Polio’s Return After Near Eradication Prompts a Global Health Warning

By DONALD G. McNEIL Jr.MAY 5, 2014

Alarmed by the spread of polio to several fragile countries, the World Health Organization declared a global health emergency on Monday for only the second time since regulations permitting it to do so were adopted in 2007.

Just two years ago — after a 25-year campaign that vaccinated billions of children — the paralyzing virus was near eradication; now health officials say that goal could evaporate if swift action is not taken.

Pakistan, Syria and Cameroon have recently allowed the virus to spread — to Afghanistan, Iraq and Equatorial Guinea, respectively — and should take extraordinary measures to stop it, the health organization said.

“Things are going in the wrong direction and have to get back on track before something terrible happens,” said Gregory Hartl, a W.H.O. spokesman. “So we’re saying to the Pakistanis, the Syrians and the Cameroonians, ‘You’ve really got to get your acts together.’ ”

The declaration, which effectively imposes travel restrictions on the three countries, represented a newly aggressive stance by the health organization. In the past, it has often bent to pressure from member states demanding no consequences even as epidemics raged inside their borders and sometimes slipped over them.

“This is a fundamental shift in the program,” said Dr. Bruce Aylward, the organization’s chief of polio eradication. “This is the countries of the world signaling that they will no longer tolerate the spread of the virus from the countries that aren’t finished.”

The emergency was declared though the total number of known cases this year is still relatively small: 68 as of April 30, compared with 24 by that date last year.

What most alarmed experts, Mr. Hartl said, was that the virus was on the move during what is normally the low transmission season from January to April.

“What we don’t want is cases moving into places like the Central African Republic, South Sudan or the Ukraine,” said Rebecca M. Martin, director of global immunization for the Centers for Disease Control and Prevention, which has provided money and expertise to the eradication campaign since it began in 1988.

Fighting the virus normally includes several rounds of vaccination of all young children in a target country. But, in an unusual step, the agency also said that all residents of Pakistan, Syria and Cameroon, of all ages, should be vaccinated before traveling abroad, and that this restriction should be retained until one year after the last “exported case.”

http://www.nytimes.com/2014/05/06/health/world-health-organization-polio-health-emergency.html?hpw&rref=health&_r=0&assetType=nyt_now

Getting serious about a single payer system [Commentary]

By James F. Burdick

Updated May 1, 2014

A single payer system — where the government pays for health costs — is now recognized by many in the U.S. as the best solution for our health care problems. It was taken "off the table" in 2009 by Sen. Max Baucus, A Montana Democrat who reportedly received more money from the pharmaceutical and health insurance industries than any other Congressman. But now the flood of single payer advocacy cannot be turned off by vested business interests. It is time to progress from the stereotype of single payer to having a serious discussion about it.

Ironically, even after its recent success in covering millions more Americans, the problems with the Affordable Care Act serve to illuminate the advantages of single payer. The public, although confused by the divisive rhetoric around health care reform, is coming to realize that the complexity of the law and the pursuit of insurance company profits are major problems for the ACA. Back in 2009, a majority of Americans favored a single payer-like system. The country may now lose patience with the protracted process of ACA implementation, with Republicans yapping at its heels, until 2020 when the final provision closing the Medicare prescription drug doughnut hole fully kicks in.

The 30-page H.R. 676, the single payer bill of Rep. John Conyers Jr., a Michigan Democrat, shows how simple it is to cover everyone. It provides savings through quality care — including protection from harmful overuse and efficient, timely management of chronic disease — as well as savings through national monopsony buying power and freedom from insurance business profits.

But if this bill, regularly reintroduced since 2003, is now to be taken seriously, it needs improvement. Most importantly, the proposed federal board governing both payment and care decisions lacks clinical authority and is too politicized. Instead, doctors must be granted, and must accept, responsibility for a national, private, transparent, interprofessional and data-driven mechanism to define quality options for care choices. This will free us from the snarl of various quality guidelines and protect our patients from irrelevant insurance and government interference while providing authoritative relief from over-utilization. This key improvement in the bill is also needed because coverage decisions must be removed from states, as proven by their politicized Medicaid problems.

Most politicians and health policy experts with national reputations remain silent. Some may have too great a stake in the ACA to join in the single payer adventure right away. But the country did just pass this valuable law. Even recognizing the tight political maneuvering required, this attests that the political potential for major change to our health care system is there. Luminaries who have asserted the wisdom of single payer include political commentator Bill Maher, former U.S. Secretary of State Colin Powell, Nobel-prize winning economist Paul Krugman, Sen. Bernie Sanders of the Vermont Progressive Party and former U.S. Labor Secretary Robert Reich. With even conservative columnist Ross Douthat alluding to the unspeakable in the April 5th New York Times "(ahem, single payer)" and a number of states trying to establish it on their own, supporting single payer nationally no longer appears out of reach.

http://touch.baltimoresun.com/#section/-1/article/p2p-80073903/

Gilead Profit Triples, Hepatitis C Drug Revenue Reaches $2.3B

Published April 22, 2014

| Reuters

Gilead Sciences Inc (GILD), which ignited a fierce debate over prescription drug prices, said its new $1,000 hepatitis C pill generated quarterly sales of $2.27 billion, helping the company's quarterly net profit nearly triple.

The Foster City, California-based company on Tuesday reported net income for the quarter of $2.23 billion, or $1.33 a share, up from $722 million, or 43 cents a share, a year earlier.

After one-time items, Gilead said it earned $1.48 per share, which beat Wall Street estimates by some 50 cents a share.

"It's pretty remarkable that they can generate $2.3 billion in revenue (from hepatitis C drug Sovaldi) in the first 3 months on the market," said Sanford Bernstein analyst Geoffrey Porges. "People's numbers are going to go up dramatically for this year and next for Gilead."

The company's revenue doubled to $5 billion, beating by a wide margin the $3.98 billion average Wall Street analyst forecast, as compiled by Thomson Reuters I/B/E/S.

Gilead's decision to price its Sovaldi hepatitis C drug, which was approved by U.S. regulators in December, at $84,000 for a 12-week course of therapy has rankled lawmakers and insurers, spurring an outcry over the rising costs of specialty medicines.

The company continued to exclude sales of Sovaldi and other hepatitis C drugs from its forecast for 2014 product sales, which it still expects to total between $11.3 billion and $11.5 billion.

Gilead, the world's largest maker of branded HIV drugs, said overall sales of antiviral drugs rose to $4.51 billion in the quarter from $2.06 billion a year earlier.

UnitedHealth Group Inc, the largest U.S. health insurer, said last week that its first quarter costs to cover Sovaldi were much higher than expected, but it anticipated spending would moderate after the first big wave of patients are treated with the drug.

http://www.foxbusiness.com/industries/2014/04/22/gilead-profit-triples-hepatitis-c-drug-revenue-reaches-23b/print

A New Benefit for Heart Failure Patients

By PAULA SPAN

MAY 2, 2014, 5:17 PM

The number of older heart failure patients who qualify to enter a cardiac rehabilitation program paid for by Medicare has just been vastly expanded. About two million people are newly eligible, Medicare officials estimate.

But will they take advantage of it?

Medical and advocacy groups have been pushing for this change for years. Cardiac rehab, supervised by a physician, involves a monitored exercise program, usually done on a circuit of machines three times a week, in addition to instruction and counseling that help patients stop smoking, eat healthily and manage stress.

Originally, Medicare paid for 36 rehab sessions for people who’d had a heart attack, bypass surgery or “stable angina” — episodes of chest discomfort that develop with exertion. More recently, Medicare extended cardiac rehab coverage to those who have undergone procedures like heart valve replacement, stenting or transplants.

But that still left a whole lot of people who didn’t fit those criteria. Some 17 percent of Medicare beneficiaries over age 65 had chronic heart failure in 2012, the Centers for Medicare and Medicaid Services reports. Until now, they would have had to pay for cardiac rehab out of pocket.

To professionals in the field, the benefits of cardiac rehab in improving stamina, treating depression and lowering the risk of future cardiovascular problems were clear.

People with heart failure often struggle to climb a flight of stairs or walk half a block. “The heart failure patient has typically slowed down, is fatigued, has poor endurance,” said David Prince, director of cardiac rehabilitation at Montefiore Medical Center in New York. “This is someone who has learned to live with a lot of limitations.”

A few decades ago, doctors advised such patients to rest. Now, of course, exercise has become the nearly universal prescription for everything, including heart failure. “When you deliver appropriate exercise, you correct some of the muscular weakness and chemical imbalance,” Dr. Prince said. “People feel better. They sleep better. They show significant improvement in quality of life.”

http://newoldage.blogs.nytimes.com/2014/05/02/a-new-benefit-for-heart-failure-patients/?src=rechp

Inventing a Failure

MAY 4, 2014

Last week, House Republicans released a deliberately misleading report on the status of health reform, crudely rigging the numbers to sustain the illusion of failure in the face of unexpected success. Are you shocked?

You aren’t, but you should be. Mainstream politicians didn’t always try to advance their agenda through lies, damned lies and — in this case — bogus statistics. And the fact that this has become standard operating procedure for a major party bodes ill for America’s future.

About that report: The really big policy news of 2014, at least so far, is the spectacular recovery of the Affordable Care Act from its stumbling start, thanks to an extraordinary late surge that took enrollment beyond early projections. The age mix of enrollees has improved; insurance companies are broadly satisfied with the risk pool. Multiple independent surveys confirm that the percentage of Americans without health insurance has already declined substantially, and there’s every reason to believe that over the next two years the act will meet its overall goals, except in states that refuse to expand Medicaid.

This is a problem for Republicans, who have bet the ranch on the proposition that health reform is an unfixable failure. “Nobody can make Obamacare work,” declared Eric Cantor, the House majority leader, a couple of weeks ago (when it was already obvious that it was working pretty well). How can they respond to good news?

Well, they could graciously admit that they were wrong, and offer constructive suggestions about how to make the law work even better. Oh, sorry — I forgot that I wasn’t writing jokes for the White House Correspondents’ Dinner.

http://www.nytimes.com/2014/05/05/opinion/krugman-inventing-a-failure.html?hp&rref=opinion&_r=0&assetType=nyt_now

Health Insurance CEO Pay Skyrockets in 2013

Some See Their Compensation Double

Chief executive officers at Fortune 500 health insurance companies, who have opposed new regulations under the Affordable Care Act, emerged this month as one of the ACA’s greatest beneficiaries. Recently filed financial reports show that average compensation for these top nine health insurance CEOs rose by more than 19 percent in 2013, while several of the nation’s largest insurers more than doubled CEO pay.

The biggest winner was Aetna CEO Mark Bertolini, who received a staggering $30.7 million compensation package in 2013. This marks the largest payout to any health insurance executive since passage of the ACA and exceeded the compensation of the next two highest paid health insurer CEOs combined. The Bertolini pay package, which included a large “special one-time performance-based retention award,” represented a 131 percent increase over his $13.3 million compensation in 2012.

Molina Healthcare and Centene, both Fortune 500 insurers that specialize in privately managed Medicaid plans, roughly doubled CEO compensation in 2013. J. Mario Molina received $11.9 million, up from $5 million in 2012, while Centene’s CEO Michael Neidorff made $14.5 million, up from $8.5 million. Overall, average CEO pay across Fortune 500 health insurers rose from $11.6 million in 2012 to $13.9 million in 2013.

http://www.healthcare-now.org/health-insurance-ceo-pay-skyrockets-in-2013

After a Heart Attack, Eat Your Fiber

By NICHOLAS BAKALAR

MAY 5, 2014,

It is never too late to increase your consumption of dietary fiber, a new study suggests.

It is well known that fiber reduces the risk of cardiovascular disease. Now a study published in BMJ has found that it also decreases the risk of death after surviving a heart attack.

Researchers analyzed pre- and post-heart attack dietary and medical information on 4,098 people. In a nine-year follow-up, there were 1,133 deaths — 558 from cardiovascular disease.

After adjusting for age, medication use, smoking and other factors, they found that after a first heart attack, those who increased their fiber intake the most had a 31 percent lower risk of dying from any cause, and a 35 percent lower risk of cardiovascular death, than those who increased their intake the least. Only cereal fiber, not fiber from fruits or vegetables, was associated with the lowered risk.

The researchers were unable to control for how reliably people took their medicines.

http://well.blogs.nytimes.com/2014/05/05/after-a-heart-attack-eat-your-fiber/?_php=true&_type=blogs&emc=edit_tnt_20140505&nlid=1311158&tntemail0=y&_r=0

A New Women’s Issue: Statins

By RONI CARYN RABIN

MAY 5, 2014,

Should so many women be taking statins?

Medical guidelines issued late last year may double the number of Americans who are told to take these cholesterol-lowering drugs. But the recommendations don’t distinguish patients by gender, and a small, increasingly vocal group of cardiologists believe that’s a mistake.

Far too many healthy women are taking statins, they say, though some research indicates the drugs will do them little good and may be more likely to cause serious side effects in women.

“If you’re going to tell a healthy person to take a medicine every day for the rest of their life, you should have really good data that it’s going to make them better off,” said Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, and the editor of JAMA Internal Medicine. Lowering cholesterol should not be not an end in itself, she added, and cholesterol may not play the same role in heart disease in women as in men. “You can have high cholesterol and still be really healthy and have a low risk of heart disease,” she said.

Although women represent slightly more than half of the population, they have been vastly underrepresented in clinical trials of statins. As a result, evidence on the benefits and risks for women is limited.

Women tend to develop heart disease about 10 years later in life on average than men; women’s risk begins to equal that of men when they reach their mid-70s.

Studies have found that healthy women who took statins to prevent cardiovascular disease did experience fewer episodes ofchest pain and had fewer treatments like stents and bypass surgery. But statins didn’t prevent healthy women from having their first heart attacks and didn’t save lives.

http://well.blogs.nytimes.com/2014/05/05/a-new-womens-issue-statins/?emc=edit_tnt_20140505&nlid=1311158&tntemail0=y

Universal Mammogram Screening Shows We Don’t Understand Risk

MAY 6, 2014

In an effort to reduce childhood injuries, the American Academy of Pediatrics issued a policy statement in 2001 recommending that all kids younger than 2 sit in safety seats in airplanes as they do in cars.

The change meant that families traveling with small children would no longer be able to have them sit on an adult’s lap. Instead, parents would need to buy an extra ticket. But the added expense of purchasing a seat for small children would be prohibitive for some traveling families. They might choose to drive instead, which is a real problem, because driving is far more unsafe than flying.

It turned out that if just 5 percent of families chose to make an additional 400-mile road trip because of this policy, then the number of children killed each year would increase. The policy would also be enormously expensive.

Try relating this story to people, and you quickly learn that instinct often trumps data. They just know, deep in their hearts, that flying is scary and dangerous. They just believe that driving is safer. Convincing them otherwise is nearly impossible.

http://www.nytimes.com/2014/05/07/upshot/universal-mammogram-screening-shows-we-dont-understand-risk.html?hpw&rref=&_r=0

By Liz Kowalczyk and Michael Levenson

Massachusetts plans to scrap the state’s dysfunctional online health insurance website, after deciding it would be too expensive and time-consuming to fix, and replace it with a system used by several other states to enroll residents in plans.

Simultaneously, the state is preparing to temporarily join the federal HealthCare.gov insurance marketplace in case the replacement system is not ready by the fall.

The strategy announced Monday will still cost an estimated $100 million, and it creates many uncertainties, especially for insurance companies and consumers. Some customers might eventually need to change insurance plans.

As late as March, the state had considered rebuilding the balky Health Connector site, which has left thousands of consumers frustrated and many without coverage for months. But Sarah Iselin, the insurance executive whom Governor Deval Patrick tapped to oversee repairs to the site, said that approach turned out to be far too risky.

The state’s online insurance system must be ready by Nov. 15 for consumers to enroll in new health plans for 2015, and Massachusetts is one of several states under pressure from the Obama administration to make sure it meets the deadline.

“The responsible and prudent thing to do was to have another plan,’’ Iselin said in an interview. “Unlike other IT projects where the deadlines are self-imposed, we have a law. It’s not flexible.’’

Iselin said that adopting the new software, called hCentive, and preparing to connect to the federal website simultaneously will cost about $100 million through 2015. That is about 30 percent less than the estimated expense of rebuilding the existing site, she said. But it is unclear how much money the federal government will contribute and how much will fall to Massachusetts taxpayers.

http://www.bostonglobe.com/lifestyle/health-wellness/2014/05/05/mass-scrapping-flawed-health-insurance-website-saying-too-broken-fix/oVT1f1X9hE4jaNOfF5XaiP/story.html?s_campaign=email_BG_TodaysHeadline

Massachusetts Starts Over on Health Website After Troubles

By ABBY GOODNOUGHMAY 5, 2014

WASHINGTON — Massachusetts will stop trying to fix its deeply flawedhealth insurance website and instead buy new software to help its residents enroll in coverage, officials there said Monday. But the state will also prepare to join the federal insurance marketplace by the next enrollment period, which starts in November, in case the new system is not working in time.

The decision follows months of problems with enrollment through the state website, which Massachusetts set up in 2006 under its landmark health insurance law. The site worked well until it was revamped last year to comply with the Affordable Care Act, President Obama’s health care law. The state had put CGI, the company that also helped design the initially problem-plagued federal exchange, in charge of the overhaul.

Massachusetts announced in March that it was dropping CGI, but it is still negotiating the terms of ending its $69 million contract, of which the state has paid $17 million. The state received $174 million from the federal government to overhaul its health insurance website and has spent about $57 million so far, including the amount paid to CGI, according to Glen Shor, the state’s secretary of administration and finance.

Sarah Iselin, a health insurance executive whom Gov. Deval Patrick appointed to oversee fixes to the website, said the new “dual-track” plan would cost a little more than $100 million through 2015. But she said it was too soon to know whether the state would seek more federal money; that will depend partly on whether the state ends up owing CGI more money.

http://www.nytimes.com/2014/05/06/us/massachusetts-starts-over-on-health-website-after-troubles.html?hpw&rref=us

Health reform’s problems run deeper than a glitchy website

By Dr. Philip Caper, Special to the BDN

Posted Nov. 14, 2013, at 11:49 a.m.

Serious problems with the websites created by the Affordable Care Act continue, and probably will for a long time. Although frantic efforts at incrementally improving them are being made by the Obama administration, and some sites are working better than others, they are a long way from working well.

As I’ve written before, the causes of the website’s problems are far more serious than poor software design. They are baked into the law by its extreme complexity.

There is growing frustration and anger at the administration in Congress from both Democrats and Republicans. Much of it is being expressed by the same people whose hypocrisy and obstructionism is responsible for a failure to do the right thing in the first place. Calls from members of Congress to delay the ACA’s implementation or to repeal it entirely will intensify.

Instead of expanding our existing Medicare program, which has been working well for almost 50 years and is our country’s most efficient and least intrusive health care financing program, the ACA creates complex new law that perpetuates and reinforces the chaos and confusion of our hodgepodge of public and private insurance programs. Coverage and financial assistance continue to depend on an individual’s employment status, income, place of residence, age, conjectures about future health status, and many other factors, some of them subject to change with little or no warning and many impossible to predict.

Smooth implementation of the ACA depends upon the ability of many parts of government and thousands of insurance companies to seamlessly communicate with one another and agree on data drawn from myriad different public and private sources. Some in the health insurance field believe such a task will be difficult or impossible to achieve.

We have to ask ourselves, who are the winners from requiring us to go through the expense and confusion inherent in trying to implement a law of over 2,000 pages? The answer is clear. It’s a health insurance industry that profits from complexity and confusion, and providers of pharmaceuticals, medical supplies, devices and services who benefit excessively from the very weak cost controls inherent in our fragmented system of paying for services.

http://bangordailynews.com/2013/11/14/health/health-reforms-problems-run-deeper-than-a-glitchy-website/print/

By Deborah Kotz

| GLOBE STAFF MAY 05, 201

The groundbreaking Massachusetts health insurance law may have prevented about 320 deaths a year, according to a Harvard study of the legislation that was used as a model for President Obama’s national health program.

The researchers from the Harvard School of Public Health, in a study published Monday, estimated that the law, which expanded coverage to most residents, has saved about one life for every 830 people who enrolled in health insurance.

“This is a strong and credible finding,” said Austin Frakt, a health economist at Boston University School of Medicine who wrote an editorial that accompanied the study. “I think there’s enough evidence at this point to conclude that health insurance does improve health and mortality.”

During the four years after Massachusetts implemented the 2006 law, death rates in the state dropped by nearly 3 percent among young and middle-age adults compared with similar populations in states that did not expand coverage, the researchers concluded.

Some health policy specialists were dubious about attributing the decline in deaths to the law. “I am skeptical that such an immediate and significant drop in mortality would occur after getting health insurance,” said Dr. Scott W. Atlas, a senior fellow at Stanford University’s Hoover Institution.

Previous studies investigating whether health insurance led to fewer deaths have yielded mixed results. Researchers have observed that increasing Medicaid coverage to low-income people in certain states led to a drop in death rates, but an ongoing study of Oregon residents who were randomly assigned to get health coverage or not has found no difference in death rates. Facing a funding shortfall, Oregon in 2008 picked people by lottery for its Medicaid program, creating the unusual opportunity to conduct a randomized study of health insurance — which is the gold standard of health research.

http://www.bostonglobe.com/lifestyle/health-wellness/2014/05/05/death-rate-drops-massachusetts-after-state-health-law-implemented-study-suggests/8JELx4L1MgWMN4yauxpnyM/story.html

Medicaid expansion is the final battle in war over Obamacare

Michael Hiltzik

COLUMNIST THE ECONOMY HUB

The final battles of any war often are the bloodiest. They're waged by the last holdouts, dead-enders desperate to prove to themselves and their dwindling followers that their efforts were not in vain.

The final battle of the war over the Affordable Care Act is being waged today over expanding Medicaid. As the act was originally conceived, Medicaid would provide healthcare for more than 10 million of the poorest uninsured Americans, most of them childless adults with earnings up to 138% of the federal poverty level. (This year, that income ceiling is about $16,000.)

Then the Supreme Court ruled in 2012 that Congress couldn't impose the expansion on state governments, but had to make it voluntary. Republican legislators and governors in 28 states turned the expansion down. A handful later reversed themselves. These include four that, with federal permission, are temporarily trying out novel Medicaid formats.

The refusal of more than half the states to cover so many of their neediest citizens — the number who have fallen into the "coverage gap" is estimated at 5 million — amazes and frustrates health experts. That's especially so because the federal government covers 100% of the cost of expansion through 2016. After that, the federal share will slowly decline to 90% in 2020 and beyond.

The holdout states are "willing to sacrifice billions of dollars of injections into their economy in order to punish poor people," observed Jonathan Gruber, a health economist at MIT who helped design the health insurance reform in Massachusetts on which the ACA was modeled. Speaking in a recent online video chat with health economist Harold Pollack, Gruber added: "It really is just almost awesome in its evilness."

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-20140504-column.html#page=1

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