In 2006, when the government began offering prescription drug coverage for seniors through Medicare Part D, the goal was to increase utilization of prescription drugs by the elderly who may not have been able to afford them before, and also to lower the average price of these drugs. The idea was that insurers—representing all the new Medicare Part-D recipients—would be able to use the clout of having this huge market to negotiate price discounts with pharmaceutical companies.

Studies since then—like this one from The Annals of Internal Medicine—have found that Medicare Part D “appears to have led to modest savings and modest increases in drug use by older people.”  With a new provision coming from the Affordable Care Act that aims to help “fill the donut hole” that seniors experience in coverage, these effects should be heightened.

But two new studies have revealed some unintended consequences of Medicare Part D. According to an AARP Rx Price Watch report released today, the retail prices for some of the most popular brand-name drugs sold to seniors increased 41.5% over the last five years, while the consumer price index rose only 13.3%. For example, the drug Flomax (which began facing generic competition this year and is usually prescribed for incontinence due to prostate problems), had the biggest price jump, climbing 24.8% in 2009. Over the past five years, Flomax increased in price by an alarming 92%. Other popular name brand drugs that experienced sharp price increases over that time span include the respiratory drug Advair (40%), the Alzheimer’s drug Aricept (40%), Nexium (28%) and Lipitor (24%)

Continue reading →

Last week I had my first visit with my new primary care doctor. I picked him based on recommendations (plus he’s one of the few that accepts my insurance), and also because he seemed to be an eager adopter of electronic medical records (EMR). On his website, there was a portal for making appointments on-line, asking questions of the doctor and staff by e-mail and once a registered patient, I could also use a secure system to access my medical records. With EMRs being portrayed as key drivers of quality and savings in health reform, I felt encouraged by my new doctor’s embrace of the technology.

But when he greeted me in the examining room, I was surprised to see the medical assistant hand my doctor a pad of paper with my height, weight and blood pressure written on it. As we talked and he examined me, he wrote notes down on the same pad—even though there was a computer in the room. When I asked how he felt about his EMR system, he said it was a great advance for his practice—but unfortunately it had crashed  that morning and the “tech guy” said it might take a while to get it back on track. “By next week or so we should have you in our system,” he sheepishly explained.

Continue reading →

Over at Wachter’s World, Bob Wachter, M.D., Associate Chairman of the Department of Medicine at the University of California, San Francisco  relates what it’s like to be on a plane and hear the airplane’s PA system ask: “If there’s a doctor on board, please ring your call button!”

Wachter has been answering this request for some twenty years and offers a surprisingly candid, wonderfully funny, and ultimately reassuring description of how he has responded. Physicians are trained to be professionals, and most put patients’ interests first.

Over at the New Republic, Jon Cohn reports that the Affordable Care Act gives Kathleen Sebelius great latitude in regulating insurers. And Cohn thinks that she is likely to use it.

“It's not impossible,” to regulate private sector insurers, Cohn writes. “Countries like the Netherlands and Switzerland both have adopted this model with considerable success. But it's a difficult task, particularly in a country like ours without the same tradition of strong regulation and enlightened corporate management.

“The architects of the Affordable Care Act understood this and, to the extent they could, they packed the law with regulations designed to force insurers change their behavior. But, by design and necessity,” Cohn notes, “the law was relatively vague on a lot of matters, leaving final determination of the rules to the Secretary of Health and Human Services and her department.”

Continue reading →

Summary:  Some optimistic liberals have begun to suggest that if conservatives manage to block the Affordable Care Act (ACA) , this  could open the door to better reform legislation.

Why that won’t happen.

       ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~             

If conservatives manage to kill health care reform legislation, what will happen next?

I really don’t want to go there.

First, I’m convinced that conservatives won’t be able to repeal the Affordable Care Act (ACA).  Democrats will hold onto the Senate, and President Obama still has a veto. If necessary, he will use it to protect the bill. Meanwhile, the majority of the public either favors the legislation or want to “wait and see” how well it works. Most voters would be utterly disgusted if Congress returns to the health care debate this fall. It was ugly the first time around; virtually no one wants to watch re-runs on C-Span.  In the months ahead, Americans hope that their elected representatives will do just three things: create jobs, create jobs, and create jobs.

Continue reading →

After the House voted this week to approve a $26 billion aid package to states—$16 billion of which will go toward helping keep strained Medicaid programs limping along—Rep. Joe Barton, of Texas, the ranking Republican on the House Energy and Commerce Committee who voted against the measure said; "There is no emergency," "There is no pending financial catastrophe." House Republican leader John Boehner called the aid package a “payoff to union bosses and liberal special interests.”

What alternate universe do Barton, Boehner and many of their fellow Republicans who opposed the aid package live in? States of all stripes—red and blue alike—are facing a deep crisis in their Medicaid programs.Women and children are losing benefits, and eligibility requirements have only gotten more stringent.

Continue reading →

Health Wonk Review offers a summary of some of the most provocative health care posts of the preceding two weeks. The newest edition went up today, and it’s hosted by the “Disease Management Care Blog’s” Jaan Sidorov here

Highlights:

Over at “Health Affairs,” Timothy Jost, a law professor at Washington and Lee University and co-author of Health Law, the nation's standard textbook for that subject, offers lucid in-depth analysis of yet another section of the Affordable Care Act (ACA): the temporary high risk health insurance pool.  Under the reform legislation insurers will not be able to deny coverage to customers suffering from pre-existing conditions—but that provision doesn’t kick in until 2014.  To bridge the distance between now and then ACA offers a temporary high risk pool known as the Pre-Existing Condition Insurance Plan, or PCI.P.  The program can be run either by the states or by the federal government through a nonprofit entity.  Twenty-nine states plus the District of Columbia chose to operate their own plans, while HHS will administer the program in 21 states. The federal PCIP  is in fact already taking applications, as are several state plans.

Continue reading →

That Republicans don’t support health care reform.

Opponents of health care reform have been touting the results of yesterday’s primary in Missouri as if it were a national referendum on “the will of the people.” After all, more than 70 percent of voters who came out for the primary cast ballots in favor of Proposition C, a  measure that would allow state residents to opt out of mandatory health insurance.

Continue reading →

Continue reading →

In “Bad Medicine” the Cato Institute white paper exploring “The Real Costs and Consequences of the New Health Care Law,” Cato senior fellow Michael Tanner declares the individual mandate "perhaps the single most important piece of health care legislation.” By insisting that citizens have insurance –or pay a penalty– Congress has taken an “unprecedented” step, says Tanner. Like many who object to the mandate, he argues that “The government has never required people to buy any good or service as a condition of lawful residence.”

In fact, that isn’t quite true.

But before getting to what the federal government has or hasn’t required of its citizens in the past, let me say that I agree with Tanner on his first point: the individual mandate is the lynchpin at the center of the Accountable Care Act (ACA). 

Continue reading →