Misleading Reporting

Today’s Managing Health Care Costs Indicator is $6,058

Here’s the first paragraph of an article from the Boston Herald   abstracted by Commonhealth   yesterday:

The nation’s anemic economic recovery could suffer a brutal blow at the hands of Obamacare, critics say, as a new study shows mandated health care in Massachusetts cut $6,000 from some Bay State residents’ annual pay.


Here’s the conclusion from the actual paper.


Our results suggest that mandate-based reform has the potential to be a very efficient approach
for expanding health insurance coverage nationally.

The same researchers previously reported that health care reform in Massachusetts decreased the number of uninsured, and


Using new measures of preventive care, we find some evidence that hospitalizations for preventable conditions were reduced. The reform affected nearly all age, gender, income, and race categories. We also examine costs on the hospital level and find that hospital cost growth did not increase after the reform in Massachusetts

So – the researchers conclude that there is less “dead weight loss” from a mandate than from a broad-based tax to cover health care costs.  Further, Massachusetts iscovering more people and not spending appreciably more.  The Connector Authority (our health insurance exchange) is set to announce a second year of premium decreases.  

Health Care Reform in Massachusetts is working – the Herald headline notwithstanding.

Diabetes Care: The Spectrum of Success

Today’s Managing Health Care Costs Indicator is  8.3%

Diabetes is a major killer in the US – the disease strikes about one in twelve  Americans ( 8.3% in the entire population; one in four over age 65), is responsible for over 70,000 deaths, and is the leading cause of blindness and kidney failure.   The Centers for Disease Control and Prevention estimates that the annual cost of diabetes in the US is $168 billion in medical treatment, and $58 billion in lost productivity.

I’m struck by two studies published in the last week that use diametrically opposed approaches –and both appear to work.  (Both studies are small, though , so it’s possible that the results will not be sustained in larger samples).

The NEJM  published two studies showing that intensive surgical intervention helps.   Italian researchers showed that bariatric surgery (the most invasive surgical treatments) could “cure” diabetes in 75-95% of those treated, compared to NO cures in the medically treated group.  American researchers showed that those who had less-invasive surgical treatments were three times as likely to have an excellent diabetes control (Hemoglobin AIC of <6).   The conclusion –for diabetics with morbid obesity, surgical treatment is strikingly effective.  Other  studies have shown that bariatric surgery can pay off in a few years in the general population – this set of studies provides further evidence that we should cover this expensive ($11-$26,000) procedure for those with morbid obesity.

The Annals of Internal Medicine published an elegant study  which randomized 118 African American veterans with diabetes to usual care, financial rewards ($100-$200), and peer mentoring.  The financial reward for better HbAIC led to a 0.4% average decrease in HbAIC, while the peer mentoring led to a 1.1% decrease in HbAIC.

There are often many roads that lead to the right outcome in health care – and these studies are all small and did not include similar groups – so shouldn’t be compared.   It’s nice to know that both high tech and low tech solutions can have a substantial impact, and have the potential to decrease diabetic complications in our increasingly-obese population.