The American Medical Association has announced
its opposition to a public-sector health plan that would compete with private
insurers. Why? Because the AMA fears that Medicare E (for everyone) might not
pay some specialists as handsomely as private insurers do now. 

Why do private
insurers pay more? Because they can pass the cost along to you and I in the
form of higher premiums.  Medicare E has
no one to pass costs on to—except taxpayers. And taxpayers will already be helping
 to subsidize those who cannot afford
insurance.

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Today’s New York Times tries to tell a story at the very center of what is shaping up as a stormy debate over  just how much waste there is in our healthcare system.   But while striving to be even-handed,  the Times quotes both informed and uninformed sources—sometimes taking informed sources out of context—and in the process, makes hash of the facts.

The Times begins by reporting that the New Yorker article that I wrote about last week “has become required reading in the White House.” This story, by Dr. Atul Gawande, describes pricey and potentially harmful overtreatment of patients in McAllen, Texas, where Medicare spends more, per capita, than in any other town in the country.  The data behind the story comes from more than two decades of Dartmouth research showing “widespread and unwarranted variations” in how much care very similar patients receive in different parts of the country.  

The Times explains that the Dartmouth research focuses a “problem that intrigues the President very much . . . the huge geographic variations in Medicare spending per beneficiary.” What’s shocking is that “the higher spending does not produce better results for patients.” The paper goes on to quote Senator Ron Wyden (D. Oregon): The president “came into a [recent] meeting with that article having affected his thinking dramatically. He, in effect, took that article and put it in front of a big group of senators and said, ‘This is what we’ve got to fix.’”

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Alex Gibney, best known for his 2005 film, Enron: The Smartest Guys in the Room  and his 2007 Academy Award Winning documentary, Taxi to the Dark Side has made a 90 minute documentary of my book, Money-Driven Medicine: The Real Reason Health Care Costs So Much

The Century Foundation and the New York Society for Ethical Culture are co-hosting the New York premiere on June11,  7p.m.  at the New York Society for Ethical Culture, 2 West 64th Street at Central Park West. Doors open at 6:30.  Admission is free.  If you’re planning to attend, please RSVP  Loretta Ahlrich ahlrich@tcf.org  or (212) 452-7722 so that we can have a rough idea of how many people will be coming.

Alex Gibney will be there, and following the screening, he will take questions about film-making and I’ll answer questions from the audience about healthcare and healthcare reform.  
Here’s a clip of the opening sequence of the film: 

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Grazing online, I ran into this remark by Princeton health care economist Uwe Reinhardt.  Talking about “the essential difference between Americans and peoples elsewhere,” Reinhardt quotes author Ian Morrison: “In other countries, having health insurance is a right while owning a gun is a privilege. In the U.S. it is the other way around.” 
With that in mind, Morrison defines Canadians as “unarmed North Americans with health insurance.”
(Reinhardt describes Morrison as “a latter-day de Tocqueville.” Hat tip to the National Journal online where Reinhardt’s remark appeared.)

This week-end, I stumbled upon a story written by “BuckEye Surgeon” (Jeffrey Parks),  a general surgeon in Cleveland, Ohio that I found provocative.  Parks wrote the post back in 2007, but it’s just as relevant today as it was then.
The piece, which is titled “No Chance” describes how and why Buckeye operated on a patient who he knew had no hope of surviving. Whether or not this patient had an operation, he  was going to die. The post raises medical ethical questions, and reminds us that in the messy reality of hospitals—where human beings are suffering and dying—the answers are not always so clear-cut. I think BuckEye surgeon was brave to tell this story and that he tells it very well. Did he do the right thing?  I’m not a surgeon, so I’m not going to try to second-guess the physicians who read this blog. But I would say, from a patient’s point of view, if I (or a loved one),  had been the patient, I would be glad that Buckeye did what he did—for the reasons that he gives.  But I suspect I may not be in the majority on this one. Click here to read the post.
What do you think?

HealthBeat has long argued that Medicare reform will pave the way for healthcare reform, and that the Medicare Payment Advisory Commission’s (MedPac’s) recommendations could serve as a brilliant blue print for overhauling Medicare.  (Also see our Century Foundation report on Getting More Value From Medicare).

Now President Obama appears to be backing a proposal that would empower MedPac to realize its vision for reform.  Yesterday, in a White House meeting with Senate Democrats, the president  reportedly “went out of his way” to mention a bill, introduced by Senator Jay Rockefeller ( D-W.Va)  that would move decisions about Medicare benefits away from Congress, by turning MedPAC into an independent executive agency.  Currently, MedPac is an independent panel that advises Congress. It has no formal power. But under Rockefeller’s bill it would be able to implement its recommendations and fund policy initiatives.

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In a letter to Senators Ted Kennedy and Max Baucus that the White House just released this afternoon, President Obama spelled out his vision for health care reform, making it clear that he wants a public sector alternative to private insurance: “operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”  (Hat Tip to Jonathan Cohn, over at The Treatment  for calling attention to this letter.

So much for speculation that the administration would back down on this issue.

The President also is “putting another $200 to $300 billion on the table,” Cohn notes, “proposing to extract that money from savings in Medicare and Medicaid.” He pairs the offer with a proposal he talked about yesterday that would give the Medicare Payment Advisory Commission (MedPac) the power to implement its recommendations for Medicare reform. (MedPac is an independent panel that advises Congress on Medicare Spending and under legislation sponsored by Senator Jay Rockefeller, MedPac would have authority to set fee schedules for both hospitals and doctors.)

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Did
you know that in the U.S. more people die each year from the
complications of surgery than die in car accidents?  This is one of
many stunning facts that Atul Gawande reveals in his most recent
contribution to the New Yorker, “The Cost Conundrum.”

He
elaborates: “In recent years, we doctors have markedly increased the
number of operations we do. In 2006, doctors performed at least sixty
million surgical procedures, one for every five Americans. No other
country does anything like as many operations on its citizens. Are we
better off for it? No one knows for sure, but it seems highly unlikely.”

In Part I of
this post , I described what Gawande discovered when he visited McAllen
Texas, home to the most expensive health care in the world.  First, he
asked, why is care in McAllen so costly?  The answer: Volume.  The
citizens of this poor Rio Grande town receive “more of everything”—more
diagnostic testing, more hospitalizations, more surgery, more home
care.

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Did you know that the Federal Employees Health Benefits (FEHB) didn’t cover contraception until 1998—decades after most Americans had accepted “the Pill”?  FEHB did cover other prescription drugs and devices, but not birth control. Congress just didn’t approve. 

The government does not provide insurance to federal employees directly. It contracts with hundreds of private sector insurers to provide a menu of policies—some good, some not so good.. But Congress does lay done some rules.  As Naomi notes in her post below the plans cannot pay for abortions—even though many other private sector plans do provide coverage.

This is one reason why I like the idea of a hybrid health care system, private sector alternatives competing with Medicare E (for everyone).

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HealthBeat readers who responded to my invitation to join the “truth squad” have sent in a number of superb examples of how the opponents of reform distort the truth. I’m starting with a piece by Dick Morris because it includes some of the most common false claims that are clouding the debate on healthcare reform. (Hat Tip to reader Harry Wetzler for calling my attention to Morris’ column.) In future posts, I’ll be spotlighting other, attacks on reform. Please keep the submissions coming. The only way to defeat campaigns of disinformation is to be as tireless as they are. 

Very likely, the name “Dick Morris” sounds familiar. This is because Morris was Bill Clinton’s campaign manager when Clinton ran for re-election in 1996—until the papers broke the news that Morris had allowed a prostitute to listen in on his conversations with the president on more than one occasion.  (The morning after, even the hooker raised an eyebrow: “Someone as intelligent as he is should have kept his lip buttoned when he unzipped his pants,” she told the Washington Post. “I mean, how can you maneuver worlds, and he can’t even control what he’s doing in his own room with a paid lady?”)  The New York Times reported that Morris also gave the prostitute sneak previews of speeches that First Lady Hillary Rodham Clinton would be delivering.

Morris was known as a “spin doctor,” and not well liked by some of Clinton’s advisers. Former White House Chief of staff Leon Panetta later blamed Morris for advising Bill Clinton to lie about Monica Lewinsky: “All Clinton needed to do was to tell the truth at once, instead of listening to the advice of his double-crossing ex-consultant Dick Morrris,” Panetta told a reporter. “It was Morris, immediately after the scandal exploded a year ago, who explained to Clinton that America would never forgive him for his escapades with Monica. I had warned Clinton from the beginning about the bad influence of that man, who cares only about opinion polls, bends with the wind of the moment, and doesn’t give a damn about moral and is still on the scene political principles.”

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