January 10, 2009
COBRA: Too Costly
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."
January 9, 2009
Daschle Confirmation Hearings
On other appointment matters, it appears that the House of Representative's John Conyers is not a big fan of Dr. Sanjay Gupta.
Genetic Testing: Some Considerations
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.
January 8, 2009
The Latest Twist on Your Body as Property
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.
Myths About Health Care Reform
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] . . . .
January 7, 2009
Shortage of Primary Care Physicians
As a part of their continuing series on the challenges of health care in the United States, the NewHour had an excellent story involving the shortage of primary care physicians in Massachusetts. It is worth a read or a viewing. Here is a brief excerpt:
JIM LEHRER: Next, the second of our stories on health care problems facing President-elect Obama and the next Congress. Tonight, health correspondent Betty Ann Bowser reports from Massachusetts on the shortage of primary care doctors. Our Health Unit is a partnership with the Robert Wood Johnson Foundation.
DOCTOR: Would you recommend interventional radiology as the way to go?
BETTY ANN BOWSER, NewsHour Correspondent: It's the annual career day for third-year medical students at Boston University.
DOCTOR: There are lots of procedures that are done, though, in radiology that are done in interventional radiology.
BETTY ANN BOWSER: They are engaged in a kind of academic speed date, moving from table to table every few minutes to hear doctors describe their specialties.
DR. THOMAS HINES, Boston University Medical Center: The most essential skill for a good family doctor is knowing what you know, knowing what you don't know, and being able to distinguish the difference between those two things.
BETTY ANN BOWSER: The students listen respectfully to the primary care physician, but the truth is very few of them will ever go into the field.
A recent survey published in the Journal of the American Medical Association found that only 2 percent of medical students plan to go into primary care. And since 1997, the number of medical school graduates going into the field has dropped 50 percent.
One reason is salaries. Family medicine doctors frequently are on the bottom of the pay scale, making an average of $185,000 a year. Specialists, like radiologists and cardiologists with two to seven more years of training, make two times that much.
Also, because of the sophisticated interventions and procedures specialists offer, they are paid more by insurance companies than primary care physicians.
Dr. Bruce Auerbach is president of the Massachusetts Medical Society.
DR. BRUCE AUERBACH, President, Massachusetts Medical Society: A primary care physician spending 30 minutes with a patient, talking to them about their health care needs, would get paid about a third of what a gastroenterologist would get paid for spending 30 minutes to do an endoscopic procedure.
And the young people certainly know that. And they're hearing that in their training. And they're seeing what happens. They understand the reimbursement system, very specifically values, those that are intervening with procedures rather than those that are sitting in an office and talking to someone about healthier lifestyle, weight reduction, exercise, taking care of their diabetes, and getting the right testing, and the like.
The Return of SCHIP
As the country prepares for the new President and as the new Congress get to work, the Wall Street Journal's Health Blog reports good news on the return of SCHIP:
The Democrats aren’t wasting time in their push to expand government health insurance for children. Rep. Henry Waxman, who recently won the chairmanship of the House Committee on Energy and Commerce, says he expects the House to vote Tuesday or Wednesday of next week on a bill to expand the State Children’s Health Insurance Program, the Associated Press reports. . . It isn’t clear yet exactly what the new bill will look, but Waxman told the AP he doesn’t expect it to stretch for a full five years. He didn’t how much the tobacco tax would be increased to help pay for the expansion. Prior bills raised the tobacco tax by 61 cents, to $1 a pack.
January 6, 2009
Sanjay Gupta: New Surgeon General?
According to numerous news sources, Dr. Sanjay Gupta has been offered the position of Surgeon General. Here is an exceprt from the bio for Dr. Gupta from his current employer CNN,
Dr. Sanjay Gupta is chief medical correspondent for the health and medical unit at CNN. Gupta, a practicing neurosurgeon and an assistant professor of neurosurgery, plays an integral role in the network's medical coverage, which includes lead reporting on breaking medical news, regular health and medical updates for American Morning, anchoring the half-hour weekend medical affairs program House Call with Dr. Sanjay Gupta and reporting for CNN documentaries.
Based in Atlanta, Gupta also contributes health news stories to CNN.com and CNNHealth.com, co-hosts “Accent Health” for Turner Private Networks, provides medical segments for the syndicated version of ER on TNT, writes a column for TIME magazine, anchors the global health program Vital Signs for CNN International and is featured in a weekly podcast on health issues called "Paging Dr. Gupta.". . .
In addition to his work for CNN, Gupta is a member of the staff and faculty of the department of neurosurgery at the Emory University School of Medicine in Atlanta and regularly performs surgery at Emory University Hospital and Grady Memorial Hospital, where he serves as associate chief of neurosurgery.
Before joining CNN, Gupta was a fellow in neurosurgery at the University of Tennessee's Semmes-Murphy clinic, and before that, the University of Michigan Medical Center. He became partner of the Great Lakes Brain and Spine Institute in 2000, and in 1997, he was chosen as a White House Fellow — one of only 15 fellows appointed. He served as special advisor to first lady Hillary Clinton.
Gupta has been published in a variety of scientific journals and has received numerous accolades. His health reports swept all three health and medical awards in 2006 – the first year the National Headliner Awards honored such journalism in a dedicated category. Also in 2006, his report, "Sabrina’s Law," earned him his first Clarion award, and "Charity Hospital," his first Emmy®. He is also a contributor to 60 Minutes and the Evening News with Katie Couric on CBS. . . .
A board-certified neurosurgeon, Gupta is a member of several organizations, including the American Association of Neurological Surgeons, Congress of Neurological Surgeons, and the Council of Foreign Relations. He serves as a diplomat of the American Board of Neurosurgery and is a certified medical investigator. Gupta is also a board member of the Lance Armstrong LiveStrong Foundation.
Gupta received his undergraduate degree from the University of Michigan and a doctorate of medicine from the University of Michigan Medical Center.
Problems for Uninsured
The NewsHour had a report on how an increasing number of individual's with health insurance cannot afford to pay co-pays and deductibles and are putting off necessary care. Here is a brief excerpt:
BETTY ANN BOWSER: The Orozcos pay $800 a month for their employer-based coverage through Allen's job. But after a $1,500 per person deductible, it only covers 80 percent for most surgical procedures and diagnostic tests. And they couldn't afford their share of both her surgery and treatment for his lung infection.
HEATHER OROZCO: Eight hundred dollars is a huge amount of money for us every month. We're on one income. I'm in school, and Allen's our sole provider right now, and it's very difficult. We're on a very limited budget.
BETTY ANN BOWSER: Allen works for a mortgage company that has cut bonuses and raises because business is down.
ALLEN OROZCO: It's absolutely frustrating, but to have to sit there and think, "Let's see, should I take care of my wife's gallbladder that bothers her every day, or do I need to take care of my asthma? Can I do my best to suck it up a little longer?"
HEATHER OROZCO: It's gotten to the point where at least two to three times a week I'm so nauseous I wake up in the middle of the night and I'm extremely nauseated. And, you know, I have to get up in the morning. I have to go to class. I have the kids to get ready for school.
BETTY ANN BOWSER: Dr. Leah Patton is the Orozco's primary care physician.
DR. LEAH PATTON, Nashville Medical Group: I worry about her and many, many, many others.
BETTY ANN BOWSER: Every day she has patients who are putting off seeing her...
DR. LEAH PATTON: That one's a little bit infected.
BETTY ANN BOWSER: ... because of a $10 or $20 co-pay required by their insurance.
PATIENT: I can feel it. I can feel a lump.
BETTY ANN BOWSER: Some patients also have co-pays on each of their prescription drugs that can exceed $100 each. . . . .
January 5, 2009
Improving Hospital Transparency
Paul Levy, writing at the Health Care Blog, has a resolution for the new year involving hospital transparency. He writes,
. . . What if all of the hospitals in the Boston metropolitan area -- academic medical centers and community hospitals -- decided as a group to eliminate certain kinds of hospital-acquired infections and other kinds of preventable harm? And what if they all committed to share their best practices with one another and to engage in joint training and case reviews in these arena? And what if they all agreed to publicly post their progress on a single website for the world to see?
Let's start simply.
1 -- Eliminating central line infections (Metric: The number of CLIs, as defined by the CDC. Goal = 0)
2 -- Adopting the IHI bundle to help avoid ventilator associated pneumonia (Metric: Percent compliance with the bundle. Goal = 100%)
3 -- Adopting the WHO protocol developed by Brigham and Women's Hospital's Atul Gawande for surgical procedures (Metric: Percent of surgical cases in which the pre-op, time-out, post-op checklist has been followed. Goal = 100%)
I have to admit - his resolution and hopes for 2009 are somewhat less selfish than mine.
Free Generic Antibiotics
Giant Grocery has decided to offer free 14-day supply of generic antibiotics to customers until the near the end of March. Here is their brief statement of the program:
As part of our health and wellness initiative we're offering you and your family this special service.
Starting January 2, 2009, and continuing through March 21, 2009, our pharmacy is offering you up to a 14-day supply of the most commonly prescribed generic antibiotics for free. Simply bring in your valid prescription from your doctor.
Your good health is important to us. And with cold and flu season in full-swing, we want to do what we can to help keep you and your family feeling your best during the winter months.
At Giant, we're trying to make a difference every day... and we're just getting started!
National Public Radio's "All Things Considered" provided a good overview of the program and why Giant feels the need to provide these freebies. The Wall Street Journal's Health Blog has more information on other companies offering somewhat similar deals and the benefits the companies receive..
January 4, 2009
California's Good Samaritan Law
The New York Times has a brief editorial lamenting the California's Supreme Court's interpretation of the state's Good Samaritan Law. The editorial provides,
“Good Samaritan” laws give legal protection to bystanders who courageously come to the aid of people in emergencies. Last month, the California Supreme Court gave its state law a disturbingly narrow interpretation that could discourage future good Samaritans from providing help out of fear of being sued.
The ruling came after the victim of a car crash sued her would-be rescuer for negligence. On Halloween night in 2004 the car in which Alexandra Van Horn was riding crashed into a light pole. When her co-worker, Lisa Torti, who was in another car, saw the accident, she rushed over to help. Worried that the wrecked car would catch fire or blow up, Ms. Torti lifted Ms. Van Horn out of the front passenger seat. Ms. Van Horn, who ended up being paralyzed, sued, contending that Ms. Torti’s negligence in moving her caused her paralysis.
In her defense, Ms. Torti invoked California’s good Samaritan law. All 50 states have laws of this kind, but the protection they offer varies. By a 4-to-3 vote, the California Supreme Court ruled that the state’s law did not give Ms. Torti immunity from liability because it applies only to people who offer medical help.
The justices in the majority relied heavily on the fact that the California good Samaritan law is included in the part of the state’s laws that covers emergency medical services. The dissenters, however, had the better argument. As they noted, by its plain language, the California law — which speaks generally of “emergency care” — should apply to both medical and nonmedical help. . . .
The full story of the case is here is here. The full opinion is here. For a great overview of the no-duty rule, see Professor David Hyman's article, "Rescue Without Law: An Empirical Perspective on the Duty to Rescue,” 84 Tex. L. Rev. 653-738 (2006),