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Thursday, July 28, 2016

Health Care Reform Articles - July 28, 2016

Medicare-style system needed for Americans

By Richard Master
The Morning Call (Allentown, Pa.), Letters, July 19, 2016
Reflecting on the story, "New peak for U.S. health care spending," that annual U.S. health care cost has surpassed $10,000 per person: That's an astounding figure that should wake up readers, that our health care system is eating the rest of the U.S. economy alive. Clearly, other countries of the industrialized world deal with health care more effectively.
Vince Mondillo of Easton and I researched and produced "Fix It ... Healthcare at the Tipping Point," a documentary at fixithealthcare.com that describes our administratively complex and costly system. Unfortunately, the Affordable Care Act was a compromise measure that expanded coverage to more citizens but further entrenched commercial insurance companies' costly practices.
"Fix It" presents the business case, the economic case, for a Medicare-for-all system. Single-payer reform has worked to provide superb care to all citizens in many countries of the industrialized world. It's not a government takeover but tax-financed, privately delivered health care.
We Americans are unfortunately stuck in the Dark Ages, trying to put a shine on an archaic, complex expensive health care system that works for special business interests (Big Pharma, insurance companies, massive hospital networks and, yes, the media through advertising revenues) but doesn't work for our society.

Richard Master is CEO of MCS Industries Inc., Palmer Township, and executive producer of "Fix It ... Healthcare at the Tipping Point." He resides in Bethlehem.
http://www.pnhp.org/print/news/2016/july/medicare-style-system-needed-for-americans


Olympus told U.S. executives no broad scope warning needed despite superbug outbreaks
by Chad Terhune - LA Times
Faced with superbug outbreaks in three countries by early 2013, Japanese device giant Olympus Corp. told U.S. executives not to issue a broad warning to American hospitals about potentially deadly infections from tainted medical scopes, internal emails show.
After two dozen infections were reported in French and Dutch hospitals, the company alerted European customers in January 2013 that a scope it manufactured could become contaminated.
A top Olympus executive in the U.S. grew concerned because the company was investigating a similar outbreak at a Pittsburgh hospital.
“Should [we] also be communicating to our users the information that [Olympus Europe] is communicating to their European users?” Laura Storms, vice president of regulatory and clinical affairs in Center Valley, Pa., asked in an email to Tokyoheadquarters on Jan. 31, 2013.
No, that’s not necessary, said Susumu Nishina, the company’s chief manager for market quality administration in Tokyo in a Feb. 6, 2013, reply.
It is “not need[ed] to communicate to all the users actively,” Nishina wrote, because a company assessment of the risk to patients found it to be “acceptable.”  However, he added that Storms should respond to questions from a customer. 
Outbreaks of infection at hospitals in Los Angeles, Milwaukee, Denver and other cities followed over the next three years. All told, at least 35 people at U.S. hospitals have died since 2013 – three of them at UCLA’s Ronald Reagan Medical Center – after suffering infections from contaminated gastrointestinal scopes manufactured by Olympus, according to hospitals and public health officials.
Olympus’ actions – and inaction – are being closely examined in lawsuits by American patients and their families who contend that the manufacturer was negligent and might have prevented the outbreaks and deaths had it been more forthcoming. In addition, federal prosecutors are investigating Olympus’ handling of the infections – and the emails could become crucial evidence in any future case.
The company’s internal emails reveal conflicts inside Olympus over how to respond to a growing threat to patient safety, pitting U.S. executives against their superiors in Japan who had the final say. The emails were filed in a Pennsylvania court this month as part of a patient lawsuit and obtained by Kaiser Health News working in collaboration with the Los Angeles Times.
Olympus, which controls 85% of the U.S. market for gastrointestinal scopes, declined to comment on the emails, citing the pending litigation. It also declined to discuss the ongoing investigation by the U.S. attorney’s office in New Jersey.
Storms, Nishina and other company officials named in the emails didn’t respond to requests for comment.
In a statement, the company said “patient safety is our top priority. The duodenoscope issue continues to receive the highest level of attention at Olympus, and we remain committed to working with the proper authorities and our stakeholders to understand and address the potential root causes.” The company declined to address why it didn’t feel it was necessary to inform U.S. hospitals when it was alerting those in Europe.
At the time of the safety alert in Europe, Olympus was already aware that design flaws could make it difficult to clean its duodenoscope for the next patient. Used in about 700,000 procedures annually in the U.S., the snake-like device is put down a patient’s throat to diagnose and treat problems in the digestive tract such as cancers and blockages in the bile duct.
As The Times reported in December, an investigator hired by Olympus and a Netherlands hospital concluded in a June 2012 report that the scope’s design could allow blood and tissue to become trapped, spreading bacteria from one patient to another. The independent expert called on Olympus to conduct a worldwide investigation and recall all its scopes if similar problems turned up.
A Senate report released this year said Olympus knew about at least three outbreaks – at hospitals in the Netherlands, France and Pittsburgh – affecting an estimated 46 patients when the European alert went out in early 2013.
Inside Olympus, the debate about how to respond to the emerging outbreaks in the U.S. came to a head on Feb. 6, 2013, the emails show.
Just a few hours after her exchange with the Tokyo official, Storms was confronted by her own U.S staff.
Donny Shapiro, a director of regulatory affairs for Olympus in San Jose, Calif., sent an email to Storms and seven other employees with “Duodenoscope safety recall??” in the subject line. He cited the problems in Europe and results from the company’s microbiology lab showing Olympus scopes had tested positive for bacteria at the University of Pittsburgh Medical Center.
“Why was the alert only issued in Europe?” Shapiro asked his colleagues.
Six minutes later, Storms wrote back: “Donny, [Olympus Japan] has determined that a global communication is not required.”

You Probably Don’t Need Dental X-Rays Every Year

by Austin Frat - NYT
My dental hygienist complimented me on the health of my teeth and gums. Then she said something that you, too, have undoubtedly heard while sitting back in the dentist chair.
“Would you like bitewing X-rays? It’s been a year since your last ones. Your insurance will cover them annually.”
The easy answer was: “Yes. Bring on the bitewings!” They are, after all, painless, don’t take much time, and, as I was reminded, would not cost me a penny because they are covered by my insurance.
But the easy answer isn’t necessarily the right one. Do I need bitewing X-rays every year?
The American Dental Association says I don’t, and you may not either. Adults without apparent dental problems do not need dental X-rays of any kind every year, the A.D.A. says. Adults who properly care for their teeth and have no symptoms of oral disease or cavities can go two to three years between bitewing X-rays, according to the A.D.A.
Adults with a high risk of cavities (like those with a history of them) should receive them at least every 18 months, and possibly more frequently, depending on the condition of teeth and gums.
The interval between X-rays is determined by the rate at which cavities develop. Typically, it takes about two years or more for cavities to penetrate adult teeth enamel. The rate is faster for children, so the recommended bitewing intervals are shorter for them.
However, children with adequately spaced primary (baby) teeth and no cavities do not need any dental X-rays. Older children with a low propensity for cavities can go 18 months to three years between bitewing X-rays. Those at the highest risk may need them more frequently.
Bitewing and other dental X-rays have their place; there is risk in not taking them. Sometimes decay can spread quickly. The X-rays help dentists see cavities, gum disease, the position of teeth still below the gum line and other dental conditions not visible with the naked eye. Other kinds of dental and orthodontic imaging — like full-mouth, full-head, panographs or 3-D cone-beam computed tomography — reveal more.
But dentists tend to overuse them. Jay W. Friedman, a dentist who advises Consumer Reports on dental issues, has been warning of overuse of dental imaging since the 1970s. “Many patients of all ages receive bitewing X-rays far more frequently than necessary or recommended,” he said. “And adults in good dental health can go a decade between full-mouth X-rays.”

Pharma trade group says price gougers are outliers, but then accepts two more
by Ed Silverman

File this under “How ironic.”
For months, the trade group representing big drug makers has argued that Valeant Pharmaceuticals and Turing Pharmaceuticals, which was once run by Martin Shkreli, were outliers for brazen pricing practices that outraged Americans.
At every turn, the Pharmaceutical Research and Manufacturers of America has worked hard to convince lawmakers and the public that its members are not the equivalent of “hedge funds” that exist to set sky-high prices while failing to sufficiently invest in developing new medicines.

Among five companies that were just added to its roster, two of them — Jazz Pharmaceuticals and Horizon Pharmaceuticals — have also relied on excessive pricing to fuel their growth, while investing much less than other drug makers in research and development.
This is “intriguing given their pricing strategies and (the) PhRMA effort to distinguish its membership from sharp pricers,” Sanford Bernstein analyst Ronny Gal wrote to investors last week.
Intriguing is one way to describe it. Hypocritical might be another.
Consider Horizon.
In late 2013, the company bought the Vimovo pain reliever from AstraZeneca and, in January 2014, on the first day it could sell the pill, Horizon raised the list price for 60 tablets to $959, a 597 percent increase from $127, according to Truven Health Analytics. This is the same tactic for which Valeant and Turing were criticized. And Horizon has since boosted the price six more times; it’s now at $2,250.
There’s more. Gal also pointed out that Vimovo is actually a combination of two older medicines. So while the company sells the drug at expensive brand-name prices, patients could actually purchase the generic components separately at a more modest cost. The drug is Horizon’s second-biggest seller, by the way, and contributed 22 percent of overall sales last year.
The drug maker’s biggest-selling product is Duexis, a treatment for rheumatoid arthritis and osteoarthritis that similarly combines two older medicines. Horizon launched the pill in 2012 at $190 for a 90-day supply and, since then, has raised the price 10 times. The last price hike took place this past May, when the cost jumped to $2,250, according to Truven.
Meanwhile, Horizon spent 5.5 percent of sales on R&D in 2015. This is well below the nearly 18 percent of sales that the trade group likes to boast the pharmaceutical industry spent overall last year.
A Horizon spokesman argued that pricing is not “a key driver of our business,” and sales growth was due to more prescriptions written. He also maintained that 98 percent of commercially insured patients have copays of $10 or less due to assistance programs. And he added that, over the past two years, prices have remained flat or fallen due to rebates. Of course, any rebates would still be working off higher starting prices, so unless rebates keep pace, costs to payers still go up.
As for Jazz, 72 percent of its sales last year came from just one drug — the narcolepsy medicine, Xyrem. Over the past three years, most Xyrem sales were driven by pricing. During that time, the price of a 180-milliliter bottle rose to $4,455 from $2,707, according to Truven. Gal noted the drug sold for about $70,000 per patient last year, up from $35,000 in 2013.
Jazz was more willing to spend on R&D — 10 percent of sales were funneled in that direction in 2015, which was up from 7 percent during the previous year. But this was still well below the level touted by the trade group. We asked Jazz for a comment, but no one responded.
So what does the trade group say about this?
Nothing. PhRMA declined to put anyone on the phone to explain how it reconciles these practices with its repeated insistence that its members are not aberrant price gougers.
Perhaps the trade group needs the membership fees. Or perhaps, as Gal speculated, this is a sign that the industry is more confident it can deflect any legislative moves on Capitol Hill to rein in pricing.
“Whatever the reason, it’s certainly disturbing to see this sort of pricing behavior become legitimatized by accepting these companies as members,” said John Rother, who heads the National Coalition on Healthcare, a group of insurers and employers, among others, that object to rising drug prices. “And I think it undercuts the assertion this kind of strategy is only characteristic of outliers.”
Indeed, the pharmaceutical industry may find it easy to explain away egregious pricing when one or two companies are involved. But the trade group seems too willing to look the other way in this instance. And maybe after a while, there won’t be any outliers left.

Michael Moore’s latest movie hits Americans where we don’t live

Emmet Meara - Bangor Daily News

Oh, alright. Michael Moore is fat. Michael Moore is sloppy. You can just imagine him with mustard on the front of his shirt. Maybe that’s why I like him so much.
Plus, he enrages caveman conservatives such as “Six-gun” Purcell in South Carolina. That’s a plus.
Last week, I actually watched Moore’s latest work, “Where To Invade Next?” Like all movies today, it was at least 30 minutes too long and in dire need of sharp editing. Moore is so intent on preaching that he forgets he is in the entertainment business.
But in the week sandwiched between the conventions of the two major political parties, the Moore movie illustrates the failure of both parties to create a fair, modern civilization. Despite the title, there is no invasion involved — just an appreciation of the progress of other, smaller countries.
I hate to admit it, but I am a third-degree addict of the show “Cops.” I enjoy the “cinema verite” quality of the show, but I wince every time the SWAT team bashes in a front door and spread eagles all the occupants — for marijuana. Look at the terrible cost of prosecuting these smokers, then imprisoning them for decades.
On his global tour, Moore stops in Portugal, where drugs have been decriminalized. All drugs. Not just marijuana but heroin and crack. Portugal lets you do what you want to do with your body. The crime rate and prison population in Portugal are a tiny fraction of what they are in the U.S. and its endless “War on Drugs.”
Just sayin’.
At his stop in France, Moore shares the gourmet-style meal served every day in French schools. All French schools. Each school meal has a cheese course. The French chef could not explain what a “sloppy Joe” was. When he was filled in, he would not consider adding it to his menu. The French schools have a very highly involved sex education class that would make a Mississippi reverend blush. The result is an illegitimate birth rate, once again, a fraction of what it is in the U.S.
Could we do better?
Are your kids graduating with a degree and a $100,000 student debt? Not in Germany. In Germany colleges are free to all — even a group of Americans who couldn’t afford tuition in Colorado. So many of the courses are in English that language is not a problem, students said.
Everybody hated homework. I certainly did. You cannot believe this, but Finnish schools have done away with homework and seek to educate the “whole person” rather than teaching students to succeed in a single test. The result? The Finnish schools are rated No. 1. In the world.
The U.S. economy GNP leads the world at $17.9 trillion according to my always shaky research. Slovenia comes in just after Tunisia at $49 billion. But tiny Slovenia had no (zero) college tuition, and efforts to establish it are always met with passionate street demonstrations. American students graduate with a crushing financial load. Moore calls Slovenia a “Magic Kingdom.”
Maybe we could learn something.
After watching “Invade,” many American workers might consider moving to Italy. There the very average worker gets eight weeks vacation each year. Many companies offer a bonus for the vacation period. “No sense taking a vacation if you can’t afford to go where you want,” one worker said.
Conservatives say these benefits are created by a tax rate much higher than the U.S. Moore argues that when you add the fees, tuition, health care costs along with maintaining the largest prison population in the world, we already are paying far more than other countries.
Moore might be fat and sloppy. He might have a mustard stain on his shirt. He stomps all over his message for two hours, but I think it might be productive to study the lessons of other countries if we truly profess to love our own.
The lesson I took is that big business, Democrats and Republicans alike use big government to create the New Servant Class — and you are in it.
Slovenia? Watch the movie.


Fraud and Other Threats to Medicare

By THE EDITORIAL BOARD
Last week, when the Department of Justice charged three people in Miami with fraud and other crimes in a $1 billion scheme to bilk Medicare, it was the single largest criminal case in the nine-year history of the Medicare Fraud Strike Force, a coalition of federal, state and local law enforcement agencies. A month earlier, a crackdown by the strike force led to civil and criminal charges against 301 people in dozens of schemes totaling $900 million in allegedly false billings.
Clearly, health care fraud is vast. Less obvious is that prevention, detection and punishment of fraud have improved in recent years, though that would be threatened if the Affordable Care Act of 2010 were weakened, as Republicans have long demanded.
Obamacare provided an additional $350 million to expand the Medicare Fraud Strike Force to nine cities, from only two in 2007, and to develop advanced data and accounting systems to uncover fraud. The law also toughened sentencing for Medicare fraud, in part, by clarifying that prison terms are to be based on the falsely billed amounts, not the amount actually paid out before the fraud was detected.
To date, some 2,000 of 2,900 defendants charged with felony health care fraud in strike force cases have been convicted. Most have been sentenced to prison, not merely probation. In addition, courts have ordered defendants to repay the government more than $5.5 billion, which is about the total amount the government paid out in the frauds that have been prosecuted.
That is just a sliver of the size of Medicare. But progress against fraud goes beyond saving money. Stopping fraud also leads to better care, because billing fraud often involves ordering unnecessary tests for patients and prescribing unnecessary drugs.
Fighting fraud is also crucial to maintaining public confidence in the health care system. Republican opponents of a government role in health care often portray the system as broken and unsustainable. In fact, the Affordable Care Act’s improved fraud detection is only one of several ways it has improved Medicare’s overall financial outlook, as was made clear last month in the annual report of Medicare trustees.
Medicare fraud is a scourge. But those who would weaken the health care system for ideological reasons are an even bigger problem.

Why are doctors plagued by depression and suicide? A crisis comes into focus
By JUDITH GRAHAM
A sense of angst was rattling students at the University of Southern California’s Keck School of Medicine. One of their peers had taken his life days before.
Professor Mikel Snow felt the dark undercurrent and knew he had to speak up. So, for the first time, he told his students about his decades-long struggle with depression. As word spread, students across the campus started contacting him to discuss the suicide — and to share their own psychological distress.
“The reaction has been astounding,” Snow said. “It crystallized that this is a much bigger issue than any of us really realized.”
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Suicide among medical students and doctors has been a largely unacknowledged phenomenon for decades, obscured by secrecy and shame.
Now, it’s beginning to emerge from the shadows.
More than 62,000 people — many of them medical professionals and their families — signed a petition this year calling on medical associations to track physician suicides, provide confidential counseling, and require doctor training programs to address a “culture of abuse” too often characterized by bullying, harassment, and humiliation.
Those groups are responding. The Association of American Medical Colleges last month convened a meeting to address an escalating crisis of depression, burnout, and suicide among physicians. Among the ideas under consideration: encouraging medical students to join clubs so they feel less isolated; ensuring that counseling is more accessible and private; and more actively tracking the mental health of students and doctors.
“This is something that the profession as a whole needs to come together around and deal with as a shared concern,” said Dr. Darrell Kirch, president of the AAMC.
He knows the pain firsthand: He lost two students to suicide during his tenure as dean at medical schools in Pennsylvania and Georgia.
The Accreditation Council for Graduate Medical Education, which oversees the doctor training programs known as residencies, is also focusing on the issue. Officials are studying residents’ deaths to determine which might have been preventable, and how to respond. The group sets standards for residencies and is looking at how to strengthen them to protect young doctors’ mental health.
Hospitals, too, are racing to launch support groups, peer counseling, and sessions to teach doctors to manage stress by meditating or keeping journals.
The new attention to physicians’ mental health comes too late for Cheryl Collier, who had no inkling that her 25-year-old son, Sean Petro, had plunged into despair during his third year at USC’s medical school.
“If only he’d said, ‘I’m depressed, I’m unhappy, I don’t know what to do.’ Perhaps I could have helped him,” said Collier, weeping with grief and frustration.
In the weeks after Sean’s death in May, someone mentioned to Collier that medical students and physicians have a high suicide rate. “I had no idea that was even a possibility,” she said.


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