Friday, June 26, 2009
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.
Thursday, June 25, 2009
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. . . .
Today National Public Ratio began a new series discussing the lobbyists in the room during health reform debates.
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.
Wednesday, June 24, 2009
The Associated Press reports on the death of Dr. Jerri Neilsen FitzGerald,
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. . . .
The Wall Street Journal reports on some concerns of state governors about expanding Medicaid. Jonathan Weisman writes:
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. . . .
Tuesday, June 23, 2009
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.
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.
Monday, June 22, 2009
The Associated Press reports on the new deal that the drug companies have negotiated with Medicare's drug provision. The story provides,
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.
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. . . .
Sunday, June 21, 2009
The CDC Press Briefing from last week reminds Americans that the H1N1/Swine Flu continues to spread. The briefing transript provides,