Pay for the person - not the procedures
When people talk about health reform it’s often shorthand for covering the uninsured. But improving access without tackling costs is a recipe for a fiscal crackup.
Just take a look at Massachusetts, a pioneer in universal coverage, where the cost of medical care is growing at more than 8 percent a year. Ballooning subsidies for coverage of the poor are one problem. Another is heavy use of high-priced hospital care.
The Boston Globe reports on the recommendations of a state commission to pay doctors and hospitals a set amount for each person’s care for a year. (Read the report here.)
Some might call it capitation redux. The payment approach, once popular with managed care, aims to curb incentives for doctors and hospitals to do more to get paid more. Previous attempts at capitation were too stingy and inflexible and remain worries this time around, critics say.
On the national front, the cost of health reform is moving to the fore, galvanizing opposition to the plans advanced in Congress. The Washington Post reports that the head of the Congressional Budget Office “delivered a devastating assessment” of the fiscal consequences of the proposals because they don’t do enough contain the fast-growing costs of government health programs.
Popular bypass technique may raise risks
There’s nothing too glamorous about bypass surgery. Your chest gets cracked wide open and the surgeon probably uses veins stripped from your legs to reroute blood around the blocked arteries that feed your heart.
The good news is that when those new pipes are put in properly they can last a decade or longer. But when minimally invasive techniques are used to pluck those veins from the legs instead of the more painful direct approach, the outcome of bypass might not be as solid, according to a study just published in the New England Journal of Medicine.
Patients whose bypass grafts were obtained the less invasive way were more likely to have reclogging after a year than those whose veins were obtained the old-fashioned way. (46.7 percent vs. 38.0 percent). Worse, at three years patients with endoscopically harvested veins were more likely to have had serious problems, including death.
The less invasive approach to extracting blood vessels for use as replacements for coronary arteries is popular – used about 70 percent of the time – because it doesn’t hurt as much and infection rates are lower. But this study, despite its limitations (it was observational and not prospective) raises questions about the best way to go. “The decision about the best way to harvest veins for [bypass] has just gotten a lot more complicated,” writes cardiologist Harlan Krumholz for Journal Watch.
Health reform scrapes by on $1 trillion
Filed under: Health care reform, Hot Health Headline
You might think that more than $1 trillion, even when spread over 10 years, would be enough to cure all manner of problems in health care.
But USA Today’s Susan Page reports the “eye-popping price tag” that’s the budgetary line in the sand for proposals kicking around Capitol Hill right now won’t come close to fulfilling every reformer’s wish.
Most of the money would go to expanding coverage for the uninsured. But a House bill wouldn’t subsidize coverage for as many families as previously expected and would jack up Medicaid costs for states, USA Today reports. A decade from now 15 million to 20 million people would probably still be uninsured.
All right. But we’re still wondering where all that cash, limited as it now seems to be, is going to come from? Medicare savings are supposed to provide a big wad. And then there’s a proposal from House Democrats to soak the rich, which the Washington Post explains, would slap a surtax on families earning more than $350,000 a year and individuals pulling down more than $280,000.
None of the scenarios matter if nothing becomes law. The White House appears intent on pushing ahead, despite growing Republican opposition. David Axelrod, Obama’s top political strategist, told Bloomberg, that a bipartisan approach would be nice but not absolutely necessary. “We’d like to do it with the votes of members of both parties,” he said. “But the worst result would be to not get health-care reform done.”
Update
Health reform marched ahead on a Senate health committee vote along party lines that approved legislation to expand health coverage. In a statement, President Obama said, the milestone “should provide the urgency for both the House and Senate to finish their critical work on health reform before the August recess.”
Swine flu blues: Vaccinations could be delayed
Filed under: Hot Health Headline, Public health, Uncategorized
Summertime and forgetting about swine flu is easy. But the World Health Organization yanked us back to reality.
The H1N1 virus isn’t taking a vacation. Dr. Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research, said the “pandemic is unstoppable” and “all countries will need to have access to vaccines” in a briefing yesterday.
But making a swine flu vaccine looks more difficult than expected, which could delay when folks could get immunized against the bug.
Even when a vaccine becomes available there won’t be enough to go around. So WHO recommends that health-care workers get jabbed first.
A big problem remains that there simply aren’t enough vaccine factories to supply the world’s needs, WHO Director General Margaret Chan said today. She defended the patent system and called for incentives to encourage innovation by drugmakers.
Generic biotech is coming - eventually
When people carp about the high prices of drugs, the poster kids are often the biotech wonders that can cost tens of thousands of dollars a year.
Sure, a nifty new cancer medicine may be worth a lot of money to the person whose life it lengthens. But should the maker of drugs like those enjoy a price monopoly indefinitely?
For biotech drugs – proteins produced by living cells – the answer in the United States has pretty much been yes because there’s no simple path for the Food and Drug Administration to approve generic versions of blockbusters such as Genentech’s Herceptin (annual cost: $48,000) or Johnson & Johnson’s Remicade (annual cost: $20,000).
As part of health reform, Congress is wrestling with rules to clear the way for so-called follow-on biologics. The main sticking point: how long should the inventor of a biotech medicine be protected from rivals?
The Wall Street Journal’s Alicia Mundy reports that the biotech industry appears to be getting its way, with extra protection that could last as long as 13½ years.
The lengthy protection period is being championed by the Senate health maven Ted Kennedy (D-Mass.) and is nearly twice as long as the seven years proposed by the White House. Others in Congress, including Sen. Chuck Schumer (D-N.Y.), have pushed for 5½ years.
Why does the number matter so much? Competition. The Federal Trade Commission concluded in a recent report that protection lasting 12 to 14 years “is unnecessary to promote innovation” and would inhibit the introduction of more biotech options at lower prices.
Update
In a win for the biotech industry, the Senate’s Health, Education, Labor and Pensions Committee voted 16-7 to protect biotech medicines from generic competition for 12 years. The term could still be changed by the full Senate or in negotiations with the House.
JAMA drops gag rule for whistle-blowers
Disclosure of potential conflicts in health care always seems like a great idea until people start asking questions about you.
The editors at JAMA, the Journal of the American Medical Association, found the tables turned when they sought to keep people who bring complaints about conflicts of study authors from going public with the allegations while the journal investigates. (To read the back story and the online JAMA editorial about the change, see this post from The Wall Street Journal Health Blog.)
Well, the JAMA editors have relented and an editorial published in the current issue of the journal drops the gag language while affirming the other elements of conflict policing.
In April, the Association of Health Care Journalists weighed in with a letter to JAMA calling the
policy “counterproductive” because “it could discourage potential whistle-blowers from coming forward with crucial information that physicians and the general public urgently need to make informed decisions about medical care.”
NIH rules more stem cells eligible for funding
Right off the bat let’s just note that the promised cures from stem cells have been slow in coming.
Science is hard. But many researchers trying to harness embryonic stem cells, which have the potential to produce any kind of cell in the human body, say restrictions on the cells that qualify for federal funding have made the work even harder. (AHCJ article - Covering stem cells: Background on science, politics and global competition)
When stem cells like these human embryonic stem cells divide, each new cell has the potential to remain a stem cell or become a cell with a more specialized function, such as a muscle cell or a red blood cell. Photo: National Institutes of HealthEarlier this year the Obama administration rolled back limits from the Bush era that restricted federal funding to only a few cell lines. But it still hasn’t been clear which stem cells are OK and which are verboten.
The National Institutes of Health has waded in with clarifying guidelines that take effect today. The upshot: if the old cell lines were created ethically, then they should be good to go. The main issue is whether researchers got the appropriate consent of donors.
Next up, an NIH committee will pass judgment on existing cells and produce a Web site itemizing the ones that are legit.
“Every institution shouldn’t have to rediscover which cell lines are eligible for NIH funding, so having a registry is very practical,” George Q. Daley, a stem-cell researcher at Children’s Hospital Boston told The New York Times.
Covering stem cells: Background on science, politics and global competition
Tip Sheet: Stem cell research in California
Intense competition in stem cell research: Mark Johnson of the Milwaukee Journal Sentinel writes a three-part series detailing the discovery of how to create embryonic stem cells out of normal cells. The online package includes a time-lapse video of an embryo’s first five days of development and links to a discussion about the ethics of stem cell research.
Obama order expected to increase speed, efficiency of stem cell research
National Center for Biotechnology Information
Medical Advances: Treatments, Cures, Possibilities: Presentations from this Knight Center for Specialized Journalism seminar are available.
Ex-Hill honchos make lobbying roundtrip
You can’t tell the health-care lobbyists without a program. So The Washington Post, working with data from the Center for Responsive Politics, has come up with one just in time for the next round of health-reform negotiations on Capitol Hill.
More than 350 former congressmen, committee staffers and federal bigwigs are busily advancing the interests of drugmakers, insurers, hospitals and medical groups, the Post reports.
Buying influence is easy but it ain’t cheap. The Post calculates the “record-breaking” campaign is costing the health-care industry more than $1.4 million a day.
What does it get for the money? A seat at the table, for starters, and maybe much more. For their part, the ex-government employees get a pretty rich payday.
“For people like me who are on the outside and used to be on the inside, this is great, because there is a level of trust in these relationships, and I know the policy rationale that is required,” Richard Tarplin, a lobbyist working for the American Medical Association, told the Post. Tarplin used to work for Health and Human Services and Sen. Chris Dodd (D-Conn.), who’s a key player in the health debate.
From The Washington Post
If you do nothing else, check out the slick graphic showing the influence of ex-staffers from the Senate Finance Committee.
FDA rethinks ‘black box’ warning
Quitting smoking, always nerve-racking, may prove even tougher in the wake of a Food and Drug Administration decision to require its strongest warnings for some drugs popular with folks trying to kick the habit.
Pfizer’s Chantix, GlaxoSmithKline’s Zyban, and Zyban’s generic equivalents will now carry a lengthy “boxed warning” about risks of some pretty serious changes in behavior, including hostility and suicidal thoughts, that could dissuade people from using the drugs.
Photo by flattop341 via Flickr
But a “boxed warning?” Hey, FDA, don’t you mean “black box warning?” That’s the way the agency has long been proud to talk about the toughest warning at its disposal. Well, maybe not so much anymore.
CNBC’s Mike Huckman tweeted during an agency call with reporters about the rowback: “FDA official wants media to stop using term ‘Black Box’ & just say ‘Boxed Warning.’ ‘Black Box carries implication ‘Don’t u dare use this.””
Forbes’s Matt Herper wrote that during the call Robert Temple, director of the FDA’s drug evaluation office said the beefed-up boxed warnings on Chantx and Zyban aren’t meant to stop people from using smoking-cessation drugs. “Smoking is really bad for you,” Temple said. “What you want is that people don’t [use the drugs] casually.”
What’s a reporter to do? U.S. News and World Report health writer Katherine Hobson poked FDA on Twitter, “What’s a better substitute for ‘black box warning’? Gentle reminder?”
How about, “Whoa! You sure you really wanna take this pill?”
Let the comparison shopping begin
The august Institute of Medicine is out with academic medicine’s answer to the Billboard Hot 100. A panel of experts has come up with a list of the top 100 health topics that deserve a rigorous comparison of options to determine which are best.
The recommendations, part of a larger report that lays out a blueprint for research, are organized by quartile, and the top 25 would be the ones with a bullet, to stretch the pop music analogy.
Some of the high priorities:
- What are the best strategies to reduce infections spread in health-care settings?
- What’s the best way to use expensive biotech drugs – like Remicade, Enbrel and Humira – to treat inflammatory diseases, such as rheumatoid arthritis?
- How should dental care be delivered to children to most effectively prevent cavities?
Comparing effectiveness is suddenly an idea whose time has come. “Health care decisions too often are a matter of guesswork, because we lack good evidence to inform them,” said Harold C. Sox, editor of The Annals of Internal Medicine, and panel co-chairman, according to The New York Times.
In legislation to boost the economy, Congress set aside more than $1 billion to fund comparisons that would pick health winners and losers. It was the IOM’s job to come up with recommendations on where to start.
For a little peek into how the priorities were chosen, Consumer Reports‘ Health Blog has a Q&A with Consumer Union President Jim Guest, who was a member of the Federal Coordinating Council for Comparative Effectiveness Research that came up with the recommendations.
The New England Journal of Medicine weighed in with a “Perspective” piece on implications of the report. For more about comparative effectiveness, see this piece from AHCJ board member Andrew Holtz, M.P.H.
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