Feeding the Bacteria in Your Gut

• MARCH 31, 2009

By LAURA JOHANNES

We've all heard of healthy bacteria called probiotics, commonly found in yogurts and dietary supplements. A new wave of products now include prebiotics, dietary ingredients intended either to help increase levels of good bacteria naturally found in the body, or to be used in combination with probiotics to improve their efficacy. Scientists say prebiotics do increase levels of good bacteria in the gut, and some research has linked their consumption to health benefits.

Tim Foley

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Think of it as feeding the good bacteria in your body. Food companies are increasingly claiming health benefits for foods containing prebiotics. So far, all the well-established prebiotics are fibers, such as inulin, extracted from chicory roots. They work by providing a food source in the colon that is particularly attractive to healthy bacteria, causing them to grow and squeeze out unhealthy bacteria.

"A prebiotic is to your colon what grass food is to your lawn. It feeds the grass, but not the weeds," says University of Nebraska microbiologist Bob Hutkins.

Prebiotics are being added to beverages, cottage cheese, breakfast cereals, yogurts, kefirs, breads and even chocolate sauce. While more common in Europe, products making prebiotic health claims are beginning to take root in the U.S. General Mills Inc.'s Yoplait Yo-Plus yogurt, introduced in 2007, includes both a probiotic and a prebiotic fiber, which the company says together promote digestive health. Nestle SA last month launched Juicy Juice Immunity, a kid's fruit drink with prebiotic fiber that the company says helps promote good digestion and a healthy immune system. Other health claims being made in the U.S. for prebiotic-containing products include enhanced absorption of calcium and better bone health.

Many scientific studies have shown that prebiotics>>>

Tallying the Cost to Bring Baby Home

• MAY 7, 2009

By ANNA WILDE MATHEWS

Bringing my newborn son home was a joy. Figuring out the hospital bill wasn't.

Cedars-Sinai Medical Center in Los Angeles provided excellent care and thoughtful treatment during my uncomplicated traditional delivery in December. Then the invoices started coming. The hospital sent one for me, and another for my baby. The doctors billed separately. The total charge for three days: $36,625.

People lucky enough to have good health insurance, including me, don't have to come up with such sums. Insurers typically pay a lower, negotiated price for hospital care, and patients pay a portion of that amount. Even people without insurance often get sharp discounts from list prices on their hospital bills.

Still, consumers have a big financial stake in the cost of care. People who get health insurance through their workplaces have been paying higher premiums in recent years, and more people have been enrolling in plans that include very high deductibles. A recent survey by the International Foundation of Employee Benefit Plans found that two-thirds of employers are increasing, or considering an increase in, workers' deductibles, co-insurance and co-payments.

It's important for patients to get good information about what they have to pay and why. That's not easy. Before my son was born, it was difficult to figure out what I was going to owe. And I struggled after the birth to learn whether the amounts I was told to pay were appropriate. I could have done a better job at calculating some of my costs. But often, information wasn't available, or was hard to decipher.

My own health plan is a so-called PPO,>>>

In ObamaCare, Middle Class Gets The Shaft

By JEFFREY H. ANDERSON | Posted Wednesday, July 08, 2009 4:20 PM PT

The Obama administration might like to "spread the wealth around," but its proposed "health care reform" wouldn't spread consumer choice around. Rather, it would constrict consumer choice substantially — except for the very rich.

That's the great irony of President Obama's ambitious health care agenda: His administration, which seems to feel little empathy for the rich, is paving the way to a two-tiered system in which only the very rich would have a choice.

Under ObamaCare, the rich would continue to get the care they want — whether here or abroad — by paying for it out of their own pockets. The rest of us would stand in line and wait for rationed care.

Most Americans want consumer freedom. They want to be able to shop for health care value — for the best care, at the best prices. They'd like to have a lot more freedom to shop for such value than they currently have. That's why Democrats are couching their proposed expansion of government-run health care in the language of competition and choice.

Listen to the president as he pitches the centerpiece of that agenda — a "public option," a form of Medicare for all. He says it's merely a way to give Americans another choice: People can buy private health insurance, just like now, or they can instead choose the government option.

But millions of middle-class Americans who are happy with their employer-provided insurance would soon find the choice isn't theirs to make.

The government would make it cheaper for employers to contribute to the government-run option than to keep providing private insurance.

Millions of employers would do the math and pick the government option. The "public option" would provide a choice — for millions of employers, against the wishes of millions of employees.

The Lewin Group, a prominent consulting firm, estimates that a widespread "public option" with Medicare-like reimbursement rates would result in 118 million Americans losing their private insurance and being forced into government-run care. Meanwhile, private insurance wouldn't be able to compete on the uneven playing field that Congress would establish.

In its competition with FedEx and UPS, the Post Office at least has to provide a service. But the "public option" would merely use government's coercive powers to dictate prices and availability of services provided by others — by doctors, nurses, hospitals, etc. Private insurance can't similarly fix prices and would be run out of business.

Lower reimbursement rates, coupled with a dwindling pool of private insurers to whom to pass on costs, would mean lower incomes for medical professionals. The eventual result would be fewer people entering the medical profession.

A two-tiered system would then emerge: The very rich would take their spots like first-class passengers on the Titanic, paying for fine care and not asking the price. The rest of us would take our spots in steerage class, awaiting the inevitable collision between government-run health care and the iceberg of budgetary disaster.

White House budget director Peter Orszag recently opined that "the deficit impact of every other fiscal policy variable" is "swamped" by the deficit-threat posed by Medicare and Medicaid.

Obama's solution? A massive new Medicare-like program!

Medicare may not pay much to doctors, but taxpayers pay plenty to Medicare. As my recent Pacific Research Institute study shows, since 1970, Medicare's costs have risen 34% more, per patient, than the costs of all health care in America apart from Medicare and Medicaid. Medicare's costs have risen $2,511 more per patient.

Across nearly four decades, government-run health care has been far more expensive than privately run care. It comes down to a simple comparison and an obvious verdict: Privately run care offers choice and is cheaper. Government-run care denies choice and is more expensive.

But the particular losers under Obama-Care would be the middle class. The uninsured poor would largely benefit, although they might benefit even more — while hurting others far less — from fixing the unfairness in the tax code and giving them the health care tax-break that millions of insured Americans already enjoy.

The truly rich would be largely unaffected, as they never really needed private insurance anyway. They would continue to pay for the care they want, because they can.

Middle-class Americans wouldn't enjoy that freedom. They would lose their employer-provided insurance and be left with only the government-run "option." And, under a government monopoly, they would get rationed care. And every April 15, they would get a higher tax bill for their troubles, which just might make them feel sick enough to get back in line.

Anderson is a senior fellow in health care studies at the Pacific Research Institute.

The Undercovered

By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 08, 2009 4:20 PM PT

Health Care: Having been on the receiving end of a letter-writing campaign, we are acutely aware that many are concerned about the plight of the uninsured. Too bad they're not similarly aware of the facts.

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IBD Exclusive Series: Government-Run Healthcare: A Prescription For Failure

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"It is no longer acceptable to have over 46 million Americans without health care," says one of the letter writers, touching on the recurring theme that it's somehow immoral to let a part of the population go without medical insurance.

The debate over the uninsured generates a lot of heat. That's why more than 50 letters supporting the White House's public option plan were e-mailed to us over an 18-hour period beginning Tuesday afternoon.

What's missing is some light, which is exactly what economists David and June O'Neill provide in a recent report prepared for the Employment Policies Institute.

The O'Neills classified the uninsured in two categories: the "involuntarily" uninsured, made up of those "likely unable to afford" coverage; and the "voluntarily" uninsured, 18- to 64-year-olds who have incomes at or above 2.5 times the poverty line and "likely have the means to obtain health care coverage."

At least 43% of the 46 million, the O'Neills say, belong to the voluntarily uninsured group.

That leaves 27 million Americans who aren't covered because they ostensibly cannot afford it.

There's much more to the story, though. The O'Neills found that:

• One-third of those who are involuntarily uninsured are high school dropouts; only 7% of the privately insured didn't graduate.

• A "disproportionately large" portion — almost 52% — of the involuntarily uninsured are young, 18 to 34.

• Immigrants make up a third of the involuntarily uninsured.

• Almost half of those the authors placed in the involuntary column are single and childless.

• While the uninsured tend to have higher mortality rates, their coverage status is "not likely to be the major factor" because they "have multiple disadvantages that are associated with poor health," such as "education, socioeconomic status and health-related habits like smoking."

Lost in the debate is the key fact that lacking insurance is not the same as lacking access to care. The uninsured do receive treatment, spending roughly 40% of the amount spent on health care by insured Americans each year.

The uninsured are screened for conditions such as cancer, as well. And the services they get are no worse than what they would get under a socialist system.

"When compared with screening rates for Canadians (who largely receive health care coverage through a nationalized, single-payer system), the uninsured in the United States actually compare favorably," write the O'Neills.

These statistics do not make a compelling case for Washington to seize control of 18% of our nation's economy just to make sure a small part of the population has medical insurance.

Punishing the many who are taking care of themselves to reward a few at an absurdly high cost is an abuse of the trust that the voters have put in their elected officials.

Coming Soon: The Nightmare From Up There

By SALLY C. PIPES | Posted Thursday, July 02, 2009 4:20 PM PT

In his recent speech to the American Medical Association, President Obama counseled Americans to beware "dire warnings about socialized medicine and government takeovers; long lines, and rationed care; decisions made by bureaucrats and not doctors."

Unfortunately for the president, there are a few Cassandras whose warnings are worth heeding. Chief among them are the millions of Canadians who have received substandard care at the hands of a government-run health system.

Before America emulates the Canadian model with a new trillion-plus-dollar health plan, it's worth examining whether government-run systems are all they're cracked up to be. As a Canadian by birth, I can assure you they're not.

A "culture of queuing" dominates my native land. In 2008, the average Canadian waited 17.3 weeks from the time his general practitioner referred him to a specialist until he actually received treatment, according to the Vancouver-based Fraser Institute.

That's 86% longer than the wait in 1993, when the Institute first started quantifying the problem. In 2008, more than 750,000 Canadians — 2.8% of the population — were on waiting lists.

My mother's case is instructive. In June 2005, she wasn't feeling well and thought she might have colon cancer. She asked for a colonoscopy but was told by her doctor that it was unnecessary. The doctor ordered an X-ray, which revealed nothing.

By December, she was 30 pounds lighter, bleeding — and finally eligible for care. She spent two days in the emergency room and two days in a transit lounge waiting for a room. A colonoscopy revealed advanced cancer. She died two weeks later.

Stories like this of care delayed — and thus denied — are common.

Sometimes they're comical — like the revelation in 1998 that a major hospital had been renting its MRI machine to veterinarians for use on pets, even as people waited for their turn.

In most cases, though, waiting lists are no laughing matter. Former Canadian Member of Parliament Belinda Stronach steadfastly opposed any privatization of Canadian health care while in office.

Yet in 2007, after being diagnosed with breast cancer, she effectively opted out of her beloved public system in order to have surgery in California. For most Canadians, such medical tourism is not an option.

Both Canada and the United States spend ever-greater amounts on health care, thanks to the increased utilization of technology and continuous medical innovation. But the two nations part ways when managing those expenditures.

In the United States' decentralized system, payers compete to drive the hardest bargains with health care providers. In Canada's system, provincial governments dictate what will be spent using global budgets. There's only so much money per person over the course of a year. Rigid budgets naturally lead to rationing.

Sometimes, rationing is implicit. Take my mother's first pass with her doctor. She didn't appear on a waiting list but was denied a colonoscopy all the same. At that time, there were 2,858 people in British Columbia awaiting a colonoscopy. The average wait was nine weeks — five weeks longer than considered clinically safe.

At other times, rationing is explicit. In 2001, government bureaucrats told the Queensway-Carleton Hospital in Ottawa to ration babies. The facility was on track to deliver 2,700 bundles of joy. But officials sought to reduce that number by 600, figuring it would save $600,000.

"We felt we were being kicked out, penalized for providing service," Dr. Paul Legault told the Globe and Mail. "I trained 12 years in order to do obstetrical care, not sit in my office and refuse patients."

Many U.S. politicians seem blind to the failings of a "government-pays" system. Those who recognize these horrors assure us that things will be different here. Obama has promised Americans that they'll be able to keep their current health plan if they like it. And many lawmakers have pledged to "build" on the existing private system.

But many of these health reformers are also committed to creating a public insurance program to compete with private providers. This new government plan would be able to tap the public purse to keep prices artificially low.

As a result, more and more patients would be shifted onto the lower-priced federal alternative — until it's the only option left. This is why most honest analysts admit that a "public option" paves the way for a single-payer system — Medicare for All.

Our neighbor to the north provides a glaring example of what government health care looks like. Let's hope our leaders take a look before it's too late.

Pipes is president and CEO of the Pacific Research Institute. Her latest book is "The Top Ten Myths of American Health Care: A Citizen's Guide."

Plan To Slash U.S. Health Costs May Be Tough Pill To Swallow

By DAVID HOGBERG
INVESTOR'S BUSINESS DAILY | Posted Thursday, July 02, 2009 4:30 PM PT

When someone takes out a scalpel, it's usually going to hurt — a lot.

Yet Peter Orszag, President Obama's budget director, claims the U.S. could slash $700 billion in annual medical costs without affecting quality.

That would make it much easier to pay for sweeping health care reform, which is struggling on Capitol Hill over cost concerns.

But divining and adopting best practices is trickier than Orszag may realize, some researchers say.

The head of the Office of Management and Budget draws heavily on the Dartmouth Atlas of Health Care. The atlas has found that Medicare spending varies greatly across the U.S., yet higher spending regions have no better and, at times, worse outcomes than regions that spend less. For example, Miami spends 30% more than Minnesota, but patients aren't any healthier.

Less Is More?

Areas with coordinated care and more primary-care physicians tend to use fewer resources than those with more disjointed care and more specialists.

"We would be on a path toward a much more efficient system," Orszag said recently of achieving health care reform. "When you go to see your doctor, that doctor will have much more information about what specifically is likely to work for your diagnosis, and will have better incentive to be providing high-quality care to you rather than just more care."

But knowing the right treatment is often quite difficult.

"The difference is in the utilization of services that are in the 'gray area' of medicine," said Amitabh Chandra, a public policy professor at Harvard who has worked closely with the Dartmouth Atlas. "These are services that don't lend themselves to clinical trials. Reasonable physicians will disagree over what the right rate of treatment is."

Chandra cites CT scans and MRIs. "They are undoubtedly valuable, but there is an unlimited amount of patients you can perform these procedures on."

Greg Scandlen, head of the conservative Consumers for Health Care Choices at the Heartland Institute, said: "It is often impossible to know ahead of time what is going to work and what won't. The notion that a physician should only deliver services that he knows ahead of time will work ignores real-life conditions."

Chandra largely agrees with that but thinks Orszag understands the nuance and difficulty of eliminating medical waste.

Scandlen is less charitable: "It's offensive that a bean counter like Orszag should Monday-morning-quarterback physician decisions."

Dr. Elliot Fisher, principal investigator at the Dartmouth Atlas, has urged the Obama administration to use the buying power of Medicare and Medicaid to inform patients and incentivize providers to adopt the practices of good organized-care centers like the Mayo Clinic.

"If we're thoughtful about creating incentives for organized systems to form . . . we could get the kind of performance that we want," Fisher recently told NPR.

Scandlen responds: "To say we're going to create some kind of management system that will turn everything into the Mayo Clinic is absurd. Bureaucrats miss the human element of all of this stuff. Mediocre people can take any kind of management system and turn it into something not very good."

The Real World

Even assuming that experts can identify best practices, can they impose their will? Doctors, hospitals, drugmakers and patients will all demand that their treatments, their choices, are approved.

It will be hard to resist the media and political pressure when, say, a patient dies because Medicare did not permit a particular drug or test.

Dr. Richard Cooper of the Wharton School says it is unwise to base policy on the Dartmouth Atlas, as Medicare is a poor measure of total health care spending.

"Higher health care spending results in better health outcomes," Cooper said. "Dartmouth is measuring regional variation in sociodemographic characteristics, not health care spending."

He argues that areas with higher Medicare spending tend to be areas that are poorer, have lower total health care outlays and have more medical problems.

Chandra says Cooper's measures aren't reliable and that his own research suggests that areas with higher Medicare spending also have higher total health spending.

Rushing Ahead In Health Care Wonderland

By THOMAS SOWELL | Posted Monday, June 29, 2009 4:20 PM PT

Most political and media discussions of medical care have an air of unreality reminiscent of Alice in Wonderland. There is an abundance of catch-phrases but remarkably few coherent arguments.

Let's start at square one. Why is there alarm about American medical care? The most usual reason given is because its cost is high and rising.

That is certainly true. We were not spending nearly as much on high-tech medical procedures in the past because there were not nearly as many of them. And we weren't spending anything at all on some of the new pharmaceutical drugs because they didn't exist.

This general pattern is not peculiar to medical care. Cars didn't cost nearly as much in the past, when they didn't have air conditioning, power steering and high-tech safety features. Homes were cheaper when they were smaller, had fewer bathrooms and lacked such conveniences as built-in microwave ovens.

Benefit Fairy

We would like to have all these things without the rising costs that come with them. But only with medical care is such wishful thinking taken seriously, with government regarded as a sort of fairy godmother who will give us the benefits without the costs.

A cynic is said to be someone who knows the price of everything and the value of nothing. If so, then it is political cynicism to point to other countries that spend less on medical care, including some countries where there is "universal health care" provided "free" by their governments.

Cheaper For A Reason

Just as medical care, houses and cars were all cheaper when they lacked things that they have today, so medical care in other countries is cheaper when they lack many things that are more readily available in the United States.

There are more than four times as many magnetic resonance imaging units (MRIs) per capita in the United States as in Britain or Canada, where there are government-run medical systems. There are more than twice as many CT scanners per capita in the United States as in Canada and more than four times as many per capita as in Britain.

Is it surprising that such things cost money?

The cost of developing a new pharmaceutical drug is now about a billion dollars. Neither political rhetoric nor government bureaucracies will make those costs go away.

We can, of course, refuse to pay these and other medical costs, just as we can refuse to buy air-conditioned homes with built-in microwave ovens. But that just means we pay attention only to prices and not to the value of what we get for those prices.

We can even refuse to pay for so many doctors. But that just means that we will have to wait longer to see a doctor — as people do in countries with government-run medical systems.

In Canada, 27% of the people who have surgery wait four months or more. In Britain, 38% wait that long. But only 5% of Americans wait that long for surgery.

Surgery may well cost less in countries with government-run medical systems — if you count only the money cost, and not the time the patients have to endure the ailments that require surgery, or the fact that some conditions become worse, or even fatal, while patients wait.

A recent report from the Fraser Institute in Canada shows that patients there wait an average of 10 weeks to get an MRI, just to find out what is wrong with them. A lot of bad things can happen in 10 weeks, ranging from suffering to death.

Stop, Think

Politicians may talk about "bringing down the cost of medical care," but they seldom even attempt to bring down the costs. What they bring down is the price — which is to say, they refuse to pay the costs.

Anybody can refuse to pay any cost. But don't be surprised if you get less when you pay less. None of this is rocket science. But it does require us to stop and think before jumping on a bandwagon.

The great haste with which the latest government expansion into medical care is being rushed through Congress suggests that the politicians don't want us to stop and think. That makes sense, from their point of view, but not from ours.

Copyright 2008 Creators Syndicate, Inc