Health Care Reform Articles - September 30, 2012

The Conservative Case for Obamacare

By J. D. KLEINKE

Washington

IF Mitt Romney’s pivots on President’s Obama’s health care reform act have accelerated to a blur — from repealing on Day 1, to preserving this or that piece, to punting the decision to the states — it is for an odd reason buried beneath two and a half years of Republican political condemnations: the architecture of the Affordable Care Act is based on conservative, not liberal, ideas about individual responsibility and the power of market forces.

This fundamental ideological paradox, drowned out by partisan shouting since before the plan’s passage in 2010, explains why Obamacare has only lukewarm support from many liberals, who wanted a real, not imagined, “government takeover of health care.” It explains why Republicans have been unable since its passage to come up with anything better. And it explains why the law is nearly identical in design to the legislation Mr. Romney passed in Massachusetts while governor.

The core drivers of the health care act are market principles formulated by conservative economists, designed to correct structural flaws in our health insurance system — principles originally embraced by Republicans as a market alternative to the Clinton plan in the early 1990s. The president’s program extends the current health care system — mostly employer-based coverage, administered by commercial health insurers, with care delivered by fee-for-service doctors and hospitals — by removing the biggest obstacles to that system’s functioning like a competitive marketplace.

Chief among these obstacles are market limitations imposed by the problematic nature of health insurance, which requires that younger, healthier people subsidize older, sicker ones. Because such participation is often expensive and always voluntary, millions have simply opted out, a risky bet emboldened by the 24/7 presence of the heavily subsidized emergency room down the street. The health care law forcibly repatriates these gamblers, along with those who cannot afford to participate in a market that ultimately cross-subsidizes their medical misfortunes anyway, when they get sick and show up in that E.R. And it outlaws discrimination against those who want to participate but cannot because of their medical histories. Put aside the considerable legislative detritus of the act, and its aim is clear: to rationalize a dysfunctional health insurance marketplace.

http://www.nytimes.com/2012/09/30/opinion/sunday/why-obamacare-is-a-conservatives-dream.html?_r=1&pagewanted=print

Cut we must

By Sun Journal,

Posted Sept. 17, 2012, at 3:25 p.m.

The Maine Hospital Association warned last week that automatic Medicare cuts will cost the state $21 million next year and nearly 3,000 jobs.

This is the result of the robotlike sequestration process Congress came up with last year. That scheme was designed to be so frightening and so repugnant to both sides that it would force Democrats and Republicans to compromise on a more rational, less harmful plan.

As it turned out, Republicans and Democrats disliked each other even more than they disliked the nightmare of sequestration and the plan failed. True story.

Everyone who’s anyone now says sequestration was a stupid idea in the first place and will cripple the economy if enacted. Yet, here we are, with the stupid plan as our only plan.

The hope now is that with the election out of the way Congress can act swiftly to avert a crisis. Everyone who has faith in that happening, raise their hand.

Yeah, didn’t think so.

Maine’s hospitals are clearly hoping for that miracle. They not only face the sequestration cuts, but Affordable Care Act cuts and Medicaid cuts imposed by the Republican Legislature.

But even if sequestration isn’t the answer — and it’s clearly not a good one — hospitals had better be about the job of cutting expenses over the next decade.

Medicare is unsustainable, and you don’t have to be a hospital CFO to understand that. It is the elephant in the room when politicians try talking about the deficit.

Bluntly, we spend too much on health care and, by a lot of measures, we do not get our money’s worth.

http://bangordailynews.com/2012/09/17/opinion/cut-we-must/print/

The Psych Approach

By DAVID BROOKS

In the 1990s, Vincent Felitti and Robert Anda conducted a study on adverse childhood experiences. They asked 17,000 mostly white, mostly upscale patients enrolled in a Kaiser H.M.O. to describe whether they had experienced any of 10 categories of childhood trauma. They asked them if they had been abused, if their parents had divorced, if family members had been incarcerated or declared mentally ill. Then they gave them what came to be known as ACE scores, depending on how many of the 10 experiences they had endured.

The link between childhood trauma and adult outcomes was striking. People with an ACE score of 4 were seven times more likely to be alcoholics as adults than people with an ACE score of 0. They were six times more likely to have had sex before age 15, twice as likely to be diagnosed with cancer, four times as likely to suffer emphysema. People with an ACE score above 6 were 30 times more likely to have attempted suicide.

Later research suggested that only 3 percent of students with an ACE score of 0 had learning or behavioral problems in school. Among students with an ACE score of 4 or higher, 51 percent had those problems.

In Paul Tough’s essential book, “How Children Succeed,” he describes what’s going on. Childhood stress can have long lasting neural effects, making it harder to exercise self-control, focus attention, delay gratification and do many of the other things that contribute to a happy life.

Tough interviewed a young lady named Monisha, who was pulled out of class by a social worker, taken to a strange foster home and forbidden from seeing her father for months. “I remember the first day like it was yesterday. Every detail. I still have dreams about it. I feel like I’m going to be damaged forever.”

http://www.nytimes.com/2012/09/28/opinion/brooks-the-psych-approach.html?src=me&ref=general&_r=0&pagewanted=print

Posted: September 29 Updated: Today at 12:02 AM Health Care: Reform law supported in Maine A poll finds a majority like Obamacare and oppose its repeal, which diverges from U.S. survey results. By John Richardsonjrichardson@mainetoday.com State House Bureau Mainers are much more supportive of President Obama's health care reform law than most Americans are, according to the latest statewide poll by Critical Insights Asked whether the Affordable Care Act, also known as Obama- care, will be good or bad for the country, 47 percent said good and 38 percent said bad. That is the opposite view of Americans in general, who say the law will be bad, 51 percent to 37 percent, according to a Rasmussen poll during the same week in mid-September. The same is true when voters are asked if they support repeal of the law. In Maine, voters said they oppose repeal 55 percent to 39 percent, according to the Critical Insights poll. Nationwide, voters support repeal 53 percent to 43 percent. The 2010 Affordable Care Act includes a sweeping set of reforms aimed at reducing the number of uninsured Americans. A core piece of the law, and the most controversial, is a requirement that most uninsured Americans buy health insurance through government-run exchanges starting in 2014. The exchanges will provide subsidies to help qualified people pay for the coverage http://www.pressherald.com/politics/health-care-reform-law-supported-in-maine_2012-09-30.html

Spiritual side of health care

By Ahmed Kutty, M.D.
Kearney (Neb.) Hub, Letters, Aug. 24, 2012
On Aug. 15 at the dedication of the new west wing and the Cope Heart Center at Good Samaritan Hospital, Bishop William Dendinger of Grand Island paid tribute to the late Cardinal Joseph Bernardin, who held a strong belief that the sacred dimension of the healing professions was just as vital as its scientific foundations.
In November 1996, the cardinal passed away after battling advanced pancreatic cancer, which brought him into direct and personal experience of pain and suffering. While very satisfied with the care he received at Chicago’s Loyola University MedCenter, Bernardin spoke out with anguish and passion regarding the plight of 45 million fellow Americans who were uninsured and often did not receive needed and timely medical care simply because the cost of coverage was unaffordable.
The Affordable Care Act of 2009 (Obamacare), while addressing some of the major flaws in our current dysfunctional system, has a long road to travel before a publicly funded health care financing mechanism is in place, providing necessary, appropriate and evidence-based medical care, both preventive and curative, to all citizens of this country. Achieving universal Medicare (Improved Medicare for All) will take a sustained, hard and bitter fight before the powers that be will concede it.
If we, the people, carry on the struggle for the cause that was very dear to his heart, the cardinal could not have wished for a worthier tribute
http://www.pnhp.org/print/news/2012/september/spiritual-side-of-health-care

Health Care Reform Articles - September 29, 2012

FDA warning public of risks of online pharmacies

By LINDA A. JOHNSON/AP Business Writer

The Food and Drug Administration is warning U.S. consumers that the vast majority of Internet pharmacies are fraudulent and likely are selling counterfeit drugs that could harm them.

The agency on Friday launched a national campaign, called BeSafeRx, to alert the public to the danger, amid evidence that more people are shopping for their medicine online, looking for savings and convenience.

Instead, they're likely to get fake drugs that are contaminated, are past their expiration date or contain no active ingredient, the wrong amount of active ingredient or even toxic substances such as arsenic and rat poison. They could sicken or kill people, cause them to develop a resistance to their real medicine, cause new side effects or trigger harmful interactions with other medications being taken.

http://www.pressherald.com/news/FDA-warning-public-of-risks-of-online-pharmacies-.html

Health care reform — what do physicians think?

By Dr. Erik Steele,

Posted Sept. 27, 2012, at 4:10 p.m.

Physicians agree on — maybe — two things. First, they agree they don’t agree on anything. Actually, some probably disagree about that. Second, they usually agree that everyone who disagrees with them is wrong. It should therefore come as no surprise that physician opinions about health care reform cover more territory than a bad rash.

That is reflected in physician opinions about President Obama’s Affordable Care Act, or ACA, in particular. Talk to five physicians and you get five opinions that sometimes overlap, sometimes don’t, and are almost always strongly held. And as we know, opinions are like bacteria — everyone has them and some of them are nasty. That’s why a Florida urologist who probably had a big prostate clouding his thinking put a sign on his office door telling Obama supporters to seek care elsewhere.

The difficulty understanding what physicians think about all of this is compounded by the fact there are few really good surveys of them on these issues, and results of them seem contradictory. One of those — a survey of 2,694 physicians commissioned by the Jackson Healthcare System — found 55 percent felt the ACA should be scrapped, but one-third of respondents felt the act did not go far enough and a single-payer health system was needed. That means some of those who felt the law should be scrapped did so because they thought it went too far, and others thought so because it did not go far enough.

On the other hand, a 2009 survey of 2,130 physicians found 62.9 percent supported universal insurance through public (government-sponsored) and commercial options. They differed on how to achieve that universal insurance, with 25 percent supporting commercial insurance as the only option, and less than 20 percent supported government-sponsored insurance as the only option.

Despite this diversity of opinion, general patterns of physician perspective have emerged. Perhaps two-thirds support some kind of insurance for all Americans, because most recognize that lack of insurance puts their patients in jeopardy. Just as there seems to be an emerging consensus among physicians, there is also one among their professional associations (such as the American Medical Association and the American Osteopathic Association) that all Americans need access to comprehensive, affordable health care, and that some kind of insurance is required to ensure that access. That evolution is part of what brought the AMA from its position in the 1960s opposing the formation of Medicare to its position in 2011 in support of the ACA.

http://bangordailynews.com/2012/09/27/health/health-care-reform-what-do-physicians-think/print/

ACOs are another distraction from universal single-payer health care

By Peggy Anna Carey, M.D.
Vtdigger.org, Sept. 26, 2012
Fletcher Allen Health Care and Dartmouth-Hitchcock Medical Center have formed their new accountable care organization (ACO) called OneCare Vermont. The stated vision is “a statewide network with a coordinated clinical model and toolset … to enhance the quality of the care provided to Vermont’s Medicare beneficiaries while remaining good stewards of health care expenditures …”
The first question should be what exactly does this statement mean? Am I mistaken, or hasn’t the Vermont Legislature created the Green Mountain Care Board to establish the statewide infrastructure to create our universal single-payer health care system called Green Mountain Care? Does not Green Mountain Care model both high quality and cost-effectiveness by eliminating the morass of administrative waste created by the present health care situation that is virtually run by for-profit corporations?
ACOs such as “OneCare” are a ruse for hospitals, insurers and providers to consolidate more of their clout to control their turf of profits. The Medicare Shared Saving Program that is encouraging the formation of these ACOs is based upon pilot studies that showed little savings and little improvement in care. Amy Goldstein, medical reporter for The Washington Post, wrote over a year ago:
“The five-year test enlisted 10 leading health systems around the country and offered financial bonuses if they could save enough by treating older patients more efficiently while providing high-quality care. In 2010, the final year, just four of the 10 sites, all long-established groups run by doctors, slowed their Medicare spending enough to qualify for a bonus, according to an official evaluation not yet made public. Two sites saved enough to get bonuses in all five years, the evaluation shows, but three did not succeed even once. The uneven progress is significant because the experiment involves ‘accountable care organizations,’ one of the hottest trends in health policy and an idea included in the year-old federal law intended to overhaul the nation’s health-care system.”
http://www.pnhp.org/print/news/2012/september/acos-are-another-distraction-from-universal-single-payer-health-care

Big Firms Overhaul Health Coverage

September 28, 2012

Sears Holdings Corp. and Darden Restaurants Inc. are planning a radical change in the way they provide health benefits to their workers, giving employees a fixed sum of money and allowing them to choose their medical coverage and insurer from an online marketplace, says the Wall Street Journal.

• The companies say the change isn't designed to make workers pay a higher share of health coverage costs.
• Instead they say it is supposed to put more control over health benefits in the hands of employees.

The approach will be closely watched by firms around the United States. If it eventually takes hold widely, it might parallel the transition from company-provided pensions to 401(k) retirement savings plans controlled by workers and funded partly by employer contributions. For employees, the concern will be that they could end up more directly exposed to the upward march of health costs.

http://www.ncpa.org/sub/dpd/index.php?Article_ID=22410&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+ncpadpd+(Daily+Policy+Digest)

Real ways to fight the obesity epidemic

The state and country must do more to address today’s most significant public-health problem: obesity. When researchers know that, if current trends continue, more than half of all adults in Maine will be obese by 2030, policymakers and health professionals cannot stand still. Lowering the obesity rate will take many specific steps — and time. Nothing about it will be easy, not just because a person’s weight is affected by many different factors, but because it will require a new way of thinking and a reworking of how the food industry operates.

Increasing sedentary lifestyles and greater access to fatty, sugary foods, which often cost less per calorie than fruits and vegetables, have led to the obesity epidemic. A lack of incentives for both consumers and the medical profession to address the health threat have contributed to the problem. Studies of molecular genetics have helped the country understand eaters’ short- and long-term motivations and could help researchers develop drugs to fight obesity.

But the biggest changes will not come from a medicine for ending obesity. To effectively reverse the obesity rate, policies must address the principal causes.

One main cause of obesity has its roots in the overproduction of food. With the U.S. food supply generating about twice the number of calories the average adult needs each day, food companies compete for a greater share of the market through advertising, more “appealing” products and larger portion sizes, according to Marion Nestle, a professor of food studies and public health at New York University. The food companies prosper when people eat more.

The government can make it easier for people to make healthy choices and help structure the market to be more health-based. It can subsidize commodity crops less and fruit and vegetables more. It can require that foods bought and distributed in federal programs are healthy. It can work with schools to serve nutritious meals and snacks, as the National Prevention Council Action Plan proposes. It can place more restrictions on food marketing to children.

http://bangordailynews.com/2012/09/28/opinion/real-ways-to-fight-the-obesity-epidemic/print/

Big Pharma Medicaid Fraud Penalties at Record High

Major pharmaceutical companies undeterred as profits continue to rise

- Common Dreams staff

Settlements between pharmaceutical companies and state and federal governments over cases of Medicaid fraud are at an all time high, with financial penalties for major drug companies on the rise, according to a new report by Public Citizen. However, as Public Citizen urged Thursday, much still needs to be done in order to curb big pharma malpractice, as major profits still largely outweigh the costs of legal penalties, making it difficult to deter future violations.

The charges against major pharmaceutical companies accused of defrauding their Medicaid programs, include overcharging health programs, largely in the form of drug pricing fraud, as well as unlawful promotion of 'off-label' drugs (promoting drugs for unapproved uses).

2012 has already broken the record for financial penalties and court settlements against the pharmaceutical industry, with $6.6 billion recovered by mid-July.

The big pharma corporations associated with the largest penalties include GlaxoSmithKline, Johnson & Johnson and Abbott. These companies were responsible for two-thirds of the financial penalties paid out to the federal and state governments over the course of the study period. GlaxoSmithKline topped the list with $3.1 billion in settlements.

http://www.commondreams.org/headline/2012/09/28-1?print

Federal grants boost Maine health centers

By Jackie Farwell, BDN Staff

Fourteen community health centers in Maine will be awarded $55,000 each in federal grant money to improve care and increase the number of screenings for cervical cancer.

The Maine health centers are among more than 800 nationally to receive funding from the U.S. Department of Health and Human Services. The grants will help the health centers to become “patient-centered medical homes,” a model in which primary care doctors lead a team of health providers to coordinate patients’ care, including managing chronic diseases and hospital admissions.

http://bangordailynews.com/2012/09/28/health/federal-grants-boost-maine-health-centers/

Health Care Reform Articles - September 27, 2012

Health insurance costs grew slowly for two years. Now, they’re speeding up.

By Sarah Kliff , Updated: September 25, 2012

U.S. spending on health insurance grew at an accelerated rate in 2011, breaking a two-year trend of smaller cost increases. The culprit, a new study suggests, is not Americans seeking more treatment but rather rapid growth in the price of medical care.

Spending for private health insurance surged by 4.6 percent in 2011, according to a report from the Health Care Cost Institute. That growth rate is faster than the rest of the economy and higher than the previous year, which had 3.8 percent growth.

Average spending on a private insurance patient rose to $4,547 in 2011, compared with $4,349 in 2010. That statistic suggests that a recent downturn in health-care spending may have been a temporary product of the recession rather than a more permanent change, as some health-care economists have hoped.

“We don’t know yet whether this is a one-off year aberration or a resumption of patterns of higher growth,” said Health Care Cost Institute Director David Newman. “We just don’t know. When you have one data point, you’re cautious.”

The Health Care Cost Institute used data from 40 million Americans with private insurance provided by health plans such as Aetna and Kaiser Permanente. The research does not include data on public insurance programs, such as Medicare and Medicaid, which the federal government will make available in early 2013.

Employers typically have tried to control costs by reducing the volume of care delivered, whether that means higher co-pays for doctor visits or using prevention to catch costly diseases earlier.

http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/09/25/health-insurance-costs-grew-slowly-for-two-years-now-theyre-speeding-up/?print=1

The Democrats' Market-Friendly Health-Care Alternative

The Romney-Ryan vision would slash federal health spending by shifting costs to seniors, businesses and states while empowering insurance companies to ration care.

By EZEKIEL J. EMANUEL ,
NEERA TANDEN And DONALD BERWICK

Many commentators, including The Wall Street Journal, frame the health-care debate as a choice between government control and individual choice. But that is a false contrast. The choice is really between encouraging health-care providers to be more efficient, innovative and focused on keeping patients healthy—or shifting the financial burden to patients, businesses and states. The latter approach harms seniors and others, and it will fail to control health-care costs.

The Romney-Ryan health-care plan recasts Medicare as a voucher program. If the voucher's value fails to keep pace with rising health-care costs, seniors will be forced to pay ever more to buy private insurance. There is no evidence that competition among insurance plans would do anything to address the underlying costs of health-care providers.

http://online.wsj.com/article/SB10000872396390444017504577645193107383610.html?mod=googlenews_wsj

Medicare working to boost Obama in swing states, poll finds

By Jon Cohen and Peyton M. Craighill, Thursday, September 27, 9:23 AM

Voters in three critical swing states broadly oppose the sweeping changes to Medicare proposed by Republican vice presidential candidate Paul Ryan and, by big margins, favor President Obama over Mitt Romney on the issue, according to new state polls by The Washington Post and the Kaiser Family Foundation.

Among seniors, the issue rivals the economy as a top voting issue, undercutting Romney’s appeal in Florida, Ohio and Virginia. Generally, the more voters focus on Medicare, the more likely they are to support the president’s bid for reelection.

A focus on Medicare as an issue also blunts potential fallout from Obama’s 2010 health-care reform law. The law remains controversial and is, according to an analysis of these new poll results, a drag on Obama’s reelection prospects. In Florida and Ohio, more voters have “strongly unfavorable” than “strongly favorable” impressions of the health law.

Sizable majorities of voters in each of these three states — as well as those across the country — say they prefer to keep Medicare as a defined benefits program, rather than moving to a system of fixed payments to seniors to buy coverage from private insurance or traditional Medicare. The “premium support” idea is one featured in the Republican budget proposed by Ryan and backed by Romney. The desire to keep the system as it is peaks at 65 percent in Florida, where more than one in five 2008 voters were age 65 and up.

http://www.washingtonpost.com/politics/decision2012/medicare-working-to-boost-obama-in-swing-states-poll-finds/2012/09/27/b8a53a0e-0822-11e2-858a-5311df86ab04_print.html

Romney touts his health-care law, bashes Obama’s law

By Philip Rucker , Updated: September 26, 2012

TOLEDO — Over the course of a half hour on Wednesday evening, Mitt Romney put on a vivid display of his political flexibility on the lightning-rod issue of health care.
 
As his surrogates were warming up a crowd of 3,600 at the SeaGate Convention Centre in downtown Toledo, Romney sat backstage for an interview with NBC News, during which  he fully embraced the health care overhaul he signed into law as governor of Massachusetts.
 
“Don’t forget,” Romney said, “I got everybody in my state insured. One hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record.”

Then, just minutes later, Romney stepped out to rally his supporters here with a sharp critique of Obama’s national health-care overhaul, calling the federal law “Exhibit No. 1” of Obama’s liberal view of government, even though it is very similar to Romney’s own Massachusetts law. 
 
“I will repeal Obamacare and replace it with real health care reform,” Romney said at the rally. “You see, Obamacare is really Exhibit No. 1 of the president’s political philosophy, and that is that government knows better than people how to run your lives. It is a view that government should stand between you and your doctor. I don’t believe in a bigger and bigger government…I believe in freedom.”

Romney’s comments to NBC represented his strongest embrace of the Massachusetts law in some time, while his attack on Obama’s law at the rally was one of his toughest.

http://www.washingtonpost.com/blogs/election-2012/wp/2012/09/26/8114/?print=1

Maine Medical Center notifies state of $40M renovation project

By Jackie Farwell, BDN Staff

Posted Sept. 26, 2012, at 3:58 p.m.

PORTLAND, Maine — Maine Medical Center has notified the state that it’s planning a $40 million expansion and update of several of the hospital’s operating rooms.

MMC plans to replace and modernize five surgical rooms to help the hospital accommodate surgeries that are increasing in volume and complexity, said Mark Harris, senior vice president of planning and marketing for MMC and its parent organization, MaineHealth.

“We’re pretty compressed with regard to our surgical capacity,” he said. “What I mean by that is we’re operating very early in the morning and very late at night. This will help decompress that activity.”

MMC performs approximately 28,000 surgeries each year in its 34 operating rooms.

Earlier this month, MMC notified the Maine Department of Health and Human Services’ Certificate of Need unit, which evaluates health care projects, that it planned to pursue the renovations. It’s an early step, which will be followed in coming months by MMC submitting a formal application after its board of directors approves final plans.

MMC expects to invest $40 million in capital into the project, but the board still must determine the effect on the hospital’s operating expenses, Harris said.

If the board’s review and regulatory approvals proceed without a hitch, construction would kick off next spring, Harris said. The project will involve renovating the second floor of the Bean building on MMC’s Bramhall Street campus and wouldn’t be visible from the street.

The existing operating rooms date back to 1984, and at about 400 square feet, aren’t large enough for many modern surgeries, Harris said. The new 650-square-foot rooms will be known as “interventional rooms” that can house not only surgeries, but other services as needed, such as radiology and cardiac catheterization, he said.

http://bangordailynews.com/2012/09/26/health/maine-medical-center-notifies-state-of-40m-renovation-project/print/

Plan Selection in Medicare Part D

Fewer than 10 percent of individuals enroll in what for them would be the most cost-effective plans.

In Plan Selection in Medicare Part D: Evidence from Administrative Data (NBER Working Paper No.18166), co-authors Florian Heiss, Adam Leive, Daniel McFadden, and Joachim Winter analyze data on medical claims in Medicare Part D drug insurance programs. They find that fewer than 10 percent of individuals enroll in what for them would be the most cost-effective plans. This is apparently because seniors pay more attention to their out-of-pocket premiums than to the overall benefits of the dozens of drug plans available to them. Equally significant, the researchers believe that how seniors decide whether to enroll in Medicare Part D, and what plans they select, is important not only for management of the Part D program, but also is indicative of how consumers behave in real-world decision situations with a complex, ambiguous structure and high stakes. The researchers add that their findings may yield predictions for how seniors will handle plan choices in the new general health insurance exchanges that will implement the Patient Protection and Affordable Care Act of 2010.

http://www.nber.org/digest/oct12/w18166.html

Health Care Reform Articles - September 26, 2012

Ann Telnaes Animation

Romney says uninsured have access to health care

http://www.washingtonpost.com/opinions/telnaes?hpid=z3

SEPTEMBER 25, 2012, 12:23 PM

Antibiotic Prescription? It May Depend on Where You Live

By ANAHAD O'CONNOR

A new study has found that older men and women in the South are more often prescribed antibiotics than older Americans elsewhere, even though there is no evidence that the South has higher rates of pneumonia and other diseases for which antibiotics are necessary. The findings suggest there are greater rates of antibiotic overuse in that part of the country.

Many experts have expressed concerns that antibiotics are being overprescribed and overused, leading to unnecessary spending on prescription medicines as well as more widespread bacterial resistance to the drugs. In the elderly, who are more likely to suffer adverse side effects and reactions from antibiotics, the health consequences can be amplified.

Despite this vulnerability, antibiotic use among seniors has not been as closely studied as it has been among younger Americans. So a team of researchers looked at prescribing patterns among men and women over 65 across the country, comparing rates over a period of several years and doing breakdowns quarterly. Their research, published in Archives of Internal Medicine, showed that during a typical three-month period, about 21.4 percent of older Americans in the South used an antibiotic, compared with about 17.4 percent in the West. The rate in the Midwest was 19.2 percent, and in the Northeast it was 18.2 percent.

http://well.blogs.nytimes.com/2012/09/25/antibiotic-prescription-it-may-depend-on-where-you-live/?hpw&pagewanted=print

Redistributing wealth upward

By Harold Meyerson, Published: September 25

Which is the more redistributionist of our two parties? In recent decades, as Republicans have devoted themselves with laser-like intensity to redistributing America’s wealth and income upward, the evidence suggests the answer is the GOP.

The most obvious way that Republicans have robbed from the middle to give to the rich has been the changes they wrought in the tax code — reducing income taxes for the wealthy in the Reagan and George W. Bush tax cuts, and cutting the tax rate on capital gains to less than half the rate on the top income of upper-middle-class employees.

The less widely understood way that Republicans have helped redistribute wealth to the already wealthy is by changing the rules. Markets don’t function without rules, and the rules that Republican policymakers have made since Ronald Reagan became president have consistently depressed the share of the nation’s income that the middle class can claim.

Part of the intellectual sleight-of-hand that Republicans employ in discussions of redistribution is to reserve that term solely for government intervention in the market that redistributes income downward. But markets redistribute wealth continuously. In recent decades, markets have redistributed wealth from manufacturing to finance, from Main Street to Wall Street, from workers to shareholders. Rules made by “pro-market” governments (including those of “pro-market” Democrats) have enabled these epochal shifts. Free trade with China helped hollow out manufacturing; the failure to regulate finance enabled Wall Street to swell; the opposition to labor’s efforts to reestablish an even playing field during organizing campaigns has all but eliminated collective bargaining in the private sector.

http://www.washingtonpost.com/opinions/harold-meyerson-the-party-that-truly-believes-in-redistribution/2012/09/25/c5877b7a-0740-11e2-afff-d6c7f20a83bf_print.html

Maine not alone in hunt for Medicaid savings

The Associated Press

AUGUSTA — Maine is not alone among the states that have reduced spending for Medicaid programs, a health care spending consultant on Tuesday told a panel that's looking to add to cuts that already have been imposed.

Cuts elsewhere range from eyeglasses and eye exams to hearing aids, dental care, chiropractic services and mental health services, according to a summary prepared by Seema Verma of SVC Inc. for the MaineCare Redesign Task Force.

"A lot of the states are in a similar situation where they're looking for cost-containment strategies," Verma, of the Indiana-based consultancy, told the task force. "There are no easy answers to this. Any decisions you make will have advantages, will also have some disadvantages."

Medicaid already has undergone major cuts in Maine, notably coverage for 19- and 20-year-olds, reduced access for elderly people already eligible for Medicare and increased eligibility requirements for non-disabled, non-pregnant adults on Medicaid. But even while the Legislature is adjourned, the search for more cuts continues.

Gov. Paul LePage says the costs of Medicaid, known in the state as MaineCare, are unsustainable over the long term. As part of the state budget update that was passed in May, the Legislature created the nine-member task force, whose members have expertise in health policy and health care finance.

The panel must find $5.25 million in savings this fiscal year, then formulate longer-term strategies. Among the first approaches taken by other states is increased cost sharing through larger co-pays, a strategy some states see as an incentive for people receiving benefits to take more personal responsibility, Verma said.

But she warned that the states may not be able to change standing cost-sharing rules because of national Affordable Care Act restrictions on such changes. She also said increased cost sharing may have a downside in the form of reduced access to care.

http://www.pressherald.com/news/Maine-not-alone-in-hunt-for-Medicaid-savings-.html

Finding healing: How to reduce hospital readmission rates

When a patient is treated at a hospital and released she should know exactly what medications and continued care she’ll need. If she’s underinsured or uninsured, she should be connected to nearby free clinics and drug assistance programs. These are just a few ways to help prevent her from having to return to the hospital with complications.

As political leaders discuss how to make the $486 billion Medicare program more efficient, they have and will continue to press hospitals to reduce readmissions — both to cut costs and improve people’s health. As Maine hospitals work to lower their readmission rates, they can learn from what has worked at other hospitals.

http://bangordailynews.com/2012/09/24/opinion/editorials/finding-healing-how-to-reduce-hospital-readmission-rates/

Affordable health care — invented by Republicans

By Rufus Wanning, Special to the BDN

Posted Sept. 24, 2012, at 1:02 p.m.

There are only three ways this country could move toward universal health care. We could extend Medicare to the entire population, having the government pay for it; we could require employers to insure their workers, with government picking up the bill for the rest, or we could have an individual mandate. The individual mandate is the most politically conservative plan, and it is the plan Obama and Congress chose when they enacted The Affordable Care Act.

The plan was first proposed in 1989 by the conservative Heritage Foundation. In 1993, a similar bill was proposed by prominent Republican senators. In 2005, another such bill was proposed by Mitt Romney as governor of Massachusetts, which became law the next year. All these reforms included an individual mandate, which somehow was never a big issue. Romney even said, in a 2008 Republican primary debate, “I like mandates.”

Now Romney calls the Affordable Care Act “an assault on freedom.” You explain this; I can’t.

The Massachusetts bill became the model for Obama’s Affordable Care Act, passed in 2009. From what I’ve heard, the Massachusetts bill has been fairly successful, although a little more expensive than hoped. Massachusetts is the only state in the Union where the individual mandate is NOT a big issue, because they already have it.

http://bangordailynews.com/2012/09/24/opinion/affordable-health-care-invented-by-republicans/print/

Pay off the hospitals, then collect the cash

Posted Sept. 24, 2012, at 1:01 p.m.

Since there is apparently a pot of gold at the end of Maine’s liquor contract rainbow, it’s not too early to begin thinking about how that money should be handled.

Maine Gov. Paul LePage is rumored to have his own plan, and we can only hope it’s different from the one offered in the early years of the John Baldacci administration.

In 2003, the newly elected governor was looking at a biennial budget with a $1.2 billion structural gap. That meant the budget needs for the next two years were $1.2 billion larger than projected revenues.

So Baldacci and the Legislature began looking for ways of closing that gap. There are only two ways of doing that without resorting to gimmickry: either raise more revenue or cut expenses.

Baldacci was adamantly opposed to increasing any broad-based taxes, so his administration focused mostly on cutting expenses and, to a lesser extent, increasing fees.

And, according to several sources, Maine lobbyist Severin Beliveau approached Baldacci with an idea: Sell off the state’s liquor control business, which at the time earned the state about $26 million a year.

That was the first plan, but state Sen. Peter Mills, now executive director of the Maine Turnpike Authority, was shocked by the suggestion.

The idea of selling off a reliable, monopolistic revenue stream struck him as “crazy” and “obscene,” he told the Sun Journal last week.

http://bangordailynews.com/2012/09/24/opinion/other-voices/pay-off-the-hospitals-then-collect-the-cash/print/

Health Care Reform Articles - September 25, 2012

Report claims state health insurance reform not working

By Scott Thistle, Sun Journal

Posted Sept. 22, 2012, at 12:40 p.m.

AUGUSTA, Maine — A Republican-backed state law aimed at lowering health insurance premiums in Maine is being panned in a new report by affordable health care advocates.

But supporters of the law, especially those who wrote and co-sponsored it in the Maine Legislature, say the law is working but needs to be fully implemented before anyone draws conclusions about its effectiveness.

Supporters say key provisions of the law, including one that allows people to buy health insurance across state lines, have not yet gone into effect.

In its report issued earlier this month, Consumers for Affordable Health Care examined health insurance rate renewal information at the Bureau of Insurance. The report focused on renewal rates for insurance customers in the individual and small-group markets.

What they found did not bode well for the new law’s effectiveness, said Joe Ditre, executive director of the consumer group.

Key findings showed 54 percent of individual policyholders in Maine saw premium increases, while 90 percent of small business policyholders saw rates go up. Small-group plans cover up to 50 employees.

The report also draws attention to a new $4 assessment tacked on to all health insurance policies in Maine as a result of the law.

That assessment is used to build an annual fund of nearly $21 million that a new nonprofit organization , the Maine Guaranteed Access Reinsurance Association, also created by the law, uses to reinsure the most costly or high-risk clients on the books of Maine insurance companies.

“No one knows they are paying this tax,” Ditre said. “They are being taxed, and this is all under the radar.”

http://bangordailynews.com/2012/09/22/health/report-claims-state-health-insurance-reform-not-working/print/

Liking It or Not, States Prepare for Health Law

By ABBY GOODNOUGH

PHOENIX — Like many Republican governors, Jan Brewer of Arizona is a stinging critic of President Obama’s health care law. When the Supreme Court upheld it in June, she called the ruling “an overreaching and unaffordable assault on states’ rights and individual liberty.”

Yet the Brewer administration is quietly designing an insurance exchange — one of the most essential and controversial requirements of the law. Officials in a handful of other Republican-led states say they are also working to have a framework ready by Nov. 16, the deadline for states to commit to running an exchange or leave it to the federal government to run it for them. That is just 10 days after Election Day, which is likely to decide the future of the law.

Given that the health care overhaul remains a lightning rod — just last week, Oklahoma revised a lawsuit against it — even the most tentative discussions about carrying it out in Republican states tend to take place behind closed doors or “underground,” as the leader of a health care advocacy group in the South put it.

In Mississippi, Mike Chaney, the insurance commissioner, who is laying the groundwork for a state-based exchange there, recently learned the difficulties of moving forward in anything but the utmost secrecy. At a luncheon this summer he found himself facing down an opponent of the law in a confrontation that is now circulating on YouTube.

“I was invited to the picnic, and I was the main course,” said Mr. Chaney, a Republican and an elected official.

http://www.nytimes.com/2012/09/24/us/like-it-or-not-states-prepare-for-health-law.html?hpw&pagewanted=print

Medicare Bills Rise as Records Turn Electronic

By REED ABELSON, JULIE CRESWELL and GRIFFIN J. PALMER

When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, the goal was not only to improve efficiency and patient safety, but also to reduce health care costs.

But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care.

Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a New York Times analysis of Medicare data from the American Hospital Directory. Regulators say physicians have changed the way they bill for office visits similarly, increasing their payments by billions of dollars as well.

The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone, federal regulators said in a recent report, noting that the largest share of those doctors specialized in family practice, internal medicine and emergency care.

For instance, the portion of patients that the emergency department at Faxton St. Luke’s Healthcare in Utica, N.Y., claimed required the highest levels of treatment — and thus higher reimbursements — rose 43 percent in 2009. That was the same year the hospital began using electronic health records.

The share of highest-paying claims at Baptist Hospital in Nashville climbed 82 percent in 2010, the year after it began using a software system for its emergency room records.

In e-mailed statements, representatives for both hospitals said the increases reflected more accurate billing for services. Faxton also said its patients required more care than in past years.

http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitals-with-electronic-records.html?src=rechp&pagewanted=print

Romney's Medicaid Remarks On '60 Minutes' Raise Eyebrows

Mitt Romney talks with 60 Minutes correspondent Scott Pelley.

It's not so much what Mitt Romney said about whether the government should guarantee people health care in his interview on CBS's 60 Minutes Sunday that has health care policy types buzzing. It's how that compares to what he has said before.

http://www.npr.org/blogs/itsallpolitics/2012/09/25/161719767/romney-medicaid-remarks-raise-eyebrows

Panel Reminds Doctors to Screen for Alcohol Misuse

By SABRINA TAVERNISE

Primary care doctors and nurses should screen their adult patients to determine whether they are misusing alcohol, and provide counseling when risky behavior is detected, a panel of medical experts reaffirmed on Monday.

About a third of Americans misuse alcohol, though far fewer are addicted, according to the panel, the United States Preventive Services Task Force. The misuse results in an estimated 85,000 deaths a year, making illness related to alcohol abuse the third-leading cause of preventable death in the United States, after smoking and obesity.

After reviewing recent research, the panel concluded that primary care doctors and nurses could help patients cut down on drinking by offering a brief counseling session or a series of sessions. Doctors would determine whether counseling was needed by asking a simple set of questions about alcohol use during the patient’s primary care visit.

The National Institute on Alcohol Abuse and Alcoholism considers more than 14 drinks a week excessive for men and more than seven drinks a week excessive for women. It says daily consumption should not be more than four drinks for men and three for women.

The questions that doctors should ask, the task force said, include, “How often do you have a drink containing alcohol?” and “How often do you have five or more drinks on one occasion?”

The task force did not recommend the same screening and counseling for adolescents because, it said, it was less clear whether the benefits would outweigh the potential harm, like anxiety or the stigma of being singled out.

http://www.nytimes.com/2012/09/25/health/doctors-reminded-to-screen-for-alcohol-problems.html?hpw&pagewanted=print

The Conservative Mind

By DAVID BROOKS

When I joined the staff of National Review as a lowly associate in 1984, the magazine, and the conservative movement itself, was a fusion of two different mentalities.

On the one side, there were the economic conservatives. These were people that anybody following contemporary Republican politics would be familiar with. They spent a lot of time worrying about the way government intrudes upon economic liberty. They upheld freedom as their highest political value. They admired risk-takers. They worried that excessive government would create a sclerotic nation with a dependent populace.

But there was another sort of conservative, who would be less familiar now. This was the traditional conservative, intellectual heir to Edmund Burke, Russell Kirk, Clinton Rossiter and Catholic social teaching. This sort of conservative didn’t see society as a battleground between government and the private sector. Instead, the traditionalist wanted to preserve a society that functioned as a harmonious ecosystem, in which the different layers were nestled upon each other: individual, family, company, neighborhood, religion, city government and national government.

Because they were conservative, they tended to believe that power should be devolved down to the lower levels of this chain. They believed that people should lead disciplined, orderly lives, but doubted that individuals have the ability to do this alone, unaided by social custom and by God. So they were intensely interested in creating the sort of social, economic and political order that would encourage people to work hard, finish school and postpone childbearing until marriage.

http://www.nytimes.com/2012/09/25/opinion/brooks-the-conservative-mind.html?ref=global-home&pagewanted=print

A Call for Caution on Antipsychotic Drugs

By RICHARD A. FRIEDMAN, M.D.

You will never guess what the fifth and sixth best-selling prescription drugs are in the United States, so I’ll just tell you: Abilify and Seroquel, two powerful antipsychotics. In 2011 alone, they and other antipsychotic drugs were prescribed to 3.1 million Americans at a cost of $18.2 billion, a 13 percent increase over the previous year, according to the market research firm IMS Health.

Those drugs are used to treat such serious psychiatric disorders as schizophrenia, bipolar disorder and severe major depression. But the rates of these disorders have been stable in the adult population for years. So how did these and other antipsychotics get to be so popular?

http://www.nytimes.com/2012/09/25/health/a-call-for-caution-in-the-use-of-antipsychotic-drugs.html?ref=global-home

Report: Premium hikes for top Medicare drug plans

By RICARDO ALONSO-ZALDIVAR/Associated Press

WASHINGTON — Seniors enrolled in seven of the 10 most popular Medicare prescription drug plans will be hit with double-digit premium hikes next year if they don't shop for a better deal, says a private firm that analyzes the highly competitive market.

FILE - In this Feb. 20, 2008, file photo, a shopper walks toward the pharmacy at a Little Rock, Ark., Wal-Mart store. A study says seniors in seven of the 10 most popular Medicare prescription drug plans will be hit with double-digit premium hikes next year if they don�t shop for a better deal. The report by Avalere Health is a reality check against the Obama�s administration�s upbeat pronouncements. Back in August 2012, officials had announced that the average premium for basic prescription drug coverage would stay the same in 2013, at $30 a month.

http://www.pressherald.com/news/Report-Premium-hikes-for-top-Medicare-drug-plans-.html

Why care under the Affordable Care Act will be unaffordable

By Richard Amerling, Special to the BDN

Posted Sept. 25, 2012, at 1:56 p.m.

Several recent articles should dispel any remaining notion that care provided under the so-called Affordable Care Act will in fact be affordable.
Just the opposite is true.

The Wall Street Journal reported that when physicians sell their practice to hospitals and become hospital employees, services they provide to patients become significantly more expensive. The reason for this, simply put, is that overhead is much higher, and third parties reimburse at a higher rate for exactly the same service.

Another way to say this is that hospitals are less efficient than a private office. And, as I have pointed out, physicians are considerably less productive when working for a salary, as opposed to fee-for-service. This was an entirely predictable outcome.

Yet, health planners behind the Affordable Care Act pinned their hopes for cost containment on exactly this consolidation occurring. The act promotes Accountable Care Organizations; groups of “providers” and administrators who will assume financial risk for caring for patients assigned to them, by accepting a lump-sum payment to cover all their medical needs.

Accountable Care Organizations are the latest version of managed care, and will have similar problems. They will have a strong financial incentive to cherry pick healthy patients; those with serious problems will end up in emergency rooms and hospitals, where care is much more costly.

This brings us to the most recent article from the New York Times, which shows that when hospital emergency rooms and physician practices adopt electronic health records, reimbursements for physician services go way up.

Wait a second. Isn’t the EHR the magic wand that is somehow going to result in huge efficiencies and cost savings? Well, not exactly. It seems doctors and hospitals are able to use the EHR to “enhance” documentation of patient encounters and services provided, which entitles them to “up-code” and receive higher reimbursement from third party payers.

http://bangordailynews.com/2012/09/25/opinion/why-care-under-the-affordable-care-act-will-be-unaffordable/print/

Feds: Health reform law helps Mainers save $13 million

By Jackie Farwell, BDN Staff

Posted Sept. 24, 2012, at 1:33 p.m.

Federal officials say Maine seniors and people with disabilities have saved $13.1 million on prescription drugs since President Obama’s health reform law was enacted in 2010.

The health care law has allowed Mainers in the Medicare prescription drug coverage gap known as the “doughnut hole” to save an average of $522 during the first eight months of this year, according to the U.S. Department of Health and Human Services.

The health reform law, fiercely opposed by Republicans, calls for the doughnut hole to be closed by 2020. The law began phasing out the coverage gap in 2010, giving Medicare beneficiaries who hit the doughnut hole a $250 rebate. Last year, beneficiaries received discounts on generic drugs and some brand name medications.

The Affordable Care Act improves Medicare coverage for prescription drugs and provides seniors with preventive care at no cost. U.S. HHS touted a new report this week that found the law will save the average person with traditional Medicare coverage $5,000 from 2010 to 2022. People on Medicare who have high prescription medication costs will save more, around $18,000, over that period.

“I am pleased that the health care law is helping so many seniors save money on their prescription drug costs,” U.S. HHS Secretary Kathleen Sebelius stated in a recent press release. “A $5,000 savings will go a long way for many beneficiaries on fixed incomes and tight budgets.”

Nationally, more than 5.5 million people have saved nearly $4.5 billion on prescription drugs since the law was enacted, according to U.S. HHS.

The reform law also made a number of preventive health services, such as yearly wellness checks and colorectal cancer screenings, free to seniors without co-pays or deductibles. U.S. HHS said in February that the law provided more than 400,000 Maine residents with preventive care last year.

The Affordable Care Act has been vehemently opposed by Republicans, becoming a centerpiece issue in this year’s presidential campaign. Republican presidential nominee Mitt Romney has vowed to repeal the law while keeping of its more popular provisions, saying the law harms businesses and represents a government takeover of health care.

http://bangordailynews.com/2012/09/24/health/feds-health-reform-law-helps-mainers-save-13-million/print/