When it comes to what lawmakers should do next on health reform, Americans' views are all over the map: 28 percent want to expand the law, 19 percent leave it as is, 23 percent repeal it and replace it with a Republican-sponsored alternative, and 20 percent repeal it and not replace it.
Support for a "Republican-sponsored alternative" is considerably lower than support for "expand the law," and the inclusion of "Republican-sponsored alternative" means that "expand the law" actually means something akin to expanding the law. And so there you have it: 47 percent want to keep or expand health-care reform, and 43 percent want to repeal and/or replace. The "repeals" do not have it.
And that's not the only interesting part of the poll: As Greg Sargentnotes, "when asked what they want done with the law if repeal fails, only 33 percent of Americans support cutting off funding to gut the law, versus 62 percent who disapprove of this course of action."Thomas Goetz: It's time to redesign medical data
The people who will really decide whether health-care reform succeeds or fails
The New Yorker isn't allowing Atul Gawande's latest article out from behind the paywall, but you can read the abstract here. The basic point is well worth keeping in mind amid all the arguments over the Affordable Care Act: Health-care costs -- and thus our paychecks, and the federal budget -- won't be decided by how we deliver and structure health-care insurance. They'll be decided by how we deliver and structure health care. And though national policy has a role in that, it's not always a huge role, and it's not usually a controversial one.
Gawande relates a series of stories showing innovation in the toughest corners of the care-delivery system. The most inspiring is about Jeffrey Brenner, a Camden-based physician who began playing with his city's hospital claims data and making maps of where the money was being spent. It turned out that there were two city blocks, containing two particular buildings, where 900 people were responsible for "more than four thousand hospital visits and about two hundred million dollars in health-care bills" over the past seven years. So that's where he focused.
Insurers try to run from the costliest patients. They try to kick them out for having preexisting conditions, or they rescind their coverage, or they price coverage beyond their reach. That just makes them costlier, of course. Inconsistent access to medical care means more medical emergencies, and more medical emergencies mean higher medical costs. Brenner, by contrast, is lavishing them with attention. He's calling them daily. He's checking up on their medications, their lifestyles, their habits. He wants to open a doctor's office in their building. His patients averaged "sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after — a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after — a fifty-six-percent reduction."
We don't really know if his success can be replicated. But somebody'scan be. And that'll be where policy -- in particular, where Medicare -- comes in. The administration's vision sees things running something like this: A promising experiment or pilot program will come to the attention of the newly established Center for Medicare and Medicaid Innovation. The center will fund it on a larger scale and study it more intensely if. If it proves promising, the Independent Payment Advisory Board will force Medicare to implement it fairly quickly. And history shows that if something works in Medicare -- and, quite often, even if it doesn't -- it's soon adopted by private insurers.What Are Your Odds?
In case you didn’t know, life is risky. Here are your odds:
In South Los Angeles, New Fast-Food Spots Get a ‘No, Thanks’
Los Angeles is making one of the nation’s most radical food policies permanent by effectively banning new fast-food restaurants in South Los Angeles, a huge section of the city that has significantly higher rates of poverty and obesity than other neighborhoods.
A handful of much smaller cities have enacted similar regulations for primarily aesthetic reasons, but Los Angeles, officials say, is the first to do so as part of a public health effort. The regulations, which the City Council passed unanimously last month, are meant to encourage healthier neighborhood dining options. Supporters envision more sit-down restaurants, produce-filled grocery stores and takeout meals that center on salad rather than fries.
Health care systems around the world are failing to use evidence obtained through research when making decisions, causing inefficiencies and reduced quantity and quality of life, according to a leading expert in the field of “knowledge translation.”
“Failures to use research evidence to inform decision-making are apparent across all key decision-maker groups,” said Dr. Sharon Straus, a geriatrician and director of knowledge translation at St. Michael’s Hospital.
...
Extrapolating data from the United States, Dr. Straus estimated in her article that about 55 per cent of adult patients do not receive recommended care. Studies have shown that only 40 per cent of people with osteoporosis get appropriate therapy, as do only two-thirds of stroke patients.
For example, while several randomized clinical trials have shown that cholesterol-lowering drugs known as statins can decrease the risk of death after strokes, they are “considerably under-prescribed,” she said. In contrast, antibiotics continue to be over-prescribed for children with upper respiratory tract infections despite evidence they are ineffective.Medical device company paid kickbacks to doctors, settles with Justice Dep’t
St. Jude Medical Inc. said late Thursday that it has reached a $16 million agreement with the U.S. Department of Justice to settle charges that it paid kickbacks to doctors who enrolled patients in post-market studies that were really a way to induce the doctors to use the company’s products.
Post-market studies are routinely conducted by medical technology companies to see how products work after they are approved by the Food and Drug Administration. The government focused its investigation on three St. Jude studies, Aware, Assist and Housecall Plus, as well as its Act registry of patients.
Little Canada-based St. Jude allegedly paid participating doctors a fee that ranged up to $2,000 per patient as a way of encouraging use of the company’s pacemakers and defibrillators. More.Pharmaceutical Drug Heists on a Scale the Sopranos Would Love
First, the good news. In 2010 there were only 49 cargo thefts of drugs. Now the bad news: the average heist netted the thieves almost $4 million. (At $3.78 million per theft, drug heists were triple the value-per-incident of freight thefts of tobacco products, which came in second.) In one successful robbery of a Connecticut warehouse, the thieves made off with 70 pallets of drugs valued at $75 million.East Texans’ Bad Health and Bad Habits Promote a ‘Stroke Belt’
The proof of Anderson County’s live-hard, die-young culture is in the bread pudding — and the all-you-can-eat fried catfish, the drive-through tobacco barns and the dozens of doughnut shops that dot this East Texas county of about 57,000.
In a community where heavy eating and chain smoking are prevalent, where poverty, hardheadedness and even suspicion hinder access to basic health care, residents die at an average age of 73 — seven years earlier than the healthiest Texans, according to a preliminary county-by-county analysis by the University of Washington Institute for Health Metrics and Evaluation. Black males live to be just 65. And white men outlive black men by roughly six years, one of the largest disparities by race in the state. Indeed, life expectancy lags across most of East Texas, which lives up to the grim medical nickname the Stroke Belt.
The early deaths are the result of high rates of obesity, diabetes, cardiovascular disease and cancers, afflictions directly linked to lifestyle choices, including poor dietand smoking. Anderson County’s hospitalizations for preventable conditions like congestive heart failure, high blood pressure and adult asthma far outpace the state average.
Such maladies are tied firmly to race and poverty.Tussling Over Jesus
Make no mistake: This clash of values is a bellwether of a profound disagreement that is playing out at many Catholic hospitals around the country. These hospitals are part of the backbone of American health care, amounting to 15 percent of hospital beds.
Already in Bend, Ore., last year, a bishop ended the church’s official relationship with St. Charles Medical Center for making tubal ligation sterilizations available to women who requested them. And two Catholic hospitals in Texas halted tubal ligations at the insistence of the local bishop in Tyler.
The National Women’s Law Center has just issued a report quoting doctors at Catholic-affiliated hospitals as saying that sometimes they are forced by church doctrine to provide substandard care to women with miscarriages or ectopic pregnancies in ways that can leave the women infertile or even endanger their lives. More clashes are likely as the church hierarchy grows more conservative, and as hospitals and laity grow more impatient with bishops who seem increasingly out of touch.Setting up health insurance exchanges, states face big decisions
Governors have deep differences over national health care reform, but when it comes to so-called insurance exchanges — a centerpiece of the sprawling new federal law — nearly every state is moving ahead with implementation.
Working under crushing deadlines, often with staffs thinned by layoffs, states have a massive job ahead of them: to essentially reorganize the entire health insurance industry within their boundaries. The goal of the exchanges is to make it easier for individuals and small businesses to shop for comparable coverage.
They’re also intended to make it easier for low-income people to apply for Medicaid and help business owners and moderate-income individuals apply for federal tax credits. States must have simplified insurance offerings and a standardized application — plus a consumer-friendly online presentation — ready to pass muster with federal regulators by December 31, 2012. If they don’t, the federal government will step in and run the exchanges for them.House GOP considers privatizing Medicare
Months after they hammered Democrats for cutting Medicare, House Republicans are debating whether to relaunch their quest to privatize the health program for seniors.House Budget CommitteeChairman Paul Ryan, R-Wis., is testing support for his idea to replace Medicare with a fixed payment to buy a private medical plan from a menu of coverage options.
Party leaders will determine if the so-called voucher plan will be part of the budget Republicans put forward in the spring.Hospice care lifts profits, raises questions
Data released Thursday suggest that the long-term care industry is an economic juggernaut, but an ongoing inspector general investigation is examining how nursing homes have incorporated hospice care into their business model and whether that’s good for patients or Medicare.
The data, released today the American Health Care Association, show that in 20 states, long-term care is one of the top 10 employers. In eight states — California, Florida, Illinois, Texas, Pennsylvania, North Carolina, Ohio and New York — the industry provides more than 100,000 jobs.
“In this economic engine that is the American economy, long-term care is one of the pistons, consistently firing even in the worst of hardships,” Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living and a former Republican governor from Kansas, told POLITICO. “Because of $45 billion in Medicaid every year by federal and state governments, we are able to generate $529 billion in total economic activity, support and create over 5.4 million jobs, and return over $60 billion in taxes back to federal and state coffers annually,” he said.
One of the little-known drivers of this revenue is a growing trend of hospice within the nursing home. Federal spending on hospice has tripled between 2000 and 2007 — and much of that money is being misspent, suggests a Kansas physician who has been pushing hard to reverse the trend.
According to Medicare data, almost 40 percent of Medicare patients who died in 2005 had elected hospice. By 2007, almost 1 million patients were in hospice, and Medicare spending for the benefit had more than tripled from $2.9 billion in 2000 to just over $10 billion.What Should Medicare Do with Patients Who Have No Possibility of Improvement?
Plaintiffs say almost 78 percent of the 46 million or so Medicare beneficiaries have at least one chronic condition, such as multiple sclerosis or Alzheimer’s. Denying them care if they don’t meet the so-called “Improvement Standard,” the advocates argue, can prevent them from performing routine daily activities or even cause their condition to deteriorate – leading to higher costs down the road…. The agency’s claims are processed by private subcontractors, many of whom require improvements in patient conditions and deny coverage to thousands of people every year as a result…
The suit seeks to require Medicare to cover certain types of rehabilitative care even when it likely won’t lead to an “improvement” in patients’ condition.Why Don’t Employers Fire the Employees with High Health Care Costs?
What It’s Like to Work in an ACO
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