Health Care 2010: A Battle From Start to Finish

As 2010 comes to a close, The Century Foundation has once again charged us with composing a “Best of/Worst of” list to recount the year’s highs and lows in health care. I am off for vacation tomorrow so my list is still under construction—to be completed at the beginning of the New Year. But as I sit here thinking (TCF is, after all, a think-tank so that is what we’re actually paid to do) it strikes me that 2010 started off with a frantic battle: the last major push in Congress to get enough votes to pass the Patient Protection and Affordable Care Act. After a long and bruising battle in Congress that included strident opposition from most Republicans, the bill squeezed through and was signed into law by President Obama on March 23.

What followed was relief (and a bit of exhaustion for those of us who for months had been writing ferociously, and in the case of Maggie, optimistically, about the bill). There was also a sense of accomplishment and satisfaction that we were finally on our way to achieving affordable, comprehensive health care in this country.

Just One Week before Christmas

Summary: The “Dream Act” seemed to come and go so quickly in the news cycle. Legislation to repeal “Don’t Ask, Don’t Tell,” plus the hoped-for treaty with the  Soviets  pushed the failed bill off the media’s radar screen.

I wrote this post Saturday, but then didn’t put it up on Health Beat because I felt I wasn’t adding anything new to the debate. (Ask long-time Health Beat readers “What do you think Maggie thinks about the Dream Act”? and many could probably write the post themselves.) But as I thought about it, it seems to me that I do have something to say.

We should stop to grieve for these students. And we should put the Dream Act at the top of a liberal agenda next year. I realize that as the Tea Party joins Congress, it will be harder to welcome new immigrants to this country. But the Latino vote will be extraordinarily important in 2012. If only for political reasons, liberals should show their support for this legislation—and force conservatives to try to justify cutting off opportunities for 17-year-olds who live in this country.
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What Does the Tax Cut Deal Mean for Medicare, Social Security and Health Care Reform? --Part 2

When the Obama-McConnell tax compromise passed the House last week, 112 Democrats voted against the legislation. Just 139 Democrats supported the bill. The split within President Obama’s own party underlines the uncertainty as to whether passage of the legislation really represented a “win” either for the president--or for the country.

Bloomberg that “Representative David Obey, a Wisconsin Democrat who is retiring after 40 years,” was among those who expressed his disgust with the deal. “’Wonderful,' he said, as he left the House floor for one of the last times in his career. “Just what we need: [a law that] further exacerbates income inequality in this country.”

“It is a huge giveaway to the super-rich in these tough economic times,” added Representative Jim McDermott, a Washington Democrat. “It just boggles the mind. It’s indefensible, unconscionable.”

According to Bloomberg, even House Speaker Nancy Pelosi, who played the role of a loyal lieutenant by selling the legislation to House liberals, sounded less than thrilled: “I salute President Obama for getting in the bill what is in there,” she said. “I’m sorry for the price that has to be paid by our children and our grandchildren to the Chinese government,” she added, referring to the fact that this bill will add $860 billion, plus interest, to the deficit-- for a total of more than $1 trillion. (China is among the many foreign investors who buy our Treasuries, lending us the money needed to carry an extraordinary amount of debt. As of July 2010, the U. S. Treasury reports that China owned $846.7 billion, or 20.8 percent of U.S. debt held by foreigners.)

What Does the Tax Cut Deal Mean for Medicare, Social Security and Health Care Reform? Part 1

When President Obama struck a deal with conservatives on tax cuts, his opponents set the stage for 2012. With this legislation, the conservative agenda of the Bush administration once again becomes national policy. The goal: to redistribute wealth upward--even if that means letting the deficit balloon.
Not long ago, conservatives on the Deficit Commission were warning that the deficit represents a “cancer” that will "destroy the country from within."

Now, politicians on the right are arguing for tax cuts that will add $858 billion to the deficit over ten years—plus $383 in interest over the same span—bringing the total impact on the national debt to $1.24 trillion through 2020. And somehow, that is suddenly a brilliant idea?

Trust me, there is a method to Mitch McConnell’s madness: The larger the deficit, the more compelling the conservative case for  shrinking entitlements such as  Medicare, Medicaid, Social Security and Health Care reform in 2012.

"Mini-med" Plans: Free-Market Health Care At Its Worst

Thanks to the new health care bill, beginning in 2014, insurers will not be able to set annual caps on medical coverage. Already, since September 23, annual coverage limits on health care costs can be set no lower than $750,000. The idea is that most insured Americans can rest assured that even in the event of a catastrophic illness, their policies will help offset the bulk of their medical expenses. Note that I wrote, most Americans. This provision doesn’t apply if you happen to be one of the 1.5 million mainly low-income workers covered under limited-benefit plans—the so-called “mini-med” plans—offered by McDonalds, Waffle House and other employers that hire low-wage employees.

In October, Joe Barton (R-TX), ranking member of the House Committee on Energy and Commerce and two other Republican subcommittee members, sent a letter to Kathleen Sebelius registering their concern that the new provisions in the health care law would force insurers and employers that offer mini-med plans to drop out of the business. McDonald's, for one, warned regulators that high administrative costs might lead to the company dropping its health insurance plans for 30,000 hourly workers unless it was exempted from this policy.

Tea Party Activists Protest Tax Deal—Will We Have a Public Debate?

It’s nice to know that the liberals are not the only politicians who know how to form a circle, and then shoot directly into the center.

Today, with a critical procedural vote on the tax deal scheduled in the Senate, some Tea Party activists and other conservatives are denouncing an agreement that gives the Republican leadership virtually everything that they might conceivably hope to win from the White House. 

Not satisfied, the party’s right wing is launching an attack. According to The New York Times “a group called the Tea Party Patriots is circulating a petition accusing Republican lawmakers of cutting a bad, backroom deal with the president that violates the principles that Tea Party candidates campaigned on during the midterm elections.

Stent Scandal: A Shocking Story, But Not News

           
Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac stents in the arteries of as many as 585 patients who didn’t need them. A hard worker, he managed to knock off those 585 procedures in just two years, from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for the treatments.

The Baltimore Sun broke Dr. Midei’s story in January. In February the U.S. Senate Committee on Finance, which oversees Medicare and Medicaid, began investigating. Monday, the Finance Committee released a 1200-page report.

The report reveals that Midei was a favorite son of Abbott Laboratories, the company that manufactured the stents. Indeed, in August of 2008, Abbott celebrated the fact that the handy doctor had inserted 30 of the company’s cardiac stents into trusting patients in a single day: “Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home.”  Employees from St. Joseph’s attended the feast.

Opinion: Some Common Stents

Below, a guest post by Dr. Nortin M. Hadler, MD MACP MACR FACOEM
Professor of Medicine and Microbiology/Immunology, School of Medicine University of North Carolina at Chapel Hill and Attending Rheumatologist, UNC Hospitals

The 5-year mortality for a well man after his first heart attack has dropped from 50% to 5% in one generation. The line of people who are taking credit for this happy turn of events is very long. At the head of the line stand the cardiovascular surgeons and interventional cardiologists. They bask in the praise of the media and of their celebrity patients who consider them saviors. If you have survived one of these modern medical miracles unscathed, you feel blessed to live in such a medically advantaged community. If symptoms return, it seems so reasonable to return to this technological fountain. If you survived scathed or ultimately succumb, it means that even modern medical miracles were no match for the magnitude of your affliction.

“Slow Medicine”

Below, Kent Bottles, M.D. reflects on the difference between “slow medicine” and what he calls “UCLA medicine.” (For the full post, see “Kent Bottles’ Private Views” )

“I have been thinking about the difference between slow medicine and UCLA medicine. It has made me realize how complex and difficult it is to transform American health care so that we lower per-capita cost and increase the quality of our lives. And yet we must achieve these two goals.

“Slow medicine is practiced by a small, but growing subculture whose pioneer and spokesperson is Dr. Dennis McCullough, author of the book My Mother, Your Mother: Embracing ‘Slow Medicine,’ The Compassionate Approach to Caring for Your Aging Loved Ones. Slow medicine is a philosophy and set of practices that believes in a conservative medical approach to both acute and chronic care.

“McCullough describes slow medicine as ‘care that is more measured and reflective, and that actually stands back from rushed, in-hospital interventions and slows down to balance thoughtfully the separate, multiple and complex issues of late life.’ Shared decision-making, community and family involvement, and sophisticated knowledge of the American health care system are some of the slow medicine practices that sharply contrast with UCLA medicine.

“UCLA medicine is the status quo where the hospital is the center of the medical universe; where care is often uncoordinated and hurried, and where cure is the only acceptable outcome for both patient and physician. I call it UCLA medicine because the CEO of that well-regarded medical center was quoted in a New York Times Sunday Magazine article as saying, ‘If you come into this hospital, we’re not going to let you die.’   This is a statement that puzzles me as an old time anatomic pathologist.”

I would add that I find the UCLA CEO’s statement more than puzzling; I find it frightening.

I can’t help but think of the doctor who explained: “Once you’re in the hospital, you’re in ‘the system.’”  I imagine a prison door closing behind me. I am now in a place where people no longer ask me what I want.  Instead, they tell me:  “This is what we’re going to do.”

Of course, Bottles goes on to acknowledge that “there are times (serious acute illness correctly diagnosed where there is an evidence-based treatment that has a good chance of success) when I hope I am treated in UCLA’s ICU or operating room by UCLA specialists. However, there are also times as I get older that I hope I end up living in the Kendal-at-Hanover retirement community cared for by a wise and experienced geriatrician like Dennis McCullough and the community’s nurse practitioner; I want my providers to take things slowly and listen to what I want out of life.”

Comparing the Fiscal Commission’s Proposals to the Accountable Care Act

Today, “The National Commission on Fiscal Responsibility and Reform” a bi-partisan group that President Barack Obama appointed earlier this year, released the final version of a report recommending ways to rein in the budget deficit.  I’m not going to try cover all of the Commission’s proposals in this post, but I think it’s important to compare how the Accountable Care Act reins in Medicare spending to the Commission’s more Draconian approach.

The commission takes aim at healthcare for seniors by hiking co-pays and deductibles for Medicare patients without considering what patients can afford. Under these proposals, many middle-class Medicare beneficiaries will not be able to afford health care. Those who are sickest would suffer most. The report then blindly freezes and ultimately cuts Medicare payments to all physicians--ignoring the fact that, today, some are underpaid for essential services.  Finally, it calls for reinstating the dreaded sustainable growth rate (SGR) formula as a benchmark for reducing reimbursements to physicians, beginning in 2015.

Friday, the 18-member panel will vote on the plan. If 14 members of the group say “yea,” it will go to Congress for its consideration.  

 How the Fiscal Commission Would Reduce Medicare Payments to Doctors: The commission’s co-chairs, Alan Simpson and Erskine Bowles, released an outline of the report on November 10 which called for "modest reductions" in Medicare reimbursement for physicians, but did not specify an amount. Today's full-fledged report unveils the numbers.