Medicare reimbursement rates for physicians are set to be cut by 21% on March first.  But the Wall Street Journal reports that the jobs bill Harry Reid is putting together includes yet another "short-term patch" that would temporarily block the cuts.   Just how long the patch would last was still being negotiated on Tuesday, the article says.  A draft of the bill has been posted on Politico.

From the Wall Street Journal health blog:

The calculus on this issue is always basically the same. There's widespread political support for blocking scheduled pay cuts to doctors. But doing so is expensive. So rather than get rid of the formula that keeps calling for the cuts -- which would require Congress to acknowledge that the country is going to be on the hook for billions of dollars in additional Medicare costs -- Congress keeps passing these short-term patches.

For the full story, click here and to read the draft  job bill, click here.  For our previous posts on Medicare reimbursement click, here and here. 

The New York Times Prescriptions Blog is reporting that Senator Judd Gregg (R-New Hampshire) has proposed a starting point for the February 24 Health Care Summit. 

"Senator Gregg ... praised President Obama's call for a bipartisan summit meeting on health care legislation and suggested that there are two plans that could serve as a basis for compromise: a proposal that he developed called "Coverage, Prevention, Reform" -- C.P.R., for short -- and a bill put forward by Senators Ron Wyden, Democrat of Oregon, and Bob Bennett, Republican of Utah...

Mr. Gregg suggested two starting points for compromise: his own plan, which was described in an op-ed piece on Yahoo with further details provided on his Web site (pdf), and a bill put forward by Mr. Wyden and Mr. Bennett that would end the tax exclusion for employer-provided health benefits and provide more choice and flexibility for consumers (pdf), including those who already have insurance".

As previously reported on this blog, both parties have been pessimistic whether any real progress can be made at the Health Care Summit.  In spite of his praise for President Obama in calling the Summit, Senator Gregg did express some reservations:

"I am pleased that the president is finally willing to sit down with members of the Republican Party to discuss ways that we can work together to produce a bipartisan health care bill that will reduce health care spending, improve the quality of care and provide access to affordable health insurance for all Americans." Mr. Gregg also said he had concerns about the legitimacy of the talks. "I hope these conversations are constructive and serious, not used as an arena for political theater," he said.

For the full blog post in the New York Times, click here. 

Comparative effectiveness seems like an elegant and simple tool to control health care costs while improving quality.  In a nutshell, comparative effectiveness analysis is the science of evaluating treatment alternatives to determine which ones are the most effective.  The results of the analysis are shared with providers who will then treat patients only with the most effective methods, saving money and improving patient outcomes.  In practice, however, comparative effectiveness analysis is not as persuasive as reimbursement rates in determining what treatments some patients receive.   From The Wall Street Journal:

[A] study, known as "Courage" and published in the New England Journal of Medicine ..., shook the world of cardiology [in 2007]. It found that the most common heart surgery--a $15,000 procedure that unclogs arteries using a small scaffold or stent--usually yields no additional benefit when used with a cocktail of generic drugs in patients suffering from chronic chest pain.

While health care reform has stalled at the national level, state legislatures have nonetheless been busy crafting objections to the requirements in both the House and Senate health care reform bills that would require everyone to purchase health insurance.  The Tea Party movement is behind many of the states' objections to the mandatory insurance requirements but the measures have attracted bi-partisan support in many state legislatures. 

The objections ... may turn out to be largely symbolic. But they nonetheless serve notice to President Obama and the Democrats of real anger over their health care plans and signal the potential for political upheaval down the road.

These measures, which are in various stages of ripening in about 36 states, could also pave the way for a major court challenge....

President Obama has invited Republican lawmakers to a televised Health Care Summit, to take place later this month.  From the Washington Post:

The president made the offer in an interview with CBS News anchor Katie Couric hours before the network televised the Super Bowl. Obama challenged Republicans, who have been largely unified in opposing his proposals, to bring their best ideas for how to cover more Americans and fix the health insurance system to the public discussion.

"I want to consult closely with our Republican colleagues," Obama said. "What I want to do is to ask them to put their ideas on the table. . . . I want to come back and have a large meeting, Republicans and Democrats, to go through, systematically, all the best ideas that are out there and move it forward."

The invitation to meet together on Feb. 25 -- and to do so live in front of the American public -- represents an effort by Obama to hit the reset button on the top domestic priority of his first year in office. It also reflects a recognition that he must have at least some Republican support if he hopes to see health-care reform pass.

For the full story, click here.

Related coverage:

Obama Plans Bipartisan Summit on Health Care , The New York Times

White House Announces Televised Health Meeting, Politico

Obama Calls for Health-Care Summit, The Wall Street Journal

As reported in The Wall Street Journal, spending on publicly funding health care will soon account for half of all US healthcare spending. 

For the first time, government programs next year will account for more than half of all U.S. healthcare spending, federal actuaries predict, as the weak economy sends more people into Medicaid and slows growth of private insurance.

The figures show how federal and state spending is taking a bigger role while Congress hesitates over a health-care overhaul.

Over the next ten years, health spending is expected to balloon to $4.5 trillion. Despite this, the government's health overhaul has stalled, Peter Landers reports.  Government health programs are a growing burden on the federal budget, which is running annual deficits of more than $1 trillion, and rising health costs continue to batter private industry.  By 2020, according to the new projections, about one in five dollars spent in the U.S. will go to health care, a proportion far beyond any other industrialized nation.

"It's going to be a desperate issue five to 10 years out," said Gail Wilensky, the former top Medicare official in the George H.W. Bush administration. She said the U.S. will have to decide soon between raising revenue to pay for Medicare or reducing benefits.

In 2008, the last year for which figures are available, government health care spending was 47% of the total health care spend. 

For the full story, click here. 

Now that comprehensive health care reform legislation is on hold, Democrats have begun a piecemeal approach to reform.  First on the agenda is repealing the antitrust exemption for health insurance companies.  From the Wall Street Journal:

After focusing intensely on health care for months, Democratic leaders have removed completion of the overhaul from their agenda indefinitely, and even talk of the subject is scarce.

Instead, House Democrats are turning to a targeted provision with populist appeal in search of a small victory. They say repealing the federal antitrust exemption would drive insurance prices down in regions where one health insurer dominates. Insurers say they already face tight regulation by the states, and the practical impact of the move is uncertain.

Next steps for the Democrats are uncertain now that their super majority in the Senate has been lost and Republicans are showing no signs that they are going to help Democrats out of their predicament. 

For the full story click here  For a related story in Politico about the Democrat's new health care strategy, click here. 

Health and Human Services Secretary Kathleen Sebelius has told lawmakers that she cannot guarantee greater transparency in health care reform negotiations in spite of President Obama's  repeated statements about providing greater transparency into the negotiations. 

"I am not a principal in the negotiations," Ms. Sebelius said in testimony before the Senate Finance Committee. "Nor is my staff."

Ms. Sebelius said administration officials provided "technical support" to Congress, but did not control the negotiations.

Her comments came about five hours after President Obama affirmed the need for openness in efforts by the administration and Congress to finish work on a health bill intended to expand coverage and rein in costs.

In the rush to pass legislation in December, Senate leaders and White House officials did much of their work behind closed doors, and Mr. Obama said Wednesday that the perception of secrecy may have undermined public trust.

For the full story in the New York Times, click here. 

The Puget Sound Business Journal reports that The state Health Care Authority (HCA) said it plans to ask private insurers to help it create a coverage option that anyone in the state could buy for about $100 a month.  The agency will issue a request for proposals to the insurers asking how much they would charge for a benefit package outlined by the agency.  Based on the bids, the agency would determine what premium insurers may charge for the package. Insurers who figure the premium would not cover their claims and administrative expenses could choose not to participate.

Washington State has an estimated 875,000 uninsured people that the HCA is hoping to open up coverage for.  Opponents of the proposal say that state regulations deny private insurers the right to offer comparable policies to the HCA plan and would destroy the individual insurance market.  Some lawmakers have introduced legislation to changes these regulations but legislative observers expect this legislation to run into stiff opposition from Democrats who control both the House and the Senate. 

For the full story, click here.

Health Leaders Media reports that one segment of health care reform may go ahead with or without a comprehensive reform package:

While Congress may not have approved healthcare reform legislation yet, one of the more well-discussed--and sometimes controversial--areas included in the reform bills was included in President Obama's proposed fiscal 2011 budget: comparative effectiveness research (CER).

However, a scan of the proposed budget will detect no references to "CER;" its new name is instead: "patient-centered health research."

In the Department of Health and Human Services (HHS) budget, no explanation is given for the name change. The fiscal 2011 budget request provides a total of $286 million--which included $273 million for research and $13 million for related program support--targeted in part for the Agency for Healthcare Research and Quality (AHRQ) to support new research projects.

A central tenant to President Obama's health care reform proposals has been comparative effectiveness research.  Comparative effectiveness research compares similar treatments in terms of both the relative medical benefits and risks of each option, and also the costs and the benefits of those options.  Comparative effectiveness is increasingly being viewed as a viable way to help drive down spiraling health care costs while continuing to provide quality care. Roughly $700 billion each year goes to health-care spending that can't be shown to lead to better health outcomes, according to the non-partisan Congressional Budget Office.

For the full story click here.  For the CBO report on comparative effectiveness research, click here.

Politico is reporting that House Speaker Nancy Pelosi is proposing a two track approach to health care reform:  less controversial incremental changes now with more sweeping changes tabled until a later date when the political climate improves.

"We believe that it's possible to have comprehensive health care reform as we go forward, but at the same time, it can be on another track where some things can just be passed outside of that legislation, and we'll be doing both," Pelosi said in an interview with POLITICO.

Though the Democrats' loss of Ted Kennedy's old Senate seat has complicated efforts to get the 60 votes they need for a sweeping health care bill, Pelosi insisted that comprehensive reform is still on the agenda.

"We have to get it done," the speaker said. "What the process is doesn't matter. The outcome is what is important, and what it means to working families in America."

For the complete story including video of the interview, click here.

The Congressional Budget Office (CBO) cites federal healthcare spending as "the single greatest threat" to the United States' budget stability in its new report, The Budget and Economic Outlook: Fiscal Years 2010 to 2020. Under current law, Medicare spending will reach $1,038 billion in 2020, with Medicaid spending coming in at $458 billion.  In 2009, higher unemployment drove up Medicaid spending by 9 percent ($18 billion). For the previous 10 years, the program's average annual growth rate had held at 7 percent. Medicare outlays also rose faster than average, jumping by 10 percent ($39 billion).

For an article summarizing the report, click here and for the CBO report, click here.