The media has been paying too much attention to the lies about health care reform that the conservatives have been circulating. Perhaps this is understandable: they are Big Lies, colorful canards, horrifying rumors. But they are simply, totally wrong—made up out of whole cloth.

The job of the media is not to repeat rumors, but to present facts—so that the public can draw rational conclusions from empirical evidence. Today, the New York T.imes ran an Op-ed signed by Drs. Atul Gawande, Donald Berwick Elliott Fisher and Mark McClellan that does just that. http://www.nytimes.com/2009/08/13/opinion/13gawande.html?pagewanted=1&_r=1&hp The four tell the story of ten U.S. communities that have managed to do what progressives claim health care reform can do: “change how care is delivered so that it is both less expensive and more effective.”  We don’t have to ration care. We don’t have to raise taxes for the middle-class or the upper-middle class. We may need modest tax hikes for the very wealthy to seed healthcare reform. But structural changes in our health care system can ultimately provide the savings needed to offer high quality, affordable care to everyone.

Last night, the Lehrer Report made the same point: http://www.pbs.org/newshour/indepth_coverage/health/healthreform/  We already know how to lift the quality of care while reducing costs.  This is not a theory dreamed up by ivory-tower academic physicians. It is a fact.

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Business Week has just published an excellent piece exploring the pros and cons of Amgen’s new drug for osteoporosis.  It illustrates how drug-makers—and Wall Street investors—view new products.  It also demonstrates why government regulators should begin  taking a close look at pricey “me-too” drugs before committing billions of tax-payer dollars to pay for those new products.

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As regular readers know, Academy-Award-winning documentary film-maker Alex Gibney (“Enron: the Smartest Guys in the Room,”  “Taxi to the Dark Side”) has produced a 90-minute documentary based on my book, Money-Driven Medicine. Andrew Fredericks directed the film and I narrated it. 

ABC’s Nightline interviewed Alex and me about the film in a segment that aired August 11. Below, a link. (When you get to the website, scroll down and click on Nightline, August 11 on the left hand side of the screen)

Money-Driven Medicine producer Alex Gibney and author Maggie Mahar interviewed on Nightline's Tuesday, Aug 11 show.

Watch the interview here.

If you are interested in either buying or renting a DVD of the film, go to www.moneydrivenmedicine.org.

The seamy underside of the organ transplant business made the news recently when Levy-Izhak Rosenbaum, a Brooklyn businessman, was arrested on accusations of trying to broker the purchase of a kidney for $160,000.

That the organ shortage is so great in this country that people are resorting to buying and selling kidneys is not a surprise; it probably happens more than we know. That’s because some 102,640 patients are waiting for an organ donation in the United States, according to the United Network for Organ Sharing. More than 7,000 people died last year while they awaited kidneys, hearts, livers, lungs, and intestines.

The situation is particularly dire when it comes to kidneys. A sharp increase in diabetes rates in this country has fueled demand;  there are now more than 80,000 people on the official waiting list for a kidney transplant. Reports are that thousands of other patients–those that aren’t in bad enough condition to warrant a spot on the official list—could benefit from a kidney.

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Imagine that you are Billy Tauzin. You’re known as a brazen politician, with few scruples. You helped shepherd the Bush administration’s Medicare bill through Congress—legislation that included a startling provision that actually forbid Medicare from even trying to negotiate discounts with drug-makers.

Mission accomplished, a few weeks later you quit Congress (after having assured your constituents that you planned to run for re-election), and take a $2 million job as president of Pharma, the trade organization representing the very drug-makers who benefited, so handsomely, from the legislation.

Flash forward to 2009:  you find yourself up against a progressive White House, and a president who targeted you personally, in a televised advertising campaign.

What do you do?

You keep your friends close, your enemies closer.

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Below, a memo and a chart that a hospitalist recently sent to his residents. To protect his identity, I have removed the name of his hospital from the memo. Suffice to say that it is a well-known hospital in one of the 20 largest cities in the U.S., and that it is located in a very affluent section of that city. This hospital does not serve an unusually large number of very poor or very sick patients.

The memo itself seems to me a splendid and courageous example of what physicians should be teaching residents. And he is an excellent teacher: the chart makes its points in a way that is easy for a busy resident to read quickly—and it drives the message home.

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Claim:   Recently, Karen Ignagni, president and chief executive officer of America's Health Insurance Plans (AHIP),  has been trying to put the industry’s best foot forward, arguing that when it comes to reform, healthcare insurers have been the most cooperative members of the healthcare industry.

After all, insurers have agreed to stop shunning sick patients: They will no longer turn away customers who, through no fault of their own, suffer from pre-existing conditions such as breast cancer. Graciously, insurers have said that they will refrain from dropping paying customers because the insurer suddenly “discovers” a pre-existing condition –after the customer is diagnosed with MS. Finally, insurers have pledged to stop charging sicker patients sky-high premiums. Instead, everyone in a given community will pay the same premium for the same plan. (This is now the law in some states).

Truth: What the industry has agreed to hardly represents a “concession”. They have consented to do what insurance companies are supposed to do: cover not just the young and healthy, but those who might actually use the policy. 

But Ignagni is right on one point: Insurers are more enthusiastic about reform than most in the healthcare industry. This is hardly surprising. Universal coverage—with a mandate that everyone buy insurance–will bring them as many as 47 million new customers, government subsidies in hand.

What’s not to like?

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 On Alternet, Bill Moyers summarizes what happened in D.C. last week: “Push finally came to shove in Washington . . . .as the battle for health care escalated from scattered sniper fire into all-out combat.” 

Moyers is right. But I’m more optimistic than he is about how this battle will end.
As usual, Moyers, pulls no punches: “As the Republicans fired away, big business stepped up the attack too, their lobbying and advertising guns blazing. The Chamber of Commerce, for one, announced a major campaign of rallies and print and Internet ads to crush the White House plan for a competitive public option allowing consumers to choose between a government plan and private health insurance . . .

“Supporters who want to scrap the present system for fundamental change are staring glumly though the fog of war at a battlefield in total disarray.

“They fear that in the White House's desire to get a bill — any bill – passed by Congress, it will have been so compromised, so bent to favor the big interests, that it will be less Waterloo than watered down, a steady diluting of the change they had hoped for and that America needs."

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Over at Dr. Roy Poses’ Health Care Renewal, contributor  Anne Peticola offers a post titled: An Outsider’s Take On American Medicine.

She writes: “Jonathan Kaplan’s The Dressing Station was published in 2001, but I am only reading it now. Much of the book is about battlefield medicine, but one part concerns his coming from Britain to America in the late 1980s.  . . .With research budgets cut under Thatcher, he came to America to be able to pursue his medical career.

“After his dreary British experience during a period of budget cutbacks, he greatly enjoyed the cheerful commercialism and general prosperity of American medicine. He promptly found a research project to work on that would enable him to write a Master’s thesis, and the work was fun and went swimmingly.

“Nonetheless, Dr. Kaplan was quite disconcerted by some of the differences between British and American medicine. Working on another study, he reviewed hemorrhoid surgery results. He was startled to realize how much more surgery was done for minor piles in the U.S. than in Britain, though results were unimpressive – then ‘I found the payment invoices in each patient’s folder. These were met by the health insurers, who paid out a lot more for an operation than injections. . . . The logic of a for-profit system appeared to lead to expensive solutions and spiraling costs.’

"He was also startled by anecdotal reports of how the stock market crash of 1987 led one surgeon to actually shed tears mid-surgery when he heard the news. As well, the serious, money-oriented medical students surprised him, as he was used to quite a number of more arty, intellectual types among medical students in other countries."

Read the rest of Peticola’s post  here.

Friday, Politico.com editor Fred Barbash posed this question to “Arena” contributors: “Does the ongoing debate about healthcare reform reflect a :"kind of culture war” that can be traced to a “fundamental difference in world views?”  

Barbash then pointed to a thought-provoking piece by Bill Bishop, titled “Health Debate Runs Along Familiar Lines” which was published on Politico.com in March. http://dyn.politico.com/printstory.cfm?uuid=CD297E8F-18FE-70B2-A882654169CEAC57  

Bishop, who  is the co-author of “The Big Sort: Why the Clustering of Like-Minded America Is Tearing Us Apart,” argues that “The health care discussion reveals that the country is still divided along lines drawn more than 100 years ago. . . divisions in the country were never about specific issues . . .. They were about ways of looking at this world (and the next), and those century-old differences are now shaping the health care discussion.”

 Bishop frames the age-old religious debate this way: “Do you get to heaven by your good works, by what you do for your brothers and sisters on Earth? Or do you find salvation by your individual relationship with God? Does the world get better through public acts or private ones?

“When Sen. Jim DeMint (R-S.C.) said recently that ‘this health care issue s D-Day for freedom in America’ he was talking from one side of this division. President Barack Obama says,  ‘I am my brother’s keeper.’ That’s the view from the other bank.

 “This isn’t a policy issue or a disagreement about strategy,” Bishop adds. “It is a fundamental difference in worldview. It’s a division in what people expect out of life, and it’s been part of this country for more than 100 years.”

He points out that “Religious historian Martin Marty described the late 19th-century split between what he called private and public Protestants. Private Protestants promoted individual salvation and personal morality.

By contrast, Bishop exatplains that “Public Protestants saw riots by workers [fighting for unions]  as a failure of society. Pubic Protestants promoted the minimum wage and  the 8-hour days . .  . Public Protestants believed that either the needs of people would be met, or the kingdom of God [on earth] would never arrive. ‘Either society confronted social injustice or society would fall,’ wrote one prominent public Protestant. ‘It is either a revival of social religion or the deluge.’”

There were “two types of Christianity” alive in the country, Bishop adds, “Congregationalist minister Josiah Strong wrote in 1913. ‘Their difference is one of spirit, aim, point of view, comprehensiveness. The one is individualist; the other is social.’”

In my response  http://www.politico.com/arena/perm/Maggie_Mahar_642F5006-E55B-4901-8D36-2340F6213AE3.html  I  tried to connect the dots between Private vs. Public Protestants and today’s progressives and conservatives.

 Regular readers may not find many surprises in my comment on healthcare reform, but I suspect many would enjoy Bishop Paul Moore’s spectacular analysis (which I quote in the second paragraph of my comment), explaining where former president George W. Bush fits in the Private vs. Public  Protestant debate.