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.