Why Americans Pay So Much for Health Care: Friends in High Places (Just Not Your Friends)
If you wonder why we spend more money on health care than any other country but have some of the worst health outcomes, you need look no further than the halls of Congress to it figure out.
And you need look no further back than the recent "fiscal cliff" drama for compelling proof of how decisions are often made, not based on protecting the public's interest and bringing costs down but on protecting the profits of pharmaceutical companies, insurance firms and other special interests that grease the palms of our elected officials.
Drug makers have long had cozy relationships and outsized influence on lawmakers in Washington. That's why Obamacare barely touches that industry. Big Pharma essentially blackmailed members of Congress and the White House by threatening to bankroll a huge PR and lobbying campaign to kill health care reform if serious consideration was given to allowing Medicare officials to negotiate for lower drug prices.
We hear constantly from lawmakers about how unsustainable the Medicare "entitlement" program is, yet when they had a chance to make a difference in how much Medicare has to shell out to drug makers, they looked the other way. Taxpayers could save billions of dollars a year if Medicare didn't have to pay so much for drugs, but drug companies have much more clout on Capitol Hill than taxpayers.
Quiet deaths don't come easy
A study finds that Medicare patients near death are increasingly choosing hospice or palliative care over heroic measures in their last days — but that many go through futile hospitalizations and treatments first.
By Melissa Healy, Los Angeles Times
9:07 PM PST, February 5, 2013
But for a growing number of dying patients, that is preceded by a tumultuous month in which they endure procedures that are often as invasive and painful as they are futile.
New research finds that the proportion of Medicare patients dying in hospice care nearly doubled from 22% in 2000 to 42% in 2009, an apparent bow to patients' overwhelming preference for more peaceful passings free of heroic measures. At the same time, though, many of those patients were treated aggressively until days before death seemed inevitable.
Based on the medical and death records of almost 850,000 Medicare patients, the study, published in Wednesday's edition of the Journal of the American Medical Assn., paints a picture of increasing commotion in the final weeks of patients' lives.
The patients in the analysis all suffered from the end stages of chronic diseases such as cancer, chronic obstructive pulmonary disease or dementia. But thousands of them endured multiple hospitalizations and treatments before receiving care aimed solely at making their final days comfortable.
During the decade studied, the proportion of patients who spent part of their last month in an intensive care unit grew from 24% to 29%, and the percentage who were hooked to a ventilator rose from 8% to 9%. Among dying patients, the median number of disruptive moves — for example, from nursing home to hospital, from hospital to hospice, from rehabilitation facility to home — grew from 2.1 to 3.1. Among those who spent their final days in a hospice program, 28% were there for under four days.
"I suspect this is not what patients want," said Dr. Joan Teno, a palliative care physician and professor of health services policy and practice at Brown University, who led the study.
In surveys, almost 9 in 10 Americans say that when the end is near, they would prefer to die at home, with medical care that maximizes their comfort and minimizes the pain and turmoil of treatments aimed at extending, not saving, their lives.
Those evolving views have helped drive a surge in U.S. hospice programs from 2,300 to 3,500 during the 10 years of the study. It also fueled the growth of hospital-based palliative care that places more emphasis on maximizing the quality rather than the quantity of patients' remaining days; the number of such programs doubled during the same period and is now available in 63% of American hospitals.
http://www.latimes.com/news/science/la-sci-end-of-life-care-20130206,0,5309666,print.story
CVS' Medicare drug program causing headaches for enrollees
Many seniors enrolled in SilverScript have found themselves facing inexplicably large bills that CVS has refused to negotiate.
David LazarusFebruary 5, 2013
Deborah Shapiro decided a few months ago to switch her prescription drug coverage from her former employer's plan to Medicare. The Medicare literature made clear that she could save hundreds of dollars on the various drugs she and her husband required.
Shapiro, 76, of Woodland Hills, studied her options carefully and decided to enroll in SilverScript, the Medicare-approved drug program run by CVS Caremark.
That turned out to be not such a good decision after all.
Shapiro was one of many seniors who found themselves facing inexplicably large bills that CVS refused to negotiate. As a result of cases like hers, CVS was sanctioned last month by Medicare, which means the company can't enroll new people in SilverScript until it cleans up its act.
The federal Centers for Medicare and Medicaid Services said in a letter to CVS' SilverScript subsidiary that its inability to process prescriptions correctly "poses a serious threat to the health and safety of Medicare beneficiaries."
The federal agency blamed the problems on "widespread data system failures" that have "created disruptions in tens of thousands of Medicare beneficiaries' access to prescription medications."
SilverScript handles the drug requirements of about 4 million Medicare beneficiaries.
In Shapiro's case, she told me that she'd ordered a 90-day supply of an estrogen pill that was supposed to cost $85. Instead, SilverScript sent her a 30-day supply running $70.61.
Shapiro said she got the runaround from three separate CVS supervisors until a company representative finally insisted that she had to take what she was given and pay the amount CVS was demanding.
She said the company deemed the $70.61 bill a "transition fee" from her former drug insurer, which, as it happens, was also run by CVS.
"They need to charge me a transition fee from CVS to CVS?" Shapiro said. "That makes no sense."
http://www.latimes.com/business/la-fi-lazarus-20130205,0,3947160,print.column
Medicaid appears off-limits to talk of budget cuts
As President Obama and congressional Republicans prepare for a new battle over spending, the White House puts up a wall around healthcare for the nation's poor.
By Noam N. Levey, Washington Bureau6:11 PM PST, February 2, 2013
WASHINGTON — Healthcare for the nation's poor, once viewed as especially vulnerable in this era of budget cutting, has emerged as a surprisingly secure government entitlement with as much political clout as the Medicare and Social Security retirement programs.
Even as President Obama and congressional Republicans gear up for a new budget battle, Medicaid and the Children's Health Insurance Program, which together provide coverage to more than 1 in 5 Americans and almost 1 in 3 Californians over the course of a year, appear off-limits despite their huge price tag.
The president protected Medicaid in 2011 when Congress and the White House slashed $1.2 trillion in federal spending, including on Medicare — the healthcare plan for seniors and disabled people — as part of a deal to raise the nation's debt limit.
Medicaid was spared again last month in the budget compromise that raised tax rates on high-income households — a deal that included even more Medicare cuts.
Now, with Obama banking on a dramatic Medicaid expansion next year under his landmark healthcare law, the White House is drawing another bright line around the program. The president explicitly defended Medicaid in his inaugural address, and top aides have amplified his words since.
"Medicaid cuts, from this president, from this administration, are not on the table," Gene Sperling, the head of the National Economic Council at the White House, declared in a speech Thursday to a healthcare conference, explicitly ruling out even cuts that the administration previously had considered.
"We've made a tough choice" to wall off Medicaid from cuts, he said, making the budgetary trade-off explicit: "It means we will have to look harder for Medicare savings."
A major reason for the White House position is the key role that Medicaid plays in Obama's health reform effort. The president's law is slated to provide nearly $1 trillion in new federal aid to states over the next decade to help them open Medicaid to all low-income Americans for the first time starting in 2014. That is central to the law's program for expanding insurance coverage to an estimated 30 million people by 2022.
http://www.latimes.com/health/la-na-medicaid-20130203,0,6755917,print.story
In the dark on doctor perks
Regulations to bring new transparency about corporate and other payments to physicians are 15 months past due.
February 1, 2013Though few patients realize it, many doctors receive thousands of dollars from pharmaceutical companies for each patient enrolled in an experimental drug trial. The medication might be the best thing for the patient's condition. The doctor's motives might be pure. But patients should be able to find out about such payments so they can discuss them with their doctors and decide for themselves whether the doctor's participation in an experiment might compromise his medical advice.
A provision of the 2010 healthcare reform law should bring new transparency about these and other corporate payments to physicians — including lavish dinners, gifts and industry-sponsored conventions that are more luxury vacations than medical conferences — by publishing the information in an online database. But the final regulations to implement the Physician Payment Sunshine Act were supposed to be published in October 2011; the database was supposed to go live later this year. Instead, the regulations are 15 months overdue.
As with the new food-safety act regulations — most of which were finally released in January, a full year past deadline — the sunshine rules have been drawn up by the appropriate agency but have been held up by the Office of Management and Budget. One theory for the delay, advanced by critics of the administration, is that President Obama wanted to avoid issuing regulations during election season, when the extent of government's reach was a contentious issue. That would be a poor excuse, if true. In any case, the election is over; at this point the delay smacks more of bureaucratic inefficiency than political expediency.
Most physicians put their patients' well-being first, but a study showed that doctors who receive food from a company are more likely to prescribe that company's products, even though they might not be doing it consciously.
http://www.latimes.com/news/opinion/editorials/la-ed-medical-sunshine-20130201,0,1445349,print.story
Most states lack healthcare consumer protection laws
If 39 states do not enact laws to enforce new consumer protections in the Affordable Care Act, the federal government may have to step in to guarantee them.
By Noam N. Levey, Washington Bureau9:00 PM PST, January 31, 2013
WASHINGTON — Nearly 4 out of 5 states have not enacted laws essential to enforcing new consumer protections in President Obama's healthcare law, less than a year before it is supposed to be fully implemented, a new survey indicates.
Millions of Americans still stand to benefit in 2014 from protections in the Affordable Care Act, such as a new guarantee that consumers with preexisting medical conditions cannot be denied coverage.
The law also limits how much more insurers can charge older consumers and requires health plans to cover a basic set of minimum benefits.
If the 39 states that have not enacted their own laws codifying these protections don't do so, the federal government could step in to guarantee them. But that means Washington would essentially regulate critical parts of insurance markets that are typically state-regulated.
If state lawmakers want to retain local control, they must move this year, said Katie Keith, lead author of the survey by the New York-based Commonwealth Fund.
"We expect the 2013 legislative session to be a critical time for state policymakers who wish to limit direct federal enforcement of the reforms," said Keith, who teaches at Georgetown University's Center on Health Insurance Reforms.
The 11 states that have taken steps to enact these protections include many of the same ones that have moved most aggressively to implement the healthcare law since Obama signed it in 2010. They are Arkansas, California, Connecticut, Maine, Maryland, New York, Oregon, Rhode Island, Utah, Vermont and Washington. The District of Columbia has also adopted the provisions.
http://www.latimes.com/health/la-na-health-states-20130201,0,3559756,print.story
Oregon rally shows growing support for single payer
A house bill sponsored by Rep. Michael Dembrow, D-Portland, is not expected to pass, but advocates claim momentum
By Christopher David GrayThe Lund Report (Portland, Ore.), Feb. 5, 2013
SALEM, Ore. – Nearly a thousand people swarmed the front of the Oregon Capitol Building for the opening session Monday, demanding that Oregon become the second state to enact single-payer health care legislation, which would set up a government financing system to pay for and provide health care coverage and access for all Oregon residents.
Protesters at the Health Care for All Oregon rally hoisted signs, listened to speeches, heard woeful tales of the current health care system, and sang along to bluesman Norman Sylvester: “I don’t care what party you’re in, Democrat or Republican, we don’t need to fight, health care is a human right.”
“The brother said we don’t need a fight, but they’re going to fight us,” said Rep. Michael Dembrow, D-Portland, leading the crowd. Dembrow is the chief sponsor of the single-payer legislation, House Bill 1914. “We don’t necessarily need to fight back, we need to organize. Let’s go forward and organize this state, everybody in, nobody out.”
Dembrow said HB 1914 and companion legislation in the Senate already had 19 co-sponsors, all Democrats — eight more sponsors than its predecessor from the last session, HB 3510.
One of those new sponsors, Rep. Jennifer Williamson, D-Portland, said she supported the legislation because her sister was one of the thousands of Oregonians who each year file for bankruptcy under the weight of medical bills.
http://www.pnhp.org/print/news/2013/february/oregon-rally-shows-growing-support-for-single-payer
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