What Rep. Ryan’s Medicare Proposal Means If You’re Over 55

“Divide and Conquer” is a strategy that has served conservatives well over the years. Remind younger Americans that their elders are “greedy geezers.”  Set the middle-class against the poor, by telling tall tales about welfare queens. Pit the native-born against new immigrants.

And now, Rep. Paul Ryan’s (R-WI) plan for Medicare draws a bright line between Americans over 55 and those who have not yet reached that turning point in their lives. As I explained in an earlier post, Ryan would give folks in that younger group a voucher when they retire, send them out into the private sector to buy their own insurance, and wish them good luck keeping up with health care inflation. Those over 55, on the other hand, would be allowed to keep the federal program that guarantees their care. For once you may think, it pays to be older.

Fact vs. Fear-mongering About the Independent Payment Advisory Board-Part 1

A headline in last week’s New York Times suggested that, at last, conservatives and liberals have found an issue that they can agree on: “Obama Panel to Curb Medicare Finds Foes in Both Parties,” the story announced, referring to the Independent Payment Advisory Board (IPAB) created by the Accountable Care Act (ACA) to monitor and curb Medicare inflation. The article quotes both Democrats and Republicans warning that the panel is, in fact a “rationing board” made up of “unaccountable bureaucrats” who threaten to “endanger patient care.” While spotlighting the board’s opponents, the Times quotes only one Democrat who supports the bill: Senator John D. Rockefeller IV, (D, W.VA), the chief architect of IPAB. One is left with the impression that legislators have found a righteous bipartisan cause, and that the IPAB is likely to be repealed.

Then, there are the facts:  Exactly four Democrats have signed on to Rep. Phil Roe's (R-Tenn.) IPAB repeal bill:  Reps. Shelley Berkley (D-Nev.), Michael Capuano (D-Mass.) Larry Kissell (D-N.C.) and Rep. Allyson Schwartz (D-Pa)  Meanwhile, in his recent speech on the deficit, President Obama made it clear that that he has no intention of eliminating the board; to the contrary, he hopes to strengthen IPAB. Any legislation that attempts to kill or seriously weaken the Independent Payment Advisory Board faces a certain veto. In other words, reports that IPAB is about to be repealed are greatly exaggerated—as are suggestions that IPAB poses a threat to Medicare beneficiaries.

This Year’s Pulitzer for Sophistry

Joseph Rago, a senior editorial writer for the Wall Street Journal, won a Pulitzer Prize yesterday for a collection of pieces that mount a relentless attack on the federal health care law that he derogatorily refers to as “ObamaCare.”

Editorial writing by definition requires the author to take an opinion—and sometimes to offer prescriptive alternatives. The Pulitzer Prize board says Rago's columns are “well-crafted, against-the-grain editorials challenging the health care reform advocated by President Barack Obama.” And in the partisan battle that continues to surround health reform, clearly there is an important role for just this kind of bully pulpit. But if you read Rago’s body of work you will find editorials that are perhaps well-crafted stylistically (i.e. he’s not a bad writer), but his staunchly conservative opposition to the Affordable Care Act relies on oft-repeated mistruths. In fact, his criticisms of the health law pretty much go “with the grain” of those who have led the attack against not just the Affordable Care Act but against Obama’s leadership in general.

In fact, Rago’s series of columns promote opinions that are the standard fare on Fox News and spouted as fact by other right-wing pundits. He assails the individual mandate as unconstitutional, warns that “ObamaCare” actually is a government take-over of health care and charges that Accountable Care Organizations will lead to a dangerous consolidation of power that will increase costs by crushing competition and ending the “autonomy of independent practice.” He misstates figures concerning health spending and savings and repeats alarmist misinformation.

Health Care Reform and the Market’s Response: Is Reform Already Baked Into the Cake?

While markets may lack the rational intelligence needed to become the “invisible hand” that guides constructive change, free markets (and the shrewd marketing experts that corporations employ), can be quite astute when it comes to responding to changing trends. This is, after all, a matter of survival.  If they don’t get ahead of the trend, they risk a rendezvous with a moving train.

Although members of the American public may not be at all certain what the Affordable Care Act will mean for them, insurers, hospitals, drug makers and device makers have made it their business to read the legislation carefully. These companies realize that it would be reckless to assume that the legislation will be repealed:  their competitors already are preparing for change. Thus, market-watchers say that in the medical marketplace, reform is becoming a reality as the health care industry implements fundamental changes in insurance coverage, access, payment, and how health care is delivered.

New Health Indicators Site is a "Treasure Trove" of Valuable Data

At a meeting last week of health care journalists, Centers for Medicare and Medicaid Services director Donald Berwick unveiled a new government site called the Health Indicators Warehouse (HIW) that provides public access to what he calls “a treasure trove of data.”

According to Covering Health, the blog of the Association of Health Care Journalists, HIW includes “information never released before in an easily accessible form, including patient safety data, preventive health care indicators, Medicare payment claims and hospital performance at the state and hospital referral region level. Information is searchable by topic, location, health outcomes among other factors.”

Once on HIW, you can search for information on a whopping 1,119 health indicators—including adolescent health issues, hospital readmission rates, obesity statistics, patient safety data and many, many more—broken down by topic, geography and by initiative.

Using Medicare’s Clout to Negotiate Drug Prices—Did Obama Put That Back On The Table?

This week during his speech at George Washington University, President Obama said one of the ways he plans on cutting Medicare costs is to cut government spending on prescription drugs by $200 billion over ten years. He said, “We will cut spending on prescription drugs by using Medicare's purchasing power to drive greater efficiency and speed generic brands of medicine onto the market.”

With this statement, Obama seems to suggest that he wants Medicare to use its clout and to start negotiating prices directly with pharmaceutical companies, something the Veterans Administration, for one, has been doing for years. The only problem is that back in 2006 when Congress expanded Medicare to cover prescription drugs, the law included a gift to drug companies that specifically prohibits the government from directly negotiating on drug prices.

While campaigning for the presidency, Obama often spoke about taking on drug companies and allowing Medicare to have bargaining power over prices. He also supported the re-importation of cheaper prescription drugs from Canada as a way to lower health care costs. But in order to get Pharma support for the Affordable Care Act, these two measures were taken off the table and left out of the legislation.

Addicted and Mentally Ill Patients: Just As We Stigmatize Them, We Undervalue Those Who Try to Help Them

A licensed social worker with a master’s degree earns less than a manager of a fast-food restaurant, according to the 2011 Behavioral Health Salary Survey just released by the National Council for Community Behavioral Healthcare. The survey finds that the nation’s mental health and addictions treatment professionals are paid far less than their counterparts in other health care sectors.
 
“Just as people with mental illnesses and substance-use disorders are routinely stigmatized, it appears those working in the behavioral health sector are also treated differently—even within the health care community,” says Linda Rosenberg, National Council president and CEO.

Why the stigma? A few reasons come to mind.

Some people believe that it isn’t worth spending much on caring for and counseling the mentally ill because “they’ll never  be able to make much of a contribution to society.” (I recall an attorney who was defending a city that refused to follow state laws about educating and mainstreaming handicapped children explaining to me that:  “These kids will never get good jobs and pay enough in taxes to return on the investment the city would be making in their education.” )

Reducing the Cost of Medical Errors: Spend A Little To Save A Lot

When hospitals make errors, patients end up injured, have longer hospital stays and some 100,000 or more die each year as a result. If patients are discharged too soon or without adequate care instructions, follow-up doctor appointments and few links to community or home-care services, those patients often end up bouncing right back into the hospital in fewer than 30 days.

From these blunders come significant costs—measured in terms of injury and death as well as dollars spent on “measurable medical errors” (those that cause harm to patients) and higher hospitalization charges. According to an April 7 report in Health Affairs, medical errors now cost our over-burdened health care system some $17.1 billion a year; the cost of avoidable hospital readmissions adds another $13 to 18 billion dollars a year.

Another study in the same issue of Health Affairs found that up to one-third of all hospital stays lead to hospital-related injuries ranging from serious acquired infections to deadly surgical mistakes. Don Berwick, the Administrator of the Centers for Medicare and Medicaid Services, said the study “raised the stakes by finding … that the number of adverse events could be ten times greater than we originally thought.”

Bribing Doctors

Over at GoozNews.com, Merrill Goozner raises a very good question. Under the headline “SEC Slaps J&J with $70 Million Penalty for Overseas Corruption” Merrill asks: “What’s the difference between what the medical supply company did abroad compared to what it or companies like it do every day in the U.S.?”

My response would be “not much”—except that U.S. patients are the victims when these companies bribe our physicians.

Goozner continues: “Forget for a moment that Johnson & Johnson was also accused of paying kickbacks to the Iraqi government to illegally obtain business. The Securities and Exchange Commission’s main charge accused J&J of “bribing public doctors in several European countries.”

“Here’s how the press release described the violations:

“Since at least 1998, subsidiaries of the New Brunswick, N.J.-based pharmaceutical, consumer product, and medical device company paid bribes to public doctors in Greece who selected J&J surgical implants, public doctors and hospital administrators in Poland who awarded contracts to J&J, and public doctors in Romania to prescribe J&J pharmaceutical products.

“Moreover, according to the SEC’s complaint filed in federal court in the District of Columbia, public doctors and administrators in Greece, Poland, and Romania who ordered or prescribed J&J products were rewarded in a variety of ways, including with cash and inappropriate travel. Another violation: J&J subsidiaries, employees and agents used ‘sham civil contracts’ with doctors.

“These wouldn’t be consulting agreements, would they? I fail to see how J&J’s actions abroad in these particular aspects of the case were any different from what makes the front page of the New York Times and the Wall Street Journal every couple of months with regard to payments to U.S. physicians for attending dinners and lectures, installing preferred medical devices, and offering sham consulting agreements. In 2007, the government brought a major case against five device companies that temporarily cracked down on these practices. A week ago, a front page story told us these practices continue unabated at least one major U.S. hospital. Where are the ongoing investigation indictments in those and other cases?”

Read the rest of Goozner’s post--and see his recommendation that we pass a Corrupt Domestic Practices Act. 

 

The Illusory Side of “Comparative Effectiveness Research”

 

Below, a Guest Post by Dr. Nortin M. Hadler, Professor of Medicine and Microbiology/Immunology, University of North Carolina at Chapel Hill and Dr. Robert A. McNutt,  Professor of Medicine, Chief,  Section on Medical Informatics and Patient Safety, Rush University Medical Center, Chicago.  Their argument that comparative effectiveness research (CER) needs an “anchor”—one treatment with known efficacy—is a good one, and gave me a new perspective on CER. In their analysis of randomized controlled trials, they highlight the crucial question: how high should we set the bar to consider the results of the trial compelling?

                                              ABSTRACT

“Comparative effectiveness research” is now legislated as a priority for translational research. The goal is to inform decision making by assessing relative effectiveness in practice. An impressive effort has been mobilized to target efforts and establish a methodological framework. We argue that any such exercise requires a comparator with known and meaningful efficacy; there must be at least one anchoring group or subset for which a particular intervention has reproducible and meaningful benefit in randomized controlled trials. Without such, there is a likelihood that the effort will degenerate into comparative ineffectiveness research.

As charged in the American Recovery and Reinvestment Act, the Institute of Medicine defined comparative effectiveness research (CER) as “ …the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care… at both the individual and population levels.”