Americans to believe Rebecca is lying about this “horror story” but this is only the beginning of Rebecca’s experience so far with ObamaCare.

As it turned out, Rebecca could save $15 a month with the new plan with one little caveat: she would lose her doctor whom she has received care from for the last 9 years. If, however; Rebecca wants to keep seeing this doctor she can do so if she is willing to pay an additional $140 a month:

Rebecca: So, the lowest monthly premium is, um, way higher than I was paying before and I thought this was supposed to be lower.

Rep: Now this could be way higher if it’s a doctor, if you have a doctor that’s (??) in there. So, often, if you have a doctor that you work with, you can be picking plans that are higher, if that doctor is a more specialized doctor.

Rebecca: She’s just a general family doctor. She’s not specialized.

A few minutes later, Rebecca was looking for dental coverage but was having some trouble with the website. The navigator explained that she needed to remove the filters Rebecca had in place for her doctor (stupid citizen!):

Rebecca: Do I have to go through the whole filter thing again?

Rep: Is your doctor listed when you hit ‘Find a Dental Plan’?

Rebecca: I don’t know why she would be. She’s not a dentist.

Rep: But she was put in as a provider? (pause)

Rebecca: Ok, my hospital was listed too, so I removed them both [as search filters]. However, what if I want to keep her? I’ve been with her a long time, and I don’t want a different doctor.

Rep: If you want to keep her then you’re looking to pay the 515 dollars a month.

Rebecca: So they’re going to penalize me because I want to keep my doctor?

Rep: Yes.

There you have it Mr. Reid. One individual whose experience is that 1. she lost the healthcare plan she liked, 2. can keep her doctor if she wants to pay a higher price, and 3. had some difficulty with the website (I’ll leave it to the readers and you to decide if its the fault of Rebecca or the website).

And lest you believe, Mr. Reid; that Rebecca, the original reporter on this story, or I have taken this call out of context, please feel free to listen to the entire 24 minute conversation in the player below.

You see Mr. Reid, no amount of smearing of the groups which oppose ObamaCare, no amount of calling people liars, and no amount of repeating “billionaire Koch brothers” can change the objective fact that some people are now worse off than before ObamaCare. Perhaps many others will also record these phone calls to expose your lies. I’m quite confident that Rebecca Ryan of Fort Collins, Colorado is but one person being hurt by this boondoggle.

I Want My — I Want My — I Want My DNA

Today the FDA dropped a big m-fing hammer on 23andme, a service that will allow you some insight into your own genome. They offer, along with the ability to get a raw report about the specific genes they track, some level of analysis of your genome. They can use your data to look for specific known genetic markers of inherited conditions, and giving you advance warning that you may be at elevated risk of certain problems. In addition, by trying to build a large database of genetic data, they are vastly accelerating the degree to which future genetic markers can be understood for analysis.

This, according to the FDA, is data used for diagnostic and prevention purposes, and therefore makes 23andme a “Medical Device”. Suffice to say that medical devices must to be FDA approved, according to the law, and 23andme hasn’t completed all the hoops necessary to allow me to spit in a cup and send it to a lab. So they can’t sell their kits any longer.

This puts some people, like my wife and myself, in a bit of a strange position.

As many of you know, our 4yo son is autistic. We’ve been through quite a bit to potentially understand the causes of his autism. Without getting too deep into the matter (there are many possible causes, each with its own camp of die-hard adherent believers, all of whom hate each other*), one of the avenues we’ve been traveling down is testing for various types of biomedical dysregulation. As a result, we’ve found that he has a genetic mutation common in a lot of autistic individuals related to what is called the “methylation pathway”. This is a biologic process related to brain activity and development, so the fact that it’s short-circuited gives some indication of where things can be helped**.

So my wife and I are taking this as a chance to better understand more about our own genetic profiles, and with the added benefit of determining more clearly where my son’s genetic mutations have come from***. So we both did the “spit in a tube” thing last week, and our samples are happily on their way to 23andme.

Now, I’m smart enough to know that genetics is NOT an exact science. That getting a report that there might be elevated risk for X doesn’t mean I have X****. I’m not going to use the information to make rash decisions about my medical care.

But it’s a start. It’s information that I don’t have today. It’s information that may be of immeasurable benefit to me in the near term and down the road, if it reveals something real. And it’s information that the FDA doesn’t trust me to have.

“Trust” is the term there. The FDA doesn’t trust us mere citizens. It doesn’t believe we’re capable of making decisions that affect our very lives. The 23andme genetic information isn’t perfect, but they believe that if we can’t get perfect information, we’re better off with no information. This information, of course, is getting better. One of the possible advantages of a widening circle of people partaking in 23andme research is that they can improve their ability to analyze a sample, looking for correlations years from now based on the sample I just gave. Part of the reason I wanted to do this was based upon expected future benefit in addition to learning about the aspects of my genetic that already relate to known markers.

So, our saliva is on the way. With the FDA’s recent proclamation, does that mean that 23andme will complete the testing on our samples? Or will the brakes be put on before they’re allowed to run the test? Will this action end up killing the company, so that even if I *do* get my results today there will never be any future research to make the findings more valuable to me?

So thanks a lot, FDA. You’re making me wonder if I’ll ever get the information I absolutely want and paid for. You’re making the future value of that investment lower, by putting into question the future of 23andme and the amount of data they have access to to analyze. And by doing so, you’re probably putting the brakes on the speed at which future genetic breakthroughs will manifest by artificially culling the data set. Nobody will know how many people will die in the future as a result of slower progress in the growing field of genetic research, but they won’t thank you, nor will I, for protecting me from this information today.

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Bye Bye 4th and 5th amendment: Obamacare info may be used for Law Enforcement and Audit activities

Well… we knew that the 4th and 5th amendment meant nothing to them… never mind HIPAA… but really?


Obamacare Marketplace: Personal Data Can Be Used For ‘Law Enforcement and Audit Activities’

Maryland’s Health Connection, the state’s Obamacare marketplace, has been plagued by delays in the first days of open enrollment. If users are able to endure long page-loading delays, they are presented with the website’s privacy policy, a ubiquitous fine-print feature on websites that often go unread. Nevertheless, users are asked to check off a box that they agree to the terms.

The policy contains many standard statements about information automatically collected regarding Internet browsers and IP addresses, temporary “cookies” used by the site, and website accessibility. However, at least two conditions may give some users pause before proceeding.

The first is regarding personal information submitted with an application for those users who follow through on the sign up process all the way to the end. The policy states that all information to help in applying for coverage and even for making a payment will be kept strictly confidential and only be used to carry out the function of the marketplace. There is, however, an exception: “[W]e may share information provided in your application with the appropriate authorities for law enforcement and audit activities.” Here is the entire paragraph from the policy the includes the exception [emphasis added]:

Should you decide to apply for health coverage through Maryland Health Connection, the information you supply in your application will be used to determine whether you are eligible for health and dental coverage offered through Maryland Health Connection and for insurance affordability programs. It also may be used to assist you in making a payment for the insurance plan you select, and for related automated reminders or other activities permitted by law. We will preserve the privacy of personal records and protect confidential or privileged information in full accordance with federal and State law. We will not sell your information to others. Any information that you provide to us in your application will be used only to carry out the functions of Maryland Health Connection. The only exception to this policy is that we may share information provided in your application with the appropriate authorities for law enforcement and audit activities.

The site does not specify if “appropriate authorities” refers only to state authorities or if it could include the federal government, as well. Neither is there any detail on what type of law enforcement and/or audit activities would justify the release of the personal information, or who exactly is authorized to make such a determination. An email to the Maryland Health Connection’s media contact seeking clarification has not yet been answered

The second privacy term that may prompt caution by users relates to email communications. The policy reads:

If you send us an e-mail, we use the information you send us to respond to your inquiry. E-mail correspondence may become a public record. As a public record, your correspondence could be disclosed to other parties upon their request in accordance with Maryland’s Public Information Act.

Since emails to the marketplace could conceivably involve private matters regarding finances, health history, and other sensitive issues, the fact that such information could be made part of the “public record” could prevent users from being as free with their information than they might otherwise be. However, as noted, any requests for such emails would still be subject to Maryland’s Public Information Act which contains certain exceptions to the disclosure rules.

Read the fine print eh?

 These are such clear 4th and 5th amendment violations I can’t believe anyone didn’t immediately say “uh guys… we cant actually do this”…

… but as I said, we know that our elected and selected “lords and masters” don’t give a damn about the 4th or 5th amendments (or really any of the others ones any time they become inconvenient).

So while I’m sure they were told they couldn’t do it, I’m sure they said “ahh well the disclaimer and release is enough, we’ll be fine”.

 Yeah no.

 And as far as HIPAA goes… In reality these terms of use are not anywhere near an adequate HIPAA disclosure release, so using any of this data in any manner other than for healthcare purposes would be a federal offense.

I am a cynically romantic optimistic pessimist. I am neither liberal, nor conservative. I am a (somewhat disgruntled) muscular minarchist… something like a constructive anarchist.

Basically what that means, is that I believe, all things being equal, responsible adults should be able to do whatever the hell they want to do, so long as nobody’s getting hurt, who isn’t paying extra

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