Still wondering about Scott Brown and health reform

His opposition to the Senate plan was a big factor, possibly a turning point, in his win. Sunday’s NY Times Magazine profile of Sen.Scott Brown gives pretty much zero insight into what our new senator plans to do about health reform.  The story does suggest he didn’t explain his plans very clearly in the campaign.

….If he wasn’t particularly eloquent in explaining why he opposed federal health care legislation modeled largely on a Massachusetts measure he supported, he nonetheless made it through interviews and debates without any outsize flubs.  

Here’s Scott’s position on health reform from his web site. He supports “private market system with policies” that will cut costs and expand coverage. Details would be good since many argue that private solutions haven’t worked so far.  

I believe that all Americans deserve health care coverage, but I am opposed to the health care legislation that is under consideration in Congress and will vote against it. It will raise taxes, increase government spending and lower the quality of care, especially for elders on Medicare. I support strengthening the existing private market system with policies that will drive down costs and make it easier for people to purchase affordable insurance. In Massachusetts, I support the 2006 healthcare law that was successful in expanding coverage, but I also recognize that the state must now turn its attention to controlling cost.

So, despite his key role in blocking the Senate bill, Sen Brown did not get and invitation to the Health Summit. But Tufts grad student Timothy Ridout, writing in  The Christian Science Monitor, thinks Brown could engage in some elusive bipartisanship. 

Will he join Republicans in efforts to “break” Mr. Obama, or will he work to break gridlock in the Senate? This is not just about passing healthcare reform; it is about whether anything will get done in Congress. At a time when the country needs an effective legislature, Congress seems incapable of rising above partisan bickering, which explains why respected moderates such as Sen. Evan Bayh (D) of Indiana are leaving in frustration.

Brown can serve Massachusetts and the country by restoring the lost art of compromise. As a Republican representing a liberal state, he is uniquely positioned to foster bipartisanship by balancing the interests of his party with those of his constituents. If he chooses mere obstructionism, he will have a lot of explaining to do when he faces voters in 2012. 

Moreover, he is the successor to Sen. Ted Kennedy, a man beloved by his constituents. Brown may feel some pressure to pick up Kennedy’s fallen standard and say to the nation, “Let’s solve our problems.” Kennedy was a staunch liberal, but he was known for his willingness to work with his conservative colleagues to advance important legislation.

 The latest from Brown,  via his spokeman, it that he is again reconciliation. From the 2/23 Boston Herald: 

“If the Democrats try to ram their health-care bill through Congress using reconciliation, they are sending a dangerous signal to the American people that they will stop at nothing to raise our taxes, increase premiums and slash Medicare,” said Brown spokesman Colin Reed in a statement. “Using the nuclear option damages the concept of representative leadership and represents more of the politics-as-usual that voters have repeatedly rejected.”

So, we know what he’s against. It would be nice to know what he’s for.

Also,  note the post on WBUR’s Commonhealth on last week’s meeting of local universal care activists

Health care summit streaming live

Health care summit streaming live via the excellent Association of Health Care Journalists.  Or from The White House.  (11:45 Both appear to be down and the moment.)

For live blogging: a view from the right at the Cato Institute and a view from the left at the Daily Kos.

Also, it is worth noting that health care reform marches on in Massachusetts without action in Congress.

See the Globe’s story today about one group of doctors sending  most of their patients to a hospital willing to coordiate care with primary care docs. (Disclosure: I am a Harvard Vanguard patient.)

Harvard Vanguard Medical Associates said it has started sending many of its Boston patients to Beth Israel Deaconess Medical Center, unless the patients have a prior relationship with a doctor at the Brigham, where Harvard Vanguard doctors have referred nearly 100 percent of Boston patients for years.

Dr. Gene Lindsey – chief executive of Harvard Vanguard’s parent organization, Atrius Health – said he felt the organization could better coordinate care at Beth Israel Deaconess, partly because the hospital has agreed to send patients back to their primary care doctor or a specialist at Harvard Vanguard after their inpatient stay, rather than keep them in the more expensive hospital system.

Atrius, which has more than 800 doctors, is also shifting many of its new orthopedic referrals to New England Baptist Hospital from Faulkner Hospital, which is part of the Brigham. Atrius doctors did 1,000 procedures at the Baptist last year; Lindsey said he expects that number to double this year, a move driven in part by the Baptist’s success at reducing surgical infections.

There is also a substory here about the expansion of digital health care.  Read here from John Halamka’s blog. 

Cancer Cocktail Crusader Comes to MGH

A  bit overstated but here is the NY Times story about Dr. Keith Flaherty of University of Pennsylvania. He’s trying to do good medicine and targeted therapy within the corporate culture of drug studies. The story reports that, starting next month, Flaherty will oversee targeted therapy development across all cancer types at Massachusetts General Hospital.

He had some luck with a drug for melanoma called PLX4032. Then the cancer came back.

The problem, which had bedeviled targeted therapies for other cancers, was that while PLX4032 blocked the protein made by one mutated gene, a second mutation now seemed to be driving the cancer’s growth. If that mutation could be identified, they believed, its protein could also be blocked, in a game of biological Whac-a-Mole that just might be possible to win….

For his part, the doctor would try to keep his patients alive. And he would work to convince the pharmaceutical industry that the fastest path to finding a combination that really worked would require changing their standard operating procedure.

One of three stories from Amy Harmon in The Target Cancer series. Which ”chronicles the first human trial of an experimental cancer drug, exploring the challenges that face the doctors and

On Point:Reliable Sources on Health Reform

WBUR’s On Point offers an hour on Obama’s latest – or last? — push for health reform. BHN’s ears turns up the volume when NPR’s Julie Rovner is a guest. She’s been covering health reform in Washington for many years. Rovner reliably offers the background and clarity that many people need to understand this complex issue. Tune in now, or at 7  p.m. or listen on-line after 3.

Patient Deaths, Doctor Shortages and Reform in Maine

Also, Obama’s proposal is up.

More coverage here.

The Globe had a good story Sunday on a fatal device breakdown at Mass General

 Looking at the second paragraph, it appears this story was heavily lawyered, as we say in the news biz — edited with liability in mind. It lists everything that MGH has done since and goes on to quote someone saying these devices are faulty.

A Massachusetts General Hospital patient died last month after the alarm on a heart monitor was inadvertently left off, delaying the response of nurses and doctors to the patient’s medical crisis.

Hospital administrators said they immediately began an investigation, which led them to inspect and disable the off switch on alarms on all 1,100 of Mass. General’s heart monitors within a day of the death. The hospital also has temporarily assigned a nurse in each unit to specifically listen for alarms, out of concern that sometimes even functioning alarms can’t be heard over the din of a busy ward.

Patient safety officials said the tragedy at Mass. General shines a spotlight on a national problem with heart sensors and other ubiquitous patient monitoring devices. Numerous deaths have been reported because alarms malfunctioned or were turned off, ignored, or unheard.


From AP via WBZTV

ME Lawmakers Urged To Keep Working On Health Care

AUGUSTA, Maine (AP) ― Many measures aimed at expanding health care coverage in Maine should await final action in Congress, but policymakers should not stop working on the issue, Maine insurance regulators say.

In a preliminary report, the state Insurance Bureau says Maine’s options to improve access, affordability and security in the health care system will vary depending on what, if any, federal laws are enacted. Separate bills passed by the U.S. House and Senate await final disposition.

KHN story on rural doctor shortages cites Mass fix: Make nurse practitioners primary care providers.  (Note. I wrote a story about 15 years ago about how the county featured here had no doc. It is very isolated part of the state. NC has a good rural health program but it can be hard to keep them down on the farm.)

Why Mass Voters Rejected Senate Health Bill

You might be surprised. According to a poll by Move On, quite a few of them didn’t think it went far enough – even among those who voted for Brown.

After the Massachusetts special election, MoveOn and the Progressive Change Campaign Committee commissioned a poll of Massachusetts voters who backed President Barack Obama in 2008 but supported Brown or didn’t vote.

Among those who voted for Brown, the poll found that 48 percent opposed the Senate health care bill — and 36 percent of them said it was because the legislation didn’t go far enough, as opposed to 23 percent who felt the bill went too far.

Among the Obama supporters who stayed at home, 53 percent said the Senate legislation didn’t go far enough in reforming the system, while just 8 percent said it went too far.

The poll also showed overwhelming support — 82 percent — for a government-operated health insurance plan similar to Medicare that would compete with private offerings.

Politico reports that some progressives are looking at the demise of the Senate bill as an opportunity to push for broader reform.

Plenty of Democrats viewed the Massachusetts Senate upset as a message to move cautiously. But some are convinced Scott Brown’s victory sent just the opposite message, which means the sort of intraparty power struggle that got nasty during the health care debate isn’t likely to go away anytime soon.

This week, progressive groups that ran ads pushing Democratic moderates to embrace sweeping reform efforts are expected to launch a new round of ads that are likely to target the party’s already vulnerable incumbents.


For my UA-Huntsville biologist friend

 He survived Friday’s shooting  because he was at the far end of the room. But, he had to live through it.  (We were undergrads at BU.)

Gun control opponents say guns don’t kill people. But research shows that easy access to guns leads people to use them to shoot other people.

For years, gun violence has been recognized as a public health issue. Here are some APHA links.

Harvard has a gun violence research center with stats like this:

Guns and homicide (literature review).
We performed a review of the academic literature on the effects of gun availability on homicide rates.
Major findings:  A broad array of evidence indicates that gun availability is a risk factor for homicide, both in the United States and across high-income countries.  Case-control studies, ecological time-series and cross-sectional studies indicate that in homes, cities, states and regions in the US, where there are more guns, both men and women are at higher risk for homicide, particularly firearm homicide.

Publication:  Hepburn, Lisa; Hemenway, David.  “Firearm Availability and Homicide: A Review of the Literature.” Aggression and Violent Behavior: A Review Journal.  2004; 9:417-40.

The Ethics of Force-Feeding Hunger Strikers


 BU Experts to Discuss Hunger Strikes and ‘Secret’ Force-Feeding Practices at Feb. 23 Forum

The  forum, “Hunger Strikes and Physicians,” will feature experts who have studied the legal and ethical questions surrounding physicians’ involvement in force-feeding hunger strikers at Guantanamo and U.S. prisons  and who worked to change the practice during the Bush administration . The event will include film clips showing the actual force-feeding of prisoners, a process in which detainees are placed in restraints and fed Ensure or other nutritional supplements through a nasogastric tube. Human rights advocates, including the International Committee of the Red Cross, and physicians’ groups, including the AMA and the World Medical Association, have deemed the practice inhuman and degrading. “We want to educate people about this practice, which has been conducted in secret — and, as importantly, talk about what physicians and the public can do to try to end it before it becomes accepted American policy, ” said George Annas, professor and chairman of health law, bioethics & human rights at BUSPH, who has been an outspoken opponent of the force-feeding of hunger strikers for years. 

Annas will be joined at the forum by Michael Grodin, MD, professor of health law, bioethics and human rights and professor of psychiatry at the BU School of Medicine; Sondra Crosby, MD, an internist at Boston Medical Center, associate professor of medicine and assistant professor of health law, bioethics & human rights who has visited Guantanamo and other  U.S.  prisons to conduct medical exams on hunger strikers  at the request of their lawyers ; Caroline Apovian, MD, an associate professor of medicine who heads the nutrition center at Boston Medical Center; and Scott Allen, MD, a physician from Brown University who specializes in prison medicine.  Crosby, Grodin and Apovian are co-authors of the leading medical article on caring for hunger strikers, which appeared in the journal JAMA in 2007.  

The forum will be held Tuesday, Feb. 23, from 4 to 6 p.m. in the Hiebert Lounge, located on the 14th floor of the School of Medicine at 80 E. Concord Street. It is open to all students, faculty, staff, media and interested community members.


Local Battles over Health Care Costs, Quality and Coverage

Health reform is about controlling costs, improving the quality of care and expanding coverage.  Here’s  how all that is playing out in New England this week:

 Barbra Rabson, executive director of the non-profit Massachusetts Health Quality Partners offers details on a new statewide quality of care report on WBUR’s Commonhealth blog.

While MHQP is only one of many organizations in the state that is dedicated to advancing the quality and safety of health care, we have the longest track record of public reporting, so, with six years of data behind us, what can we say about the quality of patient care in Massachusetts?

 Nurses picket Tufts and BMC over staffing levels (in case you missed the full-page ad in the Globe.)

 The registered nurses of Boston Medical Center’s East Newton Campus and Tufts Medical Center, who are represented by the Massachusetts Nurses Association, are taking the unprecedented step of conducting joint informational picketing outside their respective facilities on Feb. 11, 2010 to protest what they believe are dangerous changes in RN staffing levels, which will result in nurses caring for too many patients at one time and could compromise the quality of patient care.

 From the Globe: Gov wants to review increases in health care costs and premiums

 Governor Deval Patrick is seeking sweeping authority to review and reject rates charged by hospitals, physician groups, medical imaging centers, and insurers, in a broad new effort to make health care more affordable, particularly for smaller companies and their workers.

If you can pick through the foaming at the mouth comments on the story, you’ll find BIDMC head Paul Levy offering the unenthusiastic hospital point of view.

WBUR’s Commonhealth, again, gets reaction.

Both Lora Pellegrini, acting president and CEO of the MA Association of Health Plans, and Lynn Nicholas, president and CEO of the MA Hospital Association argue — not surprisingly — that the governor’s plan may not address the thorniest problems contributing to rising costs.


 From AP: Maine lawmakers consider lifetime coverage limits

AUGUSTA, Maine –One of the strongest supporters of a bill to prohibit health insurance companies from setting annual and lifetime limits on the amounts they will pay couldn’t be at a legislative hearing on the measure Wednesday because he has cancer and was getting a blood transfusion.

Since Richard “Rocky” D’Andrea’s cancer was discovered in 2008, the 63-year-old Limerick man also found out that his insurance policy carried a $250,000 lifetime cap, his wife Theresa told the Insurance and Financial Services Committee. Now the couple are struggling to keep their house. Their credit cards are maxed and they’ve spent all of their savings and retirement, she said.

After paying a combined 60 years in taxes and years of insurance premiums, “we are in financial ruin,” D’Andrea said. “We are asking ourselves who will answer our call for help.”

Theresa D’Andrea joined others in asking the committee to endorse a bill similar to one of the major health insurance proposals under consideration in Congress. Insurance companies say eliminating the caps will have a cost that would be reflected in higher premiums.


Computers, Health and Boston

A couple of items of note on computers and health AKA  health information technology:

Even though the federal government is spending $2 billion to wire the health system, Heathcare IT News reports that, Vish Sankaran, speaking in Boston for the federal HIT effort, said: “We don’t want the federal government to be in this business forever.” The aim, he said, is for government to “raise the bar, tip the market,” and then engage with the private sector…

Mass Device has a long Q & A with one of the local industry players: … PatientKeeper Inc. president and CEO Paul Brient on why healthcare IT won’t save the healthcare system, why it’s still crucial to healthcare reform and how it could revolutionize the practice of medicine.

A bit of background.  The idea that computers can cut health care costs seems pretty abstract. But, with all the money wasted on claims processing, prescribing errors and questionable care, it makes sense. Computers could get at the cost of administration, medical errors and unnecessary testing and treatment. So, the Feds are investing $2 billion into the push for electronic medical records, computerized prescribing and patient portals.  BHN and the Globe have reported that docs and policy makers from Massachusetts – in many cases on loan from Partners – are deep into the government planning. A huge industry is growing up around it, much of it here.

To see some of how this will work, see  a post from Dr. John Halamka on connecting BIDMC with a network of area doctors.  Dr. Halamka is the CIO of Beth Israel Deaconess Medical Center.

Nationally, the effort has hit some rough patches, he notes. In a recent blog post, the self-described geek doctor tries to put the setbacks into perspective.

It’s 2010 and everyone in healthcare IT is complaining. Meaningful Use is too hard. Too many grants have simultaneous deadlines. There are more policy and technology changes than ever before in history.


In another post, he and his class came up with a list of potential barriers to getting medical record into computers.

 The creation of a digital health will be complex and problematic. For a less wonkish, more local  perspective on all this, BHN senior writer Tinker Ready spent some time in Newburyport this fall reporting on the effort to wire that town for healthcare. Her radio report ran on WBUR radio’s “World of Ideas” on  Dec. 27.  Click here to listen to the Newburyport story alone or here to listen to the entire show.


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