December 19, 2007
California's Health Reform Bill
Ezra Klein blogs about California's recent health reform measure. He states,
Potentially big news out of California . . . . where the Assembly has passed the first piece of a massive health care expansion. Passage in the Senate will be a bit trickier, and the funding component isn't even in the legislation, and is instead being offered as a ballot measure a few months down the road. So there are many hurdles left to leap.
Still: It would be a big deal to have the Golden State pass universal health reform. Schwarzenegger's bill is, in many ways, similar to Clinton and Edwards' plans -- and in certain ways it goes further. It forces insurers to offer insurance at standard rates rather than discriminating based on preexisting conditions; imposes an individual mandate to ensure broad buy-in; and offers heavy subsidies up to 250 percent of the poverty line and limits health spending to 5.5% of income for those making between 250 percent and 400 percent of the poverty line. It puts a sliding scale tax on businesses, a small tax on hospitals, and a $1.50 on cigarettes. It allows the state to purchase pharmaceuticals as a whole in order to negotiate better prices. . . .
December 18, 2007
Doctor Liability to Third-Party
The Massachusetts Supreme Judicial Court ruled December 10th that a "doctor who failed to warn his patient about the effects of his treatment can be held liable for injuries to a third party." Coombes v. Florio, Mass., No. SJC-09869, 12/10/07. The BNA Health Law Reporter summarizes the case and states,
The divided court ruled in favor of the mother of a 10-year-old boy killed in an automobile accident by an elderly driver who had been taking several strong medications. The decision overturned a finding of summary judgment by a lower court in favor of Dr. Roland J. Florio and allowed Lyn-Ann Coombes to proceed with a lawsuit charging Florio with negligence.
Florio "owes a duty of care to all those foreseeably put at risk by his failure to warn about the effects of treatment he provides to his patients," Justice Roderick L. Ireland said. Although there was no conclusive evidence that the effect of the medication was the cause of the accident, there is a genuine issue of material fact, making summary judgment inappropriate, he found.
In a strongly worded dissent, Chief Justice Margaret H. Marshall said that "the inevitable result" of the ruling will be "a significant increase in third-party litigation against doctors and an attendant increase in expenses at a time when our health care system is already overwhelmed with collateral costs."
More is available at the BNA website and the full opinion is available here.
Health Care Reform According to Commonwealth Fund
Americans could save $1.5 trillion in healthcare costs over the next decade while covering the uninsured and improving overall quality, according to a report to be released today. But it would take widespread reforms to root out inefficiency, not to mention higher tobacco taxes and other levies.
"We are not getting good value for our dollar," said Karen Davis, president of the Commonwealth Fund, a New York-based research group that prepared the report. "Will we continue to head down a path of less access to care [and] higher costs . . . or will we start now to make the changes needed to transform our healthcare system?"
Intended to provide a menu of options for the next president, the report blends ideas put forward by leading political candidates with other proposals. Many of the ideas are likely to stir controversy.
For example, the report calls for boosting the federal tobacco tax by $2 from the current 39 cents a pack. It also proposes a penny tax on 12-ounce, sugar-sweetened soft drinks to fund a campaign against obesity. And it proposes a 1% levy on insurance premiums to finance rapid computerization of records kept by doctors and hospitals. . . . .
Such a combination of different approaches -- there are a total of 15 major proposals in the report -- could work together to produce hundreds of billions in savings, the authors say. . . . .
The United States will spend about $2.3 trillion on healthcare this year, twice as much on a per-capita basis as any other country. But the health of Americans is not appreciably better than that of people in other industrialized countries, most of which offer government-run care systems.
And U.S. healthcare costs, which are growing faster than wages and faster than the economy, are projected to double in the next 10 years. Economic experts who advise both government and the business community say the current rate of growth is unsustainable. Demanding greater efficiency has become a popular refrain among Democrats and Republicans. . . .
Hopefully with a new President - we might see some changes. Currently, President Bush does not seem to think that there is much wrong with our health care system. He announced yesterday in Virginia,
I’m going to tell you something — we have fabulous health care in America, just so you know. I think it’s very important — before people start griping about the health care system here — and of course there’s always grounds for complaint — just to compare it with other systems around the world.
ThinkProgress provides more discussion about how our health care system compares to other countries, noting in particular,
In 2002, the U.S. spent more on health care per person than other industrial countries like Britain, Canada, France, and Germany. But unlike those countries, which have universal health care systems, there are roughly 47 million Americans who lack health coverage.
In 2000, the World Health Organization (WHO) did a comparative assessment of the health systems of 191 countries. The WHO found that in terms of the five measured performance indicators, the U.S. ranked 37th:
The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th . Several small countries — San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy.
December 17, 2007
Bird Flu Update
Five members of a family in Pakistan are among eight people who may be the country's first human cases of bird flu, the World Health Organization said. At least one brother died.
Pakistan's national laboratory found the lethal H5N1 avian flu strain caused the infections in three brothers and two cousins from the same family, according to information from a Dec. 15 WHO statement and Gregory Hartl, a WHO spokesman in Geneva. Another brother from the U.S., who attended a funeral for one of the victims, and his son tested negative for the virus at a hospital in Nassau County, New York, Hartl said.
Medical teams have been sent to Pakistan to assist local authorities in investigating the cases, in which two people had only mild symptoms, Hartl said. Doctors are monitoring for signs avian flu may be adapting to humans by killing fewer people, fostering its spread.
Daily Kos goes on to note the importance of keeping informed. They state,
So what do we take away from all of this? H5N1 is endemic in bird populations and will not simply go away. New outbreaks in new countries are likely part of the 'new normal', and we should expect a steady diet of news like this, particularly this time of year. In addition, the idea that "this will never be seen in North America" needs to be seriously rethought by anyone still holding on to that concept. We had a near miss last week, and modern travel conditions make the possibility of a human case in NYC more than just science fiction. . . .
Preparations to mitigate a pandemic need to be carried out beforehand, and are currently being done in many places throughout the United States and the world (for example, by groups as diverse as the American Red Cross, law enforcement, State Departments of Health, and many others). The ubiquity of the preparations, which may include your local school system, tells you something about the threat.
The next pandemic may not be H5N1, but H5N1 remains a candidate virus, and the planning to handle an event such as a pandemic will help with whatever comes (there's nothing wrong with an all-hazards approach to disaster preparation, as long as the all-hazards approach includes things as extensive as pandemics). Do yourself a favor and review your own family plans for natural disasters such as hurricanes, tornadoes and ice storms. Stock up on two weeks of food and water, and plan for power outages, if relevant to your community (it's very relevant in New England). You can rotate your stock and keep it fresh. It's time well spent and the effort will not go to waste.
Pharmaceutical Companies: How Much Influence Do They Have?
The Wall Street Journal's Health Blog has an interesting discussion concerning the recent treatment of pharmaceutical companies. It reports,
Former FDA big shot and perennial defender of the free market Scott Gottlieb makes the case in the WSJ that drug makers are being persecuted by Washington.
Exhibit A: Eli Lilly’s guilty plea to a criminal indictment from the Bush Justice Department in 2005 over the off-label promotion of the company’s osteoporosis pill Evista to reduce the risk of breast cancer in post-menopausal women. Lilly paid $36 million in fines and disgorged its ill-gotten gains, he notes. But, Gottlieb asks, what was the crime? Lilly’s campaign to get the word out relied on findings “from a series of landmark national studies, some eventually touted by government research,” he writes. He goes on to cite another example involving the government’s investigation of Genentech for alleged promotion of Rituxan for unapproved uses in cancer.
There was the problem that Lilly only got FDA approval of Evista’s cancer indication this September.
But in Gottlieb’s view, ” ‘Off label’ are now dirty words in (the) conventional lexicon, made synonymous with lawbreaking as a result of these prosecutions, even though these words describe the way more than half of cancer medicine is practiced. It is true that some off-label drug use is based on very unsettled science and has more risks. But medicine — and not just cancer care — involves lots of hard choices.”
On this very same day, Paul Krugman, writing in the New York Times, notes how hard it will be to reform health care partially because of the influence of --- pharmaceutical companies. He writes,
Broadly speaking, the serious contenders for the Democratic nomination are offering similar policy proposals — the dispute over health care mandates notwithstanding. But there are large differences among the candidates in their beliefs about what it will take to turn a progressive agenda into reality.At one extreme, Barack Obama insists that the problem with America is that our politics are so “bitter and partisan,” and insists that he can get things done by ushering in a “different kind of politics.” At the opposite extreme, John Edwards blames the power of the wealthy and corporate interests for our problems, and says, in effect, that America needs another F.D.R. — a polarizing figure, the object of much hatred from the right, who nonetheless succeeded in making big changes. . . . .
The argument began during the Democratic debate, when the moderator — Carolyn Washburn, the editor of The Des Moines Register — suggested that Mr. Edwards shouldn’t be so harsh on the wealthy and special interests, because “the same groups are often responsible for getting things done in Washington.”
Mr. Edwards replied, “Some people argue that we’re going to sit at a table with these people and they’re going to voluntarily give their power away. I think it is a complete fantasy; it will never happen.” This was pretty clearly a swipe at Mr. Obama, who has repeatedly said that health reform should be negotiated at a “big table” that would include insurance companies and drug companies.
On Saturday Mr. Obama responded, this time criticizing Mr. Edwards by name. He declared that “We want to reduce the power of drug companies and insurance companies and so forth, but the notion that they will have no say-so at all in anything is just not realistic.”
Hmm. Do Obama supporters who celebrate his hoped-for ability to bring us together realize that “us” includes the insurance and drug lobbies? O.K., more seriously, it’s actually Mr. Obama who’s being unrealistic here, believing that the insurance and drug industries — which are, in large part, the cause of our health care problems — will be willing to play a constructive role in health reform. The fact is that there’s no way to reduce the gross wastefulness of our health system without also reducing the profits of the industries that generate the waste.