The big policy news this week is that we still have a government. Yes, Congress passed a stopgap measure to avert a government shutdown, but that will not even get us to Christmas. At issue is spending. By now you know that the budget of the nation is greatly influenced by the tax structure and also on major expenditures like health care. Major expenditures that must be resolved to attain a budget including the funding of ACA subsidies and thus stabilization of the ACA insurance market places. There is also a lot of pressure for CHIP or the children’s health program to be refunded. People across the board are NOT happy about that program being in jeopardy. Now if we can just show people that the health of women and the health of children are deeply intertwined, we will be even better off.
Did you know that health care spending is not first nor even second on the list of big Federal expenditures? It is third. I am lifting a great infographic from pewresearch.org and giving you the link to encourage you to read the whole article.
Now that you know the proportions, how about some actual dollar amounts ?
Health care spending reached it’s new max in the end of 2016 at $3.3 trillion dollars. It increased in 2016, but not as much as it increased the prior year in 2015. The share of the economy devoted to health care went up to 17.9% representing a gradual increase. This grew slightly faster than GDP ( gross domestic product). Expenditure on heath insurance grew to about $2500 per year, while OOP ( out of pockets) grew to about $350 bucks per person per year.
Is this amount of spending good or bad ? Is it appropriate to spend this percent of income on health? My health means a great deal to me. If you compare countries with health care that is equal to or better than ours, you will find they spend much less personally but generally pay considerably more in taxes. Their taxes are larger, but the distribution of good health care in their countries is wider. Their higher taxes buys them less income and health disparity as a a country, broader prosperity and better social stability. Do you think that is worth it ?
You may have noticed from the infographic that number one and two on the list of federal expenditures are Social security at 24% and Medicare at 15%. Do you feel like health care has taken all the budget scrutiny heat ? These other programs may now be in jeopardy too. After the immediate legislative sessions, the GOP is looking at cutting other parts of the social security “ safety net” which old folks have been paying into all this while… Social Security and Medicare. How do you feel about that ?
The States not the Fed are taking charge of key practical health care issues that need prompt attention. Instead of engaging in the philosophic, sociological or religious debates characteristic of Capitol Hill, they are taking care of business. For example, North Carolina has addressed its high risk pregnancy situation and has created a statewide initiative to identify and give special care to high risk pregnancies. They are doing this through multidisciplinary “ medical homes” where advanced Obstetrical care can be rendered. The District of Columbia has voted unanimously to mandate that insurers offer contraception, breast cancer screening, STI counseling, without raising copays or deductibles. As previously reported, other states such as Massachusetts have protected contraception.
In medical news, we have a great new data gathering resource, Pregsource. The NIH (National Institute of Health) has partnered with ACOG ( American College of Obstetricians and Gynecologists) to gather a wide variety of data from pregnant women. Research on pregnant women is hard to design and fund, since there are concerns about the fetus. But we need usable information on pregnant women just as much as on other people, and so there needs to be an acceptable way to move forward. The idea of including pregnant women in drug studies is rapidly becoming a hot topic, since to date they have mostly been excluded. But this is often without medical reason, and both caregivers and patients are starting to raise the alarm.
Here is Pregsource:
If you are pregnant, there is no reason not to join. Tell your caregiver so they can make their other patients aware. This is a fantastic example of citizen science in action. It is also a relatively low cost way to assemble a much needed research base of data on pregnant women.
In the mostly good news department, Sanofi has devoted what appears to be an effective Zika virus vaccine, It has shown good immunogenicity, and a 90% response. However it has been tabled due to “political pressure over pricing”. I think this is promising since it shows that such vaccines are possible. Apparently there are other similar vaccines in the works. I can’t help but connect the dots between the high drug prices we pay and the amazing things that drug companies are able to do with that money.
Ob/Gyns are becoming a dying breed. I can certainly understand why, what with coverage challenges, political upheaval and malpractice threats. Apparently a new study has shown that 50% of US counties lack an Obstetrician Gynecologist. Just so you know, high risk cases in either Gyn or OB can scarcely be handled by any other types of doctors, except for perhaps general surgeons, and they are generally overburdened to begin with. The number of Ob/Gyns is due to diminish further with a shortage of nearly 8000 by 2020 two years from now.
A new study on oral contraceptive pills is apt to be misconstrued by the media. It is a large Danish study which has shown a slight increased risk of breast cancer with oral contraceptive pill use of at least a year. They hastened to add the the overall all risk was low, and that it was considered safe. However a twenty percent increased risk on top of a very small number is still a very small number. This is the thing I think the press will miss. I hope the press does not fail to point out the very real DECREASE in risk of ovary, uterus and colon cancer that happens at the same time with oral contraceptive pills. And oh, by the way these prevent pregnancy the vast majority of the time, and pregnancy carries its own risks which are not inconsiderable.
In sobering news, research out of the CDC (Centers for Disease Control) has shown that black women in dies in childbirth 3-4 times as often as white women. This circumstance of childbirth highlights the worst case of health related racial disparity that we in the US know. We in the US are on a Perinatal Mortality par with Mexico and Uzbekistan.
If you ask me, now is not the time to be gutting the budget for women’s health.
Stay tuned for more breaking news from the World of Obstetrics and Gynecology.