Sunday, February 28, 2010
Kaiser Health News has posted a series of videos of the Health Care Summit
Consumers in the United States are being exposed to steadily increasing levels of novel and untested substances as a result of their contact with consumer products containing nanoparticles. Hundreds of consumer products are being marketed for human consumption, including food, dietary supplements, cosmetics and sunscreens. This expanding market ignores the growing scientific understanding that nanoparticles can create unintended human health and environmental risks. This Article discusses the public health, regulatory, legal and ethical issues raised by the developing appreciation of the health risks associated with nanotech products.
The Article proposes alternative methods of regulating nanotech products that better protect public health while encouraging technical innovation. These proposals are based on lessons learned from past introductions of new chemicals and innovative technologies such as asbestos, PCBs, DES, Thalidomide, medical X-rays and Benzene that all had serious, long-term public health consequences.
Children in the United States snack almost three times a day on salty chips, candy, and other junk food .... The increase in snacking--which now accounts for more than 27 percent of daily caloric intake in children--added 168 calories per day to kids caloric intake between 1977 and 2006.
"Our study shows that some children, including very young children, snack almost continuously throughout the day," said Barry M. Popkin, a professor in the Department of Nutrition at the University of North Carolina at Chapel Hill, and lead author of the paper.
For audio and slides used in a March 2 briefing in Washington D.C can be found here.
The updated Kaiser Foundation interactive side-by-side health reform comparison tool now reflects provisions included in President Obama's health reform proposal released this week.
The online tool now allows users to quickly compare the new proposals with the House and Senate bills approved separately in each chamber last year and 12 other comprehensive reform proposals put forward by various members of Congress, committees and other leaders during the ongoing debate.
In addition, the Foundation has updated its interactive calculator to reflect the subsidies proposed in the President's reform proposal and added it to its summary of proposed Medicare changes. These resources are all available through the Foundation's health reform gateway.
Saturday, February 27, 2010
A 21% cut in Medicare payments to physicians is scheduled to start on Monday. While the House has voted to postpone these cuts, the Senate may delay any action. The WSJ Health Blog reports that
[i]n response, the AMA is telling its members what they can do about the lower payments, including closing their doors to new Medicare patients, CNN reports. “To our physicians, we are providing information on their Medicare participation options, including how to remove themselves from the Medicare program,” AMA President James Rohack told the cable channel.
There’s nothing new about these cuts — they have been scheduled to go into effect regularly since 2003. Congress has blinked with a temporary reprieve each time in the past, but hasn’t done so yet this time with the cuts slated to begin Monday. Here’s why:
The House yesterday adopted a one-month delay in the cuts as part of a $10 billion employment bill with various other health provisions. “The legislation, which the Senate may take up next week, would give lawmakers more time to debate the fee cuts,” Bloomberg reported today.
But there could be a big hangup in getting that bill through the Senate in a hurry because Republican Sen. Jim Bunning of Kentucky wants to delay any swift action. That runs counter to what Senate leaders on both sides of the aisle had in mind, but senators can do that. Here’s how Politico describes the messy situation.
The AMA wants a permanent fix to banish the planned cuts in Medicare fees that they think are too low to begin with. There was an effort to include a long-term fix as part of the health overhaul, but we all know that hasn’t happen, at least not yet. So a temporary patch became part of the employment bill, but that hasn’t happened yet, either.
Tuesday, February 23, 2010
Approximately two dozen medical schools have recently opened, or are projected to open, across the country, the most at any time since the 1960s and ’70s. In comparision, only one new medical school was established during the 1980s and '90s. The New York Times explains:
The proliferation of new schools is ... a market response to a rare convergence of forces: a growing population; the aging of the health-conscious baby-boom generation; the impending retirement of, by some counts, as many as a third of current doctors; and the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system.
The Association of American Medical Colleges, a trade group, has called for a 30 percent increase in enrollment, or about 5,000 more doctors a year. The association’s Center for Workforce Studies estimates that 3,500 more M.D.s will enter graduate training over the next 10 years, roughly half of the 7,000 international medical school graduates now entering medical residencies in the United States every year, according to Edward Salsberg, director of the center.
If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country. (By comparison, there are 200 law schools approved by the American Bar Association.) And beyond the new schools, many existing schools are expanding enrollment, sometimes through branch campuses. While The Commonwealth is an independent school, many of the other new or proposed schools are affiliated with established universities, like Hofstra, which is teaming up with North Shore Long Island Jewish Medical Center; Quinnipiac University in Hamden, Conn.; the University of California, Riverside; Central Michigan University; and Rowan University in Camden, N.J.
Supporters of the expansion say that having more doctors will improve care, by getting doctors to urban and rural areas where they are needed, by shifting care to primary and family practice physicians rather than expensive specialists, and by reducing long waits for people to see a doctor and get the care they need. But skeptics say that although many parts of the country do need more primary care, American doctors tend to congregate in affluent, urban and suburban areas that already have a generous supply.They say that doctors create demand for their own services, and that nurse practitioners and physician assistants could fill gaps in medical care at a lower cost.
The following job announcements in the agricultural sector were posted on the US Agriculture & Food Law and Policy Blog:
USDA GIPSA: there are three vacancies for attorney positions with US Department of Agriculture's Grain Inspection, Packers & Stockyards Administration. The announcements close on March 8, 2010. Applicants must be admitted to the bar of a state, a U.S. Territory, or the District of Columbia. The vacancies are in three different locations, so separate applications must be submitted for each location the applicant in which the applicant is interested in applying for. The locations and links are: Aurora/Denver, CO-click here or here.; Atlanta, GA-click here or here.; and Des Moines, IA-click here or here.
Monday, February 22, 2010
This just out from the NYT:
President Obama on Monday laid out for the first time a detailed legislative proposal for overhauling health care, largely sticking with the approach passed by the Senate with unified Democratic support in December but making concessions to the House version as well.
Mr. Obama's proposal is the opening act to a week of high drama around health care that will culminate on Thursday, when the president convenes Democrats and Republicans at an all-day televised health care "summit" at Blair House. The White House is hoping the session can jump start the stalled health bill.
Seton Hall University School of Law’s Leuven-Geneva Program in Health, Intellectual Property and International Law combines a broad-based introduction to the laws, policies and institutions of the European Union (EU) with a unique, interdisciplinary examination of cutting-edge issues in intellectual property, pharmaceutical development and global public health. The Program will consist of two courses. European Union Law, a two-credit course,will be taught mainly at the Leuven Institute in Leuven, Belgium and will include a special trip to Luxembourg to visit the European Court of Justice. Students will also visit some of the main EU institutions in Brussels, such as the European Parliament and Commission.The goal of this part of the Program is to introduce students to the essential principles and institutions of the EU and to explore firsthand the challenges facing this unique confederation of different languages and cultures. For the Geneva component of the Program, students will study Health and Intellectual Property Law in a Global Environment, a four-credit course, co-taught by one intellectual property law professor and one health law professor. The course will be conducted in collaboration with Geneva-based international organizations involved in health and intellectual property law issues, including theWorld Health Organization, UNAIDS, theWorldTrade Organization and the World Intellectual Property Organization. Students will work on a series of case studies related to the work of these organizations, both in the classroom and in on-site meetings with organizational representatives. In addition to students from the Seton Hall Program, the Geneva component of the Program will also be open to students from the University of Zurich Ph.D. program in Biomedical Ethics and Law.
More information about the program is available here: http://law.shu.edu/Students/academics/studyabroad/Geneva/index.cfm
An article published this week by Health Affairs finds that the causes of Medicare spending growth have changed dramatically over the past two decades.
Twenty years ago, most of the increases were due to inpatient hospital services, especially for heart disease, but recent annual increases are the result of outpatient treatment of chronic conditions such as diabetes, arthritis, hypertension, and kidney disease, say Kenneth Thorpe of the Rollins School of Public Health at Emory University and coauthors.
This study analyzed data about disease prevalence and about level of and change in spending on the ten most expensive conditions in the Medicare population from 1987, 1997, and 2006. The data were drawn from the 1987 National Medical Expenditure Survey (NMES), and the 1997 and 2006 Medical Expenditure Panel Survey (MEPS). Among the key findings: heart disease ranked first in terms of share of growth from 1987 to 1997. However, from 1997 to 2006, heart disease fell to tenth, while other medical conditions -- diabetes the most prevalent -- accounted for a significant portion of the rise. Furthermore, the authors postulate that increased spending on diabetes and some other conditions results from rising incidence of these diseases, not increased screening and diagnoses.
Sunday, February 21, 2010
Janene R. Finley (Augustana College, Department of Accounting) & Amanda M. Grossman (Murray State University, Department of Accounting) have published Equity in Reforming the Tax Treatment of Health Insurance Premiums, 34 Seton Hall Legis. J. 1 (2009). Hat tip to Paul Caron at Tax Prof Blog who provides this part of the Introduction:
This Article evaluates the inequities in current and proposed tax treatments of health insurance premiums, and proposes a potential solution to eliminate such inequities. Part II of this Article discusses the historical tax treatment of health insurance premiums. Part III describes the current tax treatment and analyzes its advantages and disadvantages. In Part IV, different proposed changes in the tax treatment of health insurance premiums are discussed, as well as the advantages and disadvantages of those proposals. Part V illustrates how the proposals fail to account for the inequity between single and family plans and sets forth a legislative alternative that rectifies this inequity. This alternative solution is a tax cap equivalent to the amount of the premiums paid for a single health insurance plan for employees, with the excess included in taxable income. Single individuals that pay for their own policies, including self-employed individuals, would be allowed to deduct from gross income the amount paid for a single health insurance plan or an equivalent amount if a family plan is purchased. Married individuals filing a joint return would be able to deduct an amount up to the value of two single plans. Finally, Part VI describes the proposed solution in terms of both equitable tax treatment and social policy.
Friday, February 19, 2010
Over 3 million people joined Medicaid last year, increasing enrollment to 46.8 million and placing additional burdens on states already struggling to deal with budget concerns. The story in the Washington Post explains that
[t]he recession has fueled the greatest influx of Americans onto Medicaid since the earliest days of the public insurance program for the poor, according to new findings that show caseloads have surged in every state.
The analysis by the Kaiser Family Foundation, a health policy and research organization, found that in three-fifths of the jurisdictions, including Maryland and the District, people rushed into the safety net for health coverage at more than twice the rate as the year before.
Like the rising demand for food stamps and welfare benefits, the increase in people turning to Medicaid reflects the millions of Americans who have lost jobs and economic self-reliance and are asking the government for basic help, in many instances for the first time.
Because the program is large and expensive, the spurt in Medicaid caseloads has produced far more damaging effects on state budgets than the other two programs. In the past year or two, many states have responded by reducing the medical services available to Medicaid patients or payments to doctors, hospitals and other providers of health care.
Now, 29 states are considering further reductions or have made them since their current fiscal year began.... Such strains exist even though the federal government has been giving states extra money for Medicaid as part of the economic stimulus efforts Congress set in motion a year ago. The extra subsidies are due to expire at the end of this year, and states are lobbying hard to continue them for at least six months.
The worsening financial burden imposed by Medicaid also has heightened some governors' wariness about the approach to redesigning the nation's health-care system that is favored by the White House and congressional Democrats. In the health-care bills passed by the House and the Senate, an expansion of health coverage to the uninsured would rely substantially on Medicaid. If the legislation were enacted, the federal government would pick up the cost for the first few years, but, after that, states would contribute a small portion.
Tuesday, February 16, 2010
A New Study Disputes Belief that U.S. Immigrants Place a Disproportinately Large Financial Burden on U.S. Health Care System
A new article in Health Affairs disputes the widely held belief that U.S. immigrants place a disproportionately large financial burden on the U.S. health care system.
The study by Jim Stimpson of the University of North Texas and coauthors examined health care spending between 1999 and 2006 for both adult naturalized citizens and immigrant noncitizens, which included some undocumented immigrants. It found that the cost of providing health care to immigrants is lower than that of providing care to U.S. natives and that immigrants are not contributing disproportionately to high health care costs in public programs like Medicaid. However, with tighter residency requirements in public programs such as Medicaid, noncitizen immigrants were more likely than U.S. natives to have a health care visit classified as uncompensated care, although uncompensated care declined across all groups during the study period.
'Health care expenditures for the average immigrant have not been a growing problem relative to expenditures among U.S. natives,' conclude the authors. 'It is likely that lower expenditures among noncitizens are due to lower need for services and to increasing barriers to care such as fear, lack of insurance, or lack of a regular provider. These findings have important implications for both immigration and health care reform.'
Monday, February 15, 2010
The decision by Anthem Blue Cross to raise premiums 39% for some people in California is questionable in light of its fourth quarter earnings of $2.7 billion. The WSJ Blog points out that this dramatic increase comes at a convenient time for Democrats looking to regain a little health-care-overhaul momentum. In light of the huge profits,
... it’s no surprise that HHS Secretary Kathleen Sebelius sent a letter calling on the company to justify the rate increase. After WellPoint, Anthem’s parent company, responded with this letter, Sebelius released a skeptical statement that cited WellPoint’s fourth-quarter earnings of $2.7 billion.
The rate increase applies only to policies for people in the individual market. WellPoint’s letter says that, in the troubled economy, many people are choosing to go without health insurance. And many of those who are keeping their insurance are buying cheaper policies that offer less coverage.
The people who do tend to hold onto good insurance plans are those who need them most — people who are already sick. Of course, when you have healthy people bailing out of insurance plans and sick people hanging on, the average health-care cost per person in the plan is going to go way up — and that’s going to be reflected in rising premiums.
As the WSJ notes this morning, the insurance industry and the Obama administration actually agree on the solution to this problem: Require everyone to buy insurance. For their part, Republicans argue against such a mandate, saying that people should be allowed to choose whether or not to buy health insurance.
Sunday, February 14, 2010
Saturday, February 13, 2010
Massachusetts now has at least some form of health coverage for most of its citizens. The next step is to try to figure out what to do about the rapid rise of health costs. Jacob Goldstein of the WSJ Health Blog reports that
[t]he latest proposal comes from the state’s governor, Deval Patrick, who yesterday proposed a bill that would give the state the power to review — and, in some cases, reject — rate increases by doctors and hospitals.
Here’s a key paragraph from the bill:
Any contract under which provider payments increase by an amount in excess of the applicable Consumer Price Index for Medical Care Services shall be presumptively disapproved. The division may conduct a hearing on any contract that is presumptively disapproved and will approve or disapprove the contract based on its findings following the hearing.
The bill would also allow the state to prevent health-insurance plans sold to small businesses from raising premiums by more than 1.5 times the rate of medical inflation, and impose a two-year moratorium on lawmakers mandating new health benefits that plans must cover (those mandates drive up costs).
The Boston Globe said reaction “was mixed, with small business groups expressing cautious optimism, insurers saying the measures do not go far enough, and health care providers worrying that smaller hospitals could be disproportionately harmed and that some might have to lay off caregivers.”
Friday, February 12, 2010
A new call for proposals (CFP) from the Robert Wood Johnson Foundation's Public Health Law Research Program (PHLR) has been released today. The CFP is available at www.publichealthlawresearch.org
While PHLR funds studies that mainly focus on the intersection of law and public health, researchers from other disciplines, such as medicine, economics, sociology, psychology, public policy and public administration are encouraged to be part of multi-disciplinary teams of applicants. Research teams that include government agencies, community organizations, and advocacy and policy related groups are especially encouraged to apply.
This year's CFP will have about $3.5 million available for funding studies at two levels. Short-term studies will be funded up to $150,000 each for up to 18 months, while complex and comprehensive legal and public health studies will be funded up to $450,000 each for up to 30 months. The deadline for submitting brief proposals is April 14, 2010.
A press release can be found at:
Thursday, February 11, 2010
Scientists report that they have created a new way of preventing harmful plasticizers such as phthalates -- the source of long-standing human health concerns -- from migrating from one of the most widely used groups of plastics called polyvinyl chloride (PVC) plastics. This new generation of PVC plastics could be safer than those now used in packaging, medical tubing, toys, and other products. According to ScienceDaily
Helmut Reinecke and colleagues note that manufacturers add large amounts of plasticizers to PVC to make it flexible and durable. Plasticizers may account for more than one-third of the weight of some PVC products. Phthalates are the mainstay plasticizers. Unfortunately, they migrate to the surface of the plastic over time and escape into the environment. As a result, PVC plastics become less flexible and durable. In addition, people who come into contact with the plastics face possible health risks. The U.S. Consumer Product Safety Commission in 2009 banned use of several phthalate plasticizers for use in manufacture of toys and child care articles.
The scientists describe development of a way to make phthalate permanently bond, or chemically attach to, the internal structure of PVC so that it will not migrate. Laboratory tests showed that the method completely suppressed the migration of plasticizer to the surface of the plastic. "This approach may open new ways to the preparation of flexible PVC with permanent plasticizer effect and zero migration," the article notes.
The new study is published in the American Chemical Society's bi-weekly journal called Macromolecules at Navarro et al., Phthalate Plasticizers Covalently Bound to PVC: Plasticization with Suppressed Migration.