HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, July 7, 2009

Public Plan: Cost Containment Rationale

Urban Institute has an article by John Holahan and Linda Blumberg concerning the type of public plan that   should be included in health reform legislation:

This paper makes the argument that a public plan is important to health reform because it will contribute to cost containment, primarily by addressing problems caused by increased concentration in insurance and hospital markets. We describe how the public plan might be structured, how many people might be expected to enroll, and how much money the public plan might save. We discuss the most frequent arguments that are made in opposition to the public plan. We conclude that the private insurance industry would survive at about the same size but be more efficient and more effective in controlling health care spending.. ..

The arguments around the public plan too often ignore what we believe is the central reason for including a public plan as a component of reform: that health insurance markets today, by and large, are simply not competitive. And as such, these markets are not providing the benefits one would expect from competition, including efficient operations and consequent control over health care costs. We believe that the concentration in the insurance and hospital industries that has taken place over the past several years has been a significant contributor to this problem. The role of the government plan is to counter the adverse impacts of market concentration and, in doing so, slow the growth in health care costs....

July 7, 2009 | Permalink | Comments (0) | TrackBack (0)

Food Inc. and New Food Safety Rules

This looks like a great movie, Food, Inc.  It makes me think that now would be a good time to start a      garden ... Here is the Movie's Director, Robert Kenner, on the Daily Show.

In a related matter, the Obama Administration announced new rules for food safety.    National Public Radio reports,  

The Obama administration has announced plans for aggressive rules aimed at making the nation's food supply safer. The moves come in the wake of a series of serious food outbreaks and concern within the food industry that people fear their food. Reaction so far has been positive, both from industry and consumer groups.

Recalls Scare Consumers

At the announcement of the new initiatives Tuesday, Vice President Biden set out to make one thing clear: Food safety is important to this administration.  "You know, my dad used to say if everything is equally important, then nothing is important. There have to be priorities, and this is one of those priorities," he said.   Secretary of Health and Human Services Kathleen Sebelius told food producers and food-safety advocates that enough is enough. "We've seen too many large-scale recalls, everything from spinach to peanut products, pistachios, peppers, mushrooms, alfalfa sprouts and recently even cookie dough."   Five thousand Americans die from contaminated food each year, she said, and tens of millions get sick.

The administration is directing its agencies to design tougher production standards for marketers of poultry, beef, leafy greens, melons and tomatoes. The Food and Drug Administration and the U.S. Department of Agriculture will be designing a national food registry so contaminated food can be traced back to its source, and so consumers can be alerted immediately once a problem is discovered.

Stopping Salmonella

Meanwhile, the FDA announced a special initiative on eggs. Egg producers will have to buy chicks and young hens only from buyers who monitor for the salmonella bacteria. They'll have to have specific safety plans, eliminate rodents and pests, guard against bioterrorism, test regularly for salmonella, and refrigerate eggs during storage and transportation. . . .

July 7, 2009 | Permalink | Comments (0) | TrackBack (0)

Monday, July 6, 2009

Final Stem Cell Guidelines

The Scientific Activist reports on the final stem cell guidelines released by the NIH today and has some interesting commentary:

Today, the NIH has released its final guidelines (pdf).

Not much has changed, so there's not really much to say that I haven't already. The bad news is that the fairly restrictive nature of the rules was maintained (i.e. no federal funds for hESC lines derived from embryos generated specifically for research), but the good news is that the government didn't cave into some fairly outlandish requests (clearly from anti-abortion activists) to insert some loaded language into the rules.

July 6, 2009 | Permalink | Comments (0) | TrackBack (0)

Timing of Health Reform: Delay?

ThinkProgress and RollCall report on Senator Dodds recent discussion about the timing of a health reform bill. David Drucker of RollCall writes:

Senate Democratic leaders’ hopes of approving health care reform before adjourning for the August recess appear all but dead, with the prospect of meeting President Barack Obama’s demand for a bill on his desk by Oct. 15 looking increasingly difficult.

Logistical hurdles in the Senate, while significant, are only part of the problem. A major political battle looms over the key components of health care reform — particularly over the role of the federal government — that could stall Democrats even after they gained a filibuster-proof majority with the addition of Sen.-elect Al Franken (D-Minn.).

Sen. Chris Dodd (D-Conn.), managing the health care bill in the Health, Education, Labor and Pensions Committee, signaled late last week that Democratic leaders do not expect a bill to clear the Senate in the next five weeks. Rather, Dodd indicated, the goal is to complete the tricky merger of the HELP and Finance Committee bills, with the floor fracas over a final bill put off until after Labor Day....

The Finance Committee has yet to put out a mark on its bill, which is still being negotiated. The pending merger of the Finance and HELP bills could be tricky.

Finance Chairman Max Baucus (D-Mont.) is attempting to draft a bill that costs less than $1 trillion, is deficit neutral and can garner significant bipartisan support. The HELP bill has been drafted to satisfy liberal reform goals, including a robust government-run insurance option Republicans will never accept.

HELP announced last week that its legislation would cost approximately $611 billion over 10 years. But that is not a deficit-neutral figure, and the score did not include the cost of expanding Medicare, projected by some to be worth another $400 billion in additional spending.

Meanwhile, political difficulties abound in Obama’s push to overhaul the nation’s $2.3 trillion health care system this year. ...

July 6, 2009 | Permalink | Comments (0) | TrackBack (0)

Sunday, July 5, 2009

AIDS Success in Haiti

Americablog's Chris reports on some good news out of Haiti and writes,  

What a great report out of Haiti.

. . . In the early 1980s, when the strange and terrifying disease showed up in the U.S. among migrants who had escaped Haiti's dictatorship, experts thought it could wipe out a third of the country's population.  Instead, Haiti's HIV infection rate stayed in the single digits, then plummeted. . .  .

Much of the credit went to two pioneering nonprofit groups, Boston-based Partners in Health and Port-au-Prince's GHESKIO, widely considered to be the world's oldest AIDS clinic.

"The Haitian AIDS community feels like they're out in front of everyone else on this, and pretty much they are," said Judith Timyan, senior HIV/AIDS adviser for the U.S. Agency for International Development in Haiti. "They really do some of the best work in the world."

July 5, 2009 | Permalink | Comments (0) | TrackBack (0)

Saturday, July 4, 2009

Happy Fourth of July

Images The Declaration of Independence:         When in the Course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation. We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed.

July 4, 2009 | Permalink | Comments (0) | TrackBack (0)

Friday, July 3, 2009

Medical Malpractice Reform as a part of Health Reform

RollCall reports on the push to make medical malpractice reform part of the overall health reform legislation:

The Senate Health, Education, Labor and Pensions Committee’s markup of health care legislation is just the latest skirmish in what has been a long-standing partisan battle — the fight to change medical malpractice laws. The issue has long been a fixture of legislative fights over health care policy....

Republicans have long argued that the system is weighted against doctors. They say that limitless damage awards lead to crushing insurance costs for doctors, who pass them along to patients, and that physicians are practicing defensive medicine, which drives up health care costs through unnecessary treatments. Sen. Judd Gregg (R-N.H.) argues that reforming this system will help drive down health care costs and expand coverage.  “We cannot possibly reduce the cost of health care in this country without reducing defensive medicine,” he said....

Democrats reject this argument, countering that the current system is necessary to protect patients from medical mistakes that can cause them irreparable harm.  “I honestly really don’t see this as a health care issue,” said Sen. Sheldon Whitehouse (D-R.I.). Instead, the Senator, a former Rhode Island attorney general, argued that medical malpractice is more of an “intruder” into the debate to protect insurance companies, hospitals and doctors from being accountable for their mistakes....

Some observers say the American Medical Association and other doctors’ groups could put pressure on Democrats to accept some sort of reform in exchange for their support of health reform. However, Gregg said, “Medical providers have never been able to organize enough of an offensive” to force change.

A Republican Senate aide agreed. If the reform bill includes changes to medical malpractice, it will infuriate trial attorneys. A better way to go might be to focus on changing doctors’ Medicare reimbursement rates, the aide said. Doctors have also fought to increase these rates and, unlike tort reform, there is no powerful lobby opposing that issue....

However, the White House has shown some willingness to explore the issue. Obama told AMA members in June that some medical malpractice reforms were necessary as part of health reform.

“I recognize that it will be hard to make some of these changes if doctors feel like they’re constantly looking over their shoulders for fear of lawsuits,” Obama said.

Meanwhile, the AMA is moderating its goals for reform beyond caps on damages, given Democratic control of Congress....

July 3, 2009 | Permalink | Comments (0) | TrackBack (0)

Insurance Concentration

Steven Benen of the Washington Monthly reports on the concentration in the insurance industry:

Zachary Roth has a very good piece today pointing to a HCAN report documenting the fact that most Americans don't enjoy "anything like a competitive marketplace for health care."

The report, released by Health Care for America Now (HCAN), uses data compiled by the American Medical Association to show that 94 percent of the country's insurance markets are defined as "highly concentrated," according to Justice Department guidelines. Predictably, that's led to skyrocketing costs for patients, and monster profits for the big health insurers. Premiums have gone up over the past six years by more than 87 percent, on average, while profits at ten of the largest publicly traded health insurance companies rose 428 percent from 2000 to 2007.

Far from healthy market competition, HCAN describes the situation as "a market failure where a small number of large companies use their concentrated power to control premium levels, benefit packages, and provider payments in the markets they dominate."

So extreme is the level of consolidation, in fact, that one former top Federal Trade Commission official working with HCAN has sent a letter to the Justice Department's Antitrust Division, asking for an investigation into the health insurance marketplace.

Specifically, the Justice Department considers a marketplace "highly concentrated" if a company's market share tops 42%. HCAN found 10 states in which one or two companies control 80% or more of the market. In Alabama, home to Sen. Richard Shelby (R), one of the strongest opponents of reform, Blue Cross Blue Shield controls 83% of the statewide market.

Individual insurance companies enjoy practical monopolies in many parts of the country, which keeps prices high, profits high, and consumers screwed. It's why the public option is seen as such a serious threat -- it would introduce at least some competition, and offer consumers some choices. . . .

July 3, 2009 | Permalink | Comments (0) | TrackBack (0)

Thursday, July 2, 2009

Congressional Budget Office on the Cost of Health Reform - New Numbers

Ezra Klein points out the new budget numbers on the Senate's HELP bill:         

The big news of the morning is a new version of the Senate HELP Committee's health-care reform bill that seems to have everyone confused. The short version is this: CBO estimates that by 2019 the bill will cover 21 million people at a cost of $597 billion. But -- and this is important -- the HELP Committee's bill doesn't include the Medicaid expansion, because Medicaid is under the sole jurisdiction of the Finance Committee. But if Medicaid is expanded to 150 percent, it will cover an additional 20 million at a cost of about $1 trillion. Add in the savings that Finance is expected to get from reforming Medicare and you're looking at a bill that will cost $1 trillion to $1.3 trillion and cover 42 million people (which would mean 97 percent of the legal population in 2019 would have health insurance) by 2019.

The importance of this set of numbers can be understood only in terms of the catastrophe that was the last set of numbers. On June 15, the Congressional Budget Office scored an incomplete version of this bill. The office estimated that it would cost $1 trillion over 10 years and cover 16 million people. It would've cost, in other words, 70 percent more and covered 20 percent fewer people. The big question, then, is what accounts for the change? And luckily, there's a simple answer: the employer mandate. ...

But oh, what a difference a mandate makes: The new version of the HELP bill includes an employer mandate for firms with more than 25 workers. Every full-time worker who isn't given health-care coverage triggers a penalty of $750. Every part-time employee not given coverage costs $375. Doesn't seem like very much, does it? But it's enough. In Massachusetts, the employer mandate has been a success with a piddling $295 penalty. Indeed, the evidence we have suggests that the small penalty creates a massive change in behavior. ...

July 2, 2009 | Permalink | Comments (0) | TrackBack (0)

FDA Panel Recommends Ban on 2 Painkillers

The New York Times:

A federal advisory panel voted narrowly on Tuesday to recommend a ban on Percocet and Vicodin, two of the most popular prescription painkillers in the world, because of their effects on the liver.
The two drugs combine a narcotic with acetaminophen, the ingredient found in popular over-the-counter products like Tylenol and Excedrin. High doses of acetaminophen are a leading cause of liver damage, and the panel noted that patients who take Percocet and Vicodin for long periods often need higher and higher doses to achieve the same effect.

Acetaminophen is combined with different narcotics in at least seven other prescription drugs, and all of these combination pills will be banned if the Food and Drug Administration heeds the advice of its experts. Vicodin and its generic equivalents alone are prescribed more than 100 million times a year in the United States....

The panel’s 20-17 vote to recommend a ban on the combination drugs was one of 11 it took at a meeting called to advise the F.D.A. on problems arising from the extraordinary popularity of acetaminophen. In 2005, American consumers bought 28 billion doses of products containing the ingredient.  While the medicine is effective in treating headaches and reducing fevers, even recommended doses can cause liver damage in some people. And more than 400 people die and 42,000 are hospitalized every year in the United States from overdoses.

In hopes of reducing some of these accidents, the committee voted 24 to 13 to recommend that the F.D.A. reduce the highest allowed dose of acetaminophen in over-the-counter pills like Tylenol to 325 milligrams, from 500. And members voted 21 to 16 to reduce the maximum daily dosage to less than 4,000 milligrams.

But they voted 20 to 17 against limiting the number of pills allowed in each bottle, with members saying such a limit would probably have little effect and could hurt rural and poor patients. Bottles of 1,000 pills are often sold at discount chains.    “We have no data to show that people who overdose shop at Costco,” said Dr. Edward Covington, a panel member from the Cleveland Clinic Foundation. ...

Still, some doctors predicted that the recommendation would put extra burdens on physicians and patients.  “More people will be suffering from pain,” said Dr. Sean Mackey, chief of pain management at Stanford University Medical School. “More people will be seeing their doctors more frequently and running up health care costs.”

In a statement, Johnson & Johnson, Tylenol’s maker, said it “strongly disagrees” with the proposed restrictions on acetaminophen, adding that they would be likely to “lead to more serious adverse events as consumers shift to other over-the-counter products,” like Advil and aspirin.

Linda A. Suydam, president of the Consumer Healthcare Products Association, said the committee had ignored studies showing that doses sold by her members — two pills of 500 milligrams, up to four times a day — were safe. “I think this is a very effective dose and one needed for individuals who experience chronic pain,” she said.

The committee also turned its attention to over-the-counter children’s medicines containing acetaminophen, voting 36 to 1 to limit them to a single formulation. Right now the liquids are sold in two different concentrations, leading to confusion among doctors and parents.  “I don’t think it’s safe to have two formulations out there,” said Dr. Nelson, the acting chairman. . . .

Today's Diane Rehm Show has a further discussion of the FDA panel's recommendation:

PainKiller Safety:   An update on recommendations to the Food and Drug Administration to restrict acetaminophen and ban the popular painkillers Percocet and Vicodin because of possible risks of overdose and liver damage.  Guests:    Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen; editor of;  Dr. Andrew Putnam, director, palliative care program at Lombardi Comprehensive Cancer Center at Georgetown University Medical Center; Linda Suydam, president, the Consumer Healthcare Products Association;      Dr. Sandra Kweder, deputy director of the FDA's Office of New Drugs.


July 2, 2009 | Permalink | Comments (0) | TrackBack (0)

Wednesday, July 1, 2009

Drug Resistant Swine Flu

The Associated Press reports,   

For the first time, a case of swine flu has proven resistant to Tamiflu — the leading pharmaceutical weapon against the new virus, international health officials said Monday.    The resistance was seen in a patient in Denmark, who has recovered.  "The goods news is they just found one," said Dr. Carolyn Bridges of the U.S. Centers for Disease control and Prevention. . . .

Until an effective vaccine is developed, the drugs Tamiflu and Relenza have been considered the best available defense against the swine flu virus, which has caused nearly 28,000 reported illness in the United States, including more than 3,000 hospitalizations and 127 deaths.

The Danish case was isolated, however, and guidelines from the CDC and the World Health Organization continue to recommend Tamiflu as a treatment. No details were released on the patient's age or gender, or on when the patient was sick.   "It is possible to see occasional reports of resistance while a drug remains largely effective," said Terry Hurley, a Roche spokesman.

July 1, 2009 | Permalink | Comments (0) | TrackBack (0)

Diane Rehm on Primary Care Doctors

Diane Rehm discusses the need for more primary care doctors today:    

10:00     Primary Care Doctors

The role of primary care doctors in the U.S. health care system and efforts to address what some believe is a crisis in primary care.


Dr. Atul Grover, Association of American Medical Colleges

Dr. Fitzhugh Mullan, Murdock Head Professor of Medicine and Health Policy, George Washington University School of Public Health and Health Services

Dr. Walker Ray, Vice President for The Physicians Foundation, and retired after 38 years as pediatrician in Atlanta

July 1, 2009 | Permalink | Comments (0) | TrackBack (0)