Sunday, December 16, 2007
Medical Futility Blog
Health reform: the time for happy chatter is over
We're told that the uninsured are our biggest health-care problem, but they aren't. Runaway health spending is. although politicians pay lip service to that, what they really enjoy is increasing spending.
It's understandable because expanding benefits is so much more politically rewarding than trying to control them. Everyone believes in adequate health care; people should have it when they need it. Politicians cater to these beliefs. But the intellectual and even moral laziness of this approach results in an invisible abdication of political responsibility. We are letting the unchecked rise in health spending determine national priorities. Consider:
- Health spending already totals more than $2 trillion annually, about 16 percent of national income (gross domestic product). By 2030, it could easily exceed 25 percent -- one dollar out of four -- projects the Congressional Budget Office.
- There's a massive transfer of income from young to old. Americans 65 and older now represent about an eighth of the population and account for about a third of all health spending. By 2030, their population share will be about a fifth, and they could account for nearly half of health spending, the Centers for Medicare and Medicaid Services has found.
- Neither the government nor the private sector has succeeded in controlling health spending. From 1970 to 2005, average spending per Medicare beneficiary rose 8.9 percent a year. For similar services, spending for Americans with private health insurance rose 9.8 percent annually over the same period. The small difference may reflect cost shifting. When Medicare imposes price controls, doctors and hospitals increase prices for privately insured patients.
Samuelson argues for changes that illuminate rather than obscure the costs of care -- by increased cost-sharing by Medicare beneficiaries, a dedicated federal health-care tax to pay for all federal health programs (as the costs go up, the tax goes up), and elimination of the federal tax subsidy for employer contributions to employee health benefit plans. This is hardly new stuff: all of these ideas have been kicking around for years, and most health care economists seem to agree that cost control won't be possible without reducing the role of third-party payors and putting more of the cost of care on consumers.
Samuelson's contribution to the debate is to point out that the debate so far is largely missing a very big -- possibly the big -- point. Here's why:
These proposals would inflict "pain," and candidates who embraced them would invite political ruin. There's a consensus for evasion that most politicians echo. The impulse is to focus on a simpler problem -- say, the uninsured. In some ways, this is less serious than it seems. About 40 percent of the uncovered are young (18 to 34); most are healthy and don't need much care.
But for all the uninsured, the cost of coverage is a major obstacle. Health care is ultimately a political issue of making choices. Our present politics aims to camouflage the costs and skew the choices. Until we change that, our debates will lead to dead ends.
Monday, December 03, 2007
ACP publishes advance copy of major health reform policy statement
Universal health care insurance is necessary to ensure that everyone within the United States has access to needed health care services of high quality. The federal government should assure that all persons within the borders of the United States also have access to health care services without undue financial barriers and that health care services provided are adequately reimbursed. The ACP recommends two alternatives: a system funded solely or principally by government (federal and states), commonly known as a single-payer system, or a pluralistic system that incorporates existing public and private programs with additional guarantees of coverage and with sufficient subsidies and other protections to assure that coverage is available and affordable for all. The ACP has [elsewhere] proposed a step-by-step plan that would achieve universal coverage while maintaining a pluralistic system of mixed public and private sector funding.
Summary and Conclusions
Health care in the United States has many positive features and in many respects is superb compared with health care anywhere else in the world. Those with adequate health insurance coverage or sufficient financial means have access to the latest technology and the best care. However, as this paper points out, the U.S. health care system is inefficient and inconsistent: Health care quality and access vary widely both geographically among populations, some services are overutilized, and costs are far in excess of those in other countries. Moreover, the United States ranks lower than other industrialized countries on many of the most important measures of health.
Current international comparisons of measures of health (life expectancy at birth, infant mortality, and deaths per 100 000 for diseases of the respiratory system and for diabetes) indicate that population health in the United States is not better than in other industrialized countries despite the greater U.S. expenditures (58). The experience and innovations of health care systems in other countries provide many lessons as the United States tries to improve its health system. Among these lessons are the value of an orientation and emphasis on patient-centered primary care and the importance of assuring a well educated physician workforce that meets the country's need for primary care physicians.
The quality and accessibility of health care in the United States could be improved by adopting reimbursement programs like those in other countries that provide substantial rewards based on performance on quality metrics and care coordination rather than solely on the volume of services provided. These payment systems together with national workforce planning might also help address the impending primary health care workforce shortages in the United States. Universal and compulsory health insurance coverage could eliminate many of the disparities and inequities in the United States. Expanded use of health information technology and substantial governmental investments and support for a health information technology infrastructure with appropriate patient privacy protections could enhance health care decision making by physicians and patients and would bolster the growing movement for consumer-directed health care. These are some of the lessons we can learn from other industrialized countries.
Other lessons for a more efficiently functioning health care system include achieving lower administrative costs by standardizing coverage and insurance transactions; providing coverage through publicly funded programs rather than private insurance; and automating transactions among providers, patient, and insurers. This article does not address many other issues in depth. Topics for further in-depth analysis include the costs and impact of malpractice liability insurance, determination of prescription drug prices, differences in medical education (including costs and student debt), financing long-term care, and physician earnings and income. The United States may also benefit by examining how other countries manage end-of-life care, determine the distribution of health care resources, and make decisions on coverage and benefits.
The ACP has offered a series of recommendations to achieve a well-functioning health care system. All Americans should have access to a primary care physician and should have a patient-centered medical home for their ongoing, continuous,
comprehensive, and coordinated care. All Americans should have health insurance coverage that includes preventive and primary care services, as well as protection from catastrophic health care costs. Federal health policy should support the patient-centered primary care model. The United States lacks a national health care workforce policy. It should provide for sufficient support for the infrastructure required to educate and train an adequate supply of health professionals that would properly meet the nation's health care needs, including primary and principal care physicians that are trained to manage care of the whole patient. Workforce planning should specify an appropriate mix of physicians between primary and specialty care and describe the policies required to achieve that goal. Public and private investments in research must continue to support advances in basic and clinical medical science as well as in health services research. Other ACP recommendations call for financial incentives to encourage quality improvement and reduction of avoidable medical errors, support for a health information technology infrastructure to assist patients and physicians in making informed decisions about the appropriate use of health care services, and use of technology to achieve a more efficient health care system.
The main lesson of this article is that many countries have better functioning, lower cost health care systems that outperform the United States. We must learn from them.
Sunday, December 02, 2007
New York City Law Review Issues Call for Papers on Health Care
The Symposium will look at two critical questions: (1) Can international human rights frameworks help the United States overcome obstacles to universal coverage? and (2) Can innovative litigation expand coverage to vulnerable populations? Given that the 2008 general election has already placed health care as a central campaign theme, now is a critical time to evaluate the practical litigation and policy models for providing access to the uninsured and vulnerable populations, says Matthew Monroe, one of the symposium's organizers. For more details on the symposium and how to make topic submissions, visit: http://www.nyclawreview.org/
AHLA Health Lawyers Weekly, Nov. 30
- OIG Takes Back Power To Investigate Employee Criminal Conduct From FDA -- The Department of Health and Human Services Office of Inspector General (OIG) will no longer share responsibility with the Food and Drug Administration (FDA) for investigating potential criminal misconduct by FDA employees, Inspector General Daniel Levinson said in a September letter to FDA Commissioner Andrew C. von Eschenbach. Full Story
- CMS Releases List Of 54 Worst Performing Nursing Homes -- The Centers for Medicare and Medicaid Services (CMS) has released the first ever list of the nation's 54 poorest performing nursing homes, the agency said in a November 29 press release. Full Story
Articles & Analyses
- Illinois Hospitals Face Conflicting Requirements Regarding Nurse Staffing, by Janice A. Anderson and Anne M. Cooper, Foley & Lardner LLP
 AHA Presses DOJ To Block Health Plan Merger
 FTC Reaches Settlement With Barr Involving Oral Contraceptive Drug
California Appeals Court Finds Nursing Home Arbitration Agreements Invalid
- Criminal Law
Prominent Plaintiffs’ Attorney Indicted For Attempting To Bribe Judge
U.S. Court In Indiana Finds Plaintiff Alleging EMTALA Violations Cannot Amend Complaint To Seek Damages Under § 1983
- Fraud and Abuse
Michigan Appeals Court Reverses Dismissal, Remands Medicaid Fraud Case For Trial
- Healthcare Access
 CMS Approves Wisconsin’s Plan To Expand Eligibility For Its SCHIP Program
 Hospitals Face Increasing Challenges In Obtaining Emergency On-Call Coverage From Specialists, Study Says
- Hospitals and Health Systems
Florida Appeals Court Upholds State Agency’s Decisions Allowing Hospitals To Recover Payments From Workers’ Compensation Carriers
- Managed Care
 Health Net Fined $1 Million For Failing To Disclose Compensation Based On Plan Rescission
 NY Physician Ranking Model To Become State Law
U.S. Court In Delaware Holds State’s Residency Requirement For Medicaid
Eligibility Violated Constitutional Right To Travel
- Medical Malpractice
 Washington Appeals Court Holds Malpractice Plaintiff May Not Rest Informed Consent Claim On Evidence Of Physician’s Inexperience
 Georgia Appeals Court Finds No Right To Indemnity Where Liability To Pay Judgment Not Compulsory
 Florida Appeals Court Finds Medical Malpractice Plaintiff Presented Sufficient Expert Testimony To Proceed To Trial
 Iowa Appeals Court Remands Medical Malpractice Case For New Trial, Finding Abuse of Discretion In Lower Court’s Rulings
 Lawsuit Seeks Medicare Part D Coverage Of Drugs For Medically Necessary Off-Label Uses
 Medicare Continues To Reduce Improper Claims Payments, CMS Says
Eighth Circuit Rejects MSP Action By Individual Claiming Standing As Qui Tam Relator
 CMS Issues Report To Congress On Medicare Hospital Value-Based Purchasing
- News in Brief
GlaxoSmithKline Agrees To $1.4 Million Settlement With Texas
- Patient Safety
Massachusetts Hospitals Will Not Charge For Adverse Events
 Washington Appeals Court Affirms Sanctions Against Physician For Unprofessional Conduct
 U.S. Court In Washington Finds Hospital Did Not Violate Physician’s Civil Rights In Denying Application For Privileges
Informed consent & SCOTUS: A tale of two doctrines
Case Western Reserve University - School of Law
Texas Law Review, Vol. 86, No. 2, December 2007
Case Legal Studies Research Paper No. 07-28
Top Ten Health Law Stories in 2008: FDA
The nation’s food supply is at risk, its drugs are potentially dangerous and its citizens’ lives are at stake because the Food and Drug Administration is desperately short of money and poorly organized, according to an alarming report by agency advisers.
- The FDA cannot fulfill its mission because its scientific base has eroded and its scientific organizational structure is weak.
- FDA does not have the capacity to ensure the safety of food for the nation.
- The development of medical products based on “new science” cannot be adequately regulated by the FDA.
- There is insufficient capacity in modeling, risk assessment and analysis.
- FDA science agenda lacks a coherent structure and vision, as well as effective coordination and prioritization.
- The FDA cannot fulfill its mission because its scientific workforce does not have sufficient capacity and capability.
- The FDA has substantial recruitment and retention challenges.
- The FDA has an inadequate and ineffective program for scientist performance.
- The FDA has inadequate funding for professional development.
- The FDA has not taken sufficient advantage of external and internal collaborations.
- The FDA cannot fulfill its mission because its information technology (IT) infrastructure is inadequate.
- The Subcommittee believes that there is evidence of important, but slow, progress to improve information sciences and technology at the FDA over the past few years, yet significant gaps remain.
- The FDA lacks the information science capability and information infrastructure to fulfill its regulatory mandate.
- The FDA cannot provide the information infrastructure support to regulate products based on new science.
- The FDA IT infrastructure is obsolete, unstable, and lacks sufficient controls to ensure continuity of operations or to provide effective disaster recovery services.
- The IT workforce is insufficient and suboptimally organized.
If that's not enough to make your Post Toasties wilt, I don't what is . . . .