HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

A Member of the Law Professor Blogs Network

Tuesday, October 16, 2007

Annual Check-Ups Overrated

It turns out those annual visits to your doctor are actually not that helpful.  According to an article in the Chicago Tribune

 

     Your doctor probably knows it. Medical organizations certainly do. But most  patients have no idea.  The annual physical examination -- that encounter when a physician looks in your throat, listens to your heart, pokes your abdomen, checks your reflexes and tests your blood -- is no longer a generally recommended medical practice. That's because there is scant scientific evidence showing that yearly checkups help prevent disease, death or disability for adults with no symptoms. Many tests and procedures performed during the visits have questionable value, experts say.

Instead of an annual physical, healthy adults should undergo a much-streamlined exam that's focused on prevention every one to five years depending on a person's age, sex and medical profile, the American College of Physicians and other professional groups suggest.

Men and women see physicians more frequently for yearly medical checkups than for any other reason, at a cost of $7.8 billion a year in the U.S., close to the $8.1 billion spent on breast cancer care, according to a recent report in the Archives of Internal Medicine. The figure reflects the strong attachment to this entrenched medical tradition felt by patients and doctors.  "There's a feeling of well-being you get from having your doctor look you over and pronounce you in good health," said Andrew Griffo, 48, a financial adviser who lives in Park Ridge and schedules a physical every year.  Largely out of public sight, however, the medical orthodoxy that all adults should undergo a comprehensive annual medical review to detect potentially significant clinical abnormalities has been under scrutiny since the 1970s. 

Experts' concerns revolve around two components of the traditional checkup: the comprehensive physical exam and an extensive battery of tests checking a person's blood, urine, thyroid and heart. (A third component, an updated patient history, hasn't prompted the same scrutiny.)   . . . .

Some believe that for many patients an annual checkup may not be needed at all. In fact, the new Archives of Internal Medicine study found most patients receive the bulk of recommended preventive care -- such as counseling about weight or blood-pressure checks -- not during physicals but on other occasions, such as when they see doctors about a cold or a chronic condition like diabetes.  The report also estimates that, a third of the time, routine physicals become an occasion for unnecessary tests such as electrocardiograms, boosting medical bills by more than $350 million and contributing to soaring medical expenses.

There's good reason to ask "whether the time and resources being spent are worth it," said Dr. Ateev Mehrotra, the study's lead author and assistant professor at the University of Pittsburgh School of Medicine.

Thanks to Ezra Klein for the link.

October 16, 2007 | Permalink | Comments (0) | TrackBack (0)

Reproductive Health Website

Here is a helpful reproductive health website.

October 16, 2007 | Permalink | Comments (0) | TrackBack (0)

Myths about SCHIP

Here is a nice run-down about some of the truths and myths about the SCHIP program from the folks at Families USA and Firedoglake:

FamiliesUSA has put out a mythbusting fact sheet about SCHIP, a sad and tragic necessity in the wake of the abject lies told by the President of the United States and those who get off licking his shoeleather. To wit:

Claims by the President that this bill raises the CHIP eligibility level to $83,000 (400 percent of the federal of the poverty level) in annual income are unambiguously false. There isn’t a single state in the country with such a high eligibility level. One state, New York, wanted to set the eligibility standard at that level, but its request to do so was denied by the Administration.

I’m also fond of the newfound sense of fiscal responsibility espoused by George Bush, who now says we simply can’t afford that kind of expenditure if it’s kids’ lives on the line instead of, say, nuclear warheads.

October 16, 2007 | Permalink | Comments (0) | TrackBack (0)

Monday, October 15, 2007

Republicans for Health Care Reform

Republicans have moved toward promoting a form of health care reform according to the politico.com

Under fierce attack by Democrats over the children’s health insurance plan, House Minority Leader John A. Boehner said Sunday Republicans will unveil their own health care plan over the next few months.

“Republicans are working on a plan that will provide access to all Americans to high quality health insurance, make sure that we increase the quality of insurance that we have in American, and we want to foster a sprit of innovation,” said Boehner on “Fox News Sunday.” “This is a plan we’ll see over the next coming months where we put the patients in charge of their health care.”

Republicans have taken a beating on SCHIP, the $35 billion measure that would expand health insurance for children. The fight quickly turned nasty as Democrats ran campaign ads attacking Republicans who voted against the bill in their home districts.

Should be interesting to see what both parties come up with for health care reform.  Perhaps we might actually see some movement toward more coverage for all.

 

October 15, 2007 | Permalink | Comments (0) | TrackBack (0)

Sunday, October 14, 2007

Smaller Class Sizes and Health

Slate.com has an interesting article discussing the impact of class size on elementary school children's health:

This week, Dr. Sydney Spiesel discusses a potential link between smaller elementary school class sizes and better health, a safer way to give painkillers, and treatments for ADHD.

Smaller classes, better health?

Question: An extraordinarily provocative article in this month's American Journal of Public Health ties together two seemingly unrelated phenomena: the size of school classes and the health of students. Could smaller class sizes be a good investment not only for educational reasons but for medical ones?

New study: Peter Muennig of the Columbia University School of Public Health and Stephen Woolf of Virginia Commonwealth University in Richmond drew their data from Project STAR, which began in 1985 and randomly assigned almost 12,000 Tennessee kids to classes of different sizes in kindergarten through third grade. Some of the kids were in classes of 22 to 25 students, and others were in classes of 13 to 17 students. Teachers were also randomly assigned. The children were then tracked to determine the effect of class size on educational attainment.

Model: The educational effects were considerable. Now Muennig and Woolf are making use of the findings in a whole new way. They used Project STAR's statistics about educational attainment to build a computer model of a hypothetical group of 5-year-olds exposed for four years to small classes (of 13 to 17) and then followed until the age of 65. The researchers calculated projected earnings, welfare payments, and crime costs based on what we know about the relationship between these outcomes and educational attainment. They also drew on statistics relating degree of education to quality-of-life scores and age-specific mortality. And they accounted for the cost of maintaining smaller class sizes.

Findings: Based on their model, the authors project that reductions in class size would generate a lifetime net cash return of almost $200,000 (presumably in the form of taxes collected) for each additional low-income student who graduates from high school as a result of early placement in a small class. In addition, they project that four years of small classroom size will lead to improvement in health and longevity. These benefits, they calculated, would on average add up to the equivalent of an additional 1¾ years of life in perfect health.

Conclusion: It's important to point out that these numbers are based heavily on assumptions that might not hold true for the future or for places outside Tennessee (kudos, by the way, to that state for supporting this bold experiment). But these are plausible assumptions, at least. And the numbers they generate are astonishing, because they suggest that investment in reducing elementary school classes is better, in cost-benefit terms, than money spent on antibiotics, or hospital buildings, or even vaccines (long thought to be one of the most cost-effective interventions for health care). Perhaps I would do better for my patients if I gave up pediatrics and became a member of my local school board.

October 14, 2007 | Permalink | Comments (0) | TrackBack (0)

Our Teeth and Our Health Care System

Frank Pasquale at Concurring Opinions has some observations about our teeth and the state of our health care system.  He writes,

What is the future of American health care?  Many believe that we need less reliance on government funding.  The current state of American dentistry suggests the likely consequences of such a move--along with the imbalances caused by "marketization" that focuses on the demand side while neglecting a cartelized supply side.

As social stratification deepens, ever more sophisticated cosmetic dentistry becomes the norm for the wealthy.  Meanwhile,

[M]any poor and lower-middle-class families do not receive adequate care, in part because most dentists want customers who can pay cash or have private insurance, and they do not accept Medicaid patients. As a result, publicly supported dental clinics have months-long waiting lists even for people who need major surgery for decayed teeth.

[E]ven as so many patients go untreated, business is booming for most dentists. They are making more money while working shorter hours, on average, even as the nation’s number of dentists, per person, has declined.

***

Even if more students wanted to enter the profession, states are not moving aggressively to expand dental schools or open new ones. Training dentists is expensive, because dental schools must provide hands-on training — unlike medical schools, which send doctors to hospitals for training after they graduate. Hospitals receive federal subsidies for the training they provide to medical interns and residents, but the equivalent system does not really exist in dentistry. Meanwhile, the A.D.A. does not support opening new dental schools or otherwise increasing the number of dentists. The association says it sees no nationwide shortage of dentists . . . .

So while the doctors' lobby has finally acknowledged the need for more medical schools, the dental lobby is holding a hard line.  One key question: is the problem that Medicaid underpays dentists, or the state's failure to assure the training of enough dentists? Consider the hard line the dental lobby takes against the allied health professions:

Despite the rise in dental problems, state boards of dentists and the American Dental Association, the main lobbying group for dentists, have fought efforts to use dental hygienists and other non-dentists to provide basic care to people who do not have access to dentists.

***

"What we’re extremely uncomfortable with is that they need to drill teeth and sometimes extract teeth,” said . . . the association’s president. Use of therapists would create a two-tier system where some people have access to dentists, while others must settle for less-qualified practitioners, she said.

The entire post is an interesting and thought-provoking read with a number of potential solutions discussed to the problem of physician shortages.

October 14, 2007 | Permalink | Comments (0) | TrackBack (0)

Thursday, October 11, 2007

Medicaid Enrollment Drops

ThinkProgress reports on a drop in Medicaid enrollment.   The story states,

Enrollment in Medicaid, the public health insurance program for our most vulnerable population, declined in 2006 for the first time in nearly a decade. A new report by the Kaiser Family Foundation finds that enrollment growth among the elderly and disabled was 40 percent less in 2006 than it was in 2005. Additionally, the number of children and parents enrolled in Medicaid decreased by 113 percent during this same period.

While this decline is in part due to two positive factors — an improved economy and low unemployment — another factor is at play: the conservatives’ cumbersome new regulation requiring proof of citizenship and identity when applying for Medicaid coverage.

This law was enacted in large part to prevent undocumented immigrants from enrolling in public programs such as Medicaid illegally even though evidence showed that illegal enrollment of undocumented immigrants into the program is not a problem.

What the law has done, however, is caused a drop in enrollment of eligible individuals. Reports are showing that the new rules have “contributed to slower enrollment growth in fiscal year 2007 and caused significant delays in processing applications and increased the administrative burdens placed on states” and individuals. . . . .

October 11, 2007 | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 10, 2007

Quality of Children's Health Care

McClatchy News reports on a study in the latest issue of the New England Journal of Medicine discussing the quality of childcare in the United States.  It writes,

In the largest study of its kind, researchers found that America's children received appropriate medical care only 46 percent of the time when they visit health professionals, faring even worse than adults and raising serious questions about the quality of care delivered by the world's most expensive health system.

The study, to be published in the Oct. 11 issue of the New England Journal of Medicine, was conducted by the RAND Corp., the Seattle Children's Hospital Research Institute and the University of Washington School of Medicine.

It followed the health care experiences of 1,536 children from 12 metropolitan areas over a four-year period. By interviewing the youngsters' parents, reviewing the children's medical records and comparing their treatments to established care standards, researchers found that even basic care was a hit-or-miss proposition for children who visit hospitals and pediatricians.

The study found only 19 percent of seriously ill infants with fevers had the right lab tests done, only 44 percent of youngsters with asthma were on the right medications and only 38 percent of youngsters were screened for anemia in their first two years of life.
In addition, only 31 percent of children ages 3-6 have their weight measured at  annual checkups.

Failure to provide proper care makes it harder to reverse illnesses and increases the chance that youngsters will carry health problems into adulthood. "How do we catch a child at risk for obesity if we don't look," said co-author Dr. Rita Mangione-Smith, an associate professor of pediatrics at the University of Washington School of Medicine.

The results are surprising, not least because most of the youngsters in the study were white, middle-class and had health insurance.  "These are the kids who most people assume are getting excellent care in this country, and unfortunately they're not," Mangione-Smith said. 
Ironically, the study's dearth of low-income and ethnically diverse youngsters likely skewed the final data, resulting in an "overly rosy" picture, Mangione-Smith said.

The entire McClatchy piece provides a good overview of the study printed in the NEJM (free full text article available).

October 10, 2007 | Permalink | Comments (0) | TrackBack (0)

Suspensions over Sneaking Peek at Clooney's Medical Records

Oops!  Those darn medical privacy laws - how are people supposed to get good gossip.  Huffington Post reports on recent suspensions at the hospital that treated actor George Clooney after his recent motorcycle accident.  These suspensions result from from allegedly peeking at Mr. Clooney's medical records.  Huffington Post states,

WCBS-TV in New York reported Tuesday night that as many as 40 staffers, including doctors, were suspended without pay, accused of accessing Clooney's medical records and possibly providing information to the media, a violation of federal law.  The Jersey Journal of Jersey City reported that 27 employees, but no doctors, had been disciplined, and only for looking at the records without authorization.

The investigation was not prompted by a complaint from Clooney, who said he only learned of it on Tuesday.  "This is the first I've heard of it," Clooney said in a statement. "And while I very much believe in a patient's right to privacy, I would hope that this could be settled without suspending medical workers."

A spokeswoman for the union representing some of the workers said they had been suspended without pay for four weeks.  "We believe this is a harsh penalty and an overreaction," said Jeanne Oterson, a spokeswoman for the Health Professionals and Allied Employees union, adding that a grievance could be filed pending further investigation.

Eurice Rojas, the hospital's vice president of external affairs, told The Jersey Journal that hospital officials do not believe any employees leaked Clooney's medical information, but some staffers did improperly access his records.  Federal law mandates that only direct caregivers _ including doctors, nurses, technicians and support staff involved in a patient's care _ see such information.

October 10, 2007 | Permalink | Comments (0) | TrackBack (0)

Tuesday, October 9, 2007

A Day in the Life - Without Government

Ezra Klein points to a website by Douglas J. Amy, Professor of Politics at Mount Holyoke College, which examines how the government provides assistance to individuals everyday.  Here is a brief section from his Government is Good blog: 

Ask yourself this question: “What has government done for me lately?” If you are like most Americans, you will probably answer: “Not much.” Surveys show that 52% of Americans believe that “government programs have not really helped me and my family.”1 But let’s see if that is really true. Let’s examine a typical day in the life of an average middle-class American and try to identify some of the ways that government improves that person’s life during that 24 hour period.

6:30 a.m. You are awakened by your clock radio and listen for a few minutes to the news before getting up. But you can listen to your favorite station only because the Federal Communications Commission brings organization and coherence to our vast telecommunications system. It ensures, for example, that radio stations do not overlap and that stations signals are not interfered with by the numerous other devices – cell phones, satellite television, wireless computers, etc. – whose signals crowd our nation’s airwaves.

6:35 a.m. Like 17 millions other Americans, you have asthma. But as you get out of bed you notice that you are breathing freely this morning. This is thanks in part to government clean air laws that reduce the air pollution that would otherwise greatly worsen your condition.

6:38 a.m. You go into the kitchen for breakfast. You pour some water into your coffeemaker. You simply take for granted that this water is safe to drink. But in fact you count on your city water department to constantly monitor the quality of your water and to immediately take measures to correct any potential problems with this vital resource.

6:39 a.m. You flip the switch on the coffee maker. There is no short in the outlet or in the electrical line and there is no resulting fire in your house. Why? Because when your house was being built, the electrical system had to be inspected to make sure it was properly installed – a service provided by your local government. And it was installed by an electrician who was licensed by your state government to ensure his competence and your safety.

6:45 a.m. You sit down to breakfast with your family. You are having eggs – a food that brings with it the possibility of salmonella poisoning, a serious food borne illness affecting tens of thousands of Americans every year. But the chance of you getting sick from these eggs has now been greatly reduced by a recently passed series of strict federal rules that apply to egg producers.

7:00 a.m. You go into your newly renovated bathroom – one of a number of amenities that you enjoy in your house. But the fact that you can even own your own house is something made possible by government. Think about this: “ownership” and “private property” are not things that exist in nature. These are legal constructs: things created by laws that are passed and enforced by government. You couldn’t even buy your home without a system of commercial laws concerning contracts and a government that ensures that sales contracts are enforced. So the fact that you live in your own home is, in part, a benefit of government and the rule of law.

October 9, 2007 | Permalink | Comments (0) | TrackBack (0)

Website Accessibility

Last week, a federal judge permitted a class action lawsuit to proceed against Target Corporation that concerns the lack of access by the blind to its website.  Reuters reports,

According to the lawsuit, plaintiff Bruce Sexton, a California resident, uses screen reading software to access the Internet but has been unable to use certain features of Target's site. The software vocalizes text and describes the content of the Web page. The plaintiffs, including the federation, say redesigning the Target site to be readable by blind people would be technologically easy and not economically prohibitive.

Minneapolis-based Target said in a statement that it was disappointed that the judge had granted class-action status to the case, but said the decision was a procedural ruling only.  "We will request an immediate review of the ruling granting class certification and we are confident that we will prevail on the merits of this case," the company said. . . .  In the decision, the judge said that after the lawsuit was filed, Target has made some modifications to its Web site to make it more accessible to the blind. . . .

The case was filed in February 2006. The court threw out a portion of the suit in September 2006, dismissing the plaintiffs' claims to the extent that they are based on Web site features that were unconnected to the physical stores.  Martin Wymer, a partner at law firm Baker & Hostetler LLP who represents companies in litigation matters, said that other retailers are likely taking a hard look at the accessibility of their Web sites.  In addition to trying to avoid lawsuits, "there's a business benefit from opening up your doors to that many more customers," he said.

The case is:  National Federation of the Blind v. Target Corp., 2007 WL 2846462
(N.D.Cal.,October 2, 2007).

October 9, 2007 | Permalink | Comments (0) | TrackBack (0)

Monday, October 8, 2007

Nobel Prize for Medicine Awarded to Gene Researchers

NPR.org discusses the winners for the 2007 Nobel Prize for Medicine:

Two American scientists and a British researcher share this year's Nobel Prize in Medicine or Physiology for devising the tools to figure out what individual genes do and how to fix them.

Mario Capecchi of the University of Utah, Oliver Smithies of the University of North Carolina and Sir Martin Evans of Cardiff University in Wales will share the $1.5 million prize this year.

The Nobel Committee says these scientists laid the groundwork for the main work in biology today: figuring out what each of the 30,000 human genes does. Capecchi invented a way to target single genes and turn them off to see what they do. Smithies used gene targeting to correct defective genes. Evans showed that embryonic stem cells can integrate corrected genes into living animals.  Together, these techniques are a big reason why scientists are so excited about the potential for embryonic stem cell research to cure a wide range of human ailments.

October 8, 2007 | Permalink | Comments (0) | TrackBack (0)

Daily Show on the SCHIP Veto

Ok, I promise to stop always posting on the SCHIP issue after this (at least until we find out what Congress plans to do with the veto) but here is Jon Stewart of the Daily Show discussing the veto.

October 8, 2007 | Permalink | Comments (0) | TrackBack (0)

Law School Musical

Just for fun - here is a creative take on the law school experience.  Unfortunately, I don't think that Disney plans to pick this up and make a full fledged movie/musical.  I am not sure that it would appeal to the masses.  Thanks to Professor Caron at TaxProfBlog for the link.

October 8, 2007 | Permalink | Comments (0) | TrackBack (0)

Sunday, October 7, 2007

Medicare Cheats

The New York Times has a front page story about some problems in the administration of the Medicare Part D program.  It reports,

Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.

The problems, described in 91 audit reports reviewed by The New York Times, include the improper termination of coverage for people with H.I.V. and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.

Medicare officials have required insurance companies of all sizes to fix the violations by adopting “corrective action plans.” Since March, Medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits.

The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and Wellpoint. 

The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications.

The article discusses some typical problems found in the audits:

¶UnitedHealth, which serves more than six million Medicare beneficiaries, did not have an “effective program” to supervise its marketing representatives, agents and brokers. In some cases, United improperly denied claims without giving any explanation to beneficiaries. Peter L. Ashkenaz, a company spokesman, said, “We terminated a few agents and brokers for misrepresenting our products.”

¶WellPoint, one of the nation’s largest insurers, had “a backlog of approximately 354,000 claims” at certain Medicare plans offered through its UniCare subsidiary. The company’s call center took an average of 27 minutes to answer phone calls from its members and 16 minutes to answer calls from health care providers. More than half the callers hung up before speaking to a company representative. Karen Brown, a spokeswoman for WellPoint, had no immediate comment.

¶In March, Sierra Health Services ended drug coverage for more than 2,300 Medicare beneficiaries with H.I.V./AIDS, saying they had not paid their premiums. In many cases, the premiums had been paid, and beneficiaries had canceled checks to prove it. Sierra initially refused to reinstate them, but eventually agreed to do so after repeated requests from federal officials. Peter O’Neill, a vice president of Sierra, said this particular drug plan, which attracted people with very high drug costs, would not be offered in 2008.

¶Humana, which covers more than 4.5 million people on Medicare, promised to investigate every complaint about its marketing practices, but it received so many complaints that it could not keep up. Many beneficiaries said they had received incorrect information from Humana agents. Medicare officials said some agents had not been adequately trained or supervised. Thomas T. Noland Jr., a senior vice president of Humana, said the company had taken “corrective action to improve the situation.”

¶Humana did not always tell beneficiaries about changes in its list of covered drugs. In some cases, Humana did not explain its reasons for denying claims and did not inform beneficiaries of their appeal rights.

¶The Sterling Life Insurance Company, a subsidiary of the Aon Corporation, did not pay claims correctly or handle appeals in a timely way. The company has “a demonstrated pattern of failure” to meet Medicare performance standards. Problems were compounded by a rapid growth in enrollment. Sterling said it had taken steps to improve compliance.

¶Two sponsors of popular Medicare drug plans, MemberHealth and Bravo Health, did not act on requests for coverage of specific drugs within 72 hours, as required by the government. Bravo did not comply with federal rules requiring doctors to review all claims denied for a “lack of medical necessity.”

Chris in Paris, writing at Americablog asks a good question, "Why are these companies even allowed to continue doing business with the US government? If they are cheating the US government and cheating their customers, cut them off completely. Let them round up business elsewhere, but of course, they love working with the government and raking in government money so they won't be going anywhere. They all may talk about the fear of national health care, but in a hybrid public-private system (as in France) they do just fine and still make healthy profits. Cut these companies out of government contracts for five years,  . . . make it two or even one year, and let's see how they react. I'd be able to hear the screaming and crying all of the way over here in Paris. If only someone would stand up to these America-hating businesses."

October 7, 2007 | Permalink | Comments (0) | TrackBack (0)

Friday, October 5, 2007

Infant Mortality Rates Compared

The New York Times reports on disparities in infant mortality rates around the New York city area.

The  infant mortality rate, a general barometer for public health which measures the number of children who die before age 1, was 12.5 deaths per thousand in 2006 and 11.3 deaths per thousand from 2004 to 2006 in Brownsville. Other communities with persistently high infant mortality from 2004 to 2006 include Jamaica East (9.1 per 1,000) and Central Harlem (7.9 per 1,000).

Over all, the city rate fell to to 5.9 infant deaths for every 1,000 births, down from 6 the previous year. It is lower than the national rate, which was 6.8 per 1,000 births from 2004 to 2006, the most recent number on record. In recent decades, the infant mortality rate has been decreasing across the country. However, in the last two years, progress has stalled in the Deep South.

The districts with the lowest rates are the Lower West Side (2.6 per 1,000), Kips Bay-Yorkville (2.9 per 1,000), and Sunset Park (3.2 per 1,000).

From highest to lowest, the infant mortality rates of the five boroughs in 2006 are the Bronx (7.1 per 1,000), Brooklyn (6.0 per 1,000), Queens (5.3 per 1,000), Manhattan (4.2 per 1,000) and Staten Island (3.4)

A troubling and persistent phenomenon over the last decade is that infant mortality rates for black and Puerto Rican New Yorkers are more than double those for whites and Asians — a gap persists even when poverty is factored out. Infants born to higher-income black women died at nearly three times the rate of those born to higher-income white women.

Academics have sliced race and infant mortality relationship in a variety of lenses — historicalsocioeconomic distress and even the impact of the New Deal. Some experts believe the stress of experiencing of racial discrimination may affect the health of black women.

October 5, 2007 | Permalink | Comments (0) | TrackBack (0)

Responses to SCHIP Veto

No one seems to be too happy with the Presidential Veto of SCHIP.  Paul Krugman takes a dim view of the matter.  He states,

On Wednesday, President Bush vetoed legislation that would have expanded S-chip, the State Children’s Health Insurance Program, providing health insurance to an estimated 3.8 million children who would otherwise lack coverage.

In anticipation of the veto, William Kristol, the editor of The Weekly Standard, had this to say: “First of all, whenever I hear anything described as a heartless assault on our children, I tend to think it’s a good idea. I’m happy that the president’s willing to do something bad for the kids.” Heh-heh-heh.

Most conservatives are more careful than Mr. Kristol. They try to preserve the appearance that they really do care about those less fortunate than themselves. But the truth is that they aren’t bothered by the fact that almost nine million children in America lack health insurance. They don’t think it’s a problem.

“I mean, people have access to health care in America,” said Mr. Bush in July. “After all, you just go to an emergency room.”

And on the day of the veto, Mr. Bush dismissed the whole issue of uninsured children as a media myth. Referring to Medicaid spending — which fails to reach many children — he declared that “when they say, well, poor children aren’t being covered in America, if that’s what you’re hearing on your TV screens, I’m telling you there’s $35.5 billion worth of reasons not to believe that.”

Perhaps some people need to get out more often and see how people are actually living . . . .  The New York Times editorial page notes further that Pesident Bush's rationale for his veto doesn't stand up to scrutiny.  Frank Pasquale at concurring opinions has more thoughts and potential solution. 

October 5, 2007 | Permalink | Comments (0) | TrackBack (0)

Thursday, October 4, 2007

Hillary Clinton and Health Care

The New Republic's Jonathan Cohn has a long interview with Senator Hillary Clinton on her views about health care.  He states,

A goal of your plan is to make for-profit insurers change a lot of their business practices, like excluding people with preexisting medical conditions. But will that work? Is it possible to make them act more like non-profits?

 

It wasn't so long ago that we had a lot of not-for-profit insurance companies, as you may recall. There may be a relationship here that may be worth exploring. [Laughs]

This is a new business model and it may be that some will go back to being non-profit. It may be that profit will be realized by competition, on the basis of cost and quality. Because, remember, this is an industry that spends $50 billion a year excluding people either altogether by denying them coverage, or by denying them care that they need.

$50 billion is no longer going to be an expense to them, so this could actually provide the opportunity of a new business model for for-profit insurance.

The insurance industry is not going to name me "woman of the year" any time soon. But I think this is a business opportunity that some may understand and see.

The other piece of this, which I've talked about many times before, is that with the advances in our understanding of the human genome, and individualized genetically-based treatments, the model of our system may be out of date anyway. If your whole model is based on excluding for preexisting conditions, and we will find out that nearly all of us have such a genetically-based preexisting conditions, how do you have an insurance model that really is going to last beyond the next 20, 25 years?

There's a lot going on here that is, I think, pushing for some recognition that the insurance industry's model, as they have allowed it to develop, with rejection of not-for-profit health care, the transformation of not-for profits to for-profits, the increasing money spent on underwriting,
the double-digit profit margins--it may have provided short-term financial benefits for individual companies but it has been bad for the economy.

The entire interview is not very long and is an interesting read on her health care reform proposal and some of the obstacles it may face if she is elected.


That is what the fight is going to be over. There are those ideologically who will cling to a for-profit model with no regulation. But, by doing so, they are really dooming millions more to both no insurance and underinsurance--and they are continuing to hobble the economy. And I think that's much more clearly understood today than it was 15 years ago.

October 4, 2007 | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 3, 2007

President Vetoes SCHIP expansion program

Think Progress reports on the President's veto of the SCHIP expansion program:

Breaking: Bush vetoes children’s health insurance.

President Bush’s veto of an SCHIP expansion was only the fourth veto of his presidency. AP reports that the White House “sought as little attention as possible, with the president wielding his veto behind closed doors without any fanfare or news coverage.” House Majority Leader Steny Hoyer (D-MD) said that they have not yet scheduled a date for an override vote, but it could be “next week” or “the week after.”

Click on Think Progress link for video response from Families USA.  Please be aware that some comments at the bottom of the Think Progress story contain strong language.

October 3, 2007 | Permalink | Comments (0) | TrackBack (0)

EMTALA and Torture

Interesting tidbit from Professor Jack Goldsmith's testimony yesterday about the"torture memos"-Turns out that the definition used torture came from EMTALA!  Who knew . . .   TPMmuckraker reports:

Much of Goldsmith's difficulties, of course, centered around his efforts to revise earlier Department memos defining torture, such as the infamous 2002 "Bybee memo" (named after Goldsmith's predecessor Jay Bybee) that defined torture as "equivalent in intensity to the pain accompanying serious physical injury, such as organ failure, impairment of bodily function, or even death." Goldsmith called that reasoning "severely flawed."

During today's hearing, Sen. Sheldon Whitehouse (D-RI) asked Goldsmith where that definition had come from. "It came from a health care statute designed to define the circumstances under which there was an emergency situation warranting health care benefits," he answered. He explained that "severe pain" is hard to define, and so the lawyers likely cast around for a way to define it -- but that the health care code probably wasn't the best place to look.

Here is the EMTALA statutory language:

"A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in --

placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

  serious impairment to bodily functions, or

  serious dysfunction of any bodily organ or part, or

  "With respect to a pregnant woman who is having contractions --that there is inadequate time to effect a safe transfer to another hospital before delivery, or that the transfer may pose a threat to the health or safety of the woman or her unborn   child."




October 3, 2007 | Permalink | Comments (0) | TrackBack (0)