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 Tag: physiciansOur newsletter features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. It is emailed in an HTML format from the galen@galen.org email address, via Constant Contact, and you may have to adjust your email settings and junk mailbox to ensure that you don’t miss an issue.NewslettersMay, 9 2008
Making ProgressI spent the early part of this week in Las Vegas at the Consumer Health World conference at the Venetian Resort and continue to be awed by the innovative ideas and investment in solutions, technologies, and advances in health care and coverage. HighlightsCONSUMER HEALTH WORLD: I spent the early part of this week in Las Vegas at the Consumer Health World conference at the Venetian Resort and continue to be awed by the innovative ideas and investment in solutions, technologies, and advances in health care and coverage. Sally Pipes of the Pacific Research Institute and I did a keynote address with thoughts about how the policies of a new Republican or Democratic president would impact consumers and health care. But the real news was from business and medical leaders who are leading market changes, including: Digital medical care, the globalization of medicine, medical tourism, the unstoppable demand for more personalized information from consumers, technologies to extend a medical home, sophisticated employee wellness programs, and ways to dramatically reduce health costs through efficiencies in the delivery of care. My take away from the conference: More and more companies from other industry sectors are focusing their skills, technologies, and experience on the health care space, with the potential to produce dynamic, bottom-up change. The political climate matters a lot in being receptive to these changes, but these companies have the potential to be transformative in reducing costs and increasing quality if we will let the market work. The next conference will be in Washington, Dec. 8-10, just after the presidential election, and it will be even more important then to see what these leaders see for the future. Congratulations to Skip Brickley and his team at Transmarx for another great conference. It's hard work, but hugely valuable.  The conference happened to coincide with the opening night of the new Cher concert in Las Vegas, and my dear husband figured out how to get us tickets. Cher is a world-class performer with spectacular sets and at least a dozen even more spectacular costumes. At age 61, she is the quintessential performer.  She will be rotating with other performers (Elton John, Bette Midler) for the next three years at Caesars Palace. See the show if you can. It's not to be missed. WYDEN-BENNETT BILL: The Wyden-Bennett health reform bill received a coveted "budget neutral" cost estimate from the Congressional Budget Office and the Joint Tax Committee last week, and the bi-partisan legislation is attracting even more attention as a result. But let's look at the fine print:
Budget scorings are important. Former HHS Secretary Donna Shalala said during a Senate Finance Committee hearing this week that a CBO estimate of the cost of the Clintons' proposed Health Security Act in 1994 was "devastating. It changed the momentum of the discussion." Alluding to CBO's estimate that Sen. Wyden's Healthy Americans Act would be budget neutral, Shalala said that if one starts the debate with a score of budget neutrality, "you take a giant step." But the numbers also reflect the reality of the bill. And it would be a major, major change from the current system. The details matter. AN OPEN LETTER FROM DOCTORS: Physicians are mad as hell and they're not going to take it anymore. That's the conclusion we draw from a new grassroots campaign by a group of physicians to get signatures on an open letter to Americans from physicians. Their unifying theme: "We all desire to provide the best medical care possible to patients in our respective communities. This is at the heart of everything we do." But they are "alarmed by the current trends in our healthcare system…and the challenges we face in providing quality care to our patients." The idea was proposed by Sean Khozin, MD, MPH, and gained 1,000 signatures just in the first day it was posted on the Sermo website (a very interesting, innovative, and important secure web-based discussion platform that allows doctors to consult with each other about medical cases). The doctors say that "For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources." But they say that as a result of high costs and third-party intrusion, "patients have lost their freedom of choice…As a result, it has become difficult for physicians to deliver the best possible care," and the doctor-patient relationship is being compromised. The doctors don't make any policy recommendations in the letter, but it is a way for them to give a voice to their central concern about wanting and needing to put their patients first. That's the right place to start with any policy discussion. Grace-Marie Turner Recent News Articles and Studies How Risky is Individual Health Insurance? How Risky is Individual Health Insurance? Mark V. Pauly and Robert D. Lieberthal, Wharton School at the University of Pennsylvania People in fair or poor health who have health insurance are less likely to drop or lose coverage if they have individual insurance than if they have small-group coverage, according to a study from Mark Pauly and Robert Lieberthal of Wharton. In particular, the study found that among workers in relatively worse health, those with small-group coverage who became unemployed were substantially more likely to also become uninsured than their counterparts with individual coverage. Among those with small-group coverage, 67% of workers in fair or poor health who became unemployed also became uninsured, while among those with individual coverage, only 9% of workers in fair or poor health who became unemployed also became uninsured, according to the study. The authors say this result stems largely from a unique policy feature generally included in individual health insurance policies: guaranteed renewability at class-average rates. Drug Companies Win Alzheimer's Appeal Against Watchdog Nigel Hawkes Tens of thousands of Alzheimer's sufferers and their families had their hopes raised last week as two drug companies won a landmark victory in the U.K.'s Court of Appeal, reports The Times. The National Institute for Health and Clinical Excellence (NICE), the powerful body that controls access to new drugs, was judged to have acted unfairly in making an appraisal of the Alzheimer drug Aricept. NICE had ruled that Aricept should not be prescribed on the NHS to patients with mild Alzheimer's disease because the economic model failed to show that it provided good value. But it refused to allow Eisai and Pfizer, who market the drug, full access to the model. The court ruled that NICE must give up its most precious secrets — how it measures the benefits that novel treatments bring. The ruling is the first case that NICE has lost in court and means that, in the future, it will have to be transparent in the way it reaches its decisions, revealing the inner workings of the models it uses to measure value for money, reports the Times. UnitedHealth: HSA Enrollment Exceeds Traditional Accounts Carissa Wyant UnitedHealth Group said last week that for the first time, enrollment by its members in health savings accounts (HSAs) have surpassed enrollment in more traditional health reimbursement arrangements (HRAs), reports the Minneapolis/St. Paul Business Journal. UnitedHealth said it had 2.7 million individuals enrolled in its consumer-driven health plans; 1.38 million were enrolled in HSA-qualifying insurance as of March 31, compared to 1.34 million members who were enrolled in HRAs. The figures include plans which are employer-sponsored as well as plans purchased by individuals and families. More than 22,000 employers now offer such plans through UnitedHealthcare, and it recorded an increase of 325,000 participants from December 2007 to March 2008, reports the Business Journal. A new podcast from Deloitte on "Embracing Disruption: How Consumers Are Transforming the U.S. Health Care System" describes consumer activists who are searching for quality care and are willing to go outside the traditional health care system to get it. Sally Satel, M.D., American Enterprise Institute Do various financial relationships between doctors and the pharmaceutical industry — promotional marketing, paid speaking and consulting, and research funding — compromise patient care, bias medical research, and diminish the integrity of the profession, asks AEI's Sally Satel. Unfortunately, on many medical-center campuses, the verdict is already in: physicians who engage in any financial relationship with industry are not to be trusted. Such blanket condemnation of all associations with the companies that invent and produce countless life-saving healthcare products will surely have real costs to society, writes Satel. We can live without free pens and mouse pads. The real threat to medicine and the public interest is suppression of freedom of university-based researchers to interact with their scientific colleagues in the pharmaceutical industry, writes Satel. That might make anti-industry purists feel better — at least until they look for the next breakthrough drug only to find that it doesn't exist. Scott Gottlieb, American Enterprise Institute As a presidential candidate, Sen. Barack Obama says people lack health insurance because "they can't afford it." But he is also partly responsible for why health insurance is too expensive, writes Gottlieb. During Mr. Obama's tenure in the Illinois state Senate, 18 different laws came up for a vote and passed that imposed new mandates on private health insurance. Mr. Obama voted for all of them. A long list of studies shows that mandates like the ones Mr. Obama has championed drive up the cost of insurance for the very people priced out of coverage, writes Gottlieb. One way to make insurance more affordable is to allow people to purchase health plans across state lines. People could choose which state regulations to buy into, creating a market for the insurance mandates. This would give states more incentives to fix local problems that have helped make health insurance expensive in the first place. Wal-Mart Expands Low-Price Drug Program Peggy Harris Wal-Mart Stores Inc., the world's largest retailer, announced Monday it would expand its discounted prescription drug program to offer 90-day supplies for $10 and add several women's medications at a discount, reports the Associated Press. The move marks the third phase of a company program that began in 2006 to provide a 30-day supply of generic prescription drugs for $4. With the expansion, the company began filling prescriptions Monday for up to 350 generic medications at $10 for a 90-day supply at Wal-Mart, Neighborhood Market and Sam's Club pharmacies in the U.S, reports the AP. Almost all the prescription generics in the company's $4 program were included in the expanded $10 offer. In addition, the company will add several women's medications to its list of prescriptions available for $9, including drugs to treat breast cancer and hormone deficiency. Wal-Mart also said it would lower the prices of more than 1,000 over-the-counter drugs to $4 or less in its pharmacies. New Georgia Law Gives Best Health Insurance Options Center for Health Transformation, 05/08/08 A new Georgia law will result in Georgia families having the best health insurance options available in any state, according to the Center for Health Transformation (CHT). The law makes premiums for health savings account-eligible plans 100% deductible against state income tax for individuals. It also allows a $250 tax credit per employee for small employers who offer HSAs to their employees. By creating opportunities for Georgia insurance companies to offer new, innovative products not only will the state benefit from a robust and competitive marketplace, but also a half million uninsured Georgians will soon have access to health coverage, writes the CHT. Department for Innovation, Universities & Skills in collaboration with the Department for Business, Enterprise & Regulatory Reform, 11/07 This report, published by the UK government, summarizes the 2006 data on investment in R&D and financial performance of the 850 most active UK companies and the 1,250 most active R&D companies globally. Key highlights include:
Saving on Surgery by Going Abroad Avery Comarow Medical tourism can produce significant discounts on care, writes U.S. News & World Report as part of its "Consumer's Guide to Medical Travel." Thousands of Americans — estimates range from 5,000 to 500,000 annually, if minor procedures are counted — leave the U.S. for surgery, especially if they are paying for the procedure themselves. For example, Brad Barnum, a 53-year old building contractor, had knee and hip replacement surgery in India for $23,000. Even after adding about $5,000 for airfare, passport, visa, and incidentals, the total was nearly 80% less than the $125,000 or more he expected it to cost in a U.S. hospital, reports the magazine. Medical travel has captured the world’s attention and imagination, but a new McKinsey study suggests that the market isn’t as large as reported and that most medical travelers seek high quality and faster service instead of lower costs. Upcoming Events Grace-Marie Turner speaking on the Kirby Wilbur Show Racial and Ethnic Disparities: States and Feds to the Rescue? The Seniors' Entitlement Crunch: The Politics of Social Security and Medicare Reform 6th Annual Health Care Conference Health Reform and the 2008 Election: Opportunities and Pitfalls National Medicare Education Program (NMEP) Coordinating Committee Meeting Whatever Happened to Medicare Reform? Presidential Forum on Health Care Reform Social Determinants of Health & Consequences of Disparities Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at http://rs6.net/tn.jsp?t=epyitmcab.0.0.xkzt75bab.0&ts=S0339&p=http%3A%2F%2Fwww.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.
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CDHC April, 18 2008
Good News and BadThe House passed legislation on Tuesday, the mis-named "Taxpayer Assistance and Simplification Act," that contained the awful provision that would throw a mountain of paperwork at Health Savings Accounts. But the good news is that the White House sent a letter to Congress warning that President Bush would veto the tax bill if it contains the HSA provision.
Upcoming Event And be sure to mark your calendars to join us for our major Medicare forum in Washington on April 29. It will feature an address by HHS Secretary Michael Leavitt on "Drifting toward Disaster" and a distinguished panel of experts offering diverse ideas on "Solutions for Sustainability." We will send you a separate email shortly with your invitation, but please do mark your calendars now to join us — 9:45 a.m., Tuesday, April 29, at the Newseum in Washington. HSA Threat The House passed legislation on Tuesday, the mis-named "Taxpayer Assistance and Simplification Act," that contained the awful provision that would throw a mountain of paperwork at Health Savings Accounts. But the good news is that the White House sent a letter to Congress warning that President Bush would veto the tax bill if it contains the HSA provision. Also, the Senate has shown no interest in the provision that would require verification of every HSA transaction in real time. At the very least, it should hold hearings on this measure to find out the real costs and implications. We may dodge a bullet this year, but it clearly shows that HSAs are vulnerable. The NFIB was not helpful on an issue that should be of great interest to small business. They issued a key vote letter that encouraged passage of the tax bill containing the HSA provision. Their letter offered an ambiguous statement about HSAs, but by saying this was a "key vote" that will determine how members are ranked in the NFIB rating, it put pressure on members to vote yes. The policy community is once again confused and upset about NFIB's position.
Real Insurance A new study from the Kaiser Family Foundation looks at the resources available to people who are uninsured and finds that "households with few assets cannot handle the cost-sharing requirements of many high-deductible health plan options." The study, by Paul Jacobs and Gary Claxton of Kaiser, is flawed in a number of ways:
Bottom line: Don't believe every headline you read!
Medicaid You will recall my testimony of two weeks ago about the administration's rules designed to curb some of the most obvious abuse of the Medicaid program. Well, the House Energy and Commerce Committee on Wednesday approved by a vote of 46-0 a bill that would stop the new rules from going into effect. Health and Human Services Secretary Leavitt warned that President Bush will veto the bill if it reaches his desk. The ranking Republican on the committee, Joe L. Barton of Texas, said he did not think Republicans would vote to sustain the veto. "I don't think the veto threat was appropriate, and I don't think it will be successful if vetoed, because the votes simply aren't there," Barton said. The wild card could be the Senate. Sen. Charles Grassley, ranking Republican on the Senate Finance Committee, does not support blocking the rules. "We ought to let them move forward instead of just delaying all of these Medicaid regulations all at once," Grassley said. So the Senate, of all places, may be the place we look to protect taxpayers from having Medicaid dollars be used for expenses that clearly are not medically-related, like transportation to bingo games, and for states determined to game the system.
BlackBerry Friendly I know when I am trying to read newsletters like this on my BlackBerry, the text is interrupted by strings of annoying links. But, when you read the newsletter on your desktop, the links and the nice graphics are welcome. We'd like to offer you a choice: If you would like to receive the newsletter in a text-only, BlackBerry-friendly format, we'd be happy to send it to you that way. Just send a quick note to Tara Persico at tara@galen.org and she will make the change here. Grace-Marie Turner Recent News Articles and Studies Medicare's Bad News: Is Anyone Listening? Medicare's Bad News: Is Anyone Listening? Unlike the mortgage crunch, Medicare's fiscal crisis does not seem real to most people. The difference in the public reaction to these two serious financial problems reveals three major issues with the way Medicare's bad news is communicated and perceived: it fails to connect on a visceral level with the public and the press; the trust fund concept in Medicare instills a misleading sense of confidence in the program's financing; and, no simple, easily understood number adequately captures the magnitude of Medicare's financing crisis. Yet, if the current trends continue, Medicare's Hospital Insurance trust fund will be depleted in 2019 and future generations will face a tax bill of $85 trillion to make good on the health care benefits promised to Americans. Antos suggests that structural reform — not merely tinkering around the edges of the current program — is needed. We need to replace Medicare's culture of entitlement, which distorts the decisions of patients and providers alike, with a culture of individual responsibility and efficient delivery of care. George Shultz and John Shoven's Big Fix Economist and former Secretary of State, Treasury, and Labor George P. Shultz has leapt into the reform fray with a bold new plan that aims not just to fix the health care system but also to solve the impending entitlement cost crisis and even to reinvigorate the economy, reports ReformPlans.com. Shultz and Stanford University economist John B. Shoven are co-authors of the new book, Putting Our House in Order. Their prescription includes more responsibility and authority for individuals, greater competition among insurers, and new kinds of "smart" means testing for public programs. Former Senators Tackle Health Issues Former Senate majority leaders Bob Dole, a Republican, and George Mitchell, a Democrat, may be facing their biggest challenge to date — reforming the nation's health care system, writes The Washington Post. The two senators said this week they would be joined by two other former Senate majority leaders, Democrat Tom Daschle and Republican Howard Baker, in crafting a series of health policy recommendations that would be delivered in 2009 to a new president and Congress. The senators will each oversee forums on four key pillars for reform: improving quality and value, improving access, ensuring a strong role for consumers, and finding a way to finance it. They will get technical advice from Dr. Mark McClellan, who recently oversaw the Centers for Medicare and Medicaid Services under President Bush, and Chris Jennings, former health advisor to President Clinton. While advisers will provide technical expertise, the senators stressed that they will be the ones responsible for the recommendations and will have final say on what's in the package. Sen. Daschle will lead the project's first health care forum on April 24 in Washington, D.C. 'Evidence-Based' Rx Miscues Hillary Clinton, Barack Obama and John McCain all favor increased federal funding for so-called "evidence-based" medicine to address the problem of escalating health-care costs, writes Pitts. The theory behind evidence-based medicine is simple: If government were to run clinical trials testing the effectiveness of drugs and medical technologies, and then use the results to determine what to cover, taxpayers would avoid paying for treatments that aren't effective enough to justify their price tag. Too bad that in practice, evidence-based programs are largely driven by the political imperative to cut costs — not the medical imperative to give patients the best care possible. Medical treatment should be based on the specific genetic, clinical and demographic factors of an individual patient. In an era of personalized medicine, one-size-fits-all health care strategies are dangerously outdated. Dollars to Doughnuts Diagnosis Many physicians feel that it's their mission to serve as many patients as possible rather than to provide the best care possible, writes Beverly Hills internist Albert Fuchs. Most significantly, doctors today are preoccupied with the bureaucracy of insurance companies. When Fuchs began his own private practice in internal medicine, volume grew quickly and so did his work hours. So he dropped an insurance plan — one that gave him the least compensation. Almost immediately, he had fewer patients but more time and energy for those he maintained. Like hundreds of doctors across the country, Fuchs now does not receive a single dollar from any insurance company. When doctors break free from the shackles of insurance companies, they can practice medicine the way they always hoped they could, he writes. And they can get back to the customer service model in which the paramount incentive is providing the best care. Code Red A few weeks ago, the Washington Post broke the dramatic medical news that as many as one third of all people waiting for an organ transplant are actually ineligible to receive one. Suggesting that the organ shortage is a manufactured crisis is misleading, write Satel and Hippen. Strikingly, most patients who are designated by their physicians as ineligible for immediate transplant were once fit enough to receive an organ. Tragically, they deteriorated during the years-long wait and became too sick to transplant. According to the United Network for Organ Sharing (UNOS), there are 98,517 people — transplant candidates — waiting for an organ. By summer, the queue will reach a daunting 100,000, with three quarters seeking kidneys. And the waiting time to renal transplantation is getting longer. Today it is five to eight years in major cities and by 2010 it will be ten years for some patients. With about one in three waitlisted patients on dialysis not surviving beyond five years, the majority of candidates just don't have that kind of time. This very trend is potent evidence why those who say the need is not so pressing are dead wrong. If the list had so many ineligible patients, then time-to-transplantation would be getting shorter not longer. Single-Payer Health Care for Maryland: Two Analyses This paper responds to a bill proposed by Maryland State Delegate Karen S. Montgomery (D-Montgomery), which would have established a "single payer" system in which the state would pay for all Marylanders' health care and no Marylander would be permitted not to participate in the system. Although the General Assembly did not adopt the Montgomery proposal, special interest pressure remains strong in Annapolis for government-financing of Marylanders health care. This report offers two analyses that address the flaws in a statewide universal health care system, including the high cost to the state budget that would inevitably lead to rationing of services by government officials. The study also issues strong warnings to Maryland from Canadians living under a single-payer system. Use of Health Savings Accounts Grows In a market where health insurance costs continue to rise for employers, more companies are turning to high-deductible health plans — and the accompanying health savings accounts to defray costs, writes the Springfield Business Journal. An estimated 7 million people are covered by 2.2 million health savings accounts as of the beginning of 2008, according to a survey by industry publishing company Atlantic Information Services Inc. Those accounts hold $3.2 billion, up 60% from $2 billion at the beginning of 2007. Several banks that offer health savings accounts say the accounts' popularity is growing — especially among small businesses that want to reduce their costs while still offering insurance benefits to employees. And demand for HSAs is only expected to continue. The U.S. Treasury Department estimates that, assuming the laws regulating HSAs are unchanged, up to 30 million people will be covered by HSAs by 2010. Upcoming Events Grace-Marie Turner speaking on KDKA News Radio Show 5th Annual World Health Care Congress Grace-Marie Turner speaking on The Scott Voorhees Show Hospital CEO Roundtable: Balancing Cooperation and Competition Grace-Marie Turner speaking on the Bill Mick Live Show A Roundtable Discussion with Mark Miller of the Medicare Payment Advisory Commission Grace-Marie Turner speaking on The David Smith Exchange Show Grace-Marie Turner speaking on Senior LifeStyles Show 2008 Leadership Development Breakfast Healthcare Policy Discussion: Cost vs. Coverage Third Annual World Intellectual Property Day Innovations in Health Care Delivery Concho Valley Community Media Relations Training on the Uninsured Engineering a Learning Healthcare System: A Look at the Future Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors. |
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