The view from here

Killing the Frankenstein veto

2007-06-26T06:44:00.000-07:00

I've hated the line-item veto from the start, especially so a few years ago when we the people of Wisconsin had to go to extreme measures to stop Tommy Thompson's abusive Vanna White veto, so I'm no fan of Governor Doyle's Frankenstein veto. I'd like to see it die.

The trouble is, the solution that's been offered doesn't solve the problem. A proposed constitutional amendment by Republican Senator Sheila Harsdorf of River Falls does not kill Frankenstein.

Harsdorf's constitutional amendment would continue to allow governors to stitch together bits and pieces of an appropriation bill to create laws that the Legislature did not approve or authorize. It would expressly prohibit one way governors do that, but still leave plenty of room for mischief.

The proposed amendment says governors "may not create a new sentence by combining parts of two or more sentences of the enrolled bill." That means a governor could still delete one or more parts of a single sentence, such as the word "not," and stitch together the remnants to create a law with the opposite meaning of the one approved by the Legislature. A governor also would continue to be permitted to delete whole sentences or paragraphs or sections or subsections of bills and piece together what remains to fashion new laws that the Legislature did not approve, as long as care is taken not to create a new sentence by combining parts of two or more sentences.

The proposed amendment to our state constitution would not have prevented Governor Doyle from stitching together the remnants of a single sentence to increase the state's bonding authority for major highway projects from $140 million to $1 billion without the approval of the Legislature. That Frankenstein veto can be found in Section 683d of 2003 Wisconsin Act 33.

If the proposed amendment had been in effect during Tommy Thompson's tenure in office, it would not have prevented Governor Thompson from vetoing parts of a single sentence to spend $319 million per year that the Legislature did not authorize. This veto appears in Section 2135t of 1991 Wisconsin Act 39 and resulted in $1.2 billion in spending over four years for a school tax credit that the Legislature had decided to eliminate and replace with a different form of property tax relief.

The proposed amendment also would not have prevented Governor Thompson from vetoing parts of a single sentence to repeal the Property Tax Rent Credit. This little beauty in Section 2m of 1999 Wisconsin Act 10 cost taxpayers $234 million in higher income taxes before the tax credit was eventually restored.

Another time, Governor Thompson unilaterally increased the amount of sales tax collections that retailers were required to pay by using Frankenstein vetoes to reduce the amounts that could be deducted as "administration expenses" in Section 510 of 1991 Wisconsin Act 269. That veto increased revenues by something on the order of $25 million to $35 million. Harsdorf's amendment wouldn't have stopped that one either.

Governor Doyle used the same stitching technique that Thompson employed to unilaterally increase an agricultural chemical cleanup surcharge from 38 cents per ton to 83 cents per ton, while the Legislature had approved an increase to only 63 cents per ton. That veto can be found in Section 1745 of 2003 Wisconsin Act 33. Again, the proposed constitutional amendment would allow this Frankenstein to live.

Neither side – not those who oppose fixing the problem just because they belong to the same political party as the current governor who now wields this monstrous veto authority and not even those who support the proposed constitutional amendment that is advertised as a remedy – gets it. Neither group of legislators is doing what's best for the Legislature and the people its members represent or what's right for democracy.

Pandemic flu prep goes grassroots

2007-04-20T06:57:00.000-07:00

As this story from the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) web site describes, there's been a great deal of governmental and academic interest in grass roots efforts to prepare for pandemic flu and other natural disasters. After Katrina, everyone is interested in getting it right.

Governmental plans for an influenza pandemic are missing an important opportunity to improve US preparedness, according to two new reports: They are not reaching out to communities and grass-roots groups that could refine plan details and increase public support.

Meanwhile, ad hoc communities and preparedness alliances are forming—in the real world and online—with minimal input from government planners. And, confirming the reports' concerns, some members of those communities say they have networks and resources to offer to official efforts, but are frustrated by their inability to make themselves heard.

The first report, "Community Engagement: Leadership Tool for Catastrophic Health Events," was published Apr 4 by the Center for Biosecurity at the University of Pittsburgh Medical Center (UPMC). The report, which sums up the findings of a 27-member panel convened by the center during 2006, asserts that official planning incorrectly assumes the public will panic and create a "secondary disaster."

"The civic infrastructure—comprised of the public's collective wisdom and capability to solve problems; voluntary associations (both virtual and face-to-face) that arise from shared interests or a public good; and social service organizations that look out for the well-being of various groups—is essential to managing a mass health emergency," the report says.

"US homeland security and health emergency policies, however, do not adequately reflect the civic infrastructure's proven contributions in catastrophes. Nor have most top officials yet realized the potential value for local and national communities—and for themselves—of preparing knowledgeable, trained networks of constituents who can mobilize in a crisis." ...

The second report, "Citizen Engagement in Emergency Planning for a Flu Pandemic," was published Apr 13 by the National Academies Press and sums up the findings of an Institute of Medicine workshop held Oct 23, 2006. It says that seeking community input about policy decisions and setting up channels through which residents can talk back to government has been critical to the success of recent environmental-action and public-health campaigns and should be folded into pandemic planning as well.

Flu Wiki is prominently featured both in the article and in the academic papers:

"The central cyber-site for pandemic planning is the FluWiki, a sprawling collection of thousands of collectively assembled posts that has garnered 1.5 million visits in its 22 months."

but the important concept is the use of interactive blogs and wikis (aka Web 2.0) to influence and be part of the dialogue. To the extent that the public participates, existing institutions are strengthened. To the extent that the public is ignored, institutions are likely to make wrong choices unaccepted by the 'stakeholders' (i.e., we the people). Public health institutions at the highest level are beginning to sign on to the idea.

It's no different than what we've learned here about politics. Citizen participation is what makes politics work, and the web is a powerful tool to engage citizens. And there's little about Web 2.0 that you do not already experience.

It's nice to see the reality we know be accepted by the institutions we are trying to influence. That sort of dialog can only be good for America (and everywhere else these principles are adopted). Oh, and in case you didn't know, there's more to bird flu risk assessment and preparation than what you see on cable TV. If our public health infrastructure can be rebuilt to prepare for that, it should serve us well for everything else that comes (and I include mental health and health care as part of public health). Those issues will resonate in 2008. But that, of course, is another story for another day. For now, check out the American Red Cross's panflu prep page.

Family Preparedness Guide Fact Sheet - Available in
English and Español
Preparing for a Flu Pandemic Pandemic: Coping and Emotional Well-being
Pandemic Flu: Self-study presentation

Step by step 'what you need to know' information is there. They'll even provide slide shows and instruction for you to prepare your neighbors and community.

Why is the Red Cross interested in this? They were there in 1918, and they haven't forgotten.

One reason there's no money for health care?

2007-01-11T09:35:00.001-08:00

31,709 Earmarks Later, Bush Decides Pork Is A Problem In 2006, Congress allocated a record $71.77 billion “to 15,832 special projects, more than double the $29.11 billion spent on 4,155 pork-barrel projects in 1994.” In 2005, Congress inserted 15,877 pork projects into spending bills. In his weekend radio address, President Bush called on Congress to reform this earmarking process:

[O]ne of the best ways we can impose more discipline on federal spending is by addressing the problem of earmarks. … My administration will soon lay out a series of reforms that will help make earmarks more transparent, that will hold the members who propose earmarks more accountable, and that will help reduce the number of earmarks inserted into large spending bills.

Pork is a problem. But Bush should also address reform in his own administration. Bush’s earmarks are much tougher to find, often appearing “only in closely held supplements separate from the public budget books. … [A]s head of the executive branch, the president often doesn’t need earmarks: Once federal agencies get funding from Congress, his appointees are fairly free to steer sums to places, programs and vendors as the administration decides.” A few examples of Bush’s bacon:

– “While the Education Department’s budget would be cut, Mr. Bush propose[d] a 16% increase to $204 million for teaching sexual abstinence in high schools, a popular cause for social conservatives.”

– Rep. Anne Northup (R-KY), “a target of Democrats in this year’s midterm elections,” secured “a $3.5 million research grant for a local surgical team. The funds came not from congressional earmarks but from Pentagon accounts, according to the report.”

– Bush requested “$10 million for Preserve America grants for communities’ historic preservation efforts and $50 million for the Helping America’s Youth Initiative — also among programs championed by Mrs. Bush.”

Bush may say he’s against pork, but in his six years as President, Bush has never once vetoed any of Congress’s pork-laden spending bills.

Big Pharma fails

2007-01-11T09:21:00.000-08:00

Too Little Bang For The Buck In Drug Research? "Whenever critics complain about the high cost of prescription drugs, the pharmaceutical industry's standard defense is that companies have to plow so much money into researching innovative new medicines. But a recently released report from the Government Accountability Office casts doubt on that rationale. Yes the industry is spending heavily on R&D, the GAO found, but it turns out big pharma isn't actually generating such a good return on their investments. The congressional watchdog agency's 48-page study came up with disturbing numbers. From 1993-2004, spending by U.S. drug companies on research and development jumped 147%, from $16 billion to nearly $40 billion annually. But the number of applications the pharmaceutical firms submitted to the Food and Drug Administration for potentially groundbreaking new drugs during that 10-year period increased only a meager 7%. And since 1995, the applications for these innovative drugs have been dropping each year. 'The productivity of research and development investments has declined,' the GAO concluded." (Time)

When they cut Medicaid $$, remember this...

2007-01-11T09:12:00.000-08:00

Rep. Keith Ellison (D-MN) blogs on the “myth of scarcity.”

In America today, we are encouraged to believe in the myth of scarcity - that there just isn’t enough - of anything. But in the story of the miracle of the loaves and fishes, Jesus, who the Muslims call Isa, found himself preaching to 5000 (not including the women by the way) at dinner time, and there didn’t appear to be enough food. The disciples said that there were only five barley loaves and two fish. We just have to send them away hungry. We simply don’t have enough. But Jesus took the loaves and the fish and started sharing food. There was enough for everyone. There was more than enough. What was perceived as scarcity was illusory as long as there was sharing, and not hoarding. … If scarcity is a myth, then poverty is not necessary. America need not have 37 million Americans living below the poverty line. It is a choice. Hunger is a choice. Exclusion of the stranger, the immigrant, or the darker other is a choice.

Community rating for health insurance

2007-01-11T09:08:00.000-08:00

Kevin Drum writes: One of the arguments in favor of limited universal health care proposals -- like the one Arnold Schwarzenegger unveiled on Tuesday for California -- is that it's the best we can realistically hope for. Sure, an honest-to-goodness single-payer system might be superior, but special interests will never allow it to happen. Better to mollify the special interests and take what we can get.

Over at TNR, Jonathan Cohn suggests that it's not that simple. In fact, his guess is that special interests will fight just as hard to kill any plan, no matter what we do to try to get them on board:

This is one reason that, paradoxically, plans like Schwarzenegger's -- which seek to graft universal coverage onto the existing private insurance system, rather than create a single-payer plan that would supplant private insurance altogether -- may actually be as hard, if not harder, to accomplish politically. Any plan for universal health care is bound to offend at least some special interests. And these special interests will fight hard. So while trying to soften their opposition with a less radical plan helps, it may be more important to craft an alternative that captures voters' imaginations and rallies support behind it -- even if that means proposing even more sweeping changes.

The same thing is true nationally. Although Schwarzenegger would surely resist the comparison, his plan has more than a few elements in common with the Clinton health-care plan. The architects of that scheme tried very hard to come up with something that would please various stakeholders. That's a big reason that they, like Schwarzenegger, rejected calls for a single-payer system and settled instead on a proposal in which most people would continue to get insurance through the private sector. Yet, to their dismay, few of those stakeholders became enthusiastic supporters of the Clinton health-care plan. In fact, quite a few attacked it, pretty much sealing its defeat. It's easy to imagine a similar scenario playing out here.

This is the reason I swing back and forth on whether it's worth supporting half-hearted plans like Schwarzenegger's.

On the pro side: (1) It's better than nothing. If it helps people even a little bit, that's better than letting them suffer while we all wait for nirvana. (2) Liberals have gotten burned more times than I can count by not accepting half measures when they were offered. Inevitably, a decade later, we wish we'd accepted the compromise and then worked to improve it. (3) It might work. Stranger things have happened.

On the con side: (1) Cohn is right. You need public support to overcome special interest inertia, and the only way to get that is with a simple plan that people understand. Compromises just don't generate the requisite enthusiasm. (2) Compromise plans sometimes lock weird incentives into place forever. Just take a look at how the United States ended up with employer-based health care in the first place. (3) One of the whole points of single-payer health care is that it saves a lot of money by reducing administrative costs. Compromise plans don't. Without the cost savings, it's possible that we'll end up with a system that's even worse than what we have now.

In the end, the reason I support Schwarzenegger's plan is because it includes insurance company regulation, and in particular because it enforces community rating (i.e., a requirement that insurers accept all comers at the same price, regardless of age, occupation, or medical history). And while I can't back this up with a solid argument, my gut tells me that community rating will eventually put private health care insurers out of business. Even with universal coverage, there are just too many contradictions in trying to run a profit-making insurance company while being forced to insure even people that you know for an absolute fact you're going to lose money on.

I might be wrong about that. Insurance company managers are clever folks, after all, and might very well figure out how to game the system just well enough to stay around. But there's at least a chance that Schwarzenegger's plan will lead to their eventual demise, and thence to a more efficient, more rational health care system. For now, that prospect is enough to get me on board.

Paying investors when you're sick

2007-01-11T08:59:00.000-08:00

You want reform? Then the time has come to drive a stake through the heart of the for-profit insurance industry and replace this merciless, cruel and anti-American beast with a taxpayer funded single-payer system.

And if you don't believe me, maybe you'd like to take a look at what Paul Krugman has to say about our imploding system.

Go to the link I've provided and you can read his entire column for free.

Universal health care, much as we need it, won’t happen until there’s a change of management in the White House. In the meantime, however, Congress can take an important step toward making our health care system less wasteful, by fixing the Medicare Middleman Multiplication Act of 2003.

Officially, of course, it was the Medicare Modernization Act. But as we learned during the debate over Social Security, in Bushspeak "modernize" is a synonym for "privatize." And one of the main features of the legislation was an effort to bring private-sector fragmentation and inefficiency to one of America’s most important public programs.
http://www.dohiyimir.org/...

His reference to the private-sector is a polite euphemism for the for-profit U.S. insurance industry. The for-profit insurance industry is the crown jewel of the U.S. health care system. And never forget that every dollar they spend on your health care goes against their corporate bottom line.

Let me explain again that paying your health care bills is bad, very bad indeed for the financial health of the insurance industry. And therein lies the blood curdling reality.

Back to Krugman.

The process actually started in the 1990s, when Medicare began allowing recipients to replace traditional Medicare — in which the government pays doctors and hospitals — with private managed-care plans, in which the government pays a fee to an H.M.O. The magic of the marketplace was supposed to cut Medicare’s costs.

The plan backfired. H.M.O.’s received fees reflecting the medical costs of the average Medicare recipient, but to maximize profits they selectively enrolled only healthier seniors, leaving sicker, more expensive people in traditional Medicare. Once Medicare became aware of this cream-skimming and started adjusting payments to reflect beneficiaries’ health, the H.M.O.’s began dropping out: their extra layer of bureaucracy meant that they had higher costs than traditional Medicare and couldn’t compete on a financially fair basis.

Now if you're wondering why your mother, father, grandmother or grandfather was shoehorned into a plan which is cynically named Medicare Advantage, it's because the scum Congress which passed the vile Medicare D legislation (of which Tommy Thompson says he's so darn proud) made certain that there were big bucks for the for-profit insurance industry. Here's what Krugman has to say.

That should have been the end of the story. But for the Bush administration and its Congressional allies, privatization isn’t a way to deliver better government services — it’s an end in itself. So the 2003 legislation increased payments to Medicare-supported H.M.O.’s, which were renamed Medicare Advantage plans. These plans are now heavily subsidized.

According to the Medicare Payment Advisory Commission, an independent federal body that advises Congress on Medicare issues, Medicare Advantage now costs 11 percent more per beneficiary than traditional Medicare. According to the Commonwealth Fund, which has a similar estimate of the excess cost, the subsidy to private H.M.O.’s cost Medicare $5.4 billion in 2005.

Enough on Medicare D.

Let's move onto the health care reform being championed by the Republican governor of California. Again, don't take my word for anything. Take a look at this brave and brilliant op-ed which was in the Los Angeles Times yesterday.

WHEN Gov. Arnold Schwarzenegger, on crutches, unveils his expected grand redesign of the state's health insurance system Monday, he must tackle the biggest obstacle to insuring the uninsured: insurance companies.
The governor said recently that California's high number of uninsured residents — about one in five — acts as a hidden tax on the insured by forcing them to pay higher premiums, deductibles and co-pays. He has strongly hinted that he favors a system requiring individuals to buy health insurance, as well as assuring coverage for all children in the state (who constitute about 12% of the uninsured).

But he's said nothing about reforming insurance companies or HMOs.

http://www.latimes.com/...

This is the truth you must understand. Everywhere you look, all you see when the subject of health care reform is discussed is, in reality, more of the same. It's all about maintaining the status quo of the for-profit insurance industry. And what does this mean for you and me? More of the same too, delay, deny and deceive.

Delay and deny us lifesaving health care, delay and deny us and our health care providers payment for services rendered. Deceive us about everything: Trial lawyers are responsible for spiraling health care costs (Wrong!); Health savings accounts are good for you and me (Wrong!)

Schwarzenegger's experience with health insurers is not your average citizen's. Anyone as rich as he is doesn't have to worry about medical expenses. He and his surgeon surely didn't have to seek permission for treatment. They didn't have to argue with a cost-control center demanding something cheaper — such as outpatient surgery. The governor won't fear that his insurer will retroactively cancel his policy or double his premiums because of the surgery.

Not only is Schwarzenegger immune to most people's struggles with insurers, he's also enjoyed nearly $1 million in direct political contributions from them, according to public contribution reports.

It is this political relationship that should worry Californians hoping for real health care reform. Insurance companies, after all, will spend whatever it takes and call in every favor they're owed to stop reforms that restrict their profits, curb their extravagant overhead or limit what they can pay their chief executives.

The money paragraph from the L.A. Times.

California insurers won't like these proposals, and won't be shy in reminding the governor and Legislature about favors owed. Whether our elected officials respond to the desires of insurers or the needs of California will determine everything about health care reform.

Will Democrats stand up for the American people or their insuance industry patrons?

It's become almost oxymoronic. As the guy said: "I don't mind paying a doctor, but I don't understand why I have to pay an investor every time I get sick."

The human cost of the "market"

2007-01-11T08:55:00.000-08:00

Lisa Girion, continuing her wonderful work exposing atrocious insurer practices in the LA Times, has a great piece detailing yet another tragic absurdity: In California, insurers will simply refuse to provide individual coverage to applicants from certain occupations. So if you're a roofer, or an athlete, or a dockworker, or a firefighter, and you apply for coverage, you'll be turned down, sight unseen. And even if you're not in one of these "risky" professions, if you've taken such medications as Celebrex, Lipitor, or eight of the Top 20 bestselling prescriptions in the United States, you can still be blackballed from all coverage.

This is the world traversed by the unfortunate souls condemned to seek coverage on the individual -- non-employer provided -- market. One of those souls was Maria Leavey, a luminous, unceasingly generous progressive who decided to make her life and living doing the organizing and social capital building and advising and bridging that no one else seemed capable of. Last week, at the age of 52, her heart failed her. A congenital defect, much like the one that killed her father, had lain undetected over the years, and it struck over the holidays. Maria had no health insurance.

It's impossible to know if coverage would've averted her death. I've no idea if she ever felt chest pains, and decided to wait, or was recommended for a precautionary ECG, but preferred to put her money into rent. But the very possibility smears our society's illusions of justice and fairness. Beyond her extraordinary personal and moral qualities, Maria was following the American Dream -- the very one politicians so often extol. She was a political entrepreneur, creating an occupation and pathway that hadn't existed before she conceived of it. She could've worked corporate had she so chose, or entered the bureaucracy at some larger institution. She was on a first-name basis with everyone from Howard Dean to Harry Reid -- a perch in a communications shop somewhere wouldn't have eluded her for long. Her sin was, instead, to take the road less traveled, to create something new and add as much value as her talents and vision allowed. That isn't a life course that comes with health insurance, Indeed, it's entirely possible that she applied, and had taken a painkiller at some point, or had a surgery, and was simply turned away. She never went corporate, and so she didn't deserve coverage.

Maria Leavey died last week. And maybe health insurance wouldn't have saved her. But maybe it would've. And what sort of society do we inhabit where we allow that question to linger?

Dems Expected to Produce Health Care Reform

2007-01-11T08:43:00.000-08:00

Few domestic priorities facing congressional Democrats generate more concern among voters than health care reform, and the challenge is aptly encapsulated in the title of Ezra Klein's op-ed in the LA Times -- "Going universal: The American healthcare system is, simply put, a mess, but we may finally be ready to fix it." Klein succinctly delineates the dimensions of the health care crisis and discusses some of the current reforms being debated. He believes the time is ripe for health care reform to gain some political traction:

Across the country there are unmistakable signs that the gridlock and confusion sustaining our sadly outdated system are coming to an end and that real reform may finally emerge...Nationally, the Democratic resurgence has returned universal healthcare to the agenda and its advocates to power. In the House, Rep. Pete Stark (D-Fremont), a staunch Medicare-for-all advocate, is expected to be chairman of the health subcommittee.

Dems who want to get up to speed on public opinion on health care reform will find no better place to go than Ruy Teixeira's article "What the Public Really Wants on health Care" at The Century Foundation. As Teixera notes:

The public desire for change in the health care arena is so strong that policy-makers would be well-advised to start concentrating on the issue now, rather than face the wrath of a frustrated public in the next election cycle.

Teixeira cites opinion data showing that nearly twice as many Americans are more worried about health care costs than unemployment and nearly three in ten say someone in their household has not had needed medical care or medicine during the last year because of cost. Teixeira also shows overwhelming majorities in favor of universal coverage and concludes that "The public is ready for change and the next election cycle is likely to punish those who stand in the way."

Democrats in congress will have to decide whether "big package" health care reform is now tactically as feasible as a step-by-step approach. But when November '08 rolls around, it is critical for Dems that a significantly higher percentage of Americans feel their health security has improved.

Lies, damn lies and health insurance

2006-12-06T13:04:00.000-08:00

Transparency in Health Care Insurance

By Kip Sullivan (a friend of mine; cross-posted from Z Magazine Online)

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Comedian Jon Lovitz used to do a skit for “Saturday Night Live” in which he played Tommy Flanagan, the pathological liar. Lovitz’s character was always telling tall tales that made him look good. When a tale would become so outrageous even he suspected he was about to be exposed, Flanagan would stop for a moment, then, with a huge grin, he would blurt out a new fib and proclaim, “Yeah, that’s the ticket.”

The health insurance industry is proving to be a master at the Jon Lovitz routine. For a quarter-century the industry and its apologists in business, politics, and academia told the public managed care would solve the health care crisis. When even diehard defenders of the industry realized in the late 1990s that managed care had flopped, the industry came up with a new excuse to justify its existence and to distract public attention from real health care reform. Of the several names bestowed on the new excuse, the most faddish is transparency in health care. “Yeah, transparency, that’s the ticket.”

Like “health maintenance organization” and “consumer-driven health plan” (to name two other misnomers coined by the insurance industry and their hangers-on), “transparency in health care” is terribly misleading. The phrase evokes glorious visions of a world in which:

Data on the quality of doctors and hospitals and other health care providers are published in great quantities (by whom is unclear)
This cornucopia of data forces providers to improve quality
The improved quality leads to lower costs

The odds against any of these steps occurring are great. The likelihood that all three will occur is zero. But the promoters of transparency dogma are powerful. Transparency evangelists come from the insurance and computer industries, big business, the Republican and Democratic parties, academia, and the world of corporate-funded think tanks. CEOs John Chambers (Cisco Systems), Steven S. Reinemund (PepsiCo), Frederick W. Smith (FedEx), and Ivan G. Seidenberg (Verizon) are just a few of the business executives who tout transparency. Senator Hillary Rodham Clinton (D-NY) is the most prominent Democrat in the movement. In 2005 she sponsored legislation promoting the computerization of all medical records (an essential component of the transparency fantasy) and held press conferences celebrating the magic of quality measurement with Senator Bill Frist (R-TN) and former Speaker Newt Gingrich.

Like managed care theology before it, transparency theology draws support from the elite because it is consistent with conservative fantasies about making “the health care market” work. The insurance industry and its conservative allies understand that if “market reform” fails to solve the health care crisis, greater regulation, possibly in the form of a single-payer (or Medicare-for-all) system, will come sooner rather than later.

George W. Bush is one of many conservatives who misrepresent what regulation or a single-payer system would mean (government will “tell your doctor how to practice medicine” is the usual misrepresentation) and then brandish that caricature as justification for their support. Bush’s opening remarks at a press conference in Minnesota last August, at which he endorsed “transparency in health care,” illustrate this tactic. “We’ve got an interesting debate in health care in America,” Bush intoned in front of an invited audience in a fancy hotel in a wealthy suburb of Minneapolis. “And I guess if I had to summarize how I view it, I would say there’s a choice between having the government make decisions or consumers make decisions. I stand on the side of encouraging consumers. I think the most important relationship in health care is between…the patient and the doc.… And health care policy ought to be aimed at bolstering the consumer, empowering individuals to be responsible for health care decisions—is kind of the crux about what we’re talking about.”

In Bush’s world transparency is the great weapon against further government involvement in the U.S. health care system, and transparency will be achieved by the publication of report cards on clinics and hospitals. The grades on these report cards will render doctors and hospitals transparent. Once transparency is achieved, a series of other events will occur, to wit: patients will “shop” for the best providers, quality will rise, costs will come down, and everybody but the crummy clinics and hospitals, which scored poorly on report cards, will be better off.

Bush announced he had selected Minnesota to endorse transparency in health care because it is the home of Community Measurement Project (CMP), a coalition of Minnesota’s largest health insurance companies that produces a report card on Minnesota providers. Bush told the executive director of the CMP, who was present at the event, that the CMP is a “leading edge” report card that will make providers transparent. The CMP report card (www.mnhealth.org) suffers from four defects:

It has very limited scope (it covers only a portion of Minnesota’s clinics and hospitals and attempts to measure only a tiny fraction of medical services offered by those providers)
It measures services at the “provider” level, not the individual doctor level
Grades tend to bunch up so that distinguishing one “provider” from another is impossible
The grades are inaccurate

A brief discussion of each of these defects shows how expensive it will be to fix them. First, the CMP report card is quite limited in the number of providers and services it purports to grade. It covers fewer than half of all clinics in the state and covers only child vaccination rates, well-baby visits to doctors, and treatments for six diseases (asthma, depression, diabetes, high blood pressure, cancer, and chlamydia) out of thousands of diseases and conditions for which people are treated these days. Obviously, collecting data on thousands of other medical services on all providers in the state will make this report card much more expensive.

Second, despite Bush’s talk about “you and your doctor,” there is no information about individual doctors on the CMP report card. Grades are available only for entire “provider networks”—groups of clinics and hospitals, some with dozens of clinics and hospitals in them. Common sense and research indicate that to the extent patients want information on medical quality, they want it for particular health care professionals, not for entire clinic-hospital chains. The reason data on individual doctors is not offered is that the CMP is not collecting data on enough patients to make a statistical analysis of individual doctors possible. In other words, if the total number of patients in CMP’s current database were broken down by doctor instead of by provider network, the sample sizes for the vast majority of doctors would be too small to permit rigorous analysis. Collecting data on many more patients means, obviously, greater expense.

Like the first two defects, the third defect—bunched up grades— is due to CMP’s effort to make report cards on the cheap. CMP issues only three grades (one, two, or three stars; which look like the glittery little plastic stars elementary school teachers use) and the vast majority of networks get two stars. Even if you wanted to know the grade of entire provider fiefdoms rather than of individual doctors, CMP grades rarely distinguish one fiefdom from the other .

The fourth and most important defect in the CMP report card is that it is grossly inaccurate, and—to make this defect more insidious— the inaccuracy is not mentioned or even hinted at in the CMP website. On the contrary, the first page of the website assures readers that the report card contains “accurate, comparative details on the quality of care at Minnesota’s provider groups.” The grades are inaccurate for several reasons. The two most important of which are failure to adjust the grades to reflect differences in patients that doctors have no control over and failure to ensure that patients the CMP says are patients of Network X really are patients of Network X.

The grades are not adjusted for differences in the patients seen by each network, notably, differences in their health, quality of insurance, and income. It is much easier for doctors who see primarily healthy, well-insured, and/or upper-income patients to score well on CMP’s report card than it is for doctors who see primarily sicker-than-average, poorly insured, and/or low-income patients. “Some communities… have more resources to influence outcomes than others,” said Dr. Randall Maxey, an Inglewood, California nephrologist, in a recent interview with American Medical News about report cards the Bush administration is preparing for physicians who treat Medicare beneficiaries. “I may treat you exactly correctly and give you the right pills, but if you have to choose between buying pills and giving your baby milk, that drug may lose out and my performance may be judged as poor because of it.”

Consider two of the CMP “quality measures” for diabetes: percent of diabetic patients who have their HbA1c count (a measure of blood sugar) under 8 percent and percent who have their cholesterol under 130. The Neighborhood Health Care Network (NHCN), a coalition of six clinics which serves primarily poor, uninsured people in the Twin Cities, ranked very low on this “quality” measure. Only 46 percent of the diabetics who visited NHCN doctors in 2004 had their blood sugar under the target level and (apparently coincidentally) only 46 percent had their cholesterol under 130. By comparison, the average for all provider groups for both measures was 65 percent. The 46 percent score was so low compared to the other provider groups that CMP gave MHCN one star.

What should readers make of this bad grade? By assuring readers that the report card is “accurate,” the insurance companies behind the CMP project lead readers to think NHCN is doing an inferior job of getting the sugar and cholesterol levels of its diabetics down. But because the CMP did not adjust NHCN’s grades to reflect the fact that NHCN doctors treat a sicker, less well-insured, and poorer population, we cannot conclude that NHCN’s doctors are inferior. Given the circumstances NHCN’s doctors are up against, it’s possible they are superior doctors and their low grades reflect forces they cannot overcome. NHCN doctors may have prescribed appropriate cholesterol-lowering medications (such as Lipitor or Zocor) to all their diabetics, for example, but because many of those patients had insurance with no drug coverage, or drug coverage that required co-payments they couldn’t afford, they failed to fill their prescriptions.

The inaccuracy of the CMP grades is aggravated by the sloppy methodology used to “assign” patients to networks. The CMP simply assigns patients according to which network patients used the most in the course of a year. So, for example, if you were a diabetic who made seven visits to doctors in one year, and four of those visits were to doctors in Network A and three were to doctors in Network B, Network A will take all the blame or all the credit for your cholesterol level.

Like the other three defects, this fourth defect is fixable, but only at great cost. The CMP could, in theory, decide to adjust grades on diabetes care, for example, to correct for differences in factors outside doctors’ control—patient age, sex, cholesterol, and blood pressure levels when the patient first visited the clinic, number of years diagnosed with diabetes, history of other diseases such as coronary artery disease, education level, income level, and presence of co-payments for prescription drugs, to name a few. But the cost of collecting all that data will be immense. And that’s just for the diabetes scores.

When he endorsed transparency and the Community Measurement Project last August, Bush claimed the CMP-like report cards would lead to a cut in total health care spending of 25 to 30 percent. That will never happen.

The insurance industry, cheered on by the transparency crowd, may crank out lots of cheap report cards suffering from the four defects of the CMP card. Or it may spend enormous sums of money to produce report cards that don’t have those defects. Whichever route they choose, costs are more likely to go up than down. The transparency hype will, however, have distracted attention from the only solution to the health care crisis—single-payer or Medicare for all.

Kip Sullivan is author of The Health Care Mess: How We Got Into It and How We’ll Get Out of It (AuthorHouse). He is on the steering committee of the Minnesota Universal Health Care Coalition.

Once a hack, always a hack?

2006-11-15T06:49:00.000-08:00

I received a letter this week from a fellow association executive in Wisconsin, annoucing that he and one of his association staff members are running a lobbying firm on the side and wondering whether WHO would like to hire their services.

I've known this guy for years and he's been a Republican party operative since long before I knew him. He wasn't just a hired gun, he was a true believer, so his sideline of lobbying intrigued me. Overlooking the obvious question (Might not his clients' interests conflict with his employer's interests, and might there not be ethical issues involved in accepting payment from both? Just askin'.), I wondered whether he would be able to remove the far-rightwing blinders he'd been wearing for so long and enable himself to see -- and represent -- the missions, causes and goals of those clients that did not fall on his side of the political spectrum. The answer was quick in coming.

The third and fourth sentences of his introductory letter read as follows: "There are many new faces in the Wisconsin legislature. New people with BIG ideas for our state, such as taxing medicaid (sic) funding or new regulations that can drive up the cost of your business." (You'll have to forgive that his fourth sentence was incomplete and failed to properly capitalize a proprer noun.) While all our ears perk up at the threat of new regulations, I call your attention to the earlier clause in this sentence fragment, in which he not only paints increased Medicaid funding as a threat in need of fighting, he blithely assumes that WHO -- and you -- will agree with this portrait.

Set aside for a moment the data that shows Medicaid funding is great for Wisconsin's business climate, let's take a look that moral implications of his assumption -- an assumption that is dripping with far-right political thinking. And let's be clear: It is not Republican thinking, it's "fringe" thinking.

He's assuming that everyone who runs a business is so fixated on increasing their own material wealth that they're willing to short-change funding for the health and well-being of our neediest citizens (including children), our disabled and our frail elderly. In short, he's assuming that our greed is so strong it's twisted us into a perverse caricature of human beings. Beyond being amused by that level of stupidity in a marketing letter sent to WHO, I take offense to the assumption about the state of your soul and mine.

Christmas is just around the corner and one of our best loved seasonal stories, "A Christmas Carol," contains an applicable and rather pointed scene between two main characters:

Marley's Ghost, explaining his chains, was despairing over "life's opportunities misused."

Scrooge, trembling with fear and beginning to share in Marley's guilt, said: "But you were always a good man of business, Jacob."

The ghost cried out in anguish and anger: "Business! Mankind was my business. The common welfare was my business; charity, mercy, forbearance, and benevolence, were all my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!"

These words stand as an eloquent expression of our grand human purpose. It is our inner thoughts and feelings, our motives, our priorities, which contribute to making our lives an emptiness or a fullness. What we are in our whole being is so much grander than anything we can measure by surface values. In Goethe's words, "We are shaped and fashioned by what we love."

We can see what has shaped the soul of this hack, but what is shaping us? Let us neither sink to our lowest nature, not be swayed by those who appeal to our owest nature. The notion that running a business, making a living and taking care of our needy are mutually exclusive, or even contradictory, is unsupported by data, archaic and immoral. If we can't kill it off, let's at least ignore those who sell it.

Health system in need of hospice care?

2006-11-13T13:15:00.000-08:00

Critics debate whether our health system is actually on the verge of collapse, or just facing bad publicity from well-publicized but anomalous problems. But if you look at the facts squarely, there's no question that the system is close to failing, says John Abramson, a clinical instructor at Harvard Medical School. In fact, we spend far more on health care than other Western countries, and get worse results, he contends. Column

Somehow, I'm skeptical of this HMO report

2006-11-13T13:13:00.000-08:00

New research suggests that hospital visits decrease as the level of cost the patient bears go up. While this might be worrisome--we don't want people to avoid hospital trips and end up sicker--the study also found that the higher co-pays actually didn't have a negative effect on patient health. In fact, they saw no increase in negative clinical events such hospitalization, intensive care admission or deaths. To gather their data, researchers followed more than two million commercially insured patients and 250,000 Medicare insured patients.

OK, that's a large number of patients, but color me skeptical. I'd like to know how forcing poorer patients to decide on their own how sick they are could possibly have no impact on outcomes. Maybe the fact that Dr. Hsu is affiliated with Kaiser Permanente--a health plan which stands to make money if visits go down--has something to do with the result? Hey, I'm just asking...

For more background on the research:
- read this Medical News Today article

I like this guy!

2006-11-13T12:25:00.001-08:00

It's not often that you see a hospital CEO walk away from the lucrative, high-profile job to take on the backbreaking work of nursing. But that's just what former respiratory therapist and Milton Hospital CEO George Geary did. At age 56, he went to nursing school, and now, at age 59, is working overnight shifts at a Boston-area hospital as a green recruit. It's not that Geary failed at being a CEO--Milton Hospital has run in the black for 14 years--it's because he wants to be closer to patients. Article

More fun with our HMO friends

2006-11-13T12:14:00.000-08:00

It's not just about William McGuire (photo) anymore. Now it appears that stock options drama will have a much greater impact, forcing the company to restate earnings all the way back to 1994. True, the outgoing UnitedHealth CEO agreed to reprice his personal stock options, cutting about $200 million in value from his staggering $1.78 billion haul. Incoming CEO Stephen Hemsley has agreed to forfeit $190 million on options he holds, as well. In a recent release commenting on the repricing, McGuire's attorneys bragged that the company had grown 8400 percent during his tenure, which apparently makes the stock option skulduggery OK. I don't know about you, but I think McGuire's management track record has little to do with whether his options were improperly backdated, or what--if anything--should be done to punish him. But then again, I'm not on his payroll.

UnitedHealth had previously estimated that stock option-related charges would cut $286 million from reported earnings for 2003 through 2005. Now, executives say that that losses will be "significantly higher," though they haven't yet named a figure. In an apparent response to these ongoing troubles, the company's CFO has been moved out of his job into as-yet-unspecified new duties.

To get the latest details on the options scandal:
- check out this Wall Street Journal piece (sub. req.)
- read this Associated Press article
- see Dr. McGuire's statement

Related Articles:
UnitedHealth CEO ousted. Report
UnitedHealth CEO denies actions hurt patients. Report

Moral hazard theory debunked

2006-11-13T11:55:00.000-08:00

Most current health care policy--and health plan benefit structure--is based on the assumption that consumers will over-utilize health care services if there's no financial penalty for doing so. Economists call this notion the theory of "moral hazard." But New Yorker columnist Malcolm Gladwell disputes this conclusion strenuously, arguing that you can't apply this theory to health care demand. What happens when patients are forced to carry a larger share of costs, in reality, is that rather than cutting wasteful utilization, it encourages patients to neglect serious conditions like diabetes and high blood pressure. "When it comes to health care, many of the things we do only because we have insurance--like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care--are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health care system a good deal of money," he writes. Column

Uninsured man dies while we all stand by

2006-11-13T11:53:00.000-08:00

It's one of those tragic stories that makes one absolutely certain that our health care system is broken (if you had any doubt). Middle-class, employed Delbert Davis incurred hundreds of thousands of dollars in medical debts, declared bankruptcy and ultimately died because he wasn't able to get insurance or self-pay for a liver transplant. Delbert, who was in the printing business, lost his health insurance in late 2004. Not long after, he was diagnosed with cirrhosis of the liver but told that his liver could regenerate if he took care of himself. Meanwhile, though he worked part-time and his wife full-time, neither was able to get health insurance again. When his liver failed to regenerate, doctors told him that he needed a transplant, but without insurance, the region's transplant centers wouldn't place him on the candidate list. Besides, there was no way the two could have come up with the $120,000 to $500,000 needed to pay for the procedure. With the couple's income barring them from Medicaid coverage and other programs, Davis didn't get the transplant and died only three years after the couple married. While I realize that the hospitals involved needed to make hard, cold financial decisions here, I wonder why nobody other than his wife seems to have fought hard for Delbert. It's a sickening spectacle.

To read the whole story of Delbert Davis' death:
- read this piece in the Austin American Statesman

Insurers hit record profits (what's in YOUR wallet?)

2006-10-19T09:35:00.000-07:00

The story goes that insurers, especially medical malpractice insurers, are charging increasingly higher rates because of too many lawsuits and too many fraudulent claims. Well, as is pointed out in this post, one has to ask themselves if insurance companies are being so squeezed by lawsuits that they have to increase rates simply to stay afloat and are not just choosing to do so to make more money, shouldn't they be making far less money than they used to? The recent statistics on property and auto insurance company profits, even after Hurricane Katrina, do not fit well into this narrative.

Insurance industry profits hit record highs in 2005, despite Hurricane Katrina.

* The property-casualty insurance industry's after-tax net income for 2005 was the highest ever, a record-breaking $44.8 billion!

* 2005 profits are up 18.7% over last year's profit of 38.7 billion; 2004 had been the record until 2005.

* The property/casualty industry's surplus also is at the highest level ever, rising by more than 7% to nearly $427 billion.
(link to full Center for Justice and Democracy piece)

Even in light of these astounding post-Katrina numbers, insurance companies still argued that they need more support from the state and will need to premium raise rates.

They said that even with the increase, insurers face deep problems that can be fixed only by substantial premium hikes, a scaling back of commitments by several firms to the most disaster-prone portions of the country and, according to some, a greatly expanded role for the state and federal governments in insuring individuals against the largest of catastrophes.

"Unless insurers can get relief, you're going to see a pullback by the private industry," warned Robert P. Hartwig, chief economist of the industry-funded Insurance Information Institute.

"We're not being good stewards of our investors' capital or our policyholders' surplus if we keep doing business where we can't make money." (link to Los Angeles Times Article)

This perspective is already kind of hard to swallow, but it almost gets worse.

As explained by Peter G. Gosselin, of the Los Angeles Times, these insurance companies are doing fine because they have over time pulled back their coverage and (beleive it or not) gotten their own insurance for their insurance policy losses. In short, they have slowly shifted financial risks to be increasingly "borne by individuals:"

But the industry's remarkable performance also reflects a dozen-year effort by insurers to insulate themselves from the most extreme financial consequences of catastrophe by, among other things, shifting risks previously borne by companies to policyholders and the public.

The effort started after the last big batch of natural disasters in the early 1990s, among them Hurricane Andrew in Florida in 1992, and the Oakland hills firestorm in 1991 and Northridge earthquake in 1994 in California.

The effort has included industry adoption of increasingly sophisticated techniques for analyzing catastrophic risk, as well as self-imposed limits on how much firms will cover and where. It also has included successful campaigns to get states or state-created entities to shoulder such dangers as earthquakes in California and wind in Florida, Texas, Hawaii and elsewhere. And it has involved tightening policy language -- by, for example, narrowing the definition of "replacement cost" for homes -- in ways that leave individuals bearing more of the burden of putting their material lives back together after trouble strikes.

While premiums for homeowners insurance have increased by more than half since the early 1990s, coverage, especially in disasters, has shrunk. Historically, insurers covered a little more than 60% of total losses in disasters, according to Hartwig, the industry economist. During the 2004 hurricanes in Florida, they covered less than 50%, according to Hartwig's numbers. During Katrina, he said, they covered about 30%, due in part to the high flood damage.

In making these changes, the insurance industry has been part of a trend that has picked up steam as the U.S. economy has grown more competitive in recent decades -- a shift of financial risks from business and often government to individual households.

"If last year's hurricane season had occurred 10 years ago, it would have been devastating for the company," said Allstate Vice President Fred F. Cripe in an interview. "Last year, it was merely disappointing."
(link to Los Angeles Times Article)

See Justinian'stelling post and chart on this issue.

Ideas for fixing what's wrong

2006-10-19T09:33:00.000-07:00

When we take a long view on improving health, we usually find reasons to celebrate. In the last century, for example, infant mortality dropped by 90% and maternal mortality decreased 99%. Yet today, despite scientific advances, we face the fact that we are not a healthy nation:

– Our children’s life expectancy may be shorter than our own.

– About 70 % of deaths and health costs in the U.S. are now attributable to chronic diseases (e.g., cardiovascular disease, cancer) — many of which are preventable.

– More people die from obesity or tobacco than from homicide.

Our health care system has gravitated toward quick fixes rather than the persistent actions with lifetime rewards. Proven clinical and community preventive services go unused. Two out of three adults fail to get a flu vaccine or recommended colorectal screening. Millions of lives are lost needlessly. As a nation, we dedicate only three percent of our health dollars on health promotion — but over 20% of costs to the last year of life.

A new approach is needed. As part of its overall plan to fix the fundamentally flawed health system, the Center for American Progress proposes a Wellness Trust. The Wellness Trust would:

– Deliver prevention outside of the bounds of the health system by paying for services wherever they are delivered, in pharmacies or supermarkets, workplaces or senior centers.

– Use its pooled financing to create incentives for providers, employers, schools and individuals to prioritize prevention.

– Operate independently like Social Security, with expert Trustees.

The premise of the Wellness Trust is that disease prevention is more like homeland security than health insurance: everyone needs it, no one notices if it works, and it depends on persistent, strong leadership and systems. While change will come at a cost, this cost would be dwarfed by the lost lives, productivity, and public resources that will result from a failure to act.

Health care opinion survey results

2006-10-19T09:27:00.000-07:00

Kaiser, ABC, and USA Today just released a pretty expansive poll documenting the country's opinions on health care. The nickel version is that your countrymen are mostly liberal, deeply confused, and more likely to loathe the status quo than clearly conceptualize potential alternatives. Respondents said it was the third most important issue in the country, behind Iraq and the economy, but before immigration, gas prices, or terrorism. That's probably because opinions toward the system are so overwhelmingly negative: 80% are dissatisfied with the cost of health care in the country, and 54% are dissatisfied with the quality. So the system starts out with few friends.

From there, things get more complicated. Nearly 90% are satisfied with the quality of care they received. Nearly 60% are satisfied with their costs. In other words, Americans believe everyone else's health care system costs too much and delivers too little. Their own system rocks. Meanwhile, a full 25% reported that they or someone in their household had problems paying for medical bill in the last 12 months, and 28% put off medical treatment due to cost. Of that 28%, 70% admitted that the delayed treatment was "serious." And remember, this is all in the last year.

Individual fears become more acute when asked about the future: 60% fear affording insurance "over the next few years" and 56% fear losing their coverage if they lose their job.

As for what's driving all these high costs, the reported culprits, in descending order, are excess profits of drug and insurance companies, medical malpractice lawsuits, fraud and waste, overpaid doctors, administrative costs, unnecessary treatments, unhealthy lifestyles, expensive new treatments, the aging population, and better medical care.

So, in sum: The health care system sucks, but nearly every American's health care is great. That would suggest the opportunities for reform are minor, unless directed at the loathed elements (like insurance or Pharma). Folks don't like the high costs and fear they'll soon be overtaken by bills, but they blame all manner of minor and moderate contributors for the problem, not their own health choices, overtreatment, or new technologies. Universal care is heavily desired, but only if it doesn't cost anything or demand any sacrifices. In other words, the appetite for reform outpaces the realism of would-be reformers. The tradeoffs of the current system seem poorly understood, and attitudes towards its desirability are contradictory. Not a whole lot of hope in here for anyone.

Managed care: We're trying to LOOK like we care

2006-10-19T09:24:00.000-07:00

Blue Cross of California has settled a group of more than 70 lawsuits and claims filed by patients who alleged that the health plan canceled their insurance after they got sick. The settlement comes in response to pressure from state regulators, which already fined the health plan $200,000 for canceling one California woman's policy, according to the Los Angeles Times. While the dollar amount was not disclosed, the patients received a substantial cash settlement and are "pleased" with the outcome, according to one plaintiff's attorney. Five other suits, including one filed against Blue Shield of California, are currently pending, according to the Times.

The suits accused Blue Cross of exploiting a state law allowing health plans to cancel individual policies if the insured lied on their application. They contended that the insurer intentionally designed the forms to be misleading, generating innocent mistakes that could be used against them as evidence of deceit. Blue Cross only checked over the forms when a patient filed a claim for treatment of a chronic condition or costly care, the plaintiffs said.

Find out more about the suit: Read this article from the Los Angeles Times

Meanwhile, Blue Cross of California has been working to position itself as a good corporate citizen (bwahaahaahaa), funding rural and urban health care initiatives across the state. Article

Will senior voters decide the House?

2006-10-04T14:02:00.000-07:00

Democracy Corps: "Seniors are the most volatile and persuadable group in this off-year electorate and certain to turn out in large numbers and thus the number one target for campaigns in the final month. Although seniors favored Bush by a 5-point margin in the last presidential election, Democracy Corps’ recent senior poll indicates that Democrats are winning the seniors’ vote by 4 points, 45% to 41%. Keeping and building that margin will determine how many seats Democrats win."

However, a new AARP survey finds that 59% of seniors are still undecided for their House races, and 52% for Senate races.

Assembly Repubs flip-flop on ethics bill

2006-10-04T06:01:00.000-07:00

Just in time for election day! State Republican legislators who helped kill WHO-endorsed Senate Bill 1, the ethics reform bill, are now claiming to be supportive of the measure. It's no surprise that this comes just weeks before an election being dominated by that very issue.

To refresh our memories, recall that the State Senate passed the bill overwhelmingly on a vote of 28-5 back in November of last year, and Gov. Jim Doyle said he would sign it. Assembly Republicans killed the bill back in May on a 45-51 vote.

Assembly Speaker John Gard (now running for Congress), brushed off the need for the bill in this quote from the local daily a few weeks before the vote:

"The fact of the matter is we have the toughest ethics laws in America," Gard said. "Those laws were enforced in Wisconsin, and people were convicted and are being punished. Combining the ethics and elections boards is a whole 'nother discussion."

Starting last year, five ex-legislators - former Senate Majority Leader Chuck Chvala (D-Madison), former Sen. Brian Burke (D-Milwaukee), former Assembly Speaker Scott Jensen (R-Town of Brookfield), former Assembly Majority Leader Steven Foti (R-Oconomowoc) and former Rep. Bonnie Ladwig (R-Racine) - were convicted of misconduct or ethics violations.

Ellis said Assembly Republicans view his bill as an attack on Jensen, who faces sentencing May 16.

"They haven't accepted the fact that what Jensen did was wrong and if they were to pass this, they would have to come to grips with reality and admit what he did was wrong," he said.

Among other reforms, the bill would combine the state Elections and Ethics boards to create an independent Government Accountability Board.

SB 1 history here.

From our HMO and insurance friends

2006-10-02T09:48:00.000-07:00

GAO slams health savings accounts

2006-10-02T09:46:00.000-07:00

In a word, the GAO says health savings accounts (HSAs, pushed by Bush and the GOP) are only reasonable if you're rich, young and don't get sick. Can we now put HSAs into the garbage can once and for all?

HSA-eligible plan enrollees generally had higher incomes than comparison groups, but data on age differences were inconclusive. In 2004, 51 percent of tax filers reporting an HSA contribution had an adjusted gross income of $75,000 or more, compared with 18 percent of all tax filers under 65 years old.

. . .HSA-eligible plan enrollees who participated in GAO's focus groups generally reported positive experiences, but most would not recommend the plans to all consumers. Participants enrolled in the plans generally understood the key attributes of their plan. Few participants reported researching cost before obtaining health care services, although many researched the cost of prescription drugs. Most participants were satisfied with their HSA-eligible plan and would recommend these plans to healthy consumers, but not to those who use maintenance medication, have a chronic condition, have children, or may not have the funds to meet the high deductible. http://www.gao.gov/....

You don't get what you paid for

2006-10-02T09:44:00.000-07:00

The just released report from the Commonwealth Fund describes the deplorable state of the U.S. health care system--the most expensive but by no means the best health care system in the world.

Once upon a time, it was taken as an article of faith among most Americans that the U.S. health care system was simply the best in the world. Yet growing evidence indicates the system falls short given the high level of resources committed to health care. Although national health spending is significantly higher than the average rate of other industrialized countries, the U.S. is the only industrialized country that fails to guarantee universal health insurance and coverage is deteriorating, leaving millions without aff ordable access to preventive and essential health care.http://www.cmwf.org/...

Grandma's checkbook...

2006-10-02T09:43:00.000-07:00

...is gonna take a hit now that the Medicare "Doughnut hole" is kickin' in:
Millions of older Americans are confronting a temporary break in their Medicare drug coverage this month that will require them to pay the full cost of their prescriptions or face the painful prospect of going without. ...
"Virtually everyone who calls to say they've been denied coverage, they're shocked," said Robert M. Hayes, president of the Medicare Rights Center, a nonprofit that helps seniors navigate Medicare. "Trying to explain that this is the way the program was created by Congress angers folks who think it makes no sense. Many people feel blindsided."

84-20-18 adds up to disaster

2006-10-02T09:40:00.000-07:00

Since 2000, “workers’ health insurance premiums have risen a total of 84 percent, while their wages have increased 20 percent and inflation has risen 18 percent.”

So what's the holdup?

2006-10-02T09:39:00.000-07:00

“Americans clearly want a system that guarantees health care for everyone,” concludes a new report by the Citizens Health Care Working Group. The group was created by Congress and is composed of 15 members, including Health and Human Services Secretary Mike Leavitt.

What's left in your wallet?

2006-10-02T09:36:00.000-07:00

A new Kaiser Family Foundation report says health care costs are rising at twice the rate of inflation. It's part of a new plan with a brilliant premise: rich people get the best care because they pay the most money, so if everyone pays the most money, everyone gets the best care!

Labors bear few fruits

2006-10-02T09:32:00.000-07:00

“Most of the 9 million uninsured children in the U.S. live in homes where at least one parent works full time,” a new Families USA report finds. “In more than one-quarter of the cases, there are two working parents.”

Cuz who wants to cure cancer anyway?

2006-09-25T06:34:00.000-07:00

Over at The Wall Street Journal, Sharon Begley has an important column on the underfunding of the National Institute of Health and all the promising research that's falling by the wayside. She tells the story of Dan Welch, a molecular oncologist who discovered a molecule that suppresses metastases (and thus, cancer's progression) and sought to test whether it could be switched on to fight the disease. But when he went to the NIH, they said he needed to gather preliminary breast cancer tissue from hundreds of women, a project he simply lacked the funding for.

That, replicated over and over again, is the story of the modern NIH. Clinton had accelerated the agency's funding, but, in 2004, Bush and the Republican Congress shut off the spigot, and money has flat-lined since. That's left a significant gap between the number of promising proposals from reputable scientists that get submitted and the number of promising proposals from reputable scientists that get funded. Even worse, the NIH, like all big institutions, is a bit hidebound and loathe to gamble, so it's been the boldest and riskiest ideas that are getting shot down. Most of these would evaporate, but if a mere couple worked, the implications would be tremendous. These are the tradeoffs we make to fund tax cuts and hopeless wars -- and I wonder if the American people would really prefer another few years in Iraq to fully funding efforts to cure cancer.

Free market health care? Not so much.

2006-09-25T06:28:00.000-07:00

If we treat health care like any other market, allowing consumers free rein to purchase the services they like best, will it produce high quality results? A recent study suggests not:

Researchers from the Rand Corp. think tank, the University of California at Los Angeles and the federal Department of Veterans Affairs asked 236 elderly patients at two big managed-care plans, one in the Southwest and the other in the Northeast, to rate the medical care they were getting. The average score was high — about 8.9 on a scale from zero to 10.

In the second part of their study, the medical researchers systematically examined 13 months of medical records to gauge the quality of care the same elderly patients had received. The average score wasn't as impressive as those in the patient-satisfaction surveys: 5.5 on a 10-point scale. But here's the interesting part: Those patients who graded the quality of their care as 10 weren't any more likely to be getting high-quality care than those who gave it a grade of 5. The most-satisfied patients didn't get better medical care than the least-satisfied.

Surprise! Patients are poor judges of whether they're getting good care. And if consumer preferences don't map to high quality care, then a free market in health care won't necessarily produce better results or higher efficiency, as it does in most markets.

Back to the drawing board. Perhaps a national health care system would be a better bet to reduce costs, cover more people, provide patients with more flexibility, and produce superior outcomes. After all, why are we satisfied with allowing the French to have a better health care system than ours even though we're half again richer than them?

Social Security still under threat

2006-09-25T06:24:00.000-07:00

You still don't believe Social Security will be phased out next year if the GOP retains control of Congress? Then you definitely need to read this.

Good news

2006-09-25T06:16:00.000-07:00

A new blog from the Boston Women's Health Collective (who created the groundbreaking and invaluable resource Our Bodies, Ourselves) called Our Bodies, Our Blog.

Big Pharma thumbs nose at Project Bioshield

2006-09-25T06:09:00.000-07:00

You'd think that pharmaceutical companies would be eager to help the government have extra medical supplies on hand in the event of a terrorist attack, right? Um, actually, wrong. But at least Big Pharma and the government make a great team at one thing: having millions of extra dollars on hand in the event of a political campaign.

HMOs and Insurance Co's: Enemy #1

2006-09-25T05:57:00.000-07:00

What can be done? It's not a query I'm particularly well-equipped to field, but I think a good start would be photocopying this article on retroactive cancellations by insurers and handing a copy out to each and every American. No other piece I'm aware of exposes the absurdities and cruelty of the system as clearly, and so irresistibly signals the need for reform.

The actual facts in the report are basic: California state regulators are investigating Blue Cross for unlawful cancellations of policies. When you buy individual coverage, unlike when you buy into group coverage, insurers can reject you based on your health history or conditions. In order to protect against fraud -- say, someone being diagnosed with heart disease, then applying for insurance the next morning without mentioning it -- the law allows for insurers to cancel policies if the applicant engaged in "willful misrepresentation."

What's clever is how the insurance industry has redefined the standard: If you had a condition you didn't know about, they'll seek to not only yank your policy, but dispatch debt collectors to recover what they've already paid out.

In practice, the scam works like this: Selah Shaeffer, age four, was found to have an aggressive, cancerous tumor in her jaw. The family had been with Blue Cross for about a year, and the bump was examined and biopsied after they'd bought their insurance. But because it was growing before, Blue Cross cut off reimbursement for surgeries it had already authorized, and is now trying to recover $20,000 from the Shaeffers.

Or take the Nazertyans, who had premature twins. They were covered by Blue Shield all throughout the pregnancy, and disclosed all facets of the birth and operations. Blue Shield not only dropped them, but was trying to get back $98,000 they'd already paid under the rationale that the Nazertyans hadn't disclosed an earlier miscarriage. After the Los Angeles Times reported the story, Blue Shield called off the debt collectors.

What's so remarkable about all this is what it exposes about the health insurance system in this country: We rely almost exclusively on private insurers whose primary business imperative is not to pay when we get sick. They do that by seeking to deny coverage before the fact, or reject claims afterwards. They pay for platoons of employees who have no job other than to scrutinize thousands of policies a week in the hopes of finding sufficient cause for cancellation. Say what you will about the inefficiencies of the public sector, but can it really match the ruthlessness and absurdity of insurers spending large amounts of money so they don't have to insure? Is that sort of profit motive really what you want underlying your health care coverage?

Bionic woman

2006-09-15T07:03:00.000-07:00

No, not Lindsay Wagner. Her name is Claudia Mitchell, and she lost her arm in a motorcycle accident.

The process doctors used to create a responsive prosthetic arm for her is nothing less than a medical wonder:
In preparation for the bionic arm, Kuiken and his surgical colleagues first re-create a biological control panel for a hand on the amputee's chest. They use muscle and skin that can be sacrificed -- or, more precisely, hijacked -- for that purpose.

They cut the nerves to two chest muscles, the pectoralis and serratus, at a point where those nerves have branched to go to different parts of the muscles, but far "upstream" from the point where the nerves divide into tiny fibers that attach to individual bundles of muscle fiber.

They then sew the stumps of the large nerves that once went to the arm and hand to the cut ends of the chest-muscle nerves. In the same operation, the nerves carrying sensation from the skin over the pectoral muscle are also sewn into the arm nerves.

Over several months, the arm nerves grow down the sheaths of the motor fibers and attach to the muscles. (Interestingly, the amputee assists this process by mentally "exercising" the missing hand, which helps promote a firm nerve-muscle connection.) Simultaneously, the sensory nerves grow down the sensory sheaths and into the skin.

If all goes well, a person is left with chest muscles that twitch in different places in response to such thoughts as "bend the wrist back," "move the thumb" and "clench the fingers." The person also ends up with a patch of skin about the width of a baseball that, when stroked, warmed or pricked, feels like a hand rather than part of the chest.

The bionic arm makes use of this feat of anatomical alchemy.

The prosthesis is strapped onto the shoulder stump and torso in a way that positions electrodes over the regions of the chest muscles that are responding to different "hand instructions." Those electrodes, in turn, are wired to a computer and then on to motors in the forearm and hand of the device.

When the amputee tells the fingers to close, the designated part of the pectoral or serratus muscle twitches and the electrode over it detects the signal, activating the appropriate motor.

Wow. That's all, just wow. Do read the whole thing.

$11 million per hour

2006-09-11T08:50:00.000-07:00

That's what we're spending in Iraq. Think about that the next time you're working on your agency's budget, staffing and case load. How much healing and comfort can be had for a fraction of that?

Uninsured numbers still rising

2006-09-11T08:42:00.000-07:00

President Bush says “the foundation of our economy is solid, and it’s strong.” That’s true, for some: corporate profits have now climbed to their highest share of GDP since the 1960’s.

But new Census Bureau data show the real state of the current economy. The Bush record on combating poverty and insuring more Americans is an undisputed failure.

At left are the number of our uninsured measured in millions.

More on the new census data HERE.

Playing shell games with Medicare payments

2006-09-11T08:39:00.000-07:00

September 30 is the end of the federal fiscal year, and it has special meaning -- this year -- for those of you providing services to Medicare recipients. George Bush's minions have had a brainstorm at your expense: Federal bureaucrats will put off as many purchases as possible until October so that this year's spending looks nice and frugal for those midterm elections. And, if no actual purchases can be delayed, just delay payment for services already rendered. Like, say, for Medicare services: In essence, you will be giving the federal government an interest-free loan of nine days worth of payments. (The feds are supposed to send you what hey owe you some time after October 1, when the payment can be attributed to the 2007 fiscal year.)

This way, the Medicare mouskateers happily say, the Medicare bill for 2006 will look like its $5.2 billion less than it really is. This will help those folks who are in office pick up a few more votes to stay in office. That $5.2 billion will get tacked onto next year's budget, so we're saving anything, but there's no election next year.

I swear, every time I think these guys can't get any more childishly foolish they do. It's like having a bunch of scheming high school freshmen running the country.

Consumer directed care: another empty promise?

2006-09-11T08:28:00.000-07:00

The big push right now is for consumer directed care, and it's based on the theoretical assumption thaht if we treat health care like any other market -- allowing consumers free rein to purchase the services they like best -- the results will be higher quality care. A recent study suggests not:

Researchers from the Rand Corporation's think tank, the University of California at Los Angeles and the federal Department of Veterans Affairs asked 236 elderly patients at two big managed-care plans to rate the medical care they were getting. The average score was high — about 8.9 on a scale from zero to 10.

Then they poured through 13 months of medical records to gauge the quality of care the same elderly patients had received and found an average score wasn't as high as those in the patient-satisfaction surveys: 5.5 on a 10-point scale.

But here's the kicker: Those patients who graded the quality of their care as 10 weren't any more likely to be getting high-quality care than those who gave it a grade of 5. The most-satisfied patients weren't getting any better medical care than the least-satisfied.

Patients, it seems, are rather poor judges of whether they're getting good care. And if consumer preferences don't map to high quality care, then a free market in health care won't necessarily produce better results or higher efficiency. Don't expect mere facts from mere scientific studies, however, to slow down the political rush to consumer-directed care. The politicians know that: 1) this stuff buys votes, and 2) by the time we all figure out it was another false promise, they'll all be safely out of office.

We're still unprepared for disaster

2006-09-11T08:27:00.000-07:00

A recent Government Accountability Office (GAO) report finds that "the U.S. isn't prepared to handle disasters and lacks an effective way to track $88 billion doled out to help rebuild the Gulf Coast after last year's killer hurricanes." A show of hands: Anyone shocked by this?

Social Security still threatened

2006-09-11T08:25:00.000-07:00

You still don't believe Social Security gets phased out next year if the GOP retains control of Congress? Then you definitely need to read this.

Audit bureau confirms: state gov't for sale

2006-08-25T07:59:00.000-07:00

A legislative audit of state business assistance programs released earlier this week mirrored findings in a 2005 Democracy Campaign study that, among other things, pointed out that companies whose executives made campaign contributions received grants, subsidized loans and tax breaks eight times greater than non-contributors.

State Commerce Department officials took sharp exception to WDC's report, calling it "a little off base."
Now the Legislative Audit Bureau has confirmed one of the Democracy Campaign's key conclusions – that oversight of state economic aid programs is so bad that it is virtually impossible to determine whether the assistance actually created any jobs. In fact, the auditors found situations where companies that received state help later laid off employees.

VA system shows wisdom of integrated coverage

2006-08-25T07:14:00.000-07:00

That fragmentation of the health care system lies at the root of much of the waste and fraud in our health care system. Each player tries to pump up profits and often waste through excessive billing of third parties. Each party avoids taking responsibility by shifting the increased costs onto government or other third party providers. Short-term profiteering means long term investments in preventive care or technology gets shortchanged.
A recent Business Week profile (read the whole article at the link) of the Veterans Administration health system emphasized that an integrated health care system like the VA can accomplish savings that the rest of the balkanized for-profit health insurance system cannot.

After reforms in the 1990s, the 154 hospitals and 875 clinics run by the VA now rank as best-in-class on health quality, on measures ranging from quality of chronic care to percentage of members receiving flu shots to having a prescription accuracy rate of 99.997% (compared to a 3% to 8% inaccuracy rate more generally). According to research by the University of Michigan, the VA now outranks private-sector hospitals in patient satisfaction.
And the VA delivers this quality at a cost of $5000 per patient versus a national average of $6,300.

How does it achieve these savings and quality? According to Business Week:

Not having to rely on piecemeal insurance payments means the VA can finance large-scale improvements such as the electronic medical-records system, up and running in all of its facilities since 2000-- compared to just 20% of civilian hospitals with computerized their patient records. When hospitals were evacuated from New Orleans during Hurricane Katrina, the VA's patients were the only ones whose medical records could be accessed immediately anywhere in the country.

Because the VA treats patients throughout their lives, it can invest in prevention and primary care, knowing it will reap the benefits of lower long-term costs. Because the government pays the bills, the VA doesn't have to waste time or money on claims-related paperwork.

Unlike Medicare, the VA is allowed to negotiate prices with drug companies and other suppliers, and it uses that power aggressively. The consumer group Families USA estimates that Medicare Part D enrollees, on average, pay 46% more than the VA for the same drugs.

And because its doctors are salaried employees, the VA can implement systemwide changes without having to persuade outside doctors to go along (and without doctors having a financial incentive to undermine reforms by self-referrals or other profiteering).

The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies.

States can and will continue to pursue piece-meal reforms, but as they seek to achieve more universal coverage they can take lessons from the VA and begin ending the fragmentation of health care systems in favor or encouraging more integrated and publicly-accountable health care systems.

States may not achieve the level of integration of a completely publicly-run system like the Veterans Administration, but by simplifying and integrating health plan options across employers and the public sector, states can create more of the accountability and cost savings that in turn can help finance those broader health coverage goals.

More Resources

HMOs sued for not paying MA providers

2006-08-25T07:09:00.000-07:00

A dozen Georgia physicians have filed a suit against three private HMOs -- Peach State Health Plan, AMGP Georgia Managed Care Company and Wellcare of Georgia -- claiming that the plans owe millions of dollars in Medicaid reimbursements to doctors, hospitals and other providers. The providers allege that the HMOs knew before they bid on a $3 billion state contract that they'd be unable to reimburse physicians. Because the HMOs haven't paid them, the doctors say they've had to cut down on the number of indigent patients they accept. "These are doctors who have made a commitment to treat the less fortunate, and a substantial percentage of their patients are Medicaid patients," the plaintiff's lawyer, Rod Edmond, told the Atlanta Journal-Constitution. "And if they are owed $50,000 or $75,000 in outstanding claims, it could literally put them out of business." The physicians hope their suit will receive class-action status and that other providers across the state will join them. Remember: Gov. Doyle thinks HMOs are going to save our Medicaid program. To get more background on the suit check out this report from the Atlanta Journal-Constitution for details.

Gov wannabe breaking state rules

2006-08-25T06:33:00.000-07:00

A Wisconsin Democracy Campaign review of contributions from special interest political action committees (PACs) to Republican candidate for governor Mark Green shows that most of the donations run afoul of the state law requiring PACs donating to state campaigns in Wisconsin to be registered with the state. The Democracy Campaign brought the new finding to the attention of the state Elections Board in a memo sent to board members. Last month, WDC wrote to the board that the PAC money Green has accumulated to help finance his run for governor exceeds the amount allowed under state law. The Elections Board has put the issue on the agenda.

Another exmaple of how HMOs work

2006-08-25T05:57:00.000-07:00

In California, the SEIU has leaked an internal John Muir Physician Network (JMPN) memo that instructs doctors not to "refer patients for a screening colonoscopy if their life expectancy is less than five years." The memo orders doctors to deny the test to patients with AIDS, chronic renal failure, advanced cirrhosis of the liver, COPD, active hepatitis, obesity and other conditions. The memo also threatens "financial penalties" for doctors who don't comply with the order. Taken at face value, JMPN's blanket denial of colonoscopies for certain patients is a violation of several federal laws. Regulators say they are planning to investigate the matter.
For more on the controversy: check out this article from the Contra Costa Times and read the SEIU press release for more details from the memo. Remember: Gov. Doyle thinks guys like these -- HMOs -- are going to save Medicaid. Sigh.

P.S. And who gets to decide whether you "life expectancy" is less than five years? Doctors have enough trouble with the 6-month rule for hospice. I'm willing to bet that since this decision has "financial penalties" attached to it, that the docs have to figure out who the HMO expects to life fewer than five years. In fact, the HMO has already given them a starting point: the list of conditions for which they are prohibiting colonoscopy. I note, with personal interest, that the obese are on the list. I guess I have fewer than five years left to live. Idiots.

Thanks to Bush, Thompson and Tauzin

2006-08-03T08:39:00.000-07:00

Medicare’s “doughnut hole” is starting to hit shocked and angry seniors. “They have just learned that their Medicare drug plans are maxing out on early coverage and that they must spend $2,850 from their own pockets before coverage will resume.”

This explains a few things

2006-08-03T08:30:00.000-07:00

Only 1% of our representatives in Congress have family in service. Some 32, however, are apparently married to lobbyists. See the story here.

A ray of hope for the disabled

2006-07-27T12:23:00.000-07:00

I just thought this was cool:

Aided by a tiny chip implanted in his brain, a 25-year-old quadriplegic played video games, controlled a television and operated a mechanical arm using only his thoughts, researchers said recently.

The technology, reported in the journal Nature, is the latest step toward enabling people paralyzed by stroke, spinal cord injury or amyotrophic lateral sclerosis, or ALS, to control their wheelchairs or feed themselves simply by thinking about those actions....

A wire the thickness of a strand of vermicelli carried the impulses from the brain to a half-inch-tall pedestal attached to the skull. From there, an external cable transmitted the signals to a computer.

The patient, Matthew Nagle, played the video game Pong and performed other tasks by imagining he was moving his arm. Researchers said that although Nagle's accuracy was as high as 90%, he couldn't react as quickly as able-bodied people.

Still, Nagle said he often defeated lab technicians who challenged him at Tetris.

Med Mal: fix errors or fix the courts?

2006-07-27T11:39:00.000-07:00

How should government deal with rising healthcare costs? Part of the GOP plan -- on state and national levels -- is attacking the ‘problem’ of medical malpractice. Ezra Klein in Slate does a nice job of tackling the ‘malpractice myth’ and examines a countering idea from Senators Clinton and Obama that would “cut the number of medical malpractice cases by reducing medical errors.”

The difference between Republicans and Democrats on this issue, Klein notes, is Republicans generally favor tort reform (“suits and payouts are the ill”) while Democrats believe the problem is “a slew of medical injuries of which the suits are a symptom.” And studies show Democrats are right. Read the Slate piece here.

Appointing the unqualified: no wonder we're in this mess

2006-06-06T07:07:00.000-07:00

In terms of the criminal trial, it's important that David Safavian, the Bush administration's former top procurement official, acknowledged yesterday that he provided "a lot of insight and advice," including government information not available to the public, to Jack Abramoff. Since Safavian was arrested last September for doing secret favors for Abramoff, his former employer, it was a key admission.

But for political purposes, I think this development was even more entertaining.

Safavian conceded to Justice prosecutor Peter Zeidenberg that he most likely didn't believe he had the qualifications to be chief of staff at the Government Services Administration, the position he held when he had the dealings with Jack Abramoff he is accused of covering up.

"Did you think you were qualified for the job?" Zeidenberg asked.

"Probably not, actually," Safavian said.

What a helpful admission. In fact, I can think of dozens of top administration officials who might have similar responses to the same question.

For example, I'd love to hear the response to the "Did you think you were qualified for the job?" question from former Small Business Administration head Hector Barreto, a former Republican fundraiser who had no experience or relevant qualifications. Or maybe his replacement, Steven Preston, who has the same problem.
For that matter, why don't we also pose the same question to Stewart Simonson, the Health and Human Services Department's point man "on matters related to bioterrorism and other public health emergencies," despite a complete lack of experience in the fields of public health and/or national security. His only qualification was that he's a long-time friend and fund-raiser for Tommy Thompson. And how about Douglas Hoelscher, who went from being a low-level White House staffer, arranging presidential travel, to a top post in the Department of Homeland Security despite no experience at all?

We could also ask Ellen Sauerbrey, who Bush appointed to be Assistant Secretary of State for Population, Refugees, and Migration, despite having literally no background in setting up refugee camps, delivering emergency supplies, and/or mobilizing international responses to humanitarian crises. We could then ask Julie Myers, who Bush named to help lead the Bureau of Immigration and Customs Enforcement, despite the fact that she has no management experience at any level.

This list just never seems to end. Safavian's admission was helpful, but we'd probably get the same response out of most of the administration's political appointees. There might as well be a "No Policy Experts Need Apply" sign hanging in the West Wing.

More on the med-mal hype

2006-05-31T07:00:00.000-07:00

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.

A better idea for medical liability reform: make fewer mistakes

2006-05-31T06:58:00.000-07:00

"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

2006-05-31T06:53:00.000-07:00

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.)

Secret vaccine bill written by vaccine lobbyists -- shocked?

2006-05-10T07:23:00.000-07:00

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.

More malpractice myths debunked

2006-05-10T06:23:00.000-07:00

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?

2006-05-10T05:36:00.000-07:00

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?

2006-05-10T05:21:00.000-07:00

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

Playing with public health

2006-05-06T22:25:00.000-07:00

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."

Private sector pandemic flu preparation resources

2006-05-06T22:21:00.000-07:00

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.

US helath care: past time for a change?

2006-05-05T12:02:00.000-07:00

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:

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.

Hate Medicare D? Brace yourself for the next one.

2006-05-02T20:17:00.000-07:00

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.

Medicare: 12 years to zero

2006-05-01T20:27:00.000-07:00

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...

Least shocking headline of the year!

2006-03-20T08:55:00.000-08:00

Lobbyists Foresee Business As Usual
Post-Abramoff Rules Expected to Be Merely a Nuisance
Washington Post, March 19, 2006; Page A01

Feeling safer now? Me neither.

2006-03-20T04:24:00.000-08:00

Last week Health and Human Services Secretary Michael Leavitt announced that Americans should prepare for bird flu by stashing canned tuna and powdered milk under their beds (What? No chicken soup?) . "When you go to the store and buy three cans of tuna fish," said Secretary Leavitt, "buy a fourth and put it under the bed. When you go to the store to buy some milk, pick up a box of powdered milk. Put it under the bed." Sure. Right next to the duct tape and plastic sheeting we'll use in case of a bioterrrorist attack. If this is what passes for public health policy, we're all in deep trouble.

Good news! Unqualified crony resigns

2006-03-17T06:50:00.000-08:00

Stewart Simonson, the Bush administration's "point man for just about every health emergency that may hit our shores, ranging from anthrax attacks to an avian flu pandemic," has resigned. It's about time: Simonson had "no background in medicine, public health, or bioterrorism preparedness."

Here's the scoop on Stew, as I presented it here back in October:

...Simonson graduated from the University of Wisconsin law school in 1994 and served as legal counsel to Tommy Thompson while he was governor of Wisconsin from 1995 to 1999. Simonson then followed Thompson to Washington when the governor was appointed as head of HHS. Simonson’s bio at HHS states that "from 2001-2003, he was the HHS Deputy General Counsel and provided legal advice and counsel to the Secretary on public health preparedness matters. Prior to joining HHS, Simonson served as corporate secretary and counsel for the National Railroad Passenger Corporation (AMTRAK)."Congressman Henry Waxman has recently pointed to Simonson as an example where Bush has "repeatedly appointed inexperienced individuals with political connections to important government posts, including positions with key responsibilities for public health and safety.

"In addition to being very close to Thompson, Simonson has given generously to the Bush political machine. The website, Political Money Line’s contribution database shows that he contributed $3,000 to various Bush-Cheney committees in the 2004 election cycle and gave $250 to the RNC.

The Washington Drug Letter published an article in its December 2004 issue in which Hauer was harshly critical of Simonson: Speaking as part of a biodefense panel in Washington, D.C. Dec. 15, Jerome Hauer, formerly the Assistant Secretary for Public Health Emergency Preparedness (ASPHEP) at HHS, said the $877 million contract awarded to VaxGen to produce a new anthrax vaccine was insufficient. He also insinuated poor policymaking has left the country vulnerable to terrorist attacks using weapons of mass destruction.

Hauer faulted the current management at the ASPHEP Office, including acting secretary Stewart Simonson, for not being better prepared to handle its duties. He called for the creation of a new federal office to coordinate U.S. biodefense activities.. . ."The decisions being made do not appear to have a sound basis," said Hauer, currently senior vice president of government relations for consulting firm Fleishman-Hillard.

Last spring, Simonson came under fire from several Republican senators. The first was by Idaho Senator Larry Craig before the Homeland Security Subcommittee in April who questioned the acquisition process for influenza vaccine:Noting that the flu can be lethal to some populations such as the elderly, Sen. Larry Craig, R-Idaho, said the country was unprepared to deal with a possible flu pandemic.Simonson . . . stopped short of agreeing with Craig’s assessment, but said "it would pose an enormous challenge."

Sen. Ted Stevens, R-Alaska, and Gregg also questioned if the process used by Simonson’s office to award vaccine development contracts ensured open competition and delivery to prevent a vaccine shortfall. "Are we creating the same situation with anthrax?" Gregg asked, referring to the flu vaccine shortfall last winter.

Although Simonson said the different agreements show that they are "seeking not to put all our eggs in one basket," he added that he remains unsure if the contract award process is being done right. "We’re learning as we go," he said.The bottom line is that there is a risk of a flu pandemic that could kill millions of people worldwide if it is able to jump from human to human. Hurricane Katrina amply demonstrated what happens when underqualified yet well-connected lawyers are in charge.

How lobbyists control health care policy

2006-03-16T13:26:00.000-08:00

I believe the technical name for this sort of thing is Dingbat Kabuki. Yesterday, Republicans in the Senate appeared to do something good and benevolent on the health care front when they voted to allow Medicare to use its vast bargaining power to negotiate lower drug prices. The GOP had originally forbidden the government to do this when it crafted the drug benefit back in 2003, succumbing to pressure—and lavish campaign contributions—from the pharmaceutical industry. Now, however, the party seems to be scared of a senior backlash over the entire Medicare fiasco, and wants to do something.

Well, sort of. Really, though, it's extremely unlikely that anything will come of this. What the Senate actually passed yesterday wasn't in any way a binding resolution or piece of legislation. It's merely an amendment to a budget resolution that "provides only guidance for future legislation." In other words, cheap talk. A quick prediction: This measure will never make it into law. The GOP would never, ever go against the wishes of Big Pharma, and this amendment is only meant to help the party look like it's trying to fix the disastrous Medicare drug benefit. Seniors, after all, tend to have a lot of influence when midterm elections roll around. Best to try to appease them, quietly.

For further proof that the GOP will only ever pass bills paid for and written by lobbyists, look no further than a second Los Angeles Times story on yet another health care vote. Yesterday a Senate Committee also approved "a bill that would preempt state laws that require insurance policies to cover specific services, such as maternity care and supplies for diabetics."

It's a terrible idea for, you know, actual people. Guess who came up with it.

States require insurers to cover specific services because otherwise, those insurers could end up making certain services—like maternity care and supplies for diabetics—unaffordable for certain people. For their part, insurers have always complained that all those burdensome state requirements force them to raise premiums. Maybe they have some small point, but then again, they would say that, and the insurance industry is pretty much the last industry to get the benefit of the doubt, ever. They've also been complaining for years that an epidemic of malpractice lawsuits has driven up premiums—a line that's totally false. It was never even sort of true.

On the bright side, the new bill, if passed, should help pad the industry's profit margins. And Republicans on the Health, Education, Labor, and Pensions Committee can look forward to fatter re-election campaign chests.

Read it and weep

2006-03-16T09:44:00.000-08:00

U.S. Health Care 'Mediocre,' Regardless of Race, Age,Economic Status, Study Says http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=36060

Lies, damn lies and Medicare statistics

2006-03-15T09:36:00.000-08:00

Today, President Bush repeated a highly misleading claim about the Medicare prescription drug program: “Twenty-six million seniors so far have taken a look and said, I think it’s worthwhile to sign up.”

This figure is meant to convince the public that tens of millions of seniors have chosen to enroll in the prescription drug program. But as the Boston Globe reported a month ago, the “actual number of voluntary enrollees is much smaller, about 5 million.” The rest either were automatically enrolled or already had drug coverage from their former company’s health plan.

Ron Pollack of Families USA explained: "For an administration that frequently provides inaccurate information, the use of the 25 million enrollment figure breaks new ground in misleading propaganda. The only real number that is worth focusing on is the approximately 4 million to 5 million who now have prescription drug coverage who did not have it prior to the start of the program. Unfortunately, the administration is trying to mask that failure with an exaggerated number that has nothing to do with new people who gained coverage."

The facts haven’t gotten in the way of the White House spin, however. Below are just some of the times the administration has used the inflated number:

President Bush:
* More than 25 million people with Medicare now have prescription drug coverage, and hundreds of thousands more are enrolling each week. This new coverage is saving seniors money on their drug premiums. [2/25/06]
* And I want to tell you something. We’ve signed up 25 million people since January 1st for this new reformed system. And, sure, there’s some glitches. [2/17/06]
* About 25 million seniors have signed up for this new plan since January 1st. That’s a lot of folks in a quick period of time. [2/17/06]
* Millions of folks — about 25 million people have signed up for the new Medicare benefit. [2/16/06]
* Twenty-four million Americans have now signed up to the new Medicare plan since January 1st. That’s a lot of folks, 24 million. Hundreds of thousands are enrolling each week. [2/15/06]
* Since the program went into effect six weeks ago, more than 24 million people with Medicare now have prescription drug coverage, and hundreds of thousands more are enrolling each week. [2/11/06]

Vice President Cheney:
* The program is underway, and some 24 million Americans are going to have benefits as a result of that and live longer and be healthier while they do it. [Newshour with Jim Lehrer, 2/7/06]

Scott McClellan:
* I think there are some 26 million people that are already enrolled in the prescription drug benefit. There has been great progress made in terms of signing people up and enrolling them in the program. [Press Briefing, 3/13/06]

Skewing the numbers to paint the outhouse

2006-03-14T13:32:00.000-08:00

A new survey released by industry trade group America's Health Insurance Plans (AHIP) challenges the view that Medicare Part D is a disaster. The study, which was conducted by Alexandria, VA-based Ayres, McHenry & Associates found that 8 out of 10 seniors who enrolled in a Part D plan had no trouble doing so. Three out of five surveyed said they had saved money. "What seniors are saying is this program is working for them. It's making a difference," said AHIP President Karen Ignagni.

Given that the Medicare Modernization Act has been a bonanza for private insurers, less interested observers of research methodology might note that surveying just those who did manage to join, when a small minority of those who were eligible to sign up voluntarily have done so, smacks just a little of subject selection. The survey drew scoffing from advocacy groups, who called the results distorted and biased. "The HMO industry and its Washington lobbyists may be the least trusted sources of honest data in the country" said Medicare Rights Center president Robert Hayes.

See this article from The Washington Post

Maybe we can quit blaming nurses and doctors?

2006-03-10T11:07:00.000-08:00

Uwe Rheinhardt gave a talk at Duke, arguing that the U.S. health care system has the moral responsibility to address rising administrative costs. Article

QIOs & hospitals: too much love?

2006-03-10T10:58:00.000-08:00

The Institute of Medicine released a much-anticipated report on Medicare Quality Improvement Organizations (QIOs), arguing that the responsibility for investigating patient complaints should be given to somebody else. The report echoes earlier findings that had argued QIOs may not be looking into problems as rigorously as necessary because of financial links to doctors and hospitals. The Institute argues that QIOs should refine their focus to concentrate solely on providing technical assistance to hospitals, a role that is expected to become increasingly important as quality ratings take on a higher profile role in the health system. Recommended changes include greater oversight of QIO activities and increased organizational transparency.
- see this article from The Washington Post
- read the report from the Institute of Medicine

Dissing part D

2006-02-27T20:01:00.000-08:00

Another day--another very negative news story about the new Medicare "Part D" prescription drug benefit, this time from the Washington Post, where Ceci Connolly explains that even the very poor Americans targeted by the program are avoiding it like a cobra in a pill bottle. This finding is entirely in character with the benefit's terrible history. Even back when it was new and shiny, and basically involved handing out prescription discount cards without premiums or other costs to beneficiaries, seniors didn't like or trust the new program. The incredibly botched roll-out of the full Part D ball of twine has entrenched the perception of the program as a classic bureaucratic boondoggle, to the point that people who really need the benefit don't much want it. It takes a special breed of public officials to design and deliver a new entitlement program that nobody likes. Really, really special.

Current health care system: "just plain stupid"

2006-02-26T20:01:00.000-08:00

Six years ago Adam Gopnik and Malcolm Gladwell debated healthcare in the pages of the Washington Monthly. Gopnik was for universal healthcare and Gladwell was agin it. But wait! Gladwell has blinked! He now says Gopnik was right:

Why have I changed my mind? Some of my reasons are in the piece on moral hazard I wrote for the New Yorker last summer. The bigger reason is simply that I woke up one day and realized what much smarter people than me (Adam Gopnik) realized a long time ago, which is that the idea of employer-based health care is just plain stupid — and only our familiarity with it and sheer inertia prevent us from rising up in rebellion.

I always try to think of a suitable analogy and fail. The closest I can come is to imagine if we had employer-based subways in New York. You could ride the subway if you had a job. But if you lost your job, you would either have to walk or pay a prohibitively expensive subway surcharge. Of course, if you lost your job you would need the subway more than ever, because you couldn't afford taxis and you would need to travel around looking for work. Right? In any case, what logical connection is there between employment and transporation? If you can answer that question, you can solve the riddle of the U.S. health care system. And maybe I'll change my mind back.

Gladwell wrote this because, for some reason, his old debate with Gopnik has suddenly gotten renewed attention in the blogosphere (20 cites in the past week) and, he says, "I shudder when I read what I said back then." By the way, did you know that Malcolm Gladwell now has a blog? Well he does.

Sigh. Yet another Medicare lie

2006-02-03T05:53:00.000-08:00

Good news, campers! The Department of Health and Human Services says the Medicare prescription plan is coming in under budget! Not so fast....

When the program was being developed, before we had any actual experience with the cost of drug coverage, it was estimated that the Part D benefit would cost about $700 billion in its first ten years. But as plans compete for seniors’ business, they are driving the costs of prescriptions down. According to our latest estimates, the costs of the Medicare prescription drug benefit are significantly less than expected.

The federal government now projects the cost to be about 20 percent less per person in 2006. Over the next five years, payments are now projected to be more than 10 percent lower than first estimated. That is a significant savings for taxpayers.

Well. That is good news, isn't it? Competition is certainly a wonderful thing.

And yet....something is niggling at me. You see, back when the program was being developed, HHS actually estimated it would cost $400 billion, not $700 billion. As we later learned, this was just a flat out lie, designed to fool Congress into voting for it. Shortly after the bill passed, HHS admitted that its chief actuary had actually estimated a cost of $500-600 billion but had been forbidden from revealing this to anyone. Then, last year, they upped the estimate again to $720 billion. So assuming that the 10% "savings" applies to the entire 10-year budgeting period, it means HHS is now estimating a cost of $650 billion, which is actually far higher than either of the estimates from two years ago.

It's also worth noting that HHS has come up with this alleged 10% savings after a grand total of one month of experience with the program. In fact, it comes from a document called "The Secretary's One Month Progress Report on the Medicare Prescription Drug Benefit." So take this news with a great big shaker of salt.

Still more $$ for the drug makers

2006-02-03T05:49:00.000-08:00

Speaking of Medicare prescription drugs, here's a little tidbit that somehow didn't make its way into the administration's progress report:

The new Medicare drug benefit will give drug companies up to $2 billion in extra profits this year because they're no longer required to pay rebates on drugs bought by the government for the elderly poor.....The boost in profits comes from a shift in the drug coverage of 6.4 million poor and elderly people from Medicaid to the new Medicare drug benefit. Unlike Medicaid, which requires drug companies to charge their lowest or "best price" for medications, the Medicare program relies on competition among private drug plans to keep prices low. By eliminating the need to discount drugs for the government, the industry can now pocket the savings.

"The net effect over 10 years is probably closer to $40 billion in extra profit," said Stephen Schondelmeyer, a pharmaceutical economics professor at the University of Minnesota.

This is no surprise, of course. After all, you don't think the pharmaceutical industry would have supported the bill if they really thought "competition" would drive down prices, do you?

Priorities out of order

2006-02-02T12:59:00.000-08:00

A day after he got the GOP congress to cut Medicaid, student loans, child support enforcement, welfare and other programs for the needy by $39 billion over the coming years, Bush tells Congress that he needs another $70 billion for Afghanistan and Iraq for just next year. If we're going to finance a war of choice (Iraq) on the backs of the needy here at home, maybe we should spend the rest of the year demanding that the $70 billion be paid for by eliminating corporate welfare and tax subsidies and breaks. Update: He's actually going to ask for $120 billion. Even worse. Almost twice as bad.

You can call the outhouse a palace, but it still smells the same

2006-02-02T11:37:00.000-08:00

Well, sponsors of the latest version of TABOR have decided that TABOR carries too many negative connotations, so they're changing its name. Now it's the TP amendment, or the Taxpayer's Protection Amendment.

We know that Wisconsin Manufacturers & Commerce employed its considerable marketing skills on behalf of TABOR supporters to rename TABOR, but couldn't they have come up with a better acronym than TP?
When one concerned citizen called Sen. Ron Brown (R-Eau Claire) to oppose TABOR, he was told TABOR was dead and legislators were now working on the Taxpayer Protection Amendment, which he was told was different. Really?

Instead of being TABORized, we're now merely going to beTP'd. It turns out that states across the country are fleeing from the acronym TABOR, if not the concept.

In Arizona, Republicans still like the idea of a TABOR-like creature, they just don't like the negative connotations that TABOR has aroused, among thinking citizens everywhere, not just in Colorado. State Sen. Dean Martin of Phoenix: "This really is a different animal," Martin, who prefers that the measure he's helping sponsor be known as the Budget Stabilization Act, told the Arizona Republic.

Of course, that acronym is BS...

A bandaid for a hemorrhage

2006-01-29T08:32:00.000-08:00

We all know Medicare Part D is an absolute mess and a terribly designed bill. But legislators are coming up with impotent (and totally uninventive) ways of fixing it:

Olympia Snowe said she will continue to push for a bill (S 2168) that would extend from May 15 to Dec. 31 the deadline for beneficiaries to enroll in the drug benefit without paying a penalty. According to AP/Long Island Newsday, at least 140 lawmakers -- most of whom are Democrats -- support various bills that would extend the enrollment deadline.

In the House, 10 bipartisan co-sponsors support a bill that would extend the enrollment deadline to June 30, 2007. A second House bill, which has 131 co-sponsors, would extend the deadline to Dec. 31 and allow beneficiaries to change plans once during the year.Seniors don't need more time (past the May 15th deadline). Nor do they need more information. None of these bills -- especially one extending the date way into 2007 -- will do a thing, because the problem is the bill itself. And not that it's just too complicated (although that's a major issue) -- it's just not a benefit that a lot of seniors deem worth paying for. Premiums are expensive, as are out of pocket costs. There's a huge donut hole in the middle, and there's no guarantee their drugs will be covered.

So while it's all well and good that legislators are trying to help, someone needs to send them a memo that extending deadlines won't fix anything.

Seniors ignoring Part D

2006-01-29T08:15:00.000-08:00

A new poll indicates that more than half (53%) of seniors have no plans to enroll in a prescription drug plan. Less than a quarter (24%) have chosen a plan so far, and another quarter (23%) plan on enrolling but haven't done so. These poll results are consistent with findings from six months ago, a troubling sign for the Bush administration that in spite of additional information, seniors still do not want to participate in the new benefit.

There's good reason to trust this new poll, as it's fairly consistent with the number of seniors who've signed up thus far, especially if you adjust for seniors who are incapacitated or in nursing homes and not included in the sample. Health and Human Services (HHS) needs 15 million more people to sign up to meet its enrollment goal. Using the poll, if we expect 23% more seniors to enroll, another 8.1 million should do so by the end of the year. That leaves HHS almost 7 million short of its enrollment goal.

The poll also collected data on respondents who did not plan on signing up for Medicare Part D. In general, they:

* were among the lowest users of medical services
* had substantially higher incomes
* had higher education levels
* were more likely to be married, and
* did not differ in age from those already enrolled or likely to do so.

These findings aren't surprising in the least; they're just a stark illustration that legislators have failed to convince those unlikely to need a prescription benefit to pay for it anyway. For these individuals, a 1% penalty per month is an insufficient incentive.

The poll also found that education efforts conducted between September and January were fairly effective. While only 11% of seniors in September and 8% in June were "very familiar" with Part D, that number increased to one quarter in December. Seniors are more able to correctly answer questions on the details of the bill, with 68% percent of seniors answering at least five of six questions correctly in December, compared to only 23% in September.

It's fairly troublesome that education efforts haven't increased the number of seniors planning to enroll. To convince that other 53% that it's in their best interest to sign up, some part of the bill will have to be altered. There's a number of fixes that might work, but one thing's for sure: further educational pushes will only be a waste of time.

Medicare Part D by the numbers

2006-01-25T11:30:00.000-08:00

Kaiser has released their report examining the number of beneficiaries enrolled so far in Medicare Part D.

Health and Human Services (HHS) has set a goal of 29.3 million enrollees in 2006. As of January 13, 14.3 million beneficiaries have enrolled in Medicare Part D plans. At first glance, that number appears to be 50% of the goal, so things must be on schedule, right?

Wrong. Dual eligibles, or people enrolled in both Medicare and Medicaid, were automatically assigned to a plan. As there are 6.2 million dual eligibles, that automatically enrolled number is almost half of everyone that's signed up thus far. And, it's important to note, those dual eligibles were already getting their medications through Medicaid.

Then there are the Medicare Advantage enrollees. Medicare Advantage acts as HMO-style coverage for Medicare, and with the passage of Part D, many of these Advantage plans added drug coverage. The process for signing up for a Medicare Advantage Part D plan is much simpler than choosing from the larger pool of Part D plans. So far, 4.5 million Medicare Advantage enrollees have signed up.

That leaves only 3.6 million people (out of the 14.3 cited by HHS) who have signed up for stand-alone Medicare Part D plans. Only 25% of those enrolled so far went through the debacle-style enrollment process .

HHS needs an additional 15 million beneficiaries to enroll by the end of the year to meet its goal. With all the dual eligibles (read: automatic) already signed up, that 15 million must comprise only Medicare Advantage and standard Medicare enrollees. In 2005 only 12% of Medicare enrollees had Medicare Advantage Plans. That means the vast majority of the 15 million people who still need to sign up in 2006 will have to go through stand-alone Medicare Part D Plans.

To meet HHS' goal, more than 10 million will have to overcome the "choice," confusion and frustration to participate in the drug benefit. The program needs these people to sign up to ensure its long-term viability and to keep premiums from soaring. So, while states have come to rescue providing temporary coverage and reimbursement, there's been no fix to make it easier for 15 million more people to sign up. There's still room for an ingenious lawmaker to come up with that.

Federal (Medicare) corruption watch

2006-01-25T11:02:00.000-08:00

Just what do you make of this news report?

House and Senate GOP negotiators, meeting behind closed doors last month to complete a major budget-cutting bill, agreed on a change to Senate-passed Medicare legislation that would save the health insurance industry $22 billion over the next decade, according to the nonpartisan Congressional Budget Office.

The Senate version would have targeted private HMOs participating in Medicare by changing the formula that governs their reimbursement, lowering payments $26 billion over the next decade. But after lobbying by the health insurance industry, the final version made a critical change that had the effect of eliminating all but $4 billion of the projected savings, according to CBO and other health policy experts.

The change in the Medicare provision underscores a practice that growing numbers of lawmakers from both parties want addressed. More than ever, Republican congressional lawmakers and leaders are making vital decisions, involving far-reaching policies and billions of dollars, without the public -- or even congressional Democrats -- present.

The corruption scandal involving Republican former lobbyist Jack Abramoff and the bribery plea of former congressman Randy "Duke" Cunningham (R-Calif.) have prompted calls for a restructuring of lobbying rules and congressional practices that make lobbying easier.

Maybe one day, when the slime is scraped off, home care will get a fair hearing in Washington DC. I'm a dreamer, I know.

State corruption watch

2006-01-25T11:01:00.000-08:00

Even as top lawmakers are being convicted of corruption, the criminal investigations of the way the public's business continues to be conducted at the Capitol are intensifying. The latest sign is news of a federal grand jury investigation into a controversial state travel contract. Bringing to justice the ringleaders of the so-called caucus scandal, while important, will not put an end to Wisconsin's political corruption problem, because the problem is not a handful of politicians who lost their way, it's a system that is rotten to the core. Until this system that forces politicians to take out a second mortgage on their souls to run competitively for public office is changed, we'll continue to have more investigations, indictments and convictions.

Another twist on tort "reform"

2006-01-25T10:57:00.000-08:00

Patients sometimes file malpractice suits simply to obtain information about their own treatment. They do this because hospitals routinely refuse to disclose information about their quality of care unless they are taken to court.

Check this out: Claudia Mejia gave birth eight and a half months ago....Twelve days after giving birth at Orlando Regional South Seminole hospital, she was transported to Orlando Regional Medical Center where she became a quadruple amputee. Now she can not care for or hold her baby.

"Yeah, I want to pick him up. He wants me to pick him up. I can't. I want to, but I can't," she said. "Woke up from surgery and I had no arms and no legs. No one told me anything. My arms and legs were just gone."

Her attorney, Judy Hyman wrote ORHS a letter saying, according to the Florida statute, "The Patients Right To Know About Adverse Medical Incidents Act," the hospital must give her the records....The hospital's lawyers wrote back, "Ms. Mejia's request may require legal resolution." In other words, according to their interpretation of the law, Mejia has to sue them to get information about herself.

Don't get me wrong. I don't think the doctors at Orlando Regional Medical Center just hacked off Mejia's arms and legs for no reason. She had contracted both a flesh eating bacteria and toxic shock syndrome, and amputation might very well have been the only option.

Still, if I woke up from surgery with no arms or legs, I'd want to know every last detail about what happened to me. Why should I have to file a lawsuit to get that?

State of the Union: Health care

2006-01-25T10:24:00.000-08:00

Not to belabor the obvious, but: The American health care system is broken.

Skyrocketing costs have placed enormous burdens on families and small businesses. The United States spends approximately $1.7 trillion -- more than 15% of the nation's economy -- on health care, yet the nation still falls behind on basic health care measures. "Health care costs are seen as the primary threat facing our country's economy," and the Bush administration has only made the situation worse. During President Bush's term, "the number of Americans without health insurance has increased by 6.2 million," now totaling nearly 46 million. Most damning, in my mind, is the fact that 11.2% of all children in this country—8.3 million—lack even basic health insurance.

The American health care system needs fundamental reform to be fixed -- "reform that provides affordable coverage to all Americans, controls costs and makes prevention a national priority."

In his 2004 State of the Union address, Bush promised to "extend the benefits of modern medicine throughout our country." But he has not kept his promise; the "number of Americans without health insurance rose by 800,000 last year, reaching a record high of nearly 46 million." The number of uninsured Americans now exceeds "the cumulative population of 24 states plus the District of Columbia." Unless the nation drastically changes course, approximately 52 million are expected to be uninsured for the entire year in 2010.

The #1 reason people are uninsured is because health care coverage is too expensive. Medical bills account for half of all personal bankruptcies. Health insurance premiums for workers have increased by 73%, while wages have grown by only 15% and inflation by 14%.

Bush's 2004 State of the Union promise to work with Congress to "control those [health care] costs" has run hollow. Between 2001 and 2003, national spending for prescription drugs increased by 14%. Employees are increasingly being left to find coverage on their own; nearly half of all small businesses no longer provide health coverage for their workers. Employee contributions for health care have increased 126% over the last 5 years, compared to a 76% increase for employers.

America spends 2.5 times more per capita than the average of other wealthy nations on health care -- which provide health care to all their citizens -- yet the nation still ranks 34th in life expectancy, 41st in infant mortality, and 37th in overall health system performance. Total national health expenditures increased by 7.7 % in 2003 over 2002, "four times the rate of inflation in 2003." Despite high spending and technological advances, "Americans have lower odds of surviving colorectal cancer and childhood leukemia than Canadians," and the confusing American health care system has resulted in "30% of adults in the U.S. -- more than the rate in comparable nations -- have problems with coordination of care."

Racial, ethnic, and socioeconomic disparities still pervade America's health care system. Nationwide, black Americans continue to have higher death rates from chronic diseases than any other U.S. racial or ethnic group. The infant mortality rate for black Americans is twice the rate for whites and the life expectancy for black American males is 7 years less than for white males. Among "Medicare beneficiaries, white patients were more likely to receive high-cost procedures than black patients, and the disparity had increased, in some cases and places, between 1992 and 2001." People with lower incomes continue to have worse health. A failure to address these problems "will inevitably keep us in the lesser ranks of nations in terms of health and health care."

The Bush administration's "consumer-driven health care" plans -- health savings accounts -- are doing more harm than good by shifting costs from the healthy to the sick and allowing prices to rise unchecked. "'Consumer-driven' is a nice slogan, but it turns out buying health care isn't at all like buying clothing," said New York Times columnist Paul Krugman. The Bush administration's implementation of its new Medicare prescription drug plan has been an "unmitigated disaster" and Gov. Tim Pawlenty (R-MN) said, "The new federal program is too complicated for many people to understand, and the implementation of the new program by the federal government has been awful."

The Bush administration's policies have been friendly to one group at least: While many Americans cannot afford coverage at all, drug companies made more profits in 2002 than the other 490 companies in the Fortune 500 combined.

Fixing Part "D"isaster with propaganda

2006-01-25T06:15:00.000-08:00

Bush's new Medicare drug prescription plan is causing growing unease among seniors - according to Reuters, "tens of thousands of people were unable to get medicines promised by Medicare," since the new program began, and not only that, but, "several states declared public health emergencies, and many states announced that they would step in to pay for prescriptions that should have been covered."

So how is the Bush administration going to fix its dreadful Medicare plan? Why, it's nothing a good strong dose of propaganda can't fix!

It turns out that the administration is spending taxpayer cash to send its health advisers on a nationwide tour to prop up flagging support for the plan. After all the good work George W. Bush did promoting his plans to reform Social Security last year, I'm sure this latest tour will be a smashing success.

Oh, and by the way - those states, including Wisconsin, that paid for prescriptions that should have been covered by Medicare? The federal government isn't going to reimburse them. Apparently they've got plenty of money to spend on pumping up the new Medicare plan, but no money to actually fund it. Sounds about par for the course.

Good news update: The Bush administration has "agreed to help repay states that stepped in to buy prescription drugs for poor seniors whose coverage failed under the beleaguered Medicare prescription drug benefit."

Medicare, HMOs, the GOP and secret government

2006-01-25T06:04:00.000-08:00

The conventional wisdom about the Medicare prescription drug bill is that it was a huge giveaway to the pharmaceutical industry. And it was. But the real payoff was to the insurance industry, one of the Republican Party's favorite special interest groups.

Yesterday, the Congressional Budget Office reported on the latest valentine from the GOP to the insurance industry. It turns out that Republicans met in closed session last month to make technical changes to a budget cutting bill that saved the industry $22 billion:

The Senate version would have targeted private HMOs participating in Medicare by changing the formula that governs their reimbursement, lowering payments $26 billion over the next decade. But after lobbying by the health insurance industry, the final version made a critical change that had the effect of eliminating all but $4 billion of the projected savings, according to CBO and other health policy experts.

...."It happens in the dead of night when lobbyists get a [Republican lawmaker] in the corner and say, 'We've got to have this,' " said Rep. Fortney "Pete" Stark (Calif.), the Democrats' point man on Medicare issues. "It's a pattern that just goes on and on, and at some point the public's going to rise up."

[Senate Finance Committee Chairman Charles] Grassley disputed the CBO's interpretation of the change as "ridiculous," dismissing what appears to be a major insurance industry victory as merely a mistake in CBO calculations, not a substantive policy change. He said he accepted the policy change because he "didn't see a big difference from the Senate position and the conference position."

Indeed. Not a "big difference." Then why did the insurance industry lobby so desperately to get it passed?
Read the whole thing. It's another good example of how minor technical changes with huge consequences get inserted into conference reports with no oversight from either the public or from Democrats. Only the lobbyists and the GOP know what's going on.

And it works pretty well. $22 billion is a pretty good payoff for the insurance industry's $24 million in contributions to Republicans during the 2004 election cycle, isn't it? And it all comes out of your pocketbook.

Bush will push health savings accounts

2006-01-24T08:02:00.000-08:00

President Bush's Bold Proposal for 2006 is apparently going to be Health Savings Accounts, a half-baked pseudo-solution to the healthcare crisis that sounds intriguing primarily to people who are young and healthy and therefore don't think they're going to need much health care. That's just the right target audience for a health care plan, isn't it?

Technically, the idea behind HSAs is that you put, say, $2,000 in a tax-free account and then buy a health plan that doesn't pay anything until your expenses exceed $2,000. You pay for your normal health care expenses by drawing money out of the HSA, and if there's any left over at the end of the year you get to keep it. Ezra has more about it here.

For the quick and dirty explanation behind HSAs, here is Peter Gosselin in the LA Times this morning:

Most conservatives — including those in the administration — believe that the root cause of most problems with the nation's health care system is that most Americans are over-insured.

The debate over HSAs is going to get mighty wonky over the next few months, but always keep this explanation in mind as you're trying to make sense of the charges and countercharges. The fundamental idea behind HSAs is not to provide better healthcare, it's to provide less healthcare. Conservatives want you to think twice before spending a hundred bucks for your regular pap smear.

I'm probably going to write enough about HSAs over the next few months to make everyone scream for mercy, especially since I assume the White House will decline to publish an actual plan, leaving us instead to speculate wildly about what they really have in mind. So I'm going to wrap up this post right here. Just remember: If you think more risk, more complexity, and less healthcare are the answer, HSAs are for you. The rest of us will keep pushing for something that actually makes sense.

The Part D doughnut hole

2006-01-24T07:56:00.000-08:00

Speaking of making healthcare more complicated, Michael Hiltzik has another column about George Bush's Medicare prescription drug debacle today:

Let's consider how this system will work in practice, using the drug Actonel, a once-a-week pill routinely prescribed for elderly patients to combat osteoporosis, as an example.

Of the 48 commercial Medicare drug plans offered in Southern California, three don't cover Actonel at all; their enrollees will have to pay full price. Twenty-eight plans require prior authorization. The remaining 17 plans cover the drug, no questions asked.

That's not all. There's wide variation in how much each plan charges for a month's supply. Most price it around $500, or $125 per pill. One lists a month's supply at $470. Blue Shield lists it at $602....[But] any patient can purchase a month's supply of Actonel from drugstore.com, an online pharmacy, for $67.99, cash — spending slightly more for a year's supply than some plans charge for a month.

The column is mainly about the absurd and cynical "doughnut hole" built into Bush's prescription drug plan — the result of policymakers who don't actually care about healthcare policy combined with lawmakers who don't care about anything except pretending that their plan costs less than it actually does. In other words, it's the toxic intersection of incompetence and venality.

Read the whole thing.

GAO warned of Part D failure; CMS blew it off

2006-01-18T14:21:00.000-08:00

Here's a Government Accounting Office report, issued in December, warning that the Bush administration hadn't done enough to make sure the most medically and financially vulnerable Medicare beneficiaries could actually get their drugs. As we've seen over the past two weeks, the GAO was exactly right.

If you do get around to reading it, make sure to check out the part where Mark McClellan, director of the Center for Medicare and Medicaid Services, says the GAO has it all wrong — the part where he insists that "CMS has established effective contingency plans to ensure that dual-eligible beneficiaries will be able to obtain comprehensive coverage and obtain necessary drugs beginning January 1, 2006."

You know, that sounds familiar. The Bush administration is warned that its planning is inadequate but it ignores the advice and plows ahead without listening. Verrrrrry familiar. It's on the tip of my tongue.... Hmmmmm... Help me out here.

Bush orders insurers to cover Part D meds for 30 days

2006-01-17T10:41:00.000-08:00

The Bush administration has ordered insurers to provide a temporary 30-day supply of medicines to Medicare Part D recipients in an effort to control growing problems. The White House also ordered co-pays for low income seniors to be capped at $5 per prescription. The move is seen as an admission that things are not going as smoothly as they could be. Over the weekend, Centers for Medicare and Medicaid Services administrator Dr. Mark McClellan conceded that "thousands" of program recipients have been denied access to their prescriptions in the benefit's first week. Widespread problems have led many states to take action to ensure that those who need medicines get them.

Supreme Court upholds assisted suicide law

2006-01-17T07:57:00.000-08:00

The Supreme Court, with Chief Justice John Roberts dissenting, upheld Oregon's one-of-a-kind physician-assisted suicide law Tuesday, rejecting a Bush administration attempt to punish doctors who help terminally ill patients die. Justices, on a 6-3 vote, said the 1997 Oregon law used to end the lives of more than 200 seriously ill people trumped federal authority to regulate doctors.

That means the administration improperly tried to use a federal drug law to prosecute Oregon doctors who prescribe overdoses. Then-Attorney General John Ashcroft vowed to do that in 2001, saying that doctor-assisted suicide is not a "legitimate medical purpose."

Justice Anthony Kennedy, writing for the majority, said the federal government does, indeed, have the authority to go after drug dealers and pass rules for health and safety.

But Oregon's law covers only extremely sick people -- those with incurable diseases, whom at least two doctors agree have six months or less to live and are of sound mind.

Tuesday's decision is a reprimand of sorts for Ashcroft. Kennedy said the "authority claimed by the attorney general is both beyond his expertise and incongruous with the statutory purposes and design."

"The authority desired by the government is inconsistent with the design of the statute in other fundamental respects. The attorney general does not have the sole delegated authority under the (law)," Kennedy wrote for himself, retiring Justice Sandra Day O'Connor and Justices John Paul Stevens, David Souter, and Ruth Bader Ginsburg, and Stephen Breyer.

Roberts and Justices Clarence Thomas and Antonin Scalia dissented. (If you're keeping score, this will be one that the addition of Alito will not be able to overturn.)

Scalia, writing the dissent, said that federal officials have the power to regulate the doling out of medicine.

"If the term 'legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death," he wrote.

The ruling backed a decision by the 9th U.S. Circuit Court of Appeals, which said Ashcroft's "unilateral attempt to regulate general medical practices historically entrusted to state lawmakers interferes with the democratic debate about physician-assisted suicide."

Ashcroft had brought the case to the Supreme Court on the day his resignation was announced by the White House in 2004. The Justice Department has continued the case, under the leadership of his successor, Attorney General Alberto Gonzales.

Priorities: health care or politics?

2006-01-13T20:58:00.000-08:00

With reports of widespread failure by the federal government to properly enroll seniors in the Medicare Part D program, Governor Doyle announced today emergency measures to ensure seniors and people with disabilities in Wisconsin get the life-saving drugs they need. Elsewhere, it's good to see Republican administrations taking the actual administration of federal programs so seriously:

California officials ordered emergency action Thursday to cover drug costs for 1 million elderly citizens, many of whom have been denied life-saving medications or charged exorbitant amounts because of glitches in the new federal prescription drug program.

Critics said the program, which Bush has touted as the most significant advance in Medicare in 40 years, was fast becoming a public health emergency. California officials said that as many as one fifth of the 1 million elderly, poor or disabled state residents who were switched into the federal program on Jan. 1 could be wrongly denied their medications because of flaws in the program.

In Illinois, Gov. Rod Blagojevich, a Democrat, took action similar to Schwarzenegger's, ordering state funds to be used to provide emergency drug coverage for the elderly. Arkansas Gov. Mike Huckabee, a leading figure among Republican governors on health policy issues, took a similar step Wednesday. Nine states, including Wisconsin, have stepped in to fill the gaps in the federal program.

If George Bush and Karl Rove spent half as much time on the actual governance of the country as they do on figuring out new ways to portray Democrats as weak-kneed terrorist appeasers, seniors might be getting their drugs. But we all have our priorities.

Helping just doesn't pay

2006-01-12T06:47:00.000-08:00

Let's start with the obvious: Chronic care is hard work, but some are asking whether it is worth the effort. Disease management programs are only partially effective because — even if you get it right — it goes against the incentives of doctors and hospitals (to do more, and more expensive, procedures) and health insurers (to get sick people off their rolls ASAP). In a long look at diabetes care, the NY Times comes up with the conclusion that In the Treatment of Diabetes, Success Often Does Not Pay. It‘s a long article but well worth a skim for those of you wondering what’s wrong with our health care system.

We're not alone: Medicare D crashes in other states too

2006-01-11T12:25:00.000-08:00

Problems continued with the implementation of Medicare Part D, as more states said they are experiencing difficulties with the new prescription drug benefit's roll-out. At least six states are now offering recipients aid to help them to purchase needed medicines and others appear ready to launch similar programs. In Massachusetts, there were reports of patients being turned away from pharmacies, despite a pledge by state officials to cover the costs of all prescriptions.

- see this AP article http://lists.fiercemarkets.com/c.html?rtr=on&s=69l,hjiz,osy,lm5q,ekry,jgga,m74o
- and this article from the Boston Globe http://www.boston.com/business/globe/articles/2006/01/11/action_by_state_fails_to_fix_drug_plan_woes/

Medicaid and the Machete Budget

2006-01-10T20:40:00.000-08:00

Remember pre-election 2000 when Bush said that we shouldn't balance the budget on the backs of the poor? He was of course joking (and not just about the balancing part), as Bob Herbert points out in his article -- The Machete Budget.

Contrast the cuts in Medicaid that are in the latest budget with the $10m spent on a bahmitzvah party by a defense contractor who made $70m last year supplying apparently faulty flak-jackets to our troops. And they claim that there’s no war profiteering. Of course in WWII a real American hero, Harry Truman stopped that stuff dead in its tracks.

More garbage about Canada

2006-01-10T20:37:00.000-08:00

An apparently well funded website has decided to “take down” what it calls The Health Care Lies of Paul Krugman. You will quickly have fun spotting the errors, the total bias, and the thinly veiled racism. Of course if you want to know something real and researched about the subject you could do worse than read this.