BHN reports: Push for single-payer lives on in Massachusetts

by Tinker Ready All rights reservedWith the ACA under constant fire, it’s easy to think that single payer is off the table.  Try getting that through Congress.  Still, seems, here in Massachusetts, single payer supporters are not ready to give up.

On Wednesday night,  Mass-Care invited former CMS director and gubernatorial candidate Don Berwick to a meeting on “What can be done legislatively to achieve Single Payer in Massachusetts.”  An overflow group filled a small meeting room in the Downtown Crossing office shared by Mass Care and other progressive groups like The Women’s Institute for Leadership Development and the Industrial Workers of the World.

Berwick, who added single payer to his campaign platform, didn’t really need to make a case for the plan. He was preaching to the converted when he argued that turning the government into our insurer would help the country achieve “better care, better health and lower costs.”

It will have to happen on the state level, he said. “I don’t expect national leadership on this from either party.”

He cited the usual statistics – we spend 40 percent more per-capita than any other nation. Then he added a few more. While running for governor, he took a look at 15-year tends in the state budget. Funding was down for almost every item, he said.  – local aid, parks, higher ed. For health care, state spending rose 72 percent in that period.

To pull that lens out a bit, he cited a recent  Commonwealth Fund study that estimate the costs savings had the US had adopted a single –payer plan similar to one used in Switzerland: $15.5 trillion over 30 years.

None of these arguments has provided single payer with the kind of traction it needs to move into the mainstream.

“When you say, don’t worry, the state is going to be your insurer, that’s a hard sell,” Berwick said.

So, he and others are starting to emphasize another point – we are spending money on health care that could be better spent elsewhere. In other words, the co-pay may be so high on your knee surgery, you’re might not be able to pay the rent.

“There is a transfer of opportunity in society from other things to health care,” Berwick said.

Or pay for a week at the beach or a private college for your kids.  As the discussion turned to how to sell the approach to the public, several people – including a group of medical students from BU – pointed out that high health care costs are not just a problem for the low–income and uninsured.

“How do we sell this to the middle class? “ asked Andy Hyatt, a first-year medical student at BU and a member of the school’s chapter of Physicians for a National Health Program. While it’s important to help the disadvantaged, he said, health for middle-income people “still sucks”

Just how to address that group is what these supporters of single payer health care are trying to figure out.

“We’re wondering what we as medical students can do,” asked Jawad M. Husain, also of the BU PNHP. “We want to practice in a system where we can treat people fairly.”

Berwick’s answer: “Political mobilization.” But he noted that the students will have to look outside the classroom for guidance on that. ” It’s not something I learned in medical school”

#NEJM #Relman obit: “A master in the use of the bully pulpit” #HCR

A not entirely objective perspective on the  career of the journal’s storied editor. Here’s the last paragraph:

In the increasingly complex world of health care, Bud Relman was a prophetic figure, larger than life. He acted nejmas our conscience. In his writing and speaking, he always reminded us that the medical profession is far more than a business and that as physicians, we have the responsibility to do what is right for patients and for the community as a whole. As distinguished as he was as a researcher, clinician, editor, teacher, and administrator, Bud Relman will be most remembered for the way he fought for a fundamental reshaping of our nation’s health care system. His passionate commitment to that cause will forever secure his position in the pantheon of leaders in medicine.

 

 

Harvard and MIT use clinical trials to study health policy #ACA #HCR

A New York Times story on the feds’ failure to use randomized clinical trials for health delivery research led us to J-Pal, a joint Harvard MIT program. Here’s a link to the group’s health page. 

J-PAL’s Health Program seeks to promote the important contributions that randomized evaluations can make in understanding how improvements in health services and delivery can reduce poverty. J-PAL’s Health Program seeks to promote the important contributions that randomized evaluations can make in understanding how improvements in health services and delivery can reduce poverty. Each year, significant resources are allocated to global health and development initiatives. However, despite substantial investment, improvements in global health indicators have been uneven. For example, according to the World Health Organization’s (WHO) latest data, encouraging declines in child mortality rates have occurred globally, while improvements in maternal mortality, TB, and HIV/AIDS have been slower (World Health Statistics Report 2010). Moreover, the WHO reports worsening of certain key indicators such as prevalence of undernutrition in a number of countries.

The Times story quotes researchers saying that the federal government needs “to to do more randomized trials and fewer demonstration projects. “

The situation is different in the developing world. There, randomized trials have become common in health care and other areas, sponsored by a variety of groups like J-PAL, a global network of researchers that was organized by M.I.T. and Harvard economists.

So far, J-PAL has conducted over 440 randomized trials in 55 countries, according to Amy Finkelstein, an M.I.T. economist.

Dr. Finkelstein and Lawrence Katz, a Harvard economist, have now started J-PAL North America to spur randomized trials in, among other areas, health care.

Dr. Finkelstein was encouraged by the Medicaid study she and Katherine Baicker of Harvard did in Oregon. The state wanted to expand Medicaid coverage but could not afford to insure all, so it used a lottery.

The lottery was essentially randomizing people to have Medicaid or not, so Dr. Finkelstein and Dr. Baicker designed a study to see the effects.

Over 18 months, those who got Medicaid saw doctors and went to emergency rooms more often and got more health care. They were less depressed. But so far, their health is not better and they cost the system more.

“It is getting so much attention not just because it is important and credible,” said Dr. Finkelstein, “but because it is rare.”

 

Globe, Times on some of the the 3 million newly insured

globe-ssWith the uproar about computer glitches with the new health insurance exchanges, you would never know that millions of people were about the get coverage at a reasonable cost.

Today, The Boston Globe’s  Chelsea Conaboy offers stories on five of them. The story is  behind the pay wall. You can look at the pictures, go out and buy the Sunday paper or get a digital subscription. 

Much has gone wrong since state and federal health insurance websites created under the Affordable Care Act launched on Oct. 1. Technological glitches have frustrated customers, flustered politicians, and fueled debate about President Obama’s landmark legislation.

Lost amid all the fury, however, have been the success stories.

Many who struggled without insurance are getting it. Others with poor coverage have found better plans. Some whose policies cost a lot, yet covered little, have obtained more comprehensive coverage that — with government subsidies — often costs less.

About 3 million people have signed up for a private health plan through the online insurance exchanges, a senior US health official said Friday. More people are newly enrolled in Medicaid in states expanding that program, which provides coverage to people with low incomes.

Or, check out this story from last week’s New York Times about how the law is having an immediate impact on people who suddenly qualify for Medicaid.

WELCH, W.Va. — Sharon Mills, a disabled nurse, long depended on other people’s kindness to manage her diabetes. She scrounged free samples from doctors’ offices, signed up for drug company discounts and asked for money from her parents and friends. Her church often helped, but last month used its charitable funds to help repair other members’ furnaces.

Ms. Mills, 54, who suffered renal failure last year after having irregular access to medication, said her dependence on others left her feeling helpless and depressed. “I got to the point when I decided I just didn’t want to be here anymore,” she said.

So when a blue slip of paper arrived in the mail this month with a new Medicaid number on it — part of the expanded coverage offered under the Affordable Care Act — Ms. Mills said she felt as if she could breathe again for the first time in years. “The heavy thing that was pressing on me is gone,” she said.

 

Data, health, news contest draws applications from Bostonians

How to get most of the city’s health writers in the same room as a bunch of app developers? A health-themed meet-up of the local Hacks and Hackers group might do it. But last week, a good number of us gathered a WBUR for a presentation on the Knight News Challenge. (WBUR has won in the past for a court-related project.)  The media innovation project has drawn 650 entries,  including one based on  BHN’s ongoing HealthDecider project.  The handful of winners gets money and support for a project designed to answer the following question: How can we harness data and information for the health of communities?

May the best projects win.  Here’s mine.

Here are some others from Boston or with a big local footprint.  Great ideas and stiff competition. (WBUR has its own list with lots of overlap.)

Unlocking the Potential of Patient Blogs To create the first searchable repository of health blogs, giving patients a chance to connect to others with similar medical problems and better understand what it’s like to live with their health issues.

Big Data to Big Story leverages academic medicine’s foremost health-record data-mining tool to allow the public to gain critical, previously unavailable answers about medical treatments and their outcomes.

Gimme My DAM Data This crowdsourced web site will assign a letter grade to each hospital or app privacy policy, thereby encouraging data holders to participate in the health data commons. (This on links to one of Ross Martin’s health policy music videos from The American College of Medical Informatimusicology

Increasing Patient Buy-In to a Statewide Health Data Sharing Effort We will educate consumers about the benefits of sharing their personal medical information in the statewide data-sharing network while also informing them of their rights and gathering input about their concerns, which we will share with decisionmakers at the Massachusetts Executive Office of Health and Human Services to lead to an improved data-sharing system.

Data to Table: A Healthy Recipe for Urban Agriculture The Data to Table website will visualize the details of Boston’s new rezoning ordinance for urban farming, making the information transparent and accessible for those interested in fostering healthy communities through local agriculture.

 Nothing to Hide: Tracking patient harm and hospital efforts to prevent errors We aim to help consumers wisely choose the safest hospitals by building a website that tracks incidents of patient harm at Massachusetts hospitals

 HealthNewsReview.org & Crowdsourcing: We will improve the public dialogue about health care by providing patients and health care consumers a proven platform for telling media messengers what they’re doing well, and where they’re missing the mark with the health care news and information they deliver. 

 

Storify: Gruber on health reform at Boston health writers meeting #hcr

Harvard health policy event: The year in health law and a look to the future #HCR

globe aca from

More Boston health events here.

Health Law in P/Review

When:Fri, February 1, 1pm – 5pm WhereWasserstein Hall 2036,
Milstein East C, Harvard Law School (map)

 1:00-5:00pm (reception to follow)
Wasserstein Hall 2036, Milstein East CHarvard Law School

The past year was an historic one for health law, with the SupremeCourt issuing the final word on the constitutionality of the Affordable Care Act alongside a host of other critical developments. 2013 promises to continue the trend, with a number of other important topics on the horizon, from employer coverage of contraceptives to gene patenting and more.Please join us for the first annual Health Law Year in P/Review event, bringing together leading experts to review some of the most important changes in the health law landscape over the past year, their implications for the future, and a preview of what is to come.Our inaugural session will feature the following topics and presenters:The ACA and Health Care Reform

Personhood Amendments and Contraceptives Coverage

Immigrants’ Access to Health Care

Affirmative Action and Medical School Admissions

Gene Patenting

Tobacco and Obesity Policy and the First Amendment

Summary and Wrap-up
A wine and cheese reception will follow at 5:00pm.

For questions, please contact petrie-flom@law.harvard.edu, 617-496-4662.
Co-sponsored by the Petrie-Flom Center at Harvard Law School and the New England Journal of Medicine.

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