Black Lives Lost
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Almost forty years have passed since the “Heckler Report,” an effort by then-President Reagan’s Secretary of HHS Margaret Heckler to focus attention on the health and well-being of America’s Black population, (first volume of the report is here, all eight volumes are here).
Now a study in JAMA (here) reports that “From 1999 to 2020, the disproportionately higher mortality rates in Black males and females resulted in 997,623 and 628,464 excess deaths, respectively, representing a loss of more than 80 million years of life. Heart disease had the highest excess mortality rates, and the excess years of potential life lost rates were largest among infants and middle-aged adults.”
A report on the study in the Washington Post (here) noted that “The reasons for the excess deaths and resulting economic toll are many, including mass incarceration, but the root is the same, according to the reports published Tuesday in the influential medical journal JAMA: the unequal nature of how American society is structured.”
“It’s not just the ’85 report, it’s going back to ‘The Philadelphia Negro’ with W.E.B. Du Bois,” which was published 124 years ago and was the first ethnography to outline problems faced by the Black community, said Darrell Hudson, who researches health disparities at Washington University in St. Louis. “The outcome is not new. Our understanding of the mechanisms, policies and practices have evolved.”
The Post noted, “In the decades since, modern medicine has witnessed major scientific discoveries and technological breakthroughs, but those advances haven’t benefited everyone equally. When taken together, researchers say, the reports released Tuesday dispel several myths about how society has — and has not — responded to the alarm sounded more than a generation ago.”
“The numbers represent something else, said Harlan Krumholz, a cardiologist at the Yale School of Medicine and co-author of the excess death study: a greater need to recognize ‘where we’re failing and the magnitude of the problem.’”
“Why don’t we accept that this is really racism as cause of death?” Krumholz asked. “What other health problem has created that kind of loss?”
More Unnecessary Death
The CDC has reported that overdose deaths in the U.S. edged higher in 2022, the second time drugs killed more than 100,000 people in a year.
The Wall Street Journal (here) reported that “The Centers for Disease Control and Prevention on Wednesday released a provisional count of overdose deaths last year that indicated the toll of the fentanyl crisis leveling off after two years of surges during the Covid-19 pandemic. The CDC counted 109,680 overdose deaths in 2022 compared with 109,179 deaths from a similar 2021 projection.”
“The plateau follows a 16% increase in overdose deaths in 2021 and a 30% surge in 2020. The U.S. has only recorded two years in which drug fatalities declined in the past several decades, 1990 and 2018.”
The Longer View
In the longer run, all Americans are losing out, comparatively, in life span, according to a report (here) in The American Journal of Public Health. In “The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933–2021,” researchers reported that “During 1933 to 2021, 56 countries on 6 continents surpassed US life expectancy. Growth in US life expectancy was slowest in Midwest and South Central states. The US life expectancy disadvantage began in the 1950s and has steadily worsened over the past 4 decades. Dozens of globally diverse countries have outperformed the United States. Causal factors appear to have been concentrated in the Midwest and South.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Payments Gaps for Radiology, Comparing Medicare to Medicaid Rates
Radiology Business reports that “New data from the Neiman Health Policy Institute (here) highlight the ‘massive gap’ between what Medicare and Medicaid pay for diagnostic imaging.”
“In Rhode Island, for one, 32% of the population is on Medicaid, in a state where professional rates are just 64% of what Medicare pays. The study also unearthed wide variation for specific procedures from one state to the next. In New York, Medicaid pays 59% of the Medicare rate for CT of the abdomen and pelvis. In Nebraska, meanwhile, the rate is 159%.”
The Neiman report noted that the gap has grown since 2012. “Ten years ago, payment for a single-view chest X-ray was nearly equal between the two payment programs in Rhode Island. But by 2022, Medicaid in the state paid only about 64% of the Medicare amount. In another example, Medicaid payment for an esophagram with upper gastrointestinal imaging was 98% and 99%, respectively, in Connecticut and Rhode Island. But by 2022, the Medicaid professional reimbursement is less than half of what was paid by Medicare.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Milliman Says Cost For American Family Of Four Covered By Average Employer-Sponsored PPO Plan Is Now $31,000
RevCycle Intelligence reports, “Health care costs for Americans are climbing higher once again following slower growth and even a rare decrease during the COVID-19 pandemic, according to the latest Milliman Medical Index (MMI)”, report here). The article adds, “The cost for a hypothetical American family of four covered by an average employer-sponsored preferred provider organization...plan is now $31,065.”
The report noted that “After decreasing in 2020 for the first time in MMI history, healthcare costs came roaring back in 2021 and have continued to increase in 2023.”
Preventing Preventive Care
The Hill Health Care reports that “A federal appeals court on Tuesday [today] will hear arguments about whether to continue a pause of a Texas district court's ruling that struck down an ObamaCare provision requiring insurers to cover preventive services for free. Last month, the U.S. Court of Appeals for the 5th Circuit temporarily paused Judge Reed O’Connor’s decision until a panel could hear oral arguments on whether the stay should be continued during the appeals process.”
The report continued, “The Biden administration will argue that keeping the stay in place until the court rules on the merits of the case won't cause the plaintiffs any harm and that the district court should not have granted relief to groups not party to the lawsuit. The Affordable Care Act requires insurers to cover more than 100 preventive health services recommended by the U.S Preventive Services Task Force. The provision is broadly popular and has been in effect since 2010.”
“A lawsuit put forward by a group of conservative Texas employers and individuals challenged that requirement, arguing the task force's members are not appointed by the president or confirmed by the Senate, yet its recommendations are binding.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
© 2023 Fred Hyde & Associates, All rights reserved.
Editor: Jane Guillette; Systems and Distribution: Colby Miers, Los Angeles