A lot of thought goes into the naming of new legislation. Calling the health bill the Patient Protection and Affordable Care Act hits on the essential goals of health care reform—medical security and financial savings. So the GOP’s proposed law to repeal the health legislation needed an equally pithy title to rally support: “Repealing the Job-Killing Health Care Law Act” is nothing if not evocative.

With the repeal effort, the GOP is counting on bringing the focus back to the one issue that most of the country is very concerned about; unemployment. By using the words “job-killing,” the implication is that the Affordable Care Act will lead to increased expenses for employers, followed by job losses and a worsening of our country’s financial recession. House leaders have set the date for a vote on repeal (largely symbolic since the effort is sure to stall in the Senate) for January 12, although there are signs it might come even earlier.

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After all the ridiculous fear-mongering by Sarah Palin and her conservative compatriots about government funding of “death panels,” Congress dropped a proposal to encourage end-of-life planning from the health reform legislation passed last March. But early this week, it came to light that the administration had in fact quietly included reimbursing doctors for end-of-life counseling along with a host of new Medicare regulations. The provision, which authorizes payment for “voluntary advance care planning,” went into effect on Jan. 1. 
 
Now, just four days later, there’s been a complete reversal of that decision. According to an unnamed official in the Obama administration, the provision was removed from the new Medicare regulations because of a “mix-up”; “the advance care planning component wasn’t included in a proposed rule offered for public comment last summer,” the official tells the New York Times. Instead, the rule was mistakenly put into the final regulations in November by Donald Berwick, the new head of the Centers for Medicare and Medicaid Services. But despite the administration’s attempts to make Berwick the fall guy and to blame the reversal on a procedural mix-up, it’s more likely that other forces—namely politics—are the real reason for the government’s very public back-down on end-of-life planning.

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As 2010 comes to a close, The Century Foundation has once again charged us with composing a “Best of/Worst of” list to recount the year’s highs and lows in health care. I am off for vacation tomorrow so my list is still under construction—to be completed at the beginning of the New Year. But as I sit here thinking (TCF is, after all, a think-tank so that is what we’re actually paid to do) it strikes me that 2010 started off with a frantic battle: the last major push in Congress to get enough votes to pass the Patient Protection and Affordable Care Act. After a long and bruising battle in Congress that included strident opposition from most Republicans, the bill squeezed through and was signed into law by President Obama on March 23.

What followed was relief (and a bit of exhaustion for those of us who for months had been writing ferociously, and in the case of Maggie, optimistically, about the bill). There was also a sense of accomplishment and satisfaction that we were finally on our way to achieving affordable, comprehensive health care in this country.

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Thanks to the new health care bill, beginning in 2014, insurers will not be able to set annual caps on medical coverage. Already, since September 23, annual coverage limits on health care costs can be set no lower than $750,000. The idea is that most insured Americans can rest assured that even in the event of a catastrophic illness, their policies will help offset the bulk of their medical expenses. Note that I wrote, most Americans. This provision doesn’t apply if you happen to be one of the 1.5 million mainly low-income workers covered under limited-benefit plans—the so-called “mini-med” plans—offered by McDonalds, Waffle House and other employers that hire low-wage employees.

In October, Joe Barton (R-TX), ranking member of the House Committee on Energy and Commerce and two other Republican subcommittee members, sent a letter to Kathleen Sebelius registering their concern that the new provisions in the health care law would force insurers and employers that offer mini-med plans to drop out of the business. McDonald's, for one, warned regulators that high administrative costs might lead to the company dropping its health insurance plans for 30,000 hourly workers unless it was exempted from this policy.

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 Yesterday the Federal Trade Commission proposed a broad framework for protecting consumer privacy both on the Web and off-line. The framework is meant to help guide policymakers in crafting legislation to prevent the tracking and wholesale collection and sale of consumer information that is practiced by large on-line companies like Google, Mozilla, and Microsoft. Yesterday I wrote about health information “data mining;” (see post below) the collection and sale specifically of web-user’s health data, including the conditions they suffer from, medications used and identification information like name, age, gender and even personal doctor. As the FTC notes in its proposal; “The more information that is known about a consumer, the more a company will pay to deliver a precisely-targeted advertisement to him."

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A year ago, I wrote about how pharmaceutical companies are increasingly paying third parties like IMS Health or CVS-Caremark to provide them with the prescribing records and identification information for individual doctors. Armed with this information, drug companies—sometimes taking on the role of “concerned experts”—can tailor their marketing directly to these doctors; visiting their offices and sending them letters and informational material suggesting that they use a different (usually newer and more expensive) medication for certain patients or suggest that they adjust dosages. 

This practice, called data-mining, is a highly lucrative business (In 2005, data mining provided IMS alone with revenues of $1.75 billion) that is rapidly replacing direct-to-consumer advertising as the preferred form of pharmaceutical marketing. Data miners will have an even easier time amassing the information they sell to companies as more physicians and practices adopt electronic health records. Prescribing information about patients is coming from other sources too: Websites designed to help patients connect with others suffering from the same disease (breast cancer, Parkinson’s disease, fibromyalgia, etc.) have also started selling information about which medications their members use to drug companies. And even the American Medical Association is in on the game; last year the group garnered $44 million in profits by selling physician profile information that data miners like IMS use to blend with prescribing records to help drug companies target individual doctors.

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Senators Scott Brown (R-MA) and Ron Wyden (D-OR) have introduced a bill that would let states apply in 2014 for waivers to allow them to get federal funding for health reform schemes that opt out of such integral provisions of the Affordable Care Act as the individual mandate, the employer penalty for not providing coverage, and minimum standards for a basic health insurance policy. Currently, states may only apply for such waivers in 2017—three years after the insurance exchanges and other major provisions of the legislation have been set in motion.

In theory, this bill, dubbed the "Empowering States to Innovate Act", could allow Vermont, for example, to set up the single-payer system that both the governor-elect and Senator Bernard Sanders support. It could also allow Tennessee to receive federal funding for a free-market, consumer-driven system that focuses on health savings accounts and catastrophic coverage, a plan advocated by some leaders in that state. There are important caveats included in the bill, according to Wyden: States will only be granted waivers if their plans will result in the same number of residents having affordable coverage as would occur under the ACA's mandates and subsidies. Also, the insurance coverage must be “at least as comprehensive as provided under federal law,” and the plan must not add to the federal deficit.

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Let’s say you’ve enrolled in a new health insurance plan and need to find an internist who participates. How do you decide which doctor to choose? My (long deceased) grandmother made her choices by using the following criteria: She looked for a male doctor with a Jewish-sounding last name who graduated from an American medical school—preferably one located in New York City. Nowadays her narrow (and culturally biased) criteria would have excluded some of the most esteemed practitioners around.

If you are like most people, you don’t depend on your grandmother’s advice to find a physician, but rather ask friends, colleagues or other doctors for recommendations. But taking one person’s experience with an internist or surgeon as a signal that he or she is “really good” is still far from the optimal way to choose a practitioner.

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On this eve of the mid-term elections, it’s becoming increasingly likely that Republicans will win a majority in the House and gain a sizable number of seats in the Senate. Some political pundits are predicting that Rep. Joe Barton, R-Texas could take over as chairman of the powerful House Energy and Commerce Committee next year and, according to Kaiser Health News, “the Texas Republican vows to make life miserable for Democratic defenders of the health care overhaul law.”

Between calls for complete repeal (highly unlikely to make it past President Obama’s veto) and rumors that Republicans will block funding for key initiatives, the media is rife with reports that health reform is in danger of death by a thousand cuts.

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Are you wondering what kind of information will be gleaned about pharmaceutical company-physician relationships once the Physician’s Payment Sunshine Act takes effect in 2013? That’s the year when drug companies will have to start publicly reporting all payments and gifts they dole out to doctors who conduct “educational” speeches and seminars that promote proprietary pharmaceuticals.

In their recent “Dollars for Docs” project, reporters from the investigative news organization ProPublica offer a sneak preview of what kind of money we’re talking about. Reporters from the group probed the “labyrinthine websites” of seven Big Pharma companies that are already reporting this kind of data and discovered that between 2009 and 2010 these firms paid a whopping $257.8 million to about 17,700 providers for giving “educational” talks and seminars to colleagues about certain medications. Charles Ornstein, a reporter for ProPublica told NPR  “In our database we found that there were 384 doctors who, over the course of just the past 18 months, have received at least $100,000 from the drug companies that have reported so far.”

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