July 2009 Archives

Kaiser Health News (which does an amazing job every day, recapping all the craziness) gives us a weather report for the coming month:

August Health Reform Forecast: High Probability of Hot Debate, Crowded Airwaves

A snippet:

"House Majority Leader Steny H. Hoyer , D-Md., conceded that Democrats have been losing the message war over the legislation, as Republicans hammer away at its costs and claim it would lead to a 'government takeover' of health care," CQ Politics reports. Hoyer said, "We're responsible for putting together a plan, and so we've been focused on that... Republicans have been somewhat free to conjure up whatever they want" (Roth, 7/31).

"This congressional recess, health care will be on the front lines," NPR reports. Rep. Chris Van Hollen, D-Md., a top House Democrat, said "we want to make sure that we come out of August stronger on the health care reform message." Of course, so does the GOP. NPR adds: "The Republican National Committee plans to run radio ads in 60 districts in 33 states referring to health care changes as 'the dangerous experiment President Obama and the Democrats in Congress want,' and saying the Democrat proposals 'just can't be the right answer.' House Minority Leader John Boehner says Republicans are bringing the fight to the Democrats. 'I think it's safe to say that over the August recess, as more Americans learn more about their plan, they're likely to have a very very hot summer'" (Seabrook, 7/31).

The Washington Post takes a look at the practice of self-referrals (mainly for imaging) in the wake of health reform:

In focusing on health-care reform this year, President Obama pledged that a revamped system would hold down exploding costs. But none of the players -- Congress, the administration or the array of interests involved in the process -- has offered a clear path to that goal. And efforts to control medical practices that have driven up expenses, including physician "self-referrals," underscore how difficult it is to alter entrenched patterns.

A host of studies and reports by academics and the federal government shows that physicians who own scanners order many more scans than those who do not. As a result, Americans pay billions of dollars in extra taxes and insurance premiums.

Government panels have found that, across several areas of medicine, ordering more procedures does not improve health outcomes. In the case of medical scans, unnecessary imaging also creates a health risk -- as many as 1 percent of all cancers in the United States appear to be caused by radiation from medical imaging, according to Amy Berrington de Gonzalez, a radiation epidemiologist at the National Cancer Institute.

Some pretty amazing stats:

[H]igh-tech MRI and CT scanners have become smaller, making it possible for many more physicians to use the "in-office" exception.

A dramatic increase in imaging has followed for the most expensive scans -- MRI, CT and certain cardiac stress tests. According to a GAO report last year, Medicare reimbursed $28 for the most commonly prescribed X-ray in 2006, compared with $1,118 for the most commonly prescribed MRI.

Nationwide, a growing share of physician income came from imaging fees: In 2000, scans in the offices of cardiologists earned the doctors 23 percent of their total Medicare revenue, according to the GAO. In 2006, the figure was 36 percent.

In a report last year, Laurence Baker, a health research professor at Stanford University, found that each new MRI scanner is associated with 733 additional procedures in a region and that each new CT scanner is associated with 2,224 additional scans. That is among only Medicare patients age 65 and older, Baker said, meaning the overall use of the machines probably is much higher.

But the article gives one of the final words to Sanford J. Siegel, a urologist: "Just because doctors have CT scanners in their office does not mean they are abusing the system. Is everyone a Bernie Madoff or a crooked politician? Most doctors are dedicated to providing outstanding patient care. They don't think, 'A CT scan is coming and I am going to make money.' They think, 'A patient needs a blood test or a scan, and I am doing it for him.' "

Hmm.

Another day, another group. This one, however, claims 450,000 doctors - nothing to sneeze at. From yesterday's American Academy of Family Physicians press release:

America's front-line family doctors want you to know what they think about the current dysfunctional health care system and the benefits that could be realized from a system built on primary care.

Today marks the launch of "Heal Health Care Now." This Web-based initiative (HealHealthCareNow.org) consists of several elements, including a provocative video of family doctors speaking in support of the health system reform legislation Congress is debating currently. The video culminates with a call to action encouraging viewers to let their legislators know they stand behind nearly half a million doctors to support reform. The Web site also provides a quick and easy tool that encourages viewers to contact their legislators directly.

Also today, organizations representing 450,000 doctors signed and delivered a joint letter indicating their support of health care reform to Sen. Harry Reid (D-Nev.) and his colleagues in the U.S. Senate. The American Academy of Family Physicians along with the American College of Physicians, the American Osteopathic Association, the American Medical Student Association, Doctors for America and the National Physicians Alliance signed the letter which reads in part, "We are confident that the reforms being proposed will allow us to provide better quality care to our patients, while preserving patient choice of plan and doctor."

And the video where you can hear from some of them:

Let's hope the American people are not even trying to follow along at home - this debate has become almost impossible to follow, even for professional political junkies.

We have been on the phone with health care CEOs, investors, policy makers and assorted hacks - and not only can we not tell which way is up, but no one else seems to be able to either.

Many fatalist conservatives thought the game was over when the Blue Dogs fell in line yesterday - followed by sounds of  growing"compromise" from the Senate.  However, another backroom drama seems to be unfolding (as reported in Politico):

Liberals, Hispanics and African-American members -- Pelosi's most loyal base of support -- are feeling betrayed after House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) reached an agreement with four of seven Blue Dogs on his committee who had been bottling up the bill over concerns about cost.

By sundown Wednesday, the outcry from the left had become so loud that Waxman was forced to scrap a scheduled markup of the compromise measure. He rescheduled the meeting for Thursday morning and convened a mass question-and-answer session for a deeply divided Democratic Caucus -- a meeting that is expected to be extremely contentious.

Two months ago, most of the 80-plus members of the Congressional Progressive Caucus signed a pledge that they would oppose any health care bill that didn't contain a bona fide public option that would compete with private insurers.

On Wednesday, they seemed willing to stick to their promise.

So, perhaps everyone can take solace in the fact that this process seems destined to settle out around a lowest common denominator set of proposals. If Nadler, Frank and others can't find compromise with the Blue Dogs, and if the House and the Senate end up as far apart as they seem to be heading - the one change we can believe in is that there won't be much change at all.

And, with all the confusion in the air right now, we aren't convinced that's a bad thing...

"We are introducing this bill because we support health care reform, but in way that empowers patients," said Brendan Buck, a spokesman for the House Republican Study Committee. "While the president continues to insist there is appetite for the status quo in Congress, it's not coming from Republicans." - AP News, 7/30/09

---

The plan, drafted by Rep. Tom Price, R-Ga., a physician. "would offer tax credits to help people buy insurance, yet unlike Democratic proposals, wouldn't require either individuals or employers to get coverage." Some other high points, from the AP article:

The plan ...

• Would not set up new federally regulated purchasing pools for individuals and small businesses.
  
• Would allow individuals to use the Internet to purchase lower-cost coverage available anywhere in the country.
  
• Would offer tax deductions and tax credits to help make the purchase of health insurance more affordable for individuals.
  
• Would provide grants to states to help set up high-risk pools for people with medical problems who are denied coverage by commercial insurers.
  
• Would allow employers to automatically sign workers up for the company's coverage -- similar to what's done with 401(k) retirement plans.
  
• Would take on medical malpractice, limiting jury awards for pain and suffering and creating new health courts in which a specially trained judge would hear and decide cases involving medical negligence.
  
• Would give doctors what amounts to veto power over recommendations from a new federal board that's been assigned to compare the benefits of new treatments, tests and medications. Recommendations from the Council for Comparative Effectiveness Research could not be enacted without the approval of the medical specialty society that would be affected.

Oh, and they say it's all paid for.

Oh, man. Can we hear more about that anti-scam language in the pile of health reform papers?

Federal authorities arrested more than 30 people, including doctors, and were seeking others in a major health care fraud investigation in New York, Louisiana, Boston and Houston. More than 200 agents worked on the $16 million case, which included 12 search warrants at health care businesses and homes across the Houston area, where the bulk of the arrests were made.

• Federal authorities say those businesses were giving patients "arthritis kits," which were nothing more than expensive orthotics that included knee and shoulder braces and heating pads. Patients told the authorities that the kits were unnecessary, and many never even received them. Health care clinic owners billed $3,000 to $4,000 for each kit.

• Another scam involved billing Medicare for thousands of dollars worth of liquid food like Ensure for patients who cannot eat solid food. The authorities said clinic owners never distributed the food to patients.

• In some cases, clinic owners billed patients who were dead when they were said to have received the items.

It is the third major sweep since Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius announced in May that they were adding millions of dollars and dozens of agents to combat a problem that costs the country billions of dollars each year.

Source: Dozens Arrested in Health Care Scam Sweep

McAllen just can't stay out of the news.

In today's New York Times, we read:

One of the largest sources of campaign contributions to Senate Democrats during this year's health care debate is a physician-owned hospital in one of the country's poorest regions that has sought to soften measures that could choke its rapid growth.

The Democratic Senatorial Campaign Committee collected nearly $500,000 at a reception here on March 30, mostly from physicians and others affiliated with Doctors Hospital at Renaissance, financial disclosure records show.

The event was held at the home of a prominent McAllen developer, Alonzo Cantu, a hospital founder, investor and board member who has raised prodigious sums from the Rio Grande Valley for an array of Democrats.

Another event at Mr. Cantu's home, in September 2007, brought in at least $800,000 for the committee's House counterpart, the Democratic Congressional Campaign Committee, according to disclosure reports. The House speaker, Nancy Pelosi, was in attendance and cut a ribbon at the hospital's new women's center while in town.

The hospital, which is in Edinburg, adjacent to McAllen, is working both sides of the aisle. Its political action committee, Border Health PAC, split $120,000 last year among House and Senate candidates, including Republicans.

A nice graphic accompanies (click to enlarge) ...

"We're making progress. We're still working," Pelosi, her voice hoarse, said after the marathon negotiating session.

The news reports are saying that the Senate Finance Committee Negotiators are getting "close to health accord" - that they may even vote on a bipartisan bill before the recess. If what the Washington Post reports is accurate there are going to be a lot of disappointed folks out there:

An emerging consensus among a bipartisan group of senators is poised to shift the dynamic in the congressional debate over health-care reform and could lead to a final product that sheds many of the priorities that President Obama has emphasized and that have drawn GOP attacks.

Three Democrats and three Republicans on the Senate Finance Committee are expected to wrap up their arduous multi-week talks in the coming days, and Majority Leader Harry M. Reid (D-Nev.) said he expects a panel vote before the Senate recess, which will begin Aug. 7.

Assuming the fragile committee coalition holds, the legislation it produces would scramble the reform landscape by introducing policy ideas that have their origins in the political center. The bill is bound to disappoint liberals. But with prominent GOP backing, it also could prove more difficult for Republicans to reject out of hand -- the approach they have taken to the House bill and a second Senate version, written by the health committee.

In today's New York Times, H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H., takes a (big) step back and asks us to consider what "health" really means:

The Canadians haven't figured it out. Neither have the Japanese, the French or the British. No health care system has seriously grappled with the question most fundamental to its task: what constitutes health?

As the United States contemplates an overhaul of its system, maybe we should take a stab at it.

For years the question has been deferred to those with a financial interest in the answer -- health professionals entwined with pharmaceutical companies, biotechnology firms, manufacturers of medical devices and diagnostic technologies, free-standing diagnostic centers, surgical centers, hospitals and academic medical centers -- a group aptly labeled some 30 years ago by the editor of The New England Journal of Medicine as the "medical-industrial complex."

It's an industry that has learned a lot over those years. I know, because I've been part of it. And increasingly it has settled on a most convenient answer: health is the absence of abnormality. ...

The American Medical Association and the American College of Surgeons have both come out against the idea of an independent commission that would set the size of Medicare payments, according to the Wall Street Journal. Up till now, doctor support for the new health reform plans has seemed strong enough for President Obama to repeatedly cite "physicians' backing for his health-overhaul plans." If the commission idea continues along the path it's on, the President might lose the chance to say that:

... [D]octors are objecting to proposals that would allow a federal commission to set the size of Medicare payments to doctors, hospitals and other health-care providers. Under a proposal from White House budget director Peter Orszag, if the president accepted the commission's recommendations, they would automatically take effect unless Congress acted to block them.

Doctors' objections to the commission idea highlight the difficulty of maintaining the support of different health-care constituencies when the focus turns to controlling costs.

Today's New York Times provides an inside look (snacks and all) at the six key members of the Senate Finance Committee who are trying to reach a bipartisan deal on health reform, those who "since June 17 have gathered -- often twice a day, and for many hours at a stretch -- in a conference room with burnt sienna walls, in the office of the Senate Finance Committee chairman, Max Baucus, Democrat of Montana."

The article conjures up images of students cramming for final exams, Diet Coke cans and bags of greasy chips scattered all around:

Last week, there were chippers -- chocolate-covered potato chips -- described on a sign as "North Dakota Diet Food." More often, there are Doritos, pretzels, Oreo cookies and beef jerky: fuel to get through hours of talks on topics like the actuarial values of private insurance plans or the cost-sharing provisions of Medicare. ... The coffee, brewed in the office, is roasted in Montana, usually the Grizzly or Buffalo blends. For all the discussions about preventive medicine, and the need to encourage Americans to lead healthier lives, carrots and celery sticks are not typical.

Read the full article for the important parts: Health Policy Now Carved Out at a More Centrist Table

From Politico:

When it comes to health care reform, doctors know best.

But do they?

Some experts -- and even some doctor-politicians -- say that having an M.D. after your name doesn't necessarily mean that you're smarter than the next member of Congress on health care reform. And conflating a medical background with legislative duties can be problematic. ...

In some measure, the question of a doctor's credibility is a debate about the debate itself. Is health care reform, at its root, really about medicine? Or is it about economics? Or social justice? Or all of the above?

"This is really a bill that is not about health care," says former Republican Rep. Mickey Edwards, a lecturer at Princeton University.

"It is about what role should the government play in taking care of a portion of Americans that don't have health insurance, and what price should we be willing to pay to meet that need."

Read full article: Do Doctors Know Best?

Do doctor-politicians know best? Discuss in the VitalSigns Resource Center.

From the New York Times:

... a handful of legislators are just saying no to TV commercials for prescription drugs. The politicians are taking aim at the 60-second spots that have made viewers familiar with maladies like male urinary urgency and deficient eyelashes -- not to mention side effects like four-hour erections. ...

Meanwhile, Representative Jerrold Nadler, Democrat of New York, has introduced a bill called the Say No to Drug Ads Act. It would amend the federal tax code to prevent pharmaceutical companies from deducting the cost of direct-to-consumer drug advertisements as a business expense.

"You should not be going to a doctor saying, 'I have restless leg syndrome' -- whatever the hell that is -- or going to a doctor saying, 'I have the mumps,' " Mr. Nadler said in an interview. "You should not be diagnosed by some pitchman on TV who doesn't know you whatsoever."

Click through to read entire article: Lawmakers Seek to Curb Drug Commercials

All right, enough fun. Time to get back to business.

Politico today lists a few things that could possible "derail" a final bill:

• Co-ops versus a public plan
• The doctor fix
• The millionaires' tax

• Business penalties

The doctor fix? That's about those Medicare reimbursement rates:

House moderates are insisting on inclusion of a $245 billion provision that would boost and stabilize Medicare reimbursement rates for doctors.It's an issue that can resonate strongly in House districts, particularly rural ones, where a local doctor's opinion can have big sway in the community. But some senators, already struggling to raise the nearly $1 trillion to pay for the reform program, are considering punting on the issue rather than finding a way to pay for it. Hanging in the balance could be vigorous support from the American Medical Association and the nation's doctors, whose support is considered critical by some lawmakers.

*Image via Politico: A stack of documents comprising of the health care reform bill and its amendments are seen at the seat of Sen. John McCain, R-Ariz., Wednesday, June 17, 2009, on Capitol Hill in Washington, before a markup hearing of the Senate Health, Education, Labor and Pensions Committee. Photo: AP

On NPR's Wait Wait Don't Tell Me this weekend, Mo Rocca asked the question:

"If my head explodes from trying to wrap it around the complexity of the proposed health care plans, will my current health plan cover it?"