BHN exclusive: Single payer v. mandated insurance debated in Massachusetts

Some video quotes from the May 30  “Massachusetts Teach-in on Health Reform: Massachusetts Reform as a National Model? ” at Harvard Medical School. Find more video from the conference here.

Dr. Steffie Woolhandler of Physicians for a National Health Plan on single payer gaining momentum. 

6/8 Update:  The meeting Dr. Woolhandler refers to between Single Payer advocates and Sen. Baucus took place on 6/3.   Her husband and PNHP partner, Dr. David Himmelstein attended.  Click here more on that meeting.

 

© Tinker Ready and Boston Health News, 2009

Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Tinker Ready and Boston Health News with appropriate and specific direction to the original content.

 

Jarrett Barrios, former State Sentator and executive director, Blue Cross Blue Shield of Massachusetts Foundation, on the success of the Mass plan, aka Chapter 58.

Find more video from the conference here.

(For a round up of recent Boston news,  see my fresh posting on Mass Device.com.)

All video ©  Boston Health News.

Health Wonk Review: Bosstown edition

Today, BHN hosts the Health Wonk Review, the floating web digest of health policy blog posts.
Guy Aceto/ Backstreets

Guy Aceto/ Backstreets.com

This is Boston, but we already had a baseball theme. Summer reminds me of growing up on  the Jersey Shore. So, this week — the Boss-town edition. Dedicated to Danny Federici,  Bruce Springsteen’s organ player.  He died of melanoma last year.

 For a round up of recent Boston news,  see my fresh posting on Mass Device.com. I blog weekly for this device industry news site.

The Price You Pay

Healthcare Technology News offers a post on the health industry meeting with President Obama: “What We Call Health Care Costs, They Call Income.” The group’s proposed $2 trillion in reductions in the rate of growth of health care costs. They also pledged to reduce the growth in costs by 1.5% each year for ten years. “It’s not enforceable and there are plenty of reasons to view this cynically,” HTN asks. “But is it a signal that health care reform has a real chance this year?”

Joseph Paduda at Managed Health Matters reports on a health reform meeting sponsored by pharmacy benefits company Medco. Of the dozen meetings and press conferences on health reform each week –“This was one of the better ones I’ve (remotely) attended,” he said.  Why? “Because the conversation was realistic, pointed, and quickly got into the reality of health care reform – it’s about cost.” Special extra: retro anti-health reform graphic featuring Ronald Reagan.

Living Proof?

MedicaidFrontPage takes on reform’s hot topic. In “The Public Plan…Balance is the Key to Life,”  Brady Augustine offers updates, thoughts and links on the debate over the public insurance option. He points out that some some states already have public plans for employees or Medicaid recipients.nj post card

At the Health Affairs Blog, Harold Luft  proposes a risk pool as an alternative to the public plan in “Beyond The Public Plan Debate: A Pathway To Transform The Delivery System.”  Luft discusses the “weaknesses of the competing visions for a public plan option.” He outlines his proposed alternative: “a publicly chartered major risk pool that eliminates the need for the problematic behaviors of private health plans while enhancing choices for providers and patients.”

Reason to Believe

Kaiser Family Foundation’s head, Drew Altman, sees big differences in opinion between experts and the public on health care.

 Dave Williams at the Health Business Blog doesn’t think Altman has it quite right. He looks at the Kaiser survey point by point and tells us where he thinks the public stands on issues like HIT, quality and unnecessary care. A post on New Health Dialogue by Joanne Kenen  offers more thought on Altman’s ideas. 

Cadillac Ranch

Julie Ferguson gathers up reports on the potential impact of Chrysler and GM’s bankruptcies on state workers’ comp systems over at Workers’ Comp Insider. For example, she notes that Ohio’s Attorney General Richard Cordray has filed a "limited objection" to the pending sale of Chrysler, claiming the new owner won’t be required to meet workman’s comp obligations. WCI gives a nod to Roberto Ceniceros of Business Insurance for his thorough coverage of the issue.  

 Devil’s Arcade

Casino by Dop Deep via flickr

Photo by Dop Deep

The Health Care Renewal blog offers a post entitled From the “Era of Cyber Hospitals to an Unfinished “Pipe Dream”There, Brown University’s Dr. Roy Poses notes that testimony in the ongoing civil lawsuit against corrupt HealthSouth hospital CEO Richard Scrushy cautions against buying into innovation hype. The “digital hospital” idea HealthSouth trumpeted in 2001 is an empty building. At the trial Scrushy testified that the hospital was a “pipe dream.”

 Dr. Poses digs way back and finds a lot of cheerleading for this failed digital hospital project. “We are constantly bombarded with publicity about the latest health care ‘innovations.’ We are warned, however, that any new regulation of health care corporations may dry up the pipeline of ‘innovations,’ imperiling us all.  Yet how many of these “innovations” actually improve health?” he writes   

 

Are you tough enough to play the game they play? 

Maybe this was an excuse to play video games, but David Porter at the Health Disparities blog explains how researchers are using the World of Warcraft and other “virtual worlds”  to study natural experiments. In this case, he talks about a virtual virus – the kind that attacks player in the game, not the computer.

 For the uninitiated, this involves a using a virus-infected virtual pet to attack the enemy. Porter described it as “an excellent example of a natural experiment and how people may act during a pandemic…” He said researchers analyzed data supplied by the game developer and cites two papers one Epidemiology and another in The Lancet Infectious Diseases.

 

Working on a Dream

jersey6Anthony Wright presents Getting to universal… posted at Health Access WeBlog.  He agrees with with the CBO that an individual mandate by itself won’t get us to universal coverage, but disagrees with other supposed barriers to that goal.

 BNET Healthcare asks “Thought Leaders Propose Health Reforms, But Will They Work?”  The authors of New England Journal of Medicine article favor "accountable care organizations" that would enable healthcare providers to improve quality and reduce cost growth.  BNET thinks their view of physicians and the health care business is “too idealistic to offer a practical road map to reform.”

 Colorado Health Insurance Insider reports that the governor has signed Colorado Senate Bill 88 granting dental and health insurance benefits to domestic partners of gay and lesbian state employees.

 

Spare Parts  

The Health Care Blog offers a post by Mark Leavitt, head of Certification Commission for Healthcare Information Technology, or CCHIT. "Certifying Health IT: Let’s Set the (Electronic Health) Record Straight." In this post, Leavitt responds to accusations that CCHIT is too close to the HIT industry to act as a certifying agency. The charges emerged in stories from the The Washington Post, including one entitled “Group Seeks Sway Over E-Records System.” The Post also reported on the dispute. 

 Neil Versel at Healthcare IT Blog comments on an “outrageous statement” by the CEO of Epic Systems “Vendors, this is your wake-up call”

 

 The Big Muddy

wave 2

Sam Solomon of Canadian Medicine describes a medical crisis triggered by a nuclear accident. “When nuclear nonproliferation is the problem” He describes his post as “an article about the potential consequences, both clinical and political, of the recent shutdown of the nuclear power plant in Ontario that produces about half of the world’s supply of a certain critical radioisotope used in diagnostic imaging exams.”

 In a post entitled Death Form a Thousand Cuts Outside of the Patient Centered Medical Home,  Jaan Sidorov notes “that while health reform may be on the way, there are a surprising number of day to day hassles that are bleeding primary care physicians dry.” From the The Disease Management Care blog

 

Don’t get caught on the wrong side of that line


Mike Feehan at Insureblog contemplates the difference between medical care and health care. “In order to reach meaningful conclusions about the direction of health care reform, we need to understand the relationship of health care to wellness… We can exercise (free). We can get adequate sleep (free). We can steer clear of substance abuse of all kinds (free). We can keep a reasonable diet (free). We can always wash our hands (free). We can hold it down to 85 on the Interstate (free). We can stop smoking or never start (better than free). To a great extent we already have free health care in the U.S.”
  

Better Days

Jason Shafrin at Healthcare Economist notes that Medicare Part D plan was supposed to provide a prescription drug benefit for those who did not have it. The Healthcare Economist reviews a paper that that asked how well the program is working. It found that after the enactment of Medicare Part D,  only 7% of seniors lacked drug coverage, compared to 24% before the launch of Part D.

Glenn Laffel at Pizaazz tell us: “It’s been a long strange trip for Dendreon, the makers of Provenge a new immune therapy for prostate cancer. No one seemed to take the stuff seriously, but now the definitive trial has been completed and lo and behold, it works! No one could be happier than its shareholders.”

Growin’ Up

Philip Zorn presents guest blogger Robert Nelb on Effortless Enrollment Saves Taxpayers $ and Helps Uninsured Children Access Medicaid and CHIP posted at Say Ahhh! A Children’s Health Policy Blog. Nelb talks about a Brookings Institute paper on the need for effortless enrollment in CHIP and Medicaid programs. He makes the case that automatic enrollment would not only save taxpayers money, it could save lives.

 

Spirit in the Night

maxsFind Clearing the Haze – Is Marijuana Addictive?  at Brain Blogger. “America’s most popular illegal drug has remained largely a scientific mystery. It is a drug that millions of Americans have been using regularly for years, and, from a clinical perspective, it remains the least studied illicit drug of all.”

Patient group joins breast cancer gene patent suit

Many Boston orgs have reps working with this not-into-pink,  Bay-area group, including Silent Spring Institute, Our Bodies, Ourselves and local breast cancer activist groups.

 Here from Breast Cancer Action’s press release:

 Breast Cancer Action (BCA) is challenging the legality of patenting human “breast cancer genes.” BCA is joining the American Civil Liberties Union in suing Myriad Genetics (a private biotechnology company based in Utah), that currently holds the patent on the two human genes known as BRCA1 and BRCA2.

The BRCA1 and BRCA2 genes are present in every human. However, people with certain genetic mutations on these genes are at an increased risk of developing breast and ovarian cancer. Myriad holds exclusive rights to these genes and their mutations and to the research performed on them. Testing for the BRCA1 and BRCA2 mutations can only be performed at Myriad labs and currently costs over $3,000.

Since 1998, when BRCA1 & 2 were first patented, BCA has maintained that the patenting of human genes interferes with patients’ access to genetic testing and medical care.

“The time has finally arrived for the courts to decide who owns our genes,” said Barbara Brenner, executive director of Breast Cancer Action.

Here’s a story on the topic from MIT’s Tech Review.

Hospital care: Getting what you pay for

Health care shoppers looking for the best deal should remember the little lagniappe that came with the state insurance plan: The “My Health Care Options” page. This simple database allows patients to compare hospitals on costs and quality.  So, if you get to choose between two hospitals, you can opt for a four-star angioplasty, c-section or  gall bladder operation. (Watch those co-pays; they can add up.)

But an article posted last week on the Health Affairs website suggests that hospitals themselves don’t always get what they pay for. The researchers looked at how much hospitals spend on care , not how much they bill patients. It was written by the practice-pattern variation watchers at Dartmouth and Amitabh Chandraof Harvard’s Kennedy School

Hospital Quality And Intensity Of Spending: Is There An Association?

Here’s the abstract:

Numerous studies in the United States have examined the association between quality and spending at the regional level. In this paper we evaluate this relationship at the level of individual hospitals, which are a more natural unit of analysis for reporting on and improving accountability. For all of the quality indicators studied, the association with spending is either nil or negative. The absence of positive correlations suggests that some institutions achieve exemplary performance on quality measures in settings that feature lower intensity of care. This finding highlights the need for reporting information on both quality and spending.

ALSO

 Coming up this week: BHN hosts the Health Wonk Review, the floating digest of highlights from health bloggers near and far. My job – spare you from an avalanche of people who think they can use it to sell bogus  diets, supplements and nursing degrees.

Marcia Angell, single payer and week in review

Here’s what Marcia Angell would have said about the single payer approach if she had been invited to the Senate Finance Committee health reform meeting this week. Via the Globe.

 The reform proposals advocated by President Obama are meant to increase coverage for the uninsured. That is certainly a worthwhile goal, but the problem is that they leave the present profit-driven and highly inflationary system essentially unchanged, and simply pour more money into it – an unsustainable situation. That is what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are poor without cutting benefits and greatly increasing co-payments.

 Also, you’ll find my week in review on the MassDevice site. There you will find reports like this one:

 Massachusetts Medicaid fraud: Two ways to rip off the poor

The Globe reported this week that a Brookline couple worth $2 million pleaded guilty to fraud and larceny charges after collecting Medicaid benefits for five family members. Joseph and Jila Youshaei reported $475 in income per week and Medicaid paid for the family’s medical bills from 1999 to 2005.

And, according to a Justice Department press release:

“The United States and 16 states have joined in two whistleblower suits filed in the District of Massachusetts against the drug manufacturer, Wyeth, alleging that the company knowingly failed to give the government the same discounts it provided to private purchasers of its drugs, as required by laws governing the Medicaid program.”

Harvard students have drinking problem: bisphenol A

And, when it comes to BPA, the FDA has a little problem with objectivity, according to a report in the Milwaukee Journal Sentinal.

First to Boston. The Globe reports that a Harvard prof was inspired to do a new study on the suspect by-product of some plastics when she saw her student drinking out of bottles.

Led by Jenny Carwile, a Harvard School of Public Health doctoral student, 77 Harvard students in the study drank all cold beverages from stainless steel bottles for a week to wash BPA out of their bodies and minimize exposure. Most BPA is flushed from people’s bodies within a matter of hours. During that week, the students gave urine samples.

Then the students were given two refillable polycarbonate bottles made with BPA to drink all cold beverages from for one week. Urine samples taken over that week showed the students’ BPA levels spiked the second week to levels normally found in the general population.

Here’s a link to the actual study:

Use of Polycarbonate Bottles and Urinary Bisphenol A Concentration

On the FDA end of this story, The Journal Sentinal says it has emails that “show how government regulators relied on the trade association to do much of their work for them. The FDA relied on two studies – both paid for by chemical makers – to form the framework of its draft review declaring BPA to be safe.”

Here’s a take on BPA from that trade association, the American Chemistry Council.

The scientific evidence supporting the safety of bisphenol A has been repeatedly and comprehensively examined by government and scientific bodies worldwide. In every case, these assessments support the conclusion that bisphenol A is not a risk to human health at the extremely low levels to which people might be exposed.

The Council states the current thinking of regulators — now we know why. The environmentalists say the evidence of harm is clear – BPA has to go.

For that point of view, see The Alliance for a Healthy Tomorrow : “A broad coalition in Massachusetts working to pass laws and policies that prevent harm to our health from toxic chemicals.” Here’s why they think the Harvard study is important.  

Well, it has been thought that BPA is mostly a danger when heated, but this study shows that BPA also leaches out of polycarbonate plastic when cooled. This is particularly relevant to the adult population that drinks mostly cold beverages in polycarbonate containers, while it is mostly polycarbonate baby bottles that contain warm liquids.

This Globe story details the group’s effort to get BPA banned in the state.

 

Fun with Health Information Technology — An “Interoperetta”

The actual title of this bit of wonky fun:  “HITECH:An Interoperetta in Three Acts.”  Also on You Tube.

Here, Maryland doctor Ross Martin finds true harmonization. He also comes up with rhymes for two Boston heavies — Obama HIT man David Blumenthal and John Halamka, the CIO at Beth Isreal Deaconess Medical Center. 

 Dr. Blumenthal, Won’t you give me a call/

So I can work at the ONC (Office of the National Coordinator of HIT)…

  We’ll work for Jon Halamka / As for lunch we’ll always comp ya.

I found it this on BIDMC CIO Paul Levy’s “Running a Hospital” blog.

Health Care Reform in 2009: Massachusetts Reform as a National Model?

Note the question mark in the title of this upcoming event.  Also note that the sponsors include supporters of Obama’s plan — Health Care for America NOW! — and the single-payer approach – Mass-Care

Saturday May 30th, 2009, 9:00-3:00, Walter Amphitheater, 260 Longwood Ave

 From the organizers: 

 The Obama administration has pledged to bring forward national health care reform this year. But what does that mean to residents of Massachusetts ? How can we build a movement for real health care reform?

 We invite you to attend the MA Teach-In on Health Care Reform to hear the answer to these and other important questions on health…The event is free, and open to the public.

 The speakers include pharma critic and former NEJM editor Marcia Angell.  She and her new husband – Arnold Relman, another NEJM vet – could become Boston’s second single-payer power couple. In a recent letter to the Globe they claim that the state needs a single-payer system to make their proposed global payment system work. .

The state’s Special Commission on the Health Care Payment System correctly identifies the current fee-for-service system as an incentive to oversupply medical services in an uncoordinated fashion, but the proposed global payment plan isn’t the answer because it could not be implemented in today’s fragmented delivery system with so many independent doctors and facilities.

The most effective way to control costs would be through a single-payer universal funding plan, connected to a care delivery system based on nonprofit, multi-specialty groups of salaried physicians and government-paid, nonprofit facilities.

 

Evidence-based medicine or rationing?

  Liz Kowalczyk’s Boston Globe story on the MGH effort to keep seniors out of the ER struck me on two levels.  First, the plan makes sense.

 Under the Mass. General plan, the federal Medicare program would save millions of dollars, by reducing hospitalizations of several thousand elders by 15 percent to 20 percent while improving their care.

              I spent a lot of time in ERs with my elderly father in the two years before he died. Four or five hours with a sick, grumpy, 87-year-old New Yorker on a gurney.  There has to be a better way.

            But, it is also worth reading down into the comments on this story. (Don’t read them all. They turn into rants from the same two or three people.) Some offer a look at the opposition to a key health reform tactic: evidence-based medicine. Conservatives see it as rationing. Here’s a sample.

 The discussion around controlling healthcare costs has a very ghoulish feel to it, a character reminiscent of “1984″ style hopelessness. If you notice, the effort to control cost is focused on controlling the type of service or care that the patient gets, not making the cost of overall service cheaper and letting the doctor and patient decide what they want to do…

 This is prejudicial cost cutting due to ageism. The elderly will again receive less than quality health care from our hospitals/healthcare systems. How/when do we start placing value on lives, due to age?…

 Reducing costs? Why doesn’t the Globe just call it what it is, which is health care rationing. Health care for all, which is mistakenly called “universal health care” is really health care for none. Obama putting a pro-abortionist in charge of HHS, oama   himself being a radical pro-abortionist, and obama removing Hillary as a threat to his own plans, Mr. obama just reeks of euthanasia…

 Perhaps if we just keep older people out of all care they’ll just die off and save lots of money. wouldn’t the insurers and hospitals just love that ? I bet they would…

 …limit care to the elderly, but give illegals all the care they need.typical Massachusetts/Kennedy/Obama/Democrats…

This “cost cutting” program is just bull! It is health care rationing using a specific population called the elderly . Mass General….you should be ashamed to be so proud of your decisions and actions. Why not look at what you charge for your tests and services…you know, how you continue to get YOUR money so you can built those multi-million dollar buildings!!!! We contributed to your lofty GOALS AND MISSION STATEMENTS and now look what you have done with my hard earned money! Never again

 

Mass reform and Mass Device

Coming to you today from the public library in Gatesville, North Carolina. Yes, that means last night  I had to watch the Bruins go down surrounded by Tar Heels.  

But, you can find my week in review report on MassDevice.com. It includes a link to Senate testimony from Brandeis professor and long time health policy point man Stuart Altman.

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