Today, Health Beat is hosting Health Wonk Review, a biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant’s blog.
Thanks to all of you for your submissions. I couldn’t do justice to all of them, but here’s a sampling of some of the best posts about health care on the blogosphere:
At Health Care Policy and Marketplace Review Robert Laszewski takes on Mitt Romney’s assertion that there are “pots of money” in the states –enough to allow states to follow Massachusetts’ initiative and fund health care reform without raising taxes. Laszewski demolishes the argument, pointing out that even Massachusetts doesn’t have enough money to follow Massachusetts’s initiative. That’s why the state has had to exempt some citizens from the mandate that everyone buy insurance.
On Health Access California, Anthony Wright offers the clearest explanation I’ve seen of Governor Schwarzenegger’s plan for reforming care in California, and its merits and limitations when compared to both HRC’s proposal and the Romney plan in Massachusetts.
On Physician Executive, Zagreus Ammon’s ambitious post “Defining Universal Health Care” begins by addressing the theory that each of us is responsible for our own health—i.e. “that people do well because they make good choices and people do poorly because of poor choices.”
Here Ammon is responding to Peter Huber of Manhattan Institute fame and his editorial in IBD (Investors’ Business Daily) arguing that universal healthcare is an idle dream because eventually, the “pocket-book healthy” (read: wealthy) will get tired of paying for the “health-careless people” who don’t “live informed, disciplined lives”(read: less well-educated and poorer.) The righteous would rather see that money funneled into products that would provide them with “better hair, skin and sex,” Stern suggests. For a more generous synopsis of Huber’s argument, see H.G. Stern’s rave review on Insureblog.
Stern is a Huber fan. Ammon is not. "The logic that better consequences follow from greater adeptness at making choices is not at issue,” says Ammon. “The issues relate to the choices that will present [themselves] to people born in certain circumstances. The choices I was born into were between a Subaru and a Mazda for a first car; some of my friends, between a Lotus and an MG. Others between the bus and the subway. Such possibilities present in health as well.
“The greatest single predictor of health outcome is socio-economic status,” he continues. “The best way to be healthy in life is to be born into a wealthy family.” Moreover, he notes “much is related to the vagaries of genetics and chance. In fact, genetics seem to affect behavior more than any of us would care to admit.”
Ammon goes on to explain how “universal healthcare” addresses these issues. First, he clears up some misconceptions: “universal healthcare” isn’t necessarily “single payer,” and it doesn’t necessarily exclude private sector care. Here he points to examples in the U.K., Canada and Europe.
What defines “universal healthcare,” Ammon contends is that “it ensures that everyone contributes. Everyone stands to benefit from a pooling of resources.” Here, he rejects what he calls “the old elitist and eugenic argument: why pool my resources with genetically inferior individuals who are unable to make wise choices?”
The truth is that sometimes even the wealthy make foolish choices, as Managed Care Matters’ Joe Padua points out in his excellent discussion of Rudy’s claim that he survived prostate cancer because he had the good fortune to be an American.
As Joe observes, American are more likely to be diagnosed with prostate cancer, and so more Americans "survive" the disease. But this is not an advantage because in many cases, what are being diagnosed are “very slow growing cancers that are unlikely to prove fatal. All the diagnoses do, rather effectively, is scare the bejesus out of patients, and encourage them to get procedures that are not only costly and of uncertain benefit, but also may render the patient impotent, incontinent, or dead. Since the Brits don’t do as much screening for prostate cancer, they don’t do a lot of operations on patients that may not need them."
Charles H. Green also laments the over-testing of America at Trusted Advisor Associates, noting that in the U.S. "we’ll take a ton of false positives so as not to incur a single false negative…because the patient pays the price of false negatives—economically and emotionally." And hey, who cares about patients’ well-being, right?
For another example of the epidemic of diagnoses sweeping this country, see my piece on autism here on Health Beat. A couple of weeks ago the American Academy of Pediatricians sounded the autism alarm, telling parents that they had better keep a close eye on their children. Does your six-month old make eye contact? Does your eight-month old follow your gaze? 1 out of 150 children have autism, the AAP claims, and all children should be “screened” by their pediatrician at least twice before they turn two. But don’t be alarmed, the AAP says, not all children who display a few symptoms are autistic, and so parents shouldn’t “over-react” to quirky behavior.
Are they kidding? Parents are frantic reports Bryna Siegel, professor of child director of the Autism Clinic at the University of California, San Francisco, who describes the damage inappropriate screening and treatment could do. The report, published in Pediatrics, ends with an appendix advising the pediatrician on how to get paid, describing “reimbursement as an important part of the screening process.”
Pediatricians are not the only ones who worry about reimbursement. Many doctors have trouble getting timely payment from insurers—though that doesn’t quite explain why so many orthopedic surgeons are taking what some might call “kick-backs” from device manufactures. Over at Health Care Renewal, Roy Poses follows up on a Bloomberg News story, and does his usual in-depth job, offering a “Few Answers, and Many More Questions about Device Manufacturers’ Payments to Orthopedic Surgeons.” Consulting is one thing, but the sums are stunning: $3 million? $5.5 million?
At the other end of the economic ladder, a disabled man is fired because he’s late to work. On Worker’s Comp Insider, Lynch Ryan’s account about how a paraplegic was canned—after 17 years on the job—is particularly well-written.
Medical Information continues to be a hot topic. On The Sentinel Effect, Richard Eskow calls for a public discussion of privacy and health care data. Today “most people have no idea who sees their medical information or where it goes.We’ll have even bigger problems in the future, including the collection and use of genome data.” Eskow outlines some remedies, calling informed consent “an elegant solution.”
Meanwhile, Brian Klepper wants consumers to have access to transparent information about the track record of physicians in their community. Keppler reports that Consumers’ Checkbook (CC), a consumer advocacy organization, is battling CMS for Medicare physician data in 4 states and D.C. Keppler is rooting for CC.
What Keppler doesn’t explain is how consumers are going to “adjust” that data to reflect the fact that some doctors take harder cases and some have more non-compliant patients. Without such adjustments, a handful of patients can skew a physician’s record—which is what makes it so hard to “rate” individual doctors. It makes more sense to try to rate hospitals—along with all of the doctors who refer patients to that hospital. If the pool is large enough, difficult patients won’t tilt the results—and doctors won’t be tempted to refuse the hardest cases.
The quality of the care that a hospital provides is important, but so is the need for that hospital. At HealthBlawg, David Harlow discusses a situation in Boston that raises the sensitive question: when is it time to shutter a hospital? According to Harlow, that time is whenever you can put something more efficient, or helpful to a community, in its place. In this case, says Harlow, the answer is “a community health center or other health services could be just the ticket” because “duplicative hospital services just cost the system money—money that ultimately could be put to better uses [like] childhood vaccines and anti-obesity programs…”
Meanwhile, the drug wars continue. Over at Health Business Blog, David E. Williams continues his coverage of the ongoing controversy over Genentech’s cancer drug, Avastin. Williams notes how a combination of public opinion and the FDA is forcing Genentech to undermine its own corporate interests. In response to demand on the part of doctors, Genentech has repackaged Avastin for another purpose besides its intended one, making it a de facto competitor to another of Genentech’s products. At the same time, the company has been forced to destroy millions of dollars of inventory since the FDA has demanded a higher standard of product. Genetech feels that it has “bent over backwards” to accommodate concerns, says Williams, but doctors and patients are still peeved. It’ll be interesting to see how this develops.
Louise of Colorado Health Insurance Insider draws attention to a troubling new practice in the pharmaceutical industry, so-called “reverse payments.” These are payments provided by a brand name drug company to generic manufacturers in order to delay the release of a generic version of their drug. As Louise points out, holding out on generics can prevent people who can’t afford the big-name drugs from getting their medication by delaying affordable alternatives. She notes that “when an industry that makes a product that can literally mean the difference between life and death, there is an element of moral and social responsibility there that cannot be avoided, no matter how hard [companies] try [to claim otherwise].”
Lisa Emrich at Brass and Ivory delves into recent developments around Questcor’s Acthar Gel product. A host of questionable practices, including a rise in price and an upcoming FDA decree that Acthar get market exclusivity, have helped Questcor profits skyrocket, and Emrich highlights a message board conversation that systematically analyzes issue. In another post, Emrich also tells a personal story that illustrates how the fact that health insurance doesn’t cover integrative medicine—i.e. a medicine that takes into account natural treatments—can lead patients into the arms of quacks.
As we pay more and more for drugs–and virtually every other health care product and service– one cannot help but wonder whether we are approaching a point where our government will be spending so much on health that it can’t pay for anything else. Dr. Martin Russell thinks so, and gives his personal perspective on the issue over at his blog, Self Help.
Brainpower is like any other precious gift: use it or lose it. But on the Sharp Brains website, blogger Alvaro kicks this axiom up a notch and tries to dispel 10 myths that he feels inhibits our recognition of “science-based structured cognitive (i.e. mental) exercise” as an efficient pathway to “brain health and productivity.” According to Alvaro, this sort of brain-training represents “the birth of a new industry that crosses traditional sector boundaries” that can harness growing neurological, cognitive, and emotional research.
And last but not least, Fard Johnmar, writing at The Health Care Blog on behalf of managed care company Humana, introduces a new initiative called ChangeNow4Health. ChangeNow4Health is an online community aimed at developing a web conversation on health reform “using the wisdom of crowds to focus national attention on solutions to our shared problems.” The idea is to start an online forum and an active community of users and contributors who can guide health reform in the U.S.