Month: July 2011

Bishops lack dignity

Jul 4, 2011

By Harris Meyer

The U.S. Conference of Catholic Bishops’ policy on physician-assisted suicide approved June 16 is the latest move by Roman Catholic leaders to intervene in Americans’ personal health care decisions.

The eight-page policy, which the bishops passed 191-1 at their annual spring meeting in Bellevue, Wa., is full of inaccurate and misleading statements about the Death with Dignity laws in Washington and Oregon and the policy positions of the laws’ supporters. It ignores 14 years of experience in Oregon and two years in Washington. The head of Compassion & Choices, the main group supporting those laws, rightly criticized the policy statement as “full of reckless, unsubstantiated accusations.”

The bishops’ statement warns that the voter-approved Death with Dignity laws — which allow terminally ill, mentally competent adult patients to receive medications from their doctor to end their lives – essentially legalize murder. And it makes the stunning claim that U.S. leaders of the Death with Dignity movement advocate ending the lives of people who have not sought help in dying.

“A society that devalues some people’s lives, by hastening and facilitating their deaths, will ultimately lose respect for their other rights and freedoms,” the bishops said. “Taking life in the name of compassion also invites a slippery slope toward ending the lives of people with non-terminal conditions.”

The new policy, “To Live Each Day with Dignity,” is the U.S. church’s first official policy on aid-in-dying, which also is legal in Montana under a 2009 Montana Supreme Court ruling. The policy follows increasingly aggressive efforts by the bishops to require Catholic health care facilities and providers to insert and maintain feeding and hydration tubes in terminally ill patients — even those who have written advance directives stating they don’t want them.

The bishops also have cracked down on Catholic hospitals that performed tube-tying operations for women who are not going to have more babies. Last year, a bishop expelled St. Charles Medical Center in Bend, Ore., a century-old hospital founded by nuns, from his diocese for refusing to stop performing tubal ligations. These policies matter because the bishops oversee more than 600 Catholic hospitals and the hundreds of Catholic nursing homes, assisted living centers, and hospices.Continue reading…

The HIT Hit: PPACA’s Health Insurance Tax

Jul 3, 2011• 3

By ROBERT F. GRABOYES

The 2010 health care law, the Patient Protection and Affordable Care Act (PPACA), hits small business with a barrage of inequities. Among the most egregious is the health insurance tax (HIT) launched by the law’s Section 9010. Ostensibly a tax on insurers, its real effect will be hundreds of billions of dollars of taxation on people who purchase coverage in the fully-insured market – mostly small business employers and employees and the self-employed. These are the people who usually generate around two-thirds of America’s new jobs.

In contrast, the HIT bypasses those who have coverage through self-insured plans – mostly big business, labor unions, and governments. Like PPACA’s essential health benefits and longstanding state benefit mandates, the HIT puts an anchor around the neck of small business while leaving larger organizations free to swim unburdened. And the anchor is a heavy one.

Over the first decade, the HIT will hit the fully-insured market with an estimated $87.4 billion tab, but that figure greatly understates the long-run financial impact. The tax is not implemented until the fourth year of the decade (2014) and is only fully implemented in 2018. The tax rises from $8 billion in 2014 to $14.3 billion in 2018 and in later years, even higher according to a complex (and at this point opaque) index, discussed below.

To put this in perspective, that $14.3 billion equals around 15 percent of the total small business expenditures on employee benefits in 2007. According to IRS data, proprietorships, partnerships, and corporations with up to $10 million in annual receipts deducted $96.8 billion that year for Employee Benefit Programs. An extra 15 percent or so constitutes an enormous blow to the ability of small businesses to compete against larger entities.

The HIT’s full magnitude will only become apparent in the second decade (2021-2030), when businesses and consumers experience 10 years of a premium-indexed, fully-implemented HIT. The second-decade cost is difficult to forecast, but may exceed $200 billion or even $300 billion. It all depends on how rapidly the law’s arcane index lifts the HIT beyond its $14.3 billion base in later years. There are two major sources of uncertainty in that index.Continue reading…

Never Say Never (Events)

Jul 2, 2011• 4

By BOB WACHTER

Earlier this month, the National Quality Forum released its revised list of “Serious Reportable Events in Healthcare, 2011,” with four new events added to the list. While the NQF no longer refers to this list as “Never Events,” it doesn’t really matter, since everyone else does. And this shorthand has helped make this list, which will soon mark its tenth anniversary, a dominant force in the patient safety field.

The NQF was founded in 1999 at the recommendation of Al Gore’s Presidential Advisory Commission on healthcare quality. For its founding chair, the organization selected Ken Kizer, a no-nonsense, seasoned physician-administrator who had just done a spectacular job of transforming the VA system from the subject of scathing articles and movies into a model of high-quality healthcare, a veritable star in patient safety galaxy.

Kizer’s original charge at NQF was to develop a Good Housekeeping seal-equivalent for quality measures (“NQF-endorsed measures”). But soon after he arrived, Kizer added another item to the NQF’s wish list: the creation of a list of medical errors and harm that might ultimately be the subject of a nationwide state-based reporting system. As Kizer said at the time,

This is intended to be a list of things that just should not happen in health care today. For example, operating on the wrong body part [or] a mother dying during childbirth. That’s such a rare event today that it’s generally viewed as something that just shouldn’t happen. Now, there’s probably going to be an occasion now and then when it happens and everything was done right, but it’s so infrequent that it means you have to investigate it every time it occurs. So “never” has quotes around it in this case. Now, wrong-site surgery is a different story—that should never happen. There’s no way that you should take off the right leg when you’re supposed to do the left one. So in this case, never really means never.

Unsurprisingly, the items on the list quickly became known as “Never Events.” Twenty-seven of them were announced in 2002, and the list was expanded and revised four years later. (This primer, written by my colleague Sumant Ranji for our patient safety website, AHRQ Patient Safety Network, is the best description of the list and some of its policy implications.)Continue reading…