A blog covering the health/care ecosystem and people.

“Life well shared” is the tagline for Reader’s Digest. The publication began in 1922 and was, until 2009, the #1 best-selling magazine in the U.S. (losing its position to Better Homes and Gardens). How does a magazine that’s over eight decades old stay relevant? More digital offerings appeared in 2010. And, in 2011, Reader’s Digest is collaborating with one of the most well-used and -respected online health social networks, OrganizedWisdom (OW). How did this collaboration come to be? I spent some quality time in February 2011 with Unity Stoakes, co-founder of OW with Steven Krein, in New York City, the geographic HQ of OW.

For hospital CIOs, 2011 and 2012 are all about achieving meaningful use, focusing on clinical systems, safe-keeping health information, and staying financially healthy as an organization.  These insights are brought to you by the 22nd Annual HIMSS Leadership Survey, sponsored by Citrix. This survey has become the most important snapshot of health CIOs’ priorities looking ahead. This year’s survey results, unveiled week at HIMSS 2011 in Orlando, held some important findings. While achieving meaningful use is the top IT priority for the next two years (with 81% of organizations believing they’ll quality for MU in 2011 or 2012), clinical systems implementation and

“I’m not a class warrior. I’m a class worrier,” Robert Reich told a standing-room only crowd of thousands of health IT geeks as he delivered the first keynote address of the annual meeting of HIMSS, the Healthcare Information Management and Systems Society. This year’s crowd will have reached about 31,000 people interested in health information technology’s transformative role in health care. The 31K represents an 18% increase in attendance from last year’s crowd. The HIMSS economy is strong. Robert Reich warns, however, that the U.S. macroeconomy is far from healthy…and health care costs will be a long-term threat to the

What doctors are most likely to use patients’ personal electronic health records? Fewer than 1 in 2 are willing to. Those who most likely would include Hispanic physicians, doctors who practice in rural areas, those employed in hospitals, and surgeons. As part of the HITECH Act included in the American Recovery and Reinvestment Act (ARRA) 0f 2009, U.S. physicians have the opportunity to receive a portion of the $20.8 billion carved out as incentive payments to those who adopt and “meaningfully use” electronic health records (EHRs). Many EHRs include portals which allow patients to access a slice of their personal health information.

EURO RSCG has polled 1,000 online Americans’ views on romance through the lens of digital media, publishing results in a paper, Love (and Sex) in the Age of Social Media. This ‘digital love’ survey was conducted in January 2011.  [It’s interesting to note that EURO RSCG won the business for the Durex condom line in November 2010.] In its introduction, EURO RSCG suggests that, “the Internet is the most powerful erogenous zone that the world has ever known.” There are five aspects to digital love, based on these findings: 1. Observing love online. As more people do more daily activities online like banking,

Pfizer‘s closure of the R&D plant located in Sandwich, England, is a harbinger of more plant closings-to-come. With scenario planning hat cocked firmly on one’s head, what does this mean for the lovely region of Sandwich, and other towns where the pharmaceutical industry’s reduction in R&D spending is falling hard on similar plants located in developed Europe and the U.S.? I’m inspired by a story in today’s Financial Times, Supply Running Low, about the implications of the closure of the Pfizer R&D factory in Sandwich, England which, “pleases investors  but calls into the question the flow of new blockbusters” according to

February is American Heart Month. The month also features Eating Disorders Awareness Week, Duchenne Muscular Dystrophy Awareness, and National Condom Week. It also feels like mobile health month. I’ll be speaking three times this month at meetings featuring mobile health themes, in very different venues. On February 8, the Health|Tech|Food event will be held at the Paley Center for Media in New York City as part of Social Media Week. I’ll set the stage at the meeting for mobile health, sharing my perspective on the role of social media and mobile health, and how together these can combine to address health

Women’s #1 priority is health and wellness. Wellness means taking care of herself, based on a survey of women by Saatchi Wellness.  Women are coming out of the recession with the modus operandi of a “me-covery,” according to Saatchi Wellness’s read on women’s attitudes about the economy’s impact on their wellbeing and health priorities among 800 women polled online in August 2010. The 5 elements of the “me-covery” for women are: To eat right. This doesn’t mean “diet;” it’s striking a balance and buying healthier, and more organic, food. People most negatively impacted by the economy are buying less fast food. To

While 8 in 10 U.S. adult internet users seek health information online, they’re not the people you might assume would take advantage of the opportunity to do so. This lightbulb moment is brought to you by the Pew Internet & American Life Project’s latest survey analysis,  Health Topics: 80% of internet users look for health information online. For example, while 2 in 3 U.S. adults with one or more chronic condition go online, only one-half of them are looking online for health information. Among the 54% of online adults with disabilities, only 42% of them seek health information online. Among the 88%

While 8 in 10 U.S. adults want a physician to have primary responsibility for the diagnosis and management of their health care, many people are not sure who’s a medical doctor. Surprisingly numbers of health consumers don’t think that orthopaedic surgeons, family practitioners, dermatologists, psychiatrists, and ophthalmologists are MDs. The American Medical Association‘s survey, Truth in Advertising, published in January 2011, follows up the AMA’s 2008 survey which had similar results.  Data based on consumers answering the question, “Is this person a medical doctor,” are organized in the chart. 90% of people say that a physician’s additional years of medical education

I’m talking today at the 2011 Annual PPO Forum held by the American Association of Preferred Provider Organizations (AAPPO) on the track called, “Technology Changing the Face of Health Care: What Does 21st Century Care Look Like?” It looks like consumers connecting for health, which is the topic of my discussion. People already DIY-many aspects of daily living online, from financial management through Schwab and eTrade online to buying travel via Priceline and shopping for shoes on Zappos. A growing number of health citizens are engaging with health online — way past the tipping point for health search online, as Susannah

An Explanation of Benefits (EOB) came in the U.S. mail yesterday. A plain piece of white 8.5″ x 11″ printed in tiny font with black ink, the logo of my health insurance company in the upper left of the form, and several lines of words and numbers showing me names of providers and facilities, dollar amounts billed, dollar amounts discounted, dollar amounts paid to the providers, and dollar amounts that were the patient’s responsibility — that would be me. The procedure was for a colonoscopy, for preventive screening and base lining for future reference. The good news: my colon looks just fine, and I’ll be reminded

If you don’t speak French and/or have aging eyesight, you might not understand the label on the medicine in the photo. When someone doesn’t understand the label placed on their prescription drug, they’re in a compromising position: this lowers health literacy and potentially endangers peoples’ health. As I monitor the tweets from today’s meeting of the Business Development Institute’s (BDI) Mobile Healthcare Communications conference, covering statistics and case studies about who’s using smartphones for accessing health information and how pharmaceutical companies can bolster adherence by developing mobile health apps, I’m struck by an important story in the health news that won’t get much coverage because it’s not about

The U.S. has few bright spots when accounting for global trade: we import much more than we export. Entertainment is America’s #1 export. After that, medical innovation shines. But the window on that lead is closing. 92% of Americans believe it’s important for the U.S. to be the global leader in medical innovation and research. And, most Americans believe the U.S. has been in a strong position in medical innovation, research and development, and technical innovation, especially for new cures and treatments for patients, and medical innovations that create jobs and drive economic growth; but a weakening position in science,

The theory behind “consumer-driven health care” is that when the health care user has more financial ‘skin in the game,’ they’ll become more informed and effective purchasers of health care for themselves and their families. That theory hasn’t translated into practice, based on data from the Employee Benefits Research Institute’s (EBRI) latest Consumer Engagement in Health Care Survey. Health Reimbursement Accounts (HRAs) began appearing in employer benefit packages around 2001, with Health Savings Accounts emerging in 2004. 20% of large employers (with >500 employees) offered either an HRA or HSA plan in 2010, covering 21 million people or 12% of

Caregivers identify the most helpful technologies that benefit them in providing care to family and friends as personal health record tracking, medication support, caregiving coordination, and monitoring and transmitting symptoms. These technologies are seen to help caregivers save time, make caregiving logistically easier, make the care recipient feel safer, reduce stress and enhance feelings of being effective. The most formidable obstacle preventing caregivers from adopting beneficial technologies is cost, followed by the technology not addressing the caregiver’s most pressing challenges, care recipient resistance to using the device, privacy issues, diminishing the care recipient’s sense of independence and pride. The National Alliance

1 in 2 people who use the internet to seek health information do so to self-diagnose; this is highest in China, US, UK, Russia, and Australia. Furthermore, health citizens in emerging economies including India, Russia, China, Brazil, and Mexico, may rely more on online health searches than people in developed countries. In these regions, health seekers face high costs of face-to-face visits with medical professionals. These global findings come out of the report, Online Health: Untangling the Web, from Bupa. Bupa is a health company based in the UK that serves 10 million members in 190 countries, and another 20 million

1 in 5 among all U.S. employers (22%) would likely drop health insurance coverage and let workers buy a plan through a health insurance exchange. However, most employers would expand wellness programs driven by incentives in health reform. Employers’ perspectives on the Affordable Care Act/health reform are mixed, according to a survey conducted by the Midwest Business Group on Health, co-sponsored by the National Business Coalition on Health, Business Insurance and Workforce Management. Not surprisingly, these views vary by whether the firm is large (>500 employees) or small. More large employers support the creation of Health Insurance Exchanges and would expand wellness services;

As household incomes in the U.S. have been, at best, stagnating in the past several years, the cost of health insurance premiums rose three times faster between 2003 and 2009. By 2015, the average premium for a family of four will reach nearly $18,000, according to The Commonwealth Fund. State Trends in Premiums and Deductibles, 2003-2009: How Building on the Affordable Care Act Will Help Stem the Tide of Rising Costs and Eroding Benefits from the Fund calculates that deductibles per insured person in the U.S. increased an average of 77% between 2003-09. In a related analysis, the Fund forecasts the

The one issue in health politics that’s got bipartisan support is health care IT. While Republicans in the House may try to pick away parts of the Affordable Care Act, the HITECH Act — part of the 2009 stimulus package formally known as the American Recovery and Reinvestment Act — will stay intact, according to most industry analysts (including me). However, political agreement doesn’t equal market adoption. So forecasting what 2011 will mean for health information technology requires some deeper analysis of additional issues. For today’s Health Populi, take a look at my annual health IT forecast in California HealthCare Foundation‘s

It will be A Day of Reckoning, 60 Minutes, the CBS News weekly program, called it. This is the impending economic collapse of U.S. state economies, caused by over-borrowing, pension accounting, lower tax revenues during the recession, expanding services, and Next to the housing collapse of the past few years, this may be the largest threat to the American economy, according to Meredith Whitney, a Wall Street analyst quoted in the story. Chris Christie, Governor of New Jersey, says this is, “not an income problem, it’s a benefit problem.” When we think benefits and States, we think health care — specifically,

Just over one-half of U.S. employers plan to maintain their health plans in 2014 even if health insurance exchanges (HIEs) offer competitive priced health plans for individual employee health coverage, according to a survey of 1,400 employers by Willis and Diamond Management & Technology Consultants. 1 in 3 employers is not sure whether they’ll maintain their own health plan or shift employees toward an HIE. The Health Care Reform Survey 2010 measured U.S. employers’ knowledge of the Affordable Care Act (ACA) and its expected impact on employers’ benefits. 9 in 10 employers (88%) believe that ACA will increase the costs of the health plans with

1 in 2 office-based physicians in the U.S. use any sort of electronic medical record (EMR) or electronic health record (EHR). However, only 10% of doctors have a fully functional EMR or EHR system. This means that the great majority of doctors currently using electronic records are not yet meeting meaningful use criteria as defined by the U.S. Department of Health and Human Services (DHHS). Physicians reported the computerized functions of their electronic records systems as part of the annual Centers for Disease Control‘s (CDC) National Ambulatory Medical Care Survey (NAMCS). The chart illustrates the good news: that every year since 2003, U.S. physicians are

During the latest economic recession in the U.S., the growth in the number of the health-uninsured was greater for white people and native-born citizens than for others in the nation. At the same time, the erosion of employer-sponsored health insurance continued. The 2007-09 Recession And Health Insurance Coverage, published in Health Affairs in December 2010, analyzes data from the Census Bureau focusing on “health insurance units” in the U.S.: these are defined as nuclear families in the U.S. who can be covered under one insurance policy–the policyholder and his/her family members. The chart incorporates data from the Health Affairs article, as well

Exactly one year ago, health care companies, online portals (from Google to health advocacy sites), and advertising agencies serving the health industry convened in Washington, DC, to voice their positions to the Food & Drug Administration (FDA) concerning pharmaceutical promotion and social media. It was such a monumental meeting that a tweetstream was initiated at the event that has been ongoing for the past year at #FDASM on Twitter. Why would hundreds of individuals collectively spend thousands of hours airing their arguments, pro and con, on the issue of how pharmaceutical companies promote their products and services online? “The drug industry

In a nation where ‘no child left behind’ has been a mantra, it’s clear that in the U.S., many children are left behind when it comes to health. UNICEF’s Report Card #9 is out from the Innocenti Research Centre, providing the league table for child well-being in the world’s 24 richest countries. In health inequality — that is, the gap between kids who have ‘average’ well-being in the U.S. and those who fall below — the U.S. ranks #22 among the 24 wealthiest nations in the world. While an educated guess might put U.S. kids’ health inequality below Switzerland, Norway, and Denmark,

The majority of Americans generally like the idea of remote home monitoring for health. 3 in 5 adults (62%) across all age groups say communication with doctors via home monitoring devices would improve their health. However, only 35% of people age 65 and over are interested in home health monitoring. Interest in remote home health monitoring decreases with age. The disconnect is that 90% of Americans age 65 and older have at least one chronic health condition, according to the Centers for Disease Control. Practice Fusion commissioned a survey from GfK Roper in November 2010 through the GfK Omnibus survey among 1,008 adults

“The impending Medicaid expansion will be the single biggest change in the program since its inception in 1965,” according to an analysis in the New England Journal of Medicine dated November 24, 2010. The Patient Protection and Affordable Care Act (PPACA, or ACA for short) will newly-insure 32 million Americans through dual strategies of (1) mandating uninsured people to buy into a health plan, via subsidies and health insurance exchanges; and, (2) expanding Medicaid to cover uninsured people with lower incomes. The CBO estimates that each of these tactics will add 16 million, for the total of 32 million people entering insurance plans

Trading down is the spending ethos among American consumers in 2010: will shoppers’ frugality persist? That’s the question explored by Strategy& (formerly Booz and Company) in their survey, which begs, Forever Frugal? 2010 U.S. Consumer Survey Confirms Persistent Frugality. The firm points out that while the recession officially ‘ended’ in September 2009, most consumers don’t behave bullish in shopping matters 14 months later. In the post-recession shopping ethos, more consumers have traded down to store brands and generic labels, buying through the value-maximizing lens. “On average, consumers continue to economize everywhere — they are buying fewer discretionary items,” as detailed in the

Most caregivers involved with home care services would be inclined to dialogue with other caregivers in an online forum or social networking site, according to a  survey, How the Web and new social media have influenced the home care decision-making process, from Walker Marketing, Inc. Furthermore, 91% of caregivers would be likely to conduct research after receiving a provider referral by a professional source; while 78% would rely on a physician for recommendations, caregivers ultimately make their own decisions on long-term care providers. Websites are generally considered highly credible by caregivers, and are important sources of information for engaged caregivers on sources

While two-thirds of American adults use the internet (including social media) to seek health information, only 11% use a pharmaceutical company website most often. It is intriguing that 2 in 3 adults who seek information about health care online are looking for information on illnesses and conditions from a pharmaceutical company. But the pharma company website isn’t the top-of-mind, go-to place. In fact, 2/3 of health citizens whose households use prescription drugs say their trust in medications is not heavily influenced by advertising by pharmaceutical companies.  These insights into the new pharmaceutical consumer come out of The Evolving  Consumer and The

In the wake of last week’s mHealth Summit in Washington, DC, there’s yet another bullish forecast on mobile health to consider. The Promise of Mobile Health asks the tagline question: “Bigger than DTC?” Euro RSCG’s Life 4D group, published the paper in November 2010. Survey data in the report followed up its October 2009 digital health survey in September 2010 among 502 American adults. Euro RSCG rightly points out that consumers’ health needs are 24×7: “they take their healthcare needs with them.” The firm believes that the biggest barrier to wider consumer adoption of mobile health is the low penetration of “suitable mobile devices among consumers.” The report’s survey

6 in 10 U.S. households connected to the Internet via broadband in 2009, rising from 9% in 2001. In the U.S., the gap in the adoption of broadband between lower-income households and higher-income people is 33% — 61% of people with $25,000 to $50,000 household income connect to the Internet at home via broadband; that proportion is 94% for households with over $100,000 a year. Adoption gaps in broadband persist in the U.S. based on income, urban/rural location, race, education, and level of disability. Differences in socio-economic and geographic characteristics explain much of the broadband adoption gap associated with disability

At least one-third of American adults use social media for some aspect of health. Most seek health information online, and increasingly via mobile platforms. While many physicians engage in social networks on a peer-to-peer basis in Sermo and Ozmosis, among others, most physicians have avoided social networks where their patients and health citizens interact. The American Medical Association (AMA) released guidelines to help physician members enter the social media fray. There are five areas of recommendations: Protect privacy: using settings to protect personal information and content on social networking sites Monitor internet persona: routinely monitor presence on the internet to ensure that information is accurate

Virtually every primary care doctor in Denmark uses an electronic medical record. Danish health citizens can access their laboratory results, medication profiles, waiting list information, and other information through a digital signature: over 1 million of 5.5 million Danes have done so.   This week, I had the honor of kicking off the online health track at the J. Boye 2010 conference in Aarhus, Denmark. I spent time with an HIT guru from a major Scandinavian university hospital; a member of the Danish public sector HIT organization; marketers from the pharmaceutical industry; an entrepreneur building a portal for the growing private health sector to bring transparency of quality,

I find myself in London, England, on November 2, 2010, for a week of business in two European nations that extend universal health care to their citizens: the UK and Denmark. The Hill’s Healthwatch blog writes today that, “House Republicans will bring early vote on repeal of health reform.” Haley Barbour, head of the Republican Governors Association, exclaimed, “I think if [Republicans] don’t fully repeal and replace it, they will make such big changes in it over the next three years that you won’t recognize it.” Here in the UK, the Guardian newspaper published a column opining that, “At a macro level,

If you thought the percentage of annual medical inflation in the U.S.  was high at 3.7% in September 2010, hang on to your wallets: the cost of long-term health care in America is increasing even faster than medical costs every year. Assisted living costs increased 5.2% between 2009 and 2010, and the cost of a private room in a nursing home grew 4.6%. If you live in Alaska, you’re particularly hard hit if you need long-term care: the highest rate for a semi-private nursing home room in that Last Frontier state is $610 for a semi-private room and $687 for a

When four self-described health activists share their personal stories in the same physical (not virtual) room at the same time, in real time, it’s an exponentially moving and learning moment. WEGO Health convened a Socialpalooza event (#socialpalooza on Twitter) this week where an influential handful of health activists met face to face with some people who work in health industries. The result was a fruitful dialogue where both empowered patients and the suppliers who research, develop and market products serving those patients, learned a lot from each other. These Four Musketeers of health activism included  Alicia Staley (@stales on Twitter), who passionately shares her hard-won experiences in beating

Medical drug benefits meet doctors and their patients via mobile platforms: that’s the prescription for a retail health care experience with the consumer’s checkbook in mind, brought to you by Walgreens pharmacy and Epocrates, the #1 most widely-used mobile drug information source among U.S. physicians. In this offering, Walgreens will channel its discount formulary information through Epocrates’s mobile application. About 300,000 U.S. physicians use the Epocrates drug database for prescription information. These users will be able to use Epocrates to check a Walgreen PSC member’s formulary profile against the prescription drugs the doctor is considering. At that point-of-prescription, the doctor can have a conversation with

Low income is a risk factor for poor health in America, as quantified by the Gallup-Healthways Well-Being Index. While this finding isn’t news on its own, the health disparities between wealthy people (over $90K a year) and those with low incomes (under $24K a year) are growing. The most prevalent disparities between rich vs. poor Americans are for depression, diabetes, and high blood pressure — driven in part by a nearly 50% difference in the proportion of the poor who are obese — 32% vs. 22% of the wealthy. Cancer, too, appears more common in people with lower incomes, based

Prescription drug formularies are getting more complex to drive cost-savings as well as promote adherence to drug regimens, as told by the data in the 2010-2011 Prescription Drug Benefit Cost and Plan Design Report, sponsored by Takeda Pharmaceuticals NA. The average rate of drug cost increases is 6.3%, compared to 4.4% in the 2009-2010 survey — the lowest rate of increase since this survey was launched. A key part of the story of the new value-based benefit design is told by the co-payment differentials for Rx drugs, shown in the chart. Health consumers who have three-tiered prescription drug insurance face an

Contrary to stereotypes, older people can adapt, learn, and use new products and services. The introduction of Medicare Part D five years ago was an experiment in public policy, with some policymakers fretting about seniors’ ability to navigate a new system. It appears Medicare Part D is a hit, and people are working well with it across gender, age cohorts, incomes (from very low to upper-income strata), educational levels, and especially very sick and disabled people. Among all seniors, 90% have prescription drug coverage. 61% of U.S. adults 65 and over have a Medicare prescription drug plan, 16% are covered by an employer-sponsored

Sex, drugs, rock and roll, Victoria’s secret bras manufactured with formaldehyde, motivating kids to move about more, and texting potential sex partners your latest STD test results: the 2010 Health 2.0 Conference in San Francisco was more about real, whole health and the person-patient than about cool new tech. Furthermore, the Health 2.0 Conference turned a lot of preconceptions on their head on October 7 and 8, 2010, in a standing-room–only ballroom at the Hilton Union Square. Who could have predicted that government employees would light the room up with high energy and innovative thinking more than a panel of illustrious

The $N zillion question – whether translated into Euros, yen, pounds, lira, or pesos – is how to get more quality care and access in national health systems, while curbing health spending. Health costs have increased faster than economic development in nearly all OECD countries in the past 15 years. For the acronym-challenged, the OECD is the Organization of Economic Cooperation and Development – comprised of, generally, the most economically developed nations on Earth. This week, health maestros from OECD nations are meeting to wrestle this intractable challenge. Health costs consume about 9% of OECD countries’ budgets. This proportion of national GDPs

Medical costs will grow between 10% and 11% in 2011, depending on whether an enrollee is opting for a PPO (11%), a POS (11.2%) or an HMO plan (10.2%). These growth rates are similar to 2010 increases, with the largest percentage growth projected for point-of-service plans from 10.6% in 2010 to 11.2% next year. These cost increases are roughly eight-times inflation in the consumer price index (CPI), gauged at 1.2% in July 2010 for urban consumers. The 2011 Segal Health Plan Cost Trend Survey reflects additional costs the benefits consultants that plan sponsors will incur to comply with the Affordable Care

The ePatient Connections (ePC) conference convened this week in the City of Brotherly Love, my town, Philadelphia. And indeed, the eHealth love did flow between health citizens and organizations that seek to serve them: technology developers and health providers, alike. My flying fingers recorded nearly fifty pages of notes, and these don’t even include two tracks’ worth of presentations — social networks in health and health games — because I was the emcee for mobile health track. However, this gave me the opportunity to get to know the 11 mHealth presenters and their organizations up-close-and-personal and to brainstorm with track attendees

People in the U.S. covered by employer-sponsored health insurance assess their health insurance choices with the help of their human resource departments. Here, Blondie and Dagwood are having a discussion about three alternatives: A low cost plan A higher cost plan with better coverage A high-deductible health plan for doctors who are outside of the plan’s network. Dagwood’s solution? “Stay healthy.” Would that it were so easy! Evaluating health insurance options is no simple task, even for the savviest, Consumer Reports-reading consumers. Health citizens who want to engage as health care consumers look for trusted sources on how to make rational

Cost-competitiveness is driving overall consumer satisfaction with pharmacies in 2010, 2.5 times the importance that cost had in 2009. But even so, customer service and convenience still trump price in the pharmacy. For brick-and-mortar pharmacies, the key factors driving consumer satisfaction are: Prescription order and pick-up process (convenience) The condition of the store Cost competitiveness Non-pharmacist staff The pharmacist. In 2010, cost competitiveness accounts for 24% of overall satisfaction among brick-and-mortar Rx shoppers; that number was 9% in 2009. The retail pharmacy chains garnering highest satisfaction nationally are the Good Neighbor Pharmacy, Health Mart, and The Medicine Shoppe Pharmacy, all awarded

The U.S. has among the lowest tax-to-GDP ratios in the developed world, including state and local taxes. Only Mexico, Turkey and Korea have lower tax-to-GDP ratios among OECD members, at somewhere between 20 and 28%. The Organization for Economic Cooperation and Development (OECD) believes that U.S. tax rates are, in fact, too low and, even with modest tweaks upward, “would still keep the overall tax burden at a relatively moderate level and not impose excessive costs,” OECD states in its Economic Survey of the U.S., released today. “Tax breaks have grown significantly since the major tax reform of 1986,” the report notes, and