Monday, January 19, 2009
Atul Gwande has an interesting article in this week's New Yorker discussing health reform. He provides a history lesson on how other countries came to embrace universal health care and talks about the prospects for reform in the United States, He writes,
Yet wherever the prospect of universal health insurance has been considered, it has been widely attacked as a Bolshevik fantasy—a coercive system to be imposed upon people by benighted socialist master planners. People fear the unintended consequences of drastic change, the blunt force of government. However terrible the system may seem, we all know that it could be worse—especially for those who already have dependable coverage and access to good doctors and hospitals.
Many would-be reformers hold that “true” reform must simply override those fears. They believe that a new system will be far better for most people, and that those who would hang on to the old do so out of either lack of imagination or narrow self-interest. On the left, then, single-payer enthusiasts argue that the only coherent solution is to end private health insurance and replace it with a national insurance program. And, on the right, the free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work.
Neither side can stand the other. But both reserve special contempt for the pragmatists, who would build around the mess we have. The country has this one chance, the idealist maintains, to sweep away our inhumane, wasteful patchwork system and replace it with something new and more rational. So we should prepare for a bold overhaul, just as every other Western democracy has. True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive. . . .
Sunday, January 18, 2009
Interesting and thought-provoking story in the New York Times today about researchers using their children in research. Pam Belluck reports,
At a birthing class, Dr. Sinha, a neuroscience professor at the Massachusetts Institute of Technology, stunned everyone, including his wife, by saying he was excited about the baby’s birth “because I really want to study him and do experiments with him.” He did, too, strapping a camera on baby Darius’s head, recording what he looked at. Dr. Sinha is among a new crop of scientists using their children as research subjects.
Other researchers have studied their own children in the past, but sophisticated technology allows modern-day scientists to collect new and more detailed data. The scientists also say that studying their children allows for more in-depth research and that the children make reliable participants in an era of scarce research financing. . . .
Arthur Toga, a neurology professor at the medical school at the University of California, Los Angeles, studying brain change, scanned his three children’s brains using magnetic resonance imaging. . . . And Deb Roy, at M.I.T., embedded 11 video cameras and 14 microphones in ceilings throughout his house, recording 70 percent of his son’s waking hours for his first three years, amassing 250,000 hours of tape for a language development study he calls the Human Speechome Project.
Saturday, January 17, 2009
Newsweek reports on the resignation of the executive vice president of Autism Speaks, Alison Singer. The story states,
The warfare over vaccines and autism is heating up yet again. This week, Alison Singer, the executive vice president of communications and awareness at Autism Speaks, one of the nation's leading autism advocacy groups, announced her resignation, citing a difference of opinion over the organization's policy on vaccine research. "Dozens of credible scientific studies have exonerated vaccines as a cause of autism," she wrote in a statement. "I believe we must devote limited funding to more promising avenues of autism research." Singer, who has an 11-year-old daughter with autism, joined the organization when it launched in 2005. Singer praised Autism Speaks and its founders, Bob and Suzanne Wright, but said she could no longer work for a group that supports spending limited resources on vaccine research. Calling Singer's resignation "disappointing and sad," Bob Wright says more authoritative research needs to be conducted on the safety of vaccines given to children under 2. "We all know that autism has genetic causes, but it's highly associated with environmental factors we can't get our hands around," says Wright. "Vaccines fall into that category." NEWSWEEK's Claudia Kalb spoke with Alison Singer about her resignation. . . .
Friday, January 16, 2009
Seven states and two organizations have sued the Bush administration in an attempt to block a federal regulation that would further protect health care workers who refuse to perform abortions or other medical procedures because of religious or moral reasons.
Connecticut Attorney General Richard Blumenthal filed a lawsuit Thursday on behalf of his state, California, Illinois, Massachusetts, New Jersey, Oregon and Rhode Island. Blumenthal said the regulation would put women's health care at risk and would undercut state contraception laws. "On its way out, the Bush administration has left a ticking legal time bomb set to explode literally the day of the inaugural and blow apart vital constitutional rights and women's health care," Blumenthal said in a statement. "Women's health may be endangered -- needlessly and unlawfully -- if this rule is allowed to stand."
He said the regulation "intentionally shrouds" abortion in "new and unnecessary ambiguity," encouraging individuals to define it and to "deny virtually all forms of contraceptions, even emergency contraception to rape victims." . . .
The Department of Health and Human Services said the regulation would allow the federal government to withhold federal funds for state and local governments, health plans and health care facilities that do not follow existing federal laws that ban discrimination against doctors and other health workers who refuse to participate in procedures such as sterilizations or abortions or to make referrals for such procedures.
"We have not had an opportunity to review the lawsuits and we will respond to the court on any pending litigation," department spokeswoman Rebecca Ayers said in an e-mail. "The department followed appropriate procedures to put the regulation in place and the regulation is fully supported by law." . . .
GoozNews brings us a quick comparison of the some the health care plans being considered and points helpfully to the new Commonwealth Fund's study of the various health reform proposals. The website provides,
The Commonwealth Fund's latest study on health care reform found that plans proposed by Rep. Pete Stark, chairman of the health subcommittee of the House Ways and Means Committee, and Sen. Edward Kennedy, chairman of the Health Education Labor and Pensions committee in the upper chamber, come the closest to providing universal insurance coverage without actually going to a single-payer plan. Both their plans establish a government-run plan to cover the uninsured and give employers an alternative to the private insurance market.
For a pro-single-payer analysis of the Commonwealth study, see DrSteveB's analysis on the DailyKos blog. Using Commonwealth's numbers, he suggests the Stark/Kennedy approach would reduce overall health care expenditures even as it increased the share of those expenses picked up by the federal government. All other plans would increase overall health care costs.
The Rand Corp., meanwhile, has launched its own "tool" for analyzing health care reform proposals. Rand Compare doesn't just focus on health insurance reform, but on health system reform. . . .
Thursday, January 15, 2009
The LATimes contains a brief story concerning Wellpoint, the health insurance company, and its penalty for overcharging or denying prescription drugs to its older insured. The story provides,
Health insurer WellPoint Inc. has been barred from adding customers to Medicare plans after it denied prescription drugs to the elderly, endangering their lives, the government said Monday.
The sanctions, outlined in a letter to WellPoint from the Centers for Medicare and Medicaid Services, followed a "sharp" increase in consumer complaints, the agency said. Elderly customers were stopped from receiving essential prescription drugs, and some were overcharged because of computer mistakes, the government said. . . .WellPoint is the parent company of Woodland Hills-based Anthem Blue Cross of California, the state's largest for-profit health insurer. WellPoint did not immediately comment.
Bloomberg News published a story Monday that told a sorry tale of the country’s second largest insurance carrier (revenue-wise) and how it treated seniors who depend on coverage from the company to pay for their drugs. CMS gave Bloomberg a copy of the letter it sent to WellPoint which said the carrier has “demonstrated a longstanding and persistent failure to comply with CMS’ requirements for proper administration of its Medicare Advantage Prescription Drug Plans (MA-PD) and Prescription Drug Plans (PDP).”
The letter went on to say that the noncompliance has resulted in thousands of Medicare beneficiaries being denied access to “critical medications” that included cardiac drugs, anti-seizure drugs, anti-clogging drugs as well as medicine for asthma and chronic obstructive pulmonary disease. “WellPoint failed to follow through on its assurances to CMS that the problem was immediately and fully corrected,” the letter explained. CMS spokesman Peter Ashkenaz told me that the Medicare regulator had gotten a spike in complaints from WellPoint customers last week when new drug plans took effect. In December, he said, the agency received “under 100 complaints” and in the first week in January “we had more than 500. People were not getting their drugs.”
So the agency slapped a penalty on the carrier: effective immediately, it cannot market Medicare Part D plans, which provide pharmaceutical benefits to seniors, nor can it enroll new plan members. Even though the general Part D open enrollment season just ended, carriers can still sign up seniors with low incomes and people turning 65 who need to find a drug plan. Seniors enrolled in the controversial Medicare Advantage plans whose sellers are being overpaid by the federal government, can still switch plans until the end of March. So it’s fair to say the sanctions are likely to pinch WellPoint’s profits. WellPoint said in a statement that it had made significant progress in addressing problems cited by CMS and that since it had been working with the agency, it was “surprised by this recent action.” . . .
In case you think WellPoint is alone in designing questionable insurance practices, take note. Yesterday the nation’s biggest carrier UnitedHealth Group agreed to pay a $50 million settlement after New York attorney general Andrew Cuomo accused the insurers of overcharging millions of customers when a research firm owned by United manipulated the numbers so that the carrier underpaid policyholders when they filed claims. Said Cuomo: “This is a huge scam that affected hundreds of millions of Americans who were ripped off by their health insurance companies.”
All this should prompt reporters to investigate whether these kinds of insurance shenanigans are what Americans prefer when they say they want universal coverage. For example, what will prevent WellPoint from continuing the same practices for policyholders under 65 that CMS has said it engaged in for seniors on Medicare? What will stop insurers from paying as little as possible and shoving more costs of medical care onto unsuspecting policyholders? And while they’re at it, a hard look at whether regulation can really discourage such practices is in order. Remember, the president-elect said during the campaign that he would tightly regulate health insurance. The case of WellPoint and UnitedHealth Group invites scrutiny of this campaign promise.
The Washington Post reports on the House passage of SCHIP. The story provides,
The House easily approved an expansion of government health coverage for low-income children yesterday, a top priority for President-elect Barack Obama and the first in a series of stalled measures expected to move quickly through the Democratic Congress as President Bush leaves office.
Obama hailed the 289 to 139 vote and nudged the Senate to act with the "same sense of urgency so that it can be one of the first measures I sign into law when I am president." The president-elect vowed as a candidate to provide health coverage to every child, and the expansion of the State Children's Health Insurance Program, known as SCHIP, is a major step toward that goal. "In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens," Obama said.
The House legislation would cost nearly $33 billion over 4 1/2 years and would be funded in part by a cigarette tax increase of 61 cents to $1 per pack. Bush vetoed two similar bills in 2007, objecting to the tax increase and the expansion of government health care. The Senate Finance Committee will take up a similar measure today, with floor action expected to begin next week. . . .
The House bill would provide health insurance to an additional 4.1 million children and parents, including legal immigrant children and pregnant women, who currently must wait five years before becoming eligible for the program. A total of 11 million individuals could now receive coverage. . . .
In a policy statement, House Republicans outlined their objections, chiefly that the measure would place a new burden on states already struggling to meet soaring Medicaid costs and would permit states to enroll children from households with incomes of up to $80,000. "Increasing the amount of federal tax dollars flowing to states that consciously choose to provide benefits to children of these higher-income families before enrolling already eligible poor and low income children is the wrong policy and sends the wrong signal," the statement said.
Republicans also object to the tobacco tax as an unstable revenue source. Opponents of the bill asserted that the steady decline of smokers in recent years would have to be reversed in order to meet funding estimates for the children's health program over the coming decade. But the American Cancer Society estimates that the proposed tax increase would prevent more than 900,000 smoking-related deaths and discourage nearly 1.9 million children from taking up smoking. . . .
Wednesday, January 14, 2009
The New York Times's Robert Pear reports on the continuing debate over SCHIP, coverage for legal immigrants under age 21 is the latest controversial issue, and the liklihood that it will pass next week. He writes,
Congress is poised to give President-elect Barack Obama a quick victory by passing a bill to provide health insurance to millions of low-income children. The House Democratic leader, Representative Steny H. Hoyer of Maryland, said the bill, scheduled for a vote in the House this week, was “very much like” legislation twice vetoed by President Bush in 2007. Legal authority for the program expires on March 31. Congressional Democrats said they had decided to add a major provision allowing states to restore health insurance benefits to legal immigrants under 21, a goal of Hispanic groups since those benefits were terminated in 1996.
This part of the bill deals only with legal immigrants. But it could revive the emotional debate over immigration, as many Republicans want to establish stricter verification procedures to prevent illegal immigrants from getting health benefits. Under current law, legal immigrants are generally barred from Medicaid and the State Children’s Health Insurance Program for five years after they enter the United States. The Democrats’ proposal would give states the option of covering children and pregnant women, with the federal government subsidizing the costs as usual under both programs. . . . .
Representative Eric Cantor of Virginia, the Republican whip, said Republicans had concerns about expanding the program, to immigrants or any other group, before the original purpose of the program was achieved. “The program has not fulfilled its initial mission, to serve children of the working poor,” Mr. Cantor said in an interview. Among children, legal immigrants are less likely than citizens to receive immunizations and routine dental care. Likewise, among women, legal immigrants are less likely to receive prenatal care. . . .
House Democrats are taking their bill directly to the floor, but in the Senate, Democratic leaders plan to work through the Finance Committee, led by Senator Max Baucus, Democrat of Montana. Mr. Baucus has drafted a bill similar to the House measure. As of late Monday, his proposal did not include benefits for immigrants. But other Democratic senators, like Jeff Bingaman of New Mexico and John D. Rockefeller IV of West Virginia, have said that they, like Mr. Obama, want to allow states to cover children who are legal immigrants.
The new bills, like those vetoed, would be financed by tobacco taxes, including a 61-cent cigarette tax increase, to $1 a pack.
Tuesday, January 13, 2009
TalkingPointsMemo provides a brief piece concerning Senator Ron Wyden's thoughts on health care issues that might be addressed in the upcoming stimulus bill.
Sen. Ron Wyden (D-OR) knows how to build health care coalitions. From his seat on the Senate Finance Committee, he has watched the major health debates of the past decade -- from the 1994 Clinton flame-out onwards -- play out from the front row. . . . So he's got a pretty authoritative take on the health care proposals that are headed for inclusion in the stimulus bill.
"If there can be two good wins on health care early," he told me during a sit-down interview in his office today, "on SCHIP and COBRA for the uninsured, it's a bit of a down payment in terms of broader reform. It can build on that -- on Democrats and Republicans finding common ground."
Wyden added that reforming health information technology, allowing all Americans to have an electronic medical record within five years, is also on track to be part of the stimulus, for one simple reason: "It's a job creator."
SCHIP, the children's health insurance program administered by the states with federal help, is moving forward separately from the stimulus, headed for a quick reauthorization (and expansion) on the House floor and in Senate Finance this month, ahead of the March 31 deadline for renewal.
Adding COBRA aid to the stimulus bill, however, thus helping laid-off workers afford to keep their health care, would be a key victory for Wyden. The idea has met with positive signals from Republicans, making COBRA aid a helpful first step towards amassing broad support for major health care reform later in the year. . . . .
CNN.com reports on President-elect Obama's plan to "modernize health care by making all health records standardized and electronic." David Goldman states,
Here's the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline. Sounds good. But it won't be easy.
In fact, many hurdles stand in the way. Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.
"The hard part of this is that we can't just drop a computer on every doctor's desk," said Dr. David Brailer, former National Coordinator for Health Information Technology, who served as President Bush's health information czar from 2004 to 2006. "Getting electronic records up and running is a very technical task."
It also won't come cheap. Independent studies from Harvard, RAND and the Commonwealth Fund have shown that such a plan could cost at least $75 billion to $100 billion over the ten years they think the hospitals would need to implement program. That's a huge amount of money -- since the total cost of the stimulus plan is estimated to cost about $800 billion, the health care initiative would be one of the priciest parts to the plan.
The biggest cost will be paying and training the labor force needed to create the network. Luis Castillo, senior vice president of Siemens Healthcare, a company that designs health care technology, said the laborers will have the extremely difficult task of designing a a system that "thinks like a physician." "Doctors cannot spend hours and hours learning a new system," said Castillo. "It needs to be a ubiquitous, 'anytime, anywhere' solution that has easily accessible data in a simple-to-use Web-based application."
But highly skilled health information technology professionals are as rare as they come, and many IT workers will need to be trained as health technology experts. Early government estimates showed about 212,000 jobs could be created from this program, but Brailer said there simply aren't that many Americans who are qualified.
Furthermore, ensuring the privacy of patients' records in a nationalized computer network will be tricky. There are obvious concerns about hackers and system failures. And new online health record systems, such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law. "HIPAA was never intended for the digital age, because the laws never anticipated the emergence of Web-based records," said Brailer. "Congress can pass one of numerous policy proposals for change, it's just a question if they have the will to do that." . . . .
Monday, January 12, 2009
Last week's New York Times Science section had an interesting story on whether doctor's should inform patients about hospitals and other physicians that have more experience and better outcomes in performing various procedures. Denise Grady writes about her own relative's health care and what she believed was an important second opinion. She states,
Six years ago, a relative of mine found out that she had rectal cancer and would need surgery, radiation and chemotherapy. She lives in a small town, and she consulted a local surgeon at a community hospital. He was pleasant and kind, and clearly explained her condition and the operation he would perform. He was also painfully honest, and said that because the tumor was large, he doubted that he would be able to save the sphincter muscles that make bowel control possible. She would very likely need a colostomy, a procedure to divert wastes out through an opening cut in the abdomen, and would have to wear a colostomy bag for the rest of her life.
My relative thought it over. Being treated close to home had seemed so easy and convenient, and she dreaded the thought of shopping around for doctors when she was feeling sick, vulnerable and anxious. It was tempting to think that she would receive first-rate treatment no matter where she went. But she also recognized that this was a small hospital, and a surgeon who probably spent more time fixing hernias and taking out gallbladders than he did operating on cancer patients. She decided that she wanted a doctor who operated on patients like her all the time, and that the two-hour trip to a cancer center would be worth the trouble.
And so it was: she found a surgeon who specialized in rectal cancer, and today she’s in good health, with no need for a bag. She might have done just as well with the local surgeon, but we both doubt it.
An article published online in October in the journal PLoS Medicine really hit home with me. Noting that the quality of cancer care is uneven, its authors argued that as part of the informed-consent process, doctors have an ethical obligation to tell patients if they are more likely to survive, be cured, live longer or avoid complications by going to Hospital A instead of Hospital B. And that obligation holds even if the doctor happens to work at Hospital B, and revealing the truth might mean patients will take their business someplace else. "It’s only fair,” said Dr. Leonidas G. Koniaris, an author of the article and a cancer surgeon at the Miller School of Medicine at the University of Miami. . . . .
Ezra Klein points out some new data on health care trends since 1994. You can download the paper, complete with helpful charts and graphs here. Looks like health care reform should be at the top of the agenda in 2009 since we aren't getting better health care and people are much worse off. Here is part of his post:
Over at CAP, Ben Furnas pulled together a bunch of charts and graphs tracking trends in health care since 1994. The quick takeaway is that not only have things gotten worse, but that many things are getting worse at an accelerating rate. This is actually an important point. When you don't fix health care reform, you're not left with the status quo. You're left with the continuing deterioration of the status quo. Prices continue to rise. More join the ranks of the uninsured. More go bankrupt. More die. The status quo gets worse. And on some level, people know that. . . .
Saturday, January 10, 2009
The Washington Post has an article today on a new report by Families USA on a problem with COBRA - it costs a lot - as many newly unemployed are finding out. Ceci Connelly writes,
The cost of buying health insurance for unemployed Americans who try to purchase coverage through a former employer consumes 30 percent to 84 percent of standard unemployment benefits, according to a report released yesterday.
Because few people can afford that, the authors say, the result is a growing number of people being hit with the double whammy of no job and no health coverage. In 1985, Congress passed legislation enabling newly unemployed Americans to extend their employer-based health insurance for up to 18 months. But under the program, known as COBRA, the individual must pay 102 percent of the policy's full cost.
"COBRA health coverage is great in theory and lousy in reality," said Ron Pollack, whose liberal advocacy group, Families USA, published the analysis. "For the vast majority of workers who are laid off, they and their families are likely to join the ranks of the uninsured." . . . .
For every 1 percentage point rise in unemployment, the number of uninsured Americans climbs by 1.1 percent, according to an analysis last spring by the Kaiser Family Foundation, an independent research group.
Pollack and House Speaker Nancy Pelosi (D-Calif.) said the new report highlights the need to include health insurance subsidies in the economic recovery package being crafted this month. "Without that," Pelosi spokesman Brendan Daly said, "they simply cannot afford to pay for temporary continuation of their health insurance."
But Nina Owcharenko, a health policy analyst at the conservative Heritage Foundation, said it would be wiser to offer unemployed Americans a broad range of health insurance options, including high-deductible private policies or new state-based programs. Given how expensive COBRA is, she said, alternatives would "save the individual money and save taxpayer money."
Friday, January 9, 2009
On other appointment matters, it appears that the House of Representative's John Conyers is not a big fan of Dr. Sanjay Gupta.
Diane Rehm had Professor Doris Teichler Zallen ,Professor of Science and Technology Studies at Virginia Tech University and author of "To Test or Not to Test" on her show yesterday to discuss the advances in genetic testing and some of things that people should consider before deciding whether to be tested. The show can be found here.
Thursday, January 8, 2009
From the Daily Beast (emphasis added):
Dr Richard Batista, from Ronkonkoma, New York, who is being divorced by his wife Dawnell, has asked she include the kidney he donated to her for transplant in the divorce settlement. Batista puts the value of the organ at $1.5 million, a court in Mineola, New York, has heard. There is little chance he will get his way. Asked how likely it would be for the doctor to either get his kidney back or get money for it, Arthur Caplan at the Centre for Bioethics, the University of Pennsylvania, said it was "somewhere between impossible and completely impossible." Robert Veatch, a medical ethicist at Georgetown University's Kennedy Institute of Ethics, agrees. "It's illegal for an organ to be exchanged for anything of value" because organs may not be bought or sold, he said. And as the donation of an organ is considered a gift, legally "when you give something, you can't get it back." "It's her kidney now and ... taking the kidney out would mean she would have to go on dialysis or it would kill her," Veatch said.
More can be found in The Guardian.
The Wonk Room provides a handy list of the 10 myths about health care reform. Here is the list and also find a helpful discussion and de-bunking of these myths.
As the 111th Congress considers health care reform, conservatives and their industry allies — so-called opponents of health care reform — will likely embark on a misinformation campaign about the consequences and implications of expanding access to affordable health care coverage. The Wonk Room has compiled and debunked the right-wing’s most widely circulated myths about reform.
Myth 1: Health care reform will limit patient choice.
Myth 2: Americans will lose their existing coverage.
Myth 3: The government will ration care.
Myth 4: Affordable health care reform will create a government monopoly.
Myth 5: A new public program will only drive-up health care costs.
Myth 6: Health care reform in Massachusetts is “an unfolding disaster.”
Myth 7: Being uninsured is not a problem; it’s people’s own fault.
Myth 8: Illegal immigrants are driving the nation’s uninsured problem.
Myth 9: Health care reform won’t save money.
Myth 10: Deregulating the health care industry will solve the health crisis.
1. Health care reform will limit patient choice. In an editorial published in the Washington Post, Rep. Michael Burgess (R-TX) argued that what health care reform really “means is limiting freedom - the freedom to choose a doctor, to take your health care with you when you switch jobs, to make personal medical decisions.” [Washington Times, 11/19/2008]
REALITY: Progressive reforms would provide more choice, not less. Under progressive proposals, Americans will have the choice to keep the employer plan they currently have or buy an affordable plan from the national insurance exchange. Individuals and small businesses will be able to “compare private coverage options and a public plan and to purchase the policy that would work best for them.” [Wonk Room, 11/12/2008] . . . .