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Tag: Policy/Politics

POLICY/POLITICS: Health Reform may be back on the national agenda

Here’s my editorial from FierceHealthcare this morning.

This week may or may not have been a political harbinger for the coming years. Following a disastrous year for the Administration, Democrats have been claiming victory following wins in Virginia, New Jersey and California. Meanwhile, voters in California and Washington rejected measures that would have limited the activities (and incomes) of drug companies and trial lawyers. In Massachusetts, there may be the start of a compromise designed to get universal insurance (of a sort) for the state, and several other states are looking at the issue. Of course, nationally this will only mean something if the Democrats really carry their (so far modest) victories into the Congress next year and the White House in three years. That of course is a long time away. But health care is fast becoming the number one domestic issue and a Democratic majority will feel compelled to have another crack at it.

PHARMA/PHYSICIANS/POLICY: Oncologists getting paid for reporting data they should report anyway, by Gregory D. Pawelski

Congress has authorized the payment for oncologists reporting whether their treatment adheres to guidelines. Greg Pawelski, who follows the oncology market very carefully, was not too impressed.
When Senate Finance Committee Chairman Chuck Grassley found out that the value of the approximately $300 million-a-year medicare chemotherapy demonstration project to report on a patient’s level of nausea, vomiting, pain and fatigue was for nothing (providers were being paid $130 to simply forward the data that is already collected), they hoodwinked Congress into additional reimbursement to oncologists that report whether their treatment adheres to practice guidelines published by either NCCN or ASCO.

Looks like cancer patients will have to continue overpaying their oncologists and not have access to cutting-edge cancer treatments, and continue to suffer side-effect consequences and even death. The system will continue to serve the clinical investigators and the clinical oncologists, but not serve the best interests of cancer patients.

I think that the concept that some "authoritative" organization (made up primarily of practitioners and researchers with built in conflicts of interest) should determine the "correct" approach to cancer treatment has been very harmful to progress.

PHARMA/POLICY/POLITICS: Slick Willie syphons off big Pharma

Today is waste of money election day in California, brought to you mostly by the soon-to-be terminated Governor Arnold. But there are two other props on the ballot on which PhRMA has dropped more than $80 million to muddy the already muddied waters. It looks like Prop 78 which is nominally the one big Pharma "wants" to win and Prop 79 which is the one they actually want to lose (and the reason 78 is on the ballot) are both going down to defeat. Nonetheless I’ve had a voice message from someone claiming to be a surgeon in Fresno telling me to vote yes on 78, paid for by a host of drug companies (and admitting it as such, which is why I don’t think they want it to win).

But of course the really smart people in this state are extracting as much green from big Pharma as they can. The smoothest political operator of them all, former Speaker of the State House and former Mayor of San Francisco and the man whom is surrounded by but never touched by corruption Willie Brown, has successfully put some $500,000 of big pharma’s money in his pocket. Apparently he’s got the trial lawyers to stay neutral and conned some of the NAACP (who also know which way their bread it buttered) to actually support it. Way to go Willie! Sadly that gravy train will be over after today.

POLICY/POLITICS/TECH/HEALTH PLANS: Trown out in the trash

Politically this has been quite a week. Don’t you think that John Kerry just wishes that we had five year Presidential terms and that he was going into the election this November, rather than a year ago? This week even the great flip-flopper himself came out with a plan as to how to get our troops out of Iraq. Pity he laid off all the attacks till the election was over (and same with Al Gore too!). Bush keeps ranting on about final victory in Iraq as if he had any idea what the hell he was talking about, and that he hadn’t declared Mission Accomplished two years ago. Now he finds that most of the cabal running the country’s foreign policy for the past 4 years are on their way to disgrace and/or jail, and that his incompetence in choosing a secret wingnut instead of a well-known one for the O’Connor seat on SCOTUS has lost him (at least temporarily) the support of the loony right.

What has any of this got to do with health care?

Well as they say on The West Wing, there are a couple of stories sitting in my backlog that I want to throw out in the trash. First BusinessWeek had a profile of David Brailer, stressing that he honestly believes that there’s a free-market solution to interoperability in our current health care system. Well he’s even lost Neal Patterson on that one (and yup last year Patterson spent a fortune failing to get his wife elected to the House as a Republican). Meanwhile, another leading health care IT exec who wants to get himself elected to Senate as a Republican (Rich Tarrant of IDX) is sounding somewhat like a commie in his support for Medicare and Medicaid. (Hat-tip Don McCane) Finally there was an extraordinary long interview in the New York Times with the founders of AFLAC (itself a pretty useless insurance product) in which they showed that you can make a duck famous while having absolutely no idea about how to fix the US health care system, even if you vaguely understand the problem.

All of this leads me to believe that the business class that runs the country is somehow getting around to this problem, and that they might not object to it being solved. If the Administration’s problems continue to pile on for all the crimes and cock-ups they’ve caused us in the last five years, then next October we might, just might, get a change in the Congress and put us on the road to a Democrat in the White House in 2009. If that happens (and I know this is all speculation) then health care will have to be the first issue on the domestic burner — which is a little sooner than I’d predicted. All pure speculation just now, but this week might be the turning point.

POLICY: NY Times opinion on Medicaid

Shorter NY Times opinion on Florida Medicaid: It’s so screwed up that screwing it over more can’t make it any worse, and really Florida Republicans are deserving of our trust, as they’ve proved their fairness to their poorer and darker-skinned citizens so often in their history (as in the 2000 election).

POLICY/POLITICS: Linking Katrina, Medicare Part D and bird Flu

Here’s my FierceHealthcare editorial today:

FierceHealthcare has been following two stories all year that both had big moments this week. One is the avian flu that’s been popping up in Asia and may end up being as deadly as the 1918 epidemic. The other is the new Medicare Part D roll-out. For Medicare Part D, the complex mix of plans being offered to seniors will test their ability to understand the options on hand — anyone who’s bought insurance in the individual market knows that’s not easy — and will also challenge the Federal government’s ability to run and police a complex program with many different private and public agencies taking part. Given the nation’s recent experience with a similar challenge on the Gulf Coast, we can be forgiven for looking at the Medicare roll-out as the next great test of government, and hope that it shows improvement. Especially if we have a real crisis in the near future if avian flu becomes the pandemic we all fear.

PHYSICIANS/POLICY: Malpractice explained

Susan Sheridan, whom I wrote about last month, is even more famous. She and her son Cal who has kernicterus syndrome are the hook for a piece in The New Republic by Robert Berenson. (You may only be able to get to the first page…) It largely tells the truth about malpractice, but just to reiterate, my reading of the data is that:

1) The tort system only picks up about half of malpractice2) The medical system barely ever apologizes (Susan never got an apology), but when it does law suits are much less likely3) Too much of the money goes to lawyers and expert witnesses, and lawyers and Democrats don’t want to change that, but as they don’t hold power–so what.4) Doctors, whose Republican allies now do hold power, are only interested in reducing caps on damages, which may reduce their rates a bit but does nothing to help severely injured victims of malpractice and more importantly nothing much to reduce medical costs for the rest of us. (I live in California where we have the MICRA caps and my insurance premiums ain’t going down — sufficient proof to me that the Republican talking points about this are bunk).5) Defensive medicine makes the system and the doctors more money and until they stop getting paid for it, the whole "8-10% savings" concept is a myth6) Special courts, non-binding arbitration, apologies, openness, and a near-miss reporting system are all good ideas and are the eventual solution, but the AMA won’t back them, and their Republican allies won’t either. Why not? For them tort reform has nothing to do with patients, and not much to do with doctors, but much, much more to do with stopping what are mostly legitimate lawsuits against malfeasant corporations — and it’s much better if that all gets mixed up with an evil lawyer suing Marcus Welby MD in their PR campaign.

So unless there is some real concession from organized medicine, we’ll keep what we’ve got and it doesn’t work.  The "good" news is that it’s only a minor issue compared to the complete morass of the rest of the health care system.

(Hat-tip to Brian Klepper for the article)

PHARMA/POLICY/POLITICS: Well at least he gets to put “former FDA Commissioner” on his resume!

So just like that after a contentious time getting confirmed, FDA Commissioner Lester Crawford resigns, after only formally being in the job for less than three months (although effectively having basically run the agency for three years). I wonder what further skeletons have crawled out of his closet?

Get ready for more confirmation fatigue as the Administration searches for someone else ready to screw their reputation by placing politics (and deeply unpleasant, mean spirited politics at that) before science.

POLICY/POLITICS: The ugly side of American character revealed by Katrina, by The Industry Veteran

The Industry Veteran has been a little quiet of late. But you wouldn’t expect him to keep too quiet about an event like Katrina. Given the way that the whole thing has been turned into an Iraq-style feeding frenzy by the Republicans eager to run a privatized New Deal Mk II, here’s his sage perspective.

It’s interesting that even displays of shock and regret about Katrina, together with the belated recognition of larger problems concerning class and race uncovered by the hurricane, show an ugly side of the American character.  Read this op-ed piece from Harold Meyerson of the Washington Post and the LA Weekly.  He makes the point that American culture at its core is indifferent to the well being of the larger community.  With some minor qualifications, Meyerson is certainly correct.  This country was founded on the dark side of John Locke’s Whig philosophy, the idea that property constitutes the basis of liberty.  While “possessive individualism,” as it came to be called, can possibly be pushed in directions to show strong fellow feeling, its more typical implementation over the course of American history has been, “I’m looking out for me and mine, screw everyone else.”Reagan-Bush hucksters have self-righteously propagated the current incarnation of possessive individualism over the past 25 years by adding a fillip regarding the sanctity of markets.  According to their dogma, if any goods, services or social action appears desirable or necessary, a market will emerge to fill that need.  It is a manifest evil, according to these cowboy capitalists, for government to act in lieu of such a market or, even worse, to somehow alter the operations of an existing market to account for such an unmet need.  Of course if a market consisting of the poor and minorities makes it difficult to derive profits and, as a result, such a market is slow to emerge or never emerges, well, life’s unfair.  The free market fascists contend that government planning in the face of a market system’s well documented failures is, by definition, elitist.  Now here we have a natural disaster marked by the worst job of US government planning and response since the end of World War II and what do the Republicans propose to remedy the situation?  Well more of the same “free” market thinking that produced the problem should do the trick.  Doesn’t it make sense that generations of socially structured inequality can be remedied by granting liability exemptions to hospitals and physicians while businesses can be encouraged to hire the dispossessed by temporary exemptions from environmental safeguards?  Temporary exemptions from the estate tax will really help rebuild New Orleans as a city that provides greater opportunity, won’t it? See Wall Street Journal, 9/15/05.

The darker side of American character also helps explain the Democrats’ largely spineless failures to attack either the tactical failures or the pernicious social philosophy of Republicans.  The Democrats’ timidity comes from the fact that Republicans won the last two presidential elections, and all the off-year Congressional elections since 1994, by appealing to the dark side of the political center: prosperous suburbanites who aren’t terribly concerned about the general welfare.  As John Dickerson wrote in Slate, “For [suburbanites in SUVs], hurricane Katrina isn’t so much about race or poverty, it’s about homeland security—about what would happen if someone bombs their mall.”  The Democrats remain desperate to curry favor with this voting segment and only gauche party crashers such as Howard Dean will acknowledge that an understanding of hurricane Katrina requires us “to come to terms with the ugly truth that skin color, age, and economics played a significant role in who survived and who did not."  While the Democrats continually try to out-center the Republicans, the latter take the center for granted, favoring instead their fundamentalist and plutocratic bases.If studying social disasters is useful because they reveal a country’s underlying values and the way things really work, then I am even less sanguine about the prospects of significant health care reform than I was three weeks ago.

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