Information Sources

I have found hundreds of useful sources of information in writing Our Health Policy Matters. This page includes hyperlinks to many of them in one sentence describing each of them.  All links were live at the time they were used (although some may no longer be so).

I have divided them into these main topics and subtopics:

HEALTH FINANCING

Overall Costs of Health Care and Overall Budget

Health Insurance

Medicare

Medicaid

HEALTH PROVIDERS

Clinicians

Community Health Centers

Hospitals

HEALTH REFORM

Affordable Care Act

Long Term Care

MENTAL HEALTH

PUBLIC HEALTH

Health and Prevention

Environmental Health

Research and Rankings

Violence

Injury

SPECIAL POPULATIONS

Children

People with AIDS

Veterans

HEALTH FINANCING

Overall Costs of Health Care

The economic value of a life is estimated to come to$7 million or more.

And according to some January 2013 BLS data, the overall medical inflation rate in 2012 – which should tell us something about Medicare and Medicaid growth in the coming year – was 3.2 percent. 

In an article entitled the High Cost of Out-of-Pocket Expenses published in September 2012 by the New York Times, Judith Graham reported on the high out-of-pocket cost of end-of-life care.

Health care inflation was under 4% per year for two straight years in 2010 and 2011 for the first time in fifty years. 

In an article entitled Health and Social Services Expenditures: Associations with Health Outcomes (the abstract is available using the link; the full article is available for purchase), researchers showed that more spending on social services may lead to even greater improvements in life expectancy, infant mortality, and potential years of life lost than more spending on health services.

However, the better the business tax climate ranking, the lower that state’s health ranking seems to become.

Eighteen of the states in the top 25 in the healthy state rankings are also in the top 25 in per capita income. 

The cost of health care services is projected to rise by an average of 5.7% per year over the next ten years, from $2.6 trillion to $4.5 trillion.

According to recent data from the Department of Health and Human Services Health System Measurement Project, more than 10% of Americans now report delaying care because of cost. 

A recent Towers Watson/National Business Group on Health employer survey reported that in 2012 employees will pay an average of $2,764 toward their health insurance premiums – an increase of 9.3% in just one year – and over 34% of their total health care costs after premiums, co-pays, and deductibles are combined.

In 1950, family physicians earned an average annual salary of $12,480.  That was before Medicare, Medicaid, and a whole lot of governmental regulation.  In 1950, the average salary of a major league baseball player was comparable - $13,300.  Health care salaries have grown since then.  However, major league professional athletes, who sixty years ago earned what doctors earned, now make, on average, $2.7 million dollars each, more than ten times what neurosurgeons make. 

According data from the Organisation for Economic Cooperation and Development (OECD), no other country spends close to what our government alone does on health care. 

The 2010 uninsured numbers were released by the U.S. Census Bureau. What’s behind them in the more detailed tables that accompanied the Census Bureau release is worth examining. 

The government subsidizes private insurance through tax deductions for premiums.  The Kaiser Family Foundation estimated that the value of this tax expenditure was around $200 billion in 2007.

And according to a source at the Manhattan Institute, state and local benefit programs cost an additional $132 billion in 2008.

According to the Centers for Medicare and Medicaid Services (CMS), our total U.S. health care expenditures in 2009 were just under $2.5 trillion.

The real reasons for our debt increase were the war in Iraq and Afghanistan at a total cost of over $1 trillion (and counting), for which the federal government did not have the courage to pay.

To balance our federal budget and pay off our accumulated debt, we will have to raise taxes, pay for the wars we’ve already fought, and create more jobs – including jobs in the public sector, in which one in every six U.S. workers is employed.

Our debt problem was caused by tax cuts that didn’t create jobs, wars for which we didn’t pay, and an unsustainable and under-regulated financial bubble that burst. 

However, the federal deficit this year will be at least $1.3 trillion.

Before the passage of the recent deficit reduction act, the CBO projected that the debt would grow to $23 trillion by 2020. 

Health Insurance

When you take into account (1) the share of private insurance that is subsidized by the government through tax benefits and (2) the share of private insurance that is paid by all levels of government on behalf of public employees, the percentage of care paid for by privately-funded private insurance is only in the teens.

Even people who support universal coverage find fault with a system so stacked against the consumer – in which the cost of insurance bureaucracy alone is twice what we pay for our entire system of public health, and more than we pay for all nursing home care, home care, dental care, or veterans services in America. 

According to the US Census Bureau, the percentage of people covered by employer-based private health insurance shrank by almost 9% - to just over half the population – between 2000 and 2010.

The Health Care Cost and Utilization Report, 2010 was released by the Health Care Cost Institute (HCCI).  It was based on claims data for 33 million people – one fifth of those with employer-based health insurance.

A study released by the Kaiser Family Foundation in August 2012 reflects the 9% increase in insurance premiums in 2011.

A March, 2012, survey sponsored by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health found that 77% of all respondents, and 75% of sick ones, said that insurers “charging too much money” is a major reason for rising health care costs.

According to the federal government, over one-quarter of the population has a lapse in coverage every year.

Medicare

According to the Center for Medicare and Medicaid services, Medicare spending increased by an average of 10.9 percent per year between 1967 and 2009, and Medicaid spending by an average of 10.7 percent per year between 1975 and 2008.

A January 2013 HHS report found that per capita Medicare spending increased by just four-tenths of one percent in 2012, following increases of only 3.6 percent in 2011 and 1.8 percent in 2010.

According to the 2012 Report of the Medicare Trust Fund Trustees the Medicare Trust Fund lost $19 billion in the last year.

Kaiser Health News has an excellent summary of the doc fix dilemma on its web site for those who want to read more about it. 

According to the Office of Management and Budget, Medicare paid $517 billion in 2009-2010 – 21% of the total. 

The net government outlay for Medicare in 2010 was in the vicinity of $450 billion for a program that covers over 48 million Americans. 

The 2011 summary of the annual report of the Medicare Trust Fund trustees shows that we still have surpluses in the Medicare Trust Funds. 

Medicaid

In the study entitled Mortality and Access to Care Among Adults After State Medicaid Expansions, the authors calculated the numbers of lives saved as a result of a Medicaid expansion in three states.

Within days of the Supreme Court’s ACA ruling that made the Medicaid expansion optional, the governors of Florida, South Carolina, Iowa, and Louisiana all announced that they wanted to opt out of it.  The governors of six other states were considering the same thing.

Not by chance, the federal share is higher in the states that want to opt out of the expansion.  South Carolina gets 70%, Louisiana gets 61%, Iowa gets 59%, and Florida gets 58%. 

This year, these and other states are proposing disturbing cuts to safety net health services.  Florida is considering a proposal to turn most state health services over to counties .  The Governor of Maine wants to remove 65,000 adults from the Medicaid program.  Louisiana just announced a new round of cuts to local mental health providers.  And Connecticut has begun denying some Medicaid coverage to kids with disabilities.

 Last week, CT News Junkie carried the story of a class action lawsuit filed on behalf of a growing number of almost 7,000 potential Medicaid recipients in Connecticut as of November 2011 whose applications were not processed within the 45 days mandated by federal law.   In paragraph 25 of the complaint, the plaintiffs allege that Connecticut “has set up a system to circumvent the federal timeliness requirements by making it appear that the applicant has failed to provide required documentation.” 

Sixty percent of nursing home beds are funded by Medicaid.

Within a few months, the fallout would spread to every community health center in America.  Without Medicaid, which accounts for 37% of CHC revenue, they, too, would crumble.

According to a study published by the U.S. Library of Medicine, treatment for localized breast cancer costs the Medicaid program an average of $22,343 after twenty-four months, but the cost of advanced breast cancer averages $117,033 over the same time period.

A Merritt Hawkins and Associates 15-city survey in 2009 found that only 65% of family practice physicians, 44% of orthopedic surgeons, 44% of dermatologists, and 41% of obstetrician/gynecologists accepted Medicaid.

The American Psychiatric Association reported in 2010 that 46% of psychiatrists were accepting no new Medicaid patients as of 2008, and only a third were participating fully in the program. 

In a 2009 report prepared for America’s Health Insurance Plans, the Lewin Group found that savings in 24 different state Medicaid plans ranged from half of one percent to 20% after a switch to managed care.

Reports authored by Jack Hoadley and Joan Alker of the Georgetown Health Policy Institute and released by the Jessie Ball DuPont Fund suggest that Florida’s own Medicaid managed care pilot program has disrupted care for Medicaid recipients while saving little or no money.

Medicaid reimbursements to states result in four times the amount of revenue states receive from corporate taxes, and almost as much as they raise from all state income taxes combined.

HEALTH PROVIDERS

Clinicians

In 1960, there were approximately 7.5 primary care physicians and 7.5 specialty care physicians in the United States for every 10,000 citizens.  Fifty years later, in 2010, there were just under 7 primary care physicians per 10,000 citizens, but over 13 specialists.

Some argue that primary care providers must play a bigger role in treating obesity in its early stages. 

Community Health Centers

As of 2012, there were over 1,200 community health centers nationwide providing services at over 8,000 delivery sites for over 20 million people – a network that within a decade may see almost as many patients each year as every hospital in America combined.  

During his two terms as President, Reagan also cut funding for safety net community health centers by over 25%.

Hospitals

Two reports – Costs for Hospital Stays in the United States, 2010 and Most Frequent Conditions in U.S. Hospitals, 2010 – were released in January 2013.  The third, Most Frequent Procedures Performed in U.S. Hospitals, 2010, was released in February.

According to the Centers for Disease Control and Prevention, we all collectively accounted for nearly 124 million emergency room visits in 2008.

HEALTH REFORM

Affordable Care Act

The 2012 Supreme Court decision.

State-by-state enrollment in the Pre-Existing Condition Insurance Program (PCIP) can be found here.

This March 2012 paper by the Urban Institute show how many (or how few) people the individual mandate will affect .

Around 25 million Medicare recipients alone used free preventive services they obtained through ACA in 2011.

These are the Kaiser Family Foundation estimates of the percentages of consumers by market who were covered by plans that failed to meet the minimum standard in 2012.

Before challenging more strongly the birth control provisions of ACA, this is a link to Cardinal-designate Timothy M. Dolan, who heads the U.S. Conference of Bishops, calling the Administration’s announcement “a first step in the right direction” of “preserving the principle of religious freedom.”

This is a link to the 2012 Supreme Court brief filed by Florida, in which the attorney general provides an estimate of the cost of Medicaid expansion for Florida that was significantly less than what the Governor later claimed.

Also, over 3.4 million Part D recipients who fall into the donut hole will receive an average savings of over $500 on brand name drugs this year.

As of December 31, 2010 5,452 plan sponsors had been approved to participate in the Early Retiree Reinsurance Program (ERRP) which would be in effect until the provisions of ACA took full effect in 2014.

However, not every consumer protection applies to grandfathered plans.

The Administration has announced that it is moving forward with another consumer protection. It published a notice in early March to require any insurer proposing to increase rates by more than 10% to provide a breakdown to customers of the reasons for the increase.

In March 2012, the Congressional Budget Office calculated the cost of a full Medicaid and SCHIP expansion to be roughly $103 billion per year.  

A report released in December 2012 by the Kaiser Family Foundation looked at the costs of Medicaid expansion for states over the next ten years. 

Long Term Care

According to the Alzheimer’s Association publication 2012 Alzheimer’s Disease Facts and Figures, the cost of caring for people with Alzheimer’s Disease and other dementias – in today’s dollars – will increase from $200 billion to $1.1 trillion per year by 2050.

And by the time they are in care, almost two-thirds of patients with at least one chronic condition have at least one more.

 The Congressional Budget Office projected that the CLASS Act would have saved the federal government $83 billion in its first ten years of implementation.

In a recent issue brief on Medicaid and long term care, the Deloitte Center for Health Solutions noted that Medicaid expenditures are projected to increase by 7.5% per year, largely due to the increase in the numbers of elders and others with chronic conditions on the program.

The HHS National Clearinghouse for Long Term Care Information notes that over 70% of us will need long term care services at some point in our lives.

MENTAL HEALTH

A 2012 IOM report contains some striking evidence of the challenges we face as we confront the growing behavioral health care needs of our aging population. 

According to one recent projection completed by the Mental Health Association of Palm Beach County (available on request from that organization), a primary care practitioner can generate in excess of $100,000 in insurance payments for every 2,500 behavioral health screenings he or she completes.

A Bloomberg News article headline made clear what cuts to mental health mean: “Mental Health Cuts by U.S. States Risk Boosting Health Costs.” 

According to the Centers for Disease Control and Prevention (CDC), there were 2.4 million primary diagnoses of mental illness in general hospitals in 2006. In the same year, state mental health spending totaled $104 per capita, according to Kaiser Family Foundation State Health Facts data. 

 CDC recently released new data for 2009.  In that year, the number of primary mental illness diagnoses decreased to less than 1.6 million.

A 2009 SAMSHA report found similar reasons given by the 5.1 million civilians who also reported unmet mental health needs.

But, according to a recent article in the New England Journal of Medicine, private insurance pays for only 27% of our nation’s mental health costs (versus 37% of all health costs), leaving almost three-quarters of the mental health bill for federal, state, and local governments. 

Behavioral health services get 26% of their revenue from Medicaid.

In Mental Health in the Metropolis: The Midtown Manhattan Study (Volume 1), the authors surveyed a sample of 1,660 adult residents of Midtown Manhattan in the early 1960s.  They found that 23.4% of Midtown adults were impaired by mental illness, and 45.2% had at least moderate symptoms of mental illness.

It took the federal government many years before it passed the Mental Health Parity Act in 2008.

A 2009 IOM report argues that addressing environmental factors, including child abuse and assault, neighborhood and family violence, and substance-abusing caregivers, can prevent mental illness.

Even in the Great Depression, state policy makers increased mental health services to meet increased needs. The census of patients served in mental hospitals – the only care option available at the time – grew from 272,252 on January 1, 1929 in 1929 to 321,824 on January 1, 1934, and the number of first admissions – a signal that new needs were being met – rose from 60,500 on January 1, 1929 to 69,368 on January 1, 1933.

The three largest mental health institutions in the country are Riker’s Island, the Cook County Jail, and the Los Angeles County Jail. The largest mental health institution in Texas is the Harris County Jail.

According to the US Bureau of Justice Statistics, in 2005, more than half of over 2 million prison and jail inmates had mental health problems.

Behavioral health courts take into account a person’s mental illness in devising treatment strategies to reduce recidivism.  There’s evidence that they work.

The Federal Substance Abuse and Mental Health Services Administration Center (SAMHSA) fact sheet Violence and Mental Illness: The Facts shows the poor link between mental illness and violence.

Serious mental illnesses hit young people disproportionately, taking 25 years or more off their lives.

The resulting Op Edit, Breaking the Chain of Neglect, was published by the Courant on December 28^th and appeared in print on December 30^th.

In 1970, according to a 2009 article by Steven Sharfstein and Faith Dickerson in Health Affairs, there were 525,000 psychiatric beds in American hospitals.  Eighty percent were in public institutions.  By 2002, the number had dwindled to 212,000.  Only 27% (or approximately 57,000) were in public institutions. 

Between 2002 and 2010, states cut even more beds, reducing the number of public hospital psychiatric beds from 57,000 to just over 43,000.

Since 2008, according to the National Association of State Mental Health Budget Directors, states have cut mental health budgets by $4.6 billion.

It doesn’t take a policy expert to conclude that when 4.5 million people with serious mental illness are receiving no mental health services, this is neglect.

How I Helped Create a Flawed Mental Health System That’s Failed Millions – And My Son is an essay I wrote for Health Affairs about the impact of mental health policy on my own family’s life.

PUBLIC HEALTH

Health and Prevention

The 2012 County Health Rankings were released by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. 

Public health gets only 3% of our total health funding according to CMS data.

Reducing smoking prevalence from 42% of the U.S. population in 1965 to 21% in 2006 required a generation of a Surgeon General-led public education campaign, bans on smoking in public places, increased cigarette taxes, and restrictions on sales of tobacco products to minors.

The American Academy of Pediatrics and public health professionals both favor the 5-2-1-0 campaign. 

As recently as 25 years ago, obesity was uncommon in America.  The CDC map at this link shows what has happened since.

We have another federal agency devoted to disease prevention, the CDC.  Its total budget of $11 billion is less than one half of one percent of our annual health care expenditures.

The Framingham Heart Study was recently in the news because it released some new research linking poor health habits in middle age to brain shrinkage. 

The National Institutes of Health (NIH) is the largest funder of biomedical research in the United States.  In requesting a budget of $32 billion for FY2012, it noted that research that it funded has reduced death rates from stroke by 70% and deaths from coronary heart disease by 60% since 1970. 

A July 2011 article in Health Affairs found that Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths. 

A recent USDA report notes that Americans now consume 30 teaspoons of added sugars every day.

According to another  USDA report published in 2006, however, more than half of the sugars in babies’ teething biscuits were added sugars, as were two-thirds in a “fruit supreme” baby dessert.

In its recent publication Cancer Facts and Figures 2011, the American Cancer Society devotes a special section to a description of socioeconomic status as a carcinogen. 

People living in poverty are approximately 50% more likely to suffer from migraines, chronic back pain, chronic neck pain, and heart disease as are people who are well off.

The Robert Wood Johnson Foundation created the AIDS Health Services Program in 1986, five years after AIDS was first reported in the United States. It was also the same year that President Reagan first mentioned AIDS publically.

A government-supported university-based study shows vast and stunning differences in the life expectancies of various racial and geographic groups in the United States that can’t be so easily dismissed.

Native American and African American men have life expectancies of between 60 and 70 years, but Asian American and white women living in rural areas have life expectancies well into their 80s. These numbers are underscored by readily-available CDC data tables.

As Grantmakers in Health points out, both local and national foundations have been focused on this problem for years, leading the way by funding important initiatives looking at both populations and place as determinants of health status for many years.

CDC recently released its top ten public health achievements of the last ten years, and there are some surprising accomplishments on the list.

A report of the National Association of County and City Health Officials (NACCHO) documents the loss of 29,000 local public health people between 2008 and 2010.

Business Wire reported that prevention initiatives can save lives and dollars at little or no cost.

Environmental Health

Almost one-quarter (23%) of local health departments nationwide have reduced or eliminated emergency preparedness functions. 

Experts have noted that as many as 24% of premature deaths can be attributed to environmental factors.

Up to 15% of children who survived the tsunami, twice the norm for adults, will likely be diagnosed with PTSD.

To put this in perspective, the total cost resulting from the Japanese quake and tsunami is already estimated to be up to $60 billion, and Hurricane Katrina did even more damage than this.

The Chernobyl accident cost Ukraine alone an estimated $201+ billion.

The World Health Organization conservatively estimates the number of deaths at nearly 10,000, plus thousands more excess cancers, and other health and mental health effects.

A YouTube video shows how radiation would spread into the atmosphere if a Chernobyl-like accident were to happen in the United States.

Research and Rankings

Connecticut is the new number one in the 2012 Our Health Policy Matters Best States for Your Health Rankings.  This year’s rankings incorporated three recently-released independent rankings.  These were the 2012 KidsCount Health Rankings, the 2011 Healthy State Rankings, and the 2012 U.S. News and World Report Hospital Ratings.  They also factored in the most recent CMS data on state per capita Medicare and Medicaid spending on community (non-hospital and non-nursing home) health care services, and Kaiser State Health Facts data on each state’s prevalence of nurse practitioners and percentage of privately-insured individuals.     

Three very sick patients were injected with a new drug.  It was made from – of all things – a modified version of the virus that causes AIDS.  After a year, two were disease-free and the third had a 70% reduction in disease tissue.  One researcher was quoted as saying that the results “exceeded our wildest expectations.”

Violence

Substance abuse (but not substance abuse treatment), juvenile detention, physical abuse, and past history of violence are predictors of future violent behavior, but mental illness is not.

As was noted by researchers at the University of Tulsa in 2008, media reporting on events like the Tucson shooting makes a difference in how people react to the event, contributes to misperceptions about people with mental illness, and deflects attention away from the actual context of violent acts.

There were 4,090 children and adults killed in 2008 alone in the sixteen states participating in the CDC National Violent Death Reporting System.

There were 14,612 murders in the United States in 2011.  That’s 4.7 homicides for every 100,000 people.

Injury

In December 2012, the New York Times summarized a number of studies related to football and brain injury.  One concluded that 60% of NFL players had a least one concussion during their football playing years, and 26% had 3 or more.  

In an article published in the Journal Brain in December 2012, researchers found evidence of CTE in almost all of the brains of former football players they examined. 

SPECIAL POPULATIONS

Children

In 2005, the Institute of Medicine found that most of the $26 billion annual cost of premature birth  - or over $51,000 per child – was for neonatal intensive care. 

According to the Annie E. Casey Foundation Kids Count project, 1.5% of all U.S.  babies are born each year at “very low birth weight,” or less than 1500 grams (3 pounds, 4 ounces).

A ranking of  infant mortality rates around the world shows that the best-in-the-world standard is around 2 per thousand.

As representatives of the Iowa Child and Family Policy Center and Voices for America’s Children note in their recent publication, The Healthy Child Story Book, for the first time in our history children may live shorter and less healthy lives than their parents.

Some data from the Annie E. Casey Foundation’s KidsCount program tracking children from birth to adulthood show just how poorly we've been doing these last few years.

We put too little money into the well-being of children, and the trend line is still going in the wrong direction.

Ten years ago, child welfare advocates were telling policy leaders that children whose parents abused drugs and alcohol were almost three times more likely to be abused.

In 2002 alone, homicides took the lives of 250 children aged 4-11.

People with HIV

In 2009 there were 48,100 new HIV infections in the United States, and 17,774 people died as a result of AIDS.

CDC also reported that in 2009: New HIV infection was as common in men as salmonella poisoning and as common in women as pertussis.

Veterans

And, according to the most recent Armed Forces Health Surveillance Center Medical Surveillance Monthly Report, both the numbers and rates of service members diagnosed with mental disorders increased by 65% during the same period.

Up to 45% of returning Iraq and Afghanistan War veterans are seeking compensation for service-related injuries. 

A March 2012 Gulf War Veterans’ Illnesses Task Force Report noted that of the over 500,000 service members who served in Operation Desert Shield, 152,126 filed successful service-connected disability claims. 

According to a new report issued by the OIG, hundreds of thousands of veterans experience delays in obtaining mental health evaluations and care from the VA.

According to a Government Accountability Office report released in October, 1.2 million veterans received mental health treatment in 2010 alone.

Another October 2011 report entitled Losing the Battle: The Challenge of Military Suicide quantifies the tragic effect of this. 

As the National Center for PTSD summarizes, a re-analysis of the data twenty years later suggested that up to 80% of Vietnam veterans reported at least some symptoms related to PTSD.

But nearly 38%, or 263,000 Gulf War veterans, sought treatment from the VA alone for illnesses and chronic conditions, many related to Gulf War Syndrome.

According to the U.S. Department of Veterans Affairs, an estimated 10% to 18% of returning Iraq and Afghanistan War veterans have PTSD, and up to 25% will have Depression.

According to the National Coalition on Homeless Veterans, on any given night 107,000 veterans are homeless. 76% of these men and women have behavioral health illnesses. 140,000 are imprisoned. Half of these have mental health problems.