A major focus of President Obama’s healthcare reform initiatives included over $1B in funding for comparative effectiveness research — a discipline designed to study the most efficacious, efficient, and low-cost methods for healthcare delivery. Perhaps the most basic scenario is defined by the study of two different pharmacological therapies for the same problem. A trial published in this week’s JAMAstates, however, that relatively few studies were devoted to this research modality, a cornerstone of Obama’s pledge to research better ways to deliver healthcare more cheaply. Only a third of 328 studies published in six top medical journals from June 2008 through September 2009 met the definition of comparative effectiveness, according to the investigators.
Naturally pharma companies aren’t invested in such matters, with the majority of funding for CE trials paid for by public sources. Typical pharma-financed trials are usually designed to show positive results. Although the need for unbiased, pure research is high given Obama’s admirable concern for such resource deployments, the road to drug research using such models is a long one filled with roadblocks — as long as Pharma has a stake. Perhaps a better way to ensure greater adoption of this initiative is not only to earmark a steady stream of federal funds targeted at comparative effectiveness research, but also to compare newer treatments with longstanding existing modes of treatments (pharma or otherwise) whenever possible.
Any momentum gained by President Obama when the issue of exorbitant insurance premium hikes was the healthcare topic du jour last month seems to be all but forgotten as Insurance continues to conduct business as usual. In Mass., the Blues in that state face fighting caps on their rates as its governor, Duval Patrick, reviews requests for increases of anywhere from 8 to 32 percent.
In California, the apparent epicenter of the firestorm over rate hikes, insurance companies seem loathe to change as well, citing the “increasing costs of healthcare” as a reason for those hikes. All of this movement by Insurance is forcing Obama to take his message to the public to get support for reform. He’ll begin his week by doing so today in Philadelphia.
Wise move? It’s perhaps his only move. With the GOP urging going back to the drawingboard, moderate Dems uneasy over the pricetag of reform ($1T), and House liberal Dems suspicious of Senate motives once the bill is passed; it appears that Obama is turning to the only group left to fully convince the utility of a healthcare overhaul — the American people. | LINK
It had all the trappings of a political football; a blue state’s extremely unpopular Republican governor — looking toward a possible presidential run a year after his term ends — used his partisan hardline to threaten veto of one of the most well-funded social programs for healthcare delivery to the state’s working impoverished, all the while setting the stage for a political attack on his character for all of the nation to see at the hands of the opposing party. The apparent newfound conciliatory stance taken by Minnesota governor and 2012 prez hopeful Tim Pawlenty concerning the threatened veto of GAMC headed this scenario at the pass, however, as the healthcare delivery safety net for thousands of the state’s working poor got a last-minute reprieve to continue being funded, albeit scaled back. Of course the negative PR surrounding a pending lawsuit by three beneficiaries of the program didn’t make eating crow any easier for the chief executive.
Though funding for the program was supposed to end on April Fools Day, the brokered change in funding commitment means that service providers will see less in reimbursements. Also,
[u]nder the agreement, hospitals will receive $71 million from the state’s general fund for the year starting July 1 and $131 million the following year. About 12 to 15 hospitals likely can start serving patients in the new program on June 1. For others not yet ready, $20 million will be set aside to pay for uncompensated care for six months.
The key is in acute care — often the first and only mode by which this underserved patient population will continue to receive care. With a decrease in monies to provide it — even with a grace period of sorts for charity care — the level of participation of acute hospitals is emblematic of both ongoing problems with funding (providing care) and simply surviving as they continue to operate in a program whose demand will only increase until reform is achieved on the national stage. | LINK
Physicians — especially those of the primary care type — are spared the potential problems that come with cuts in Medicare payments. At least for another month. President Obama has delayed the anticipated 21% cut in reimbursements while Congress has to take the matter up yet again.
Sen. Jim Bunning (R-KY) created a legislative frenzy last week when he placed a procedural hold on the bill that would have extended health care benefits to the unemployed for an additional length of time. That measure would have also allowed taxpayer subsidies to be used for premiums. Bunning relinquished his standoff yesterday, allowing this extension on cuts in payments to be avoided for another 30 days.
Polling, as a result, shows just how far cuts in Medicare payments to providers and provider organizations will go in threatening care delivery to a huge segment of the chronic care patient population — the same demographic responsible for the heaviest utilization of pharma, primary care, and acute care. Approximately two-thirds of primary care physicians polled by Medscape said they would cease to care for Medicare beneficiaries as a result of the cut.
An extension only holds off the inevitable, and although Senate Democrats are looking for ways to delay cuts further, there has to be a day of reckoning. That could come October 1, if senate legislators work to pass another bill [PDF] and try to reverse the SGR formula [PDF], which is responsible to establishing pay cut schedules in Medicare provider reimbursements.
With reform, the current band-aid strategy the Obama administration is using continues on its sloppy course.
President Obama’s healthcare summit has come and gone. The mere fact that this meeting took place in front of cameras was reason enough to discount any potential for real bipartisanship to occur. The upshot? The Republicans stand firm on their ground to rally against any Obama proposal as the party brands itself on this issue ahead of a potentially gratifying November midterm.
Meanwhile, the White House and the Democrats will say that every effort is being made to “forge ahead” amid the apparent obstructionist natures of the GOP. The problem for both parties is that the American public is becoming tired of what it sees as a spectacle. According to a CNN poll [PDF], 86 percent felt that government is broken, with 14 percent saying it isn’t. Of that 86 percent, 81 percent say the government can be fixed, with 5 percent saying it’s beyond repair.
Whatever the ultimate effect this televised meeting had on patients, lawmakers, physicians, insurance companies, and other interested parties; one thing’s for certain: closed-door meetings are the only way anything can get done. Political theater for the world to see accomplishes nothing but shallow grandiosity on the bumpy road to an ultimate reform bill. | LINK
Ready…set…yawn? With all of the fanfare surrounding this morning’s healthcare reform summit in Washington, you’d think that its organizers were pulling double duty with producing the upcoming Oscars. We’ve heard the eleventh hour rhetoric from all sides — the potential for bipartisanship at this late stage in the game and how “wonderful” it is to get this forum televised so that the American people can finally acknowledge the transparency President Obama and the White House have always wanted to characterize since he came into power.
But with all of the pomp, circumstance, and…hyperbole surrounding this morning’s summit, it seems the prevailing thought is more of a, well, an afterthought. Although Barack Obama has trumpeted the bipartisan get-together as having the potential to hammer out a last minute deal that will please everyone everywhere, the public seems to have already made up its mind about the state of reform today — and the court of public opinion shows collective ennui over the multiple set-ups for multiple letdowns. Reform fatigue has finally set in.
When the ultimate news item from today’s marathon session will more than likely echo the fact that nothing can be agreed upon of any substance, the public whom Obama so much wanted to convince that reform was within reach has already packed up and moved on. According to one private Medicare exchange’s polling, approximately 1700 of them have already done so. Mr. President, let the latest installment of this drama begin.
President Obama’s version of the reform bill (the one he is personally proposing and defending, come later this week) is getting a shot in the arm. Hoping to stoke public animus against the recent massively outrageous insurance premium hikes by Blue Cross in California and in other states, Obama will once again renew the call for a bill mostly on his terms.
Coming nearly a year after he put the push toward reform into overdrive, Obama will include the new provision that will allow the government (HHS) and states the power to bar or limit such increases — even demanding rebates for consumers of healthcare in such an environment. All of this is in anticipation for the bipartisan summit with senate Republican and Democratic leaders at which Obama will add previous provisions which include barring claims denials for pre-existing conditions, and a tax on HDHP (Cadillac plans).
Republicans are standing fast on their admonition to force Obama essentially to start from scratch, with a nod toward a more tepid bill with less obvious government funding. The showdown takes place later this week and will be televised. | LINK
UPDATE: The WH has posted Obama’s proposal summary. | LINK | At initial look, the president’s plan does not appear to repeal the antitrust exemption. | LINK [PDF] | Also, without public option language in the proposed bill (as expected), what’s next for each side? The heavily hyped bipartisan summit awaits this week. But what about afterwards? Assuming the Republicans stick to their guns, obliterating the WH’s strategy of forcing them to defend their antipathy toward the bill on fiscal grounds, will the party extend the drive for nay votes toward mditerms? Since the Dems are down by at least three votes, this could be likely. Perhaps, a protracted fight among both sides will be good for the bill’s ultimate passage on (mostly) Obama’s terms — then, and only then, will the true transparency of the proposed bill’s language come to light as Americans may use November as a referendum on health reform.
It’s a little hard to tell if President Obama is making the point below (in his weekly address) to drive home the message that (1) he has to do something to save face as his #1 domestic priority falters at the hands of parties bickering with each other like five-year olds; that (2) he’s clearly warning his own party that it risks another GOP Contract with America come November if the reform vote is not acceptable to the Democratic constituency; or (3) that, given the recent publicity with respect to Blue Cross premium hikes in at least six states, a massive PR gambit has to be undertaken to positively spin reform on any level.
Regardless, it is a primer of sorts for his upcoming and much-publicized session with congressional Republicans next week on enabling bipartisanship in getting a sound reform bill passed. (The text of his entire address is here — and below the fold.)
Minnesota Governor Tim Pawlenty is making good on his executive powers to slash the state’s budgetary expenditures the only way he knows how — via veto. Almost on cue, the state’s chief executive promised to do so in a letter [PDF], explaining that Minnesota simply cannot afford the almost $300M pricetag for a stopgap program designed to be a healthcare safety net to its working poor, the chemically dependent, the mentally ill, and homeless.[1]
Amid dwindling hopes of a Medicaid expansion of funds, Democratic legislators passed the measure by large margins in both House and Senate to extend the state’s GAMC payer program for another 16 weeks. The governor’s veto underscores his support for the alternative — enrollment of GAMC beneficiaries into another finitely-funded state program, MinnesotaCare. This program has come under fire by Pawlenty’s critics as being a worse choice for public healthcare financing of this patient population, because costs to cover this high-risk demo will essentially cost the state more (since funds are not from the state’s general fund but from the more restrictive Health Care Access Fund).
GAMC beneficiaries who transition to MinnesotaCare under the governor’s proposal will have to renew membership with the new payer when the transition period ends, increasing the possibility of the loss of coverage — only postponing the pending crisis to access to care, according to Democrats. An interesting time for a bill whose language stirs passions equally among ideological camps in Minnesota, and one that appears achievable — at least for another 16 weeks. | LINK
In spite of a veto, the MN Senate has enough votes on the Dem side to override, creating a cushion. [↩]
Hot on the heels of Insurance hiking premiums among policyholders in California comes a warning of sorts from HHS Sec’y Sebelius: California is not immune. In fact, the spectre of recent burgeoning rates seen at the hands of a Blue Cross/Shield plan subsidiary in the Golden Gate State is only the tip of a rapidly moving iceberg in a healthcare marketplace within which Big Insurance says it must remain competitive.
RI, CT, and OR were three other states cited in Sebelius’s remarks. As healthcare reform moves at a more restrained pace in the run-up to an eventual bill, there is no denying the market is seeing the effects of an economy far from recovery. As millions jettison more expensive coverage for the bare minimum, costs for care delivery are beginning to reflect payouts to plans for the sicker and older portion of the risk pools, creating even more urgency for Obama and company for reform as he has seemingly moved on to his other top domestic priority — jobs. | LINK
Unemployment still sits at double digits (approx 10%) in the U.S. At the end of this month, the extension of COBRA benefits for the newly and longer-term jobless is set to expire — unless the Democrat-controlled legislature passes yet another extension based upon President Obama’s so-called “paygo” law.
Emergency spending would be exempt from typical tax increases or cuts amidst the backdrop of a national deficit. Centrist Democrats, under pressure from more left-leaning colleagues, will probably ask for discretionary spending under this statute — further stoking the ire of Republicans who voted against it in the first place, citing a slippery slope over what would be deemed “emergency spending”. | LINK
The first study of the anti-CSF prototypes for treatment/reversal of Alzheimer dementia is underway.
The trial will measure in the cerebrospinal fluid (CSF) and blood plasma of amnestic mild cognitively impaired (MCI) patients the biochemical changes that are associated with AD and correlate them with the pharmacokinetics of the drug and its metabolites.
For California, the bleeding never ends. Today, Gov. Schwarzenegger releases his spending plan for 2010-11 which details even deeper cuts to its Dept. of Human Services.
A year ago, this blog cited a study which detailed the difficulties cancer patients faced when navigating the byzantine nature of health plans which essentially made it difficult, if not impossible, to receive life-saving treatments. The paper [PDF] went on to describe the problems these patients would still face even when eligibility requirements for government assistance via Medicare or Medicaid were at least partially met.
Either through ignorance of policyholders’ plans limitations or via the inability for their out-of-pocket costs to cover the difference, cancer patients have continued to face significant challenges in accessing crucial care. The verdict may still be out on the finer points of President Obama’s goals for reform, but Insurance does not really seem to be waiting for his signature on legislation to react.
With respect to one insurer, news comes of a cancer patient’s current fight to obtain treatment oncologists thought could save his life. Relapsing neuroblastoma has sidelined a five year-old’s life right now; his insurer has refused a new treatment option it deems as expiremental — in spite of covering a cheaper treatment in 2007 that was also called such, resulting in a full remission. The child’s parents are suing the carrier.
Advocates for insurance reform have taken a backseat in the reform debate, which is not surprising. Although, Obama has described his reform plans are not a referendum on reform of Insurance in a strict sense, it is apparent that sound arguments based upon solutions in the way coverage is paid and delivered need to transcend the rather simple promise of non-discrimination based upon claims denials.
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
DOCTOR PUNDIT @ ONE YEAR
Announcing a year-long series here at Doctor Pundit which reviews healthcare policy trends over the previous year and compares them with current issues. Catch the archives here.
Either through ignorance of policyholders’ plans limitations or via the inability for their out-of-pocket costs to cover the difference, cancer patients have continued to face significant challenges in accessing crucial care. The verdict may still be out on the finer points of President Obama’s goals for reform, but Insurance does not really seem to be waiting for his signature on legislation to react.
