HealthLawProf Blog

Editor: Katharine Van Tassel
Creighton University School of Law

Thursday, November 15, 2007

Massachusetts Health Plan

Erza Klein points out a potential problems with the Massachusetts health care plan - people are not signing up.  He isn't too worried about this fact and states,

So far as I can tell, with seven weeks left, 20 percent of the state's uninsured population hasn't signed up for insurance.   Given that people are lazy, and tend to wait till deadlines to do things, that's not exactly a shocker.  You should see how I handle bills.  Moreover, the question with the individual mandate plans is not whether people sign up in advance, but whether they sign up after the plans kick in.  Put differently, what an individual mandate does is levy a financial penalty on those who don't sign up for insurance.  They do that because we expect people to not sign up for insurance.  So the question is whether that penalty works -- whether it can be enforced, be politically sustained, and then function as a spur to push people into the coverage pool.  If that doesn't work, then the Massachusetts plan won't work either.  But we're not there yet, nor anywhere near it. 

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

Universal Health Care or Else?

Crooks and Liars has a video of Presidential candidate John Edwards discussing his plan to encourage Congress to pass comprehensive health care reform including some form of universal health care coverage.  He says that he would introduce legislation to strip them of their own health care should they fail to pass health care reforms. Mmmm - I am not sure how popular that would be.  Ezra Klein has some thoughts -here and here.

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

Rising Rates of STDs

The LA Times and other papers (including my local paper which noted that Ohio's beat the national average in several STD categories).  According to the LA Times,

The number of newly diagnosed cases of the three most common sexually transmitted diseases rose for the second year in a row in the U.S., driven in part by an increase in risky sexual behavior, the Centers for Disease Control and Prevention reported Tuesday.

"Increases in all three of these STDs. . . underscore the need for vigilance," said Dr. John M. Douglas Jr., director of the CDC's division of STD prevention, which produced the report.

New cases of chlamydia, the most commonly reported infectious disease in 2006, were diagnosed at nearly three times the rate of gonorrhea, the second most commonly reported infectious disease, Douglas said.

"We believe since it's underreported, it probably represents a much bigger iceberg," he said.

Douglas said he was also worried about syphilis because "it was really primed for being eliminated, and we've seen reversals in what ought to be a preventable problem."

Officials are still analyzing why the STD rates are going up, but they believe the rise is related to insufficient public health funds, increased testing and a resurgence of risky sexual behavior in some groups.

Gosh, I am shocked.  I thought all that money spent on abstinence-only education was supposed to take care of this type of behavior.

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

Diane Rehm Show - Wednesday, November 14th

The Diane Rehm Show has several interesting medical-related topics on its show.  First, during the 10am hour, the show will review a recent study examining ADHD in children.  The NPR website states,

A new study finds children considered troublemakers in kindergarten will do just as well academically as their peers in later school years. There's also new research on children with A.D.H.D. suggesting a possible brain development delay but no long term deficit. New insights on evaluating and educating young children with behavior problems.

The guests include:  Sharon Landesman Ramey, Director, Center for Health and Education, Georgetown University; Dr. Philip Shaw, Psychiatry Fellow, National Institutes of Mental Health. E-mail:; Greg Duncan, Edwina S. Tarry Professor of Education and Social Policy Faculty Fellow, Institute for Policy Research at Northwestern University.

I have read a little about the study.  I am not sure whether it examines and explains ADHD/ADD in adults but the study's results may change how medical practicioners, parents and schools address these mental health issues.

The next hour of the Diane Rehm show is a review of Shannon Brownlee's book, "Overtreated,"  NPR states,

Many Americans assume more medical treatment means better health care. But a medical journalist says too much medicine can make us sicker and poorer. She explains how unnecessary tests and procedures are not only expensive and wasteful but can actually harm our health.  Shannon Brownlee, senior fellow at the New America Foundation is the guest.

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

Tuesday, November 13, 2007

Potential 10.1% Reduction in Physician Fee Schedules

AMNews reports on the potential for large cuts in physician fee schedules under Medicare.  It reports,

The Centers for Medicare & Medicaid Services final 2008 Medicare physician fee schedule rule institutes an average 10.1% pay cut effective Jan. 1, 2008, although the percentage will vary by specialty, practice and geography.

The rule also lists the 74 quality measures to be used in the Physicians Quality Reporting Initiative in 2008. It specifies that a $1.35 billion fund adopted last year will go to the PQRI and not toward easing physician pay cuts. The regulation also delays finalizing most of the latest revised physician self-referral, or "Stark," rules.

Medical organizations called the 10.1% reduction unacceptable.

"Congress must step in to replace the cut with payment increases that keep up with medical practice costs," said American Medical Association Board of Trustees Chair Edward L. Langston, MD. "Next year's 10.1% physician payment cut is bad news for America's seniors as 60% of physicians say the cut will force them to limit the number of new Medicare patients they can treat." . . .

Lawmakers continue to work on legislation to prevent next year's cut.

In the House, an Energy and Commerce Committee staff member said leaders are sticking with the Medicare physician pay provisions adopted as part of its State Children's Health Insurance Program reauthorization bill in early August. The measure would have increased reimbursement 0.5% in 2008 and 2009 each.

Cuts to Medicare Advantage health plans' payment would have largely funded the boost. Specifically, these cuts would have lowered Medicare's regional benchmark payments to insurance companies, ended a stabilization fund used to share risks with insurance companies and eliminated indirect medical education payments to teaching hospitals.

These changes would reduce enrollment by more than half of the projected 12.5 million enrollees in 2012, according to an Oct. 10 Congressional Budget Office analysis. Today 8.2 million people are in these health plans.  But the provisions were removed in the House-Senate compromise SCHIP bill in an attempt to maintain a veto-proof Senate majority. Many Senate Republicans oppose cutting private health plan payments.

Still, Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, would prefer to adopt a two-year payment fix by shifting some Medicare Advantage payments to fund physician reimbursement, said panel spokeswoman Carol Guthrie. But Republican members' support of such a measure was not clear at press time.

November 13, 2007 | Permalink | Comments (0) | TrackBack (0)

Economics of Universal Health Care

MrMichaelMT discusses the economics of universal health care at the DailyKos blog.  He points to many of the costs of the uninsured and says,

With the release of Sicko and the expected barrage of trash aimed at Democratic candidates from right wing radio, it's inevitable that someone will accost you. (After all, that "I'm a Progressive" tatoo on your forehead stands out.)  -   "Why should I pay for someone else's health care? I'm paying enough already!"

The major candidates have done an incredibly poor job of articulating what the savings would be to our society that universal healthcare would achieve. So I guess it's up to you.  Get ready to answer: "Yes, you are! You are paying way too much. Universal health care will save you, personally, a bundle."

When you are sitting in church or the movie theater, look to your right and your left, ahead and back. Chances are that one of those people is paying health roulette. When they get really, really sick they go to an emergency room--and you pay.

This issue update from the Kaiser Family Foundation finds that uninsured Americans could incur nearly $41 billion in uncompensated health care treatment in 2004, with federal, state and local governments paying as much as 85 percent of the care. It also finds that if the country provided coverage to all the uninsured, the cost of additional medical care provided to the newly insured would be $48 billion.

So if you just skim the headline, you might mistakenly think you are saving 7 billion by not covering the uninsured. Guess again! By waiting until health care is critical, the cost of healing the uninsured is many times the cost of insuring--and caring for--them in advance. Just remember the case of Deamonte Driver.

Deamonte Driver's life could have been spared if his infected tooth was simply removed -- a procedure costing just $80...
In the end, Driver endured two surgeries and weeks of hospital care totaling about $250,000 in medical bills. Sadly, it was too late to save the boy, and he passed away on Feb. 25. . . . .

November 13, 2007 | Permalink | Comments (0) | TrackBack (0)

Monday, November 12, 2007

Tom Delay on Health Care

ThinkProgress reports on former Congressman Tom Delay and his recent discussion on health care.  They state,

Speaking in the UK yesterday, former House Majority Leader Tom DeLay (R-TX) predicted that if a Democrat is elected president in 2008, he or she would seek to install universal health care, similar to the system in Britain. This possibility “received thunderous applause.” DeLay claimed that, under the U.S. system, “no American is denied health care”:

By the way, there’s no one denied health care in America. There are 47 million people who don’t have health insurance, but no American is denied health care in America.

The audience, understandably, greeted DeLay’s preposterous claims with “derisive laughter,” according to the AP. A recent report showed that for the sixth straight year, jobholders continued to see a decline in employer-provided health insurance, with 38 states seeing “significant” drops in benefits offered by employers.

I know that some Americans like to bash the UK's health system but there surely is no need to make a false statement like this.

November 12, 2007 | Permalink | Comments (0) | TrackBack (0)

Merck's Vioxx Settlement

Last week, Merck announced that it  The New York Times writes about the settlement as a corporate victory for Merck.  It reports,

For the drug maker Merck to pay almost $5 billion to settle lawsuits from people who contended that the painkiller Vioxx caused their heart attacks and strokes may not seem like a corporate victory.  But it is, according to lawyers and drug industry analysts who have followed the Vioxx litigation since Merck stopped selling the drug in September 2004, after a clinical trial showed it raised the risk of strokes and heart attacks.  At a fraction of the price that analysts initially estimated it would pay, Merck, one of the largest American drug makers, hopes to put one of the most troubling episodes in its history behind it.

The settlement amount it announced yesterday, $4.85 billion, represents only about nine months of profit for Merck, whose stock rose 2.3 percent on news of the agreement, even as the broader stock market was sharply lower. Two years ago, some analysts estimated that Merck would have to pay as much as $25 billion to settle Vioxx claims.

The success of Merck ’s strategy — fighting every claim against it in court for several years and only then agreeing to a blanket settlement — could encourage other pharmaceutical companies to take the same route in other lawsuits, independent legal experts say. Merck has won most of the cases to reach juries, as plaintiffs’ lawyers have struggled to convince jurors that Vioxx caused the heart problems their clients suffered.

Clinical trials prove that Vioxx raises the risk of heart attacks, but linking its use to any one person’s problems is difficult, especially when the person had other risk factors like smoking.  More broadly, the case shows that after years of aggressively lobbying against trial lawyers, corporate America has regained substantial leverage against plaintiffs and their lawyers — whose lawsuits bankrupted Dow Corning and the asbestos industry in the 1990s. In many states, changes governing lawsuits have made claims tougher to bring and win, while much public opinion has turned against plaintiffs.  “The law governing class-actions has grown decidedly less favorable than it was,” said Peter Schuck, a professor at Yale Law School who specializes in complex litigation. . . .

Of course, what is good news for Merck may be less so for the patients who suffered heart attacks or strokes after taking Vioxx. Depending on how many claims are filed to the settlement fund, those people will receive payments averaging about $120,000 each before legal fees and expenses, which could swallow about 40 percent of their payments.  Plaintiffs are not required to accept the settlement. But under terms of the agreement their lawyers must encourage them to do so — and would not be allowed to represent those clients if they insisted on bringing their cases to court. . . .

Dr. Eric Topol, a cardiologist who in 2001 was co-author of a paper in The Journal of the American Medical Association warning of the risks of Vioxx, said he believed that the payment amounted to little more than a slap on the wrist for Merck.  “I think they’ve gotten off quite easily, frankly, for the problems that they’ve engendered,” Dr. Topol said. 

The Wall Street Journal's Health Blog has more on the numbers here and here.  This Vioxx settlement should leave Merck more time to deal with the fallout from its AIDs vaccine

November 12, 2007 | Permalink | Comments (0) | TrackBack (0)