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.

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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.

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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). 

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Summary:  As regular readers know, not long ago Cato Institute senior fellow Michael Tanner published a 52-page critique of the new health care legislation titled Bad Medicine,  and I decided to write a series of posts, rebutting Tanner’s arguments about the  Real Costs and Consequences of the Law. In my first post,  I took on Tanner’s assertion that “ObamaCare remains deeply unpopular,” with the majority of Americans supporting repeal.  

Tanner’s colleague, Michael Cannon replied to my post, and I responded to his reply,   Since then, Cannon has written another post titled “ObamaCare Still Unpopular: Round Two of My Exchange with Maggie Mahar.”  Once again, he focuses on what the polls say about the public’s appetite for repeal.

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Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care.  With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. 

Ultimately, Gawande suggests, the problem with the way we deal with death today is that we have forgotten the art of dying.  Palliative and hospice care can help us recover a lost art, he adds, though not quite in the way most of us expect.  The goal is not to cut costs and curtail suffering by shortening the process of dying. In fact research shows that those who receive hospice or palliative care often live longer than other patients.

The aim of hospice and palliative care is to help patients “have the fullest possible lives,” during their final weeks or months, Gawande explains. “That means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.” 

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 In April, an independent panel established by the National
Institutes of Health came to the disheartening conclusion that currently, there
is nothing to prevent or delay the progress of Alzheimer’s disease in those of
us who are destined to join the 5 million Americans currently suffering from
this dreaded ailment.

The panel 
found that: “Although numerous interventions have been suggested to
delay Alzheimer’s disease, the evidence is inadequate to conclude that any are
effective.” Members rejected scientific evidence supporting the influence of
nutritional supplements, herbal products, dietary factors, pharmaceuticals,
medical conditions or even environmental exposures on the risk of contracting Alzheimer’s.

Now, just three months later, it turns out that there are
big developments in the Alzheimer’s field—just not in new treatments. At a conference
in Honolulu sponsored earlier this month by the National Institute on Aging and
the Alzheimer’s Disease Association, researchers from three working groups announced
that by using new imaging technologies, genetic testing, and tests of blood and cerebrospinal fluid, it will soon be far easier to diagnose
Alzheimer’s— in some cases decades before symptoms have even appeared. These
new tests are able to identify so-called biomarkers—amyloid plaques in the
brain, genetic variants, proteins and other substances in body fluids—that signal
a newly defined "pre-clinical" stage of Alzheimer's, when an individual has no symptoms but has positive
biomarkers for the disease.  

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Summary: Once again, Health Wonk Review offers a round-up of many of the most intriguing and informative health care posts that appeared during the preceding two weeks. Julie Ferguson, of Workers Comp Insider, http://www.workerscompinsider.com  hosts the most recent edition. She begins with an eloquent riff on the “dog days of summer,” July 24-August 24, a span ancient Romans described as an evil time, “when the seas boiled, wine turned sour, dogs grew mad, and all creatures became languid, causing to man burning fevers, hysterics, and phrensies.”  Ferguson suggests  that the description captures not only this summer’s heat, but the ongoing debate over health care reform.

She then goes on to do a splendid job of highlighting rich, thought-provoking posts that bloggers have managed to pen recently, despite the maddening heat. Below, I offer just a short summary of some of these pieces, along with my commentary. To read the posts in full, go to Ferguson’s Health Wonk Review  http://www.workerscompinsider.com/2010/07/-like-much-of-t.html where you will find links to each post.

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On Managed Care Matters, Joe Paduda congratulates "Several large health insurers [that] have decided it's time to get serious about managing costs. They're introducing plans with limited provider networks and either no coverage for out of network providers or high deductibles and co-insurance/co-pays. The plans, introduced by United Healthcare, Aetna, Wellpoint and others, are currently only available in a few markets as the health plans test market receptivity." 

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