October 2009 Archives

Today's WebMD heath blog looks at the bubble of baby boomers that  are entering their 60s and worries that the health care system is not equipped to handle this many elderly patients.   The elderly use medical services as a far greater rate than younger people and there has not been a corresponding increase in the number of health care workers ready to treat and care for them. 

There's a silver tsunami gaining strength, and the health care system may not be able to weather the storm.

"As the tidal wave comes, are we prepared?" asks Margaret Scott, chief investment officer of Belmont Village Senior Living in Houston. "Do we have health care providers, doctors, nurses' aides, or systems in place to keep people at home."

The answer is a resounding "no", but many in the health care field are furiously working on developing innovative, multi-pronged solutions to these problems. Improved disease prevention efforts and technology are two important parts of any potential solution, but the clock is ticking.

Experts hope that prevention efforts will help keep seniors healthier longer and ease the burden on the health care system.  This, combined with technology improvements that decrease physician time spent on administrative and record keeping tasks, if implemented quickly and effectively, could keep the baby boomers from crippling a system that is already teetering on the brink. 

Read the full post here. 

A joint NPR/Kaiser Health News report looks at one approach to reigning in health care costs that is gaining momentum in Congress and with the White House.  With a rapidly growing older population, more and more attention is being directed at controlling entitlement costs:

Amid growing signs that health care overhaul legislation will do little to "bend the cost curve" in the coming decade, lawmakers and administration officials are considering tougher steps to rein in costly entitlement programs and address mounting concerns about soaring deficits.

One approach attracting widespread attention calls for the creation of a bipartisan commission to draft proposals to control the long-term costs of Medicare, Medicaid and Social Security. Together, the three programs account for 40 percent of all federal spending, other than interest on the debt.

The recommendations of the proposed commission would command a swift up or down vote by Congress. Senate Budget Committee Chairman Kent Conrad, D-N.D., and Republican Sen. Judd Gregg of New Hampshire, the chief authors of the proposal, say they may attempt to attach it to must-pass legislation raising the government's debt ceiling in the coming weeks.

"My concern is the trajectory of our deficits and debt are completely unsustainable and that [while] health care reform helps, it is not sufficient" to control runaway entitlement spending, Conrad said in an interview. "We've got to do much more, and I don't believe it will happen in the regular order. I think it requires a special process."

The process being proposed would create a commission that would operate in a manner similar to the successful Defense Base Closure and Realignment Commission (BRAC) since their recommendations would not be subject to congressional amendment. And because a three-fifths supermajority would be required in both chambers to adopt the recommendations, the two political parties would have to work together to address entitlement reform.

[E]xperts agree that real long-term health care and Social Security cost savings would necessitate highly unpopular measures, such as reducing health care benefits and cost-of-living adjustments, boosting taxes and fees, or, in the case of Social Security, raising the eligibility age even higher or increasing payroll taxes.

"Everybody knows what the options are, that's not the problem," said William A. Galston, a senior fellow in governance studies at the Brookings Institution. "People have known for 10 years what the options are. The question is a political question, not an analytical question."

Read the full story here.

The Senate has confirmed Dr. Regina Benjamin as Surgeon General of the United States.  Majority Leader Harry Reid (D-Nevada) had blasted Senate rebublicans for stalling her confirmation.   As reported in the New York Times,

Republicans had stalled her confirmation over another issue, the so-called gag order imposed on insurance companies about whether they could inform Medicare beneficiaries about possible cuts to their benefits in the health care bills being negotiated in the House and Senate. The administration has since retreated on that issue.

Dr. Benjamin is well known as the founder of the Bayou La Batre Rural Health Clinic in Bayou La Batre, Ala., and for keeping that clinic running during two hurricanes.

Read the full story here.  For a video of President Obama announcing his nomination of Dr. Benjamin for Surgeon General, click here.   For a brief biography of Dr. Benjamin click here or here. 

Speaker of the House  Nancy Pelosi (D-California) unveiled an $894 billion health care package that would provide insurance to up to 36 million people by broadly expanding Medicaid, the state-federal insurance program for the poor, and by offering subsidies to moderate-income Americans to buy insurance either from private carriers or a new government-run plan.    The Washington Post reports that the bill, despite some sticking points, has the potential to draw support from a broad range of Democratic lawmakers:

Democratic House aides said party leaders had yet to resolve long-standing disputes over provisions to block illegal immigrants from receiving benefits and to prevent federal funds from being used to subsidize abortions. But lawmakers also said there was a growing realization among Democrats from across the political spectrum that the time had arrived to compromise and move forward after weeks of internal battling.  "At the end of the day, we've got to pass something," said Rep. Jim McGovern (D-Mass.). "The whole debate, I hope, has been about more than just therapy."   The 1,990-page bill includes a version of the "public option" preferred by moderates and raises Medicaid eligibility levels to 150 percent of the federal poverty level for all adults, a steeper increase than in earlier drafts.

The New York Times discusses the differences between the house bill introduced today and the measure that is under consideration in the Senate:

In its size and scope, the House bill is very similar to a measure under development by the Senate majority leader, Harry Reid of Nevada, who is seeking to combine bills passed by two committees.  But there are crucial differences. The House bill, for instance, would impose a new income surtax on individuals earning more than $500,000 and couples earning more than $1 million -- a so-called millionaire's tax.  The Senate bill would impose a tax on high-cost insurance policies, a move that experts say could help lower long-term health care costs by giving employers, employees and private insurers incentive to reduce expenditures.In addition to expanding coverage for the uninsured, both the House and Senate versions of the legislation would severely tighten restrictions on the health insurance industry, for instance, by barring the denial of coverage based on pre-existing medical conditions.

Read the Washington Post story here and coverage from the New York Times here. 

The public option has had a more ups and downs than a temperamental kangaroo.    Last week it was widely reported that the public option would be making its way to the White House for President Obama's signature, only three weeks after it had been declared dead after a vote by the Senate Finance Committee.  Now, the public option is again in jeopardy.  The proposal put forth yesterday by Senate Majority Leader Harry Reid may not be able to attract enough votes to override an expected Republican filibuster. 

As reported in the New York Times

Simply to get the Senate to take up the legislation, Mr. Reid has said he needs 60 votes -- effectively all 58 Democrats and the two independents who caucus with them. Senator Olympia J. Snowe, Republican of Maine, who had been open to supporting the bill, said Tuesday that she would oppose Mr. Reid's version because of the public plan.   But while some who oppose a public plan said they were willing to let Mr. Reid bring the legislation to the floor, the continuing apprehension of others indicated substantial uncertainty.

Similarly, The Washington Post reports that moderates may not be ready to back the plan:

 Senate Majority Leader Harry M. Reid's risky decision to bring to the chamber's floor a health-care bill containing a government insurance plan was met with skepticism by moderate Democrats, who said they still do not know whether they could support a public option on a final vote.  The latest challenge to the Nevada Democrat's move came from  Sen. Joseph I. Lieberman (I-Conn.), who told reporters that he was "inclined to support" a procedural motion to bring the measure to the floor. But he remains opposed to a government-run insurance plan in any form -- even with an "opt-out" provision for states that Reid said Monday he will include in the legislation.

"I really want to get to yes," said Lieberman, who caucuses with the Democrats. Unless the public-option language is dropped, however, he said, he probably will align with Republicans to block the measure.

Other moderates said they are undecided on the opt-out plan. "I'm skeptical about what Senator Reid has proposed," said  Sen. Mary Landrieu (D-La.). Like Lieberman, she opposes a government-run insurance program that would compete with the private sector. But Landrieu gave Reid slightly more reason for optimism, noting that she will "stay open to a principled compromise."

Read The Washington Post article here and the New York Times article here and additional coverage from The Wall Street Journal here.

A new Commonwealth Fund report analyzes the similarities, differences, potential impacts, and costs of current bills passed by the five committees of jurisdiction in the United States Congress: Finance Committee and Health, Education, Labor, and Pensions (HELP) Committees in the Senate and the U.S. House of Representatives' Ways and Means, Education and Labor, and Energy and Commerce committees. While the general frameworks of the bills are very similar--all bills include provisions intended to improve and expand coverage and all would create a comprehensive and coherent strategy for improving health care quality--they differ in a few key respects. Most important, the Senate Finance Committee bill does not include a public plan option or a requirement that employers offer coverage, nor does it reform for more than one year Medicare's formula for setting physician fees; the House bill includes all of these features. 

Read the full report here.   

The Washington Post reports on October 24 that support for the public option among Democratic leaders in Congress surged in the past week as more and more lawmakers concluded that it is the most economical way to cover the uninsured. 

The shift in momentum is so dramatic that many lawmakers now predict that President Obama will sign a final bill that includes some form of government-sponsored insurance for people who do not receive coverage through the workplace. Even Democrats with strong reservations about expanding government's role in the health-care system say they are reconsidering the approach in hopes of making low-cost plans broadly available.

 Senate Majority Leader Harry M. Reid (Nev.) and  House Speaker Nancy Pelosi (Calif.) sought support Friday for expansive versions of the public option as they prepared to send reform legislation to the Senate and House floors. Their goal is to pass bills with similar versions of the public insurance option so that final talks between the two chambers can focus on other issues that could prove more difficult to resolve.

On Friday, congressional leaders marveled at how quickly the landscape has changed. "This is an exact quote: 'Off the table,' " House  Majority Whip James E. Clyburn (S.C.) said, recalling the headlines earlier this month when the Senate Finance Committee rejected two versions of the public option in its reform bill.  Clyburn said the debate is no longer whether to include a public option, but "whether or not we will get this form of a public option or that form of a public option."

However,  in order to pass in the Senate, health care reform will need the support of all 60 Democrats in order to break a Republican filibuster.  All 40 Senate Republicans, including Olympia Snow (R-Maine) who voted for the Senate Finance Committee's health reform bill, have vowed to block any bill that has a public option. 

Read the full story here.

The Los Angeles Times reports that the advances in genetic research, testing, and genetically tailored treatments are not making it to the bedside because most physicians lack the necessary training. 

Individual genetic variations can affect how a patient will respond to many antidepressants, pain medications, cardiovascular medicines and certain drugs that treat cancers and gastrointestinal ailments. In all, roughly one in four American patients take medications whose effectiveness could be tweaked or predicted by a pharmacogenetic test. And purveyors of genomic testing services and devices are rushing to provide tests for them all.

However, most physicians are not equipped to use these tests in making treatment decisions: 

 A survey of more than 10,000 U.S. physicians undertaken by the American Medical Assn. and the pharmacy benefits manager Medco Healthcare Solutions Inc. found that just more than  one in four had had any type of education in the use of genetic testing to guide medication decisions. And only 1 in 10  felt he or she had the necessary training and knowledge to put pharmacogenetic testing to good use in treating patients. 

Read the full story here. 

President Obama signed  an order on October 24  declaring the H1N1 outbreak a national emergency.  MSNBC reports that under the order, Health and Human Services Secretary Kathleen Sebelius now has authority to bypass federal rules when opening alternative care sites, such as offsite hospital centers at schools or community centers if hospitals seek permission.  In addition,   

Hospitals could modify patient rules -- for example, requiring them to give less information during a hectic time -- to quicken access to treatment, with government approval, under the declaration.

It also addresses a financial question for hospitals -- reimbursement for treating people at sites not typically approved. For instance, federal rules do not allow hospitals to put up treatment tents more than 200 yards away from the doors; if the tents are 300 yards or more away, typically federal dollars won't go to pay for treatment.

Administration officials said those rules might not make sense while fighting the swine flu, especially if the best piece of pavement is in the middle of a parking lot and some medical centers already are putting in place parts of their emergency plans.

The national emergency declaration was the second of two steps needed to give Sebelius extraordinary powers during a crisis.  On April 26, the administration declared swine flu a public health emergency, allowing the shipment of roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they eventually needed them.

Read the full MSNBC story here and coverage from the New York Times here.   

The LA Times is reporting that on October 23, the FDA approved the emergency use of intravenous peramivir in the treatment of patients who have been hospitalized with H1N1 flu.    The Centers for Disease Control had requested that the FDA take this step to give health care providers another weapon in the battle against the H1N1 epidemic.    Using intravenous peramivir to treat flu patients is experimental, and the drug is still in Phase 3 clinical trials.  

The problem with existing drugs is that some people have difficulties tolerating the oral Tamiflu and that the nasal spray Relenza may not get deep enough into the lungs to reach the swine flu virus when it causes viral pneumonia. The emergency use authorization says peramivir can be used when other drugs have failed or when delivery by a route other than intravenous is not expected to be feasible.

Read the full story here and read the emergency use authorization here.