Wednesday, May 31, 2006
More on the med-mal hype
Today comes news about the latest study of medical malpractice claims. A Harvard team examined 1,452 closed cases in four areas that collectively account for about 80% of all malpractice suits, and here's what they found:
Administration and litigation costs in our system are indeed very high, but the vast majority of the claims in the study were properly decided: the patients who suffered injury due to medical errors were compensated and those who weren't, weren't.
About 150 of the cases involved patients who received compensation even though there was apparently no medical error.
Some 236 of the cases involved patients who received no compensation even though they suffered injury due to medical error.
That's some out-of-control malpractice system, isn't it? I think we all agree that it would be nice to increase the accuracy of these cases, but if we did, the cost of malpractice payouts would go up, not down.
More detail here, including the fact that nearly all cases are settled out of court, and of the ones that do go to court, patients lose 80% of them. This study, by the way, follows a long line of earlier studies that show the same thing: malpractice claims are actually pretty rare; compensation is generally fair; a more accurate system would pay out more, not less; and malpractice payouts have not been rising any faster than the overall rate of medical inflation.
The malpractice "crisis" is mostly just hype.
Administration and litigation costs in our system are indeed very high, but the vast majority of the claims in the study were properly decided: the patients who suffered injury due to medical errors were compensated and those who weren't, weren't.
About 150 of the cases involved patients who received compensation even though there was apparently no medical error.
Some 236 of the cases involved patients who received no compensation even though they suffered injury due to medical error.
That's some out-of-control malpractice system, isn't it? I think we all agree that it would be nice to increase the accuracy of these cases, but if we did, the cost of malpractice payouts would go up, not down.
More detail here, including the fact that nearly all cases are settled out of court, and of the ones that do go to court, patients lose 80% of them. This study, by the way, follows a long line of earlier studies that show the same thing: malpractice claims are actually pretty rare; compensation is generally fair; a more accurate system would pay out more, not less; and malpractice payouts have not been rising any faster than the overall rate of medical inflation.
The malpractice "crisis" is mostly just hype.
A better idea for medical liability reform: make fewer mistakes
"Making Patient Safety the Centerpiece of Medical Liability Reform," New England Journal of Medicine: In a perspective piece for NEJM, Sens. Hillary Rodham Clinton (D-N.Y.) and Barack Obama (D-Ill.) discuss medical liability, stating that the focus of reform efforts should be on improving patient safety, which would reduce the number of malpractice claims, rather than on the "possibility of mandating caps on the financial damages awarded to patients." Rodham Clinton and Obama write that a bill (S 1784) they are co-sponsoring would provide grant money and technical assistance to doctors, hospitals, insurers and health care systems to implement programs to disclose errors in patient care and to negotiate compensation for such errors outside the courtroom. The authors write that over time, the bill would reduce annual litigation costs, resolution time of claims and lawsuits, and the number of claims and lawsuits (Rodham Clinton/Obama, NEJM, 5/25).
Medicare Part D: Once again, CMS fails
Pharmacists and insurers groups clashed in Washington over payment for Medicare Part D claims. Critics say many of the companies that offer drug plans under the new benefit are taking too long to resolve claims, putting financial pressure on pharmacies. Administration officials had initally argued that the numbers showed that insurers were making payments within 21-25 days. A CMS spokesman admitted that the agency has no data backing that claim. (See this article from The Hill.)
Wednesday, May 10, 2006
Secret vaccine bill written by vaccine lobbyists -- shocked?
Last December, Senate Majority Leader Bill First (R-TN) and House Speaker Dennis Hastert inserted a provision in the Defense Appropriations bill that granted vaccine manufactures near-total immunity for injuries or deaths (even in cases of “gross negligence”) caused by their drugs during a viral pandemic, such as an outbreak of the avian flu. The legislation was “worth billions of dollars” to a small group of drug makers.
The provision was inserted in the dead of the night, after House and Senate conferees had agreed the provision would not be included in the bill. According to Roll Call, the brazen move was completely unprecedented.
A new report from Public Citizen reveals that vaccine-industry lobbyists essentially wrote the provision themselves. The Tennessean reports:
Vaccine industry officials helped shape legislation behind the scenes that Senate Majority Leader Bill Frist secretly amended into a bill to shield them from lawsuits, according to e-mails obtained by a public advocacy group.
E-mails and documents written by a trade group for the vaccine-makers show the organization met privately with Frist’s staff and the White House about measures that would give the industry protection from lawsuits filed by people hurt by the vaccines.
The final language of the provision was exactly what the vaccine manufactures requested in thier emails and meetings. How did the industry get such VIP treatment from First and Hastert? Generous campaign contributions always help. Another key component: the vaccine industry was represented by a lobbying team that included three former Frist staffers and Dennis Hastert’s son, Joshua Hastert.
Read the Tennessean article here.
The Public Citizen report is here.
The provision was inserted in the dead of the night, after House and Senate conferees had agreed the provision would not be included in the bill. According to Roll Call, the brazen move was completely unprecedented.
A new report from Public Citizen reveals that vaccine-industry lobbyists essentially wrote the provision themselves. The Tennessean reports:
Vaccine industry officials helped shape legislation behind the scenes that Senate Majority Leader Bill Frist secretly amended into a bill to shield them from lawsuits, according to e-mails obtained by a public advocacy group.
E-mails and documents written by a trade group for the vaccine-makers show the organization met privately with Frist’s staff and the White House about measures that would give the industry protection from lawsuits filed by people hurt by the vaccines.
The final language of the provision was exactly what the vaccine manufactures requested in thier emails and meetings. How did the industry get such VIP treatment from First and Hastert? Generous campaign contributions always help. Another key component: the vaccine industry was represented by a lobbying team that included three former Frist staffers and Dennis Hastert’s son, Joshua Hastert.
Read the Tennessean article here.
The Public Citizen report is here.
More malpractice myths debunked
Malpractice "crisis"? Not for insurers debunks the malpractice crisis claim by looking at the diarist's own insurance carrier, whose annual report shows the company doing quite well, with surpluses and fewer claims. So much for talking points, eh?
Med Mal caps: Unnecessary?
In an article sure to throw the cat among the humming birds, Suffolk University law professor Marc Rodwin has a study in Health Affairs showing that physicians' malpractice premiums have gone down as a share of overall revenues since 1986. Article I can't wait to hear what WMC, the insurance companies and the doctors have to say...
How's that free market health care workin' for ya, baby?
U.S. has second worst newborn death rate in modern world, report says. An estimated 2 million babies die within their first 24 hours each year worldwide and the United States has the second worst newborn mortality rate in the developed world, according to a new report. CNN: FULL STORY
Saturday, May 06, 2006
Playing with public health
It's one thing to say the burden will fall on local communities, yet another for the Bush administration and the Republican congress to have done so little to help them. But in addition the states have done little to help themselves. Along with cutting taxes and starving public services at the national level has come a feeding frenzy of the same at the state level, resulting in an enfeebled and anemic local public health infrastructure.
Democrats have gone along with this Republican initiative out of weakness or cowardice or stupidity or lack of principle. Take your pick. I simply won't give them a free pass on this. I hope now some true Opposition Party backbone is developing and that's to the good.
But there's also been too little leadership and push back from the medical and public health communities. The public health leaders within WHO have been saying it all along, and they've been right: Public health politicos stupidly embraced the promise of bioterrorism money as a way to beef up public health infrastructure, but -- not only didn't that happen -- the bioterrorism follies hollowed out public health like a cancer, diverting personnel, energies and commitments. So now a real public health threat comes along and suddenly we discover we aren't prepared. Surprise.
The root of the problem is an historic lack of funding for public health in the U.S. according to Dr. Redlener, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health: "We’re about to face the consequences of a health-care system that’s in essence been neglected and allowed to degrade over time. Now it’s too fragile to handle what could be an overwhelming emergency. The prospect of a pandemic should be putting us into high gear in terms of trying to fix the health-care system even before we get a pandemic."
In addition, Redlener says, we must face the question of who is going to pay for private-sector preparedness: "This is a public-health issue. Will the public get caught in middle between the private sector and the government in terms of fulfilling the pandemic flu agenda? We don’t want this to be a ping-pong match on who pays for it."
Democrats have gone along with this Republican initiative out of weakness or cowardice or stupidity or lack of principle. Take your pick. I simply won't give them a free pass on this. I hope now some true Opposition Party backbone is developing and that's to the good.
But there's also been too little leadership and push back from the medical and public health communities. The public health leaders within WHO have been saying it all along, and they've been right: Public health politicos stupidly embraced the promise of bioterrorism money as a way to beef up public health infrastructure, but -- not only didn't that happen -- the bioterrorism follies hollowed out public health like a cancer, diverting personnel, energies and commitments. So now a real public health threat comes along and suddenly we discover we aren't prepared. Surprise.
The root of the problem is an historic lack of funding for public health in the U.S. according to Dr. Redlener, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health: "We’re about to face the consequences of a health-care system that’s in essence been neglected and allowed to degrade over time. Now it’s too fragile to handle what could be an overwhelming emergency. The prospect of a pandemic should be putting us into high gear in terms of trying to fix the health-care system even before we get a pandemic."
In addition, Redlener says, we must face the question of who is going to pay for private-sector preparedness: "This is a public-health issue. Will the public get caught in middle between the private sector and the government in terms of fulfilling the pandemic flu agenda? We don’t want this to be a ping-pong match on who pays for it."
Private sector pandemic flu preparation resources
Private-sector continuity of operations planning (COOP) for a pandemic emergency is, we predict, the next big thing. Here, to help get the ball rolling, is a list of useful information:
PandemicFlu.gov - Business & Industry Planning - U.S. Department of Health and Human Services. Most useful is the "Influenza Planning Checklist".
CIDRAP Business Planning Section - Center for Infectious Disease Research & Policy at the University of Minnesota - February 2006. CIDRAP hosted a national summit on COOP for businesses. Many useful reports, references, and documents.
It's Not Flu As Usual - Trust for America's Health. Straightforward PDF brochures for businesses, health-care professionals, and community organizations, with "What you can do now" checklists.
Pandemic Influenza Emergency Response Manual - Human Resources Division - King County, Washington, February 2006. Detailed plans and policies to guide county-wide human resources activity in a pandemic emergency. (Big.)
Grocery Business COOP White Paper - August 2005. An anonymous grocery wholesale and retail company prepared this industry-sector analysis for the CIDRAP conference.
Water Utility COOP Guide - Association of Metropolitan Water Agencies (AMWA), March 1 2006. Customized planning checklist for water utilities.
Electric Utility COOP Guide - North American Electric Reliability Council (NERC), February 2006. Customized checklist for electricity utilities. (Look in the list for "Influenza Pandemic Reference Guide.")
Flu Wiki Business Continuity Page - Multitudinous links to a huge variety of references.
PandemicFlu.gov - Business & Industry Planning - U.S. Department of Health and Human Services. Most useful is the "Influenza Planning Checklist".
CIDRAP Business Planning Section - Center for Infectious Disease Research & Policy at the University of Minnesota - February 2006. CIDRAP hosted a national summit on COOP for businesses. Many useful reports, references, and documents.
It's Not Flu As Usual - Trust for America's Health. Straightforward PDF brochures for businesses, health-care professionals, and community organizations, with "What you can do now" checklists.
Pandemic Influenza Emergency Response Manual - Human Resources Division - King County, Washington, February 2006. Detailed plans and policies to guide county-wide human resources activity in a pandemic emergency. (Big.)
Grocery Business COOP White Paper - August 2005. An anonymous grocery wholesale and retail company prepared this industry-sector analysis for the CIDRAP conference.
Water Utility COOP Guide - Association of Metropolitan Water Agencies (AMWA), March 1 2006. Customized planning checklist for water utilities.
Electric Utility COOP Guide - North American Electric Reliability Council (NERC), February 2006. Customized checklist for electricity utilities. (Look in the list for "Influenza Pandemic Reference Guide.")
Flu Wiki Business Continuity Page - Multitudinous links to a huge variety of references.
Friday, May 05, 2006
US helath care: past time for a change?
A new report in the May 2006 issue of the Journal of the American Medical Association finds “middle-aged white Americans are much sicker than their counterparts in Britain.” For example, Americans have a much higher rate of diabetes, heart disease, strokes, lung disease, and cancer. The gap between Americans and the British are seen regardless of education and economic status.
The results are particularly discouraging, considering the United States spends roughly twice as much ($5,200 / person) on health care per capita than the British.
In a piece of good health news, the annual number of deaths in the United States has dropped by 2% in 2004. But, as MVP’s resident Debbie Downer, I should note this: though the U.S. life expectancy is at a record high, it’s still behind that of about two dozen other countries.
England and every other industrialized country in the world (US not included) have some sort of universal health care system. And the United States lags behind those countries in not only life expectancy, but also patient care: For example, in 2004 the Commonwealth Fund survived six industrialized countries, Australia, Canada, Germany, New Zealand, the United Kingdom, and US and found the US ranked last on:
The results are particularly discouraging, considering the United States spends roughly twice as much ($5,200 / person) on health care per capita than the British.
In a piece of good health news, the annual number of deaths in the United States has dropped by 2% in 2004. But, as MVP’s resident Debbie Downer, I should note this: though the U.S. life expectancy is at a record high, it’s still behind that of about two dozen other countries.
England and every other industrialized country in the world (US not included) have some sort of universal health care system. And the United States lags behind those countries in not only life expectancy, but also patient care: For example, in 2004 the Commonwealth Fund survived six industrialized countries, Australia, Canada, Germany, New Zealand, the United Kingdom, and US and found the US ranked last on:
- Patients experiencing a lab test error, including wrong tests or delays in being notified about abnormal test results.
- Patients leaving a doctor’s office without getting important questions answered.
- Patients getting care on nights and weekends.
- Number of patients who have to go to the emergency room for a condition that could have been treated by a regular doctor.
- Differences between below- and above-average income patients not filling prescriptions or skipping doses due to cost.
Tuesday, May 02, 2006
Hate Medicare D? Brace yourself for the next one.
This is a very, very dangerous bill.
From the folks who brought you Medicare Part D(isaster), here's yet another bad idea for health care reform: the so-called Health Insurance Marketplace Modernization and Affordability Act (S.1955), known here in the Beltway as the "Enzi Bill." From the bill's intro: "...to expand health care access and reduce costs through the creation of small business health plans and through modernization of the health insurance marketplace."
Sounds harmless enough, right? In reality, this is an extremely dangerous bill that, if passed, could jeopardize the health care of 85 million Americans. Find out why after the jump. If you can't wait to do something, a coalition of national organizations is sponsoring a national call-in day tomorrow, May 3rd. Please take a minute tomorrow to call your Senators, toll free--1-800-828-0498--and tell them to vote NO on the Enzi bill.
The Enzi bill would jeopardize the health care of millions of Americans by overriding existing state laws that guarantee coverage of such crucial services as cervical, prostate, and colorectal cancer screenings, as well as mammograms, mental health, and well-child care. As Ron Pollack puts it: "The bill leaves consumers at the mercy of health insurance companies by overriding a range of state laws that protect the consumer and regulate insurance company behavior. Fundamental consumer protections that will be wiped out include: rules that limit premium discrimination based on health status, age, and sex; prohibitions of huge premium increases when people get sick; and prohibitions of misleading insurance company marketing practices."
Here are some examples of medical protection losses that could result from the Enzi bill (more fact sheets at the Enzi Bill Center:
Ohio: alcoholism treatment, cervical cancer screening, contraceptives, emergency services, infertility treatment, mammography screening, mental health (general), off-label drug use, and well child care.
California: alcoholism treatment, AIDS vaccine,blood lead screening, bone density screening, cervical cancer screening, clinical trials, colorectal screening, contraceptives, dental anesthesia, diabetic supplies and education, drug abuse treatment, emergency services, home health care, hospice care, infertility treatment, mammography screening, maternity, mental health parity, metabolic disorders/PKU, minimum mastectomy stay, off- label drug use, orthotics/prosthetics, prostate cancer screening, second medical/surgical opinion, and well-child care.
Florida: Alcoholism treatment, ambulance transportation, ambulatory surgery, bone marrow transplants, bone density screening, cleft palate, dental anesthesia, diabetes supplies and education, emergency services, home health care, mammography screening, mental health (general), metabolic disorders/PKU, minimum mastectomy stay, off-label drug use, prosthetics, TMJ Disorders, and well-child care.
There's already wide opposition aligned against this bill, including 254 organizations, 41 state attorneys general, the National Association of Insurance Commissioners, and many others. Editorial writers are also weighing in: "The measure's goal is ostensibly to allow small businesses to jointly purchase health insurance for employees. A laudable goal, certainly. In our national system of employer-provided health insurance, the small enterprise is notoriously a weak link.... But Enzi's bill uses small businesses and their workers as human shields to mask an all-out assault on state regulation of health insurance across the country. He proposes to preempt state regulators on a wide range of issues, replacing their standards with federal rules that in some respects have already proven to be dismal failures, and in other respects will be easily manipulated by the insurance industry. The preemptions will apply not only to small-employer plans, but to individual health insurance and large-group plans, too -- in other words, pretty much everybody."
The result? People will have to choose between accepting barebones policies and paying higher rates for the more comprehensive coverage they need, while small business will see their health care costs skyrocket as the bill pits the young and healthy against the sick and old. A bill that wholly undermines the very concept of health insurance isn't reform--it's a giveaway to the insurance industry.
A coalition of national organizations is sponsoring a national call-in day on tomorrow, May 3rd. Please take a minute tomorrow to call your Senators, toll free--1-800-828-0498--and tell them to vote NO on the Enzi bill.
From the folks who brought you Medicare Part D(isaster), here's yet another bad idea for health care reform: the so-called Health Insurance Marketplace Modernization and Affordability Act (S.1955), known here in the Beltway as the "Enzi Bill." From the bill's intro: "...to expand health care access and reduce costs through the creation of small business health plans and through modernization of the health insurance marketplace."
Sounds harmless enough, right? In reality, this is an extremely dangerous bill that, if passed, could jeopardize the health care of 85 million Americans. Find out why after the jump. If you can't wait to do something, a coalition of national organizations is sponsoring a national call-in day tomorrow, May 3rd. Please take a minute tomorrow to call your Senators, toll free--1-800-828-0498--and tell them to vote NO on the Enzi bill.
The Enzi bill would jeopardize the health care of millions of Americans by overriding existing state laws that guarantee coverage of such crucial services as cervical, prostate, and colorectal cancer screenings, as well as mammograms, mental health, and well-child care. As Ron Pollack puts it: "The bill leaves consumers at the mercy of health insurance companies by overriding a range of state laws that protect the consumer and regulate insurance company behavior. Fundamental consumer protections that will be wiped out include: rules that limit premium discrimination based on health status, age, and sex; prohibitions of huge premium increases when people get sick; and prohibitions of misleading insurance company marketing practices."
Here are some examples of medical protection losses that could result from the Enzi bill (more fact sheets at the Enzi Bill Center:
Ohio: alcoholism treatment, cervical cancer screening, contraceptives, emergency services, infertility treatment, mammography screening, mental health (general), off-label drug use, and well child care.
California: alcoholism treatment, AIDS vaccine,blood lead screening, bone density screening, cervical cancer screening, clinical trials, colorectal screening, contraceptives, dental anesthesia, diabetic supplies and education, drug abuse treatment, emergency services, home health care, hospice care, infertility treatment, mammography screening, maternity, mental health parity, metabolic disorders/PKU, minimum mastectomy stay, off- label drug use, orthotics/prosthetics, prostate cancer screening, second medical/surgical opinion, and well-child care.
Florida: Alcoholism treatment, ambulance transportation, ambulatory surgery, bone marrow transplants, bone density screening, cleft palate, dental anesthesia, diabetes supplies and education, emergency services, home health care, mammography screening, mental health (general), metabolic disorders/PKU, minimum mastectomy stay, off-label drug use, prosthetics, TMJ Disorders, and well-child care.
There's already wide opposition aligned against this bill, including 254 organizations, 41 state attorneys general, the National Association of Insurance Commissioners, and many others. Editorial writers are also weighing in: "The measure's goal is ostensibly to allow small businesses to jointly purchase health insurance for employees. A laudable goal, certainly. In our national system of employer-provided health insurance, the small enterprise is notoriously a weak link.... But Enzi's bill uses small businesses and their workers as human shields to mask an all-out assault on state regulation of health insurance across the country. He proposes to preempt state regulators on a wide range of issues, replacing their standards with federal rules that in some respects have already proven to be dismal failures, and in other respects will be easily manipulated by the insurance industry. The preemptions will apply not only to small-employer plans, but to individual health insurance and large-group plans, too -- in other words, pretty much everybody."
The result? People will have to choose between accepting barebones policies and paying higher rates for the more comprehensive coverage they need, while small business will see their health care costs skyrocket as the bill pits the young and healthy against the sick and old. A bill that wholly undermines the very concept of health insurance isn't reform--it's a giveaway to the insurance industry.
A coalition of national organizations is sponsoring a national call-in day on tomorrow, May 3rd. Please take a minute tomorrow to call your Senators, toll free--1-800-828-0498--and tell them to vote NO on the Enzi bill.
Monday, May 01, 2006
Medicare: 12 years to zero
Medicare is set to exhaust its trust fund reserves in the next 12 years, according to the annual report issued by its trustees, two years sooner than last year’s report suggested. The trustees also projected Social Security to deplete its reserves by 2040, one year earlier than last year’s estimate. With almost 80 million Baby Boomers entering their retirement years, the trustees warn that, under current conditions, the projected growth rates of the country’s two largest benefit programs can’t be sustained. You'd think somebody somewhere sometime or other would start to take this stuff seriously...
