August 3rd, 2009 by Happy Hospitalist in Better Health Network, Health Policy
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With regards to a compromise by Blue Dog Democrats on setting the rates for paying doctors:
Waxman’s committee resumed work Thursday, with the goal of finishing Friday, after a week-and-a-half delay caused by objections from fiscally conservative Democrats. That rebellion was quelled with an agreement Wednesday that would protect more small businesses from a requirement to provide insurance to their employees, and restructure a new public insurance plan so it could pay higher rates to doctors and other providers, among other changes.
What did the the other Democrats have to say about that?
“This agreement is not a step forward toward a good health care bill, but a large step backwards,” 53 Progressive Caucus members said in a letter to House leaders Thursday. “Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates — not negotiated rates — is unacceptable.“
Let me get this straight. In a world where Medicare and Medicaid pays less than cost, these Democrats want an option where doctors have the opportunity to lose money for every patient they take care of? If negotiated rates are unacceptable, exactly how is the Medicare rate acceptable. There is a reason why many Medicare and Medicaid beneficiaries cannot find a doctor to take care of them. Because the non negotiated rates are unacceptable.
Perhaps our Congressmen and women would like the 300 million Americans to take a yearly vote on the value of their service to this country. No negotiation. Majority salary wins. You just may not like what your constituents are offering you. And you just might quit. How’s that for unacceptable.
*This blog post was originally published at A Happy Hospitalist*
August 3rd, 2009 by KevinMD in Better Health Network, Health Policy
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Reducing health spending, as Congress is finding out, is difficult.
Some health economists have pointed to medicalization of common complaints, like erectile dysfunction and attention deficit hyperactivity disorder, as one reason. Indeed, Dartmouth researchers, who are cited as favorites of the current administration, feel that an “epidemic of diagnoses” is what’s making us sick.
But, Darshak Sanghavi writes in Slate that this may be a red herring, and clouds what’s really driving up costs, namely, the amount we spend prolonging the lives of the elderly. He points to David Cutler, an adviser to President Obama, and his analysis that “it costs far more to prolong the lives of the elderly ($145,000 per year gained) than the young ($31,600), and the rate of spending on the oldest Americans has grown the fastest.”
None of the current health reform proposals target this, understandably, because it would be politically difficult to tell elderly voters that we need to spend less on their care.
And because of that, Dr. Sanghavi rightly concludes that, no matter what gets passed, “we’re just putting off the day of fiscal reckoning.”
*This blog post was originally published at KevinMD.com*
August 3rd, 2009 by Dr. Val Jones in Announcements, Medblogger Shout Outs
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Today marks the fourth year anniversary of Emergiblog, a delightful collection of Emergency Medicine musings by nurse Kim McAllister.
Kim doesn’t know this, but I use excerpts from Emergiblog when I teach blogging courses to healthcare execs. Her writing is a favorite with them – and when I ask what kind of person they think she might be (judging from her blog) they say things like:
“An experienced nurse with a heart of gold.”
“Someone who’s seen it all and still kept her marbles.”
“I want her to be my nurse when I show up in the ER.”
I agree with all those sentiments… and I wish you a very happy blogiversary, Kim! I’ll see you in Las Vegas*
*Attention – anyone who reads/writes blogs should join us at Blog World Expo, October 15-17. This is our very first year for a special medblogger track. All are welcome!
Speakers include:
Kevin Pho – KevinMD
Dr. Rob – Musings Of A Distractible Mind
Kim McAllister – Emergiblog
Dr. Val – Better Health
Dr. Mike Sevilla – Doctor Anonymous
Paul Levy – Running A Hospital
Kerri Morrone Sparling – Six Until Me
Gene Ostrovsky – Medgadget
Terri Polick – Nurse Ratched’s Place
Nick Genes – Blogborygmi
Marc Monseau – JNJBTW
August 3rd, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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I thought everyone knew the major goal of health care reform is to control spending.
Then why are Democratic leaders proposing changes that would outlaw some of the most successful cost-savings programs in the country?
Today’s The Hill reports on the new strategy to attack insurance companies as “villains.” No doubt, health insurers have a bad reputation and have done plenty to earn it. As the Hill reports, the message is going to be that the reform plan will lead to “capping what [insurers] can force you to pay in out-of-pocket expenses, co-pays and deductibles.”
But for at least half of Americans – those who work for large and mid-sized companies and their families – their “insurer” is actually their employer. And many of these employers have been using out-of-pocket expenses, co-pays and deductibles to improve employee health, and reduce the cost of care. They are creating strong wellness programs and creating financial rewards and penalties, all based on employee participation.
As I wrote in April:
Companies like Safeway, Wal-Mart, Michelin, General Mills, Marriott and so many others have implemented programs to create a “culture” of wellness among their employees and their families. Leaders at these companies constantly talk about living healthy lifestyles, and are paying to make it happen. At Michelin, employees get a cash reward for getting a biometric screening and for participating in company-sponsored health improvement programs. It even started work-site exercise programs, including yoga (although it found that with a workforce that was 82% male it had to call its yoga classes “strengthening and conditioning”).
General Mills published wellness statistics about its different plants and found that the workers in each one competed with the others to get the best scores for BMI and other important health metrics. Marriott found that by eliminating co-pays on drugs for certain chronic diseases, more employees followed doctors’ orders to take them, and although Mariott’s drug costs went up, overall health expenses went down. Abbott Labs brings in motivational speakers and set up weigh-in kiosks in its offices that took pictures of employees as they got healthier so they could see the difference. All of these companies reported on enthusiastic participation, and a sense among employees that their company cared about their well-being.
Safeway has taken this idea even further, and redesigned its entire benefits plan around this concept. Employees who live unhealthy lifestyles and refuse to participate in wellness programs pay more for their health insurance — just like a bad driver pays more for auto insurance. Safeway did this in a highly positive and motivational way, making available a wide array of free services to help employees be more healthy and enjoy lower health premiums. The results have been dramatic: Steve Burd, Safeway’s CEO reported at the WHCC that Safeway’s health costs have been flat since 2005.
This Safeway model – creating both soft and hard incentives for employee health – is one of the fastest growing trends in plan design. The idea is to give employees control over their own health care, including financial responsibility. When this happens, employees live healthier, look for value in their health care spending, and overall costs are lower.
And yet the statements from the Congressional leadership suggest they want to severely limit these kinds of innovations.
It may be good politics to demonize the insurers, but we should realize that “insurers” aren’t exactly who we think they are. Health reform that stifles the innovation that’s working at America’s best companies is no reform at all.
*This blog post was originally published at See First Blog*
August 2nd, 2009 by Medgadget in Better Health Network, News
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Researchers at University of Rochester Medical Center injected mice that had spinal cord injury with a derivative of food coloring Blue Number One. The Brilliant Blue G (BBG) dye, which helps control the activity of ATP by blocking its activation of P2X7 receptors, was shown to help repair the injured spinal cords when treated animals even started moving their previously paralyzed limbs. Interestingly, it was recently discovered that excessive release of ATP, a compound typically known as a biological power source, augments tissue injury by activating these high-affinity P2X7 receptors.
University of Rochester explains:
“While we achieved great results when oxidized ATP was injected directly into the spinal cord, this method would not be practical for use with spinal cord-injured patients,” said lead researcher Maiken Nedergaard, M.D., D.M.Sc., professor of Neurosurgery and director of the Center for Translational Neuromedicine at the University of Rochester Medical Center. “First, no one wants to put a needle into a spinal cord that has just been severely injured, so we knew we needed to find another way to quickly deliver an agent that would stop ATP from killing healthy motor neurons. Second, the compound we initially used, oxidized ATP, cannot be injected into the bloodstream because of its dangerous side effects.”
Neurons in the spinal cord are so susceptible to ATP because of a molecule known as “the death receptor.” Scientists know that the receptor – called P2X7 – plays a role in regulating the deaths of immune cells such as macrophages, but in 2004, Nedergaard’s team discovered that P2X7 also is carried in abundance by neurons in the spinal cord. P2X7 allows ATP to latch onto motor neurons and send them the flood of signals that cause their deaths, worsening the spinal cord injury and resulting paralysis.
So the team set its sights on finding a compound that not only would prevent ATP from attaching to P2X7, but could be delivered intravenously. In a fluke, Nedergaard discovered that BBG, a known P2X7R antagonist, is both structurally and functionally equivalent to the commonly used FD&C blue dye No. 1. Approved by the Food and Drug Administration as a food additive in 1982, more than 1 million pounds of this dye are consumed yearly in the U.S.; each day, the average American ingests 16 mgs. of FD&C blue dye No. 1.
“Because BBG is so similar to this commonly used blue food dye, we felt that if it had the same potency in stopping the secondary injury as oxidized ATP, but with none of its side effects, then it might be great potential treatment for cord injury,” Nedergaard said.
The team was not disappointed. An intravenous injection of BBG proved to significantly reduce secondary injury in spinal cord-injured rats, who improved to the point of being able to walk, though with a limp. Rats that had not received the BBG solution never regained the ability to walk. There was one side effect: Rats who were injected with BBG temporarily had a blue tinge to their skin.
More from National Geographic…
Abstract in PNAS: Systemic administration of an antagonist of the ATP-sensitive receptor P2X7 improves recovery after spinal cord injury
Press release: Common Food Dye May Hold Promise in Treating Spinal Cord Injury
*This blog post was originally published at Medgadget*
