Wednesday, April 13, 2016

Health Care Reform Articles - April 13, 2016

The Rich Live Longer Everywhere.
For the Poor, Geography Matters.

Sunday, April 10, 2016

Health Care Reform Articles - April 10, 2016

US elections 2016: ‘The system is rigged, the government coin-operated’

by Wendell Potter and Nick Penniman - The Nation

 few years ago, CBS News conducted a poll about Americans’ perception of government. The headline of the resulting story: Alienated nation: Americans complain of government disconnect.
The first sentence reads: “Americans see their leaders in Washington as overpaid agents of wealthy individuals and corporations who are largely disconnected from the concerns of average Americans.”
We, the people, are losing our faith in the dream of democracy. As our collective power is increasingly eclipsed by a rigged system of politics and governance dominated by a handful of billionaires and a phalanx of well-financed special interests, we are growing sceptical that the promises will come true.
Right now there is no credible outside threat to our American way of life. No other nation is sounding the death knell of ours. But the rapid proliferation of a system akin to oligarchy – within our own country – threatens to cripple our march forward.

The two following articles disagree about who should help patients "navigate" through our broken system of health "insurance". Of course in an "Improved Medicare-for-All" system, the number of financial navigators would be zero. Everybody in, nobody out.


Study Of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients’ Out-Of-Pocket Spending

  1. Wynn G. Hunter7 - Health Affairs
    Some experts contend that requiring patients to pay out of pocket for a portion of their care will bring consumer discipline to health care markets. But are physicians prepared to help patients factor out-of-pocket expenses into medical decisions? In this qualitative study of audiorecorded clinical encounters, we identified physician behaviors that stand in the way of helping patients navigate out-of-pocket spending. Some behaviors reflected a failure to fully engage with patients’ financial concerns, from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending. Many of these failures resulted from systemic barriers to health care spending conversations, such as a lack of price transparency. For consumer health care markets to work as intended, physicians need to be prepared to help patients navigate out-of-pocket expenses when financial concerns arise during clinical encounters.

Tackling the financial toll of cancer, one patient at a time
by Laurie McGinley - Washington Post

GRAND RAPIDS, Mich. — Even before Scott Steiner started treatment for a rare gastrointestinal cancer that had spread throughout his abdomen, a dangerous side effect threatened his health.
His doctor had prescribed the cancer drug Gleevec, but Steiner’s insurance refused to cover its $3,500 monthly cost. Steiner, a warehouse manager for a publisher of Bible-themed literature, and his wife, Brenda, a part-time nurse, made just $30,000 a year. No way could they afford the drug on their own.
“We still had six kids at home — how were we going to come up with that kind of money?” Steiner said. “We couldn’t re-mortgage the house, because it had already been re-mortgaged. I wouldn’t have been able to take the medication. We would have had to just trust in the Lord.”
It was a scary brush with “financial toxicity,” as researchers call the mix of economic stress, anxiety and depression cancer patients often endure. But then Steiner was assigned to Dan Sherman, an oncology social worker at Mercy Health Lacks Cancer Center who within days got a free supply of Gleevec from the manufacturer. He also made sure it was delivered promptly. The package arrived at Steiner’s home on Christmas Eve, his 46th birthday.
In the eight years since, Steiner has faced a series of medical and financial reversals, and each time Sherman has done as much as any doctor to keep Steiner going — scrambling to get the treatment he needed without sending his family into bankruptcy. “He keeps throwing me life rafts before I sink,” Steiner said.

Hepatitis C drug costs leave many without care

By Felice J. Freyer

Twenty years ago, Larry Day learned two dangerous viruses were circulating in his body, HIV and hepatitis C. Both infections came from needles shared during his years as an injecting drug user.
Only one caused him big problems: hepatitis C. That virus destroyed his kidneys, an uncommon complication. Over time, he knew, hepatitis C could lead to cirrhosis and liver cancer. So when drugs came on the market promising to cure him, Day — by then free of illicit drugs — was eager to give them a try.
But his Medicaid insurance plan said no. He could get the drugs only if his liver was damaged, and his liver was still in good shape.
The restrictions Day faced violate a federal directive, run contrary to medical guidelines, and undermine an opportunity to stop the spread of an infectious disease. But MassHealth, as the Massachusetts Medicaid program is known, is not alone in putting up obstacles to hepatitis C drugs.
Hillary Clinton reveals her plan to revise--not repeal or replace--Obamacare
by Michael Hiltzik - LA Times

Since presidential candidate Hillary Clinton quietly updated the healthcare policy page on her campaign website over the last few days, most commentators have focused on the especially notable paragraphs stating that she will "continue to support a 'public option' — and work to build on the Affordable Care Act to make it possible." 

The policy page includes several other elements aimed at improving the Affordable Care Act, including broadening the accessibility of heath coverage to otherwise excluded populations and reducing its cost. More on those in a moment.

Parents upset as insurance plan limits access to Boston Children’s Hospital

An insurance plan designed for underprivileged families is restricting patient access to doctors at Boston Children’s Hospital in an effort to control health care costs, reports The Boston Globe.
Yande Schwarzbock has been taking her 6 year-old daughter, Emmarose Logatti, to specialists at Children’s Hospital her entire life. The little girl suffered a stroke before her birth.
The family’s insurer is Neighborhood Health Plan, which changed its policy with Children’s Hospital Jan. 1. The new policy applies to Neighborhood members on Medicaid. Neighborhood has about 300,000 Medicaid members, which includes about 120,000 children. When Schwarzbock learned that her daughter would lose access to her doctors with the new plan, she quickly dropped the plan and switched to another Medicaid program.
“I can’t afford to go to another hospital, because these doctors already know her. I couldn’t afford to wait,” she told the Globe.

What’s behind skyrocketing insulin prices?

by Ed Silverman - STAT
Here’s a sticking point for diabetics: the cost of insulin more than tripled — from $231 to $736 a year per patient — between 2002 and 2013, according to a new analysis.
The increase reflected rising prices for a milliliter of insulin, which climbed 197 percent from $4.34 per to $12.92 during the same period. Meanwhile, the amount of money spent by each patient on other diabetes medications fell 16 percent, to $502 from $600, according to a research letter published Tuesday in the Journal of the American Medical Association.
“Insulin is a life-saving medication,” said Dr. William Herman, a coauthor of the analysis and a professor of epidemiology at the University of Michigan School of Public Health. “There are people with type 1 diabetes who will die without insulin. And while there have been incremental benefits in insulin products, prices have been rising. So there are people who can’t afford them. It’s a real problem.”

Caregivers who lost jobs when Maine agency closed scramble to be paid

By Beth Brogan, BDN Staff
driving in his car with a client on Friday afternoon when his team leader at Merrymeeting Behavioral Health Associates called to tell him he no longer had a job.
“She told me to lie to the client and tell them there’s an emergency, then take them home and end my day,” Pelletier said Wednesday.
Pelletier, along with nearly 200 other employees and state and local officials, had been told on March 28 that Merrymeeting Behavioral Health Associates would stop seeing clients on April 8, and close altogether on April 22, due to proposed state changes in reimbursement rates for MaineCare clients.
But last Friday, the company abruptly closed its doors without paying employees for hours worked and without providing state officials with information that would help them assist workers in finding new jobs.

Lawmakers reach compromise to ease impact of MaineCare rule changes for mentally ill

A committee votes unanimously to extend the transition period for Section 17 clients to find new providers of day services.
by Kevin Miller - PPH Staff

AUGUSTA — Lawmakers struck a bipartisan compromise Wednesday aimed at “softening” the transition of mentally ill patients at risk of losing some of the community-based services they currently receive under MaineCare.
The compromise came less than a week after an estimated 300 people converged on the State House to warn that proposed changes to a part of the MaineCare program known as Section 17 could lead to more hospitalizations, suicides or incarcerations of people with chronic mental disorders.
The proposal, which received unanimous committee support Wednesday, would direct the Maine Department of Health and Human Services to extend the transition period from 90 days to 120 days for clients now receiving help from case managers assigned to help them with daily living.
But committee members also directed the department to offer additional 90-day extensions – through June 30, 2017 – if clients can “reasonably demonstrate” that they would be unable to access other programs within MaineCare. Additionally, Section 17 clients now receiving rental assistance would be grandfathered.

Donald Trump’s Health Care Ideas Bewilder Republican Experts

by Robert Pear and Maggie Habermas - NYT

WASHINGTON — Donald J. Trump calls for “a full repeal of Obamacare” but says that “everybody’s got to be covered.” Initially, he liked “the mandate,” a central feature of the Affordable Care Act that requires most Americans to have insurance or pay a penalty, but he backed off that position under fire from conservatives.
He would allow individuals to take tax deductions for insurance premium payments. But aides acknowledge that this tax break would not be worth much to people whose income is so low they pay little or nothing in federal income taxes. For them, Trump aides say, there would be Medicaid, which the billionaire businessman says he would not cut but would turn into a block grant to state governments.
This whipsaw of ideas is exasperating Republican experts on health care, who call his proposals an incoherent mishmash that could jeopardize coverage for millions of newly insured people. But for Mr. Trump’s campaign, such criticism appears only to bolster the candidate’s outsider status. His chief policy adviser, Sam Clovis, said that Mr. Trump was running against the political establishment in Washington and was therefore not relying on advice from “traditional establishment Republican people.”
Instead, Mr. Clovis said in an interview, Mr. Trump is receiving advice on health care policy from at least a half-dozen “very prominent people,” but he declined to name them. “They are not ready to have their support of the Trump campaign known,” Mr. Clovis said.

Despite bipartisan support, mental health reform bill could be derailed
by Noam N. Levey - LA Times

Mental health advocates are pressing Democrats and Republicans on Capitol Hill not to abandon a push to modernize the nation's ailing mental health system amid rising partisan tensions over President Obama's Supreme Court pick.
The effort has picked up crucial bipartisan support in the Senate and galvanized dozens of groups representing patients, physicians and state and local leaders. The Obama administration has also backed calls for reform, proposing more than $500 million in new federal spending to expand mental health services nationwide.
But election-year politics and uncertainty over funding are fueling concerns that years of collaborative work by lawmakers from both parties may not bear fruit.
"We don't often get opportunities like this," said Paul Gionfriddo, president of Mental Health America, a leading national advocate. "This is the year for action."
An estimated 1 in 5 Americans suffered from a mental illness in the last year, according to federal data. Nearly 10 million people have a serious disease such as schizophrenia or bipolar disorder.

The Female Viagra, Undone by a Drug Maker’s Dysfunction

by Katie Thomas and Gretchen Morgenson - NYT

Last August, Sprout Pharmaceuticals had a new pill on its hands that quickly captured the nation’s imagination. The Food and Drug Administration had just approved its drug Addyi to treat low sex drive in women.
Late-night comedians joked about “female Viagra.” Wall Street analysts conjectured about blockbuster sales. In clinical trials, women reported a small, but statistically significant, uptick in the number of satisfying sexual experiences per month.
“This was just such a huge moment for women,” Cindy Whitehead, Sprout’s chief executive, told Fortune magazine at the time.
Things got even better for Sprout a day after the F.D.A. approval, when Valeant Pharmaceuticals International, a drug company whose deal-making acumen had made it a stock-market darling, bought Sprout for an astonishing $1 billion — twice its value just two months earlier.
What could go wrong? Well, just about everything.

For some migrants in Texas, obtaining healthcare means getting through immigration checkpoint

Elias Soto Sanchez’s chief concern as an ambulance carried him north to a hospital in San Antonio was not his broken right foot — it was his wife.
“You cannot go with me,” Blanca Soto recalled her husband saying when he phoned from the ambulance.
The couple has raised three children while living in the border city of Brownsville, Texas, for 13 years since crossing illegally from their native Mexico. They've done their best to stay in the Rio Grande Valley near the border and avoid the Border Patrol checkpoint here on the highway north.
But when Soto, 48, fell and broke his foot last Dec. 4, a local doctor said he needed to see a specialist for surgery about 275 miles north in San Antonio, beyond the checkpoint.
“He told the doctors, ‘I don’t have documents.’ They told him he could go. They said nothing would happen to him,” said Blanca Soto, 46. “They said, ‘We will not call immigration.’”
But the ambulance was stopped at the checkpoint, a rural ranching outpost about 75 miles north of the border on Highway 281 leading to San Antonio and Houston. Immigration officials held Soto for questioning before eventually allowing him to proceed, but noted that he would be detained. At the hospital, they stationed a guard at his room and did not allow him to speak to his wife or other relatives.
Those living in the valley without legal status learn to navigate life while keeping a low profile, but medical problems beyond the capabilities of local healthcare providers present a grim choice: forgo treatment or risk deportation.

Seeking treatment is "a risk that many people are not willing to take because it means separation from their families,” said Ana Rodriguez DeFrates, director of the Texas Latina Advocacy Network. “That’s what they tell us — ‘My children are citizens, I’m not and I don’t want to leave them.’ So they live with the pain.
“We hear from women about why they have gone five years, 10 years without a Pap smear,” she said. “A lot of people [outside the Rio Grande Valley] don’t know these checkpoints exist so far inland and that they restrict access. It’s not something that’s widely recognized as a problem.”

More Maine doctors certifying medical marijuana patients

by Gilliam Graham - PPH

A few years ago, Dr. James Li would never have dreamed of certifying his patients to use medical marijuana.
“I was a total skeptic,” says the emergency room doctor at LincolnHealth’s Miles Campus in Damariscotta. “I didn’t think there was any credibility. I thought it was a way for people to get a license to use illicit marijuana in a recreational fashion.”
But as Li saw firsthand the improvements some patients made as they traded hundreds of pills a month for medical cannabis, he started doing research. After reading all he could and talking to advocates, he decided he’d send patients he thought would benefit from marijuana to a doctor who could certify them to legally use the drug.
There were none to be found in the Damariscotta area.
So Li – still somewhat reluctant but willing to give it a try – opened a part-time private practice and joined the growing number of Maine doctors and nurse practitioners who are certifying patients to use medical marijuana.
There are now more than 300 medical providers in Maine certifying medical marijuana patients, according to data released by the Department of Health and Human Services. It’s difficult to say how that number has grown since the medical marijuana program was established in 1999 because the state did not track the number of certifying doctors until last year, but a state official, medical providers and advocates say anecdotally that there has been an increase.

Letter to the editor: Health care insurer’s decision shows why we need Sanders

I’m one of the small-time donors supporting the quixotic campaign of Bernie Sanders. That immediately tells you that in matters of grave importance, such as the future presidency of the United States, I listen to my heart even though I agree with the rational arguments of friends.
As a physician whose career has been devoted to helping individuals manage a difficult and expensive chronic condition, diabetes, I have strong opinions about health matters. I have tracked the runaway price inflation of analog insulin preparations for years. Seeing the struggles that patients have in paying for this life-saving medication, whether they have insurance or not, I can attest to the emotional distress and financial burden, as well as adverse health consequences, of our country’s inability to control medication costs.
When asked by a respected colleague to serve on the Pharmacy and Therapeutics Committee of Maine’s Community Health Options insurance company, I seized the opportunity to have a voice in their drug coverage policies. This has given me valuable insights into the financial challenges faced by insurers, including the impact of high-priced insulin as well as heavily-advertised new products.
I’ve felt proud to serve in this capacity when patients have acquired insurance and moved off the hospital’s “free care” rolls, and defended their coverage policies. I’m aware of the financial struggles that threaten Community Health Options’ viability. For all these reasons, I was disheartened to read the March 20 article reporting the doubling in pay of its two top executives.
Perhaps I’m another grumpy old man who decries the “corporatization” of my profession, and feels deeply the anguish of patients being pushed closer to the poverty level. I’m enough of a realist to know that America is not, and may never be, ready for Bernie’s revolution, but it warms the cockles of my heart to cheer him on.
John Devlin
Cape Elizabeth