Death stares at James Dean.

As a funeral director, he embalms bodies and counsels grieving relatives. As a man with advanced prostate cancer, he contemplates his death as the illness spreads and zaps his energy.

Dean, 62, of Bellevue, a tall man with a silver beard, received a controversial vaccine in October that cost $93,000 and reportedly gives patients a chance to live an average of four months longer. His insurer, Highmark, paid for the treatment — an expense Dean admits he wouldn’t have covered himself.

“Heck no, I’m not going to pay $93,000. I don’t have that money,” Dean said.

The costly vaccine, called Provenge, is the subject of debate among federal regulators, drug companies and patient advocacy groups.

Dean’s decision to receive the vaccine — because it cost him nothing, even if the benefit was limited — underscores the prevalence of aggressive and high-priced treatments in America when death looms, an investigation by the Tribune-Review found. In some cases, patients don’t want treatment but receive it because doctors say it’s the right thing to do.

Many experts warn that pricey treatments with the possibility of limited or no benefit for patients in their last weeks of life need to be evaluated because of skyrocketing health care costs and dissipating money for Medicare and Medicaid.

“Our public insurance programs and subsidies cannot afford to pay for treatments that are very expensive but produce minimal health benefits,” said Katherine Baicker, professor of health economics at Harvard School of Public Health. “The tough policy question is how to draw the line. What health benefit is just too small to warrant the expense?”

Read the rest of the story at the Pittsburgh Tribune-Review

“In Pennsylvania, the abortion rate, which has been below national rates for decades, has nudged up since it hit bottom in 1999. Then, the rate was 13.9 abortions per 1,000 among women of child-bearing ages, but in 2008 it was 17 per 1,000 women, according to the institute, which looked at all abortions performed in Pennsylvania, including those for women who did not live here.

Abortion-rights supporters and opponents said the economy has played a role in the trend.”

Read more from the Morning Call

More than half of Western Pennsylvania’s hospitals lost money in the year ended June 30, 2009, with poor investment returns and increasing uncompensated care weighing on their bottom line, a state report released today found.

The annual report on the financial health of the state’s hospitals was prepared by the Pennsylvania Health Care Cost Containment Council, which examines the cost and quality of health care statewide.

Fifteen of the 29 hospitals in Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Washington and Westmoreland counties lost money during the latest fiscal year, meaning total expenses exceeded total revenue. Statewide, 73 of 166 hospitals lost money in fiscal 2009, the latest figures available.

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Health care may be a costly drag on the economy, but it’s still a great place to find a job.

Midcareer managers and other workers have been migrating to health care jobs for years, of course. Now, with the recession, the lure is even stronger. Hospitals, which employ more than four million people, added 135,000 jobs last year and 19,400 more in the first half of 2009, even as millions of American workers wound up unemployed.

“The demand for talented leaders in health care is only going to go up,” predicted Jane Groves, a senior vice president at Integrated Healthcare Strategies, an executive search and consulting firm in Kansas City, Mo. “All that demand can’t and shouldn’t be filled by people already working in health care.”

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Health care does, of course, have its own jargon and a host of complex challenges. Managers have to know how to deal with doctors, nurses and professional groups, as well as with regulators.

“There are tons and tons of regulations, and the burden is growing,” said Dr. Steven A. Wartman, president of the Association of Academic Health Centers, a nonprofit group whose members are both research and health sciences universities that include hospitals.

The Obama administration’s $19 billion 10-year campaign to promote electronic medical records opens another huge opportunity, said Dr. Blackford Middleton, a technology research expert at Partners Healthcare in Boston. An estimated 40,000 to 160,000 additional health information professionals could be needed, he said.

Read more at the Times.

Even before the national economy tanked last fall, 30 percent of Pennsylvania’s acute care hospitals were losing money, according to a new financial analysis by the Pennsylvania Health Care Cost Containment Council.

And total margin for all hospitals — a measure of the hospitals’ profitability — dropped from 6.56 percent in fiscal 2007 to 4.7 percent last fiscal year, which ended June 30, 2008, the first decline in five years.

When calculating total margin, the council looked at a hospital’s expenses compared to revenues from both its operations and other sources such as investments. If total margin came out negative, it meant the hospital lost money.

Read more at the Post-Gazette.

In the economic downturn, some people who treat addictions are seeing a rise in demand for their services.

“There’s a lot of fear and a lot of anxiety. When those emotions come into play, people feel out of control, and they try to manage their emotions by eating too much, drinking too much,” said Paul Hokemeyer, a therapist with Caron Treatment Centers.

That drink of alcohol, that taste of sugar, that sex or shopping or Internet porn brings a sense of calm, he said.

“It calms you down instantly. You don’t have to sit with the emotion.”

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“We do know that a poor economy has an impact on drug and alcohol addiction problems. Research shows that the demand for services to treat addiction goes up in tougher economic times,” said Stacy Kriedeman, a spokeswoman for the state Department of Health.

Robin Dougherty, intake coordinator for the Salvation Army Adult Rehabilitation Center in Lower Paxton Twp., said clients tell him that life spiraled out of control after they lost jobs or insurance or benefits, so they began drinking or using drugs as an escape.

Dougherty said calls are up by 20 percent over a year ago. But like other professionals, she said it’s difficult to say whether the increase is all due to the economy, because their facility recently expanded.

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A month ago, Hokemeyer gave a seminar on the economy and recovery from addictions. “We had more people than we ever imagined would show up. It’s just in the air. The anxiety is in the air. You can’t go anywhere without hearing about it,” he said.

Read more at the Patriot.

Overhauling the U.S. healthcare system to contain soaring costs and expand medical coverage to the uninsured would help boost U.S. economic output, lower budget deficits and raise workers’ incomes, a White House report said on Tuesday.

A report by the White House Council of Economic Advisers said healthcare spending, which currently accounts for about 18 percent of the country’s economic output, could reach 34 percent by 2040 if the current rate of cost growth continues. It said that kind of growth rate was unsustainable.

“Healthcare reform is incredibly important not just for the American people but for the American economy,” said White House economic adviser Christina Romer.

Read more on how the government says reform would help our economy at Reuters.

Twenty percent of Americans say they have delayed or postponed medical care, mostly doctor visits, and many said cost was the main reason, according to a survey released on Monday.

The Thomson Reuters survey found 21 percent of U.S. adults expected to have difficulty paying for health insurance or healthcare services in the next three months.

“The results of this survey have serious implications for public health officials, hospital administrators, and healthcare consumers,” Gary Pickens of the Healthcare division of Thomson Reuters, who led the study, said in a statement.

“We are seeing a positive correlation between Americans losing their access to employer-sponsored health insurance and deferral of healthcare.”

Pickens added that “if this trend continues, it will ultimately have an impact on our collective well-being.”

Read more about the survey and its results at Reuters.

Local consumer health advocates say laid-off workers may be unaware of Saturday’s deadline to arrange for a 65 percent reduction in their COBRA health insurance premiums because former employers are not always notifying them that they’re eligible.

Paul Lodico, co-director of the Mon Valley Unemployed Committee, said the organization had fielded more 70 calls from laid-off workers who say they’ve not received notification about getting the reduced premiums. “This is a much bigger response than we normally receive.”

Missing the deadline won’t necessarily prevent someone from getting the reduction — the U.S. Department of Labor has set up an appeals process that requires a resolution within 15 days — but the fear is that the benefit will be delayed or that missing the deadline might jeopardize eligibility.

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The federal American Recovery and Reinvestment Act provides a 65 percent subsidy on COBRA continuation premiums for up to nine months for workers laid off between Sept. 1, 2008, and Dec. 31, 2009.

The program is estimated to save an average of $325 per month for individuals and $715 per month for families on the health insurance payments.

More information about the COBRA Continuation Coverage Assistance program is available at www.dol.gov/cobra on the Department of Labor’s Web site.

It was a nasty head cold that sent Kerry Parham to Cinagro’s, a health-food store in suburban Cleveland, for an $8 bottle of herbal supplements.

“If I had a job with health insurance, I probably would have gone to see a doctor by now,” said Ms. Parham, 39, who lost her clerical job at American Greetings a while back. “But instead, I’m here buying echinacea. I hope it works.”

In flusher times, Ms. Parham said, she spent $50 a month on prescriptions for her asthma, allergies and other chronic problems. Now, she pays $6 a month for over-the-counter protein supplements and oregano oil capsules. “That’s an important savings for me,” she said. “It means I can rent a movie or make the kids food that they actually like.”

A lot of consumers seem to be doing the same math. Sales of vitamins and nutritional supplements, which have grown consistently for years, have surged in recent months, rising as the stock market has fallen. People are clearly cutting back on many items, from bread and milk to designer jeans and flat-screen televisions, but they are stocking up on pills that they think can spare them expensive doctor visits.

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At the Vitamin Shoppe, a national chain with 414 stores, customers have been expressing alarm over health care costs and the high unemployment rate, said Tom Tolworthy, the company chairman. “The reduction of benefits associated with prescription drugs is sending people to prevention and alternative health care,” he said.

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Doctors caution against putting too much faith in supplements, and recent studies have cast doubt on the long-term effectiveness of products like multivitamins and vitamin E for certain cancers and heart disease. Dr. Edward L. Langston, a former chairman of the board of the American Medical Association, said he counseled his patients to take limited doses of vitamin C, but said supplements were no “panacea,” nor a substitute for traditional health care.

Read more at the NYT.