Health Care Reform Articles - September 20, 2012

Vermont could be first in line for single payer By: Joanne Kenen September 17, 2012 04:28 AM EDT

Most governors are, at best, slogging their way through the world of health reform implementation. Vermont’s Gov. Peter Shumlin is hurtling through it. Vermont is the only state to have set itself on a path to a single-payer health care system, using the national health care law as a jumping-off point. Shumlin can’t get there by 2014. He may not get there by 2017, when states get more flexibility under the health law to design their own health care systems. He may not get there at all. But he believes that even small states must aim big. “It’s a mistake for our public policymakers to think we can nibble around the broken system,” he told POLITICO in an interview at the Democratic National Convention in Charlotte, N.C. He says he wants change and believes that it’s actually easier to bring big change to little states, which he sees as less beholden than larger states and national politics are to special interests. The rest of the United States has no interest in single payer, of course, not now nor in the near future. Not only did the 2010 health law reject single payer or a public option, its rules and structures prevent a state like Vermont from going single payer, at least at the outset. But Shumlin’s ready to go — and he doesn’t want the health care law to stand in his way. “This Vermont boy wants to implement that single-payer health care system tomorrow, and I don’t know why you guys want to stop me from doing that,” Shumlin said at a recent POLITICO health policy panel. “It’s the right thing to do. The rest of the world has figured it out. Let’s grow up and join them.” The Vermont Legislature and his administration are working on setting up a state health insurance exchange under the health care law. It isn’t single-payer, although it’s often described that way. It’s an exchange. But Vermont is designing its exchange in a way that could be a platform for a state-based single-payer system. Shumlin argues that his vision is as pragmatic as it is progressive. The efficiencies of a one-payer system will slow health care spending, freeing up dollars for jobs and economic growth, he says http://dyn.politico.com/printstory.cfm?uuid=95E02BC4-4F42-4F7F-80EB-D2C89A620AC9

Tufts Medical, Vanguard Health consider alliance

Look to acquire unaffiliated hospitals, integrate care

By Robert Weisman

 |  GLOBE STAFF

  SEPTEMBER 18, 2012

Tufts Medical Center is in talks to team up with for-profit Vanguard Health Systems to buy independent hospitals and provide more integrated health care across Massachusetts.

The proposed alliance, while stopping short of a merger, could give Tufts and Vanguard more clout to compete for unaffiliated community hospitals with the fast-growing Steward Health Care System as well as with Partners HealthCare System, the state’s largest medical care provider. It could also help the expanded system negotiate better contracts with insurers.

Tufts and Vanguard have been mostly on the sidelines during the past two years as Steward, Partners, and Beth Israel Deaconess Medical Center added to their franchises. The current talks grew out of existing clinical affiliations between Tufts and Vanguard, both parties said.

Under their envisioned partnership, Tufts, located in Boston’s Chinatown neighborhood, would retain its status as a nonprofit teaching affiliate of Tufts University School of Medicine. Vanguard, based in Nashville, would remain an investor-owned chain of 29 hospitals nationwide, including MetroWest Medical Center in Framingham and Saint Vincent Hospital in Worcester.

http://www.bostonglobe.com/business/2012/09/18/tufts-medical-center-talks-with-vanguard-health-systems-about-teaming-buy-hospitals/Par4CwjFtaME4erT5VLpmJ/story.html

Collins, Snowe must protect program that helps defray costs of prescription drugs

By Wendy Owens, Special to the BDN

Posted Sept. 18, 2012, at 2:58 p.m.

What if there was a government program that helps millions of Americans maintain their health and quality of life? What if this same program comes in under its annual budget year after year? What if the vast majority of beneficiaries in this program say the program works well for them? Shouldn’t this program be the exemplar for best practices and not one threatened by devastating budget cuts?

Since its inception in 2006, Medicare Part D, the federal program that helps defray the costs of prescription drugs for Medicare patients, consistently comes in under its annual budget and does so while positively impacting its beneficiaries’ lives. A recent survey of Medicare Part D participants found that 95 percent think the system is working well. Yet, despite its fiscal and programmatic successes, Medicare Part D is at risk of severe budget reductions as part of mandatory cuts that will go into effect in early 2013.

As an advocate for affordable healthcare and prescription drugs, I’ve seen how access to proper health care helps people stay healthy. Study after study shows that when barriers to health care are eliminated, people stay on doctor prescribed health care and medication regimens. Adherence to these regimens means healthier people, and this means lower health care costs for everyone.

http://bangordailynews.com/2012/09/18/opinion/contributors/collins-snowe-must-protect-program-that-helps-defray-costs-of-prescription-drugs/print/

USM grad diagnosed with lymphoma, faces both student debt and health care crises By Seth Koenig, BDN Staff Posted Sept. 18, 2012, at 12:22 p.m. PORTLAND, Maine — As much as he prefers to focus on other things — his faith in God, appreciating the beauty in everyday life — Matthew Nelson finds himself at the confluence of two of the country’s hot button issues. Nelson graduated from the University of Southern Maine in December 2011 with $27,000 in student loan debt. Then, just a few weeks after marching with his classmates in May to pick up his diploma — and before he could secure health care benefits that often come with a full-time job — doctors found a softball-sized tumor in his chest. “It’s definitely a big battle,” Nelson, 24, said Tuesday of the debates over health care and student loans. “It’s something I try not to focus on too much. I’m not trying to be ignorant, but I’ve got to get healthy. That’s got to be my main goal. If I sit around and stress out about health care and finances, that takes energy away from getting better. But on the other hand, I do think about it.” He’s watching interest on his student loans build up as he defers payments for six months to a year, and he’s watching medical bills topping $10,000 apiece arrive in the mail. And he must live through what doctors describe as some of the most aggressive and damaging chemotherapy treatments available in order to survive lymphoma. “Luckily, because of ObamaCare, I was able to stay on my father’s insurance for a year after graduation,” Nelson said. “A few weeks ago, I got a bill of $10,000 from [the hospital]. With his insurance, they covered a lot of it. … If it wasn’t for ObamaCare, I wouldn’t have insurance right now. “In a lot of ways, I can understand where Republicans are coming from,” he continues. “They don’t want to give out free money to people. They don’t want money to get wasted. But in my situation, I’m somebody who needed this. I need to be on my parents’ insurance.” http://bangordailynews.com/2012/09/18/health/usm-grad-diagnosed-with-lymphoma-faces-both-student-debt-and-health-care-crises/print/ Tax penalty to hit nearly 6M uninsured people By RICARDO ALONSO-ZALDIVAR | Associated Press – 10 hrs ago WASHINGTON (AP) — Nearly 6 million Americans — significantly more than first estimated— will face a tax penalty under President Barack Obama's health overhaul for not getting insurance, congressional analysts said Wednesday. Most would be in the middle class. The new estimate amounts to an inconvenient fact for the administration, a reminder of what critics see as broken promises. The numbers from the nonpartisan Congressional Budget Office are 50 percent higher than a previous projection by the same office in 2010, shortly after the law passed. The earlier estimate found 4 million people would be affected in 2016, when the penalty is fully in effect. That's still only a sliver of the population, given that more than 150 million people currently are covered by employer plans. Nonetheless, in his first campaign for the White House, Obama pledged not to raise taxes on individuals making less than $200,000 a year and couples making less than $250,000. And the budget office analysis found that nearly 80 percent of those who'll face the penalty would be making up to or less than five times the federal poverty level. Currently that would work out to $55,850 or less for an individual and $115,250 or less for a family of four. Average penalty: about $1,200 in 2016. http://news.yahoo.com/tax-penalty-hit-nearly-6m-uninsured-people-194442599.html Big Pharma's Hidden Business Model and How Your Company Funds It By Donald W. Light Harvard Business Review, Sept. 12, 2012 Business executives may not know it, but they are wasting billions of their gross profits on ineffective, even harmful drugs in their health plans. That's one implication of the study Joel Lexchin and I just published in the BMJ (formerly British Medical Journal). The study assembles considerable evidence about the hidden business model of major pharmaceutical companies: to devote most of their research budget to developing hundreds of drugs that provide few if any advantages over existing drugs and then market them heavily to doctors and patients. As a result, about 80 percent of increased expenditures for drugs goes to paying for these minor variations. Even worse, testing for harmful side effects is minimal when new drugs are approved by the FDA as "safe." And only 10-15 percent are clinically superior, according to independent review bodies. So employers and employees end up paying for treating the side effects as well as overpaying for new drugs with few advantages to offset risks of harms. The chances that a newly approved drug will get a severe, black box warning or be withdrawn for serious side effects is about 20 percent over its lifetime. Drug companies also develop clinically superior new drugs, which enlarge the medicine chest of effective drugs that greatly benefit millions of people. But while they are waiting for the next big breakthrough, companies have to fill their product line with clinically similar drugs to market as "better" than their competitors' similar drugs. Even new molecules are usually not clinically superior. Equating "innovative" with new molecules misses the point: to develop clinically superior new medicines. The apparent business model of Big Pharma emphasizes the billions spent at great risk to find "innovative" and "breakthrough" new molecules that must be priced high to recover research costs that have become "unsustainable." However, revenues have increased six times more than their increased costs for research—hardly "unsustainable." This handsome return comes from the hidden business model that generates billions in costs for employers and employees. http://www.pnhp.org/print/news/2012/september/big-pharmas-hidden-business-model-and-how-your-company-funds-it