HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, November 6, 2007

Senate Passes HHS Budget

According to a recent story in AMNews, the Senate's passage of a $479 billion HHS appropriations bill, achieved the necessary majority to help override a potential presidential veto.  AMNews reports that the House and Senate expect to reach a compromise HHS bill later this month.  The Senate bill contains the following:

The Senate measure generally resembles the House version. Both would boost funding to the National Institutes of Health, prevent the president's proposed virtual elimination of the Title VII medical education loan program and increase federal community health center funding.

The president's 2008 budget proposal would reduce Title VII medical student loan assistance to $10 million from $184.7 million in 2007 and would freeze funding for community health centers at $1.99 billion. It proposes reducing the National Institutes of Health budget by $310 million (2%).

The Senate budget measure would head in the other direction. It would add $5 million (2.7%) to Title VII and $250 million (12.5%) for community health centers. It would boost NIH funding by $1 billion (3.5%).

The health center increase would allow facilities to see nearly 2 million more patients, according to Dan Hawkins, senior vice president for programs and policy at the National Assn. of Community Health Centers.

"This bill will continue the vital expansion of health centers into more medically underserved communities across the country," he said.

The NIH increase would pay for an additional 400 grants, compared with fiscal 2007 and 700 more than the president's budget.

Even the Senate bill's increase wouldn't keep pace with today's biomedical inflation rate of 3.7%. The NIH needs $1.9 billion (6.7%) annual increases from 2008 to 2010 to restore it to the spending ability it had in 2002 before a series of flat budgets, said Jon Retzlaff, director of legislative relations for the Federation of American Societies for Experimental Biology.

November 6, 2007 | Permalink | Comments (0) | TrackBack (0)

Reforming our Health Care System: The Need for Facts

Yesterday, N. Gregory Mankiw , a former adviser to George Bush, and current adviser to Mitt Romney, has an article in the New York Times business section discussing the future of health care in America and the need to examine the facts before considering reform efforts.  He then repeats and debunks what he believes are some false facts about America's health care system - a system that he believes works fine and will get better.  For example, he takes issue with the 47 million uninsured number that has been in the news for quite some time.  He states,

Some 47 million Americans do not have health insurance.

This number from the Census Bureau is often cited as evidence that the health system is failing for many American families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.

To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.

The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.

The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage. . . .

Concurring Opinions commentator Frank Pasquale disagrees with Mr. Mankiw and cites to a recent article by Professor Timothy Jost drawing some opposite conclusions about the stability and desirability of our current health care system.

But for now, I'm inclined to agree with the perspective of Tim Jost. He is a health law scholar who has thought seriously about comparative health systems, and does not share Mankiw's tendency to "look on the bright side:"

[A] series of studies over the past decade have shown that the quality of health care in the United States is seriously deficient, and, in particular, that medical errors are common and often have serious consequences. Indeed, the quality of the health care Americans receive is no better, and in some respects worse, than that provided in many other countries that spend far less on health care and yet provide it for all of their citizens.

DailyKos commentator Tonyahky also contains a sharp critique of the facts used by Mr. Mankiw.  Here is the response to the 47 million number:

Even if 10 million of the uninsured are illegal immigrants, what about the other 37 million? He doesn't tell you that 9 million of the uninsured are children. He also does not tell you that in general, the only adults who even qualify for Medicaid in most states are people receiving TANF and individuals who are eligible for SSI.

And what about those who declined coverage offered by their employers? I thought we could do a little bit of second grade math to illustrate why so many of these individuals opt out of employer sponsored health insurance I'm going to use a friend's earnings, living expenses, and her employer's insurance premiums to illustrate why many people opt not to receive health insurance: (see here for rest of discussion of cost of health insurance) . . .

In 1950, about 5 percent of United States national income was spent on health care, including both private and public health spending. Today the share is about 16 percent. Many pundits regard the increasing cost as evidence that the system is too expensive.

November 6, 2007 | Permalink | Comments (0) | TrackBack (0)

What is Torture?

Brian Leiter's blog has a review of hypothetical responses from the Bush Administration to the question of whether the rack constitutes torture.   Some examples:

Mukasey: I haven’t been read into the details of the Rack, and I
understand that these details are classified. I am firmly opposed to
torture, torture is illegal, but I do not know whether the Rack is
torture. To comment further would be to expose sincere and loyal
Inquisitors to the possibility of retro-active condemnation.

Bush: I am not going to give aid to our enemies by disclosing details of
our interrogation techniques. But if we do expose detainees to the Rack
it is not torture, because we do not torture.

Cheney: A little stretching never hurt anybody. I understand it’s
actually recommended before exercising. . . .

Gonzalez: I cannot recall what the Rack was. Nor do I have any
recollection about whether I ever discussed it with the President. The
testimony of some that they heard me mention the Rack in a meeting on
March 23rd -- a meeting which I do not remember --may have been a
confusion of Rack with Iraq.

Daniel Levin: I cannot say since I have never been exposed to the Rack.
I do have an appointment next Friday for a 50 minute session in Seville.

I find nothing funny about the current waterboarding debate but this shows how ridiculous the Administration's response to torture has become.

November 6, 2007 | Permalink | Comments (0) | TrackBack (0)

Friday, November 2, 2007

Daylight Savings Time and Your Internal Clock has an interesting piece on the impact of daylight savings time on your overall well-being: 

This week, Dr. Sydney Spiesel discusses the disruptive effect of daylight-saving time on the body's internal rhythms, . . .

Question: After midnight next Sunday, the clocks where you live will move backward by one hour to shift an hour of daylight from afternoon to morning over the next four winter months. You will share this experience of daylight-saving time with about one-quarter of the people on Earth. What happens to your body's internal clock when it is suddenly reset by society's clock?

Context: The body's daily cycle of activities—the circadian rhythm—determines when we are sleepy and alert, when we want to eat, and even when we produce less urine so our nighttime sleep will be less interrupted. Though there is a spectrum of preferences, from "larks" to "owls," the internal clocks that set our circadian rhythm are mainly regulated by the time the sun rises. (Here's how to figure out which kind of bird you are.) We are not consciously aware of this dependency, and our time of awakening is often affected by external forces, like the need to get to work on time. Chronobiologists, the scientists who study our internal clocks, correct for these effects by comparing awake and asleep times on work days and free days. They have found that the relationship between the arrival of dawn and the midsleep point—the time halfway between the moment you fall asleep and the moment you wake up—remains constant, even as the time of sunrise changes when the length of the day varies with the seasons.

Study: A new German study uses this predictable relationship to study what happens to our internal clocks when the external clocks jump an hour forward or backward. Drawing from a database of 55,000 Central European subjects who submitted daily sleep records, they showed that the normal correlation between dawn and the sleep cycle becomes disrupted during the transition to daylight-saving time.

Findings: In an effort to clarify whether this change was due to the changed clock or to some other phenomenon, the authors zeroed in on the sleep-wake and activity cycles of 50 people during the weeks around the spring and autumn leaps forward and back. They found that the spring institution of daylight-saving time was exactly the moment when the coming of dawn disconnected from the body's sleep-wake cycles. When standard time returned in the autumn, the body's circadian rhythm again linked itself to the time of sunrise.

Conclusion: Practically speaking, what does this mean? If, as some recent research has suggested, sleep and psychiatric illness may be closely tied, perhaps the sleep disruptions associated with time changes might affect the incidence of psychiatric disease during the transition periods. An early study suggested that this was, indeed, the case; more recent research on patients with depression casts doubt on the association. There is clear evidence of a spike in car accidents associated with the spring transition to DST and the fall transition back to standard time. I am tempted to think that disturbances in circadian rhythm are the cause.

Enjoy that extra hour of sleep!

November 2, 2007 | Permalink | Comments (0) | TrackBack (0)

Immigration and Uninsured Rates

Ezra Klein posts a nifty chart showing the rate of uninsured over the past few years.  The chart debunks the notion that the uninsured rate has increased due to immigration issues.  He writes:

You occasionally hear conservatives argue that the problems of the uninsured in this country are entirely due to immigration. No immigrants, no increases in the uninsured. I've shot this point up before, but EPI helpfully graphed the debate, showing what would have happened to the population of the uninsured had immigration been frozen in 2000.

As you can see, freeze immigration and the 2.1% increase in the uninsured population becomes a...1.9% increase in the uninsured population. Which equals out to 5.7 million more Americans uninsured.

November 2, 2007 | Permalink | Comments (0) | TrackBack (0)

Thursday, November 1, 2007

Evaluations of the Candidate's Health Care Plans

Matthew Yglesias writing for the examines the National Journal's evaluation of the Presidential Candidate's health care plans. 

It's true, of course, that when the crazy kids downstairs at National Journal put together a bipartisan group to evaluate the presidential candidate's health care plans that the results showed the Democrats' plans to be good, whereas the Republicans' plans are bad. More telling, though, is actually the specific nature of where the different plans did well. This is especially true because in some respects the categories appear to have been gerrymandered to make the total scores less embarrassing for the GOP. . . .

He does a nice job discussing the various ways the health plans would impact quality of care, employers, access and more.  He concludes,

All of these proposals are vague in some key respects, and nothing that's proposed on the campaign trail is going to be enacted as is by congress. But these plans show something about the values and priorities of the different parties. Republicans, basically, are looking to make sure that the federal budget contains as much headroom as possible for tax cuts for high-income and high-wealth individuals while minimizing financial burdens on large employers. Democrats, by contrast, are looking to improve the quality and accessibility of American health care.

November 1, 2007 | Permalink | Comments (0) | TrackBack (0)

Commercial for Health Insurance

Ezra Klein finds a funny ad for health insurance - boy those marketing people sure know how to sell their product.  By the way, I just hope the man, whose injury is discussed in the commercial, did not have some sort of pre-existing injury that would lead to a denial of coverage . . . .   Click here.

November 1, 2007 | Permalink | Comments (0) | TrackBack (0)

Number of Uninsured Americans Increases

What a surprise and a not-so-nice news story to start November - Reuters reports:

The number of Americans lacking health insurance rose by nearly 8.6 million to 47 million from 2000 to 2006, with children and workers from every income level losing coverage, a new report said on Thursday.  The increase was "driven primarily by the continued erosion in employer-provided health insurance," said the report by the Washington, D.C.-based Economic Policy Institute.

In 2006, 2.3 million fewer Americans received health benefits from their employers than in 2000, the report said, noting the decline does not take the population increase into account. Nearly 60 percent of the nation's children are covered by the insurance provided by their parents' employers, but 3.4 million fewer children had benefits in 2006 compared with 2000.

"Public health insurance is no longer offsetting these losses," said the report by the nonpartisan think-tank.  For jobholders, this was the sixth straight year of declines in health insurance coverage. The rate fell to just below 71 percent from nearly 75 percent in 2000.  "No category of workers was insulated from loss of coverage," as even workers whose earnings placed them in the top quintile saw coverage rates fall, the report said.

More men lost employer-provided health benefits than women. For men, the rate fell by almost 5 percentage points in the six-year period to 69 percent. For women, the rate fell just under 3 percentage points to nearly 73 percent.

November 1, 2007 | Permalink | Comments (0) | TrackBack (0)