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Matthew Holt

Pelosi’s Hidden Tort Bomb — an Alternative View

Silver_charles_lgWe once thought Democrats would accept tort reform to win Republicans’ support for national health care legislation.  Now, however, Democrats have dispensed with bipartisanship.  Perhaps they think they can ram health care legislation through without any Republican backing.  Perhaps the price required to obtain even a few Republican votes was too high.  Perhaps Democrats received too much pressure from the trial bar.  Whatever the reason, neither the bill passed by the House nor the bill pending in the Senate contains any of the tort reform provisions Republicans want. To the contrary, the House health care bill is anti-tort reform.

Not only does it reject the entire slate of lawsuit restrictions Representative John Boehner put forward in the Republican alternative to the Democrats’ bill; it contains a provision that will reward states for scrapping damages caps and other tort reforms many already have in place.  This provision flew beneath the radar during the House debate, but the editorial board of the Wall Street Journal condemned it after the vote took place.  Describing the provision as a  “hidden Pelosi tort bomb,” the Journal editors predicted that “[i]f it passes in anything like its current form, we are going to be cleaning up the mess for decades to come.”

Most predictions that the sky will fall are wrong. This one is wrong as well.

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Abortion Should Not Imperil Health Care Reform

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By MELISSA REED

The House vote to establish near-universal health-care coverage came at a steep cost to women. That cost, issued as an amendment by Rep. Bart Stupak (D-Mich.), eliminates abortion coverage by private insurance companies even when women are paying for all or most of the premium.

Stupak’s amendment is a cynical attempt to push an anti-choice agenda that imperils badly needed reform. His amendment restricts women’s access to abortion coverage in the private health insurance market as well as in a “public option,” undermining the ability of women to purchase private health plans that cover abortion. It reaches much further than the Hyde Amendment, which has prohibited public funding of abortion in most instances since 1977.Continue reading…

Genetic Testing, Fact or Fiction: You Be the Judge

Which of these two events is fact and which is fiction?

  • Organizations representing employers and health plans call for a moratorium on implementation of the Genetic Information Nondiscrimination Act, asserting that the new rules could have a “significant and adverse impact…on wellness and prevention efforts” in the workplace.

  • One of the largest companies in America begins matchmaking its employees based on their genetic compatability, hoping to save on the health insurance bills associated with imperfectly bred children.

Answer: No. 1 is a Dec. 2 press release from the Disease Management Association of America. No. 2 is a description of the Dec. 8 episode of the ABC-TV comedy, “Better Off Ted.”

Coincidence? You be the judge.

2009: A Year of Surprises and Change for the EHR Technology Market

2009 began with a bang for legacy Electronic Health Record (EHR) vendors, promising strong sales and windfall profits on the heels of stimulus package incentive bonuses initially worth more than $19 billion to doctors and hospitals. But things changed dramatically along the way.

Here ten surprises and notable events that have impacted the EHR market:

Payment for Meaningful Use of EHR technology, not for the software and hardware itself.

The idea that using EHR technologies ought to produce improvements in quality of care, better communication with patients, enhanced safety, and better public health reporting — and that these outcomes ought to be monitored and providers held accountable for their achievement — was itself a surprising innovation in 2009.  It has to be counted among the best 10 health care ideas to come out of government in the past generation.Continue reading…

Four grumpy lefties with Laura Flanders

Maggie Mahar, Jon Cohn, Jon Nichols and Olga Pierce hang out with Laura Flanders on the amusingly titled GRITtv and discuss how screwed up the politics of health care are in the Senate. Twenty minutes of amusing chat without a “moderate” or a Rpublican in sight. (Can’t get the video to embed here, so sneak over there).

Health Journos Protest FDA Interview Rules

The Association of Health Care Journalists, the Society of Professional Journalists and 9 other scribbler groups have asked the Food and Drug Administration to lift its requirement that agency officials first get permission from the public relations office before speaking with reporters. The demand came in a letter sent to Principal Deputy Commissioner Joshua Sharfstein, who is running the FDA's Transparency Task Force.

Good idea. In fact, it should be extended to every government agency.

Why Wait Four Years?

I was struck during President Obama’s health care speech before Congress several months ago that the reforms he advocates would not go into effect for four years, until 2014. This timetable, too, is written into both the House and Senate versions.

Why the delay? It is hard for me to imagine, even given the federal rulemaking process, that it should take four years to establish an insurance exchange from which people can buy coverage. This is the exchange that would eliminate the nasty practices of insurance companies: Denying coverage because of pre-existing conditions; limiting annual or lifetime payments; and rescission of policies. It is hard for me to imagine, too, why it should take four years to fully deliver targeted subsidies to lower income people so they can afford insurance.

As noted by Princeton Professor Paul Starr in an article in the  New York Times earlier this week: “By comparison, when Medicare was enacted in 1965, it went into effect the next year.”

This leaves me with a bad feeling. It looks like the Obama team does not want implementation of the health care bill to take place during their first term. Why? Perhaps they know that the cost of the plan is higher than they are saying. Or maybe they know that the options available to consumers will be less attractive than currently portrayed.

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The Patient Safety Movement Turns Ten

On December 1, 1999, the Institute of Medicine released a report entitled To Err is Human: Building a Safer Health System. Although its authors hoped to spark a national movement, they had little cause for optimism. After all, early efforts by advocates like Berwick and Leape and organizations like the National Patient Safety Foundation had barely moved the needle of public and professional attention.

The IOM Report succeeded beyond its framers’ wildest dreams, and the movement they spawned turns ten today. Please indulge me while I spend a nostalgic moment recalling the remarkable spin that launched the patient safety field. I’ll then segue to a summary of my assessment of what we’ve accomplished over the past decade (I outline this more fully in an article in this week’s web version of Health Affairs, which I hope you’ll take a look at).Continue reading…

The Leaning Tower of Jello: Why No-one Believes Health Reform will be Deficit Neutral

President Obama has promised not to sign any health reform legislation that increases the federal deficit. This promise recognized rising public concern about an Argentinean fiscal trend that, unchecked, could leave us with $19 trillion in federal debt in a decade.

Without that pledge, given the current economic climate, health reform would be one dead mackerel.

Some clarifications are essential here. I’m a Democrat and fervent Obama supporter. I voted for him twice (and that was just in the Virginia primary). I’m proud of our President. He has first class economic and healthcare teams. He deserves credit for not postponing health reform. He’s right: it’s simply not tolerable, morally or economically, for a wealthy nation to continue having close to 50 million uninsured people.

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