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Above the Fold

After Nurses Investigation, Scrutiny Turns to Other California Health Boards

Jul 24, 2009• 4

By ALEXANDRA ANDREWS Nurse_computer_flickr_20090721

Earlier this month, ProPublica and the Los Angeles Times published an investigation detailing the failure of the California Board of Registered Nursing to investigate and discipline nurses accused of misconduct in a timely manner. An examination of all disciplinary cases from 2002 to 2008 found that the board took an average of more than three years to investigate and close them — while the nurses accused of wrongdoing continued to practice without restriction. The day after the story was published, Gov. Arnold Schwarzenegger replaced most members of the board, and its longtime executive officer resigned the day after that.

The fallout has continued. There have been a slew of follow-up editorials and articles in California newspapers. One, in the Los Angeles Times, said of the governor's response: "This time, he acted to protect patients, but where was the gubernatorial outrage when the state Board of Chiropractic Examiners, which included several of Schwarzenegger's friends, was accused in a state audit of similar failures to put consumers first?"

Another, in the San Francisco Chronicle, suggested that "Schwarzenegger shares a measure of blame too: his imposed work furloughs will slow investigations, and his administration should have been on the problem earlier."

Costs v Coverage: Krugman gets it–Brooks is almost quite close

Jul 24, 2009• 11

By Matthew Holt

So Paul Krugman, the NY Times Nobel Prize winning lefty columnist, says this (and echoes what I’ve been saying for a while)

So where in America is there serious consideration of moving away from fee-for-service to a more comprehensive, integrated approach to health care? The answer is: Massachusetts — which introduced a health-care plan three years ago that was, in some respects, a dress rehearsal for national health reform, and is now looking for ways to help control costs.

Why does meaningful action on medical costs go along with compassion? One answer is that compassion means not closing your eyes to the human consequences of rising costs. When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers — but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.

So universal coverage systems find that they can’t just let the health care system increase costs because there is no safety valve of the uninsured to dump out of the system. We’re all in it.

Can HR 3200 Be Fixed?

Jul 23, 2009• 55

By ROGER COLLIER

Washington-united-states-capitol-washington-d-c-dccap1 Health care reform looks like it’s stalled. And rightly so, based on the provisions of the House Democrats’ health care reform bill. The grossly misnamed America’s Affordable Health Choices Act (HR 3200) combines the worst of all possible worlds: high taxpayer costs, big increases in federal deficits, and disincentives for businesses to hire, while leaving up to twenty million individuals still uninsured and doing little or nothing to control runaway national health care expenditures.

Although the bill would make health care coverage available to many of the millions who currently cannot afford it, its provisions will potentially add some $200 billion a year to federal expenditures, make only miniscule reductions in Medicare cost trends, and impose play-or-pay provisions and a new surtax that could hurt smaller businesses just as they try to recover from the recession.

So, is there anything that can be done to fix HR 3200 so that it would provide affordable universal health care coverage without increasing federal deficits or halting the recovery from the recession?

Rantology: Sympathy for the blue devils?

Jul 22, 2009• 21

By Matthew Holt

I do have some vague sympathy for the Blue Dogs, the group of mostly red-state Democrats who have to pretend that they care about fiscal responsibility. They, like me, think that we shouldn’t be increasing taxes on the non-health sector to pay for universal coverage. Unlike me they think that we should be reducing any commitment to universal coverage by reducing the level at which subsidies for people mandated to buy health care coverage cut off—which will leave us in a situation with lots of people who forgo coverage because they can’t afford it. I of course think that we should be finding the money to cover the uninsured from within the 16% of GDP we already spend on health care and then ratchet that overall number down, but then again I don’t have to get elected to Congress.

But I do have one modest question. Where were the dogs/devils’ concerns about the deficit when George Bush was borrowing for the future to pay for income and dividend tax rebates for the very wealthy, by invading Iraq and hiding the accounting, and by creating the boondoggle that was the Medicare Modernization Act. Now it’s late at night and I’m not going to go chasing voting records from 2001–3. But I sure have my guess….

More on the politics of health care reform:

Op-Ed: Reform- Why have our objectives been abandoned?

Jul 22, 2009• 23

By DR. ALBERT WAXMAN

In the campaign of 2008 and the first six months of 2009, the call for healthcare reform has been a refreshing and important theme. It has been widely recognized that

1. Healthcare costs are out of control. You cannot have healthcare expenses inflating at 8% in an economy that is growing in the best of times at 4%. (today, the current inflation rate is negative 1.3%)

2. 47 million Americans need coverage

3. 14,000 Americans lose their insurance everyday

4. Medicare is in peril, and along with Medicaid, the combination of ever-increasing costs are the main drivers of this government’s budget deficits that threaten our economic future.Continue reading…

Commentology

Jul 22, 2009• 6

THCB reader JB wrote us to say: Commentology

"I guess you guys are probably aware of the huge backlash that is going
on with various medical societies around the US, due to the AMA and
other physician groups endorsement of HR 3200, and the subsequent
"meltdown" of this bill??

State medical societies and
associations are "seceding" from the AMA, and threatening to further
distance themselves from AMA because their memberships massively
disagree with the purpose and positions of this proposed "healthcare
reform bill."

State Medical Associations, specialty groups
(American College of Surgeons, American College of Physicians, American
Academcy of Pediatrics, etc.) are all in full back-pedal spin mode to
try and fend of their furious doctor constituent-members, who generally
were ambushed by their professional societies full-fledged endorsement
of HR 3200.

This has created multiple rifts, and further
undermined support of this measure, even though Obama and Pelosi want
the public to believe this abomination of a bill is fully endorsed by
organized medicine as well as physicians in general. NOTHING could be
further from the truth."

Health “reform”: Lest we forget…

Jul 21, 2009• 17

By Matthew Holt

There’s been a lot of hand-wringing and b.s. discussed about the comparatively minor health reform that’s snaking its way through Congress. And when I say comparatively minor I mean it. Mostly because there’s lots this legislation doesn’t do.

1) There’s no significant reform of how we pay for health care—even though Orszag, Obama et al want it, and maybe Rockerfeller will inject the “MedPAC as Federal Health Board” into the end result….but I doubt it.

2) There’s no significant change in how we raise money for health care. Employment-based insurance stays as it is. Medicare and Medicaid basically stay as they are. Even if there are NO revenue sources for extending care to the uninsured, it’s still only a roughly a 5% increase in the cost of health care. If you hadn’t noticed we get that increase every year anyway! (By the way CBO actually scores the economics as being significantly better than that).

3) There’s no significant tax increase. Well the apologists say so, but the proposed tax increase on very high earners is trivial compared to how well they’ve done in the last twenty years. The chart below shows the share of overall earnings since the 1980s.

The Doctor Is In and Logged On.

Jul 21, 2009• 15

By RAHUL PARIKH

Parikh Wow. I’ve just taken care of three patients in 12 minutes, and I didn’t do it by “churning” them through my office as if it’s some sort of factory assembly line. Rather, those patients (their parents, more specifically — I’m a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms.

One mother attached a digital photo of a rash on her 3-month-old daughter’s face; it turned out be nothing more serious than baby acne (it’ll go away in a month or so). Another mom had noticed that her son was missing one of his pre-kindergarten immunizations (she had pulled up his shot records online) and requested that I order it. And the father of a 5-month-old boy told me that his son has been constipated off and on for the last month. I e-mailed him a questionnaire so I could determine whether the family should try something at home or bring the child to the office.Continue reading…

Op-Ed: The Unintended Consequences of “No Pay for Errors”

Jul 21, 2009• 3

By BOB WACHTER, MD

Medicare’s policy to withhold payment for “never events” – the first effort to use the payment system to promote patient safety – remains intriguing and controversial. To date, most of the discussion has focused on the policy itself at a macro level (including two articles by yours truly, here and here).

In the past month, experts on two of the adverse events on the “no pay” list – hospital falls and catheter-associated urinary tract infections – have chimed in. Interestingly, while agreeing that the overall policy has upsides and risks, they came to strikingly different conclusions about the wisdom of including their pet peril on the list.

Let’s begin with UTIs. Last month’s Annals of Internal Medicine article by Michigan’s Sanjay Saint and colleagues begins, quite cleverly, with a quote from Ben Franklin: “By failing to prepare, you are preparing to fail.” Turns out that among Franklin’s many inventions was the flexible urinary catheter (so who the hell was Foley?). The piece nicely reviews the “no pay” policy and describes the epidemiology of catheter-associated UTI (CAUTI).Continue reading…

We love Paris in the Springtime: Health 2.0 announces Europe 2010

Jul 20, 2009

By Matthew Holt

We’ve had great participation in Health 2.0 Conferences from Europe and across the globe, and today we’re delighted to announce that we’re going to be holding a Health 2.0 Conference in Paris on April 6–7, 2010. It’ll be at the Cite Universitaire, which is a beautiful building in the southern part of Paris, with hidden inside it a very modern conference facility.

The conference will be called Health 2.0 Europe 2010 and it will be a unique experience. We will integrate the best of European web/mobile based technologies, and compare, contrast and contextualize them with leading examples of Health 2.0 from North America. We’ll be seeing what works in the context of Europe’s evolving health care systems, whether there are commonalities across European systems that can lead to economies of scale (or not!), and what the “boundary-less” online world means for consumers and physicians working in distinct health care systems.