To all readers:

Yesterday (Monday March 29) some readers experienced problems when trying to leave  comments on HeathBeat. TypePad is now monitoring the situation and seems to have fixed it. But if anyone continues to have a problem, please e-mail me at maggiemahar@yahoo.com

Also, please note—if takes a while to post the comment (either because it’s long or because you’re interrupted), you may find that when you try to send it, you get a message saying that your comment cannot be accepted. This is because you’ve “timed out.”  Just “copy” your comment, close HealthBeat, open HealthBeat again, go to the post you were commenting on, and “paste” your comment in the box.   It will then be accepted.

Also, I’ve been catching up with responding to comments. If you didn’t receive a response in the past week, you might want to check back . . .

Thanks, Maggie

In the April 5 New Yorker Atul Gawande writes about the backlash that health care reformers can expect in the months ahead.  He reminds us that when Medicare passed “it faced a year of nearly crippling rearguard attacks.”

Few remember that the American Medical Association was absolutely opposed to the idea of providing medical care for all elderly Americans. They guild didn’t want the government involved, calling Medicare “the most deadly challenge ever faced by the medical profession.”  The Ohio Medical Association, with ten thousand physician members, declared that it would boycott Medicare, and a nationwide movement began. (The opponents changed their mind a year later when they realized that, thanks to Medicare, their salaries had climbed by 11 percent in just on year.)

“Race proved an even more explosive issue,” Gawande reports. Hospitals were told that if they wanted Medicare dollars, they would have to integrate. Two months before coverage was to begin, “half the hospitals in a dozen Southern states had still refused to meet Medicare certification.” But LBJ stood firm on the issue.

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Over at the New America Foundation’s New
Health Dialogue, Joanne Kenen, who covered Congress for more than a decade
before becoming a healthcare maven, reports that at least “one well-placed
Senate source is quite worried that this could be another knock-down drag it
out Bunningesque confirmation fight. After all the Republican talk about saving
Medicare,” Kenen writes, “we sure hope they don’t block the guy who can do it.”

Many
thanks to Kenen, who was supposed to be on vacation today, and was at home, “elbow
deep in matzoh balls and macaroons (home-made…hear that Ezra?),” while also tracking
down sources.

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Hannah
Fields, a med student at Mayo who has just begun blogging, offers a provocative essay
on medical care that “fits”—not the doctor’s beliefs or even objective medical
evidence, but “the patient’s reality.”

 She writes: “In the real world, we must use
different tools and ways of practicing medicine to determine the shared goal  with as much agreement as possible between
doctor and patient, and to find treatments that are within the capacity of the
patient and can be accomplished using the patient’s available resources.” http://minimallydisruptivemedicine.org/2010/03/26/hannah-fields-discusses-mdm/  (Many thanks to vmontori for calling my attention
to Hannah’s blog on twitter. http://twitter.com/vmontori

Hannah
calls this “minimally disruptive medicine”:

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The rumors that I wrote about Friday are, in fact, true. President Obama will name Dr. Donald Berwick, president of the Institute for Health Care Improvement (IHI), to run Medicare and Medicaid. Berwick, who is a professor of pediatrics and healthcare policy at the Harvard Medical School and a professor of health policy and management at the Harvard School of Public Health, will have to be confirmed by the Senate Finance Committee.

Just how tough will the confirmation hearing be? I’m not worried. Berwick can handle himself.

Granted, yesterday the New York Times called Berwick “iconoclastic,” i.e., someone who “smashes sacred religious images” or “attacks cherished beliefs.”   But most who know him describe him a “visionary” and a “healer,” a man able to survey the fragments of a broken health care system and imagine how they could be made whole.  He’s a revolutionary, but he doesn’t rattle cages. He’s not arrogant, and he’s not advocating a government takeover of U.S. healthcare.

Berwick stands at the center of a healthcare movement that would reform the system from within. In 2005, Modern Healthcare, a leading industry publication, named him the third most powerful person in American health care. In contrast to others on the list, Berwick is “not powerful because of the position he holds,” Boston surgeon Atul Gawande noted at the time.  (Former Secretary of Health and Human Services ranked no. 1, while Thomas Scully, the head of Medicare and Medicaid services captured the second slot.) “Berwick is powerful,” Gawande explained, “because of how he thinks.”

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A surprising number of Congressmen would acknowledge, privately, that in the past, legislators have meddled with Medicare reform, blocking Medicare’s best efforts to squeeze waste out of the system. When it comes to listening to appeals from powerful lobbyists, legislators just can’t help themselves. Lobbyists generally don’t like change– certainly not when the status quo is generating billions in profits.

At the same time, virtually everyone in Congress recognizes that we cannot afford the status quo. And most legislators do care about the public good. At the very least, they don’t want to see Medicare go under.  So they have chosen to tie their own hands. (This is the evidence that, in their heart of hearts, many Congressmen recognize that they themselves represent the major obstacle to reining in health care inflation.)

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Within the past hour  both New America Foundation’s Joanne Kenen and Wall Street Journal blog “Washington Wire” have reported the rumor—not yet confirmed—that President Obama has chosen Dr. Donald Berwick, the president and founder of the Institute for HealthCare Improvement (IHI) to become the new director of the Centers for Medicare and Medicaid (CMS).  Readers who have seen Money-Driven Medicine, the documentary based on my book will recognize Berwick’s name: he is one of the stars of the film.  (See clips of Berwick from the film, which is being distributed by California Newsreel here. )For more information on the film, go to www.moneydrivenmedicine.org.

Thursday, Inside Health Policy’s Brett Coughlin and Amy Lotven were the first to report the rumor : “According to several Washington sources . . . the White House has picked Harvard professor and pediatrician Donald Berwick to serve as CMS Administrator. A K Street source said that Berwick agreed to take the job ‘some time ago’ but only on the condition that health reform pass first. Although administration officials did not confirm the chatter, sources said that the announcement could come as soon as next week.” (via Politico Pulse)

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The following video segments are from the documentary Money Driven
Medicine , produced by Alex Gibney, directed by Andy Fredericks and based on Maggie's book. They and are presented courtesy of the film's distributor California Newsreel www.newsreel.org (The player uses Adobe Flash Player available here)

To view, click on the white arrow on the bottom of the screen

Is American Health Care the Best in the World?

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Those who oppose reform understand just how powerful this legislation is. They understand—better than many liberals—just what it means for a medical-industrial complex that has grown fat while profiting from runaway health- care inflation. Going forward, it will be much harder for lobbyists to block efforts to rein in health care spending. Conservatives understand the business of health care; they know just how much money is involved. And they know that while this bill will be good for patients, it will not be good for those who view medical care as a business.

Click on this link to hear a podcast that I recorded yesterday.

The figures are alarming: The cesarean rate in this country has increased 50% since 1996; hitting an all-time high of 32% of all deliveries. What could possibly be fueling this dramatic rise in surgery?

The latest figures come from a report released yesterday by the National Center for Health Statistics
and have added more fire to an already simmering debate over the increased use of cesarean sections. Cesarean deliveries carry greater risks for mothers and newborns; require longer recovery times and incur hospital costs that are almost double those for a vaginal delivery, according to the report.

In the past, some medical groups have attributed the rise in c-sections to factors like older mothers and an increase in multiple births. But the NCHS report found that the rate of c-sections rose in all age groups between 1996 and 2007; with women under age 25 experiencing a 57% increase in cesarean deliveries, the largest increase of all. Increases were found across the board in all racial and ethnic groups and at all gestational ages. And surprisingly, the rate of c-sections for single births increased substantially more than cesarean rates for multiple births.

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