November 5, 2011
Lessons for Health Innovation at Rutgers-Camden
Congratulations to Greg Lastowka, Ellen Goodman, and Michael Carrier on the launch of the Rutgers Institute for Information Policy & Law! I found the RIIPL's panel on gene patents yesterday a very interesting discussion of the Myriad case and its broader implications.
The panel on communications networks also included comments quite relevant to the future of innovation in health care. One panelist noted how severely Wall Street punished a major telecommunications company when it invested in better networks, sending its stock price plummeting and its bond rating lower. In an era of strip-and-flip casino capitalism, we should be quite wary about expecting "the market" to invest in long-term improvements to social welfare. This discussion of critical drug shortages shows how catastrophically cutthroat competition has threatened public health in the US by generating increasingly unstable and precarious supply chains.
November 3, 2011
ACO Savings & ACA Lobbying
I've been reading three recent independent pieces that when looked at together cast renewed doubt on the "affordable" part of the reform act's title.
First, Gail Wilensky, writing in the New England Journal, here, about PGPs, the ACO beta test, while noting some good news on quality measures, paints a gloomier picture on the cost front, "The savings are another matter. Even with all their experience, only two of the PGP participants were able to exceed a 2% savings threshold the first year of the demo, and only half managed to surpass that threshold after 3 years. Even within this group, the shared savings varied widely among the PGPs."
Over at the Incidental Economist Aaron Carroll, here, takes issue with the political/pseudo-populist argument that ACA shorn of the individual mandate will find more acceptance. His comment, "I have yet to see any convincing data that show there’s a significant portion of America that loves the ACA, but hates the mandate…. If the individual mandate goes, more healthy people will opt out of buying insurance in the exchanges. The likely result will be an increase in premiums, and a subsequent increase in subsidies required to make them “affordable”, which will drive up the long term projections of the price of the law. If the premiums go up too fast, the market could fail."
Finally, where are all the lobbying dollars? Dan Diamond, writing at California Healthline, here, suggests "Industry stakeholders largely are sitting on the sideline this time. Moreover, many are wishing away the GOP's repeal because it wouldn't benefit the health care sector."
Overall, the detachment of the political discourse from policy, or economics, or even reality continues to be striking. [NPT]
November 1, 2011
United States and Mercury Restrictions: Do as we say, not as we do?
Yesterday marked the beginning of the Intergovernmental Negotiation Committee (INC) meeting in Nairobi to attempt to negotiate a legally binding agreement on the international control of mercury. Negotiators hope to finish the talks in 2013 and start circulating a treaty for ratification afterward. According to Greenwire, U.S. negotiators are calling for a ban on new mercury mines, and phase out the use of mercury in a specific set of products, such as batteries, thermometers and dental amalgam, and establish binding emissions targets for "unintentional" emissions of mercury in heavily polluting countries.
Congress needs to stop holding up federal mercury control regulations so that the U.S can demonstrate the same commitment to mercury safety as our negotiators in Nairobi are urging other countries to adopt. The Administration has consistently remained committed, proposing mercury and air toxics standards for power plants in July (Federal register notice available here). Opposition in Congress has held it up, responding to the concerns of industry that that mercury control is too expensive and will hurt the economy (see my blog postings here on April 5 and July 19). As developing countries seek growth of industries and jobs, it is in our own best interests to help guide them to be as safe as possible, since pollution does not respect national borders. Congress must not place the Administration in a hypocritical position where its international treaty requests conflict with its national actions.
Health Disparities and Root Causes
Section 4302 of the Affordable Care Act required consistent data collection standards regarding self-reported race, ethnicity, sex, primary language and disability status. The standards are published here, the HHS fact sheet is here. In announcing them Secretary Sebelius stated. "Today, through these new standards, we are providing a new set of powerful tools to help us achieve our vision of a nation free of disparities in health and health care," here. However, in a sobering piece for Politico, here, Lester Feder notes that, "there are limits to what they can actually do about the problem. The root causes, public health experts say, are social forces such as poverty, poor schools and crumbling infrastructure that are outside the control of the Department of Health and Human Services." [NPT]
Guest Blogger Elizabeth Sepper - The Health of Haitian Women
Thanks again to Health Law Profs for the opportunity to blog. With October at its end, I thought I’d take the opportunity to touch on subject I care about deeply – women’s health and human rights in Haiti.
Haitian women experienced the highest maternal mortality rate in the Western Hemisphere prior to the January 2010 earthquake. Rates of contraceptive use were low and had leveled off. Almost 40 percent of family planning needs went unmet—in large part because of lack of donor funding and interest.
Today, women and girls experience even greater challenges. Nearly 600,000 people displaced by the earthquake still live in camps, protected only by tents and tarps. Human Rights Watch reports that access to family planning information in the camps is rare, contributing to high rates of unplanned pregnancies, including among teenage girls. According to a UN survey, the pregnancy rate in the camps is 3 times the average urban rate before the earthquake.
Two-thirds of these pregnancies are unplanned and unwanted. Some are linked to gender-based violence. According to grassroots groups, a number of women and girls they treated for rape became pregnant (in one case, a full 20 percent of those they saw in the months immediately following the earthquake). In a survey by the Center for Human Rights and Global Justice, 14% of respondents in camps said that, since the earthquake, one or more members of their household had been victimized by either rape or unwanted touching or both.
So what does law have to do with this crisis? First, governments have obligations under human rights law with regard women’s rights to health, autonomy, and information. Although until recently maternal mortality and access to safe abortion were not considered a legal issue by main-line human rights groups and international organizations, these views have changed relatively quickly. Just last week, the United Nations special rapporteur on the right to health issued a report compiling the international legal support for decriminalization of abortion and elimination of laws that reduce access to contraception. The report, which is well worth a read and avoids the usual UN-speak, links a wide array of laws limiting abortion and contraception to the public health.
Much of what the report says is true of Haiti. Abortion is illegal in Haiti, and unintended pregnancies are tied to lack of information, inadequate access to contraception, violence, and widespread gender inequality. Since the earthquake, medical providers have seen increased numbers of complications from unsafe abortions, with women suffering dangerous infections. These unsafe abortions are a significant cause of maternal mortality, accounting for 13 percent of maternal deaths.
Second, the continuing crisis in Haiti suggests the effects of U.S. domestic law and policy on its neighbor. From the Global Gag rule to prohibitions on delivering aid through government bodies to the use of international development funds to push economic liberalization, laws passed in the United States have undermined the enjoyment of human rights in Haiti. At the same time, U.S. legislation and policy could have positive effects on health in Haiti. Funding of women’s health and family planning needs could be made a priority. USAID could require recipients to actively engage in cooperation and capacity-building with government agencies, including the Ministry of Health. More immediately, granting humanitarian parole would allow the 105,000 Haitians who had been already been approved U.S. immigrant visas prior the earthquake to join their families and deliver remittances back to Haiti.
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.
October 31, 2011
Health Insurance Rate Regulation
Julie Appleby reporting, here, on the Anthem Health Plans rate regulation suit in Maine. [NPT]
Worth Reading This Week
Michael Carrier, Provigil: A Case Study of Anticompetitive Behavior, SSRN/Hast Sci & Tech L. J.
Jane Baron, Property as Control: The Case of Information, SSRN/Mich. Tel & Tech L.Rev.
Katrice Bridges Copeland, Enforcing Integrity, SSRN/Ind. L.J.