Coming up with “A Bitter Pill”
March 5, 2013 @ 1:02 pm
By Steven Brill
Invariably a question has come up in these interviews about how I thought of that approach. So, since this is supposed to be a column about good story ideas, I think I’ll use it to explain the genesis of “A Bitter Pill” in more detail than I’ve been able to on the talk show circuit.
I always tell the students in a journalism seminar I teach at Yale that the best stories come from what you’re most curious about. Because I’m interested in business (as well as legal and political issues), questions about business and money often are what make me most curious, sometimes to the point of idiosyncrasy. For example, when I read last week that Jeff Zeleny, a star political reporter for the New York Times, had been hired away by ABC News, one of my first thoughts was that I’d like to see a story detailing how much more money he’ll be making – I bet it’s as much as twice his Times salary – and perhaps analyzing whether for Zeleny and other journalists his move represented a wrenching market misallocation of talent, given that his work is likely to have more impact, not to mention space, in the Times than on network television.
Similarly, during the long debate over President Barack Obama’s health insurance reform proposals, a question kept nagging at me: Everyone on all sides seemed to accept as a given that healthcare was wildly expensive, and the only debate seemed to be over who should pay for it. I wondered: Well, why is it so expensive in the first place?
At about the same time, a relative suffered a series of medical crises that produced hundreds of thousands of dollars in bills. For him, it was no problem because he had Medicare and terrific insurance to supplement what Medicare didn’t cover, leaving him on the hook for just a few hundred dollars. But again, I wondered, why were the bills so high?
What finally got me to act on that curiosity and turn it into a reporting project was a chance event, which I recounted in theTime article as follows:
http://blogs.reuters.com/stories-id-like-to-see/2013/03/05/coming-up-with-a-bitter-pill/?print=1&r=
Single-payer takes on fresh debate
January 27, 2013
By Peter Hirschfeld
Vermont press bureau
MONTPELIER — A battle of ideas will be waged with a book of numbers as the Shumlin administration this year continues to make its case for single-payer health care.
Vermont press bureau
MONTPELIER — A battle of ideas will be waged with a book of numbers as the Shumlin administration this year continues to make its case for single-payer health care.
A long-awaited report unveiled by administration officials last week has become the latest touchstone in a three-year-old debate over the merits of moving to a publicly financed system of universal care. To proponents of reform, the 90-page document confirms the clarity of Gov. Peter Shumlin’s vision.
“You can cover all Vermont residents with better coverage for less money in a universal system,” Robin Lunge, director of health care reform for the Shumlin administration, told a panel of lawmakers Friday morning.
To skeptics, however, the study, commissioned at a cost of $300,000 from the University of Massachusetts Medical School, uses junk math to paper over the one question on which the future of the reform effort hinges: Who’s going to pay?
“I would immediately challenge this analysis as being misleading, quite frankly,” said Jeff Wennberg, executive director of Vermonters for Health Care Freedom, a group that has been working since about this time last year to fight single-payer. “Any representation that there are going to be savings as a result of this reform should be looked at with the most skeptical eyes.”
Wennberg’s group has little sway in the Democrat-controlled Legislature. But it lends voice to an anti-single-payer sentiment that even the most ardent reform advocates say will intensify as the movement ages.
People like Lunge will try to use findings in the new report to sustain momentum long enough to make it to single-payer, something Shumlin has said he’ll accomplish by 2017.
To Mark Larson, commissioner of Vermont Health Access, the “big story” out of the report is the savings waiting to be had in a reformed system. The report found that Vermont will, over the first three years of single-payer, save a cumulative total of $281 million.
Health care reform: New ad, old tricks
September 09, 2012
After watching Vermonters for Health Care Freedom’s new commercial, I was reminded of what my former colleagues in the health insurance industry and I used to do to influence public opinion, often using deceptive tactics. I was also reminded of why I left my job as an industry executive and began speaking out about how the use of those tactics helped perpetuate a system that fails more and more Americans, including Vermonters, every year.
The 30-second commercial is a classic example of misdirection, a form of deception frequently used in political advertising (and by magicians) to get people to focus on one thing to distract them from something else, to worry about some imagined future rather than the reality of today.
The point of the commercial is to make viewers believe that under a single-payer system, health care decisions would no longer be made by patients and their doctors, but by “unaccountable” government bureaucrats.
The misdirection here is that the ad’s sponsor wants us to forget that under our current system, “unaccountable bureaucrats” already exercise the kind of control Vermonters for Health Care Freedom wants us to fear. But the “unaccountable bureaucrats” don’t work for the government. They work for private insurance companies — both the nonprofits like Blue Cross and Blue Shield and the for-profits, like Cigna, where I used to work. And it is those bureaucrats who have the ultimate power to limit — and in many cases deny — access to often life-saving care recommended by a doctor.
The Shumlin administration presented a report on financing single payer to the legislature
on January 24, 2013. It once again demonstrates that we can provide health care to all
Vermonters at less overall cost.
Below is a joint statement released by Vermont Health Care for All and Vermont Leads about the financing proposal, as well as links to more information:
Link to report here: Health Care Reform Financing Plan, 2014 and 2017
Link to power point on report here: Presentation on single payer financing plan
News Stories:
Report details single-payer funding options, WCAX Single-payer takes on fresh debate
http://www.vermontforsinglepayer.org/images/userfiles/file/financing%20plan%20links.pdf
Below is a joint statement released by Vermont Health Care for All and Vermont Leads about the financing proposal, as well as links to more information:
Link to report here: Health Care Reform Financing Plan, 2014 and 2017
Link to power point on report here: Presentation on single payer financing plan
News Stories:
Report details single-payer funding options, WCAX Single-payer takes on fresh debate
http://www.vermontforsinglepayer.org/images/userfiles/file/financing%20plan%20links.pdf
Unreported Side Effects of Drugs Are Found Using Internet Search Data, Study Finds
By JOHN MARKOFF
Using data drawn from queries entered into Google, Microsoft and Yahoo search engines, scientists at Microsoft, Stanford and Columbia University have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration’s warning system.
Using automated software tools to examine queries by six million Internet users taken from Web search logs in 2010, the researchers looked for searches relating to an antidepressant, paroxetine, and a cholesterol lowering drug, pravastatin. They were able to find evidence that the combination of the two drugs caused high blood sugar.
The study, which was reported in the Journal of the American Medical Informatics Association on Wednesday, is based on data-mining techniques similar to those employed by services like Google Flu Trends, which has been used to give early warning of the prevalence of the sickness to the public.
The F.D.A. asks physicians to report side effects through a system known as the Adverse Event Reporting System. But its scope is limited by the fact that data is generated only when a physician notices something and reports it.
The new approach is a refinement of work done by the laboratory of Russ B. Altman, the chairman of the Stanford bioengineering department. The group had explored whether it was possible to automate the process of discovering “drug-drug” interactions by using software to hunt through the data found in F.D.A. reports.
The group reported in May 2011 that it was able to detect the interaction between paroxetine and pravastatin in this way. Its research determined that the patient’s risk of developing hyperglycemia was increased compared with taking either drug individually.
The new study was undertaken after Dr. Altman wondered whether there was a more immediate and more accurate way to gain access to data similar to what the F.D.A. had access to.
LePage pushes passage of Medicaid payoff plan
Governor vows 'nothing gets done' till progress is made; Goodall questions whether plan is unconstitutional
AUGUSTA — Gov. Paul LePage reiterated Wednesday that "nothing gets done" until lawmakers pass his plan to pay off Medicaid reimbursements the state owes to Maine's hospitals, but a top Democrat said there may be constitutional issues with LePage's plan.
Senate Majority Leader Seth Goodall, D-Richmond, cited a 2009 opinion by Attorney General Janet Mills, who determined that a proposal at the time by Republican Sen.Kevin Raye to use a voter-approved bond to pay outstanding Medicaid debt to the hospitals violated the state Constitution.
Mills's recommendation, based on several Maine Supreme Judicial Court opinions, said Raye's proposal violated a constitutional provision prohibiting the use of bond proceeds to fund "current expenditures."
Maine seniors warned about rampant Medicare fraud and how to fight it
Posted March 06, 2013, at 5:43 p.m.
BANGOR, Maine — The best weapons for fighting Medicare fraud are the seniors and disabled who benefit from the health care program, officials told a group of Bangor seniors Wednesday.
An estimated $15 billion to $60 billion per year is spent on fraudulent claims, according to Susan Waddell, a special agent in charge with the U.S. Department of Health and Human Services office in Boston. It’s a hard number to pin down because the vast majority of health care fraud goes unreported, she added.
“That’s all money that should be going into the program for folks who really need it,” said Raymond Hurd, acting regional administrator for the Centers for Medicare and Medicaid Services.
Waddell and Hurd were joined by Michael Miller, an assistant attorney general and director of the Maine Health Care Crimes Unit, and Betty Balderson, statewide coordinator for Maine Senior Medicare Patrol, at the Hammond Street Senior Center to educate seniors about how to keep their identities — and the program — safe from fraud.
Penobscot County Sheriff Glenn Ross and Chief Deputy Troy Morton, as well as representatives of local senior support organizations, also attended the event.
There are about 50 million Medicare beneficiaries in the United States and about 286,000 of those beneficiaries are Mainers, according to the Centers for Medicare and Medicaid Services. CMS receives more than 5 million claims from its beneficiaries each day.
Hurd said CMS monitors those claims with its computer systems, which flag unusual claims in much the same way that credit card company systems warn customers of suspicious purchases under their account.
In 2012, the federal government recovered just $4.2 billion, tens of billions of dollars short of what the government loses to Medicare fraud each year.
The fraud stems from a small minority of dishonest doctors’ offices, medical practitioners and suppliers who overbill Medicare recipients for procedures, bill them for procedures they never had, or bill them multiple times for the same procedure in attempts to suck more money from Medicare coffers, according to Hurd.
Fraudulent claims often go unnoticed because recipients who read their Medicare summary notices months after their doctor visit don’t examine the documents closely or don’t remember the details of what happened during the visit, Hurd said.
The officials told the seniors to carefully examine their claims reports to look for any discrepancies, which could range from an isolated billing mistake to evidence of widespread fraud by a practitioner.
If a patient notices an isolated discrepancy on their Medicare report, they first should contact the health care practitioner to make sure it wasn’t a simple mistake. If the problems persist or the practitioner isn’t responsive, the beneficiary should report the errors so agencies can investigate for potential fraud.
Seniors also were warned not to reveal their Medicare identification number over the phone.
Our Wait-and-See Culture
By ROBERT J. ABRAMSON
JUST as the captain of the Rachel in “Moby-Dick” searched for his lost son and instead found Ishmael, doctors routinely reveal the unexpected while scanning for something else. What to do with this acquired information and how to follow up is becoming an increasingly vexing problem for physicians and their patients.
Unexpected finds — which the medical community has labeled “incidentalomas” — are ever more common because of an increase in scans, driven in part by legal concerns. For me, the concept of incidentalomas went from somewhat abstract to all too real when, about two years ago, an abdominal sonogram of my bladder revealed an abnormality on my pancreas. Pancreatic lesions have always had an ominous air about them because of the historically high mortality rate for pancreatic cancer, but luckily an M.R.I. and an endoscopic ultrasound confirmed the lesion as a cyst with very low malignant potential. I was advised to follow up in six months.
After I left the doctor’s office, still in that post-anesthesia state, I tried to process the phrase “low malignant potential.” I never wanted my name and the word “malignant” mentioned in the same sentence, yet “low” was certainly better than “high” and “potential” more reassuring than actual.
Still, in the next six months, I began to notice a curious new habit: checking the obituary pages to see who and how many had died of pancreatic cancer. I don’t know if I thought that someone else’s dying of pancreatic cancer would make my chances lower — as if some magical quota had been fulfilled — or higher. Regardless, I checked the section as if it were the latest political poll, stock market listing or other world event that I had precious little control over.
An increasing number of people are finding themselves in this “follow up in six months” mode, and experiencing the same attendant anxiety. The idea of waiting is in itself an existential experience. If you go online, which I often recommend that my patients do not, you find an enormous amount of conflicting information, from “must have radical surgery now” to “wait a half-year and get a follow-up scan.”
Blue Shield and Aetna to raise healthcare rates over state objections
Despite objections from regulators, health insurers Blue Shield of California and Aetna Inc. are proceeding with double-digit rate increases that state officials said were unreasonable.
Officials at the California Department of Managed Health Care said increases that average more than 11% for about 47,000 individual and small-business policyholders of Blue Shield and Aetna were unreasonable. But state officials don't have the authority to reject changes in premiums, and increasingly health insurers refuse state demands to lower rates.
"I am disappointed that after lengthy negotiations, Blue Shield and Aetna were unwilling to bring their proposed health plan increases down to a reasonable level," said Brent Barnhart, director of the Department of Managed Health Care.
Barnhart said negotiations were more productive with Anthem Blue Cross, the state's largest for-profit health insurer and a unit of industry giant WellPoint Inc. He said Anthem agreed to smaller rate increases for 202,000 individual and small-business policyholders that will save consumers about $13 million.http://touch.latimes.com/#section/-1/article/p2p-74698275/
Republicans revisit Medicare reform to cut spending
A budget blueprint being drafted by Rep. Paul Ryan includes a proposal to create a voucher-like system, despite the GOP promise not to change the program.
By Lisa Mascaro and Michael A. Memoli, Washington Bureau
7:28 PM PST, March 2, 2013
Despite public uncertainty Saturday about the $85 billion in so-called sequester cuts, Republicans now believe they have momentum to ask Americans to make tough choices on Medicare, as rising healthcare costs combine with an aging population to form a growing part of future deficits.
That effort will form the backdrop as the White House and congressional Republicans enter their next round in the budget wars — keeping the government funded through Sept. 30. Unless they make a deal by March 27, the government could run out of money and be forced to shutter offices and curtail services.
President Obama and Republican leaders have signaled that they are eager to avoid another bruising battle and federal shutdown as both sides position themselves for the next major pressure point, in late spring or early summer, when the government faces a potential debt default.
Rep. Paul D. Ryan of Wisconsin, the former Republican vice presidential nominee, is preparing a budget blueprint that aims to balance revenue and spending in 10 years. But his effort has run afoul of the GOP vow not to change Medicare — the federal healthcare program for seniors and the disabled — for those now 55 or older.
Medicare eligibility currently begins at age 65. Ryan's approach would transform the benefits program into one that would provide a fixed amount of money in a voucher that future seniors could apply to the cost of buying private health insurance or to buying coverage through traditional Medicare.
Throughout last year's presidential campaign, the GOP promised not to change Medicare for today's seniors — only the next generation. But Republicans familiar with the number-crunching in Ryan's budget committee say balancing the budget may not be possible unless the changes start for those who are now 56 and younger.
Critics say Ryan's plan would shift healthcare costs from the government and onto seniors. Democrats who sharply criticized Ryan's proposal during the 2012 campaign say voters rejected his arguments when they reelected Obama.
Even some Republicans who support Ryan's proposal are wary.
http://www.latimes.com/health/la-na-gop-medicare-20130303,0,7366545,print.story
'Sequester' cuts to hit healthcare hard
Expected Medicare payment cuts have hospitals and doctors worried. Public health and medical research programs may suffer disproportionately more.
By Noam N. Levey, Los Angeles Times6:00 PM PST, February 27, 2013
WASHINGTON — As the Obama administration begins to implement $85 billion in cuts to federal spending this year, no part of the budget other than defense will take a bigger hit than healthcare.
And the so-called sequester appears likely to have a disproportionate effect on areas of the health system already hobbled by years of retrenchment or underfunding, including public health and medical research.
Although the Medicare program will account for the largest chunk of dollars cut from healthcare simply because of its great size, the scheduled 2% reduction in its payments to doctors and hospitals is significantly smaller than what many public health and research programs face.
Laboratories at major universities and medical centers are already laying off scientists, even before the latest round of cuts is scheduled to take effect. And local public health officials, hit by years of cutbacks, are scaling back immunization campaigns and other efforts to track and control infectious diseases.
"They are doing cuts on top of cuts on top of cuts," said Eric Hoffman, director of the Center for Genetic Medicine Research at Children's National Medical Center in Washington. Hoffman's labs have had to delay several major projects, including new research into muscular dystrophy in children.
Also threatened are new initiatives sparked by public health crises such as mass shootings — which have generated calls for strengthening the nation's mental health system — and outbreaks of food-borne illness.
Compounding the challenges is a lack of direction from Washington. Obama administration health officials have provided little guidance about how they plan to implement many of the cutbacks and when precisely they will hit.
A Health and Human Services Department spokesman said only that the agency would be sending general notifications Friday to those who rely on federal money. More specific instructions will follow. The agency is expected to cut about $15.5 billion from its overall spending, with about two-thirds of that coming from Medicare, which covers the elderly and disabled.
Major medical groups, including the American Medical Assn., the American Hospital Assn. and the American Nurses Assn., have warned that the Medicare cuts will lead to lost jobs. The reimbursement cuts may be particularly difficult for providers with fewer privately insured patients.
http://www.latimes.com/health/la-na-healthcare-cuts-20130228,0,443972,print.story
Covered California's plan to partner with Wal-Mart is criticized
The state wants retail workers to help consumers enroll in healthcare expansion. Critics say Wal-Mart does not provide adequate health coverage and shouldn't be advising consumers on the matter.
By Chad Terhune, Los Angeles Times2:59 AM PST, March 7, 2013
California officials face mounting criticism from union leaders over plans to let retail giant Wal-Mart Stores Inc. enroll shoppers in President Obama's healthcare expansion.
The state wants employees at Wal-Mart and other retailers to help consumers learn about their options and assist them in buying federally subsidized private insurance. These plans are part of state efforts to implement the federal healthcare law and reach out to 5 million Californians eligible for new coverage starting in January.
Labor unions as well as some consumer advocates protest the idea of government officials partnering with Wal-Mart and paying for its help. They contend that the nation's largest retailer has no place advising others on health coverage when so many of its workers don't qualify for company benefits and end up in taxpayer-funded programs such as Medi-Cal.
"We are appalled and offended that the exchange would contemplate partnering with Wal-Mart and other retailers notorious for failing to provide health benefits to many of their workers and providing substandard benefits to the workers who do qualify," said James Araby, executive director of the United Food & Commercial Workers Union's Western States Council. "That is highly contradictory to the mission of the program."
Quiz: Test your healthcare knowledge
Wal-Mart defended its employee benefits and said they exceed what the retail industry generally offers. A spokesman for Wal-Mart said it supports the state's efforts, but it would be premature to discuss any partnerships.
http://www.latimes.com/business/la-fi-healthcare-walmart-20130307,0,5409783,print.story
LePage: Will issue bonds after hospital payback plan gets OK
By Eric Russell erussell@pressherald.com
Staff Writer
Staff Writer
AUBURN — Gov. Paul LePage said Friday that he would issue voter-approved bonds the minute lawmakers pass his proposal to pay back hospitals with future liquor revenue.
For several weeks, the governor has stressed the importance of passing a bill to repay the hospitals. His bill would put the state's liquor contract out to bid with the understanding that a portion of future proceeds would go to the state. The state would then borrow the money to pay the hospitals and pay off the bond with those future revenues.
LePage has vowed to veto every bill that comes before his desk until that happens, and didn't back away from that pledge on Friday.
"I don't like to go back on my word," he said.
Sen. John Cleveland, an Auburn Democrat, attended the event and said after LePage's remarks that both parties want to pay back the hospitals. But Cleveland said there is real concern that the governor's bill is unconstitutional.
"I spoke to the attorney general three days ago and asked 'Can we issue bonds to pay debt?' She said 'No,' " Cleveland said.
Lawmakers are scheduled to take up the governor's bill on Monday.
http://www.pressherald.com/politics/LePage-Will-issue-bonds-after-hospital-payback-plan-gets-OK.html
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