Health & Education
States Experimenting to Lower Health Care Costs
By Jonathan J. Cooper
The Associated Press
SALEM, Ore. (AP) — Oregon health
officials are concentrating on coordinating
services and preventing hospital stays. New
Jersey medical centers are rewarding doc-
tors who can save money without
jeopardizing patient care. And Massachu-
setts is expanding the role of physician
assistants and nurse practitioners.
As states work on implementing the com-
plex federal health care reforms, some have
begun tackling an issue that has vexed
employers, individuals and governments at
all levels for years — the rapidly rising
costs of health care. The success of models
that are beginning to emerge across the
country ultimately will determine whether
President Barack Obama’s Affordable Care
Act can make good on its name.
It’s too early to tell what will work and
what won’t, but states, insurers and medical
groups are experimenting with a variety of
programs to contain costs without under-
mining care. These test runs come as
millions of new patients will gain eligibility
for health insurance under the federal law,
putting additional pressure on the system.
``Look at any of the long-term projections
for the federal budget or for state budgets,’’
said Alan Weil, executive director of the
National Academy for State Health Policy.
``If we don’t bring down health care costs,
we’re either going to be paying a whole lot
more in taxes or we’re going to stop spend-
Often overlooked are the law’s efforts to
stabilize constantly rising costs.
U.S. health care spending reached $2.7
trillion in 2011, or $8,700 per person,
according to the Centers for Medicare and
Medicaid Services. The agency says those
numbers are climbing and predicts spending
will reach $14,000 per person by 2021.
‘If we don’t bring down health care costs, we’re
either going to be paying a whole lot more in
taxes or we’re going to stop spending money
on other things we care about’
ing money on other things we care about.’’
The Affordable Care Act is expected to
extend coverage to many of the roughly 50
million Americans who lack insurance by
expanding Medicaid, the state-federal
health care program for low-income people,
and requiring most others to purchase insur-
ance or pay a fine.
The higher costs mean higher premiums
for businesses, which are passing on more
of those expenses to their employees, and
for individuals, who are seeing a rise in out-
of-pocket costs.
In the Portland area, spiking costs have
forced Steve Ferree to reduce the benefits
he offers his 32 employees at the Mr. Root-
er Plumbing franchise he owns.
``We feel bad about it,’’ he said. ``We do
provide good insurance, and we want to
make sure we take care of folks, so that’s a
tough decision to make.’’
Premiums for employee-only coverage
have spiked 65 percent since 2006, Ferree
said, and employee and spouse plans rose
90 percent. Workers cover a quarter of the
premium.
The struggles of business owners such as
Ferree illustrate the difficulty of finding
solutions, even in a state that has been held
out as a potential national model for sav-
ings.
The recession provided what is expected
to be a temporary reprieve, with health care
costs slowing to 3.9 percent annually
between 2009 and 2011, the slowest growth
rate since the government began keeping
track in 1960, according to data from the
Centers for Medicare and Medicaid Servic-
es. Over the preceding 18 years, per capita
health care costs grew an average of 6.5
percent a year.
Yet despite the recent slowdown, health
See CARE on page 11
Winter Depression Not as Common as Many Think, OSU Research Shows
By Angela Yeager,
Oregon State University
CORVALLIS, Ore. – New
research suggests that getting
depressed when it’s cold and drea-
ry outside may not be as common
as is often believed.
In a study recently published
online in the Journal of Affective
Disorders, researchers found that
neither time of year nor weather
conditions influenced depressive
symptoms. However, lead author
David Kerr of Oregon State Uni-
versity said this study does not
negate the existence of clinically
diagnosed seasonal affective dis-
order, also known as SAD, but
instead shows that people may be
overestimating the impact that
seasons have on depression in the
general population.
“It is clear from prior research
that SAD exists,” Kerr said. “But
our research suggests that what we
often think of as the winter blues
does not affect people nearly as
much as we may think.”
Kerr, who is an assistant profes-
sor in the School of Psychological
Science at OSU, said the majority
of studies of seasonal depression
ask people to look back
on their feelings over
time.
“People are really
good at remembering
certain events and
information,” he said.
“But, unfortunately, we
probably can’t accu-
rately recall the timing
of day-to-day emotions
and symptoms across
decades of our lives.
These research methods are a
problem.”
So Kerr and his colleagues tried
a different approach. They ana-
lyzed data from a sample of 556
community participants in Iowa
and 206 people in western Ore-
gon. Participants completed
self-report measures of depressive
symptoms multiple times over a
period of years. These data were
then compared with local weather
conditions, including sunlight
were a problem. Yet the study sug-
gests that people may be
overestimating the impact of win-
tery skies.
“We found a very small effect
during the winter months, but it
was much more modest than
would be expected if
seasonal depression
were as common as
many people think it
is,” said Columbia
University researcher
Jeff Shaman, a study
co-author and a for-
mer OSU faculty
member. “We were
surprised. With a
sample of nearly 800
people and very pre-
cise measures of the weather, we
expected to see a larger effect.”
Kerr believes the public may
have overestimated the power of
the winter blues for a few reasons.
These may include awareness of
Fortunately, there are many
effective treatments for
depression, whether or not it is
seasonal
intensity, during the time partici-
pants filled out the reports.
In one study, some 92 percent of
Americans reported seasonal
changes in mood and behavior,
and 27% reported such changes
SAD, the high prevalence of
depression in general, and a legiti-
mate dislike of winter weather.
“We may not have as much fun,
we can feel cooped up and we may
be less active in the winter,” Kerr
said. “But that’s not the same as
long-lasting sadness, hopeless-
ness, and problems with appetite
and sleep – real signs of a clinical
depression.”
According to Kerr, people who
believe they have SAD should get
help. He said clinical trials show
cognitive behavior therapy, anti-
depressant medication, and light
box therapy all can help relieve
both depression and SAD.
“Fortunately, there are many
effective treatments for depres-
sion, whether or not it is
seasonal,” he said. “Cognitive
behavior therapy stands out
because it has been shown to keep
SAD from returning the next
year.”
August 28, 2013 The Portland Skanner Page 9