Tuesday, March 25, 2008

Drawing Lots for Health Care -[Oregon] New York Times

Drawing Lots for Health Care - New York Times:

"Last month, right after he had the heart attack and then the heart surgery and then started receiving the medical bills that so far have topped $200,000, Melvin Tsosies joined the 91,000 other residents of Oregon who had signed up for a lottery that provides health insurance to people who lack it.

Melvin Tsosies is among Oregonians who signed up for a health insurance lottery. “They said they’re going to draw names, and if I’m on that list, then I’ll get health care,” said Mr. Tsosies, 58, a handyman here in booming Deschutes County. “So I’m just waiting right now.”

Despite the great hopes of people like Mr. Tsosies, only a few thousand of Oregon’s 600,000 uninsured residents are likely to benefit from the lottery anytime soon. The program has only enough money to pay for about 24,000 people, and at least 17,000 slots are already filled."

further down...

"Oregon once sought to serve a far larger population of those in need.
It has been more than a decade since the innovative Oregon Health Plan became a forerunner of state health care reform as it pursued universal health coverage. Conceived on a restaurant napkin in the late 1980s, the program had by 1996 reduced the number of the uninsured to about 11 percent of all residents, down from more than 18 percent in 1992. But then, early in this decade, the state endured a wrenching recession.
“Oregon was way ahead of everyone else,” said Charla DeHate, the interim executive director of Ochoco Health Systems. “And then we went broke.” "

Top o' the world, Ma!

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Most Republicans Think the U.S. Health Care System is the Best in the World. Democrats Disagree. - March 20, 2008 -2008 Releases - Press Releases - Harvard School of Public Health

Most Republicans Think the U.S. Health Care System is the Best in the World. Democrats Disagree. - March 20, 2008 -2008 Releases - Press Releases - Harvard School of Public Health:

"A recent survey by the Harvard School of Public Health (HSPH) and Harris Interactive, as part of their ongoing series, Debating Health: Election 2008, finds that Americans are generally split on the issue of whether the United States has the best health care system in the world (45% believe the U.S. has the best system; 39% believe other countries have better systems; 15% don't know or refused to answer) and that there is a significant divide along party lines. Nearly seven-in-ten Republicans (68%) believe the U.S. health care system is the best in the world, compared to just three in ten (32%) Democrats and four in ten (40%) Independents who feel the same way."

The survey results are here.

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Saturday, March 22, 2008

New Focus of Inquiry Into Bribes: Doctors - New York Times

New Focus of Inquiry Into Bribes: Doctors - New York Times:

"Once companies begin to develop the devices, leading doctors are hired as consultants to help modify the implants and related hardware. When the products are finally brought to market, companies also hire many of the same opinion leaders to train other doctors and sales representatives how to use them.

As a result, Mr. Christie has had no problem finding large sums of money — in some cases, more than $1 million annually — flowing from companies to doctors who use their devices. But doctors say it is far too simplistic to conclude, as Mr. Christie claimed last fall, that “many orthopedic surgeons in this country made decisions predicated on how much money they could make — choosing which device to implant by going to the highest bidder.”

For the most part, the hip and knee joints sold by the major companies are similar in performance, but getting surgeons to switch is a lot more difficult than persuading an internist to prescribe a prescription drug rather than aspirin."

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Friday, March 21, 2008

Capitol Hill Watch | Medical Device Industry Spent More Than $28M on Lobbying Federal Government in 2007, Analysis Finds - Kaisernetwork.org

Capitol Hill Watch Medical Device Industry Spent More Than $28M on Lobbying Federal Government in 2007, Analysis Finds - Kaisernetwork.org:

"Medical device companies in 2007 spent more than $28 million on lobbying the federal government, compared with $26.5 million in 2006, according to a preliminary analysis of U.S. Senate records conducted by the Center for Responsive Politics, the St. Paul Pioneer Press reports. In 2007, medical device companies lobbied Congress on an FDA reform bill, Medicare legislation, a bill that would require companies to disclose payments to physician consultants and legislation that would encourage health insurers to cover remote monitoring devices."

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State (MA) health plan underfunded - The Boston Globe

State health plan underfunded - The Boston Globe:

"The state's new subsidized health insurance program will cost 'significantly' more than the $869 million Governor Deval Patrick proposed in his 2009 budget just two months ago, the state's top financial official said yesterday, after insurers were granted an increase of about 10 percent.

To close the gap, the Patrick administration has asked insurers, hospitals, healthcare advocates, and business leaders to propose ways to cut costs and raise revenue. During two closed-door meetings in the last two weeks, several dozen proposals have been put forward, including raising assessments on insurers, hospitals, and businesses. The goals are to solve the short-term funding problem for next year and ensure the long-term survival of the state's near-universal health insurance initiative.

Leslie Kirwan, secretary of administration and finance, declined yesterday to discuss specifics of the proposals or the size of the budget gap, but said that without changes, the state doesn't expect 'to be able to live within' the proposed budget."

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Thursday, March 20, 2008

(Phila.) Evening Bulletin - Single-Payer Health Plan Considered

The Evening Bulletin - Inside Today's Bulletin - 03/20/2008 - Single-Payer Health Plan Considered:

"Gov. Ed Rendell (D) chiefly advocates a different plan that would subsidize health insurance for roughly 800,000 state residents who lack it. A portion of the plan that would cover Pennsylvanians who earn up to 200 percent of the poverty income level passed the state House Monday. That measure alone would cost an estimated $1.1 billion by 2013.

The nonprofit Healthcare for All Pennsylvanians wants to go even further by backing a single-payer system, noting that all other industrialized countries have opted for universal health care.

'Eighty-seven nations and our own Medicare system can't be wrong,' said Healthcare for All Pennsylvanians executive director Chuck Pennacchio. 'In fact, they demonstrate clearly that the only proven method for delivering quality, comprehensive, affordable health care for all is through a single-payer model. In the case of [this legislation], health care delivery is to be publicly funded and privately provided. Everybody in, nobody out. Period.'

But the question remains: How much care will residents demand, and how much will they pay to acquire it?"

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Friday, March 14, 2008

The Conservative Beatitudes

The Conservative Beatitudes

And turning His gaze toward His disciples, He began to say, "Blessed are you who are rich, for clearly God loves you best.

Blessed are you who conspicuously consume now, may you always be satisfied.

Blessed are you who live the good life now, for you have clearly earned it. Or inherited it. Or fell into it. Doesn't matter. Have at it.

Blessed are you when men envy and resent you, because God has bestowed wealth on you and your fathers and your children. Be glad in that day and leap for joy, for behold, your reward is forever, for God finds the Death Tax an abomination

But woe to you who are not-so-rich or downright poor, for you are receiving what you deserve. And don't be asking for entitlements, for a safety net is an abomination to God also. And besides, it builds character and maybe your children will find favor and wealth with God.

Woe to you who are hungry now, for you shall be hungry until you and your wife both get second jobs.. Woe to you who mourn and weep now, for you must pick yourself up by your bootstraps to be right with God.

Blessed are you when all men speak against you for your avarice, for their fathers used to treat the robber barons in the same way.

But I say to you who hear, screw your enemies, do misery to those who hate you,
crush under your heel those who curse you, pray for those who distrust you, so they may see your rightness with God.

Whoever hits you on the cheek, hire another to smite him severely and teach him a lesson; and whoever takes away your coat, prosecute him to the fullest extent of the law.

Give to nobody who asks of you, for it only encourages them to be lazy and dependent.

Treat others the same way you want them to treat you. Unless it involves taxes or money or any inconvenience to you. Then do whatever you believe God wants, for you are a favored one.

Blessed are you if you love those who love you, for that is impressively wonderful of you. God does not expect you to worry about others, that is God's job. And if it looks like others are suffering, well that's not your concern. God will provide (within reason).

If you do good to those who do good to you, what more could God expect?

If you lend to those who are lesser in God's eyes, make sure you get a good rate, at least 6 over prime. With multiple penalty provisions.

But love those also favored by God with wealth, and do good, and lend, expecting almost nothing in return to them; and your reward will be great, as favors beget favors and you will be most assuredly taken care of.

Be merciful, within reason; don't go crazy on this one.

Judge harshly those who do not live up to your standards and are clearly not favored by God with wealth and privilege, for they need your tough love to better themselves.

With apologies to Al Franken and Supply Side Jesus...


Render unto Caesar that which is Caesar's. But only for those things which benefit you, your family or your business interests personally such as defense, transportation, the civil and international courts, and the like. Oppose Caesar's attempts to use your money to promote the general welfare with a social safety net, healthcare or anything else that you don't personally need. And do not ask why. God is mysterious and beyond your ability to understand. And render a few bucks to charity now and then. You'll feel better.

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Thursday, March 13, 2008

Melani followed circuitous journey from Allegheny Valley to Highmark

Melani followed circuitous journey from Allegheny Valley to Highmark:

"Some peoples' lives are framed by the gravity of their forebears' legacy; others by a singular, undeniable talent. The life of Dr. Melani, now 54, was not so much framed as it was forged, by his own personality and skills as a diplomat.

Those skills have him on the cusp of becoming one of the most powerful business leaders in Pennsylvania, and one of the most important health insurance executives in the United States. Highmark is seeking a merger with Philadelphia's Independence Blue Cross, and combined, the two nonprofits will have up to 26,000 employees, 7 million policyholders, a $24 billion organization -- physicians' practices, dental, vision, casualty and life, and of course health insurance.

If the merger is completed, he'd head the entire company as its CEO.

'It's a very serious responsibility,' says Dr. Melani, who in his current job makes more than $3 million a year and occupies a radiant, 31st-floor office. 'I step back and look at it and say, Oh my God, how did little me from Cheswick, a little kid from Arnold, end up in this position? I was just going to practice medicine, and that was overwhelming to me.'"

My point in posting this is not to pick on Dr. Melani nor Highmark, per se, just to point out the obvious: These things are huge, money making machines.

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Canada's health care has 'em lining up - Pittsburgh Tribune-Review

Canada's health care has 'em lining up - Pittsburgh Tribune-Review

Coverage of the SEPP-PNHP event at Duquesne of March 10.
Not too shabby for the Scaife-Tribune, but my expectations are rather low.

My post on the event is here.

And the Waiting time section here.

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Wednesday, March 12, 2008

Doctors demand action on private health insurance

CNW Group CANADIAN DOCTORS FOR MEDICARE Doctors demand action on private health insurance:

"TORONTO, March 12 /CNW Telbec/ - Canadian Doctors for Medicare today called on the federal and provincial governments to immediately take all necessary steps to stop the spread of private health insurance for medically necessary services in British Columbia.

'The recent exposé that Acure Health Corp is selling 'Medical Access Insurance' for services already covered under Medicare undermines the public health care system to the detriment of the vast majority of Canadians, and contravenes the Canada Health Act', said Dr. Danielle Martin, Chair of Canadian Doctors for Medicare.
"Those who think private health insurance is a panacea for our system should take a look at the Australian experience. The major beneficiaries there have been higher income Australians, private insurance companies, private hospitals and medical specialists - and not the wider Australian community," said Dr. Martin.
"In its 2006, in its discussion paper "It's About Access", the Canadian Medical Association reviewed all the evidence and found: - Private insurance for medically necessary physician and hospital services does not improve access to publicly insured services
- Does not lower costs or improve quality of care
- Can increase wait times for those who are not privately insured; and
- Could exacerbate human resource shortages in the public system."

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Japan Focus: Multiple Crises in Healthcare

Japan Focus: Discusses a new system trying to address problems of the elderly that may not work out that well...

"The problems with the new system are not limited to its economic burden. The payment schedule for medical treatment is independent of other insurance programs, and it is on a fixed-cost, blanket system. The allowable expense per month is set in advance for each disease. If necessary exams and treatment are cut off because of these limits, it is a de facto restriction of medical care. This is nothing short of the government delivering a death sentence, telling the elderly to die quickly. Will Nakata and Mr. and Mrs. A be able to survive this new system?"

Other topics discussed include:

Stripping the Long-Term Care Beds
The State of Home Healthcare
Physician Shortage Causing Regional Healthcare Collapse
Obstetrics Units Closing throughout Japan
Towns Rocked by “Medical Depopulation"

"There are about 270,000 practicing physicians in Japan, or 2.0 per one thousand population. The OECD average is 3.1, and Japan ranks 27th out of the 30 member countries. Japan has the lowest ratio among the G7 industrialized economies (the US stands at 2.4, Germany and France at 3.4). To reach the OECD average, Japan would need to add some 140,000 doctors."

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Tuesday, March 11, 2008

Single Payer Debate at Duquesne U, 3/10/08

SEPP Organization - SEPP Events

(The link above takes you to the details of the event.)

I attended the debate last night among Dr. Scott Tyson and Gariel Silverman, arguing the single payer case, and Sue Blevins and Nameed Esmail, arguing against at Duquesne University last night. First, props to Duquesne: Great venue in the Power Center, easy parking, nice facility all around. And props to both groups for getting attendance to a surprisingly high level (over 200, I'd guess). Pro-single payer were in the majority, I'd guess, by a significant amount.

I'll cut to the chase: Jerry Bowyer, moderator, at the end of the evening, asked if the discussion had changed anyone from their pro or anti single payer or undecided camps, and only a handful of hands went up. Sigh. But, not, of course, unexpected.

To those of us who are familiar with the issues and arguments for and against single payer, and familiar with the players (esp. Mr. Esmail's Fraser Institute), there were not many surprises. My most pleasant surprise was Dr. Tyson's excellent performance. Powerful, personal and passionate, Dr. Tyson did a very good job of making the moral, practical and economic case.

As my bias is obvious, I won't pretend to disguise it. I found the same old arguments from the status quo/free market/every man for himself side very tiresome indeed. I'll just toss out a few "highlights."

Single Payer advocates see Canada as a Panacea solution for America's woes. I don't know of any, but it somehow forces single payer advocates into the silly position of defending Canada's system, even though it is not the one we would emulate. From now on, we should respond to the Canada graphics with ones comparing us to Germany, France, Belgium, Japan, or almost anyone, and leave Fraser to shit on their own country as they seem wont to do. Heaven forbid they offer constructive solutions. And by this, I mean ones that at least 30 or 40% of the Canadian population would at least consider.

Showing a spending chart showing Canada at the high end of spending on healthcare compared to the rest of the world, and omitting the US, cause we're so off the charts as to make the chart look laughable.

Arguing that taxation sufficient to pay for healthcare would strangle economic growth. This is just too brain-dead to answer, especially sitting in a country that spends 16.5% of its GDP on healthcare. And especially from an economist who said, specifically, that there is no "government money" only our money in government's hands.

Waiting times in Canada are intolerable and/or deadly. Please click here.

$32 Billion in Medicare fraud annually is an outrage and a scandal. I don't know the source or veracity of this figure, but the 2006 Medicare expenditures were $408 billion, meaning 92% of the money gets where it's supposed to, which needs work, but isn't awful. And the suggestion that I think Ms. Blevins made was that she preferred private insurer's solution: deny care first, and then sort out who was trying to scam you, rather than covering claims in good faith and then going after the perps. I'm all for getting the perps, but not until I've made sure the patients are taken care of first. Silly me.

Patients in Canada often have to wait 10 or 12 hours to get a hospital bed when admitted through the ER. Imagine our shock. (He did know Pittsburgh was in America, right?)

Veterans Administration hospitals are horrible places. Dr. Tyson did try to set Ms. Blevins right on this one, though I think she didn't believe him.

You cannot pay for treatment in Pennsylvania outside of your contract with your health insurer.
This one got my attention. I hope somebody will post a comment for me about it, because I'd never heard this before, and it seems exceedingly odd.

The usual "anecdote-off," for which I'll just refer you to our special section.

I was pleased to see Mr. Esmail's praise of other systems, particularly those of Switzerland, Japan, France, Sweden, Germany and some others. He rightly pointed out that the old PNHP proposal, from 1993, was fairly beholden to the Canadian model, but there are newer proposals from PNHP, and besides, they are not the only proposals out there. As has been often pointed out by our side, and always ignored by theirs, we need a uniquely American system, pulling from the best of all other extant systems. Though Mr. Esmail did seem gratified to sear Dr. Tyson say this, I doubt it was the first time he heard it. (You don't suppose he didn't watch Sicko, even as an academic exercise?) Oh, and Esmail even admitted we were rubbish for Mental Health care, too.

Oh, and a personal shout out to Scott Tyson for his wonderfully dismissive treatment of HSAs. Made me chuckle and even snort a bit!

OK, folks, that's all I can remember at this late hour, but please add your comments to remind me of things I forgot to mention....


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Monday, March 10, 2008

Washington State Results — Code Blue Now!

Washington State Results — Code Blue Now!:

"In December 2007, CodeBlueNow! worked with The Gilmore Research Group, a Northwest market research firm, to conduct a phone survey, known as the CodeBlueNow! Pulse®. The CodeBlueNow! Pulse® is intended to gauge the public's views about priorities in health care reform. CodeBlueNow! intends to use this data to give voice to citizen's values and ideas on health care reform."

I haven't had time to digest all of this. There are both a full report, an executive summary and links to Iowa results on this page.

Just glancing though, I don't find anything to surprising, though I think some of the results reflect a lack of knowledge of the current system and options by the particpants. For example, asking about "government run healthcare" is so loaded as to beg for an uninformed answer. Perhaps they phrased it better in the telephone scripit, I don't know. But even so, most people at least recognize how dysfunctional our system is, but possibly don't appreciate the possibilities and options that could be accomplished with some strong national leadership.

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Sunday, March 9, 2008

What McCain Could Do About Taxes - Ben Stein NYTimes.com

Even Ben Stein concedes the point! Finally.

[Sorry that this is off-blog-topic, but I have to put these somewhere.]

"All politicians campaign on the promise to cut federal spending by identifying hitherto unfound waste, fraud and corruption. None of them ever do so in a meaningful way. Total federal spending has not once fallen noticeably since 1954, no matter the party or the promises of the incoming chief executive.

That is the first thing you need to know. The next thing is that the Republican Party (my party and yours) has for the last 30 years or so been operating under a demonstrably false and misleading premise: that tax cuts pay for themselves by generating so much economic growth that they replace the sums lost by tax cutting.

This would be a lovely thing if true, and the best of all ideas, the “something for nothing” idea. In fact, tax cuts lower federal revenue and generate federal deficits. It is also true that they do stimulate the economy and after a long period of years, federal tax receipts go back to where they were before the tax cuts.

For example, when President Bush enacted his tax cuts in the early 2000s, income tax receipts fell dramatically. It took almost six years for them to reach the level they had been in the last year of the Clinton administration, while G.D.P. in that period rose by roughly 30 percent. In the eight years Ronald Reagan was president (and I love and worship him), tax receipts did not fall anywhere near as much, but they rose more slowly, on a percentage basis, than they did in any other comparable eight-year period after World War II.

In other words, tax cuts do not pay for themselves, at least not on any basis I can see. Certainly, they are not worthless. They make taxpayers feel good and they generate growth. But basically, they shift the tax burden from us to our progeny and add immense amounts of interest expense to the federal budget. At this point, taxpayers shell out about $1 billion a day just for that item. "

And there's even more! Ben Stein finds his inner Keynes. Or Krugman?

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Monday, March 3, 2008

Crooks and Liars » 60 Minutes: Charity Trying To Make Up For Failing U.S. Health Care System

Crooks and Liars » 60 Minutes: Charity Trying To Make Up For Failing U.S. Health Care System

"If you’re looking for a story that shows the abysmal state of health care in America, look no further. 60 Minutes traveled to Knoxville, TN to film a free clinic set up by a charity group called Remote Area Medical Volunteer Corps, or RAM. The charity was initially started in the 90’s by it’s founder, Stan Brock, former co-star of Wild Kingdom, to give health care relief to remote areas of Latin America, but after watching this segment it’s clear that America’s health care system doesn’t look too much different than that of a third world country."

The video of the 60 Minutes story is available for viewing at the C&L site and it is definitely worth watching, if only to count the thousands of anecdotes available for those who like that sort of thing.

In a related anecdote, a patient I saw today with (now) advanced lung cancer, who had this gem in his history and physical: "He developed severe, unremitting left sided chest pain beneath his clavicle and along his left anterior chest about 4 to 5 months ago. He did not seek medical attention due to lack of health insurance."

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