Saturday, October 31, 2009

Health care re-form XIV (The numbers)

In the health care reform, strike that, health insurance reform debate many numbers are bandied about by those on both sides of every argument - numbers re costs, extent of coverage, and so on. Some would appear to be pretty straight forward, such as the slides above (public opinion re an employer mandate, and the increase in health insurance premium costs, both courtesy of the Kaiser Family Foundation's Fast Facts). However, any one closely following the issue will soon realize that often (to borrow a line from Gilbert & Sullivan's HMS Pinafore) "things are seldom what they seem." A few examples:
  • OK, so this first example is not specific to the reform legislation, it is a study that shows that "a key statistic that consumer groups and the media often use when compiling hospital report cards and national rankings can be misleading." However, this kind of transparency and reporting (i.e. provider report cards) is touted as important in allowing consumers to inform their health care choices. Unfortunately, providing meaningful outcome results is a very complex business, that is prone to error, misrepresentation, and even outright manipulation. How is the consumer to know that their informed decision actually is? The jury is still out...
  • In June, Atul Gawande wrote an article in The New Yorker, 'The Cost Conundrum. What a Texas town can teach us about health care,' which turned the national spotlight on McAllen, Texas. This hit like a bombshell, was picked up by paper and blogs around the country, and by politicians all the way up to the President. The received wisdom that most took away was that the core problem was over testing by physicians (caused by perverse financial incentives.) Very few publicly took issue with the article and its interpretation... (example of one that did, here, and Gawande's response...). However, the article 'McAllen: A Tale of Three Counties' did a very detailed analysis of the numbers, comparing McAllen to El Paso and Grand Junction, and came to a different conclusion: "McAllen is different from many areas of the United States: it is sicker and poorer. The observed differences in the rates of chronic disease are highest for those conditions rampant in low income American populations: diabetes and heart disease. Further, Medicare beneficiaries in McAllen have significantly higher rates of co-occurring chronic conditions. As a result the costs of caring for McAllen Medicare population appears high in comparison to other areas but not abnormally so. McAllen suffers from a tremendous burden, but it not caused by its physicians: the care they provide leads to costs that are substantially comparable to the other counties in the article once adjustments are made for the magnitude of the health problems they face. The disturbing pattern of physician practices uncovered by Dr. Gawande sounds a warning not because it foretells a McAllen-like future but because it portrays the on-going crisis that affects both McAllen and Grand Junction and it is national in scope. Physician culture is only part of the McAllen story." However, good luck seeing this more nuanced view, it is significantly easier to propagate the "excessive testing" and "greedy doctor" arguments! (Note: this analysis seems plausible and a good application of the facts... However, it is possible that it too is a mis-application of the statistics. The fact that this blogger can't be sure either way is proof, were that needed, of a) the complexity of the issue and, b) that it is too easy to draw the wrong conclusions given the complexity of the issues and the confounding variables. In other words, exactly the same point that this blog entry is arguing!)



  • The article 'Data Fuel Regional Fight on Medicare Spending' gives us an additional example of problems with health care statistics. It's long been argued that the levels of health care spending in some areas (for example New York, New Jersey, California) are much higher because providers in those geographical locations practice more intensive medicine, and that the government (Medicare) could save very significant amounts of money if providers (doctors, hospitals, etc.) in all areas could be "as efficient as those in lower-cost states like Iowa, Minnesota, Washington and Wisconsin." The fact that there is a huge geographic variance in Medicare rates is taken as prima facie evidence of poor practice, inefficiencies, and even malfeasance. Politicians, as usual, are all over this, and seeking to make sure that their particular geographic location is taken care of. “In 2006, Medicare spent $6,671 on the average beneficiary in Waterloo, Iowa, compared with $16,351 in Miami,” said Mr. Braley, who lives in Waterloo... Meanwhile "Representative David R. Obey, Democrat of Wisconsin and chairman of the House Appropriations Committee, recently told the administration, “These reimbursement disparities are outrageous.” Unfortunately, some health care leaders are attempting to leverage these disparities in their favor as well... (see article for examples). When the Medicare Payment Advisory Commission looked at this issue it confirmed the geographic disparities. However, it found that they were could be mostly chalked up to "local differences in the cost of providing care and in the health status of beneficiaries, as well as by extra payments, authorized by Congress, for hospitals that train doctors or treat large numbers of low-income patients." After adjusting for these factors high cost areas such as Boston and New York turned out to be below the national average in costs! Bottom line: the numbers being bandied about represent very complex realities, which are not taken into account by the various parties to the debate while conclusions are being drawn from them.
OK, this blogger is not arguing that things are so complex that a paralysis should set in, and that nothing should be done. What he is arguing is that it behooves the various parties to the health care reform, (strike that, health insurance reform) debate to take the time to correctly and completely understand the issues and the numbers, otherwise the resulting legislation will have many unhappy and unintended consequences...

Some previous entries referencing hospitals & health care:
Health care re-form XIII (Bad math) - October 8th, 2009
Health care re-form XII (Random chart) - Oct 1st, 2009
Random chart - Sep 25th, 2009
Health care re-form XI (Sales job) - Sep 24th, 2009
Random chart - Sep 24th, 2009
Random chart - Sep 16th, 2009
Health care re-form X (Cowardice) - Sep 13th, 2009
Tempest in a teapot - Sep 5th, 2009
That explains it... (death panels) - Sep 1st, 2009
Health care re-form IX (Apologies due) - Aug 30th, 2009
Health care re-form VIII (More nonsense) - Aug 28th, 2009
Health care re-form VII (Nonsense) - Aug 26th, 2009
Health care re-form VI (Effectiveness) - Aug 15th, 2009
Health care re-form V (The sales job) - Aug 14th, 2009
Health care re-form IV (What is it?) - Aug 13th, 2009
Health care re-form III (Why we spend more) - Aug 8th, 2009
Health care re-form II (P4P) - Aug 4th, 2009
Health care re-form I (Issues) - Aug 4th, 2009
So? - Jul 27th, 2009
Random chart... - Jul 12th, 2009
Random charts... - May 22nd, 2009
Random chart... - May 9th, 2009
Wyeth v. Levine - Mar 22nd, 2009
Financial crisis & hospitals - III - Mar 22nd, 2009
Random chart... - Feb 1st, 2009
Financial crisis & hospitals - II - Jan 27th, 2009
Random chart... - Jan 26th, 2009
Hospitals' financial update - Dec 25th, 2008
Good for the goose - Dec 11th, 2008
Studies of intererst - IV - Nov 16th, 2008
Studies of interest - II - Nov 16th, 2008
Financial crisis & hospitals - I - Nov 14th, 2008

Also, perhaps it might be a good idea for them to keep the lessons of the "Quick reminder" blog entry of 29th September, 2008 in mind!

Wednesday, October 28, 2009

Monday, October 26, 2009

Random chart


Charts contrasting seniors' sources of income for the top and bottom quartiles, as well as the poverty rates of seniors, stratified by marital status, education, etc. Source: Income and Poverty Among Older Americans in 2008 (CRS)

Sunday, October 25, 2009

Mental health break

Short update

In September there was a lot of blathering about how wonderful it was that a unanimous vote of the Security Council showed that a consensus against nuclear weapons was developing... The 'UNSC Resolution 1887' blog entry asked how it was possible to square 1887's Section 9 (which "Recalls the statements by each of the five nuclear-weapon States, noted by resolution 984 (1995), in which they give security assurances against the use of nuclear weapons to non-nuclear-weapon State Parties to the NPT, and affirms that such security assurances strengthen the nuclear non-proliferation regime") with the U.S.'s oft repeated insistence on "keeping everything on the table" in dealing with Iran and other regimes.

Now a top Russian defense official has said that Russia reserves the right to conduct pre-emptive nuclear strikes to safeguard the country... Quotes include: "... a variety of possibilities for using nuclear force, depending on the situation and the intentions of the possible opponent. In situations critical to national security, options including a preventative nuclear strike on the aggressor are not excluded." He went on to say that nukes could be used "to repel an aggression with the use of conventional weapons not only in a large-scale but also in a regional and even local war..."

None of this actually represents a change in doctrine, merely a continuation of the status quo whereby the nuclear-haves spout platitudes, while arrogating to themselves the right to threaten other countries with these weapons...

Saturday, October 24, 2009

The change of the seasons

One tree, two weeks...

Friday, October 23, 2009

Wednesday, October 21, 2009

Tuesday, October 20, 2009

Random chart

Chart showing Iraqi access to electricity, source: Fact Sheet - Housing & Shelter in Iraq (as of 05 Oct 2009)

Random quote...

The government(s) bailout of the banking sector "created possibly the biggest moral hazard in history."
- Mervyn King, Governor of the Bank of England

Monday, October 19, 2009

Saturday, October 10, 2009

Thursday, October 8, 2009

Health care re-form XIII (bad math)

Last night this blogger idly turned on the television, and ran smack dab into a Keith Olberman rant on health care. It mainly appeared to be a soliloquy on the victimization of the hapless and helpless public by the evil depredations of the insurance companies that hold the Congress in their thrall, this apparently for the bagatelle of less than one and a half million dollars (one million, four hundred and ninety two thousand, to be precise). A kernel of (correct) health care issues/weaknesses in the country was spun into a phantasmagoric kaleidoscope of family health issues, Churchillian bombast, 'hospital as cash register drawing from your veins' imagery, more family medical travails, Dickensian "Tiny Tim" allegorical allusions, a bandying about of percentages to demonstrate that the country is on its way back to the Middle Ages, a reflection on the agony of Dr. Sabin, anecdotes from a doctor friend, even more family heartbreak, and on and on... Wow! Fortunately there were the commercial breaks, if only to allow him to catch his breath prior to launching full tilt into the next section of the diatribe.

Sprinkled here and there like small pieces of flotsam and jetsam thrown around by the raging current were some valid points... but unfortunately they were overwhelmed by the rhetorical torrent issuing forth. Where to start with a deconstruction of this... this.... words fail!

Let us consider one example of foolishness, what appears to either be some poorly thought through mathematics, or else a reliance on the poor math skills of the general population to bandy about numbers as if they "prove" his case. Per Olberman:

People, in short, are dying for the lack… of money. Dying as surely as they did when Charles Dickens wrote about the exact same problem. Of a boy who couldn't get sufficient medical care for his affliction. Of the underprivileged, suffering not just privation but death, as the comfortable, moved silently and unseeingly through the streets of London. The book was called "A Christmas Carol" and the boy Dickens imagined was called "Tiny Tim" and it was published on the 19th of December, 1843, and it is 166 years later and the problem is not only still with us, it is getting worse. The mortality rate among Americans under the age of 65 who are uninsured, is 40 percent higher than among those with insurance. In 1993 a similar study found the difference was only 25 percent.

We are moving backwards! We are letting people die because they do not have insurance. What's worse is that barring meaningful health care reform, this will only grow. The difference between the surveys from 1993 and now suggest this fatal insurance gap is growing by about one percent, per year. Your chances of dying because you don't have insurance are now 40 percent higher than those who have it. By extrapolation, three years from now your chances will be 43 percent higher. Your chances of dying because you used to smoke, compared to those who never smoked, only 42 percent higher. You heard that right. At the current rate, in 2012, you will be more fortunate, more secure, more long-lived, if you used to smoke, than if you don't have insurance. It is mind-boggling, and mind-less. This is the country you want? This is the country you will accept?

OK, so Olberman would have us believe that "you will be more fortunate, more secure, more long-lived, if you used to smoke than if you don't have insurance" because the difference in death rate between those who have and those who don't have health insurance is 43%, while the difference in death rate between those who smoke or used to smoke and those who never did is 42%. Unfortunately, he is comparing the differences between two dissimilar sets of underlying items, and simple logic tells us that these comparisons can not be extrapolated to compare the underlying situations. But, he then goes on to higher flights of fancy:

Do those other people in this country have meaning to you, or are they just extras in your movie, backgrounds in your painting, choruses in your solo? Without access to insurance for all of us and the only way we get it is with the government supplying the gaps, just like it does in flood insurance for God's sake that fatal gap will just keep growing. A 45 percent higher likelihood of death for the uninsured compared to the insured by 2014. By 2022, the figure will be 53 percent higher. Fifty-three percent! In the 1840s, as Dickens wrote a "Christmas Carol" - in a time at which we now look back with horror, the city of Manchester in England commissioned a crude study of mortality among its residents. A Doctor P.N. Holland categorized the sanitary conditions of the houses and streets of Manchester into three classes. And when he compared the death rate in the First Class Houses in the First Class Streets, to the death rate in the Second Class Houses in the Third Class Streets, he found mortality in those worst locations was 53 percent higher. If we do not reverse this trend, in fourteen years' time we will not be living in the America of 2022. The shadows of the things that may be, tell us, that we will instead be living in an insurance-driven version, of the Dickensian England of 1843! God Bless Us, everyone.

Wow, so we apparently we are headed back to 1843. Here again, he compares the differences between two dissimilar underlying items. Let's try a math exercise here... Suppose the mortality in the "First Class houses" was 15% and that of the worst locations 22.95% (i.e. 53% higher). And suppose the mortality of those with insurance today is 5% while that of those without insurance is 7.65% (i.e. 53% higher). While the difference in each case is the same at 53%, one would have to be insane to draw the conclusion that a person without insurance today is as badly off as were the poor in Dickensian times. In fact, in this example the uninsured person today is actually significantly better off than the "First Class" person of yesteryear. (Note: this blogger does not know the underlying figures. The numbers provided here are for the purposes of illustration only, to show that it is not possible to draw the parallels that Olberman does with the figures he has provided!)

Even if you give Olberman the credit of the doubt and allow that he was concentrating on the differences and thus was arguing that the disparity in 2012 will be as large as the disparity back in Dickensian times (though his language certainly seems to go far beyond focus on disparities to implying that the overall situations would be equivalent!), this would still be a poor comparison. After all, back in Dickensian times the "First Class" represented a small percent of the population, and the vast majority of the populace was in the worse position, while today it is the opposite i.e. the vast majority (80%+) have insurance, while a much smaller number is in the worse position...

Ahh... Keith, Keith, Keith.

Sunday, October 4, 2009

Mercedes Sosda, RIP

Just passed away, Mercedes Sosa...


Gracias a la vida:



Gracias a la Vida que me ha dado tanto
me dio dos luceros que cuando los abro
perfecto distingo lo negro del blanco
y en el alto cielo su fondo estrellado
y en las multitudes el hombre que yo amo.

Gracias a la vida, que me ha dado tantome
me ha dado el oido que en todo su ancho
graba noche y dia grillos y canarios
martillos, turbinas, ladridos, chubascos
y la voz tan tierna de mi bien amado.

Gracias a la Vida que me ha dado tanto
me ha dado el sonido y el abedecedario
con él las palabras que pienso y declaro
madre amigo hermano y luz alumbrando,
la ruta del alma del que estoy amando.

Gracias a la Vida que me ha dado tanto
me ha dado la marcha de mis pies cansados
con ellos anduve ciudades y charcos,
playas y desiertos montañas y llanos
y la casa tuya, tu calle y tu patio.

Gracias a la Vida que me ha dado tanto
me dio el corazón que agita su marco
cuando miro el fruto del cerebro humano,
cuando miro el bueno tan lejos del malo,
cuando miro el fondo de tus ojos claros.

Gracias a la Vida que me ha dado tanto
me ha dado la risa y me ha dado el llanto,
así yo distingo dicha de quebranto
los dos materiales que forman mi canto
y el canto de ustedes que es el mismo canto
y el canto de todos que es mi propio canto.

Gracias a la Vida
Gracias a la Vida
Gracias a la Vida
Gracias a la Vida.

(Composed: Violeta Parra)

Alfonsina y el mar:



Por la blanda arena
Que lame el mar
Su pequeña huella
No vuelve más
Un sendero solo
De pena y silencio llegó
Hasta el agua profunda
Un sendero solo
De penas mudas llegó
Hasta la espuma.

Sabe Dios qué angustia
Te acompañó
Qué dolores viejos
Calló tu voz
Para recostarte
Arrullada en el canto
De las caracolas marinas
La canción que canta
En el fondo oscuro del mar
La caracola.

Te vas Alfonsina
Con tu soledad
¿Qué poemas nuevos
Fuíste a buscar?
Una voz antigüa
De viento y de sal
Te requiebra el alma
Y la está llevando
Y te vas hacia allá
Como en sueños
Dormida, Alfonsina
Vestida de mar.

Cinco sirenitas
Te llevarán
Por caminos de algas
Y de coral
Y fosforescentes
Caballos marinos harán
Una ronda a tu lado
Y los habitantes
Del agua van a jugar
Pronto a tu lado.

Bájame la lámpara
Un poco más
Déjame que duerma
Nodriza, en paz
Y si llama él
No le digas nunca que estoy
Di que me he ido.

Te vas Alfonsina
Con tu soledad
¿Qué poemas nuevos
Fueste a buscar?
Una voz antigüa
De viento y de sal
Te requiebra el alma
Y la está llevando
Y te vas hacia allá
Como en sueños
Dormida, Alfonsina
Vestida de mar

(Composed: Ariel Ramirez)

Saturday, October 3, 2009

Great quotes

"Allah said that the black-eyed virgins are beautiful white young women, with black pupils and very white retinas, whose skin is so delicate and bright that it causes confusion. Allah said that they are like hidden pearls. They have wide eyes, and they have not been touched by man or jinn. They are virgins, who yearn for their husbands. They are all the same age, morally and physically beautiful. They are like precious gems and pearls in their splendor, their clarity, their purity, and their whiteness. They are like hidden pearls - as pure as a pearl within a shell, untouched by man. Each one of them is so beautiful that you can see the bone-marrow through the delicate flesh on their legs.. Such brilliant beauty does not exist in this world. Where can you find such beauty? Whereas the women of this world may suffer, for days and nights, from menstruation, from blood for 40 days after childbirth, from vaginal bleeding and from diseases - the women of Paradise are pure, unblemished, menstruation-free, free of feces, urine, phlegm, children... Moreover, Allah cleaned them of all impure and foul things, both in appearance and character... In character, they are not jealous, hateful, or angry. They are not greedy... they are restricted to tents, locked up for the husband. There is no such thing as going out. When he comes home - they are there. There is no such thing in Paradise as a man coming home and not finding his wife there. Allah described them as women who lower their gaze, and never look at anybody but their husband..."

- Saudi Islamist lecturer and author Sheikh Muhammad Al-Munajid, July 2009

Friday, October 2, 2009

Update, Georgia (updated)

The European Union independent fact-finding commission led by Heidi Tagliavini and tasked with examining the circumstances surrounding the brief 'war' between Georgia and Russia over South Ossetia just released its report. No surprises for anyone who had paid attention to the issue back in 2008 (e.g. see the blog entries on this topic listed below). The bottom line:
  • Both Georgia and Russia contributed mightily to raise tensions in the run up to the hostilities. "A result of the involvement of outside powers unfortunately served to harden positions rather than to build common ground," especially on the Georgian side.
  • "The proximate cause was the shelling by Georgian forces of the capital of the secessionist province of South Ossetia, Tskhinvali, on Aug. 7, 2008"
  • Once the shooting started, Russia responded disproportionately, and its reply took it "far beyond the reasonable limits of defense"
Both Georgia and Russia have found parts of the report that they like and dislike. However, very many headlines played up the "Georgia started the war" angle, and Georgia and Saakashvili have ended up with the short end of the stick. Of course, this is only because the previous U.S. administration is no longer in place, otherwise they would have been the "biggest losers"...

Lessons of the Georgia Conflict
EU Investigators Debunk Saakashvili's Lies
Pour l'UE, c'est la Géorgie a ouvert les hostilités
EU report: Georgian attack started war with Russia


10/3 Update:

Link to the actual report: Independent International Fact-Finding Mission on the Conflict in Georgia
Commentary by Venik: War in Georgia: Reviewing EU Findings

Earlier blog entries related to this topic:
Georgia update... - Nov 22nd, 2008
Georgia... - Sep 7th, 2008
Immediate Response?!? - Aug 25th, 2008
Georgia (updated)... - Aug 15th, 2008
Two-edged sword (South Ossetia) - Aug 11th, 2008

Recividism (or, 'persiste et signe')

In April 2008 His Holiness Pope Benedict XVI, 'Bishop of Rome, Vicar of Jesus Christ, Successor of the Prince of the Apostles, Supreme Pontiff of the Universal Church, Primate of Italy, Archbishop and Metropolitan of the Roman province, Sovereign of the State of the Vatican City, Servant of the Servants of God' visited the United States. His first attempt at apologizing for the 'clergy abuse of children' scandal was weak and hedged (see 'Well Said?!?') with excuses. It was rightly panned by many...

Not long after this a documentary on a particular pedophile Catholic priest documented that Benedict had known ('HH Tekel') re his activities for years....

On a visit to Australia the Pope's second, follow-up attempt at an apology was significantly better (see 'Better the second time around'), and it was universally felt that this possibly was the beginning of the healing process related to this blight on the Catholic church...

Fast forward to the present. In response to criticisms of its covering up of child abuse by a representative of the International Humanist and Ethical Union, the Holy See released a statement in its defense (sort of). "Sex abuse rife in other religions, says Vatican" reports the response.

Archbishop Silvano Tomasi, the Vatican's permanent observer to the UN, defended the Catholic Church's record. He read out a statement saying that the Catholic Church is "busy cleaning its own house." He suggested that the issue of clerical sex abuse of minors is as big (if not bigger) an issue in other denominations, and that allegations had also being leveled against Protestants, and against Jewish congregations. He emphasized the (artificial? ) distinction that most of the abusers were not pedophiles but were ephebophiles (i.e. homosexuals attracted to adolescent males), "Of all priests involved in the abuses, 80 to 90% belong to this sexual orientation minority which is sexually engaged with adolescent boys between the ages of 11 and 17. He ended, "As the Catholic church has been busy cleaning its own house, it would be good if other institutions and authorities, where the major part of abuses are reported, could do the same and inform the media about it."

Wow, as one might say today, epic fail!

Thursday, October 1, 2009

Quick recap

Some previous entries referencing hospitals & health care:

Health care re-form XII (Random chart) - Oct 1st, 2009
Random chart - Sep 25th, 2009
Health care re-form XI (Sales job) - Sep 24th, 2009
Random chart - Sep 24th, 2009
Random chart - Sep 16th, 2009
Health care re-form X (Cowardice) - Sep 13th, 2009
Tempest in a teapot - Sep 5th, 2009
That explains it... (death panels) - Sep 1st, 2009
Health care re-form IX (Apologies due) - Aug 30th, 2009
Health care re-form VIII (More nonsense) - Aug 28th, 2009
Health care re-form VII (Nonsense) - Aug 26th, 2009
Health care re-form VI (Effectiveness) - Aug 15th, 2009
Health care re-form V (The sales job) - Aug 14th, 2009
Health care re-form IV (What is it?) - Aug 13th, 2009
Health care re-form III (Why we spend more) - Aug 8th, 2009
Health care re-form II (P4P) - Aug 4th, 2009
Health care re-form I (Issues) - Aug 4th, 2009
So? - Jul 27th, 2009
Random chart... - Jul 12th, 2009
Random charts... - May 22nd, 2009
Random chart... - May 9th, 2009
Wyeth v. Levine - Mar 22nd, 2009
Financial crisis & hospitals - III - Mar 22nd, 2009
Random chart... - Feb 1st, 2009
Financial crisis & hospitals - II - Jan 27th, 2009
Random chart... - Jan 26th, 2009
Hospitals' financial update - Dec 25th, 2008
Good for the goose - Dec 11th, 2008
Studies of interest - IV - Nov 16th, 2008
Studies of interest - II - Nov 16th, 2008
Financial crisis & hospitals - I - Nov 14th, 2008

Health care re-form XII (Random chart)

So, do hospitals really 'lose' money on Medicare and Medicaid? The charts above (source: the Medicare Payment Advisory Commission's (MedPAC) 'Hospital inpatient and outpatient services' report) show that the overall Medicare margin has been deteriorating since 1997 and has been negative since 2003... It also shows that while the margin is negative overall, the effect is different for different groups of hospitals, and there are some that have positive margins.

As always, when you start to drill into the underlying data it gets very complicated in a hurry. Here's an article, 'Does Medicare Under-Pay Hospitals,?' that looks at this question and concludes that, "The situation with Medicare payments and hospital profits is much more complicated than some people would like to suggest The losses many hospitals report may be real, but there is tremendous variation depending on management choices, location, and the ways in which costs are incurred. Some hospitals are indeed losing large amounts on Medicare services, while others actually are making a profit. Most individual Medicare patients are profitable. Many others could make a profit if hospitals improved their operations." The reader may or may not agree with this conclusion...

The one thing this blogger takes issue with in the article cited is the fussing re hospital CEO pay. Granted, there may be some CEOs that are overpaid, and such cases should be dealt with. But to generally fuss that "many hospital CEO’s now making seven figure salaries" without providing any context is simply a silly appeal to the lowest common denominator. Some of these hospitals are huge and this blogger would expect that the CEOs would be paid commensurately to the size of their responsibility! For example, the University of Pittsburgh Medical Center Presbyterian has annual revenues of $9.2 billion. A six- or seven-figure salary is certainly appropriate in this case!

The above discussion has all been regarding Medicare, what about Medicaid payments from the states? Generally Medicaid payments are lower than the corresponding Medicare payments for the same services, averaging just 72% of Medicare's level. So, here it would seem fairly sure that any "loss" is greater. Drilling in, we find that there is a large geographic variation, and there are some states where Medicaid pays the same as Medicare...

The bottom line answer? An overall 'yes' that masks wide variations. As annoyingly always in the health care debate, no easy answers!

 
back to top