Health Business Blog

Like most people, I was never a fan of the old-fashioned hand dryers in public bathrooms. Unless you had 10 minutes to stand around, the machines never got your hands dry. I used paper towels whenever they were offered.

In recent years more powerful hand dryers have been popping up and now fewer bathrooms offer paper towels.

Of the new dryers, my personal favorite is the Dyson airblade. It’s powerful, quiet and has a clever design.

But I’m not so fond of the Excel Xlerator. Sure it’s powerful, but it’s also incredibly noisy. I have sensitive ears, and I’m not embarrassed to admit that when I’m exposed to a loud sound I cover my ears with my hands. But of course if I’m drying my hands I can’t use them to protect from the noise.

The Xlerator is loud enough that I suspect it’s a threat to hearing. At the very least it’s so annoying that I bet some people skip hand washing to avoid using it. My gym has one of these beasts and after being bothered by it for a while I decided to research the noise level.

I found a paper on the subject by Jeffrey Fullerton and Gladys Unger from the acoustical consulting firm Acentech. Sure enough, the Xlerator is a real noisemaker. Apparently the company has also developed a noise reduction nozzle, but I don’t think I’ve ever seen one in operation.

I followed up with the authors, who told me that OSHA does not find the level of noise generated by the Xlerator to be a danger to hearing. It’s not loud enough to cause immediate hearing loss and since it’s used for only about 15 seconds at a time it’s not likely to cause permanent damage.

They did advise me to put my hands a foot or so below the nozzle rather than a couple of inches, because hands in the airstream is a major factor in the noise level. 

So today I gave it a shot. If anyone was watching me they probably wondered why I was stooping down to use the dryer. But it actually worked. By keeping my hands lower the noise level was cut to an acceptable level. It took a little longer to dry my hands, but it wasn’t bad.

By David E. Williams of the Health Business Group 

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It’s probably impolite and childish of me, but my first reaction when I read about Chinese hackers breaking into US health care organizations was that this may be the poison pill that finally sends the Chinese off the rails. It will serve them right if they blindly copy the byzantine business processes of certain hospitals and health insurers and end up bankrupting the Chinese economy in the process.

Reading a little further into the piece I see they are mainly looking for secret information about novel drugs and devices, but business processes are also on the list.

By David E. Williams of the Health Business Group.

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Business leaders tend to be pragmatic and non-ideological, so their influence is much needed at a time when Congress is so dysfunctional. Today’s release of Social Security Reform and Medicare Modernization Proposals by the Business Roundtable and accompanying Wall Street Journal op-ed piece by Roundtable chairman Gary Loveman are welcome inputs.

The white paper wisely starts with Social Security. It was once known as the Third Rail of American Politics, but Social Security fixes are actually much easier to make than Medicare. A few simple steps: gradually raising the retirement age, means testing benefits, using a conservative measure for inflation, and adding new state and local government workers to the system are all that it will take to keep the system solvent for a long, long time.

Then the topic turns to Medicare, which is a lot more out of control. The proposals from the Roundtable are almost as simple sounding as those for Social Security, but alas they are more complex to implement and unlikely to bring about a real solution. The Medicare proposals include:

• Raising the eligibility age  over time to 70 (but exempting anyone 55 or older)
• Expanding private plans’ involvement in Medicare to compete with fee-for-service Medicare
• Provide more means testing for Medicare beneficiaries

Raising the eligibility age just shifts costs onto employers and individuals, who will probably spend more than Medicare does since they don’t get rates that are as low.

The Roundtable report cites savings from private competition in Medicare Part D (the drug benefit),  but it’s unclear that such savings can be translated across the whole Medicare program. Experience with Medicare Advantage would suggest that costs are higher rather than lower under such a scenario.

Providing more means testing is a reasonable idea, but it’s unclear how much savings can realistically be obtained.

As an aside, the Business Roundtable says it represents “leading U.S. companies with more than $7.3 trillion in annual revenues and nearly 16 million employees.” If so, that translates to roughly $500,000 per employee, which seems high. I’ve asked the folks who run the numbers for the Roundtable to explain this information to me. I will let you know what they come back with.

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Gun proponents have worked hard to characterize unfettered firearm ownership as a bedrock constitutional right, to be protected at all costs. They’ve done a good job at transforming the debate to the point where this perspective has become mainstream and even strong gun control advocates take pains to talk about protecting Second Amendment rights, rather than arguing that the amendment’s second clause,  ”the right of the people to keep and bear arms shall not be infringed,” must be understood in connection with the first, ”a well regulated militia being necessary to the security of a free state.”

I still remember a 1989 New Yorker cartoon with the caption, “How very exciting! I have never before met a Second Amendment lawyer.” That cartoon would not strike people today as absurdly funny the way it did a quarter century ago.

In the wake of the Newtown and Aurora massacres, there is some potential to make modifications around the edges of gun regulation, e.g., to limit the size of ammo clips and to have background checks. But in my view, the best long term hope for gun control in this country is to re-characterize the debate in public health terms. It doesn’t make sense to get into arguments about taking away the rights of gun owners or to debate the meaning of the Second Amendment. Instead, the gun issue should be treated neutrally along with other public health issues such as road safety, air quality, nutrition and tobacco.

A generation ago smoking in public places was the norm, and it would have been hard to imagine how much smoking would decline and how societal attitudes toward it could change. Automakers used to avoid discussing car safety at all costs, yet now they embrace it. The path for guns will be different, yet there are reasons to think that attitudes can change over time.

I’ve seen two encouraging signs of the public safety approach to guns just this week:

• Politico reports that the White House held a conference call with the Open Society Institute, McCormick Foundation, Robert Wood Johnson Foundation and California Endowment on gun violence prevention to see whether these groups would be interested in helping
• A new report on life expectancy showed the US scoring poorly compared with other rich countries. Gun-related homicides and suicides were listed as a prominent factor

The public health approach is sure to be met with opposition if the comments on the Politico article are any indication. The top-rated comment (with 11 Facebook Likes) says, “Thanks for the list. All will be stricken from organizations I will contribute to or associate with. I believe the efforts to bypass the Constitution as treason!” Somehow I doubt the commenter is contributing to any of these groups today, especially since none of them accept donations.

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When a teenage relative of mine had suspected acute appendicitis, the pediatrician told him over the phone to jump up and down to see if it made things worse. When it did she was already reasonably confident of the diagnosis.

Therefore I wasn’t that shocked to see a MedPage Today story (Painful Speed Bumps? Could Be Appendicitis), which reports on a British Medical Journal article touting the efficacy of checking in with patients on whether they found going over speed bumps on the way to the hospital painful.

“Presence of pain while traveling over speed bumps was associated with an increased likelihood of acute appendicitis,” Ashdown’s group wrote. “As a diagnostic variable, it compared favorably with other features commonly used in clinical assessment. Asking about speed bumps may contribute to clinical assessment and could be useful in telephone assessment of patients.”

On the other hand, isn’t this kind of obvious and stupid?

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Republicans have painted themselves into a corner by pursuing a policy of knee jerk opposition to whatever the Obama Administration and Democrats as a whole are in favor of. Back in May (One way for the Democrats to win: Propose everything) I wrote:

A group of right-wingers are pushing Speaker John Boehner to reject so-called ObamaCare in its entirety, including popular provisions such as allowing parents to keep their kids on their insurance until age 26, prohibiting discrimination based on pre-existing conditions, and closing the Medicare drug benefit’s donut hole.

From a Tea Party standpoint, the Affordable Care Act must look like a Communist plot, but in fact it is a fairly moderate piece of legislation that excludes things like single-payer and even a government run insurance scheme.

So here’s an idea for Democrats: propose all sorts of measures, especially those that Republicans have traditionally agreed with. Since there’s such a strong knee jerk response to any Democrat’s ideas, it seems like a pretty good way to paint the GOP into a corner. Bill Clinton actually did a version of this, taking credit for arguably Republican ideas such as welfare reform. (He balanced the budget, too.)

With the way the Tea Party has set itself up, Obama doesn’t need to be nearly so clever as Clinton. He just has to propose a set of right-of-center ideas and see the GOP marginalize itself over the next few years.

Now Mitt Romney has made himself look foolish by saying he would retain some ObamaCare provisions. It seems he favors all the items I mentioned in my prior post, although he uses some weasel words that indicate he may not be completely serious. Romney has a few problems here. If  he wants to dump ObamaCare on “Day One” how is he going to save the popular parts? If he likes parts of ObamaCare is he really a “true conservative?” Perhaps most important, by highlighting some good pieces of the Affordable Care Act Romney may inadvertently make the law as a whole more popular.

Perhaps now is the time for Democrats to induce Republicans to further marginalize themselves on health care by adopting some of the more innocuous provisions of GOP health care policy such as allowing health plans to sell policies across state lines, establishing small business purchasing pools and pursuing tort reform. Those meager proposals comprise the majority of Republican ideas to “replace” ObamaCare.

It leaves the GOP with just two main ideas: turning Medicaid into block grants to the states and making health insurance premiums tax deductible for individuals. I don’t think Democrats could swallow the idea of block grants, but probably could live with making health insurance tax deductible for individuals. Therefore they should go ahead and propose it.

With a broad health care platform like that, what exactly would be left for Republicans to propose in health care other than restricting reproductive rights and benefits for same sex couples?

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In an autoimmune disorder “the immune system mistakenly attacks and destroys healthy body tissue.” (Medline) I see evidence of a similar response in the GOP’s attack on the Patient Protection and Affordable Care Act (PPACA). And former Republican Senate Majority Leader Dr. Bill Frist seems to agree with me, although he doesn’t use the auto-immune analogy.

Many Republicans seem to view PPACA as a left-wing government takeover of the US health care system imposed on them by President Obama. The ObamaCare label is a handy shorthand term, but it’s very misleading. In truth, PPACA is a centrist piece of legislation chock full of Republican ideas including preservation of private health plans and provider organization, mandates to purchase insurance and the deployment of exchanges (i.e., competitive marketplaces) to allow individual states to experiment with different approaches. By attacking PPACA Republicans are attacking their own ideas.

The attack on exchanges is especially ironic (and harmful), because states that don’t set up their own exchanges risk having the federal government come in and do it for them. There is a perverted logic that says we want the feds to do it because they’ll fail. But how does that help the state in the end?

Frist said the resistance is misguided, noting that the exchanges were originally a Republican idea.

Here’s what Frist has to say in the LA Times (Bill Frist calls for GOP to get over opposition to healthcare law)

“As a doctor, I strongly believe that people without health insurance die sooner. Sure, they can eventually go to an emergency room. But it is often too late. They wait longer to get a breast lump checked out. They wait until their nagging cough turns into a fulminant pneumonia. They skip preventive care and then show up to the ER with severe, costly, late-stage symptoms that are harder and more expensive to treat,” he wrote.

“State exchanges are the solution. They represent the federalist ideal of states as “laboratories for democracy.” We are seeing 50 states each designing a model that is right for them, empowered to take into account their individual cultures, politics, economies, and demographics. While much planning has yet to be done, we are already seeing a huge range in state models. I love the diversity and the innovation. … Simply put, state exchanges represent a distinctly American opportunity to improve our local communities and at the same time help our nation avert a major crisis. Let’s take the plunge.”

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The Tea Party and its sympathizers have pushed ideological purity to an extreme in the Republican Party, especially the House. Last year’s willingness to trash the country’s credit rating rather than raise the debt ceiling was Exhibit A. Exhibit B may be a decision to oppose absolutely every aspect of the Affordable Care Act.

As Politico reports, a group of right-wingers are pushing Speaker John Boehner to reject so-called ObamaCare in its entirety, including popular provisions such as allowing parents to keep their kids on their insurance until age 26, prohibiting discrimination based on pre-existing conditions, and closing the Medicare drug benefit’s donut hole.

From a Tea Party standpoint, the Affordable Care Act must look like a Communist plot, but in fact it is a fairly moderate piece of legislation that excludes things like single-payer and even a government run insurance scheme.

So here’s an idea for Democrats: propose all sorts of measures, especially those that Republicans have traditionally agreed with. Since there’s such a strong knee jerk response to any Democrat’s ideas, it seems like a pretty good way to paint the GOP into a corner. Bill Clinton actually did a version of this, taking credit for arguably Republican ideas such as welfare reform. (He balanced the budget, too.)

With the way the Tea Party has set itself up, Obama doesn’t need to be nearly so clever as Clinton. He just has to propose a set of right-of-center ideas and see the GOP marginalize itself over the next few years.

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The Patient Protection and Affordable Care Act is a lengthy, complex law, which is hardly surprising given the size and scope of the health care economy it addresses. Unfortunately that also means it requires a lot of work to understand it in detail. After watching the Supreme Court’s oral arguments over the law, some commentators are concerned that the justices may not have a full appreciation for some important nuances.

During the recent oral arguments some of the justices and the lawyers appearing before them seemed to be under the impression that the law does not allow most consumers to buy low-cost, stripped-down insurance to satisfy its controversial coverage requirement.

In fact, the law provides for a cheaper “bronze” plan that is broadly similar to today’s so-called catastrophic coverage policies for individuals, several insurance experts said.

“I think there is confusion,” said Paul Keckley, health research chief for Deloitte, a major benefits consultant. “I found myself wondering how much they understood the Affordable Care Act. Several times the questions led me to wonder how much (the justices’) clerks had gone back into the law in advance of the arguments.”

There are two aspects of the law that work in offsetting ways. The requirement to purchase a health plan that covers “essential health benefits” appears to require comprehensive coverage. On the other hand, the “bronze” level will have deductibles in the $3000 to $6000 range and could be more appropriately classified as catastrophic rather than comprehensive. People under 30 can buy even more stripped down plans.

Plaintiffs disagree with this assessment, of course, but their argument is a bit of a head scratcher:

“The bronze plan is not catastrophic coverage,” said Michael Carvin, who represents the National Federation of Independent Business.

“It’s got all the minimum essential benefits in it,” he added. “It’s got to have wellness, preventive, contraceptives — all kinds of things a 30-year old would never need.”

I’m not sure which 30 year olds Carvin is hanging out with. But wellness benefits –addressing lifestyle issues such as smoking, alcohol, and eating habits– are completely relevant to someone in that age group. Some preventive services, such as colonoscopy are more relevant for older people, but others such as vaccines and Pap smears are important.

Finally, if Carvin actually thinks a 30-year-old “would never need” contraceptives then that’s very funny indeed.

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