January 4th, 2011 by PeterWehrwein in Better Health Network, Opinion
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1. Health care reform
How could the health care reform legislation that President Barack Obama signed into law on March 23, 2010, not be the #1 story of the year? Whether you are for or against it, the Patient Protection and Affordable Care Act is nothing if not ambitious, and if implemented, it will fundamentally alter how American health care is financed and perhaps delivered. The law is designed to patch holes in the health insurance system and extend coverage to 32 million Americans by 2019 while also reining in health care spending, which now accounts for more than 17% of the country’s gross domestic product. The biggest changes aren’t scheduled to occur until 2014, when most people will be required to have health insurance or pay a penalty (the so-called individual mandate) and when state-level health insurance exchanges should be in place. The Medicaid program is also scheduled to be expanded that year so that it covers more people, and subsidized insurance will be available through the exchanges for people in lower- and middle-income brackets. But plenty is happening before 2014. The 1,000-page law contains hundreds of provisions, and they’re being rolled out in phases. This year, for example, the law created high-risk pools for people with pre-existing conditions, required health plans to extend coverage to adult children up to age 26, and imposed a 10% tax on indoor tanning salons. Next year, about 20 different provisions are scheduled to take effect, including the elimination of copayments for many preventive services for Medicare enrollees, the imposition of limits on non-medical spending by health plans, and the creation of a voluntary insurance that will help pay for home health care and other long-term care services received outside a nursing home. Getting a handle on the complicated law is difficult. If you’re looking for a short course, the Kaiser Family Foundation has created an excellent timeline of the law’s implementation (we depended on it for this post) and a short (nine minutes) animated video that’s one of the best (and most amusing) overviews available. The big question now is whether the sweeping health care law can survive various legal and political challenges. In December, a federal judge in Virginia ruled that the individual mandate was unconstitutional. Meanwhile, congressional Republicans have vowed to thwart the legislation, and if the party were to win the White House and control of the Senate in the 2012 election, Republicans would be in a position to follow through on their threats to repeal it.
2. Smartphones, medical apps, and remote monitoring
Smartphones and tablet computers are making it easier to get health care information, advice, and reminders on an anywhere-and-anytime basis. Hundreds of health and medical apps for smartphones like the iPhone became available this year. Some are just for fun. Others provide useful information (calorie counters, first aid and CPR instructions) or perform calculations. Even the federal government is getting into the act: the app store it opened this summer has several free health-related apps, including one called My Dietary Supplements for keeping track of vitamins and supplements and another one from the Environmental Protection Agency that allows you to check the UV index and air quality wherever you are. Smartphones are also being used with at-home monitoring devices; for example, glucose meters have been developed that send blood sugar readings wirelessly to an app on a smartphone. The number of doctors using apps and mobile devices is increasing, a trend that is likely to accelerate as electronic health records become more common. Check out iMedicalapps if you want to see the apps your doctor might be using or talking about. It has become a popular Web site for commentary and critiques of medical apps for doctors and medical students. Meanwhile, the FDA is wrestling with the issue of how tightly it should regulate medical apps. Some adverse events resulting from programming errors have been reported to the agency. Medical apps are part of a larger “e-health” trend toward delivering health care reminders and advice remotely with the help of computers and phones of all types. These phone services are being used in combination with increasingly sophisticated at-home monitoring devices. Research results have been mixed. Simple, low-cost text messages have been shown to be effective in getting people wear sunscreen. But one study published this year found that regular telephone contact and at-home monitoring of heart failure patients had no effect on hospitalizations of death from any cause over a six-month period. Another study found that remote monitoring did lower hospital readmission rates among heart failure patients, although the difference between remote monitoring and regular care didn’t reach statistical significance. Read more »
*This blog post was originally published at Harvard Health Blog*
January 3rd, 2011 by EvanFalchukJD in Health Policy, Opinion
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Unconstitutional? How can the mandate to buy health insurance be unconstitutional? It must be some kind of misguided resistance to progressivism. Or maybe it’s someone finally taking a stand against a power-grabbing government program.
But it’s actually about something else entirely. And if you don’t know what it is, you won’t understand why the Virginia court ruled the way it did. Here’s the secret:
The U.S. Constitution grants to the federal government certain powers. These are things like raising an army, controlling currency and establishing courts. It also gives it the power to regulate interstate commerce, through something called the “Commerce Clause.” Everything else is the domain of the states.
Notice that the Commerce Clause only gives the federal government power over interstate commerce. The word “interstate,” in 1789, was probably easy to understand. Since the original 13 states were more like little countries, than part of one big country, the idea of trading goods from one state to another was identifiable as a special kind of thing. Read more »
*This blog post was originally published at See First Blog*
January 3rd, 2011 by Davis Liu, M.D. in Book Reviews, Health Policy
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The best book on health care reform — or surviving it — is the “The Innovator’s Prescription: A Disruptive Solution for Health Care.” The decade worth of research spent understanding, studying, and ultimately offering solutions to make the health care system more accessible, higher quality, and affordable is clear.
Unlike other books, the authors, respected Harvard Business School (HBS) professor Clayton Christensen, Jerome Grossman, a doctor who also was the Director of Health Care Delivery Policy Program at Harvard Kennedy School, and Jason Hwang, another doctor and graduate of the MBA program at HBS, avoid the traps the plague most other solutions by taking a completely different perspective by looking at other industries where products and services offered were “so complicated and expensive that only people with a lot of money can afford them, and only people with a lot of expertise can provide or use them.” Yet convincingly through plenty of examples, it shows how telephones, computers, and airline travel moved from only accessible to those with the resources to become available and affordable to all.
The book tackles every aspect of health care and asks how will those in health care be disrupted and subsequently surpassed by other providers which deliver care that is more convenient, higher quality, and lower cost. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
December 24th, 2010 by BobDoherty in Better Health Network, Health Policy, Humor, Opinion
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Today’s blog will be my last for 2010, as I will be taking a break to spend the Christmas and New Year’s holidays with family and friends.
In keeping with a tradition I started two years ago, I again have taken the liberty of mangling a beloved holiday song, story, or rhyme to give a humorous (I hope!) perspective on current politics. In December, 2008, I adapted “Twas the Night Before Christmas” to convey President-elect Obama as being a not-so-jolly old elf besieged by lobbyists demanding stimulus gifts. Last year, I depicted the GOP as the Grinch trying to stop “ObamaCare” from coming.
Today, I’ve re-written the “Twelve Days of Christmas” carol so that it is the government bestowing “gifts” (based on actual provisions of the Affordable Care Act) that the new Congress may later take away. (Of course, in the real world, the ACA’s changes won’t take place over 12 days, but over many years.) Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
December 21st, 2010 by Debra Gordon in Health Policy, Opinion
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“With this disappointing decision, the FDA has chosen to place itself between patients and their doctors by rationing access to a life-extending drug. . . We can’t allow this government takeover of health care to continue any longer.”
That quote, courtesy of this morning’s [Dec 17th] Washington Post, incensed me to such a degree that I am writing this blog despite the two deadlines I have today. The speaker is Sen. David Vitter (R-La). The “disappointing decision” he refers to: The FDA’s decision to remove the breast cancer indication for Avastin (bevacizumab).
I wrote about this earlier, and you can read the post here, but that was before yesterday’s [Dec 16th] decision. I’m not going to comment here on the benefits or risks of Avastin. . . except to say that I’m sure there are individual women who are alive today because of it, and, quite possibly, individual women who are dead today despite it. But that’s not how we do medical science, based on individual patients. We do medical science based on large clinical studies (which are often designed with and approved by FDA officials). It’s not a perfect system, but it’s the system we have. Read more »
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
