Amy Berman tells her story here, on the Health Care Blog. http://www.thehealthcareblog.com/the_health_care_blog/2011/01/can-good-care-produce-bad-health.html#comments
Her courage and eloquence are remarkable. Facing death, she is able to express her concern for other patients.
If you or anyone you know is struggling with cancer, you might find this post helpful.
Below, a guest post by Harold Pollack, who has recently joined The Century Foundation as an adjunct fellow focusing on issues of Economics and Inequaiity. Pollack is the Helen Ross Professor at the School of Social Service Administration, and faculty chair of the Center for Health Administration Studies at the University of Chicago .–MM
During the health reform debate, many people asserted that the uninsured are, de facto, already covered because they can always get emergency care. Here, for example, was President George W. Bush in 2008: I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."
Thursday, one of Ezra Klein's commenters says something similar, though from a different locale on the ideological spectrum:
If the Republican Party is serious about decreasing government control of health care, they should start by introducing a bill that would repeal the law signed by President Ronald Reagan that mandates free health care for all who seek it. That law, the Emergency Medical Treatment and Labor Act (EMTALA), was the largest expansion of government mandated health care since Medicare.
For obvious reasons, it would be terrible health policy to make emergency departments into our all-purpose free-care safety-net, even in a hypothetical universe where these facilities were actually capable of providing all the care that people need. But that's not what EMTALA actually does.
I may be more optimistic than Harold Pollack that the Affordable Care Act (ACA) will reduce ER use (see Pollack's guest post). After all, the ACA provides an additional $11 billion in funding for Federally Qualified Health Centers (a.k.a. “community clinics.”) Many are open after hours, and as existing community clinics are expanded and new ones are built, they could serve as medical homes for patients who now get their care at their local emergency room. This year alone, the ACA will provide a 50 percent increase in federal support for these clinics where patients can receive less expensive, preventive and primary care. (It’s worth noting that the government has already begun to distribute this money; this is just one example of many programs that cannot be “de-funded.”) The legislation also permanently authorizes the community health center program, which once had to be reauthorized every five years.
The government recaptured a record $4 billion last year from pharmaceutical companies, hospitals, doctors, nursing homes and other providers that defrauded federal health-care programs, the administration reported Monday. This is twice as much as was recouped in 2008, and funneled some $2.9 billion back into the Medicare Trust Fund.
This is a good start—Medicare and Medicaid fraud reportedly cost the government a whopping $54 billion last year—but we can do even better. In a new report from the Department of Health and Human Services and the Department of Justice, the success in recouping fraudulent payments is attributed to the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint effort between the two agencies created in 2009.
Earlier this week, new federal rules came into effect that HHS Secretary Kathleen Sebelius says will allow the government to be more proactive in preventing fraud in the Medicare, Medicaid and CHIP programs. These new rules (click here to see an overview) which are included in the Affordable Care Act, require more rigorous screenings of providers and suppliers who participate in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), levy larger fines for abuses, and also give HHS the power to immediately stop payment to providers who are being investigated for fraud. The goal of these new provisions is to prevent fraud rather than playing catch-up once the crimes have been committed.
In his State of the Union speech, President Obama devoted only a few minutes to health care reform. This might surprise some, but I think the president made a wise decision. There was little reason for him to spend more time on the issue. The Patient Protection and Affordable Care Act (PPACA) is now the law of the land. There is no reason for the President of the United States to debate it.
President Obama did allow that “anything that can be improved in the legislation” should be changed. I agree. As the law is implemented, experience will show us where adjustments should be made.
Extending a hand across the aisle, the President also said that “we can start now by reducing unnecessary bookkeeping burdens on small businesses,” referring to the provision in the heallth care reform legislation which requires that every business provide a 1099 for each vendor with whom it does more than $600 worth of business over the course of a year. This was a provision tacked onto the heath care bill, designed to reduce tax fraud. I applaud the motive, but when it comes to reforming health care, this is not an important plank in the legislation.
More importantly, President Obama made it clear that he would not bow to any effort to undermine the individual mandate: “What I am not willing to do,” he declared, “Is to go back to the days when insurance companies could deny patients because of pre-existing conditions."
President Obama is confident about the Affordable Care Act because he knows that, this year, health care reform already has begun to deliver benefis to a great many Americans:
— Small business owners are taking advantage of the tax credit and signing up for insurance for their employees
Below, a guest-post by Dr. Nortin Hadler, author of Worried Sick: A Prescription for Health in an Overtreated America and , more recently, Stabbed in the Back: Confronting Back Pain in an Overtreated Society. I admire both books because they are so well-written and richly referenced..
Hadler is Professor of Medicine and Microbiology/Immunology at the University of North Carolina at Chapel Hill and Attending Rheumatologist at the University of North Carolina Hospitals.
His commentary on “The Predicament of Backache” is adapted from, Stabbed in the Back. It puts my posts on spinal surgery in a larger context, illustrating how “cutting” is not always a cure for life’s problems
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To live a year without a backache is abnormal. Here, I am speaking of the commonest form of low back pain: the backache that bedevils working-age adults who are otherwise totally well. This is a pain that does not involve the legs, and that comes on suddenly, seemingly without cause.
Low back pain is one of many recurring predicaments of life, like heartburn and heartache. To be well is not to be spared. To be well is to have the wherewithal to cope till the pain goes away, cope so well that the episode is not even memorable.
Summary: In part 1 of this post I discussed how the mainstream media has begun the work of health care reform by making the public aware of the amount of waste and hype in the system. There, I focused on two recent stories about back surgery: the first appeared in the Wall Street Journal, the second on Bloomberg. Both tell the tale of patients injured and billions of health care dollars squandered when patients suffering from back pain caused by “degenerative” (aging) spinal discs undergo a very pricey procedure called “spinal fusion.”
As I explain in part 1, medical research shows that when back pain is caused by aging discs, fusion is not as effective as other, less lucrative, treatments. And, with fusion, the rate of serious complications is much higher. Nevertheless, from 2002 to 2008, the number of fusions done in U.S. hospitals doubled to 413,000, generating $34 billion in health care bills. In 2008, Medicare alone laid out $2.24 billion for the procedure.
Meanwhile both Bloomberg and the WSJ reported that device-makers such as Medtronic, which makes products used in spinal fusion, have been handing out millions in royalties and “consulting fees” to surgeons who promote the procedure. Congressional critics charge that in many cases, these payments are nothing more than “kickbacks."
This week, Managed Care Matter’s Joe Paduda hosted Honk Wonk Review’s regular summary of particularly provocative health care posts that appeared in the past two weeks. As always, Paduda’s insights make the Review well worth reading. (I also recommend Managed Care Matters as a blog where you’ll find very smart, objective, fact-based commentary on a wide variety of issues.)
Below, I comment on some of the posts in this week’s Review, but to read the entire round-up (and to find links to posts I mention below) please click here. http://www.joepaduda.com/archives/002013.html
Perhaps the most intriguing post in this week’s round-up comes from HealthCare Renewal’s Roy Poses. An M.D., Poses also has become a relentless investigative reporter, and in this piece he discusses “the fall of an apparently large and prestigious health care charity, which funded research projects at the most well-regarded academic centers – a charity that was involved with Bernie Madoff and some of his confederates.”
If you read Poses’ post (and I urge you to do so) you’ll discover that the charity in question–the Picower Foundation–was not quite what it seemed.
In 2008, Poses observes, both the Boston Globe and the New York Times lamented the fact that the Picower Foundation, which had become one of “Maddoff’s victims” was shutting down. Apparently their reporters hadn’t Goggled “Picower.” Poses calls attention to a more recent Wall Street Journal piece that raises some troubling questions.
Poses then takes us back to a 2001 St Petersburg Times expose of the Picower Foundation “which suggests that its Jeffrey Picower used it in a complex scheme involving self-dealing for the purposes of personal enrichment.”
He ends his tale by asking: “The big question is why people can be so easily fooled?
The war of words over health reform is increasingly focused on how the legislation will impact small business and employment. The day before the House voted—in a meaningless act of political theater—to repeal the “job-killing” health law, the White House hastily organized a conference call for reporters to speak with Karen Mills, administrator of the Small Business Administration and acting Deputy Commerce Secretary Rebecca Blank. During the call, the goal of which was to highlight how a repeal of health reform would negatively impact U.S. businesses, Mills announced that there’s already been a rise in the number of small businesses offering health coverage to their employees thanks to a new tax credit and other provisions of the law.
As evidence, Mills cited a survey conducted by the Kaiser Family Foundation that found that 59% of firms with three to nine employees offered health benefits in 2010, up from 46% the year before—a rise of 13%.
In an Opinion column on CNN, Dr. H. Gilbert Welch, M.P.H., a professor of medicine at the Dartmouth Institute of Health Policy & Clinical Practice and the author of Overdiagnosed: Making People Sick in the Pursuit of Health" (Beacon Press 2011), raises questions about a new simple blood test that is
“able to detect minute quantities of cancer cells that might be circulating in your bloodstream.”
Below just a few lines from the column that I found particularly provocative. You can find the entire op-ed here.
(Thanks to Dr.Val and Gary Schwitzer for spotlighting this column.)
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“The conventional wisdom is people either have a disease or they do not. But, in fact, there are a lot of people somewhere in between. . .
“I don't know whether this test will help some patients. It might, but it will take years to figure that out…"
“Ironically, what this test might actually teach us is that it's not that unusual for healthy people to have an occasional cancer cell in their blood.”