Friday, October 14, 2011
PPACA's effort to deal with long-term care insurance died yesterday when the Obama Administration announced it will not be able to implement the CLASS Act provisions of PPACA. Projections indicated that not enough young, healthy individuals would sign up to ensure affordable premiums.
Michelle Mello & Noah Messing, Restrictions on the Use of Prescribing Data for Drug Promotion, NEJM
Ashish Jha et al, Low-Quality, High-Cost Hospitals, Mainly In South, Care For Sharply Higher Shares Of Elderly Black, Hispanic, And Medicaid Patients, Health Affairs
Anne Beal, High-Quality Health Care: The Essential Route To Eliminating Disparities And Achieving Health Equity, Health Affairs
Lorian Hardcastle et al, Improving the Population’s Health: The Affordable Care Act and the Importance of Integration, SSRN/JLME
Thursday, October 13, 2011
Interesting Ezra Klein piece from Bloomberg, here, on The Cleveland Clinic's wellness program.
If we opt for Cleveland Clinic-style wellness programs, we won’t have to gut education, raise taxes or slash Medicare. And we’ll end up healthier. But in a country where proposed counseling sessions to discuss end-of-life options were denounced as “death panels,” are we really ready to let employers -- much less the government -- tell us to quit smoking, skip the junk food and lose weight?
Wednesday, October 12, 2011
The Center to Advance Palliative Care has just released a new report on access to palliative care state-by-state. Although the findings showed improvement in access nationwide, they nonetheless highlight stark divisions between geographic areas.
The disparities cut along the now-too-familiar axes – red state versus blue state, rural versus urban, and poor versus well-insured. In particular, the study found 73 % of hospitals with fifty or more beds have a palliative care team, compared to 51% in the South. In smaller hospitals in the South, palliative care is extremely limited (Louisiana and Mississippi have no palliative care at all in small hospitals). The 47 million Americans who are uninsured or live in isolated places are further disadvantaged by the low rates of palliative care at both public and sole community provider hospitals.
In palliative care, a team (usually a doctor, nurse, social worker, and others, sometimes a chaplain) focus on communication, coordination of care, and treatment that accords with and meets the spiritual needs and emotional wishes of a seriously ill patient. It is a rare area of medicine that explicitly acknowledges the centrality of emotional and spiritual needs of sick people to their quality of life.
For poor, rural, and red state patients, lack of hospital access to palliative care likely means inadequate treatment of pain, education, and follow-up after hospital care. Unfortunately, for these patient populations, this is hardly new. Indeed, there are a number of parallels to access to reproductive healthcare. Red states have higher rates of unintended pregnancies and lower access to abortion. Geography largely determines women’s access to and experience of medical care. Some of the root causes of the disparities seem alike as well—for instance, few training programs for physicians and lack of reimbursement (with regard to palliative care, for advanced practice nurses in some states and social workers).
It’s clear that meeting the palliative care needs of our aging population will require a new approach to availability and access. The report makes numerous recommendations—like physician training, fellowships, and more consistent compensation of advanced practice nurses. But I was struck by the absence of one proposal often seen in the reproductive health literature—namely, expanding the role of nurse practitioners.
Given paucity of trained physicians, allowing advanced practice nurses to lead palliative care seems like a natural solution. Nursing emphasizes advocacy and caring. Nurses spend more time with patients than physicians do. They also experience greater distress at the overtreatment of dying patients and the undertreatment of pain. So why not expand nursing practice in this area? How could compensation structures be revised to encourage nurse-led palliative teams? How could legislatures create incentives to increase access to palliative care? And, more importantly, how much opposition would they face from the physicians’ lobby?
The views expressed in this post are those of the author and should not be attributed to the Center for Reproductive Rights or the Health Law Prof Blog.
Tuesday, October 11, 2011
The Keystone XL pipeline, a 1,700-plus-mile pipeline proposed by TransCanada Corp. that would transport oil sands crude from Alberta, Canada to refineries in Port Arthur, Texas and other U.S. hubs, has not yet received a final permit. But the company is clearing land already, prompting a lawsuit announced last week by the Center for Biological Diversity (CBD) and other environmental groups. This follows a summer of public protests against the pipeline, where according to reports, over 1200 people were arrested. Despite a finding in the draft Environmental Impact Statement that environmental effects will be limited, the lawsuit and protests are evidence that many do not share that conclusion. Comments on the draft EIS are due on October 9.
According to a report by Friends of the Earth, it will contain one of the world’s dirtiest fuels (tar sands oil), and along its route it could devastate ecosystems and pollute water sources. The Natural Resources Defense Council points out here that tar sands oil is dirtier and more corrosive than other oils, threatening rivers, songbirds and communities along its route. Nine Nobel Peace Prize Winners wrote a letter to President Obama urging him to reject the pipeline, condemning it for the threats it will pose to communities in its path, the Ogallala Aquifer it will traverse, and the global climate it will alter. Among others, it was signed by His Holiness the Dalai Lama, Archbishop Desmond Tutu, and American landmines activist Jody Williams.
A Washington Post editorial disagrees: it may contain dirty fuel, but will not add to the climate change or its impacts on human health, since if the pipeline is not built, the oil will be transported and used elsewhere. PBS Newshour probably put it best: since the project promises to provide many jobs, it is fueling yet another environment versus economy debate.