Hounded ex-Medicare chief Berwick back in Boston

Donald Berwick, who was hounded out of Washington for saying something nice about the UK health system, is back in town and on WBUR today.

Also check out today’s NTYimes op/ed by Joe Nocera:

Dr. Donald Berwick was already in Massachusetts when I spoke to him Sunday afternoon. He was back in the Newton home where he’d lived for 30 years, being pleasantly interrupted during our conversation by his 2-year-old grandson. His last day in Washington as the administrator of the Centers for Medicare and Medicaid Services had been Thursday. Friday was packing day. Saturday was moving day. And, by Sunday, he was already talking about his too-short, 17-month tenure as the nation’s top Medicare official in the past tense. Which, alas, it was.       

Dr. Berwick, I’m here to tell you, was the most qualified person in the country to run Medicare at this critical juncture, and the fact that he is no longer in the job is the country’s loss.

Health policy digest takes on reform loopholes and clueless reporters

The latest edition of the roaming digest of health policy blogs;

Health Wonks – the SuperHero Edition!!!

The deficit battle is on and politicians are in full voice – both in Washington and out on the hustings, where GOP candidates are loudly denouncing health reform as unAmerican and a job killer.  Hipsters and greying hippies are occupying Wall Street and Main Street, while Tea Partiers are claiming they hold the title of most outraged.  The one percent is wondering what the 99 percenters are so upset about, while the 99 percenters are after their well-coiffed scalps.

Into the bloody fray, with nary a fear for life or health, reputation or career, plummet our worthies, those denizens of the blog-o-sphere that specialize in separating the non- from the -sense, the BS from the fertilizer, the ill-formed opinion from the logically-based interpretation!

Join us as we follow their heroic deeds, gasp as you read their trenchant and timely missives, awed by their grasp of the incredibly-esoteric and yet critically important.

Occupy Health Care: Boston protesters say Wall Street makes them sick

While health reform may not be at the top of their agenda, some of the Occupy Boston protesters down at Dewey Square had no problem linking the high cost of medical care to their complaints about Wall Street.  Some support Obama’s reforms; others called for a single payer system. But, nearly everyone interviewed had universal health care on his or her list of demands.

Even MIT professor Noam Chomsky said  the health care system is tainted by what he described as a government dominated by private corporations. Speaking on Saturday night, he told the crowd that the  federal budget deficit could be eliminated if the US had a health care system like other countries in the developed world — presumably single payer.

Medicare itself is not the problem, he said.

“It’s a problem because it goes through the privatized, unregulated system,” he said. “It is totally dysfunctional. You can’t talk about this in Washington because of the power of the financial institutions. “

More from the rank and file below.

Occupy Boston and Health Care

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NHS: Maybe they fund fruit fly research too

Not to knock  my UK colleagues, but –would it be fair to say that maybe the headlines of some British newspapers are not the best source of information about England’s National Health Service?

 More demonizing of CMS nominee Donald  Berwick – who has said he “loves” the UK plan — in a column in today’s Globe, under the headline:” Dangerous to our health.”

 …(T)hose who have to live with the NHS and its “bottlenecks’’ don’t always find them so admirable. The British press has been reporting horror stories about the realities of government-run health care. Some recent headlines give a sense of the coverage:

“Overstretched maternity units mean mothers face a 100-mile journey to have baby.’’

“Hundreds of patients died needlessly at NHS hospital due to appalling care.’’

“Cash-strapped NHS trust introduces rationing for common children’s conditions.’’

“Standard of care in some wards ‘would shame a third world country.’ ’’

“Stafford Hospital caused ‘unimaginable suffering.’ ’’

No one can deny that America’s health care system is flawed in many ways. But when it comes to the standard that matters most — the quality of health care provided — our haphazard, expensive, insurance-based system towers above the NHS.

The comments are rolling in:

One reader says:

  Normally, a (Jeff) Jacoby column should be taken with a few tons of salt when it comes to facts. But this one really is flawed beyond belief. I have met many Brits during my travelsand, while they will complain about the NHS, I have never met any that thought it should be done away with. When I explained how our “free market” health system actually worked they tend to react with horror. When I tell them about Republican criticisms of the NHS in the United States they usually say they are ridiculus. General overall health in Britian, they tell me, is pretty good as a result. And no one fears denial of care based on ability to pay or bankruptcy because of illness.

As for the rather shocking headlines, I decided to check them out–one is from a blog (we all know the truth value of most political blogs), two are from the Daily Mail, a tabloid paper famous for supporting fascists before the war and at least one was based on tory party propoganda from the recent election. Two were from the Daily Telegraph, derisively known as the torygraph and connected with Rupbert Murdoch. One was from the Sunday Times (the Staffordshire Hospital story) which referred to the conditions at that hospital an “anamoly”, led to a clearing house of the management of that hospital and is leading to a review of accredidation of hospital managers.

 Another offers a conflicting view of the stats. The numbers indicate international rankings:

 Per capita costs, in dollars:
#1 US: 4361.
#16 UK: 1754.
http://www.nationmaster.com/graph/hea_hea_car_fun_tot_per_cap-care-funding-total-per-capita

Infant mortality, per 100,000 live births:
#26 UK: 5.01
#37 US: 6.37
http://www.geographyiq.com/ranking/ranking_Infant_Mortality_Rate_aall.htm

Life expectancy: years, men–women
US: 77–81
UK: 77–82
http://unstats.un.org/unsd/demographic/products/socind/health.htm

Cancer deaths: per 100,000
#9 US: 321.9
#16 UK: 253.5
http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer

Poll results from the UK: preferences, percentages
Prefer the UK’s National Health Service: 89.9%
Prefer the US system: 10.1%
http://www.guardian.co.uk/commentisfree/poll/2009/aug/14/nhs-health

A quick ride in the Googlemobile presents a more mixed picture than does Mr Jacoby, who dwells on the UK system’s imperfections while ignoring ours. And one of his statistics seems disputable, if not actually wrong. Meanwhile, for all its problems, UK citizens overwhelmingly choose their system over ours. The huge number of MRI machines in this country are extraordinarily lucrative investments, costly to the system, duplicate facilities, and are of largely unproven utility in improving health care outcomes. Our increased performance of, and reliance on, diagnostic tests, too, may or may not reflect better care; it may reflect a dearth of primary care and an increased reliance on hospital emergency rooms.

 

Fair pay or bone scam?

Tons of great health reporting in today’s Globe, not all of it on the health page. See stories on brain cells, osteoporosis testing, skanky diet pills and vitamin D.

BHN takes particular note of the bone scan story and wonders — Will politics and science ever find common ground? At this point, it is becoming more and more clear that more scans — be they mammograms, MRIs or test for bone density — do not equal better health.  The message, it seems, is not getting through to heavily lobbied lawmakers

“You have to view these things through common sense. And it doesn’t take a genius to figure out that providing bone density tests for elderly Americans will save this country billions of dollars,’’ said Berkley. “In addition to saving taxpayers money, it will prevent suffering that people with osteoporosis have.’’

Berkley and the key Senate sponsor, Blanche Lincoln, an Arkansas Democrat, who was a pivotal vote in the Senate in favor of health reform, have received hundreds of thousands of dollars in campaign contributions from medical industry sources, including physicians, as have many other lawmakers.

Among the lobbyists working on behalf of several corporations on the effort was a former top staffer to Lincoln, Drew Goesl, who was listed on public disclosure records as being among the people at Washington lobbying firm Capitol Counsel who worked on the issue.

Goesl did not respond to a request for comment. A spokeswoman for Lincoln said neither campaign contributions nor Goesl’s involvement played any role in her position.

For more on bone scans, see my piece on an alternative test, which ran in the Globe in ’08.

Some doctors believe the Fracture Risk Assessment Tool, or FRAX, will improve their ability to identify patients likely to suffer the worst consequence of osteoporosis – broken bones.

For another perspective, see the National Women’s Health Network’s page  on osteoporosis.  NWHN is one of the few patient advocacy groups that does not take industry money.

On the other hand, the National Osteoporosis Foundation courts industry sponsors including:   

The Alliance for Better Bone Health  which “was formed by Procter & Gamble and Aventis in May 1997 to develop and market Actonel collaboratively in Europe, the United States and Canada.”

Medtronic

Hologic, Inc.

GE Healthcare Lunar

Now you may return to the story on Vitamin D, which also offers news on bone health.

Finally, note that Newton’s Heywoods - the family that developed its own ALS research incubator in response to a brother’s struggle with the illness – makes the news once again. A story in the NYTimes about online patient communities features “PatientsLikeMe” a patient support site that also collects data for research.

Berwick: More Dr. Death mongering

The Globe’s Susan Milligan reports today on the attempt by Republicans to tag Harvard professor Donald Berwick as a death merchant.  Berwick runs a research program that looks at ways to cut waste and improve health care services.  He is up for the job as head of The Center for Medicare and Medicaid Services, an agency that has the power to make major changes in the way health care is funded and delivered.   

… GOP’s senators are making it clear they plan to turn Berwick’s confirmation hearings into a forum for continuing debate over the newly-minted health care overhaul law. Republicans believe hammering at the law will help them win seats in the fall’s midterm elections.

Senate Republican leader Mitch McConnell of Kentucky said on the Senate floor last night that Berwick is an “expert on rationing.’’

By lauding the United Kingdom’s National Health System, McConnell said, Berwick “is applauding a system where care is delayed, denied, or rationed.’’

 At one time, only insurance companies and hosptials  balked at changes in the way we pay for care. The social conservatives stuck to abortion. Now, all that has changed. For more on that see the November 30 issue of The New Yorker  for a story on the Karen Ann Quinlan case — “The Politics of Death.”  Jill Lepore talks about how a hospital ethics panel had to decide whether the comatose women could ever recover. As she put it “These ethics committees are now better known as death panels.”

 The New Yorker has a pay wall so if you don’t have a subscriptions, it’s off to the library. You can read the abstract first.

 The Quinlan case marked a fundamental shift in American political history: in the decades since Quinlan, all manner of domestic-policy issues have been recast as matters of life and death—urgent, uncompromising, and absolute. Mentions Pope Paul VI’s “Of Human Life” and the Roe v. Wade decision in 1973. Two years later, the Quinlan case brought the end of life into the halls of government. In the wake of Roe and Quinlan, a very small but by no means inconsequential number of people have come to believe that Congress, the President, the courts, and assorted unnamed bureaucrats are plotting to deny medical care to the very sick and the very old, to babies born with deformities, to the elderly and infirm, to the ailing and the poor, to the disabled and insane. Most recently this conspiracy theory hijacked health-care reform.

 

 

Rachel Maddow v. Scott Brown and friends

4/1 update: Globe letter-writers defend Maddow, chide staff editorialists. Dan Kennedy, writing in The Guardian, says she would be a good candidate.

Note that on Thursday,  the Senate voted down Brown’s proposed amendment that would have removed a tax on medical device makers from the reform bill.

Now, Maddow isn’t running for Senate. She made that very clear in a clip on her show last night and a full-page ad in today’s Globe.  But, Maddow — who has been very pro-health reform –is unhappy that Brown is noting her rumored candidacy in a fund-raising letter.

In the ad,  she says he never contacted her to confirm her rumoured campaign. She also says Brown fits in with conservatives who “invent scary fake threats to run against — things like made-up death panels in health reform…”

Apparently some Herald readers do find Maddow scary. The story generated  these anti-gay sentiments from Herald readers. The Globe monitors comments. Looks like they were busy.

“Why is this young boy named Rachel? Is he a sissy or something? Makes ya sick!”

  

After 2 minutes watching her opine and blather nonsense I feel like I need to take a shower…ewwwwwwww!

 

What a shame the Dyke wont run against Scott. Wouldnt that have been fun seeing her run on the MSNBC platform of fruits and nuts. 

 

The Wonkette website inadvertently sent some reader to this long list of unkind rants by confusing the Globe and the Herald in their story. (!!!) 

 The comments at Wonketter were much more friendly.

 

Scott Brown joins Avatar in fight again health reform devil

A little game of connect the Globe dots.

1)     With Sen. Scott Brown at this side, Arizona Sen. John McCain sought to out-Bible his Tea Party challenger by defining himself as the Senate’s devil hunter. From the Globe:

“Scott and I just returned from trying to do the Lord’s work in the city of Satan,’’ McCain said. He called the health care plan “unsavory, Chicago-style sausage making,’’ and said, “We’re going to fight, and fight, and fight.’’

In the meantime, McCain’s opponent unleashed an ad in time for the Oscars that cast the former presidential candidate as a character from the movie Avatar. According to the ad, McCain is only acting like a conservative.

2)   In the meantime, back in town, about 20 Tea Party protested gathered outside the Liberty Hotel fundraiser featuring House Speaker Nancy Pelosi. They railed against the Democrats’ health reform plan with Mass General as a backdrop.

3)   Meanwhile, the storied hospital was coping with a letter from the Medicare program, which, during a recent inspection found problems with the quality of care, including one that “constitutes a serious and immediate threat to the health and safety of patients.”

4)     And, the state’s insurance companies want more money to pay for that care. From the Globe:

 Three weeks after Governor Deval Patrick warned that his administration might turn down health insurance premium increases it deemed excessive for individuals and small businesses, insurers have asked the state to approve rate hikes of 8 to 32 percent for April 1.

 

 

 

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.