January 17, 2009
Autism/Vaccine Controversy Continues
Newsweek reports on the resignation of the executive vice president of Autism Speaks, Alison Singer. The story states,
The warfare over vaccines and autism is heating up yet again. This week, Alison Singer, the executive vice president of communications and awareness at Autism Speaks, one of the nation's leading autism advocacy groups, announced her resignation, citing a difference of opinion over the organization's policy on vaccine research. "Dozens of credible scientific studies have exonerated vaccines as a cause of autism," she wrote in a statement. "I believe we must devote limited funding to more promising avenues of autism research." Singer, who has an 11-year-old daughter with autism, joined the organization when it launched in 2005. Singer praised Autism Speaks and its founders, Bob and Suzanne Wright, but said she could no longer work for a group that supports spending limited resources on vaccine research. Calling Singer's resignation "disappointing and sad," Bob Wright says more authoritative research needs to be conducted on the safety of vaccines given to children under 2. "We all know that autism has genetic causes, but it's highly associated with environmental factors we can't get our hands around," says Wright. "Vaccines fall into that category." NEWSWEEK's Claudia Kalb spoke with Alison Singer about her resignation. . . .
January 16, 2009
States File Lawsuits to Stop Federal Conscience Clause
Seven states and two organizations have sued the Bush administration in an attempt to block a federal regulation that would further protect health care workers who refuse to perform abortions or other medical procedures because of religious or moral reasons.
Connecticut Attorney General Richard Blumenthal filed a lawsuit Thursday on behalf of his state, California, Illinois, Massachusetts, New Jersey, Oregon and Rhode Island. Blumenthal said the regulation would put women's health care at risk and would undercut state contraception laws. "On its way out, the Bush administration has left a ticking legal time bomb set to explode literally the day of the inaugural and blow apart vital constitutional rights and women's health care," Blumenthal said in a statement. "Women's health may be endangered -- needlessly and unlawfully -- if this rule is allowed to stand."
He said the regulation "intentionally shrouds" abortion in "new and unnecessary ambiguity," encouraging individuals to define it and to "deny virtually all forms of contraceptions, even emergency contraception to rape victims." . . .
The Department of Health and Human Services said the regulation would allow the federal government to withhold federal funds for state and local governments, health plans and health care facilities that do not follow existing federal laws that ban discrimination against doctors and other health workers who refuse to participate in procedures such as sterilizations or abortions or to make referrals for such procedures.
"We have not had an opportunity to review the lawsuits and we will respond to the court on any pending litigation," department spokeswoman Rebecca Ayers said in an e-mail. "The department followed appropriate procedures to put the regulation in place and the regulation is fully supported by law." . . .
Quick Compare on Some Proposed Health Plans
GoozNews brings us a quick comparison of the some the health care plans being considered and points helpfully to the new Commonwealth Fund's study of the various health reform proposals. The website provides,
The Commonwealth Fund's latest study on health care reform found that plans proposed by Rep. Pete Stark, chairman of the health subcommittee of the House Ways and Means Committee, and Sen. Edward Kennedy, chairman of the Health Education Labor and Pensions committee in the upper chamber, come the closest to providing universal insurance coverage without actually going to a single-payer plan. Both their plans establish a government-run plan to cover the uninsured and give employers an alternative to the private insurance market.
For a pro-single-payer analysis of the Commonwealth study, see DrSteveB's analysis on the DailyKos blog. Using Commonwealth's numbers, he suggests the Stark/Kennedy approach would reduce overall health care expenditures even as it increased the share of those expenses picked up by the federal government. All other plans would increase overall health care costs.
The Rand Corp., meanwhile, has launched its own "tool" for analyzing health care reform proposals. Rand Compare doesn't just focus on health insurance reform, but on health system reform. . . .
January 15, 2009
Wellpoint: No New Medicare Customers
The LATimes contains a brief story concerning Wellpoint, the health insurance company, and its penalty for overcharging or denying prescription drugs to its older insured. The story provides,
Health insurer WellPoint Inc. has been barred from adding customers to Medicare plans after it denied prescription drugs to the elderly, endangering their lives, the government said Monday.
The sanctions, outlined in a letter to WellPoint from the Centers for Medicare and Medicaid Services, followed a "sharp" increase in consumer complaints, the agency said. Elderly customers were stopped from receiving essential prescription drugs, and some were overcharged because of computer mistakes, the government said. . . .WellPoint is the parent company of Woodland Hills-based Anthem Blue Cross of California, the state's largest for-profit health insurer. WellPoint did not immediately comment.
Bloomberg News published a story Monday that told a sorry tale of the country’s second largest insurance carrier (revenue-wise) and how it treated seniors who depend on coverage from the company to pay for their drugs. CMS gave Bloomberg a copy of the letter it sent to WellPoint which said the carrier has “demonstrated a longstanding and persistent failure to comply with CMS’ requirements for proper administration of its Medicare Advantage Prescription Drug Plans (MA-PD) and Prescription Drug Plans (PDP).”
The letter went on to say that the noncompliance has resulted in thousands of Medicare beneficiaries being denied access to “critical medications” that included cardiac drugs, anti-seizure drugs, anti-clogging drugs as well as medicine for asthma and chronic obstructive pulmonary disease. “WellPoint failed to follow through on its assurances to CMS that the problem was immediately and fully corrected,” the letter explained. CMS spokesman Peter Ashkenaz told me that the Medicare regulator had gotten a spike in complaints from WellPoint customers last week when new drug plans took effect. In December, he said, the agency received “under 100 complaints” and in the first week in January “we had more than 500. People were not getting their drugs.”
So the agency slapped a penalty on the carrier: effective immediately, it cannot market Medicare Part D plans, which provide pharmaceutical benefits to seniors, nor can it enroll new plan members. Even though the general Part D open enrollment season just ended, carriers can still sign up seniors with low incomes and people turning 65 who need to find a drug plan. Seniors enrolled in the controversial Medicare Advantage plans whose sellers are being overpaid by the federal government, can still switch plans until the end of March. So it’s fair to say the sanctions are likely to pinch WellPoint’s profits. WellPoint said in a statement that it had made significant progress in addressing problems cited by CMS and that since it had been working with the agency, it was “surprised by this recent action.” . . .
In case you think WellPoint is alone in designing questionable insurance practices, take note. Yesterday the nation’s biggest carrier UnitedHealth Group agreed to pay a $50 million settlement after New York attorney general Andrew Cuomo accused the insurers of overcharging millions of customers when a research firm owned by United manipulated the numbers so that the carrier underpaid policyholders when they filed claims. Said Cuomo: “This is a huge scam that affected hundreds of millions of Americans who were ripped off by their health insurance companies.”
All this should prompt reporters to investigate whether these kinds of insurance shenanigans are what Americans prefer when they say they want universal coverage. For example, what will prevent WellPoint from continuing the same practices for policyholders under 65 that CMS has said it engaged in for seniors on Medicare? What will stop insurers from paying as little as possible and shoving more costs of medical care onto unsuspecting policyholders? And while they’re at it, a hard look at whether regulation can really discourage such practices is in order. Remember, the president-elect said during the campaign that he would tightly regulate health insurance. The case of WellPoint and UnitedHealth Group invites scrutiny of this campaign promise.
House Passes SCHIP - President Obama Will Sign
The Washington Post reports on the House passage of SCHIP. The story provides,
The House easily approved an expansion of government health coverage for low-income children yesterday, a top priority for President-elect Barack Obama and the first in a series of stalled measures expected to move quickly through the Democratic Congress as President Bush leaves office.
Obama hailed the 289 to 139 vote and nudged the Senate to act with the "same sense of urgency so that it can be one of the first measures I sign into law when I am president." The president-elect vowed as a candidate to provide health coverage to every child, and the expansion of the State Children's Health Insurance Program, known as SCHIP, is a major step toward that goal. "In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens," Obama said.
The House legislation would cost nearly $33 billion over 4 1/2 years and would be funded in part by a cigarette tax increase of 61 cents to $1 per pack. Bush vetoed two similar bills in 2007, objecting to the tax increase and the expansion of government health care. The Senate Finance Committee will take up a similar measure today, with floor action expected to begin next week. . . .
The House bill would provide health insurance to an additional 4.1 million children and parents, including legal immigrant children and pregnant women, who currently must wait five years before becoming eligible for the program. A total of 11 million individuals could now receive coverage. . . .
In a policy statement, House Republicans outlined their objections, chiefly that the measure would place a new burden on states already struggling to meet soaring Medicaid costs and would permit states to enroll children from households with incomes of up to $80,000. "Increasing the amount of federal tax dollars flowing to states that consciously choose to provide benefits to children of these higher-income families before enrolling already eligible poor and low income children is the wrong policy and sends the wrong signal," the statement said.
Republicans also object to the tobacco tax as an unstable revenue source. Opponents of the bill asserted that the steady decline of smokers in recent years would have to be reversed in order to meet funding estimates for the children's health program over the coming decade. But the American Cancer Society estimates that the proposed tax increase would prevent more than 900,000 smoking-related deaths and discourage nearly 1.9 million children from taking up smoking. . . .
A major Republican flashpoint is the House's move to include immigrant children and pregnant women in the program. Sen. Charles E. Grassley (Iowa), the ranking Republican on the Finance Committee, said their addition would violate a 100-year-old law that requires the sponsors of new immigrants to pledge that the individuals will not become a financial burden to taxpayers.
"I feel very strongly that if you sign a contract with the government that brings people over here and you promise that they're not going to cost the taxpayers anything, you ought to keep your word to the taxpayers," Grassley said.
The Senate version of the bill does not give states the option of covering immigrants, but Finance Committee Chairman Max Baucus (D-Mont.) has said he supports adding the provision, and many Senate Democrats concur.
January 14, 2009
Starting the New Semester with Change . . .
How about making an Obamicon to help introduce yourself to your classes this semester Here is the website to help get you started, and here is what they look like - pretty nifty. Thanks to Ezra Klein for the link.
SCHIP Vote Coming Soon. . .
The New York Times's Robert Pear reports on the continuing debate over SCHIP, coverage for legal immigrants under age 21 is the latest controversial issue, and the liklihood that it will pass next week. He writes,
Congress is poised to give President-elect Barack Obama a quick victory by passing a bill to provide health insurance to millions of low-income children. The House Democratic leader, Representative Steny H. Hoyer of Maryland, said the bill, scheduled for a vote in the House this week, was “very much like” legislation twice vetoed by President Bush in 2007. Legal authority for the program expires on March 31. Congressional Democrats said they had decided to add a major provision allowing states to restore health insurance benefits to legal immigrants under 21, a goal of Hispanic groups since those benefits were terminated in 1996.
This part of the bill deals only with legal immigrants. But it could revive the emotional debate over immigration, as many Republicans want to establish stricter verification procedures to prevent illegal immigrants from getting health benefits. Under current law, legal immigrants are generally barred from Medicaid and the State Children’s Health Insurance Program for five years after they enter the United States. The Democrats’ proposal would give states the option of covering children and pregnant women, with the federal government subsidizing the costs as usual under both programs. . . . .
Representative Eric Cantor of Virginia, the Republican whip, said Republicans had concerns about expanding the program, to immigrants or any other group, before the original purpose of the program was achieved. “The program has not fulfilled its initial mission, to serve children of the working poor,” Mr. Cantor said in an interview. Among children, legal immigrants are less likely than citizens to receive immunizations and routine dental care. Likewise, among women, legal immigrants are less likely to receive prenatal care. . . .
House Democrats are taking their bill directly to the floor, but in the Senate, Democratic leaders plan to work through the Finance Committee, led by Senator Max Baucus, Democrat of Montana. Mr. Baucus has drafted a bill similar to the House measure. As of late Monday, his proposal did not include benefits for immigrants. But other Democratic senators, like Jeff Bingaman of New Mexico and John D. Rockefeller IV of West Virginia, have said that they, like Mr. Obama, want to allow states to cover children who are legal immigrants.
The new bills, like those vetoed, would be financed by tobacco taxes, including a 61-cent cigarette tax increase, to $1 a pack.
January 13, 2009
Senator Ron Wyden on Health Care in the Stimulus Bill
TalkingPointsMemo provides a brief piece concerning Senator Ron Wyden's thoughts on health care issues that might be addressed in the upcoming stimulus bill.
Sen. Ron Wyden (D-OR) knows how to build health care coalitions. From his seat on the Senate Finance Committee, he has watched the major health debates of the past decade -- from the 1994 Clinton flame-out onwards -- play out from the front row. . . . So he's got a pretty authoritative take on the health care proposals that are headed for inclusion in the stimulus bill.
"If there can be two good wins on health care early," he told me during a sit-down interview in his office today, "on SCHIP and COBRA for the uninsured, it's a bit of a down payment in terms of broader reform. It can build on that -- on Democrats and Republicans finding common ground."
Wyden added that reforming health information technology, allowing all Americans to have an electronic medical record within five years, is also on track to be part of the stimulus, for one simple reason: "It's a job creator."
SCHIP, the children's health insurance program administered by the states with federal help, is moving forward separately from the stimulus, headed for a quick reauthorization (and expansion) on the House floor and in Senate Finance this month, ahead of the March 31 deadline for renewal.
Adding COBRA aid to the stimulus bill, however, thus helping laid-off workers afford to keep their health care, would be a key victory for Wyden. The idea has met with positive signals from Republicans, making COBRA aid a helpful first step towards amassing broad support for major health care reform later in the year. . . . .
Electronic Medical Records: Within 5 Years??
CNN.com reports on President-elect Obama's plan to "modernize health care by making all health records standardized and electronic." David Goldman states,
Here's the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline. Sounds good. But it won't be easy.
In fact, many hurdles stand in the way. Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.
"The hard part of this is that we can't just drop a computer on every doctor's desk," said Dr. David Brailer, former National Coordinator for Health Information Technology, who served as President Bush's health information czar from 2004 to 2006. "Getting electronic records up and running is a very technical task."
It also won't come cheap. Independent studies from Harvard, RAND and the Commonwealth Fund have shown that such a plan could cost at least $75 billion to $100 billion over the ten years they think the hospitals would need to implement program. That's a huge amount of money -- since the total cost of the stimulus plan is estimated to cost about $800 billion, the health care initiative would be one of the priciest parts to the plan.
The biggest cost will be paying and training the labor force needed to create the network. Luis Castillo, senior vice president of Siemens Healthcare, a company that designs health care technology, said the laborers will have the extremely difficult task of designing a a system that "thinks like a physician." "Doctors cannot spend hours and hours learning a new system," said Castillo. "It needs to be a ubiquitous, 'anytime, anywhere' solution that has easily accessible data in a simple-to-use Web-based application."
But highly skilled health information technology professionals are as rare as they come, and many IT workers will need to be trained as health technology experts. Early government estimates showed about 212,000 jobs could be created from this program, but Brailer said there simply aren't that many Americans who are qualified.
Furthermore, ensuring the privacy of patients' records in a nationalized computer network will be tricky. There are obvious concerns about hackers and system failures. And new online health record systems, such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law. "HIPAA was never intended for the digital age, because the laws never anticipated the emergence of Web-based records," said Brailer. "Congress can pass one of numerous policy proposals for change, it's just a question if they have the will to do that." . . . .
January 12, 2009
Duty to Inform: Better Care Elsewhere
Last week's New York Times Science section had an interesting story on whether doctor's should inform patients about hospitals and other physicians that have more experience and better outcomes in performing various procedures. Denise Grady writes about her own relative's health care and what she believed was an important second opinion. She states,
Six years ago, a relative of mine found out that she had rectal cancer and would need surgery, radiation and chemotherapy. She lives in a small town, and she consulted a local surgeon at a community hospital. He was pleasant and kind, and clearly explained her condition and the operation he would perform. He was also painfully honest, and said that because the tumor was large, he doubted that he would be able to save the sphincter muscles that make bowel control possible. She would very likely need a colostomy, a procedure to divert wastes out through an opening cut in the abdomen, and would have to wear a colostomy bag for the rest of her life.
My relative thought it over. Being treated close to home had seemed so easy and convenient, and she dreaded the thought of shopping around for doctors when she was feeling sick, vulnerable and anxious. It was tempting to think that she would receive first-rate treatment no matter where she went. But she also recognized that this was a small hospital, and a surgeon who probably spent more time fixing hernias and taking out gallbladders than he did operating on cancer patients. She decided that she wanted a doctor who operated on patients like her all the time, and that the two-hour trip to a cancer center would be worth the trouble.
And so it was: she found a surgeon who specialized in rectal cancer, and today she’s in good health, with no need for a bag. She might have done just as well with the local surgeon, but we both doubt it.
An article published online in October in the journal PLoS Medicine really hit home with me. Noting that the quality of cancer care is uneven, its authors argued that as part of the informed-consent process, doctors have an ethical obligation to tell patients if they are more likely to survive, be cured, live longer or avoid complications by going to Hospital A instead of Hospital B. And that obligation holds even if the doctor happens to work at Hospital B, and revealing the truth might mean patients will take their business someplace else. "It’s only fair,” said Dr. Leonidas G. Koniaris, an author of the article and a cancer surgeon at the Miller School of Medicine at the University of Miami. . . . .
But patients are not often told during the informed-consent process that the results of cancer treatment can vary among hospitals, according to Dr. Koniaris and his co-author, Nadine Housri, a medical student. “I think it’s sort of starting to happen but hasn’t really become a dialogue yet,” Dr. Koniaris said. . . . .
Some medical experts say complicated treatments like surgery for cancer or heart problems should be regionalized — done strictly at specialized, high-volume centers, not at centers that don’t perform the operations often enough to become really good at them. But Dr. Koniaris and Ms. Housri suggested still another option. “We brought up the idea that maybe it should just be up to the patient,” Dr. Koniaris said. Studies have found that some people still prefer to be treated close to home even if the risks are higher there. Maybe they shouldn’t be forced to travel, especially if the difference is not large, Dr. Koniaris said. . . . His article pointed out that in a few cases in the United States and Australia, courts have ruled that doctors who had operated on people with poor results should have informed the patients that more experienced surgeons were available.
PLoS Medicine framed the article by Dr. Koniaris and Ms. Housri as a debate, with two other researchers taking different views. Dr. Robert J. Weil, a neurosurgeon at the Cleveland Clinic, argued that although it might seem a good idea to inform patients of differences in outcomes among hospitals, there would be “a variety of hurdles.” . . . .
David I. Shalowitz, a bioethicist, said that expecting surgeons and hospitals to disclose information about other doctors and medical centers would create an untenable conflict of interest for them and should be avoided. The question of what the doctor’s obligation is remains unresolved. People can ask doctors for comparative information, but many patients would fear giving offense. And judging by volume alone may have its pitfalls, because there are bound to be some hospitals that do lots of operations badly and some that perform few but do them well.
(For people who want to find out how a specific hospital performs in treating certain illnesses and performing operations, the government Web site www.hospitalcompare.hhs.gov provides information. In addition, some states require that hospitals publish their infection rates; that information is at www.hospitalinfection.org.) . . .
Health Care Reform
Ezra Klein points out some new data on health care trends since 1994. You can download the paper, complete with helpful charts and graphs here. Looks like health care reform should be at the top of the agenda in 2009 since we aren't getting better health care and people are much worse off. Here is part of his post:
Over at CAP, Ben Furnas pulled together a bunch of charts and graphs tracking trends in health care since 1994. The quick takeaway is that not only have things gotten worse, but that many things are getting worse at an accelerating rate. This is actually an important point. When you don't fix health care reform, you're not left with the status quo. You're left with the continuing deterioration of the status quo. Prices continue to rise. More join the ranks of the uninsured. More go bankrupt. More die. The status quo gets worse. And on some level, people know that. . . .