My weekly column is up over at Spot-on, and despite trying hard to avoid it, I’ve been forced into the murky waters of Medicare Part D and HSAs. There are no comments there, so feel free to come back here and comment. In addition there’s a new section on Medicare Part D and the Drug Debacle over at TPMCafe which I will at some point contribute to, when Josh Marshall hits the correct button on his keyboard.
Above the Fold
HOSPITALS/PHYSICIANS/POLICY: More data on specialty hospitals suggests the obvious
HSC is out with another study on local markets, and this time it’s looking at specialty hospitals. Not a new tune. HSC finds that purchasers in three local markets where there are plenty of specialty hospitals believe that the hospitals add to overall healthcare costs without improving quality. While purchasers may get lower prices from the new hospitals, they perceive that more procedures are recommended by physicians driving up their number of procedures and therefore overall costs. In addition, traditional community hospitals have been forced to compete by building new facilities, the costs of which get passed onto purchasers in the end, and have been raising their prices for services that specialty hospitals do not offer to compensate for their losses where the specialty hospitals have taken their business.
Yup, it’s all a scam. A war between docs and hospitals with the payers (and the taxpayer) picking up the tab. Of course, as discussed multo–times on THCB, if this was done within the context of some type of fixed budget, then maybe specialty hospitals or teams would be found to be the best way of delivering care. But in a FFS-based cost-unconscious system, they’re just adding to the death of health care affordability by a thousand cuts.
QUALITY/PHARMA: Statins in the water in the UK, but generic ones
And in more from the UK, statins are now going to be put in the water. Well not quite, but allowed to be given to anyone ever suspected of maybe in the future developing heart disease given to anyone ever suspected of maybe in the future developing heart disease, which in the UK is basically anyone.
Almost six million people in England and Wales — nearly 15 per cent of all adults — are from today eligible for treatment with statins under ground-breaking NHS guidelines. A report by the National Institute for Health and Clinical Excellence (NICE), which advises on best treatments, will recommend that anyone at risk of cardiovascular disease should be prescribed the drug.About 1.8 million adults in England and Wales currently take statins, which are thought to save 7,000 lives a year. Doctors believe that the new ruling will double uptake to 3.4 million people, saving another 10,000 lives a year.
While this might sound like fantastic news for the drug companies, I think that the decision might somehow be connected to the fact that most of the big statins (with the exception of I believe Lipitor and Crestor) have gone off patent in the UK, and one suspects that Pravachol and Zocor will be most popular!
POLICY/QUALITY: Assisted suicide, as rational as can be
In a remarkable front page story, the London Times has an excellent article on why assisted suicide should be legal in any rational country, as it is in Oregon and apparently Switzerland. The story is called Why a retired GP chose to end her life seven years before time and it shows how a determined lucid retired physician from the UK made the right choice for herself, but was forced to travel far from home to do so. Luckily her children supported her through the process, and they present a united front to those who’d interfere in the rights of those who want to make this choice. She wrote more than 100 letters explaining her actions.
On a personal note, my own grandmother made a similar choice and committed suicide when she felt the infirmities of her old age was making her life unbearable. She wrote me a loving letter that I received after her death, but unfortunately society wasn’t ready then to allow her to do it in a more public way, or to let us know it was coming. I wish that I’d had the opportunity with her that the GP’s children had with their mother.
POLICY/POLITICS: Ezra Klein skewers the HSA, Joe Paduda skewers the CDHP, with UPDATE
(This entry bumped up to top because of fun UPDATE)
Apologies for my later start this morning, those of you who follow my knee problems will perhaps be as pleased as I am to know that I spent the weekend snowboarding with apparently no ill effects on it! But it mean that there’s only limited fodder for THCB written over the weekend.
The good news is that while I’ve been slacking, over at Tapped, Ezra Klein skewers the HSA, reminding us that it’s a destruction of the risk pool. I suspect that educating Bush about health care is like the story of David Stockman trying to explain the budget to Reagan, and realizing that he never had a clue about the difference between real and nominal dollars. One of Ezra’s commenters also points out the obvious–that the HSA will do nothing to reform the underlying problems of the system’s cost explosion, and so is by definition a temporary fix.
Last year, when I bought health insurance for my law firm (me, my family, my paralegal and my secretary) I could get coverage with a five hundred dollar annual deductible for $1,900 a month. I looked through all the options and saw that a plan with a $5,000 annual deductible was $1,200 a month. If there was one with a $10,000 deductible it would maybe cost maybe $900 a month (guessing). With health-care inflation running at 8-10% a year that policy with a $10,000 deductible would soon be prohibitively expensive.
Meanwhile over on his Managed Care Matters blog, Joe Paduda skewers the CDHP, with a big assist from Alain Enthoven. Remember kids, the CDHP is the bastard child of a one night stand between a benefits consultant with nothing to sell and a right-wing think tank that can’t do basic math.
CODA: In the transcript of the debate between Enthoven and Reggie Herzlinger on the KaiserNetwork site, Reggie’s comments have all been excised. I wonder whether there’s censorship of some kind here, or whether she was so embarrassed at what she said that she asked for them to be pulled…anyone who knows the truth please get in touch!
UPDATE: Reggie apparently did ask the Kaiser people not to publish her remarks. So was she chicken embarrassed, or was it a bad hair day, or was she selling her schtick to someone else for an exclusive?
TECH/PHYSICIANS: Medtronic helps out whistleblowers, by The Industry Veteran
The Industry Veteran is back on his preferred way to make a buck in health care
Another whistle-blower makes good, this time on the device side of health care manufacturing. It appears that Medtronic pays spinal surgeons upwards of a half million dollars a year in bogus consulting arrangements (e.g., for eight days of work during the year) if these payees agree to use the benefactor’s products. What brightens the career prospects for whistleblowers in this suit is the fact that the plaintiff is not a scientist, a physician, a sales rep, an MSL or any of the usual types within either the clinical or the business operations. The woman here worked as a travel agent for Medtronic, in which capacity she arranged accommodations for the bribed surgeons. Her duties made her privy to the occasions where the amorality of business managers intersect with the usual conditions of gross immorality and psychopathic narcissism among physicians. The news here is encouraging. The day might dawn where the greed-is-good, corporate, fiduciary officers and the my-son-the-genius-doctors will have to fear their own admin assistants, office managers, temps, and maintenance workers. Well, probably not, but at least the possibility brings a smile.
TECH: JSK on Google
Over at iHealthbeat the ever wonderful Jane Sarasohn Kahn writes about Paging Dr. Google.
PHARMA/POLICY/POLITICS/PHYSICIANS: Tierney with some optimism on the DEA’s war on doctors
Writing (unfortunately behind the fire-wall) in the NYT, John Tierney attacks the Republicans as being the Party of Pain. With their attempts to stop the Oregon assisted suicide law, and the relentless attack of the DEA on pain doctors, the Republican conservative Christian establishment that captured the DOJ in 2001 continues to defy rationality. Tierney is hopeful, however, following the Supreme Court’s ruling in Oregon’s favor.
Of course we never needed to engage in this ridiculous vendetta against pain doctors anyway. In his harrowing long and excellent issue brief on the subject Ron Libby at Cato points out that Oxy wasn’t that big a deal anyway
A final problem with the DEA’s claims of an OxyContin epidemic is the agency’s inflated estimate of risk of death. In 2000 physicians wrote 7.1 million prescriptions for oxycodone products without aspirin or Tylenol, 5.8 million of them for OxyContin.55 According to the DEA’s own autopsy data, there were 146 "OxyContin-verified deaths" that year, and 318 "OxyContin-likely deaths," for a total of 464 "OxyContin-related deaths."56 That amounts to a risk of just 0.00008 percent, or eight deaths per 100,000 OxyContin prescriptions 2.5 "verified," and 5.5 "likely-related." Even those figures are calculated only after taking the DEA’s troubling conclusions about causation at face value.
So this is just a classic case of the DEA acting like the drunk looking for his keys under the lamp-post because that’s where the light is. And who suffers? Obviously the doctors in jail or ruined. And it’s not a issue for just a few pain doctors. Libby points out that between one in five and one in three pain doctors has been investigated by the DEA or local authorities. Would you keep doing your job if there was a one in three chance that you’d be investigated, maybe have your assets seized, and possibly be sent to jail for very long time just for doing it?
And why is it being done? Well the DOJ and local police departments get to keep all the money from asset forfeiture. In other words this is essentially theft with patients, doctors and the taxpayer picking up the tab
Tierney hopes that there’ll be a resolution to this:
The Supreme Court’s decision is a victory for patients and their doctors – including, I hope, some of the ones in prison for violating the federal legal theory that has now been rejected by the court. The doctors should go free, and Republicans in the White House and Congress should restrain the drug warriors who locked them up. When this year’s budget is drawn up, it’s the D.E.A.’s turn to feel pain.
These loonatics need to be stopped and whatever my political differences with Tierney and the Cato crowd I applaud them for getting this in the public eye. Unfortunately I think he’s being far too hopeful that any good will come of this given the number of theocratic fascists social conservatives still in the Administration and heading to the Supreme Court, and the current DOJ attempt to promote laws already overthrown by a (slightly) more liberal Superme Court.
BLOGS/TECH: Bloggers meeting, sadly without me
A group of tech bloggers are meeting at HIMSS at 8.30 pm on Sunday Feb 12th in San Diego at Hennessy’s Gaslamp pub. Sadly I wont be there as I don’t show up till the next a.m — being too cheap to pay for an extra night in a hotel and having non-refundable tickets and all — but Tim Gee, Neil Versel, Shahid Shah and maybe even MrHISTalk himself should be there.
POLICY: The future of retirement
In this book review of a couple of finance books in the New York Times, Neil Genzlinger is close enough to being right to remind us why we need to figure out the underlying problems in the health care system.
But as far as radical new ideas, the visionary approach would have been the blunt one: forget retirement planning. Hakuna matata. In the future, whether you have $15 million socked away or $1,500, nothing will matter – not food, not shelter, not golf, not active-senior communities – except health care benefits. Medical science, which already offers rebuilt knees and transplanted livers and faces, will soon offer new everything, but at a staggering cost. The Health Care Cabal will issue a one-page retirement plan: “In exchange for all your assets, including your children (and all their future earnings in perpetuity), the H.C.C. agrees to replace your parts as needed, while supplies last.” And everyone will sign it, because here in the have-it-all era, death is simply unacceptable.
