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Monday, December 22, 2014

Health Care Reform Articles - December 22, 2014

Editor's Note:

I'm including the following article by the Boston Globe's James Carroll not because it's about healthcare, but because it raises a question that has been of concern to me for some time - what is the moral framework of a majority of Americans?

Just (as Carroll points out) many Americans, maybe a majority believe the CIA's illegal, immoral and shameful tactics were justified by the times, many Americans seem willing to tolerate or actually support our unfair, unjust, and money-driven health care system.

As Carroll asks, is this really who we are or, more importantly, who we want to be?

Good question.

I urge you to click on the hotlink and read Carroll's full essay.

- SPC

CIA’s poisonous legacy starts with who we are


SENATOR JOHN McCain spoke the truth on the Senate floor this month, in response to the release of the Senate Intelligence Committee Report on Torture: “. . . this question isn’t about our enemies; it’s about us. It’s about who we were, who we are, and who we aspire to be.” Many voices insisted that the revelations contained in the report — savage, even murderous treatment of prisoners; illegal renditions; black sites — were not true to the American character. The CIA — having carried out torture; having lied about it at the time; and having lied about it this month in response to the report — was discussed as if it were “not who we are.” But is that true?
American officials, and the American people, know very well what the CIA is, and what it does. It was McCain who, when CIA waterboarding of terror suspects first surfaced as an issue some years ago, recalled that, after World War II, Japanese waterboarding of POW’s — what McCain calls “mock execution” — was one of the war crimes for which Japanese prisoners were hanged. But on the Sunday talk shows after the Senate report’s release, various CIA defenders, includingDick Cheney, talked of such tactics with stoic pride. President Obama decried torture and swore never again, but simultaneously defended the honor of the CIA, and declined to prosecute its war criminals. It comes as no surprise then, that in an NBC/Wall Street Journal poll released last week, a majority of Americans found that “the harsh interrogation practices” laid out in the report were “acceptable under the circumstances.” Really?
There is always something surreal about these periodic reckonings — we are “shocked, shocked, shocked!” — with the blatantly criminal activities of the agency’s not-so-covert operations. The lost decade of the American war in Iraq, with all of its attendant and ongoing blood, anguish, and destruction, was sparked by the CIA’s big lie — director George Tenant’s “slam dunk” that Saddam Hussein had weapons of mass destruction. No intelligence failure, that was a pure act of willful self-deception, designed to further the CIA’s own off-the-books mayhem, which enhances the agency’s budget and power.
Because of paranoia in post-9/11 America, half a trillion dollars have been spent on a myriad of intelligence operations, involving 16 distinct agencies with more than a hundred thousand employees. And for what? Last spring, so-called intelligence briefings underwrote President Obama’s wildly mistaken dismissal of the Islamic State as the junior varsity. With the CIA there’s one sure bet: that it will miss what truly threatens.

Vermont bails on single-payer health care

By Sarah Wheaton
Politico, December 17, 2014
Vermont Gov. Peter Shumlin on Wednesday dropped his plan to enact a single-payer health care system in his state — a plan that had won praise from liberals but never really got much past the framework stage.
“This is not the right time” for enacting single payer, Shumlin said in a statement, citing the big tax increases that would be required to pay for it.
Shumlin faced deep skepticism that lawmakers could agree on a way to pay for his ambitious goal and that the feds would agree to everything he needed to create the first state-based single-payer system in 2017.
And that was all before Shumlin, a Democrat, almost lost reelection last month in one of the country’s most liberal states. And it was before MIT economist Jonathan Gruber, the now notorious Obamacare consultant who also advised Vermont until his $400,000 contract was killed amid the controversy, became political poison.
Shumlin had missed two earlier financing deadlines but finally released his proposal. But he immediately cast it as “detrimental to Vermonters.” The model called for businesses to take on a double-digit payroll tax, while individuals would face up to a 9.5 percent premium assessment. Big businesses, in particular, didn’t want to pay for Shumlin’s plan while maintaining their own employee health plans.
“These are simply not tax rates that I can responsibly support or urge the Legislature to pass,” the governor said. “In my judgment, the potential economic disruption and risks would be too great to small businesses, working families and the state’s economy.”
And that was for a plan that would not be truly single payer. Large companies with self-insured plans regulated by ERISA would have been exempt. And Medicare also would have operated separately, unless the state got a waiver, which was a long shot.
Shumlin added that federal funds available for the transition were $150 million less than expected.
He also has a lot less political capital than before November. Shumlin, chairman of the Democratic Governors Association, still hasn’t even officially won his own reelection bid: The Legislature will settle the outcome of the November race in January because Shumlin failed to win more than 50 percent of the vote. He’s leading his Republican challenger by just a few thousand ballots.
And the substance of the plan isn’t its only politically problematic aspect. Gruber, now infamous for his blunt assessments of the Affordable Care Act and his remarks about “stupid” voters, was until recently a state consultant. Days after the election, video emerged of him dismissing criticism of Vermont’s plan in 2011 by asking, “Was this written by my adolescent children, by any chance?” State officials said they would cut off his contract.
Advocates of a single-payer plan said Shumlin should not be able to cast aside Act 48, the 2011 law that called for the creation of Green Mountain Care, without repealing it. A group planned to hold a rally in front of the statehouse on Thursday to protest his decision.
“The governor’s misguided decision was a completely unnecessary result of a failed policy calculation that he pursued without democratic input,” the group Healthcare Is a Human Right Campaign said in a statement.

Vermont's Governor Sadly Has It Wrong. Now IS the Time for Single-Payer Everywhere

by
Andy Coate

On Wednesday, Vermont’s governor, after campaigning for single payer for years, announced that he would not work to pass single-payer legislation in Vermont this year.
“Single payer” is shorthand for a reform that will replace the present wasteful and chaotic system of private health insurance, Medicare, Medicaid and out-of-pocket cash payments with a single public finance system that will redirect resources in order to guarantee access to all necessary care for everyone, which would include many essentials not covered by any present plan.
Governor Peter Shumlin, in his press conference, stated that “now is not the right time” for single payer.
I disagree.
The time for a single-payer system is now. Our patients in every state urgently need it.
Indeed, the people of Vermont, including the state’s physicians, nurses and other caregiving professionals, have repeatedly affirmed their support for single-payer reform.
Vermonters throughout the state understand that an equitable health care system must be truly universal and must remove all financial barriers to medically necessary care. They recognize that a public single payer is an essential incremental step toward these goals.
The people of Vermont have said health care should be regarded as a public good, much like fire protection, and not as a commodity you buy on the market. Gov. Shumlin was elected to office in considerable part because of his championing of this view.
Single-payer activists in Vermont have pointed out that by eliminating the unnecessary and wasteful role of private insurance companies – middlemen who put their profits above the interests of our patients — resources will be liberated to improve the health of all.
Dr. William Hsiao, the Harvard health economist who Gov. Shumlin recruited to study the impact of single payer in Vermont, estimated that a single-payer-like reform (not a true single payer, since there would still be multiple plans, including private plans) would achieve an overall savings of over 25 percent on health care spending (10 percent delivery system savings, 8.5 percent overhead savings, 5 percent reduction in fraud and 2 percent saved through lower malpractice costs.)
Gov. Shumlin stated that the costs of his proposed reform would be too great, saying, “The taxes required to replace health care premiums with a publicly financed plan that would best serve Vermont are, in a word, enormous.” (The governor’s finance proposal would have instituted an 11.5 payroll tax on employers and a progressive income tax of zero to 9.5 percent, depending on income.) The governor did not dwell upon the fact that the taxes he cited would be less, on average, than the exorbitant and burdensome premiums and out-of-pocket costs that presently weigh heavily upon households as well as employers.

PROTESTERS DEMAND ACTION ON SINGLE PAYER, CONDEMN SHUMLIN’S REVERSAL

Protesters from across the state descended on Montpelier Thursday to voice their anger with Gov. Peter Shumlin’s decision to drop his pursuit of single payer health care.
More than 60 people stood in front of the Statehouse chanting slogans and singing protest songs.
“All people, all care, make the rich pay their share,” they shouted, “The system, let’s stop it, our health is not for profit.” And: “Down with Shumlin, up with the people.”
Many shared personal stories of struggles to afford health insurance or medical services, highlighting barriers to care such as high deductibles, copayments and other forms of cost sharing.
Several burned medical bills they said they would never be able to pay off.
Among those was Cindy Taylor, 48, of Bennington, who burned $3,000 in bills from two separate emergency room visits for her daughter that were close to eight years old, she said.
Taylor has had trouble staying covered, and when she is able to enroll in Medicaid for periods of time, it’s difficult to find doctors and dentists willing to accept her as a patient, she said.
Her daughter, now 24, had to drop out of college because of medical debt and is currently uninsured because she can’t afford the premiums on the Vermont Health Connect exchange, Taylor said.
Protesters focused their ire on Shumlin. The governor acknowledged the disappointment of his supporters in remarks Wednesday, but said the economics of single payer wouldn’t allow the program to move forward anytime soon. He called it “the biggest disappointment of my public service so far.”

SHUMLIN'S DECISION TO SCRAP SINGLE PAYER A BETRAYAL OF VERMONT'S WORKING FAMILIES

      Governor Peter Shumlin abandoned single payer healthcare yesterday right when political leadership was needed most to push Vermont and the country forward. He broke five years of campaign promises to Vermonters that he would not rest until we had single payer healthcare. Yet when things got tough and politically challenging, he gave up and walked away.
      The Vermont Progressive Party did not run Progressive challengers against Governor Shumlin in the last three cycles, in large part because of his unwavering promise to lead on single payer. While we are outraged by Shumlin’s broken promises, we are not terribly surprised. Progressives have long raised the same challenges Shumlin is now using as his excuses for why we can't move ahead on single payer. We have long pushed for discussions about how we can equitably fund our new system, and live up to our promise of healthcare as a human right. But rather than work through these issues or scale back the project, Shumlin decided to scrap it entirely (and with it, many Vermonters' hopes of a just and accessible healthcare system).
      Governor Shumlin only seems concerned about the projected future economic burden to businesses, not the burden that working people are bearing right now. There are significant and meaningful steps Vermont can take as we transition to a fully publicly financed health system-- a system that doesn't punish working families who can't afford the high costs of health insurance premiums. We can't be afraid to examine ways to fund a more fair, more efficient, universal system of healthcare delivery (like they have in virtually every other country in the industrialized world). Vermont needs leaders who aren't afraid of having these tough conversations, who aren't too scared to stand up for what's right. We owe that to the people of our state. Anything less is a betrayal of all Vermont's working families who struggle with the costs of healthcare every day.  
      Vermont Progressives have built the strongest third political party in the country over the last 30 years, largely due to our unwavering commitment to reforming healthcare and economic justice. Our current elected legislators remain committed to finding a path forward. We are not backing down, despite this crisis of leadership. Vermont has a proud history of being out in front, despite the risks of opposing interest groups. We should stick with the Vermont tradition of having a difficult but honest discussion with our citizens. 

THE NEW YORK TIMES/CBS NEWS POLL ON HEALTH CARE COSTS

THE NEW YORK TIMES/CBS NEWS POLL FOUND THAT AFFORDING MEDICAL CARE IS A HARDSHIP FOR MORE AMERICANS THAN A YEAR AGO. 

 

Home | AMR Review

Responding to mounting international concern about the rise of drug-resistant infections, the UK Prime Minister, The Rt Hon David Cameron MP, commissioned Jim O’Neill in July 2014 to chair this review on antimicrobial resistance. By the summer of 2016, the Review will recommend a package of actions that we think should be agreed internationally to tackle this growing threat. The Review operates independently of the UK Government and the Wellcome Trust who are co-funding and hosting us at their headquarters in London. 
"If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine" – Rt Hon David Cameron MP
Antimicrobial resistance (AMR) is a global and complex issue which cannot be solved by any one country acting in isolation. We approach our goals with a blank sheet of paper and open minds. We want to hear from innovative minds across all countries and disciplines. In developing our recommendations, we will consider the economic priorities of all parts of the world inclusively and consult with a range of interested organisations and governments.

Hepatitis C Treatment Wins Approval, but Price Relief May Be Limited

By 

A new treatment for hepatitis C developed by AbbViewon approval from the Food and Drug Administration on Friday, setting the stage for a marketing battle with Gilead Sciences, whose two new drugs for the disease have drawn an outcry about the high cost of medicines.
Insurers and state Medicaid programs have been eagerly awaiting the approval of the AbbVie regimen, which is called Viekira Pak, hoping that competition will drive down prices.
But price competition might be limited.
AbbVie said the wholesale price of Viekira Pak would be $83,319 for a typical 12-week course of therapy. That is less than the $94,500 for 12 weeks of Gilead’s Harvoni, but probably not enough of a discount to allay complaints about high prices. 
The price is “higher than we had hoped,” said David Lassen, chief clinical officer of Prime Therapeutics, a pharmacy benefit manager owned by Blue Cross and Blue Shield plans.
Moreover, the comparison is somewhat complicated because some patients may need only eight weeks of treatment with Harvoni, lowering the average cost for that drug. And some patients on either drug may need 24 weeks of treatment. 
Morry Smulevitz, a spokesman for AbbVie, said the price for Viekira reflected both market dynamics and the value the drug brings to the health care system. 
AbbVie’s regimen is a combination of four different drugs that work by three different mechanisms to disable the virus. One of the drugs was jointly developed with Enanta Pharmaceuticals.
In studies, Viekira has been shown to be about as effective as Harvoni, curing 90 percent of patients or more who are infected with the most common subtype of the virus, known as Genotype 1. As with Harvoni, side effects are generally mild or moderate.
“The new generation of therapeutics for hepatic C virus is changing the treatment paradigm for Americans living with the disease,” Dr. Edward Cox, who oversees antimicrobial products for the F.D.A., said in a statement.
Harvoni has an advantage in that it is a single pill taken once a day, which is one reason that many analysts think Gilead will retain most of the market.

Six Maine hospitals face penalties for rates of infections, complications

By Jackie Farwell, BDN Staff
Posted Dec. 19, 2014, at 3:56 p.m.
The federal government is cracking down on half a dozen Maine hospitals for high rates of complications and infections.
The six Maine facilities are among 721 hospitals nationally with high rates of infections and other patient injuries that will see their payments cut under the federal Medicare program, according to an analysis by Kaiser Health News. The crackdown is the government’s toughest effort to date aimed at reducing avoidable medical errors.
Medicare will cut payments to the hospitals by 1 percent over the fiscal year that began Oct. 1 and ends in September 2015. The federal Centers for Medicare and Medicaid Services in June released a preliminary list of hospitals likely to face penalties, followed by a confirmed list on Thursday.
In Maine, some of the state’s largest hospitals face lowered payments. The six penalized hospitals are Maine Medical Center in Portland, Eastern Maine Medical Center in Bangor, MaineGeneral Medical Center in Augusta, St. Mary’s Regional Medical Center in Lewiston, Inland Hospital in Waterville and The Aroostook Medical Center in Presque Isle.
The penalties, estimated to total $373 million nationally, will hit academic medical centers particularly hard, with about half punished, Kaiser found. Hospitals that treat a high volume of low-income patients also are more likely to be assessed penalties, as are large hospitals and those located in cities.
The federal government looked at eight avoidable patient injuries — including blood clots, bed sores, accidental falls after surgery and collapsed lung — that result from medical treatment. It also examined urinary tract infections from catheters and bloodstream infections in patients who had central lines, or catheters, placed in major veins. Medicare assigned each hospital a score on a scale of 1 to 10. Hospitals in the top quarter — with a total score above 7 — face penalties.
About 1,400 hospitals are exempt from penalties, including small “critical access hospitals” located in rural areas. Of Maine’s 38 hospitals, 16 are critical access facilities.
Preventing infections and mistakes has become a top priority for hospitals. Preventable hospital errors are the third-leading cause of death in the U.S., claiming the lives of up to 440,000 patients per year, according to a landmark September 2013 study published in the Journal of Patient Safety. But hospitals are making progress, with a recent federal report showing about 50,000 people are alive today because hospitals committed 17 percent fewer medical errors in 2013 than in 2010.
Hospital officials argue that facilities treating the sickest patients and those that identify infections properly may score worse.
St. Mary’s recorded three urinary tract infections from catheters and three central-line bloodstream infections over the review period, an unusually high number, according to Betsey Shew, director of performance improvement and case management. So far this year, the hospital has reported none of those infections, she said.
“Some of those were just incredibly sick patients,” Shew said.
St. Mary’s reviewed its numbers in June after learning the hospital made the preliminary list of penalized facilities, she said. Some patient results were improperly categorized as hospital-acquired complications, possibly because medical coders misinterpreted physicians’ documentation of surgeries and other procedures, she said. The hospital now double checks the data.
The Medicare penalty will cost St. Mary’s an estimated $100,000, Shew said.
Dr. Robert Thompson, senior vice president and chief medical officer for Eastern Maine Healthcare Systems — the parent organization to EMMC, Inland and The Aroostook Medical Center — said Medicare based the penalties on dated information, with some of it reported in 2011.
“These ratings do not reflect our present performance, and incidences of infection and injury at EMHS have declined since this data was initially released last spring,” he said in a statement. “EMHS takes all potential harm seriously. We are continually seeking to improve through partnership with our doctors, nurses, health care workers, and our patients and families across our region.”
MaineGeneral also cited dated information, saying the serious complications data was collected well before the hospital consolidated inpatient services at the new Alfond Center for Health in November 2013. Private rooms at the new hospital help to limit infections, and the consolidation allowed MaineGeneral to streamline processes, significantly reducing urinary tract infections from catheters, according to spokeswoman Joy Leach.
“Patient health and safety is the number one goal at MaineGeneral,” she said. “Quality improvement is something we strive for at every level.”
Maine Medical Center reduced central-line infections by 50 percent compared with last year by following safety steps supported by medical evidence, such as daily antiseptic baths for patients and regular dressing changes, said Dr. Josh Cutler, vice president of quality and safety.
“We’re disappointed that we don’t measure up better in this report, but I think that we have known and we do know why that is and put a lot of effort into these areas of concern,” he said.


Report: Maine among states unprepared for disease outbreaks

By Tony Pugh, McClatchy Washington Bureau (TNS)
Posted Dec. 19, 2014, at 12:12 p.m.
WASHINGTON — Most states are not prepared to handle outbreaks of severe infectious diseases, according to a new report by the Trust for America’s Health and the Robert Wood Johnson Foundation.
“Outbreaks: Protecting Americans from Infectious Diseases” found that half the states, including Maine, and the District of Columbia scored five or lower out of a possible 10 on measures related to the prevention, diagnosis, detection and response to disease outbreaks.
Maryland, Massachusetts, Tennessee, Vermont and Virginia led all states, each scoring eight out of 10.
California, Delaware, Nebraska, New Hampshire, North Dakota, Pennsylvania and Wisconsin were next, scoring seven out of 10.
Arkansas had the nation’s lowest score with two, followed by Idaho, Kansas, Kentucky, Louisiana, New Jersey, Ohio and Wyoming, which each scored a three.
The recent Ebola cases in Dallas were a reminder “we cannot afford to let our guard down” in preparing for major outbreaks, said Jeffrey Levi, executive director of the trust, a nonprofit health advocacy organization dedicated to disease prevention.
“Over the last decade, we have seen dramatic improvements in state and local capacity to respond to outbreaks and emergencies,” Levi said. “But we also saw during the recent Ebola outbreak that some of the most basic infectious disease control policies failed when tested.”
Maine scored four out of 10 on key indicators related to responding to disease outbreaks. The state has planned for the impact of climate change on human health, performed drills to handle emerging threats at its public health lab, tracked key HIV/AIDS data and promptly tested cases of E. coli, according to the report. But Maine fell short on the six other measures.
The report found that a majority of adults, 35 percent of seniors and more than 2 million preschoolers didn’t have all their recommended vaccinations. Only 14 states vaccinated 50 percent of their residents against the flu last year.
Only 16 states performed better than the national average for health care-related bloodstream infections, and only 10 cut the number of these infections between 2011 and 2012.
The report concluded it was time to modernize the nation’s health system to deal with current and emerging disease threats. This requires shoring up a number of core functions, such as investigative and training resources, containment and risk communication strategies and supplies of vaccines and medicines.
It also recommended integrating the operation of hospitals and public health agencies and improving federal, state and local leadership.


Ebola Should Be Easy to Treat

By 
FREETOWN, Sierra Leone — NOT even 30 minutes away from the little house where I watched a girl die from Ebola sat the clinic she had been so desperate to reach. It was a modest compound, of simple rooms lined with iron cots. I didn’t see any blinking computer screens or machines that beeped. It looked more like a high school nurse’s office than an I.C.U.
In one room, nurses were quietly putting pills on little squares of paper.
“What are those?” I asked.
“That’s medicine for Ebola patients,” explained a Sierra Leonean doctor.
I checked the boxes: acetaminophen, ciprofloxacin, some oral rehydration salts — all available at the smallest pharmacies, even here. I was stunned.
“That’s it?” I asked.
“Yeah,” the doctor said. “That’s it. Maybe an IV for the really bad cases.”
I’ve covered a lot of disasters in Africa — famines, civil wars, warlords on the rampage, all the nasty things that many people associate with the poorest continent on earth. We’re used to seeing shots of Africans dead on a red dirt road with a white United Nations helicopter chugging above.
Maybe Ebola looks like that from a distance. But up close it’s different. What I learned this past month reporting in Sierra Leone is that this is one crisis that should be relatively easy to solve.
Ebola, however much some of its symptoms conjure up a horror film, is usually shockingly simple to treat. The virus is swift and ruthless, hideous and creepy, causing some patients to have bloody vomit, bloody diarrhea or even — in severe cases — bloody eyeballs. Ebola is one of the handful of viruses than can trigger a hemorrhagic fever, with internal bleeding, but in most cases the biggest threat is dehydration, which can be addressed by clean water and basic drugs.
As Daniel Bausch, an infectious disease doctor at Tulane University, has said, “It’s not rocket science” — Ebola is as much about logistics as medicine. The key to defeating it is enough ambulances, enough hospital beds and a competent way to identify sick people, get them into care quickly before they infect others and then replenish the fluids they lose because of the virus.

Military Hospital Care Is Questioned; Next, Reprisals

By 
FAYETTEVILLE, N.C. — Beyond conducting their periodic evaluation of Womack Army Medical Center, one of the military’s busiest hospitals, the inspectors who came here to Fort Bragg last March had a special task. A medical technologist had complained of dangerous lapses in the prevention of infections. The inspectors planned to follow up.
But Teresa Gilbert, the technologist, said supervisors excluded her from meetings with the inspectors from the Joint Commission, an independent agency that accredits hospitals. “I was told my opinions were not necessary, nor were they warranted,” said Mrs. Gilbert, an infection-control specialist.
The review ended disastrously for Womack, one of 54 domestic and overseas military hospitals that serve more than three million active-duty service members, retirees and family members. The inspectors faulted infection prevention and many other aspects of care, putting the hospital’s accreditation under a cloud for months.
It was disastrous for Mrs. Gilbert, too. She said she was reprimanded for being an obstructionist, reduced to part-time hours, investigated for what she called trumped-up charges and transferred to a clerk’s job.
The message to Womack workers, she said, was clear: “You don’t go against us. If you do, we will get you.”
At any hospital, patient safety and quality of care depend on the willingness of medical workers to identify problems. The goal is for medical workers to be free to speak bluntly to — and about — higher-ups without being ignored or, worse, punished.
In interviews and email exchanges, many doctors, nurses and other medical workers said military hospitals fall short of that objective.
During an examination of military hospitals this year, The New York Times asked readers to recount their experiences via a private electronic portal. Among more than 1,200 comments were dozens from medical workers about how the system thwarted efforts to deliver superior care.




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