JAMA Network | JAMA | Reshaping US Health Care: From Competition and Confiscation to Cooperation and Mobilization

 

In this issue of JAMA, 3 Viewpoints, by Powers et al,¹ Fuchs,² and Fisher and Corrigan,³ address problems, possibilities, and mechanisms for reshaping the US health care enterprise to better meet community needs at an affordable cost.

In their Viewpoint, Powers et al¹ grapple with a question as old as democracy: How can productive collective action, which is required for a state to succeed, emerge from the factional divisions for which protection is required for democratic principles to succeed?

The founding fathers of the United States debated this vigorously. In the most famous Federalist Paper,⁴ Madison favored a large republic in the hands of a meritocracy to counterbalance the passions of a majority “faction” that might overwhelm legitimate minority interests. Others wanted to protect states’ powers, arguing that smaller political units could be more responsive to local groups.

Madison defined a faction as “a number of citizens, whether amounting to a minority or majority of the whole, who are united and actuated by some common impulse of passion, or of interest, adverse to the rights of other citizens, or to the permanent and aggregate interests of the community.”⁴

Health care is ground zero for this problem, and the stakes are immense. Health care is a behemoth “faction” that controls one-sixth of the US economy and distorts the nation’s economic and political future. I recently ran as a candidate for governor of Massachusetts, and, in the course of an 18-month campaign, I saw vividly the effect of this dominating industry on the opportunities for the total well-being of a population of nearly 7 million people.

JAMA Network | JAMA | Reshaping US Health Care:  From Competition and Confiscation to Cooperation and Mobilization

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AHIP's Commissioned Report

In case you're looking for good analysis of the AHIP shot across the bow...

http://www.newamerica.net/blog/new-health-dialogue/2009/health-reform-ahip-got-what-it-paid-15314


http://www.newamerica.net/blog/new-health-dialogue/2009/health-reform-gloves-are-15299

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NEJM -- Primum Non Nocere -- The McCain Plan for Health Insecurity

NEJM -- Primum Non Nocere -- The McCain Plan for Health Insecurity:

"By this standard, John McCain emerges not as a maverick or centrist but as a radical social conservative firmly in the grip of the ideology that animates the domestic policies of President George W. Bush. The central purpose of President Bush's health policy, and John McCain's, is to reduce the role of insurance and make Americans pay a larger part of their health care bills out of pocket. Their embrace of market forces, fierce antagonism toward government, and determination to force individuals to have more 'skin in the game' are overriding — all other goals are subsidiary. Indeed, the Republican commitment to market-oriented reforms is so strong that, to attain their vision, Bush and McCain seem willing to take huge risks with the efficiency, equity, and stability of our health care system. Specifically, the McCain plan would profoundly threaten the current system of employer-sponsored insurance on which more than three fifths of Americans depend, increase reliance on unregulated individual insurance markets (which are notoriously inefficient), and leave the number of uninsured Americans virtually unchanged. A side effect of the McCain plan would be to threaten access to adequate insurance for millions of America's sickest citizens."

As I've said elsewhere, I believe McCain's plan would blow up the current system fairly quickly and lead us to our much needed national debate on how we really want to do this, but the cost in every other way is too high to risk.

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Daily Kos: My Old Friend Karl

Daily Kos: My Old Friend Karl:

Karl is a previously very conservative republican physician in central PA...

"I got a sort of Norman Rockwell picture from it all, and the whole-cloth of that, I assumed, also included a strong commitment to the Republican Party.

I couldn’t have been more wrong. 'No,' Karl said. 'When you’re a G.P. like I am, and you see how people are struggling to pay their insurance, to buy their prescription drugs, to wrench hospice care out of their tight-fisted HMOs, you can’t support the Republicans.' My head exploded. I’d dreaded a political argument, but Karl had come over from the ‘Dark Side’! 'You know', he said, 'all of the G.P.s I know are voting Obama. We all feel that this country desperately needs Obama, that it can’t possibly afford another four years of these policies for the rich. The middle class will cease to exist with four more years of this. But it’s funny: all of the specialists I know, especially the plastic surgeons, the sports surgeons, the boutique doctors, they’re all supporting McCain. They’re making money hand over fist, and all they care about is tax breaks and lower malpractice premiums.'"

Amen. This is precisely how I see things shaking out. We may be in for a "class war" in medicine at some point in the near future, fighting for the soul of medicine and what it means to be physicians.

Cheers,

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Drug Industry, Having Long Smiled on G.O.P., Now Splits Donations Equally - NYTimes.com

Drug Industry, Having Long Smiled on G.O.P., Now Splits Donations Equally - NYTimes.com:

"WASHINGTON — After favoring Republicans by a ratio of more than two to one for most of the last decade, pharmaceutical companies and others in the health care industry are now splitting their contributions evenly between the two major parties, campaign finance reports show.

Lobbyists and executives in the industry say the swing reflects the fact that Democrats control both houses of Congress, are expected to increase their majorities and may win the White House, giving them a dominant voice on health policy."

There's a surprise!

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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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NEJM -- Market-Based Failure -- A Second Opinion on U.S. Health Care Costs

NEJM -- Market-Based Failure -- A Second Opinion on U.S. Health Care Costs:

"Relentless medical inflation has been attributed to many factors — the aging population, the proliferation of new technologies, poor diet and lack of exercise, the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand, excessive litigation and defensive medicine, and tax-favored insurance coverage.

Here is a second opinion. Changing demographics and medical technology pose a cost challenge for every nation's system, but ours is the outlier. The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system.

Markets are said to optimize efficiencies. But despite widespread belief that competition is the key to cost containment, medicine — with its third-party payers and its partly social mission — does not lend itself to market discipline. Why not?"

Read on...

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Democrats get infusion of campaign money from health care | Dallas Morning News | News for Dallas, Texas | National Politics

Democrats get infusion of campaign money from health care Dallas Morning News News for Dallas, Texas National Politics:

"Depending on who is elected, the role of government and employers could swing dramatically, from Democrat John Edwards' call to require all employers with five or more workers to provide coverage or contribute 6 percent of payroll toward a public program on one end of the spectrum, to Republican Fred Thompson's call to 'divorce [the] complete dependence people have on employment for their insurance.'

In Texas, health care executives have donated almost twice as much to presidential candidates in this campaign as they did in the last election. Doctors and hospitals have a vested interest in increasing the number of people who have insurance, since that ups their chances of getting paid. Meanwhile, insurers want to ensure that people and companies keep purchasing plans from private insurance companies, as opposed to switching to a government-run system.

So, perhaps it should not be surprising that, through September, Texans in areas ranging from surgery to medical supplies donated $934,000, up 75 percent from the $531,000 poured in during the same period of the 2004 campaign.

This time around, about as much of that money went to Democrats as Republicans. Democratic candidates raked in a total of $459,650, versus $474,234 for Republican presidential candidates.
On the national level, the Democrats actually beat the Republicans. Through September, Democratic candidates collected $6.5 million from the health care industry, compared with $4.8 million for Republican candidates, according to the Center for Responsive Politics, a Washington, D.C.-based campaign finance research group.

Mrs. Clinton, the Democratic front-runner, has been the biggest beneficiary from Texas health industry donations, with $237,000 through September; Republican front-runner Rudy Giuliani came in second, with $223,000.

Next in line for Democratic contributions was Illinois Sen. Barack Obama, with $110,000 from Texas health care donors. Mr. Obama also collected the state's single-largest such donation, with $24,000 from the Dallas-based medical technology company T-System Inc., according to a study prepared for The Dallas Morning News by the Center for Responsive Politics. "

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2008 Presidential Candidates Healthcare Proposals Side by Side Comparison

Analysis - health08.org:

"This side-by-side comparison of the candidates positions on health care was prepared by the Kaiser Family Foundation with the assistance of Health Policy Alternatives, Inc. and is based on information appearing on the candidates websites as supplemented by information from candidate speeches, the campaign debates and news reports. The sources of information are identified for each candidates summary (with links to the Internet). The comparison highlights information on the candidates' positions related to access to health care coverage, cost containment, improving the quality of care and financing. Information will be updated regularly as the campaign unfolds."

This is an interesting exercise. I suggest you click on Kucinich and anyone else and view them side by side.

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Medicare Audits Show Problems in Private Plans - New York Times

Medicare Audits Show Problems in Private Plans - New York Times:

"The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications. "

"I'm shocked, shocked," says Captain Renault...

Update: I've trackbacked (or is it trackedback?) to firedoglake post on this, so that if you need lots more examples of why we need single payer, you can click on the various topics I have set up on the right to get data when you are in a fracas...

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REP. TODD TIAHRT: SCHIP IS POLITICAL TUG-OF-WAR

Kansas.com 09/26/2007

"Ensuring the welfare of America's children should be top priority among congressional members. That's why I supported SCHIP when it was created by the Republican Congress in 1997. I would continue to offer my support this year; however, Democrats have politicized this program and used it as a platform to take one giant step toward a national socialized health care system."

It's always disappointing when a member of Congress argues against the straw man of "socialized medicine" when nobody is advocating for a socialized system in which the government owns all parts of the health system. It can work: look at the VA, and imagine the VA if it weren't underfunded and forced to outsource parts of its responsibilities to those wonderful "privateers" (remember the Walter Reed debacle - outsourcing).

But virtually nobody wants socialized medicine. Virtually everyone whom I've ever heard advocate for universal coverage advocates for a single payer system where we, the taxpayers, pay for our health insurance via taxes, and it is administered through a system like Medicare is right now. Medicare contracts with private companies that operate under Medicare rules (our rules, by the way, Congress sets the rules) and pay hospitals, doctors, etc. No socialized medicine, thank you; Medicare for all, please.

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MAPLight.org | Money and Politics: Illuminating the Connection

MAPLight.org Money and Politics: Illuminating the Connection: "MAPLight.org brings together campaign contributions and how legislators vote, providing an unprecedented window into the connections between money and politics."

h/t to Mr. Pogue:

From the Desk of David Pogue, New York Times,

Following the Money Trail Online

By DAVID POGUE

Published: May 24, 2007

The first step to solving a problem is recognizing that you have one.

That's what I keep telling myself, anyway, to avoid becoming depressed by Maplight.org.

It's a new Web site with a very simple mission: to correlate lawmakers' voting records with the money they've accepted from special-interest groups.

All of this is public information. All of it has been available for decades. Other sites, including OpenSecrets.org, expose who's giving how much to whom. But nobody has ever revealed the relationship between money given and votes cast to quite such a startling effect....

All I can say is, "Let the games begin!"

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Corporate Democrats Escalate Attack on Single Payer

corporatedems050807: "CORPORATE CRIME REPORTER
Corporate Democrats Escalate Attack on Single Payer
21 Corporate Crime Reporter 20, May 8, 2007"

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Health Care and The Right's Tactics | TPMCafe

Health Care and The Right's Tactics TPMCafe: "Health Care and The Right's Tactics"

An interesting piece and discussion at TPM Cafe...

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People's Weekly World - Assessing America’s health care system

People's Weekly World - Assessing America’s health care system:

Review of: "Practicing Medicine without a License!
The Corporate Takeover of Healthcare in America "

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Top Contributors to Federal Candidates and Parties: Pharmaceuticals/Health Products

sorry, another good one...
Top Contributors to Federal Candidates and Parties: Pharmaceuticals/Health Products: "Pharmaceuticals/Health Products: Top Contributors to Federal Candidates and Parties "

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More from Open Secrets

More from Open Secrets
Top Contributors to Federal Candidates and Parties: Health: "Health: Top Contributors to Federal Candidates and Parties "

Donor Profiles: The American Medical Association (AMA) represents medical doctors across the country, promotes standards in care, and publishes a number of medical journals. The association has traditionally supported Republican candidates, agreeing with the GOP on such issues as medical malpractice reform. But over the last few years, the AMA has also begun to shift support to the Democrats, favoring their attempts to pass patients’ rights legislation and expand Medicare payments. "

And just for fun:
Top Contributors to Federal Candidates and Parties: Misc Business:
"Misc Business: Top Contributors to Federal Candidates and Parties "

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Industry Totals: Health Professionals

From OpenSecrets.org:
Industry Totals: Health Professionals:
"Health Professionals: Long-Term Contribution Trends "

Industry Totals: Pharmaceuticals/Health Products:
"Pharmaceuticals/Health Products: Long-Term Contribution Trends "

Industry Totals: Insurance: "Insurance: Long-Term Contribution Trends "

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NEJM -- Campaign Contributions from the American Medical Political Action Committee to Members of Congress -- For or Against the Public Health?

1994 article on AMPAC contributions:
NEJM -- Campaign Contributions from the American Medical Political Action Committee to Members of Congress -- For or Against the Public Health?

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