HealthLawProf Blog

Healthy Americans Against Health Reform: New AD

I find these ads quite funny, hope others to do - click here (HARRM.ORG) for their latest.   For more health reform humor, check out Tom Tomorrow's latest cartoon here.

The Public Plan: A Discussion

Several scholars discuss and debate the pros and cons of a public plan option at The American Prospect.   Here is a brief excerpt:

In "The Perils of the Public Plan," Paul Starr warns that a public-insurance option could turn into exactly the opposite of what progressives want. Here he discusses the problems with the Prospect's two other co-founders, Robert Kuttner and Robert Reich.

Paul Starr:
The far bigger question is how those exchanges work:

Are they open to all employers and individuals -- required, in fact, for employers below a given size -- or open only to the individual and small-group market?

Do the exchanges have the power to risk-adjust the premiums paid to health plans?

Can they regulate the marketing strategies and benefit designs of private insurers?

The public plan will likely end up as a dumping ground for high-cost, mostly low-income people if the exchanges are open only to the individual and small-group market and have inadequate power to risk-adjust premiums or to regulate private insurers' marketing and benefit design. In other words, we could get a public plan that instead of "disciplining" private insurers, as the president said last week, actually buttresses their dominance of the system. Watch what you wish for.

Robert Kuttner:
The public option, as it is evolving, is even more dubious than Paul Starr's apt critique suggests. Under the House leadership bill, people who have coverage through their employers are ineligible. So the proposed, head-to-head competition between the public plan and private competitors is left to employers, not individuals.

What's distressing is that progressives have put all their eggs in this leaky basket. It's clear that Jacob Hacker's original inspiration -- that over time the superior efficiencies of a true public plan would crowd out private alternatives -- is being undermined by the politics of compromise. Even Sen. Max Baucus, not exactly a lefty, remarked the other day that he wished that single-payer hadn't been taken off the table, if only for tactical reasons.

In public opinion polls and in liberal advocacy, the badly flawed public option has become a kind of proxy for what most Americans really want -- national health insurance. . . .

Robert Reich:
Paul Starr worries that the public plan would end up a dumping ground for the sicker and more expensive. If that were the likely outcome, private insurers, the pharmaceutical lobby, and the American Medical Association would be all in favor of it. But they're apoplectic about a public option because they fear exactly the opposite, which also seems to me more likely: By virtue of its scale and scope, a public plan would have the bargaining power to get lower drug prices and better deals with health providers, thereby eating into their profits. And they worry that the lower administrative costs of a public plan that doesn't have to show a profit, or spend on marketing and advertising, will further erode their margins. Of course we need to pay attention to the precise organization of the risk exchanges, but that's mainly to make sure the public plan is allowed to exert full competitive pressure on the private plans. . .      .

Krugman on Health Reform

Oxdown Gazette has an excellent post discussing Paul Krugman's response to George Will's (Washington Post) and Greg Mankiw's (New York Times) editorials on healthcare.   The blogger writes,

Fortunately, Paul Krugman had similar concerns, but expressed them more clearly, and after all, he's a decent economist. In Health Care is Not a Bowl of Cherries, he responds to Mankiw:

Both George Will and Greg Mankiw basically argue that we don’t need a government role because we can trust the market to work — hey, we do it for groceries, right?

Um, economists have known for 45 years — ever since Kenneth Arrow’s seminal paper — that the standard competitive market model just doesn’t work for health care: adverse selection and moral hazard are so central to the enterprise that nobody, nobody expects free-market principles to be enough. To act all wide-eyed and innocent about these problems at this late date is either remarkably ignorant or simply disingenuous.

Those who follow Krugman, DeLong and other economist blogs know that in several posts over recent months, Krugman and DeLong have been rolling their eyes at economists succumbing to talking points and what they call "The Great Ignorance," in which prominent economists appear to have forgotten what their predecessors figured out decades ago. This began during the stimulus debates.

Working to Prevent Painkiller Damage

The Associated Press reports on the FDA's renewed focus on painkillers and their damaging side effects. The article provides,

Tylenol, Excedrin, NyQuil. These household brands and others have come to symbolize safe, convenient relief from the aches and pains of everyday life. But this week the Food and Drug Administration is focusing on a seldom-discussed side effect of the medications: severe liver damage. Since the drugs first became widely available in the 1950s, the FDA has tried to minimize the risks of acetaminophen — the pain-relieving, fever-reducing ingredient in Tylenol and dozens of other prescription and over-the-counter medications.

Acetaminophen overdoses send an estimated 56,000 people to the emergency room each year, according to the FDA.  Despite decades of educational campaigns, bolstered warnings and other federal actions, acetaminophen continues to be the leading cause of liver failure in the U.S. . .  .   

The FDA does not have to follow the group's advice, though it usually does. Individual companies already are sparring in an effort to influence the FDA's decision.   Panelists will be asked to vote on a range of options: adding a "black box" warning label to the products, lowering the drug dosage in some products, or pulling certain types of medications off the market — which could cost manufacturers millions in sales.  The drugs that could be pulled off store shelves are combination medications, such as Procter & Gamble's NyQuil or Novartis' Theraflu, which combine acetaminophen with other ingredients that treat cough and runny nose....

Coverage for Autism

The National Law Journal reports on a settlement in Michigan involving payment for autism treatments by  insurance companies.  Tresa Baldas writes,

In what plaintiffs lawyers are calling a landmark autism case, a Michigan insurance company has agreed to reimburse at least 100 families for costs involving treatments for their autistic children.

The $1 million class action settlement from Blue Cross Blue Shield of Michigan comes amid a legislative wave in which a growing number of a states are passing laws that require insurance companies to pay for autism treatments and screenings. To date, 13 states have such laws, the most recent being Connecticut, Colorado and Nevada. New Jersey is currently considering an autism bill, and Pennsylvania's law goes into effect July 1.

The June 17 Michigan settlement, meanwhile, has autism advocates hopeful that insurance companies will stop claiming that behavioral therapy for autistic children is experimental, and start paying for it.

"It is a significant victory for the families, obviously, and it marks a trend, hopefully, that insurance companies will start to look at autism treatment differently," said Areva Martin, an attorney at Los Angeles-based Martin & Martin who is currently handling about 30 autism cases. She believes the labeling of autism treatments as experimental is "absurd." ...

In the case, Johns v. Blue Cross Blue Shield of Michigan, filed in the Eastern District of Michigan, the family of an autistic child sued Blue Cross for allegedly failing to acknowledge that a treatment known as applied behavioral analysis is scientifically valid. ABA therapy attempts to change behavior through positive and negative reinforcements.   In the suit, the plaintiffs alleged that Blue Cross' pattern and practice of characterizing ABA as "experimental" was arbitrary, capricious, illegal and contradicted by many years of scientific validation.   Blue Cross sought dismissal of the case, but a judge permitted it to go forward.

The case settled shortly after plaintiffs counsel obtained a court order requiring Blue Cross to produce documents that validated the effectiveness of ABA. Among the documents obtained was a draft of a 2005 Blue Cross Blue Shield medical policy, which stated: "Applied behavioral analysis (ABA) is currently the most thoroughly researched treatment modality for early intervention approaches to autism spectrum disorders and is the standard of care recommended by the American Academy of Pediatrics, National Academy of Sciences Committee and the Association for Science in Autism Treatment, among others."

Blue Cross' documents also stated: "The earlier the disorder is diagnosed, the sooner the child can be helped through treatment interventions." ...

Fun with Opposing Health Reform

Just for fun - you should check out the new lobbying organization:  HAARM - Healthy Americans Against Reforming Medicine.  They have a video here.  Enjoy!  Thanks to Americablog for the link.

Steve Jobs and Organ Transplants

Recently, it came to light that Steven Jobs, Apple's CEO, received a liver transplant.  There exist some concerns for those who worry about corporate disclosure issues and health privacy for CEOs but the transplant also raised again the troubling issue about how organs are distributed in this country.  The Chicago Tribune has a brief report containing an interview with Professor Arthur Caplan.  Greg Burns writes,

If Apple Inc. co-founder Steve Jobs used his billions to obtain a new liver ahead of less-privileged transplant patients, who's to blame?

Not Jobs, says Arthur Caplan at the University of Pennsylvania's Center for Bioethics.  "He did nothing illegal. And pursuing his own self-interest makes sense," Caplan said.

Instead, the blame goes to transplant doctors, the United Network for Organ Sharing and Congressional leaders. They have failed to cut off an inside track that the rich, famous and gravely ill can follow to snare a spare part ahead of everybody else. . . .

For Caplan's take on how the Silicon Valley chieftain wound up in Memphis for a new liver, click here.

Gearlog had a brief statement from Jobs' doctor.  The report states, 

Another bizarre turn in the story came today when Dr. James Eason, the head of the hospital's transplant unit, held a press conference to address the subject, telling reporters, "Mr. Jobs is doing fine."

The hospital held the conference, in part, to address criticism that Jobs's position had helped him climb to the top of the transplant list. Said Eason,

Whoever's at the top of the list, they're there because they're the sickest. Waiting time isn't even a factor anymore. If someone's been on the list a long time, they're obviously healthy enough to have survived for a long time" and therefore by definition might not be the best candidate.

Fourth Circuit Upholds Virginia's Partial Birth Abortion Ban

The Washington Post reports on the Fourth Circuit Court's en banc decision to uphold Virginia's partial birth abortion ban.  Josh White states,

A sharply divided federal appeals court ruled constitutional yesterday a Virginia law banning "partial birth" abortion that was overturned four years ago, bringing the state in line with a federal ban on the controversial procedure.

A three-judge panel of the U.S. Court of Appeals for the 4th Circuit overturned the Virginia law in 2005 by a 2 to 1 vote, finding that it did not allow for exceptions to safeguard a woman's health. The Supreme Court ordered the appeals judges to revisit the issue when it upheld the Partial Birth Abortion Ban Act two years ago, a law passed by Congress in 2003 that is similar to Virginia's ban.

Although the Virginia law permits women to choose various abortion procedures, it specifically makes it a crime for doctors to perform a rare midterm abortion that involves partially delivering the fetus before crushing its skull to ease removal.

William G. Fitzhugh, a Richmond doctor who challenged the law, argued that the procedure can be necessary to protect the life of a patient and that banning it could prevent doctors from performing legal procedures out of a fear of prosecution. Opponents of the procedure liken it to infanticide. . . .

NPR Researching Health Lobbyists and Their Influence

Today National Public Ratio began a new series discussing the lobbyists in the room during health reform debates. 

Earlier this month, lobbyists trooped in to watch as the Senate Committee on Health, Education, Labor and Pensions began working on a health-care overhaul — the first congressional panel this year to move so far.

As the lobbyists watched the 22 senators, NPR watched the lobbyists — took panoramic photos of them, in fact. After all, congressional committee meetings like this one are public events.

We wanted to know how many lobbyists go to these important sessions, what they hope to influence and, most basically, who they are. We've already begun to identify them; you can see the panoramic shot by clicking on the image at left. . .

NPR is asking for some help identifying these lobbyists.  If you check out the photos on their website and know the players, you may want to provide them with some information.

RIP Dr. Jerri Neilsen FitzGerald

The Associated Press reports on the death of Dr. Jerri Neilsen FitzGerald,

Dr. Jerri Nielsen FitzGerald, who diagnosed and treated her own breast cancer before a dramatic rescue from the South Pole, has died. She was 57.   Her husband, Thomas FitzGerald, said she died Tuesday at their home in Southwick, Mass. Her cancer had been in remission until it returned in August 2005, he said Wednesday.  

She was the only doctor among 41 staff at the National Science Foundation's Amundsen-Scott South Pole Station in winter 1999 when she discovered a lump in her breast. At first, she didn't tell anyone, but the burden became too much to bear. . . .    Rescue was out of the question. Because of the extreme weather conditions, the station is closed to the outside world for the winter. She had no choice but to treat the disease herself, with help from colleagues she trained to care for her and U.S.-based doctors she stayed in touch with via satellite e-mail. . . .

Nielsen FitzGerald spent the last decade speaking around the world about the cancer and how it changed her life, and also worked as roving ER doctor in hospitals all over the Northeast.   "She fought bravely, she was able to make the best of what life and circumstance gave her, and she had the most resilience I have ever seen in anyone," said her husband. "She fought hard and she fought valiantly." The couple would have celebrated their third anniversary next week. . . .

Expanding Medicaid: Some States Wary

The Wall Street Journal reports on some concerns of state governors about expanding Medicaid.  Jonathan Weisman writes:

Some governors are pushing to scale back or kill proposals to expand Medicaid to provide health-care coverage to the uninsured, raising a new challenge to President Barack Obama's effort to overhaul the system.

Medicaid, the health-care program for the poor, is funded through a combination of federal and state tax money. Proposals in the House and Senate would expand the program to cover at least a third of the nation's 46 million uninsured, but states are worried they would get stuck with a big part of the tab. . . .

Sen. Diane Feinstein, a California Democrat, said Sunday the issue could be a deal breaker for her.  California is in "a state of financial catastrophe," she said on CNN's "State of the Union." "[I]f you change the Medicaid rate, for example, it has an impact on California between $1 billion and $5 billion a year. Now, how could I support that?" she asked. "It would take down the state."

Currently, government-sponsored coverage of children offered by a combination of Medicaid and the State Children's Health-Insurance Program generally extends to 200% of the poverty line, or $36,620 for a family of three, $44,100 for a family of four. Parents are generally covered by Medicaid up to 67% of the poverty line, or $14,800 for a family of four. Adults without dependent children often aren't covered by Medicaid at all.

The House Democratic plan would offer coverage to any uninsured American with incomes up to 133% of the poverty line, with the federal government assuming all the cost of expansion. Proponents haven't said what that will cost. A proposal by the Senate Health, Education, Labor and Pensions Committee may go up to 150% of the poverty line. The federal government would assume all the cost for five years. During the next five years, the states would gradually assume half the cost. The Senate Finance Committee is working on legislation along the same lines, but not as generous. Pregnant women would be covered up to 150% of the poverty line. Childless adults could be closer to 115%, a senior committee aide said.

White House officials appear to be looking at other options for the uninsured poor. . . .

Rationing Health Care British Style

Ezra Klein discusses rationing of health care and why we don't have to be like the British.  He writes,

Michael Hiltzik has a smart column explaining the way rationing works in the British health-care system:

The most extensive laboratory in the field has been run by the National Institute for Health and Clinical Effectiveness, or NICE, an arm of Britain's National Health Service, the government healthcare program.

NICE's judgments about cost-effectiveness are based on a measure known as the quality-adjusted life year, or QALY. Get used to the acronym -- you're sure to hear it a lot more as the health-reform debate rages on.

In simple terms, QALY adjusts the length of time that a treatment might extend a patient's life by a factor assessing the patient's quality of life in that time ranging from 0 (death) to 1 (complete health). If a certain cancer drug would extend life by two years, say, but with such onerous side effects that those years were judged to be only half as worth living as those of a healthy person, the QALY is 1. . . .

The big problem with Britain is that there's nothing outside the National Health Service. If you want to pay for care out of your own pocket, you have to give up your state-based coverage.  There's no reason we have to copy that example. But imagine a system in which the government offered basic coverage to all Americans, regardless of age or income, for all treatments that are less than $33,000 per QALY. Above that, the government could offer subsidies for low-income Americans to purchase supplementary coverage, and higher-income folks would have to figure it out on their own.

That's not rationing, incidentally. It's simply setting limits on what comes out of the public purse. . . .   Indeed, this is basically what the French do, and many people think their health-care system is the best in the world.

Lobbying Money and Health Reform

Nate Silver at the FiveThirtyEight blog has crunched some numbers on the impact of health lobbying money on the public health option.  He concludes that such monetary influence does have an impact on several senators and their votes on the public option.  He writes,

As I lamented yesterday, health care is one of those areas where both popular opinion and sound public policy seem to take a backseat to protecting those stakeholders who benefit from the status quo. But can we actually see -- statistically -- the impact of lobbying by the insurance industry on the prospects for health care reform? I believe that the answer is yes. . . .

What happens if we set the lobbying variable to zero for all senators? That is, suppose that the health care insurance industry were prohibited from making political contributions? In that case, the model predicts, 47 senators would currently support the public option, as opposed to the 38 who actually do. In other words, the insurance industry's influence appears to swing about 9 votes against the public option. Whatever number of senators wind up supporting the public option, add 9 to it, and you'll have a decent ballpark estimate for what the level of support might be if not for insurance industry contributions. Note, however, that we haven't attempted to model the impact of contributions from other interest groups, including both pro-health reform organizations such as labor unions or other stakeholders like pharmaceutical companies. . .

The whole article is a great read and I enjoy Nate Silver's ability to provide such clarity to his research methods and results.  Thanks to HuffingtonPost.com for the site.

Drug Companies

The Associated Press reports on the new deal that the drug companies have negotiated with Medicare's drug provision.  The story provides,

President Barack Obama on Monday welcomed the pharmaceutical industry's agreement to help close a gap in Medicare's drug coverage, calling the pact a step forward in the push for overhaul of the nation's health care system.  Obama said that drug companies have pledged to spend $80 billion over the next decade to help reduce the cost of drugs for seniors and pay for a portion of Obama's health care legislation. . . .

Obama said the move on Medicare will help correct an anomaly in the program that provides a prescription drug benefit through the government health care program for the elderly and disabled. Under the deal, drug companies will pay part of the cost of brand name drugs for lower and middle-income older people in the so-called "doughnut hole." That term refers to a feature of the current drug program that requires beneficiaries to pay the entire cost of prescriptions after initial coverage is exhausted but before catastrophic coverage begins. . . .

Health Reform in Chart Format

ThinkProgress provides a helpful chart of the differing health reform plans. the Senate Finance Draft, the Tri House Bill, and HELP Bill current being considered in Congress.  Here is a brief discussion of the Tri House Bill and you can see the comparison chart by clicking through to ThinkProgress.

Today, three separate House committees — Ways and Means Committee, Energy and Commerce Committee, Education and Labor Committee — released a single health care reform bill, the Tri Committee Proposal. In a press release announcing the legislation, the three panels with jurisdiction over health policy in the House announced that they had developed “a single bill that fulfills President Obama’s goals of reducing health care costs, protecting and increasing consumers’ choices, and guaranteeing access to quality, affordable health care for all Americans."

Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option. While details are still being worked out, the proposal establishes a public plan in 2013 that will compete with private insurers, within the Exchange, on a level playing field. The public option will be required to abide by all marketing, operations, and rating rules and would initially be allowed to use Medicare plus rates. After some time, the plan would have to independently negotiate fees with providers. . . . 

The Swine Flu Remains Active

The CDC Press Briefing from last week reminds Americans that the H1N1/Swine Flu continues to spread.    The briefing transript provides,   

In terms of the numbers of infections that have been laboratory confirmed as H1N1, there are now more than 17,800 of those in the United States, including around 1,600 that have been hospitalized and 44 that have died.  As we have been saying all along, these numbers are likely an underestimate of the number of cases that are out there.  There are some surveys that indicate that the amount of disease in the areas that are having activity with H1N1 is perhaps around 7% of the population reporting symptoms due to influenza-like illness.  The virus continues to impact mostly younger people.  So far it is not causing significant illness and death in the elderly like we would see with seasonal influenza.  And the symptoms that are being reported are consistent with influenza, that being predominantly fever, cough, some shortness of breath, fatigue and chills.  There is some vomiting and diarrhea that have been associated with cases of this infection.  Everyone needs to be alert to the symptoms of the illness, and especially if you have underlying conditions, such as asthma, diabetes and heart disease.  For those folks, they need to be vigilant about their symptoms and consult their doctors or health care providers early if they develop flu-like symptoms.  All of the evidence so far indicates that antiviral drugs still work.  The inhibitors work particularly well.  And we are recommending that they be used in high-risk patients that are sick and also in those being hospitalized and those that have severe illness.

Cloning Animals For Traits?

The LATimes reports on a new twist in animal cloning,      

Even in the sometimes bizarre world of novelty animal cloning, this case is expected to generate debate and curiosity.

The Northern California cloning firm BioArts International is holding a news conference today to announce that it has cloned a dog that helped searched for victims in the rubble of New York's World Trade Center after 9/11. A retired Canadian police officer, who now lives in Los Angeles, won a contest sponsored by BioArts explaining why his rescue dog, Trakr, should be cloned. He was presented with the five cloned puppies a few days ago.

"Once in a lifetime, a dog comes along that not only captures the hearts of all he touches but also plays a private role in history," the retired officer, James Symington, wrote in his contest submission.

BioArts said in a statement that it partnered with South Korean cloning specialist Hwang Woo-Suk to clone the German shepherd. Woo-Suk is a controversial cloning pioneer who has been accused of faking human cloning evidence. . . .

[Updated at 7:50 a.m.: The debate is already beginning. The American Society for the Prevention of Cruelty to Animals notes its concerns about pet cloning: "Our current knowledge of animal cloning indicates that there are important welfare concerns at issue. Reports on the health and condition of mammalian animals produced by cloning have indicated a variety of anatomical and physiological problems."]

Health Insurance CEOs - The Reason So Many People Support Health Reform?

Kevin Drum writing at Mother Jones reports on the recent hearing on health insurance:

Yesterday the House Subcommittee on Oversight and Investigations decided to investigate the practice of recission.  This is when you pay your premiums for years to a healthcare insurer, then get sick, and then have your insurance cancelled.  The insurance industry executives at the hearing did not exactly cover themselves with glory:

A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.

The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

....Late in the hearing, [Bart] Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show "intentional fraud."

The answer from all three executives: "No."

Rep. John Dingell (D-Mich.) said that a public insurance plan should be a part of any overhaul because it would force private companies to treat consumers fairly or risk losing them. "This is precisely why we need a public option," Dingell said. ..  .

Health Stocks and Health Reform

Kaiser Health News reports on recent market activity in the health sector -

Setbacks for Democrats on health reforms earlier this week – including delays in one Senate committee and a higher-than-expected cost estimate in another – are good for the market, Dow Jones Newswires reports. "Health-care stocks rose Thursday on doubts that the Obama Administration's health reforms would be as extensive or speedy as anticipated. Humana, Coventry Healthcare and Health Net were all up more than 8 percent today, while four major insurers, UnitedHealth Group, Aetna, WellPoint and CIGNA Corp. all gained 4 to 7 percent, Dow Jones reports.

Thanks to DemFromCt at DailyKos for the link.

Health Reform: On Life Support

Talkingpointsmemo.com links to the New York Times report on the health reform effort and how things are not looking too good right now.     

What’s the latest assessment from those closely monitoring health care reform? Prognosis negative.

“Health reform is, I think it fair to say, in danger right now,” wrote Ezra Klein this morning at the Washington Post.

“Attention fellow liberals who want health care reform,” wrote Jonathan Cohn yesterday at the New Republic. “You are in danger of losing the fight for universal health insurance. And it’s not only — or even primarily — because of the public plan.”

“Anyone else think the net result of health reform is going to be that insurance companies have even more political power?,” twittered Atrios this afternoon.

What’s got the pro-reform contingent worried?

“It’s because of the money,” writes Cohn.

However, the article does provide some glimmer of hope    - 

In another post at the Democratic Strategist, former Clinton pollster Stan Greenberg concurs:

At the moment, the country is tilting toward enacting Obama’s reforms, and it will do so more enthusiastically if Obama learns from the Clinton experience and rises to the educative role that he relishes. He must respect the thoughts, feelings and calculations of ordinary citizens who are not easily spun on important issues. People will take out their calculators when he lays out his plan, and he can’t avoid speaking candidly about its costs and consequences. And he can’t forget that he has a big story to tell about a changed America, one in which health care is but a pile of bricks in the new foundation he is laying.

Obama has scheduled a nationally televised town hall on health care next Wednesday, June 24. And as Nate Silver at Fivethirtyeight notes, the public is still with him on reform. But it is going to take a bigger effort, says Silver, than just one meeting:

So far, there is no sign of erosion in the public’s support for health care reform. And the Administration appears poised to begin doing some more explicit advocacy for the legislation, beginning with a one-hour national forum on June 24th. But it had better be prepared for that town hall meeting to be a start of a trend, because history suggests that leaving a health care bill unattended before Congress is just about the worst place for it to be. . . .