This week during his speech at George Washington University, President Obama said one of the ways he plans on cutting Medicare costs is to cut government spending on prescription drugs by $200 billion over ten years. He said, “We will cut spending on prescription drugs by using Medicare's purchasing power to drive greater efficiency and speed generic brands of medicine onto the market.”

With this statement, Obama seems to suggest that he wants Medicare to use its clout and to start negotiating prices directly with pharmaceutical companies, something the Veterans Administration, for one, has been doing for years. The only problem is that back in 2006 when Congress expanded Medicare to cover prescription drugs, the law included a gift to drug companies that specifically prohibits the government from directly negotiating on drug prices.

While campaigning for the presidency, Obama often spoke about taking on drug companies and allowing Medicare to have bargaining power over prices. He also supported the re-importation of cheaper prescription drugs from Canada as a way to lower health care costs. But in order to get Pharma support for the Affordable Care Act, these two measures were taken off the table and left out of the legislation.

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When hospitals make errors, patients end up injured, have longer hospital stays and some 100,000 or more die each year as a result. If patients are discharged too soon or without adequate care instructions, follow-up doctor appointments and few links to community or home-care services, those patients often end up bouncing right back into the hospital in fewer than 30 days.

From these blunders come significant costs—measured in terms of injury and death as well as dollars spent on “measurable medical errors” (those that cause harm to patients) and higher hospitalization charges. According to an April 7 report in Health Affairs, medical errors now cost our over-burdened health care system some $17.1 billion a year; the cost of avoidable hospital readmissions adds another $13 to 18 billion dollars a year.

Another study in the same issue of Health Affairs found that up to one-third of all hospital stays lead to hospital-related injuries ranging from serious acquired infections to deadly surgical mistakes. Don Berwick, the Administrator of the Centers for Medicare and Medicaid Services, said the study “raised the stakes by finding … that the number of adverse events could be ten times greater than we originally thought.”

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The “Path to Prosperity” budget proposed by House Budget Committee Chairman Paul Ryan (R-WI), includes a plan to revamp Medicaid —which currently provides federal funding to states on an "as-needed" basis to help cover the health care costs of the poor and disabled—into a block grant program. This one initiative alone, according to the budget bill’s supporters, would save $750 billion over ten years.

There is little in Ryan’s budget proposal to support just where these savings will come from, but it’s easy to imagine that state caps on Medicaid enrollment, cuts in covered benefits and lowered physician reimbursement, along with an increase in co-pays for beneficiaries will all play an essential role.

Currently, the federal government contributes an average of 57% toward state Medicaid programs ( this ranges from 50-70% depending on a state’s federal matching rate.) There is no cap or ceiling on how much federal funding is available for the health care costs and long term care services provided through Medicaid, nationwide or for any particular state. The Congressional Budget Office predicts that the program will cover 69.5 million Americans this year, including nearly one in three children, with the recession driving many previously middle-income kids into Medicaid and CHIP. Under the Accountable Care Act, in 2014 Medicaid will undergo a significant expansion to include all the non-elderly who live at or below 133% of the poverty line, including some 16 million previously uninsured Americans.

Under the Ryan budget proposal, the health reform law would be repealed—and with it would go the federal funding that would finance some 96% of the cost of this expansion. Block grants require that the federal government pay each state either a fixed dollar amount or cap payments at a specific level, with the state responsible for all Medicaid costs that exceed the cap. If Medicaid costs rise due to increases in enrollment, economic recessions, or even health epidemics like HIV/AIDS, the federal share would remain the same.

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To commemorate the one-year anniversary of the Patient Protection and Affordable Care Act, MomsRising, a five-year-old advocacy group dedicated to building "a more family friendly America," has produced an interactive map that provides stories from across the country about how health reform has helped or eventually will impact its members.

MomsRising advocates for such issues as paid sick time, removal of toxic substances from children’s products, fair pay for women and increasingly, supports the full roll-out of health reform. The map of personal stories they’ve produced is a powerful way to convey how the health law is spurring positive changes at the grassroots level.

Here are just a few snippets from stories members around the country have submitted:

“The changes in the health care law will allow my son, who is a full time student to be covered under the health insurance policy I have through my empolyer. He was dropped in December when he turned 23. He has been unable to afford individual health insurance…” (PA)

“My 9 year old son has seizures and is able to get his medication and continue to see his specialist because of health care reform. Since his pills and Dr. visits are so expensive – I won't have to worry about him reaching a lifetime maximum for coverage…” (CA)

"Closing the coverage gap for Medicare Part D Prescription coverage will make a huge difference in our lives. My 35-year-old husband has a pre-existing condition, for which he takes expensive prescription drugs. He's covered under Medicare, but we make too much money to qualify for any other assistance. He gets to the coverage gap in April, and we spend the rest of the year paying over $500/month for his medications. It's not easy, and we are very much looking forward to this cost going down." (WI)

"Though I have been in remission for over 10 years insurance companies still believe that covering me is too great of a risk, even for illnesses and accidents that have little or no relationship to my illness. Soon my husband will be eligible for Medicare and I will be without insurance for eight years. With the provision in the Health Care Reform Bill that preexisting conditions are covered I will be able to buy insurance at a reasonable rate.” (MI)

Click on this link to access the rest of these stories or view them by clicking on the interactive map below.

Source: MomsRising 2011

Recently, I wrote about Danielle Deaver, the Nebraska woman who was denied an abortion after her 22-week fetus was deemed unviable. Instead of being permitted to terminate her pregnancy, Deaver was forced by state law to endure “10 excruciating days” waiting for the extremely premature fetus to be born.

The Deavers were victims of Nebraska’s ill-conceived “fetal pain” law which prohibits abortions in the state after the 20th week of pregnancy. It is based on the discredited notion that a fetus may feel pain at that stage of development. Physicians who break the law face felony charges that could result in five years in prison and a $10,000 fine.

At the time, the author of the Nebraska law, Speaker Mike Flood, a Republican, said that even though the infant gasped and suffered for fifteen minutes before dying, he felt confident that the statute worked as planned in the Deaver case:

"Even in these situations where the baby has a terminal condition or there's not much chance of surviving outside of the womb, my point has been and remains that is still a life," Flood told the Des Moines Register.

Well, it turns out that the sanctity of life is not applicable in all cases in Nebraska. Last year the state passed a different law that eliminated Medicaid funding for prenatal care for about 1,600 low-income women, about half of whom were illegal immigrants. Doctors and health clinic administrators told the Lincoln Journal Star, that this cut in funding has had “dramatic effects.”

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Shock and outrage ensue every time the press gets wind of the million-dollar-plus salaries and other perks reaped by some CEOs at nonprofit hospitals. This year is no different—except that the ongoing recession that is forcing states to make painful budget cuts, especially by slashing Medicaid programs, is making the compensation reports especially hard to stomach.

In New York, for example, a state Medicaid-redesign commission recently recommended cuts to health care spending that total $2 billion. But while the proposal includes limiting home health care, increasing co-pays for Medicaid recipients, reducing their dental and mental health services, and putting a $250,000 cap on malpractice claims, there was no mention of limiting what the New York Times calls “lofty” salaries for CEOs at nonprofit hospitals.

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There are many serious problems with the current U.S. mental health system, the most glaring being the over-use or misuse of psychiatric drugs, the warehousing of the mentally ill to prisons and emergency rooms, and the unholy connection between academic researchers and pharmaceutical companies that can result in stilted clinical trials of already-approved drugs and misleading efficacy information that is used to boost sales.

I have written about these issues on HealthBeat before, but no single case demonstrates the convergence of these problems better than the tragic story of Dan Markingson, a young man who suffered his first bout of severe psychosis and schizophrenia in the summer of 2003. In November of that year, Markingson was taken to the University of Minnesota Medical Center in Fairview and against his mother’s wishes, was enrolled into an industry-sponsored drug trial being run by his psychiatrist, Dr. Stephen Olson. Six months later on May 8, 2004, mentally deteriorating and still enrolled in the study, Markingson, 27, committed suicide in the shower of his halfway house by violently stabbing himself in the neck, chest and abdomen.

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In his State of the Union speech in January, President Barack Obama appeared to throw a bone to congressional Republicans when he said, "I am willing to look at other ideas to bring down [health care] costs, including one that Republicans suggested last year – medical malpractice reform to rein in frivolous lawsuits." There were scattered cheers and clapping from the audience, but since then no more details have emerged from the President.

To those who need reminding, reforming medical malpractice is a cornerstone of the Republican version of health care redesign; one of the few concrete ideas they’ve put forth for reducing the nation’s $2.1 trillion health care bill. The idea, recently championed also by Gov. Andrew Cuomo’s (D-NY) Medicaid redesign team, is to cap non-economic damages (compensation for future pain, suffering and loss of function) at $250,000 in all cases. Some 30 states already have variations of medical malpractice caps and other tort reforms in place. According to the Congressional Budget Office, the effect of these caps on reducing the number of lawsuits or the practice of “defensive medicine” (unnecessary tests and procedures doctors order to avoid being sued) has been at best, equivocal. Where they have had a moderate effect is on lowering malpractice insurance premiums for certain types of physicians and increasing their supply in some geographic areas.

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Danielle and Robb Deaver are living proof of the awful reality of Nebraska’s ill-conceived “fetal pain” law. The law, which took effect last October and is the only one of its kind in America, prohibits abortions in the state after the 20th week of pregnancy. It is based on the discredited notion that a fetus may feel pain at that stage of development. Physicians who break the law face felony charges that could result in five years in prison and a $10,000 fine.

Danielle Deaver, a nurse, was 22 weeks pregnant with her second child when her water broke. Doctors determined that her membranes had ruptured and there wasn’t enough amniotic fluid to support the fetus.But because of Nebraska’s law, Deaver could not obtain an abortion and was forced to live through “10 excruciating days” waiting for her extremely premature fetus to be born even though doctors were sure it would never survive. When finally delivered, the one-pound, ten-ounce baby girl gasped and struggled for air, dying 15 minutes later in her mother’s arms. Tragically, the Deavers had sought an abortion to avoid just such an excruciating end; they were concerned that the infant would suffer while it died, trying to breathe.

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It seems old lies never die—especially when it comes to entitlement programs for the poor.

In the contentious debate over how to reduce spending in state Medicaid programs, Mississippi Gov. Haley Barbour (R) insisted that one solution for his state is to have Medicaid recipients pay a larger share of their medication costs, saying, "We have people pull up at the pharmacy window in a BMW and say they can't afford their co-payment."

That ridiculous comment harkens back to Ronald Reagan’s use of "Cadillac-driving welfare queens," to refer to a fictitious cadre of black mothers living the high life while collecting public assistance. Tinged with racial undertones, Reagan’s characterization of welfare recipients—including a 1976 reference to the typical food-stamp user in the South being  a ‘strapping young buck’ buying T-bone steaks—helped bolster support for his overall attack on social welfare.

As Steve Benen writes in Washington Monthly today, “In other words, when Barbour claims ‘we have people’ who pick up prescriptions in Mississippi in a BMW — as if this is somehow common — he's lying.

“But I suspect Barbour doesn't much care. The point of a quote like that one isn't to draw attention to a legitimate policy concern; it's to appeal to right-wing voters on an emotional level.”

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