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.
What could possibly be worse for patients as the current state of reform (tune in tomorrow) is more uncertain than ever? According to a JAMAstudy [PDF], the fact that more physicians are cutting hours — not just primary care docs, but most physician demos across most specialties. Reasons are myriad, but the one essential kernel remains: the increasing layer of oversight (administrative and managed care constraints) has slowly but steadily gained a prominent foothold into how much time a physician can actually devote to seeing patients. According to one family physician
“It added five or six years onto my practice life – and I love what I do,” [Virginia family physician] Dr. Ellington said. “I couldn’t have continued to do what I was doing. I couldn’t do it physically, emotionally and financially. It had become overwhelming.”
And it will only get worse — at the very least for the primary care physician who is already burdened with heavier admin and paperwork hassles, lower pay, increasing patient loads, and lower Medicare reimbursement schedules. | LINK
Pennsylvania and Hawaii are the only two states in the country that do not have a mechanism in place for the regulation of premium rates set forth by insurers as it applies to their small businesses — a demographic courted heavily by both Republicans and Democrats as players in the final direction of pivotal health reform. The Pandora’s Box cast wide open by the recent Anthem BC scandal is adding a new critical layer of scrutiny not only to Barack Obama’s reform trajectory, but also to the ways in which Insurance market fluctuations influence the overall cost of healthcare delivery and access.
Implications for the these two states are obvious, as government regulatory oversight could go a long way in keeping the relationship between small business and the insurance they purchase an open, transparent, and freely accessible system for consumers of healthcare (patients), giving states’ insurance commissioners added muscle. Alternatively, control of regulatory processes by the federal government could add just another layer of bureaucracy (read: increased administrative healthcare costs to the taxpayer and shifting rising costs to other entities — like Pharma) to an already overburdened HHS Dept. Over the next few days, the unfolding issue of federal gov’t Insurance regulation over state’s private insurance markets will become a hot-button one, adding some eleventh-hour drama to the health reform debate. | LINK
Legislative grilling in California begins today for Anthem Blue Cross, the insurer whose efforts to increase some average premiums by almost 40% did not go unnoticed by the White House. Wellpoint, the payer’s parent company, will begin its time being questioned before a special state House committee tomorrow. Although the most likely effect of such questioning will be the negative national PR that has accompanied it, the excessive scrutiny of the company’s books will almost certainly provide the impetus for local reform in this area at the hands of state legislatures as it applies to other insurers — eventually leveling the playing field in the Insurance marketplace.
In other Anthem Blue Cross news, a California man’s breach-of-contract trial with the insurer has just begun.
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 often said that the beleaguered emergency department (ED) is the initial point of care for many patients. In this current broken healthcare delivery system, that means an umbrella which “covers” the uninsured as well as those who are underinsured. The total cost for these points of acute care notwithstanding, how is the best way to explain new numbers out of the CDC this week?
The CDC’s National Center for Health Statistics reported the numbers in its annual summary of U.S. data on disease conditions, health behaviors and use of medical services. The scan figures are based on visits to roughly 500 hospitals and 3,000 doctor’s offices and outpatient clinics.
According to this survey data, the CDC says that the use of imaging modalities in the ED has quadrupled since the mid-1990s. Besides being just another point of confirmation of the origin of skyrocketing healthcare costs in this country, the heavy emphasis placed on tech will not abate anytime soon. Issues pertaining to defensive medicine, integration of such tech into ingrained training of new physicians, and the cost of using such technology within the medical device market are all good reasons to try to begin attacking this startling — yet, unsurprising — statistic. | LINK
Vanderbilt University (my undergrad alma mater) has announced that it has access to a special blood test that can predict a patient’s risk for heart disease. Using genomic factors, along with the patient’s age, history of stable chest pain, and gender — the assay (dubbed Corus CAD) offers a non-invasive alternative in stratifying coronary disease risk.
The test was developed as a part of a new medical field called genomic medicine, which enables doctors to further personalize patient care based on the unique genomic makeup of individual patients — an important factor for many visiting the doctor. For this reason, the blood test interests many physicians.
Count me among those interested.
On a more dour note, there is renewed interest in the recall of rosiglitazone (Avandia), the Glaxo drug with known associations in causing cardiac disease and risk of death; confidential studies via officials in the FDA are recommending the drug’s withdrawal from the market, potentially leaving Pfizer’s pioglitazone (Actos) as the only market alternative in this class to treat diabetes mellitus, type 2.
The company has faced criticism that it has known about the heart-attack risks associated with Avandia for years. Glaxo added a “black-box” warning to Avandia in November 2007 that says the drug can cause or exacerbate congestive heart failure. The company has also faced accusations that it attempted to intimidate scientists and doctors outside the company who raised questions about the safety of Avandia. The company has said that it didn’t try to intimidate anyone.
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.)
Last Februrary, Medicare fraud once again took center stage; a Tampa, FL-based managed care outfit was outed by the federal government for intentionally hiding Medicare payments in a specially created private entity called Harmony Behavioral Health. Citing administrative costs as the reason for diversion, WellCare Health kept for itself state funds meant for mental health services and delivery. If there were any reason in the heat of Obama’s reform rhetoric in 2009 to rail against the government’s mishandling of its own Medicare reimbursement policies (as part of shoddily run MA plans) as being part and parcel of the overall increase in the cost of healthcare delivery — it was quite apparent with this case.
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
What’s the healthiest county in the state in which you live? A new survey just published by the RWF finds what is essentially common knowledge in the healthcare policy blogosphere — that persons in more rural counties fare worse than their urban counterparts with respect to decreases in healthcare access, increases in premature death, increases in hospital admissions for the treatment of highly preventable conditions, among other findings.
These findings should come as no surprise, because all (healthcare) politics is local, right? Here in Minnesota, research findings such as these take on an entirely prescient meaning — as our Governor is proposing enormous cuts in spending within the budget this cycle in order to balance it. The vast majority of those cuts are occurring in within the Dept. of Human Services, particularly its wholly funded General Assistance Medical Care public payer program. | LINK
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.
Citing administrative costs as the reason for diversion, WellCare Health kept for itself state funds meant for mental health services and delivery. If there were any reason in the heat of Obama’s reform rhetoric in 2009 to rail against the government’s mishandling of its own Medicare reimbursement policies (as part of shoddily run MA plans) as being part and parcel of the overall increase in the cost of healthcare delivery — it was quite apparent with this case.
