AHIP’s response to Sicko. Lined up in “cut to” style with answers but no questions so that it can be dropped into local news (check out the weird “B-roll” at the end). And again some of what she says is reasonable, if not a real reflection of what most of her members have been doing for the last 7 years.
But always the lie, always. She just can’t help it! Go to minute 1.00 of the video. Note what she says about Canada. And then take a look at the data.
Jonathan Weiner, Professor of Health Policy and Management at Johns Hopkins, tells it like it is in a great interview at Managed Care magazine. It’s so good I’ve extracted several real zingers. I particularly love the last one about “getting the government out of the way of the market.” Here’s a selection:
“Other developed countries have come to two realizations that we have not come to. One is that it is immoral — or at best, amoral — not to provide health care to everybody if we believe that basic health care is a sign of a developed country.”
“The second realization is that other countries acknowledge that the collective — social insurance programs like the sickness funds of Germany, government agencies, or third parties that look very much like our insurance or managed care companies — cannot provide everything for everybody.”
“When managed care plans, working mainly as agents for employers and government, tried to make some necessary changes and do the right thing, nobody would let them. We shot the messenger. We’re lousy at doing what’s necessary in our health care system. Tightly controlled managed care as envisioned in the ’90’s in the Clinton reform plan is not managed care today. I’m a big supporter of good forward-thinking managed care on the part of executives and clinicians, and I definitely support the appropriate role of the market and consumerism. But we can’t lose sight of population-based care and public policy issues that don’t come naturally to managed care organizations facing pressure every quarter to make a profit and keep investors happy.”
“Within a generation or two, we’ll see the positive side of health information technology. Health care will actually get more humane, with more human interaction and more communication, because the technical side of what doctors do now will be handled by the electronic box. Things like figuring out what tests should be ordered, what drugs should be used, looking at an EKG and comparing it to the evidence will all be done better by electronic systems, using algorithms developed by doctors at places like Cleveland Clinic and Johns Hopkins. Doctors will need to be communicators, facilitators, coordinators, and coaches. I believe that model will favor women doctors, because they happen to be better at those skills.”
“Every advanced HIT system I’ve studied — the British, Hong Kong, Kaiser Permanente, and Geisinger Health System in the U.S. — has a centralized rational entity that looks at the big picture and sees itself as being in this for the long haul.”
“Our health care system is the most expensive in the world by a factor of two, and the most inefficient probably by a factor of three. Yes, we pay our doctors and administrators more and patients who get care get a lot more, but a lot of the cost difference is due to waste. We need clinical research of the type funded by NIH, and we need more operational population-based research. The Agency for Health Care Research and Quality is terribly underfunded now, and once genomics come more fully on line, research into cost effectiveness will become even more important”
“I serve on the Medicare Coverage Advisory Committee, an academic group, and I can tell you that Medicare has nowhere close to the authority it needs. There’s a lot of good people at CMS trying to do a good job, but their hands are tied by legislation. In most cases, they are not allowed to look at cost-benefit issues.”
“Q: Who’s persuading Congress to maintain the status quo? WEINER: Device manufacturers, pharmaceutical companies, everybody and their mother. God bless Big Pharma for keeping the new technology coming out. We may all need it one day, but it doesn’t all work equally well, and it certainly isn’t all cost effective. We cannot as a society pay for everything for everybody. That is absolutely impossible and totally unethical as long as we have 18,000 people a year dying — the equivalent of fifty 747’s going down — because they lack health insurance. My tone and tune will change once we have basic health care for all. We are a rich country and we absolutely can afford it, as long as we operate within a budget.”
“When a young doctor or medical school dean tells me that in this country the market does what the market should do, and government should keep out of it, I tell them that’s fine, as long as they’re willing to return the million and a half dollars in federal and state subsidies for each doctor trained. A plastic surgeon practicing in the fanciest suburb in any city gets more of a subsidy than the family doctor practicing in an inner city or rural area, and that’s not right. Moreover, the plastic surgeon can make a half million dollars a year, while the inner city doctor is making a hundred thousand.”
So there’s a movie called Sicko out and it has the right really riled up. Why? Because Michael Moore has adopted their tactics of using somewhat out of date anecdotes without any real data. At the least he’s made a teeny TV celebrity of Stuart Browning who’s now been on shouting matches on cable twice according to emails he’s sent me. And then into my email box the other day plopped this review at the American Thinker from someone called Peter Chowka, who apparently doesn’t like socialism and the bunch of know nothing, greedy Americans who are apparently ready to abandon the paragon of market efficiency that is our health system, because they think that some other approach might just cover a few more people at a lower cost—I mean just because all those foreigners do it how dare anyone think that we Americans might? Here’s some of Chowka’s rant:
From start to end, SiCKO, the latest "documentary" from notorious writer and filmmaker Michael Moore, is a stunning example of the Big Lie. Almost shockingly devoid of fact and context, it’s instead based on highly selective, emotionally-driven, and deeply flawed anecdotes, strung together by writer-director-producer Moore’s trademark folksy, soft-spoken, whimsical personal narrative. SiCKO (the unusual capitalization is Moore’s conceit) is not a documentary at all, but a naked propaganda exercise on behalf of full-bore socialism. A better title for it would be Pinko.
Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of Money-Driven medicine: The Real Reason Why healthcare costs so much, an examination of the economic forces driving the healthcare system.
In its June
2007 report to Congress, MedPac (the
Medicare Payment Advisory Commission) highlighted one of the dirty secrets
of our healthcare system: as a nation, we are currently spending billions
on drugs, devices, surgical procedures and diagnostic tests without
having a clue as to whether they are effective. The reason, MedPac explained:
we have very little âcomparative-effectiveness researchâ that provides
head-to-head comparisons of various treatments for a particular malady.
Meanwhile,
the Medicare commission observes, âMany new services disseminate quickly
into routine medical care without providers knowing whether they outperform
existing treatments, and to what extent. For example, a recent study
showed that inexpensive diuretics may control hypertension as effectively
as expensive calcium-channel blockers (ALLHAT 2002).â
One might think
that the FDA would require that a manufacturer show that its new drug
or device is better than existing treatments—at least for some patients.
After all, new medical technologies are almost always more expensive,
so wouldnât you think they would have to be âimprovedâ in order
to be âapprovedâ?
Think again.
Thatâs not the FDAâs job. The FDA exists simply to decide whether
the benefits of a particular treatment outweigh its risks. Thus, in
order to pass FDA scrutiny
manufacturers need only test their product against a placeboâwhich,
as MedPac notes, is what most do. In other words, they demonstrate their
treatment is âbetter than nothing.â
Somehow last week in the midst of one of the busiest working months of my life I managed to squeeze in a little time with Peter Orszag who’s the new-ish Director of the Congressional Budget Office. Or as he called it the “soon to be Congressional Health Care Budget Office.” Peter is a true convert to the cult of Wennberg, and so we had a real meeting of the minds. He has started telling his story to all who’ll listen, and given the power of the CBO in Washington, plenty of important people are listening.
Go read his testimony on health care and the budget (PDF) (similar html here) from earlier this week. Pay particular attention to the figures which you can click on directly in the PDF navigation menu—especially the charts on the variance in costs for Medicare recipients by region (#3) and the impact of the current trends on future Medicare costs (#4). If enough politicians pay attention, then the second biggest problem in health care (practice variation) might get addressed at the same time as the first (lack of universal coverage).
He’ll also be having the CBO in future produce some slightly more synopsized and bite-sized reports, but for now there’s more data on their web site and you can subscribe to RSS feeds of their latest reports. I feel a blog coming on….
Meanwhile it won’t surprise you to know that the first hearing on any comprehensive health care reform legislation since 22 June 1994 is happening tomorrow, when the Wyden bill gets a hearing before the Senate Budget committee. If you want a clue as to how it’ll go, the line up on the panel is Len Nichols, Ph.D., Director, Health Policy Program, New America Foundation; Sara R. Collins, Ph.D., Assistant Vice President, Program on the Future of Health Insurance, The Commonwealth Fund and Arnold Milstein, MD,Medical Director, Pacific Business Health Group.
Luckily there were no problems in the health care system between the end of 1994 and the middle of 2007, so it didn’t matter that Congress ignored the issue.
Thank God the lunatics have at least had their charge of that part of the asylum taken away…
John Cohn on Michael Moore–Fan-fucking-tastic. It’s called “Will Michael Moore’s Sicko help or hurt the universal health care movement?” Go read it.
Ezra Klein takes the wider view on Moore’s attack on American exceptionalism, equally worth it.
As for me, well over at Spot-on I manage to link Sicko with the other big release this week…
Strange things are afoot in the normally rarefied world of health care
punditry. It’s going primetime. And I’m blaming Steve Jobs.
Come back here to comment.
It looks like it might be the end for King Drew, or as it’s known now, King–Harbor. Some of the LA board of supervisors are in favor of closing the hospital immediately, and yesterday the State of California initiated proceedings to revoke its license. No one can pretend that this hasn’t been coming for quite some time. A couple of years back, a long series in the LA Times found incredible graft, mismanagement, and corruption and appallingly poor care quality at King Drew. Given the hospital’s origins after the Watts riots of the 1960s, and its special place in the African-American downtown community, doing anything to King-Drew has always been politically charged issue. But after the recent incidents, particularly the one where the woman was left to die on the floor of the emergency department waiting room while nurses ignored her, and cleaning staff swept up around her, the hospital seems to have finally run out of defenders.
On the other hand, this is emblematic of a wider problem in American health care—how do you provide care to the poor in a system where there is no universal coverage or systemic primary care? Bob Sillen, who now runs California’s prison health care system, but used to run Santa Clara Valley Medical Center used to remark that if there wasn’t a County Hospital in which to showcase how the poor were treated it would be impossible to get any attention on to the issue.
So it is my hope that as we enter a period of concern about the future of universal insurance coverage, we don’t abandon the extremely limited safety net that is in place for the poor while we all focus on fixing the wider systemic problems.
This kid (young man’s name is John Heineman) is swimming the English channel to raise money for a free clinic in Iowa. His aunt wrote to me pointing it out, and he certainly sounds like a very interesting and incredibly determined guy. He’s combining an interest in health policy with charity work and incredible sporting fortitude/insanity. Even thought he went to Oxford, I wish him lots of luck.
Of course the picture is for enjoyment of the female/gay readers of THCB!
Nothing new for you wonks, but there’s a good summary article by Susan Brink in the LA Times today about the international comparison stuff. It’s called Care in need of a cure.
The NY Times gives an op-ed to a crackpot called Henry Miller who used to be a minor official at FDA and is now with the other loonies at Hoover. It’s called Crackpot Legislation in which he goes after those states allowing smoked medical marijuana as medicine. In this op-ed he apparently with a straight face can say this:
When presented with a cannabinoid development program that comports with modern scientific principles, both the F.D.A. and the D.E.A. have demonstrated their willingness to allow it to proceed.
This is complete and utter bullshit. The FDA has with the rest of the US government (including the crackheads at NIDA) in preventing the use of marijuana in clinical trials and medical testing for decades, despite the IOM study. Here’s a statement from a DEA judge (!) on the topic in March.
"NIDA’s system for evaluating requests for marijuana for research has resulted in some researchers who hold DEA registrations and requisite approval from the Dept. of Health and Human Services being unable to conduct their research because NIDA has refused to provide them with marijuana"
Two tiny smoked marijuana studies (including the Abrams one he cites) have been finally allowed after decades of pressure from academics, and now Sativex is being allowed into clinical trials because a) it has a pharmaceutical company behind it which is going to make money off it, and b) because the Brits and Canadians have already allowed it on the market. That action, after thirty years of preventing research into the medical usefulness of marijuana for purely political reasons, does not suggest anything like what Miller calls “willingness.”
Miller thinks that the FDA should be allowed to regulate marijuana. But of course the US government already does regulate marijuana. It’s been a schedule 1 drug, banned since 1937 by Congress incidentally against the then wishes of the AMA with no debate. So what is the FDA’s likely vote on the matter now? To continue the ban of course. Which is why medical marijuana proponents are opposing the amendment to allow the FDA to regulate them, as it’s a back door way of outlawing the progress made at the state level.
The NY Times should be asking itself why it’s allowing such a bunch of half-truths to be published when somewhere between 60 and 80% of Americans are in favor of legalizing medical marijuana, and it’s abundantly clear to anyone that the reasons for the continued ban is the politically and economically-inspired persecution of people who want to use marijuana—whether for medicine or pleasure.
And if Miller really thinks that the current drug-policy powers that be will allow Sativex to get past the FDA and be openly sold in the US, then he really is a crackpot.
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