May 27, 2009
Ezra Klein on the Senate Finance Committee
Ezra Klein, now writing at the Washington Post, has a brief post on the Senate Finance Committee and its importance to health care reform legislation. He writes,
You hear a lot about the "how" of health care reform. You hear a fair amount about the "who" of it. You even get some "when." But you don't hear that much about the "where." But the "where" matters. And the where, somewhat confusingly, is primarily the Senate Finance Committee -- the same committee chaired by Baucus.
There are two reasons for this. The first is that pushing health care reform through the United States Senate is harder than pushing it through the House of Representatives. The reason is simple enough: The filibuster. If House Speaker Nancy Pelosi could handle health reform on her own, the bill would be signed by lunchtime Wednesday.
The second has to do with the confusing composition of the Senate's committee. There is, after all, a more obvious committee where health reform could dock: The Health, Education, Labor, and Pensions Committee. "Health," after all, isn't even that committee's middle name. It's its first name.
The catch, however, comes in rule XXV of the Senate, which contains the Senate Finance Committee's charter. Among its areas of jurisdiction: "Health programs under the Social Security Act and health programs financed by a specific tax or trust fund." Health programs, in other words, that will cost money. And health reform will cost money. If this were just a matter of insurance market reform -- or simple regulations, in other words -- the HELP committee could bear the burden on its own. But since reform requires money, they're the junior partner to the Finance Committee. . . .
Health Care, Increased Costs and Decreased Quality
This week's New Yorker contains yet another great article by Atul Gawande on the costs of health care. He writes,
McAllen [Texas] as another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns. . . .
Yet public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low. . . . An unhealthy population couldn’t possibly be the reason that McAllen’s health-care costs are so high. (Or the reason that America’s are. We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.). . . .
And yet there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average. . . .
“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures. The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ” . . .
This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care. . . .
May 26, 2009
Judge Sonia Sotomayor Nominated
The New York Times reports that President Obama has nominated Judge Sonia Sotomayor to the Unisted States Supreme Court. Peter Baker and Jeff Zeleny write,
President Obama has decided to nominate the federal appeals judge Sonia Sotomayor to the Supreme Court, choosing a daughter of Puerto Rican parents raised in Bronx public housing projects to become the nation’s first Hispanic justice, officials said Tuesday. . . .
Judge Sotomayor, 54, who has served for more than a decade on the 2nd Circuit Court of Appeals based in New York City, would become the nation’s 111th justice, replacing David H. Souter, who is retiring after 19 years on the bench. Although Justice Souter was appointed by the first President George Bush, he became a mainstay of the liberal faction on the court and so his replacement by Judge Sotomayor likely would not shift the overall balance of power.
But her appointment would add a second woman to the nine-member court and give Hispanics their first seat. Her life story, mirroring in some ways Mr. Obama’s own, would add a different complexion to the panel, fulfilling the president’s stated desire to add diversity of background to the nation’s highest tribunal.
Judge Sotomayor’s father died when she was 9 years old and she was raised by her mother, who worked six-day weeks to earn enough money to send her and a brother to Catholic school. She got into Princeton University, where she once said she felt like “a visitor landing in an alien country,” but graduated summa cum laude.
After Yale Law School, where she was editor of the Yale Law Journal, she worked for Robert M. Morgenthau in the district attorney’s office in New York and later was in private practice. The first President Bush nominated her in 1991 to the federal district court on the recommendation of Senator Daniel Patrick Moynihan, Democrat of New York, and she was confirmed a year later. President Bill Clinton decided to elevate her to the appeals court in 1997 and she was confirmed a year later.
Judge Sotomayor has said her ethnicity and gender are important factors in serving on the bench, a point that could generate debate. “I would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than a white male who hasn’t lived that life,” she said in a 2002 lecture. . . .
On the appeals court, Judge Sotomayor has not been involved in many hotly disputed decisions, but one that she participated in is before the Supreme Court right now. As part of a panel, she voted to uphold New Haven’s decision to throw out a set of fire department promotion tests because no minority candidates made the top of the list. White firefighters who scored high but were denied promotion are appealing that ruling. As a district judge, she briefly earned fame in 1995 by ending a Major League Baseball strike, ruling in favor of players and against the owners, who she said were trying to subvert the labor system. . . .
The Hill reports that tobacco and tobacco products will soon fall under some government agency's jurisdiction. J. Taylor Rushing writes,
The congressional drive to bring tobacco under Food & Drug Administration control -- given new life in the Senate last week -- is poised to approach the finish line in the Senate in June, but not without a bipartisan fight from North Carolina's two senators.
Sens. Kay Hagan (D) and Richard Burr (R) plan to push a substitute bill that would put the controversial drug under the control of a newly created entity of the U.S. Department of Health and Human Services instead of the FDA. The substitute bill by Burr and Hagan has been criticized by critics who say taking control outside the FDA would short-circuit attempts at worthwhile regulation, while Burr and Hagen say HHS is better equipped to regulate the drug. . . .
The Family Smoking Prevention and Tobacco Control Act passed the House by a vote of 298-112 on April 2 -- a vote opposed by most House Republicans. Jim Manley, a spokesman for Senate Majority Leader Harry Reid (D-Nev.), said last week that Senate Democrats plan to move forward on their side sometime in June. The Senate's Health, Education, Labor and Pensions Committee passed the bill on a 15-8 vote last Wednesday. . . .
The bill -- primarily pushed by HELP Committee Chairman Edward Kennedy (D-Mass.) would set new FDA regulations on nicotine. Federal officials would gain new power to regulate the ingredients, marketing and disclosure requirements of cigarettes, for example, including the power to ban advertising that seeks to downplay the drug's effect, such as companies that advertise cigarettes as "low-tar," or "mild." The bill is also an attempt to circumvent a March 2000 Supreme Court ruling that struck down a Clinton administration attempt to regulate tobacco. On a 5-4 vote, justices at the time said the FDA was "overreaching" in attempting to regulate tobacco without congressional approval. . . .
But the bill won't go down without a fight. Democrats say they have the necessary 60 votes to pass the bill, but Burr said he will lead opposition. "FDA's core mission is to prove the safety of every product that they regulate -- except for tobacco, which we know is dangerous and kills people," said Burr. "So what do you do, ask FDA to ignore their core mission when it comes to tobacco but apply it on everything else?" Burr said he and Hagan do not disagree with the need for increased regulation. ,But where you put it is important," Burr said.
May 25, 2009
Summer Pool Tip from CDC
As if one needed to be reminded: Headline of the Day from CNN.com - Please don't pee in the pool. The rest of the story goes into more detail as to why:
Although urine in the water probably will not cause swimmers to go to the emergency room, it causes "more of a respiratory, ocular irritation: the red puffy eyes or a cough, an itchy throat," said Michele Hlavsa, an epidemiologist in the division of parasitic diseases at the Centers for Disease Control and Prevention."A big health message is not to urinate or pee in the water."
And it happens far more frequently than water-lovers would like to think. In a survey of 1,000 U.S. adults conducted in April and May, 17 percent admitted relieving themselves in a swimming pool. Even the Olympics' most decorated swimmer, Michael Phelps, confessed to urinating in the water to TV host Jimmy Kimmel. In a 2008 interview, Kimmel asked the 14-gold medal winner, "You pee in the pool, true?" "Yeah," Phelps replied. "Which nationality pees in the pool the most?" Kimmel asked. "Probably Americans," Phelps said. "Oh, so we're number one in that too," Kimmel quipped.