Hospitals across Oklahoma City have invested in a da Vinci surgical robot, a highly marketed robot that can be used to perform a variety of surgeries. I’ve interviewed several doctors who use the robot to perform surgeries, and many of them rave about it.

They say patients recover faster, have fewer complications and leave the hospital faster than patients who don’t have the same kinds of surgeries using the robot.

But there’s a catch to some of their claims — comprehensive data to back it up.

As this article points out, recently published medical research has found that robotic surgery might not always prove to be more beneficial.

In the dozen years since the Da Vinci robot has been approved for surgeries in the United States, it’s been embraced by health care providers and patients alike. Surgeons routinely use the multi-armed metal assistant to remove cancerous prostate glands and uteruses, repair heart valves and perform gastric bypass operations, among many other procedures.

Lately a key study and reports of problems have raised questions about robotic surgery’s safety and cost-effectiveness, leading to a review of the Da Vinci system by the Food and Drug Administration and causing some experts to wonder whether the benefits of undergoing robot-assisted surgery may have been overstated.

To make any claim in medicine that one approach works better than the other, you need a study published in a medical journal that says “Yes, this is very, very true.” Actually, you probably need several studies by different academic institutes that agree and say, “Yes, that study is very, very true, and here’s what we found that says it’s still very, very true.”

Surgeons I’ve talked to with say the da Vinci robot allows them to operate inside a patient and affect the least amount of tissue while inside. And so far, the debate continues, with the U.S. Food and Drug Administration currently reviewing the system.

Complications can occur with any type of surgery, and so far it’s unclear if they are more common in robotic operations. That’s part of what the FDA is trying to find out.

Intuitive Surgical disputes there’s been a true increase in problems and says the rise reflects a change it made last year in the way it reports incidents.

The da Vinci system “has an excellent safety record with over 1.5 million surgeries performed globally, and total adverse event rates have remained low and in line with historical trends,” said company spokeswoman Angela Wonson.

But an upcoming research paper suggests that problems linked with robotic surgery are underreported. They include cases with “catastrophic complications,” said Dr. Martin Makary, a Johns Hopkins surgeon who co-authored the paper.

And because of that, I can get bored quickly when you start spouting out tons of numbers.

So, here’s a visual aid of what Medicaid expansion would look like in Oklahoma.The Oklahoma Health Care Authority estimates that expanding Medicaid to 138 percent of the federal poverty line would make 180,000 Oklahomans eligible for SoonerCare, the state’s Medicaid program.

What does that look like?

Gaylord Family – Oklahoma Memorial Stadium, filled up about 2.2 times.

Boone Pickens Stadium, about three times full.

Photo by Zach Gray, for The Oklahoman

Chesapeake Energy Arena during an OKC Thunder game, about 10 times full.

Photo by Bryan Terry, The Oklahoman

The BOK Center in Tulsa, about 9 times full.

Medicaid expansion is one of the key elements of the Affordable Care Act, or “Obamacare.” (Want to know more about the health care debate? Here’s a graphic novel we created that explains the basics)

Most leaders have been quoted as saying expanding Medicaid would be too expensive for their states and that they didn’t trust the federal government to hold its end of the bargain.

So what’s the alternative plan?

Gov. Fallin hasn’t yet announced what Oklahoma’s alternative plan might be, but a few state leaders have made a proposals on how to help the uninsured in their states.

Wisconsin

In Wisconsin, Republican Gov. Scott Walker announced in mid-February that he is rejecting Medicaid expansion and instead pushing forward with his own plan.

Walker said he would instead work to increase health coverage for Wisconsinites with an alternate plan that involves lifting an enrollment cap on Medicaid programs for childless adults, tightening income eligibility for state residents able to use Medicaid programs, and bumping thousands of people from such programs to federal government-run health care exchanges where they can buy private insurance.

Avik Roy, a contributor at Forbes, wrote a detailed piece on Walker’s approach, noting:

Prominent Republican governors, like John Kasich in Ohio, have said yes to Medicaid, reasoning that if Ohio doesn’t grab the federal money, other states will. But, as Wisconsin governor Scott Walker now shows, there is a far better path forward, one that reduces the footprint of Medicaid while providing coverage to the uninsured.

Alabama

In Alabama, lawmakers are looking at Oregon’s model and discussing whether they could duplicate something similar:

Over the decades, Oregon has built a relatively generous Medicaid program and has been a bellwether for health policy experimentation. Alabama, like most other southern states, has run a barebones program with few optional benefits.

Launched last year, Oregon’s current Medicaid plan relies on local health care organizations to coordinate all forms of health care, from acute medical services to mental health and dental care, all in an effort to lower costs and improve health. Basically, the local entities, which may be headed by a hospital, physician group, community service provider or a managed care organization, are given a budget and challenged to beat it. If costs exceed the budget, the organization takes the loss.

Alabama lawmakers will soon consider a proposal from Bentley for a Medicaid overhaul based in part on Oregon’s groundbreaking “community care organizations.” Although Bentley has said he would not support an expansion of Medicaid “under its current structure,” the expected reforms are seen as paving the way for a possible expansion as early as 2015.

South Carolina

Lawmakers in South Carolina have proposed their alternative to expanding Medicaid, which includes paying hospitals to send uninsured patients to community health centers.

Instead, House Republicans this week put forward an alternative plan that would pay hospitals up to $35 million to steer uninsured patients to community health centers, free health clinics and rural health clinics. Lawmakers also pledged to give those health centers and clinics an extra $10 million in state money to care for those uninsured patients.

Those clinics, which the state gave $1.8 million this year, hailed the plan Thursday.

“The new plan is a positive alternative if the state does not decide to participate in the Medicaid expansion,” said Lathran Woodard, chief executive of the S.C. Primary Health Care Association.

In case you watched the first presidential debate tonight and found yourself saying, “I have a question!” — you have a chance to ask that question.

WebMD has teamed up with the nonpartisan Commission on Presidential Debates (CPD) to help gather questions for the upcoming debates. If you have a question for the candidates about health care, please submit it below. WebMD will compile the questions to share with the debate moderators.

To ask your question, visit this WebMD page before the next debate.

If I were to submit a question, it would likely be about health care costs (which I might have already submitted…). This Washington Post graphic shows the difference in what residents in the U.S. pay for medical procedures versus in other countries.

What would you ask about? What did you want to hear more about tonight?

Let me know either here on the blog or via Twitter at @jaclyncosgrove.

In the things-to-consider-for-the-sake-of-considering-them category, take a gander at this story from the May 27 edition of The Boston Globe: 

After healthcare reform was made law in Massachusetts in 2006, the number of newly insured patients in the state started to grow, and so did the demand for care. The demand, coupled with a longstanding shortage of primary-care physicians, is creating a real crunch for community clinics, say advocates of healthcare reform as well as area medical professionals.

About 80 percent of the new patients at a community health clinic who are covered under the state’s new health insurance program were formerly uninsured, a clinic supervisor told the newspaper. The result is a lengthy waiting list.

Clinics the newspaper contacted have had difficulty recruiting doctors.

‘What Chapter 58 has done is highlighted the crisis and the problem that we have with the primary-care workforce,’ said Dr. Bruce Auerbach, president of the Massachusetts Medical Society. According to a study conducted in 2006 by the society, 53 percent of patients who had an appointment with a primary-care physician were able to see a doctor within a week of initiating contact. Last year, only 42 percent were able to see a doctor within a week. …

Critics have said healthcare reform should not have been attempted without first addressing the workforce shortages, said John E. McDonough, executive director of Health Care for All, an advocacy group that helped craft the healthcare law. …

Healthcare advocates and providers say that the real problem is that the state underestimated the number of residents without health insurance. …

According to Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, which administers the new health law, 340,000 people who had been mostly uninsured were covered through the state’s program as of Jan. 1. Of that number, about 110,000 have bought private insurance through Commonwealth Choice. But, he said, the remaining 230,000 people have MassHealth or Commonwealth Care, the state’s subsidized health insurance programs.

One thing that’s unclear is why the formerly uninsured choose the types of clinics mentioned in the story when it looks although they could go to any doctor. Maybe they can’t, or maybe the story didn’t address it.

Either way, the unintended consequences of insuring hundreds of thousands of people are worth considering.

Thoughts? Leave a comment on this blog.

Jeff Raymond, Medical Writer

Do you think it’s fair and/or accurate to see Oklahoma ranked at or near the bottom of, well, just about every study of health that comes our way? We can’t be worst in everything health-related, can we?

I say this after reading about Wednesday’s report from The Commonwealth Fund. The nonprofit ranked children’s health in states on 13 indicators that included access to and quality of care, outcomes, equity and cost.

Oklahoma pulled up the rear. Fifty-first. Behind the District of Columbia and Mississippi. Leading the rankings were Iowa, Vermont, Maine, Massachusetts and New Hampshire.

Now, I know the devil’s in the details, and I admit I haven’t looked at the methodology of this report. I usually do, however, which is why I ask about the fairness of all this. I imagine this report would pass muster if you agree what it measures accurately sums up the state of children’s health.

Ah, here’s where it gets tricky: Are the measures used fair? Are small differences in rates or percentages blown out of proportion? Is the information current, or as current as possible?

See the state’s “scorecard” for yourself here.

The interesting thing about these reports is they are all largely slicing and dicing the same data. Sometimes it gets hard to tell them apart.

Anyone who honestly assesses the state’s health will find huge problems. But last or near-last every time? Perhaps I’m becoming desensitized, but my reaction is getting to be “C’mon!?!”

What’s yours? Tell me what you think by posting a comment on this blog.

Jeff Raymond, Medical Writer

 Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.

A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.

The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.

Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.

The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.

And health care costs show no signs of flattening or decreasing.

Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.

Fidelity recommends:

- Creating an individual retirement plan

- Starting early and maximizing opportunities to save

- Assessing health status and becoming a smarter consumer of health care

- Determining details of any employer-sponsored coverage

- Understanding the financial impact of health care costs on Social Security income

Jeff Raymond, Medical Writer

The survey found that many Baby Boomers have misconceptions about who pays for long-term care services.

If you are still unclear on all this, Medicare does not pay for long-term care. Medicaid does, but only for those who are poor or who have spent down their assets.

“This should be a wake-up call to Baby Boomers. They aren’t factoring expenses for long-term care into their retirement planning and are missing an opportunity to protect themselves,” Karen Ignagni, president and CEO of the insurance group, said in press release.

Spoken like a true insurance industry representative, but she nonetheless makes a good point.

The survey also found:

-Even among Baby Boomers nearing or at age 60, only one in four feels “very familiar” with long-term care insurance.

-Thirty-percent of Baby Boomers think they have coverage for long-term care expenses. Most likely do not.

-Fifty-four percent of Baby Boomers think Medicare will pay for long-term care.

Now, I realize these surveys are often commissioned by insurance companies that have a vested interest in selling policies. I also know firsthand that long-term care insurance is laughably expensive for a person my age — my only point of comparison. Maybe it will be a better value when I near retirement.

Just for the record: I’m not interested in buying insurance. Call me in 30 years or so.

To learn more, visit www.ltcchampions.org or www.ahip.org.

Jeff Raymond, Medical Writer

A recent policy brief from the Kaiser Family Foundation intriguingly dealt with the effects of well-documented medical insurance premium increases and cost sharing on senior citizens and young workers.

“This analysis examines the relative burdens of out-of-pocket spending on seniors and younger adults,” the Kaiser Web site said. “Seniors consistently spent a larger share of their income out of pocket on health care than younger people. Given the persistent differences between young and old, it suggests that even with Medicare’s prescription drug benefit, significantly narrowing the wide gap between seniors and younger adults in their out-of-pocket spending burdens is unlikely.”

Some things the report mentions:

• From 2000-05, average in-network deductibles for PPOs (as opposed to HMOs), almost doubled, while average monthly premiums for family coverage rose by two-thirds.
• During the same time frame, median (the point at which half of all families earn more and half earn less) family income rose by about 10 percent.
• During the same time frame, Medicare Part B premiums rose by 72 percent, while premiums rose by 35 percent for a popular “Medigap” plan.
• In 2003, median per-capita health care expenditures were five times higher for seniors than for others.

“Our findings document a persistent gap in financial burden between young and old which could have important implications for ongoing policy discussions in several areas, including the generosity of coverage for working age adults, rising health care costs, entitlements and more fundamental questions about the appropriateness of shifting more costs onto consumers,” the report states.

The main thing to keep in mind is that this cost growth shows no signs of stopping. Any thoughts? E-mail me below.

Jeff Raymond, Medical Writer

Part of the American Community Survey, which, to my understanding, replaced the Census ”long form” so many Americans loathed, the “poverty report,” as one Tulsa advocacy group called it, is an annual assessment of cities and states’ income. A related report included statistics on health insurance.

Anyway, if you read Wednesday’s paper, or check the Web, you’ll get all this.

What interested me most about the conversation with Anderson, a certified public accountant with a wide knowledge of state government, was his assertion that the rate of uninsured Oklahomans may not be as accurate as is normally portrayed — either numerically or qualitatively.

Anderson said the Census didn’t count American Indians who receive tribal health care. Nor did it reflect those who choose not to have health insurance — the young and fearless, for example. Or those who just aren’t responsible.

I haven’t been able to research his tribal health care claims, and if I have run across statistics on people shunning health plans they can afford, I have long since lost them. However, the bigger picture is more important: Are we making a public-policy crisis out of a problem? If so, to what end?

I’m not weighing in one way or the other. I just think it’s wise to consider things we repeat and take as truth sometimes have shaky foundations. The more we repeat them, the more ingrained they become.

That many Americans are uninsured is undeniable. That they cost a lot of time, money, efficiency and are less healthy than those with insurance is also, in my opinion, undeniable. What is debatable are the scope of the problem and its solution.

On an unrelated note, if you have ever had trouble managing your cholesterol but tried to make a real effort to do better nonetheless, I’d like to talk to you. Please e-mail me by clicking on my name or call me at (405) 475-3364.

Jeff Raymond