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Wednesday, April 6, 2016

Health Care Reform Articles - April 6, 2016

‘American Amnesia,’ by Jacob S. Hacker and Paul Pierson

By MATTHEW BISHOP

AMERICAN AMNESIA
How the War on Government Led Us to Forget What Made America Prosper
By Jacob S. Hacker and Paul Pierson
455 pp. Simon & Schuster. $28.
If Bernie Sanders were a book by two leading politics professors, it would be “American Amnesia.” This is the story of how government helped make America great, how the enthusiasm for bashing government is behind its current malaise and how a return to effective government is the answer the nation is looking for.
How America came to forget about the merits of good government, and the price now being paid, is the meat of “American Amnesia,” the third book by Jacob S. Hacker (Yale) and Paul Pierson (Berkeley), whom Bill Moyers calls the “Sherlock Holmes and Dr. Watson of political science.” According to these academic detectives, America’s amnesia is no accident. The country has been brainwashed by a powerful alliance of forces hostile to government: big business, especially Wall Street, spending unparalleled lobbying dollars to advance its narrow self-­interest; a new wealthy elite propagating wrongheaded Ayn Randian notions that free markets are always good and government always bad; and a Republican Party using a strategy of attacking and weakening government as a way to win more power for itself.


Medical Students Call for Single-Payer Health Insurance

By Mark Chee, Rebecca Gieseker and Rachel Stones
Chicago Maroon, March 31, 2016
As medical students, we have chosen a profession dedicated to treating illness and helping people live healthy lives.
Yet, early on during our training, we learn about the unequal access to care, unaffordable treatments, and medical debt that patients face because of our current private, for-profit health insurance system. We hear about physicians who are increasingly burdened with paperwork and frustrated by a system that does not serve their patients. We discover that despite spending more per capita on health care than other developed countries, the U.S. population has a shorter life expectancy, higher infant mortality, and worse overall health.
While the implementation of the Affordable Care Act (ACA) has expanded coverage, it fails to sufficiently address the problems our health care system faces. Around 33 million Americans remain uninsured, some indefinitely. These individuals are immigrants, who still cannot afford health insurance or live in states that have blocked Medicaid expansion. In addition to this remaining lack of coverage, increasing deductibles and cost sharing are also being used to shift the financial burden from insurers to patients. Over 50 percent of bankruptcy filings in the U.S. are due to illness and medical debt, even though the majority of individuals in this group has some form of coverage when they file for bankruptcy. Expanding insurance coverage that leaves patients vulnerable to the financial burden of illness is not the answer. Furthermore, narrow network health plans prevent patients from having continuity of care with their physicians and expose them to exorbitant (and often unexpected) out-of-network costs.
http://www.pnhp.org/print/news/2016/april/medical-students-call-for-single-payer-health-insurance

VIP’s princely care brings scrutiny to the Brigham

By  GLOBE STAFF  

He wanted the best medical care and came to the posh Pavilion at Brigham and Women’s Hospital to get it, taking over two penthouse rooms with sweeping views for a seven-month stay.
The new patient had apparent ties to Middle Eastern royalty, and brought along a personal chef and an entourage of seven attendants. This, by itself, is not unheard of in the cost-is-no-object world of VIP medicine, in which elite hospitals in Boston and other cities accommodate wealthy patients, some from distant lands, who can afford the full tab for care — and for premium amenities like deluxe rooms that cost up to $800 a day more than regular ones.

Despite Fears, Affordable Care Act Has Not Uprooted Employer Coverage

by Reed Abelson - NYT
The Affordable Care Act was aimed mainly at giving people better options for buying health insurance on their own. There were widespread predictions that employers would leap at the chance to drop coverage and send workers to fend for themselves.
But those predictions were largely wrong. Most companies, and particularly large employers, that offered coverage before the law have stayed committed to providing health insurance.
As it turns out, health care remains an important recruitment and retention tool as the labor market has tightened in recent years. Desirable employees still expect health benefits, and companies are responding, new analyses of federal data show.
http://www.nytimes.com/2016/04/05/business/employers-keep-health-insurance-despite-affordable-care-act.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

Gerald Friedman Responds to the Romers on the Sanders Plan: Different Models, Different Politics

Posted on March 8, 2016 by 
By Gerald Friedman, Professor of Economics, University of Massachusetts at Amherst
Differences between my evaluation of the impact of the Sanders economic program from that of the Romers reflect different views of the economy, the difference between a static model where national income and employment are largely fixed and a dynamic one where these are shaped by effective demand and are, therefore, susceptible to change in response to economic policy. There are no errors in arithmetic.* It is a fundamental difference in vision that divides our approaches; the same distinction that divided John Maynard Keynes from those he labelled the Classicals in his General Theory of Employment, Interest, and Money. 

Maine’s largest Obamacare insurer hit financial goals in February

By Darren Fishell, BDN Staff

PORTLAND, Maine — The health care insurer that stumbled last year after quickly enrolling people in underpriced plans exceeded its financial goals for February.
The state’s Bureau of Insurance has put the Lewiston-based co-op Maine Community Health Options under close scrutiny after it closed 2015 facing $74 million in losses. Those losses included a $31 million shortfall for the year and a projected $43 million loss in 2016.
In its second monthly report, the state regulators said the insurer is on track with the financial plan crafted to make it through the year.

Why Do We Pay So Much for Health Care—But Get Such Poor Results?

By  • 04/05/16


As a primary care physician practicing for three decades in the same location, I have had the privilege of seeing patients regularly across a span of many years. I have celebrated my patients’ joys and triumphs, but also mourned with them in their deepest tragedies and sorrows. I have shared and continue to share in their trials and vulnerabilities, and often as more than their doctor; patients sometimes confide in me things they do not even share with their families.
The result: I have encountered far too many heartbreaking stories, more than enough to be certain that our health care system is deeply broken. Too many patients watching their savings disappear overnight in the face of staggering medical bills, even those resulting from low-quality care. Too many people working tirelessly for the false promise that health insurance equals financial security. Too many families living in fear of slipping into poverty because of one illness. The physical, financial, and emotional pain is often unbearable, creating a bitterly vicious cycle that continues to spiral downward.
In the midst of a fray of political demagoguery and confusion, countless American families are struggling at the hands of a system they may not fully understand.


Study: Long-Term Antibiotics Ineffective at Fighting Chronic Lyme Disease 

By 

A new study published in the New England Journal of Medicinehas found that long-term use of antibiotics is not an effective treatment for people with persistent symptoms of Lyme disease.
Last year, Maine passed a law that protects physicians who use the controversial treatment from facing sanctions.
Some physicians say this new study puts to bed the question of whether long-term antibiotics should be used. But those affected by persistent Lyme symptoms say the study isn’t the last word on the issue.

Amid Public Feuds, A Venerated Medical Journal Finds Itself Under Attack

A widely derided editorial, a controversial series of articles and delayed corrections have prompted critics to question the direction of the New England Journal of Medicine.
by Charles Ornstein
ProPublica, April 5, 2016, 8 a.m.
The New England Journal of Medicine is arguably the best-known and most venerated medical journal in the world. Studies featured in its pages are cited more often, on average, than those of any of its peers. And the careers of young researchers can take off if their work is deemed worthy of appearing in it.
But following a series of well-publicized feuds with prominent medical researchers and former editors of the Journal, some are questioning whether the publication is slipping in relevancy and reputation. The Journal and its top editor, critics say, have resisted correcting errors and lag behind others in an industry-wide push for more openness in medical research. And dissent has been dismissed with a paternalistic arrogance, they say.

How a $15 minimum wage went from ‘extreme’ to enacted
  
What once was considered “pie in the sky” is slowly becoming law. In New York, state legislators just agreed to raise the state minimum wage to $15 an hour, with the full effect beginning in New York City by December 2018. California just passed a compromise raising the minimum wage to $15 an hour by 2022. New Jersey and the District are planning to move similar laws. After New York and California, nearly 1 in 5 (18 percent) in the U.S. workforce will be on the path to $15 an hour. 
How did this reform go from being scorned as “extreme” to being enacted? Consensus politicians don’t champion it. Pundits and chattering heads tend to ignore it. Many liberal economists deride it as too radical. The idea moved only because workers and allies organized and demanded the change.






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Saturday, April 2, 2016

Health Care Reform Articles - April 2, 2016

Brunswick mental health care provider to close, costing 170 jobs

By Beth Brogan, BDN Staff
BRUNSWICK, Maine — Citing the loss of MaineCare coverage, Merrymeeting Behavioral Health Associates notified Brunswick officials on Monday that it will close its Pleasant Street facilities on April 22, putting approximately 170 people out of work.
The organization provides outpatient case management, therapy and support services to adults and children.
In a letter to Town Council Chairwoman Sarah Brayman and officials at the Bureau of Employment Standards and Department of Labor, human resources director Kacie Parker wrote that the decision to close was prompted by a March 22 letter from the state notifying MBH that beginning April 8, MaineCare would no longer cover more than 80 percent of the community-based services the organization provides.
Clinical employees will be terminated on April 8, according to the letter.
Parker wrote that short notice from the state prevented Merrymeeting from providing the 60 days’ notice required when employees are laid off.
A spokesman for the Maine Department of Labor did not immediately return a phone call on Tuesday.

New Rule May Limit Mental Health Services to Thousands 

By  
Mainers worried about the loss of mental health services asked the Health and Human Services Committee Friday to block a change to eligibility requirements planned by the LePage administration.
The new rule could potentially move thousands of Mainers with mental illness to less intensive services. Administration officials say individuals will still receive support, but those affected fear they will lose their ability to live independently.
Department of Health and Human Services Commissioner Mary Mayhew wants to be clear about the change in rules for mental health services. “People are not going to lose access to appropriate services. This has been framed as a cut, as opposed to how do we continue to ensure people are getting the most effective treatment to help support the best possible outcomes for the individuals,” says Mayhew.
The Disappearance of Hillary Clinton's Healthcare Platform

What would happen if the media lifted the curtain on Clinton's healthcare platform and introduced any level of scrutiny to her proposed improvements on the Affordable Care Act?
by
Benjamin Day
In an extraordinary magic trick, performed on a national scale, Hillary Clinton's healthcare platform has been disappeared. While policy analysts, news anchors, and columnists have been engaged in an intense debate over Bernie Sanders’s “Medicare for All” proposal, Clinton’s incremental alternative has escaped almost all scrutiny - even among those who say they prefer it.

Combining the election-season writings of our most prolific, liberal-leaning columnists at the New York Times, Huffington Post, Vox, Mother Jones, Politico, The American Prospect, etc. you’ll find dozens of articles critiquing Sanders's single-payer plan. None have mentioned a single Clinton healthcare proposal as a point of comparison - merely that she supports a philosphy of incremental reform.

M.D. Harmon: On Obamacare’s 6-year anniversary, the news isn’t good

Republicans won control of Congress by opposing the Affordable Care Act. But nobody did anything.
The Republican Party is in trouble with many voters, who see that failing to act when action is required is just as bad as doing the wrong thing instead of the right one.
One of the principal reasons Republicans won control of Congress was its opposition to the Affordable Care Act, known popularly as “Obamacare.” But that hasn’t produced much of a result downstream.
Without broad support for a competing measure, pledges like Ted Cruz’s to repeal Obamacare on his first day in office ring hollow.
Part of the party’s dereliction of duty was failing to realize decades ago that the employer-insurance model, supplemented by programs for the elderly, the indigent and uninsured children, was costly, inefficient and unstable. Proposals were floated by think tanks and some exceptionally courageous politicians for improvements focused on giving tax breaks and decision-making power over health care to people rather than reserving them to employers and politicians.
But no one did anything, and that left the field open for an end run from the left, which has always had the (substantially more costly and inefficient) federalization of health care as a major policy goal.
Leaving us where we are today. We’ve just had Obamacare’s six-year anniversary on March 23, and the news isn’t good, to no conservative’s surprise.

Single-Payer 'Medicare for All' Gets Boost From New Study

Ken Terry
Presidential candidate Bernie Sanders' proposal to create a single-payer "Medicare for all" system has drawn criticism because, opponents say, it would lead to a big increase in taxes. But a new study estimates that the federal, state, and local governments paid for 64.3% of US health spending, or $1.877 trillion, in 2013 and that it would not take much higher taxes to finance a single-payer system.
According to David U. Himmelstein, MD, and Steffie Woolhandler, MD, MPH, from the City University of New York School of Public Health at Hunter College, who wrote the article, the government share of national health expenditures will rise to 67.1% by 2024. At that point, they argue, there will be only a 4-point spread between what the US government pays for in our public/private healthcare system and the 71% of Canadian health spending that that country's government spends on its single-payer system.
The article was published online January 21 in the American Journal of Public Health.

Newest Policyholders Under Health Law Are Sicker and Costlier to Insurers

By ROBERT PEAR

WASHINGTON — People newly insured under the Affordable Care Act were sicker, used more medical care and had higher medical costs than those who already had coverage, the Blue Cross and Blue Shield Association said Tuesday in a new study of its policyholders.



New Health Insurance Customers Are Sicker. Should We Be Surprised?

by Margot Sanger-Katz - NYT
Before Obamacare, health insurance companies routinely refused to sell policies directly to patients who had illnesses like AIDS, hepatitis C or heart disease.
It should be no surprise to anyone, then, that once the Affordable Care Act required insurers to offer insurance to sick people, a lot more sick people signed up.
That is the basic conclusion of a new report on health insurance customers from the Blue Cross and Blue Shield Association analyzing health insurance for 4.7 million Americans in 27 states and the District of Columbia. The report, which shows that new customers are sicker and costlier than people in the old individual insurance market, made a big splash Wednesday, because it implied that the Obamacare markets are more troubled than many had expected.
The problem with the report, however, is that it doesn’t really tell us how Obamacare has affected the individual insurance market. It doesn’t say how expensive it was to pay the medical bills for the whole group of people who bought their own health insurance.


Prudential pulls a fast one on long-term care insurance policyholders
by David Lazarus - LA Times
Buying long-term care insurance isn't an easy decision. It's an increasingly pricey product that requires you to look way down the road, to the possibility of shelling out big bucks for a nursing home or some other form of assisted living.
The last thing you want to worry about is having your insurer pull a fast one on you after you sign up for coverage. But that's what Prudential has done, making a sneaky change to policyholders' long-term care coverage.
At issue is what's known as an "inflation protector," which allows policyholders to boost the amount they'll be able to pay for future nursing-home care in light of rising costs. This can be an important consideration but will also increase quarterly premiums.
In the past, long-term care policyholders would be asked by Prudential from time to time if they wanted to up their insurance ante. If not, they wouldn't have to do a thing and their coverage would continue as always.
Now, however, Prudential is informing customers that the system has changed. Instead of being asked if they want to increase coverage, the insurer will assume that they do and raise rates automatically.
http://www.latimes.com/business/la-fi-lazarus-20160401-column.html





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Tuesday, March 29, 2016

Health Care Reform Articles - March 29, 2016

10 of the Worst Big Pharma Company Rip-Offs — and Their Plan to Keep the Gravy Train Rolling

Martin Shkreli isn't the only one putting high prices on life saving drugs. 
By Martha Rosenberg /  The Influence


When did you become aware of the obscene prices the pharmaceutical industry is charging for drugs? For many it was when a smirking Martin Shkreli, founder of Turing Pharmaceuticals, testified on the Hill in February about his price hike of the antiparasitic drug Daraprim from $13.50 to $750, after which he called lawmakers “imbeciles” in a tweeted goodbye.

Surprise! You're covered for the hospital, not the doctors

by David Lazarus - LA Times

fter Dave Connors' teenage son broke his leg, he was rushed to an Orange County hospital that Connors knew was in his insurer's coverage network.
It was only after the bills recently started arriving that he learned the doctors and anesthesiologist in the operating room were out of network, requiring him to pay thousands of dollars more.
"When you're at a hospital that you know is in-network, who would think to ask individual people if they're also in-network?" Connors said. "Especially when your son is being operated on."
This wasn't an isolated example of our patient-unfriendly, for-profit healthcare system.


Nearly a quarter of Californians who had hospital visits since 2013 were surprised to find that at least some charges at in-network hospitals were at out-of-network rates, according to a survey last year by the Consumer Reports National Research Center.
http://www.latimes.com/business/la-fi-lazarus-20160325-column.html

How to Stop Overprescribing Antibiotics

By CRAIG R. FOX , JEFFREY A. LINDER and JASON N. DOCTOR

ANTIBIOTICS are an indispensable weapon in every physician’s arsenal, but when prescribed unnecessarily for nonbacterial infections like the common cold, as they too often are, they provide no benefit and create problems. They wipe out healthy bacteria and can cause side effects like yeast infections and allergic reactions. Worse still, they contribute to the rise of “superbugs” that resist antibiotic treatment.

The Global War on Drugs Has Unleashed an International Health Crisis, Says Top Health Panel

Zero-tolerance policies have fueled lethal violence, disease transmission, discrimination and forced displacement.

A premiere public health commission warned Thursday that the global war on drugs and zero tolerance policies are unleashing an international health crisis by fueling “lethal violence, communicable-disease transmission, discrimination, forced displacement, unnecessary physical pain, and the undermining of people's right to health.”
A joint initiative of Johns Hopkins Bloomberg School of Public Health and the Lancet, the commission released a report calling for a global transformation of drug policy—towards decriminalization and harm reduction.

Obamacare is on back burner in the race for the White House

by Albert Hunt - Bloomberg View

No issue has aroused more partisan passion over the past six years than the Affordable Care Act. Yet, the law is playing only a secondary role in during the election.
Sure, Republican presidential candidates cater to their base by vowing to repeal and replace Obamacare, and on the Democratic side, Sen. Bernie Sanders of Vermont promises to replace it with a government-run universal coverage system.
But it doesn’t dominate the dialogue and isn’t a top priority on either side. Among the most embattled Senate Republican incumbents, the campaign websites of New Hampshire’s Kelly Ayotte, Mark Kirk of Illinois or Ron Johnsonof Wisconsin barely mention the ACA. An exception is Pat Toomey of Pennsylvania.
The explanation may be that for all its controversy and imperfections, the sweeping law has taken hold. “This is in the fabric of the nation,” Health and Human Services Secretary Sylvia Mathews Burwell said.
To be sure, the presidential election outcome will be a determinant of whether Obamacare is reshaped, bolstered or downsized.

US Doctor Group Demands Price Controls for Out-of-Control Drug Industry

American College of Physicians publishes policy paper on getting skyrocketing drug prices under control
by
Nadia Prupis, staff writer
The American College of Physicians (ACP), a group of 143,000 internal medicine doctors, on Tuesday published a position paper calling on the government to do more to regulate the skyrocketing costs of pharmaceutical drugs.
The article, written by the ACP's Health and Public Policy Committee and published in the Annals of Internal Medicine, notes that the U.S. is one of the only economically advanced countries in the world that does not have any government regulation of drug prices.
"In the United States we pay comparatively much more for prescription drugs than other countries, an increasing concern for all Americans," said ACP president Dr. Wayne J. Riley. "The impact of these rising costs can be very detrimental to patients, causing them to forgo filling important prescriptions or not taking drugs on the schedule that they are prescribed."
The ACP made seven recommendations to help slow down and maintain the price of medicine, including:
• Transparency in the pricing, cost, and comparative value of all pharmaceutical products;
• Allowing price negotiation by Medicare and other publicly-funded health programs, consideration of reimporting drugs manufactured in the U.S., and increasing competition for sole-source drugs;
• Ensuring that patient cost-sharing is not set at a level that imposes a "substantial economic barrier" to patients.
As NPR reports, the ACP also called for "drugmakers to disclose the actual research and production costs of developing and manufacturing each drug, and to disclose the prices paid for drugs—including discounts and rebates—that take advantage of basic research funded by the government, such as the National Institutes of Health and the Department of Veterans Affairs."








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Thursday, March 24, 2016

Health Care Reform Articles - March 24, 1938

Even with insurance, Mass. residents often can’t afford care

By Felice J. Freyer - Boston GlobeNearly all Massachusetts adults have health insurance, but being insured is no guarantee patients can afford health care or even find someone to provide it, according to a survey released Wednesday.
Despite the state’s landmark health care overhaul, the report found, cost and access remain problems for a significant share of residents.

Medicare Proposal Takes Aim at Diabetes

by Robert Pear - NYT

WASHINGTON — The Obama administration plans on Wednesday to propose expanding Medicare to cover programs to prevent diabetes among millions of people at high risk of developing the disease, marking the sixth anniversary of the Affordable Care Act with the prospect of a new benefit, federal officials said.
Sylvia Mathews Burwell, the secretary of health and human services, is scheduled to announce the proposal at a Y.M.C.A. here. Under the plan, Medicare would pay for certain “lifestyle change programs” in which trained counselors would coach consumers on healthier eating habits and increased physical activity as ways to prevent Type 2 diabetes, formerly called adult onset diabetes. Such programs have been found effective in people with a condition known as prediabetes, meaning that they have blood sugar levels that are higher than normal but not high enough to be considered diabetes.

Soaring prescription prices cause a nasty divorce in the healthcare market

by Michael Hiltzik - LA Times
Money always ranks high among the reasons for divorce. In the failing marriage between Anthem Blue Cross and Express Scripts, it's reasons one through 15 billion. That's how many dollars the party of the first part thinks its been cheated by the party of the second part.
For those who missed the wedding announcement back in 2009, the first is the nation's second-largest health insurance company and his (or her) partner is the nation's biggest pharmacy benefits management firm, or PBM. They seemed to be in a marriage made in heaven, until household finances strained the relationship to the breaking point. To be precise, the issue is the run-up in pharmaceutical prices, which Express Scripts was tasked with moderating but -- according to Anthem -- failed to deliver or even pocketed the savings.http://www.latimes.com/business/hiltzik/la-fi-hiltzik-anthem-express-20160322-snap-htmlstory.html

Maine sought to put struggling health insurance co-op into receivership

The Bureau of Insurance hoped to stem Community Health Options' losses, partly by ending as many as 17,000 policies, but a federal agency rejected the temporary plan.
by Edward D. Murphy - Portland Press Herald
http://www.pressherald.com/2016/03/23/state-sought-to-put-struggling-health-co-op-into-receivership/

Maine’s largest Obamacare insurer to raise rates

By Darren Fishell, BDN Staff
PORTLAND, Maine — Maine Community Health Options, the state’s largest individual health insurer, expects to raise rates for its 2017 plans after closing 2015 in the red.
The financial troubles have put the insurer under closer watch from state regulators, who said they tried to stop enrollment in the fall to stem projected premium losses estimated at $43 million for 2016.
The company posted a total $74 million shortfall last year, which includes the $43 million it will set aside to cover projected losses in the year ahead. In 2014, it was the only co-op in the country to turn a profit from its plans offered under the new Affordable Care Act.
Michael Gendreau, a spokesman for the insurer, said the insurer is not going to close and that state regulators’ scrutiny after 2015’s financial hit “does not affect our member’s coverage whatsoever.”

Our View: Insurance co-ops should have federal backing

The still-new organizations have not been given the time or financial support they need.
Editorial - Portland Press Herald
In just a year, Community Health Options went from being a national success story to a company on the verge of insolvency. It would be tempting to blame that change on local management, particularly the decision to give hefty pay raises to its top executives.
But if overpaying executives killed health insurance companies, there wouldn’t be any still in business.


Our View: Maine prescription compromise won’t heal flawed health care system

Limits on opioid dispensing here are a good start, but the addiction epidemic grows out of national policies.
http://www.pressherald.com/2016/03/23/our-view-maine-prescription-compromise-wont-heal-flawed-health-care-system/

PNHP Report Card: 2016 Selected Presidential Candidates’ Health Proposals 

By Physicians for a National Health Program
Updated March 22, 2016

How to Stop the Bouncing Between Insurance Plans Under Obamacare

by Dhruv Cruller - NYT


In a fight between nurses and doctors, the nurses are slowly winning

More states are allowing nurses to provide all the kinds of care they learned about in school.

Amid a flurry of legislation to pass in the final days of spring state legislative sessions last week, nurses won two more victories in a long war for independence.
For decades, most of the country has required physician oversight for nurses to conduct certain procedures, and especially to prescribe drugs. But that’s slowly changing, as the nation’s health-care needs rise, and nurses fight for the right to practice everything they learned in school.
The most recent wins came in West Virginia and Florida, where after many years of trying, lawmakers passed measures freeing up “advanced practice” nurses — those with more graduate education than just a nursing degree — to administer a wider range of care and prescribe most drugs without having to maintain a relationship with a physician.


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