August 2009 Archives

An article in today's USA Today, with reporting by Kaiser Health News, is getting lots of play on Twitter, blogs and the rest. The piece looks at the role age plays in how much health insurance costs:

Chris Denny, who runs a small marketing firm in Santa Rosa, Calif., buys his own health insurance for $117 a month. An avid gardener, Denny, 27, describes himself as healthy and fit.

Yet the same policy, from the same insurer, would cost a 60-year-old man $735 a month, according to an estimate at eHealthInsurance, an online marketplace that lists quotes and coverage from a variety of insurers.

Such a difference in cost -- common around the country -- doesn't surprise Denny, who says older people use more medical care: "So is it unfair to charge them (that much) more? I don't think so."

According to KHN, "This article includes a state-by-state break down of those states which currently limit how much more older people can be charged than younger ones for individual health policies and a graphic detailing the number of uninsured people in the U.S., by age-group."

(As of 11:30 central time, there were already nearly 500 article comments.)

Full article: Health care: Lowering costs for old could raise them for young

Today we feature a post by Sarah Lovinger, physician and executive director of the Chicago chapter of Physicians for Social Responsibility. (The below is a cross-post from Dr. Lovinger's series of articles at the Huffington Post.)

(We anticipate some strong reactions to this post, so please be sure to discuss within the iMedExchange VitalSigns Resource Center.)

Would a mere $2,154,200 change how you voted on the health care reform bill? If that's not quite enough, would $3,973,485 or $8,994,077 be more to your liking? Ask Senators Kent Conrad, Max Baucus and John Kerry. These multi-million dollar sums represent total donations from the health insurance industry and other groups opposed to real health care reform to the campaigns of these senators.

Significant contributions like these could kill the best chance our country has for real health care reform. The health insurance lobby certainly hopes so.

Our country will have a health insurance bill this year. Despite the angry town halls and the 'death panels', President Obama and the Democratic congress have enough momentum to pass a bill providing health care coverage for all or most Americans. But they need to pass the right bill.

Only a bill with a government option will provide meaningful health care reform. The government option is not only preferred by large numbers of Americans--as many as 20 to 30 million people, by some estimates. More importantly, the federal government is the only entity big enough to inject real competition into the health insurance market. Are you paying too much for your insurance premiums? Are you tired of a policy that only pays for 80% of your care, sticking you with 20% of the cost? Does it drive you mad that every year you pay higher co-pays for the same prescription drugs? In a country (ours) in which 94% of the health insurance markets are not competitive, according to the American Medical Association, insurance companies can continue to charge us more for health care while increasing their own profits. That's why there are some really busy health insurance lobbyists in DC these days.

Not only is the health insurance lobby giving large donations to our elected officials, they may also be behind the angry mobs protesting at town hall meetings and obsessed with fictional 'death panels'. The untruths these town halls are spreading could derail progress for real health care reform. Short-circuiting the public option benefits the health insurance industry, but not the rest of us.

Why is the public option really the antidote to all of this? According to David Borris, owner of a catering company in Chicago and executive committee member of the Main Street Alliance, an organization for small business owners, "We need an entity as big and strong as the US government to keep insurance companies honest." With little or no outside competition, the health insurance industry can keep premiums high and manipulate the market so that we consumers have very few low-cost options. A health insurance bill with a public option would inject a different type of competition into a market where insurance companies monopolize the cost of health care, adding to the enormous costs that we all pay. "We believe that the establishment of a transparent insurance exchange with a strong public plan will increase transparency and provide the competition necessary to force insurance companies to bring premiums down," said Mr. Borris.

Insurance companies currently thrive on the kind of complexity and multiplicity that prevents many people from really knowing what kind of care is covered in their policies. A transparent exchange with multiple insurers offering a limited number of insurance options in clear language would provide the ideal antidote to the current confusing set of choices most people face. For example, some policies may say that the policy-holder can choose any doctor, but the fine print gives far more limited choices. Transparency would eliminate the 'fine print'.

The exchange would provide everyone with clear and simple choices- whether in private or public plans-- so all Americans make a rational, fair and honest choices.

It's unlikely that Senators receiving large campaign contributions from such a powerful lobby can clearly grasp the benefit of a public option. With the passing last night of our country's most prominent universal health care champion, Senator Edward Kennedy, proponents of a public option will need to work even harder to have their voices heard. The US Senate needs to just say no to the health insurance lobby, and get on with the business of real health care reform.

From the Wall Street Journal Health Blog, the latest information from the CBO on the House's health reform bill, this time concerning Medicare drug costs:

If the bill were to become law (a big if at this point), seniors' average total spending on prescription drugs would decrease, but their premiums would rise.

The bill would phase out the "doughnut hole" that now leaves beneficiaries on the hook for annual prescription drug costs between about $2,700 and $4,300 per year. That would mean big savings for those beneficiaries who now get stuck with the bill.

But average premiums for Medicare Part D would rise. That rise would be outweighed by the savings for many seniors, the CBO found. Others, particularly those who don't spend much on prescription drugs, would wind up paying more overall.

(Someone's gonna go crazy with soundbites about this.)

Full post: Medicare Drug Benefit: Lower Total Costs, But Higher Premiums

New York Times article on the subject: Health Bill Would Cut Drug Spending for Many on Medicare, Budget Office Says

More on doctor payments and health reform, this time specifically looking at cardiologists and oncologists, from Bloomberg:

An Obama administration plan to cut Medicare payments to heart and cancer doctors by $1.4 billion next year is generating a backlash that's undermining the president's health-care overhaul.

While President Barack Obama and members of Congress have spent August debating health insurance and medical costs at public forums, specialists are waging what one advocate calls a "tooth and nail" fight against a separate initiative to boost the pay of family doctors, and cut fees for cardiologists and oncologists. The specialists, in newspaper columns and meetings with lawmakers, say patients will lose access to life-saving care, from pacemakers to chemotherapy.

The proposal by Medicare, the government insurer for the elderly and disabled, is an effort by Obama to focus U.S. medicine on preventive care. The fight by physicians who work with the most expensive patients is weakening support for Obama's broader goal, legislation to remake the health system, said Mark B. McClellan, 46, a former Medicare chief. ...

The cuts would be "impossible" for some small-town cardiologists who rely on Medicare patients, said Zia Roshandel, a heart doctor in Culpeper, Virginia. The town of 10,000 people is about 60 miles southwest of Washington.

Roshandel and two partners see perhaps 50 patients a day at his practice, the local hospital and a community clinic for the indigent, the 40-year-old said in a telephone interview. Medicare accounts for two-thirds of their clientele, he said.

Already squeezed by government and private insurers, Roshandel said he has cut office hours, forgone paychecks and shifted his 12 workers to a high-deductible insurance plan over the past two years. The latest proposal would push him out of private practice altogether, most likely to a hospital in a larger community less reliant on Medicare, he said.

Full article (with some strong, strong quotations): Cardiologists Crying Foul Over Obama Medicare Cuts

From Modern Physician, an update on the House bill, the public plan and negotiated payments:

Two key lawmakers said that a provision in the House healthcare reform bill that would allow a public health plan to negotiate payments with providers could be dropped from a bill passed by a crucial House panel.

Rep. Pete Stark (D-Calif.), chairman of the Ways and Means Health Subcommittee and a principal author of the America's Affordable Health Choices Act, said he wants payments based on Medicare's rate schedule--a measure that puts him at odds with the provider community as well as the more conservative wing of his party. "I think most of us agree that we pay too much to providers now," Stark told reporters on a conference call. ...

Providers have long contended that Medicare payments don't cover the cost of care. Neither Stark nor Rep. Xavier Becerra (D-Calif.), who helped shape negotiations between three different committees, suggested the provision would be a deal-breaker, but each warned that it could drive up costs rather than lower them.

"To have negotiated rates would cost American taxpayers money," Becerra said, citing a report by congressional budgeters. "If one of your principles is to really drive costs down, well, there's tens of billions of dollars on the table right now in how you structure the public option."

Full article: Lawmakers say bill may lose negotiated payments

From the Associated Press, some information on that massive conference call:

The White House is asking doctors to help promote its drive to overhaul health care, marking an effort by President Barack Obama to regain momentum on the issue.

White House health advisers held an hourlong conference call Tuesday night with close to 3,000 physicians and officials of their professional groups in which they tried drumming up support by answering questions and describing the administration's goals, participants said.

Before the call, the White House e-mailed a 12-page booklet to medical associations titled "Doctors for Health Insurance Reform." The brochure stated the administration's case for revamping the nation's health care system and suggested ways doctors could call attention to the issue. ...

At a time when the White House has had problems honing a concise message to sell its plan, the brochure said the "top line message" is "health care stability and security for all Americans." This includes new consumer protections for patients, reduced costs and giving people a choice of care and insurance, it said.

Full article: Obama asks docs to promote health care fix

Hospital & Health Networks Magazine has a colorful Physician Snapshot (mostly graphics, just a little text) in its August issue, looking at current and future physician demographics (and how all of this will shape, in part, the future of how health care is delivered). From the introduction to the graphics:

"No one believes the system will be the same in 20 years," says James Bentley, the American Hospital Association's senior vice president for strategic policy and planning.

Bentley notes discrepancies in physician supply predictions, with some studies forecasting a surplus while others warn of severe shortages. Accurately predicting the nation's future needs is important because it can take at least a decade for a physician to train and enter the workforce. The Association of American Medical Colleges projects a shortage of 124,000 physicians by 2025. AAMC advocates expanding medical school enrollment by 30 percent by 2015, as well as boosting the number of Medicare residency positions.

Some regions, especially rural areas, are already experiencing a shortage. "Many physicians want to work in diverse areas and their spouses have professional careers," says Bentley. That limits many to seeking employment in metropolitan and urban areas.

Also from HealthLeaders Media, Elyas Bakhtiari writes about the ongoing divisions that are the health reform debate, this time looking at doctors' opinions by specialty. He writes:

In thinking about different physician opinions concerning today's reform efforts, I'm reminded of a survey I wrote about last year that measured physician opinion on the more generic prospect of universal healthcare.

The report found that when asked simply if they support national health insurance, of the more than 2,000 doctors polled, 59% were in favor of and 32% were opposed, a significant jump from the previous poll in 2002.

But if you break that down by specialty, support ranged from more than 80% of psychiatrists to only 30% of radiologists. In fact, a physician's specialty seemed to be a pretty strong predictor of whether he or she supported national health insurance.

The specialties that most strongly supported it--psychiatry, pediatrics, and primary care--all make less than $200,000 (MGMA median levels) or, in the case of emergency medicine, often have patient panels with a lot of uninsured or Medicaid patients. The specialties most strongly opposed--radiology, anesthesiology, and surgical subspecialties--are some of the highest earners in medicine and the biggest beneficiaries of the fee-for-service model.

Are physicians basing these views entirely on compensation? Of course not. But reforming healthcare will affect physicians to varying degrees, and specialty affiliations can't be discounted.

Full article: Physicians Divided on Healthcare Reform

The survey he references: Doctors support universal health care: survey

Mario Motta, MD, a cardiologist in Salem, Mass., writes at HeatlhLeaders Media:

Massachusetts enacted universal healthcare three years ago, and since then many have looked at us as a potential model for the nation. We've insured close to 98% of our population, adding nearly 450,000 to the insurance roles--an enviable achievement. But the strains are evident.

With physician shortages, especially in primary care, we've discovered that universal coverage does not mean universal access to care. Some patients are having difficulty finding a primary care doctor, and long wait times exist. And like others, we struggle mightily with the cost issue, exacerbated by a shrinking budget battered by a severe recession. ...

Physicians want to be--and should be--part of the process to build a better healthcare system. We are, after all, those who deliver the care. But this willingness is tempered with a certain degree of concern, born of experience. The last two decades have produced many big ideas to improve quality and affordability, launched with high hopes and great expectations. But most of these notions have failed, often making matters worse and driving a wedge between patients and their physicians. ...

Physicians believe there must be four cornerstones to healthcare reform, each patient-centered and each as important as the other:

Healthcare spending must be affordable and sustainable. Volumes of evidence prove that when people can't afford healthcare, they don't take their medications, see their doctor, or engage in preventive care. People who defer their care get sicker, and treating them becomes more expensive and more difficult.

Spending levels must be sustainable and realistic to provide the care that patients need. One important lesson from past efforts is that cutting hospital and doctor payments alone doesn't create long-term savings, even if they succeed in squeezing out short-term savings. There needs to be a systemic approach to developing sustainable spending, or the short-term savings cannot be sustained.

Reform must support and promote high-quality care. Cutting costs without promoting quality will not be accepted by patients or physicians and would doom any effort.

Reform must support a diverse, pluralistic healthcare system--large and small hospitals, independent practices, community health centers, nursing homes, rehabilitation facilities, home healthcare, mental health, dental care, and all venues where high-quality, high-value care is delivered. Patients value choice, a value deeply embedded in our culture. Any reform that deprives people of meaningful choice will not succeed and will hinder progress.

Current proposals could make things better, but only with great care and extreme diligence. Moving to a new system will require a careful, orderly transition taking many years. Physicians will need time, funding and training to acquire the technologies, to learn how to manage this new financial risk, and to acquire expertise in new areas of the law and governance. Further, practices are not equally ready to move to a new system, and some areas of the country are better equipped to do so than others. In particular, practices in the less-populated would be especially disadvantaged by an overly rapid movement to a new system. ...

We all know that the status quo in healthcare is not an option, and much hope has been placed in these new efforts. We subscribe to President Obama's statement that we should keep what works and improve what isn't working. Let's use the wisdom we've gained from past experiments to guide us to effective, long-lasting reform.

For the full article: A Massachusetts Physician Offers a View of Healthcare Reform

Kaiser Health News has posted highlights from Sen. Edward Kennedy's health policy milestones, in timeline form (and with photos):

Sen. Edward Kennedy never had to worry about getting quality healthcare, but he spent much of his career seeking to guarantee that all Americans had that same access to health services he had. "Every American should be able to get the same treatment that U.S. senators are entitled to," he wrote in Newsweek last month. "This is the cause of my life."

Early entries, from 1966 and 1971:

After a trip to the Columbia Point Health Center in Boston, which provided health care to low-income residents, the first-term senator introduces and helps pass legislation that adds $51 million to the Economic Opportunity Act for a national system of community health centers.

On Jan. 5, Kennedy co-sponsors a bill calling for a significant increase in funding for cancer research - providing a total of $1.2 billion over three years to the National Cancer Institute, more than what was proposed by the Nixon administration. A modified version of the bill is enacted Dec. 23, 1971.

... And the last:

On June 9, Kennedy submits the Affordable Health Choices Act, and although Kennedy is sidelined fighting his cancer and not able to participate, the measure passes in his Senate Health, Education, Labor and Pensions Committee as part of the larger Capitol Hill effort on health reform. However, the Senate Finance Committee is expected to significantly alter the bill. In July, Kennedy, along with long-time speechwriter and friend Robert Shrum, published an article in Newsweek outlining his personal and political experiences with health issues over the years and describing his vision for reform.

More: In Kennedy, Democrats lose a top warrior for healthcare reform

An overview from the magazine about the top 10:

Unsurprisingly, the chief architects of healthcare reform dominated the top 10 spots on this year's 100 Most Powerful People in Healthcare, among them President Barack Obama (No. 1); Senate Finance Committee leaders Max Baucus (D-Mont.) (No. 4) and Chuck Grassley (R-Iowa) (No. 5); and Peter Orszag, director of the White House Office of Management and Budget (No. 9).

And, doctors even get a shout-out (sort of):

Doctors in the house ... The physician lobby had a strong showing this year, with heads of major medical associations dominating the newcomers' list of the 100 Most Powerful. Among them was Jack Lewin, CEO of the American College of Cardiology (No. 80); Ted Epperly, president of the American Academy of Family Physicians (No. 84); John Tooker, executive vice president and CEO of the American College of Physicians (No. 86), and J. James Rohack, president of the American Medical Association (No. 95).

Christine Cassel, president and CEO of the American Board of Internal Medicine, a physician credentialing organization, is another newcomer to the ranking at No. 34.

(One of the NYT comments reads: "There should only be two people on this list. You and your doctor of preference. That is what is missing." (From Diane))

If you have 10 minutes (ha ha), The Takeaway posted its first health care roundtable today with three doctors: Dr. Kevin Pho, a primary care physician; Dr. Charles Prestigiacomo, a neurosurgeon and associate professor at the University of Medicine and Dentistry of New Jersey; and Dr. Tyeese Gaines Reid, an emergency care resident at Yale-New Haven Hospital in New Haven, Connecticut.

The three doctors first discuss what they think about current reform ideas on the table. Then they go into what they think are the biggest problems with the current system. (Guess what ... they each identify something different: lack of access to affordable insurance, lack of primary care doctors, liability. Can you match who said what?)

If you don't have 10 minutes, there's a brief rundown on The Takeaway's website.

From the NPR Health Blog, The Scary History Of Failed Health Overhauls:

In the demimonde of health wonks, there's a special place for Paul Starr, the Princeton academic whose history of the American health system more than 25 years ago still seems fresh today.

Over the weekend, Starr brought some historical perspective to the current debate over health overhaul to NPR's On The Media. (Click here and scroll down to take a listen.) Opposition to some form of universal health coverage for American is as old as efforts to make it happen.

Around World War I, the plans foundered as opponents murmuring about an association with Germany... FDR chose to skip universal coverage as part of the package that created Social Security rather than do battle with the American Medical Association. ...Then, there's an embalmed Lenin, who opponents trotted out to torpedo President Truman's push for national health insurance in 1945.

Opponents suggested that [Truman] had "supposedly said health care was the first step toward instituting Communism," Starr says. ... The notion, as Starr puts it, that a national health plan was " a gateway drug" to "government control of everything" was enough to scuttle Truman's plans during the Cold War.

This time around the real surprise is that the major health-care interest groups (like doctors, drugmakers and hospitals) aren't leading the charge. The opposition is "ideological and political," Starr says.

The other night I was watching CNN. Wolf B. had gotten together a panel of doctors (not just Gupta), to discuss health reform. One of the doctors, the former U.S. Senator Bill Frist, threw out a number about the uninsured in the United States, I think he said there were upwards of 20 million. Everyone else on the panel was, for one instant, visibly taken aback, as 46/47 million is the number we're all used to hearing. No one "corrected" him, though.

Again, from the Deloitte report, some more numbers:

• Of the 45.7 million uninsured in the U.S. in 2008, 12 million were eligible for a government-sponsored insurance program (Medicaid, SCHIP) and 10 million are illegal immigrants (4.4 million of these undocumented). (Kaiser Family Foundation)
• 27.8 million uninsured work full/part-time: 16.8 million of these work for businesses under 100 employees (Employee Benefit Research Institute)
• 62 percent of small businesses (fewer than 100 employees) provide health insurance benefits: they pay 18 percent more per worker for the same policy that larger businesses pay (Council of Economic Advisors)

Can you see where Dr. Frist got his tally?

From the Deloitte Health Care Reform Memo, a quick look at the "relationship" between Chuck Grassley and Max Baucus:

As the Senate Finance Committee faces pressure to produce its bill, the leadership of Senators Chuck Grassley (R-IA) and Max Baucus (D-MT) looms large as a critical factor in its delivery of a bipartisan solution to reduce costs and cover the uninsured. The two have much in common: both are occasional mavericks in their parties (Grassley did not support Bush tax cuts; Baucus voted for the Medicare Modernization Act). Both are veteran legislators (Grassley has served four terms; Baucus is in his fifth), and the two respect each other--they've met weekly for eight years and have traded the Chairman's gavel for the Senate Finance Committee four times in this decade. The two have agreed to present a bill to the full committee by September 15.

Note: of the six senators leading the Senate Finance Committee's effort to craft a bill--Conrad (D-ND), Enzi (R-WY), Grassley (R-IA), Baucus (D-MT), Snowe (R-ME), Bingaman (D-NM)--only Grassley is up for re-election in 2010.