Kansas Health Institute

Blogs from here and there

Mayo, 22 other leaders encourage patient-centered reform

Feb. 23, 2010

In advance of the White House Summit on Health Reform this Thursday, Feb. 25, 2010, Mayo Clinic, along with 22 other organizations will run a full-page open letter Wednesday in Roll Call magazine to encourage Congress to come together on patient-centered reform. Our goal is to call attention to the issues that diverse interests have [...]

Payment Reform and Coverage for All a Step in the Right Direction

Feb. 11, 2010

We have been asked about the financial impact of health care reform bills on Mayo Clinic. We reiterate that both the House and Senate bills include important steps toward creating a more equitable and higher value health care system, consistent with the cornerstones of the Mayo Clinic Health Policy Center. We believe that reform provisions, [...]

Come Together on Patient-Centered Reform

Jan. 28, 2010

In his State of the Union address, President Obama urged Congress to continue to push forward and find a way to come together on health care reform. If we don’t act now, health care costs will continue to rise and more Americans will not have access to affordable, quality health care. The urgency for the [...]

Keep Patient-Centered Reform Moving Forward

Jan. 22, 2010

Reforming health care in America will not become easier with the passage of time. The status quo is not sustainable, and Mayo Clinic remains firmly committed to moving forward with patient-centered reform. We at Mayo Clinic encourage all stakeholders – government officials, patients, insurers, providers and employers – to work together to pass reforms that provide [...]

High Value, Affordable Care Will Benefit All Patients

Jan. 6, 2010

The Mayo Clinic Health Policy Center offers the following commentary in response to a Jan. 6, 2010 article in the Washington Post, “Health bills would shift Medicare money to Mayo and other ‘high-value’ hospitals.” We feel the primary goal of health care reform must be ensuring that all Americans have access to high quality, affordable care. Reforming [...]

OCR Update on Issuance of HIPAA HITECH Rulemaking

March 18, 2010

Update from Office for Civil Rights (OCR) on issuance of the Notice of Proposed Rulemaking (NPRM) implementing changes to HIPAA under the Health Information Technology for Economic and Clinical Health Act (HITECH). Health care organizations and health lawyers have been anxiously awaiting rules implementing and interpreting the changes because the effective date for many of the HITECH requirements was February 17, 2010. Of particular interest has been whether or not health care organizations are required to amend business associate agreement.The notice seems to indicate that the the date for compliance and enforcement may be delayed since it states that the NPRM "will provide specific information regarding the expected date of compliance and enforcement." However, covered entities and business associates need to weigh the risks of not complying with the new requirements while waiting for further clarification from OCR.The notice states:OCR will implement important privacy and security provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act through notice and comment rulemaking, as required by the Administrative Procedure Act. These provisions include: business associate liability; new limitations on the sale of protected health information, marketing, and fundraising communications; and stronger individual rights to access electronic medical records and restrict the disclosure of certain information. OCR continues work on a Notice of Proposed Rulemaking (NPRM) regarding these provisions. Although the effective date (February 17, 2010) for many of these HITECH Act provisions has passed, the NPRM and the final rule that follows will provide specific information regarding the expected date of compliance and enforcement of these new requirements.However, interim final rules implementing HITECH Act provisions in two areas have already been issued and are currently in effect: enforcement and breach notification. New civil money penalty amounts apply to HIPAA Privacy and Security Rule violations occurring after February 17, 2009. Covered entities and business associates must comply now with breach notification obligations for breaches that are discovered on or after September 23, 2009. OCR announced previously that it would use its enforcement discretion not to impose fiscal sanctions with regard to breaches discovered before February 22, 2010. Since that date has passed, OCR will enforce the Breach Notification Interim Final Rule, including with the possible imposition of sanctions, as it does with the HIPAA Privacy and Security Rule requirements.

West Virginia State Bar Issues Advisory Opinion 10-001 Clarifying Rule 8 Pro Hac Vice Admission

March 16, 2010

Today the West Virginia State Bar announced that the West Virginia State Bar's Unlawful Practice of Law Committee has released Advisory Opinion 10-001, relating to questions from attorneys regarding its interpretation of Rule 8 of the West Virginia Rules of Admission to the Practice of Law, relating to admissions pro hac vice.Advisory Opinion 10-001 addresses the following issues:1. Whether the requirement in Rule 8 of of admission pro hac vice extends to matters in which no action, suit or proceeding is pending;2. To what extent is the responsible local attorney required to participate in proceedings involving the attorney admitted pro hac vice;3. Whether presiding judicial officers can "excuse" local counsel form participation or "waive" the requirement of participating; and4. What limitations exist for attorneys seeking to be admitted pro hac vice, particularly their ability to be admitted on a frequent basis, or in multiple or consolidated actions.

AHLA Connections: Legal Implications of Health Care Social Media

March 10, 2010

The current issue of the American Health Lawyers Association's Connections magazine features an article I co-authored with fellow AHLA health lawyer, Jody Joiner, on the impact of social media use in health care.The article, Risky Business: Treating Tweeting the Symptoms of Social Media (PDF version), is featured in the March 2010 issue of AHLA Connections (Vol.14, No. 3, March 2010), a health lawyer magazine for the health and life sciences law community.We provide background context on the use of social media tools by health care providers, address why we think health lawyers need to understand social media, and explore some of the legal implications as social media and the law intersect. The article ends with practical guidance to health care providers and organizations on implementing policies emphasizing the appropriate use of social media.You can peruse the complete digital edition of the March 2010 AHLA Connections (Vol. 14, No. 3, March 2010). AHLA members should also check out the article in this issue on the recently launch Health Law Wiki. Great to see AHLA adding a wiki resource for members to share their expertise and experience in the complex and ever changing health care legal and regulatory world.Special thanks to the AHLA Connections staff for allowing Jody and I the opportunity to write the article and for their great editorial assistance.

Lesson for Hospitals and Health Care Providers: Photos of Shark Bite Victim

March 5, 2010

Martin Memorial too mum: Hospital staff violated privacy of shark victim, an article from the Palm Beach Post. The article highlights the impact ubiquitous mobile devices with cameras are having on our society and the potential liability risks associated with the use/misuse of these devices by health care employees.The article indicates that various hospital employees took photos of a shark bite victim when he arrived in the emergency room. The article discusses the action taken by the hospital in response to the incident. Another article indicates that the photos were emailed to others.This type of situation is a nightmare for hospital administration, the privacy officer and legal counsel. The effort and investigation that likely went into figuring out who took photos, where those photos went and the procedure for recapturing/removing the photos from the various sources was time consuming and expensive (both in $$ and reputation) for the hospital.As such, this incident provides a good example for training and reeducating health care employees on patient privacy issues. Health care employees and professionals must always remember to start from a framework of protecting the health and privacy of their patients. As the use of mobile devices with cameras and social media tools becomes more ingrained in our every day lives -- the ability for private information to be captured, transferred and spread in a viral fashion has become much easier. Caution must be used and this case highlights the importance of retraining staff and highlighting the importance of protecting your patient's privacy.

HITECH Law Blog

March 1, 2010

A warm welcome to fellow AHLA member and health law blogger, Kathie McDonald-McClure.I just ran across her blog, HITECH Law Blog. She focuses the blog on health information technology, privacy and security and the blog was named after the HITECH Act. Looks like a great addition to the health law blogosphere.Ms. McDonald-McClure is a member of the Health Care Services Team at Wyatt Tarrant & Combs, LLP in Louisville, KY.

Insurance Companies Cancelling Health Insurance of Sick Patients

Sept. 15, 2009

With President Obama’s speech to Congress last night outlining the details of his overhaul of healthcare in the United States, one interesting point popped up - the fact that Obama would guarantee that insurers could not reject people because of preexisting conditions. Health insurance companies are increasingly citing the failure to disclose preexisting conditions as a means to cancel policies and deny benefits to people in need of care. The term for this is "Post Claims Underwriting". What this means is that the insurance companies will not investigate someone for verification of entitlement to coverage until after they are sick and need the insurance. Of course, if they then determine the person is sick but not qualified they cancel the coverage and the sick consumer is left with no insurance. Insurance companies are using the term "rescission" to refer to the cancellation of insurance coverage due to a company being misled. Rather than trying to mislead companies, omissions of preexisting conditions seem to be honest mistakes by people filing out increasingly complex forms. There have been countless stories about how people have signed up for health insurance, only to have their policies later cancelled when they need care. No one knows how often policies are cancelled because of a variety of different state laws and policies in place, however, the practice has become rampant enough to result in numerous lawsuits and new regulations put in by states throughout the country. In the past year and a half, California has fined the five largest insurers in its state almost $19 million for cancelling the policies of individuals who became sick. One insurance company even admitted offering bonuses to employees who were able to find reasons to cancel policies. President Obama has been trying to gain support for his healthcare overhaul in part tapping into consumer dissatisfaction with the insurance industry, an industry that has never been popular among the American people. His plan for healthcare overhaul includes restricting insurance companies from screening for preexisting conditions, however, this still might not save people from having their policies cancelled. With new regulations, insurance companies might not necessarily cancel the policies of those individuals with undisclosed preexisting conditions, however, a company might institute further preauthorization requirements on services for certain patients, which might discourage such patients from renewing their policies. Lawsuits continue to be instituted against insurance companies who have cancelled policies. Rather than fight fraud, rescission has devolved into a backdoor route for insurance companies to stop paying the medical bills of people in their time of greatest need.

Coverage at the county level...

Aug. 19, 2009

Plenty has changed since 2006, the latest year that the uninsured of California was counted by the U.S. Census. But even then, many months before the current recession hit, the percentage of people living without health insurance in our state was startling. This week, the Sacramento Bee laid out the statistics, finding quite a disparity between those with health insurance and those without. Just in the five-county region The Bee covers, Yolo County posted an uninsured rate of 22 percent of people under 65, while the more prosperous Placer County -- with more employment-based coverage -- posted a 13.7 percent rate. That's quite a disparity, and the article by Phillip Reese and Anna Tong is worth reading. But the Bee doesn't limit information to its circulation area, it also posts online a comprehensive rundown of each of California's 58 counties' uninsured rate, along with an interactive map of the state and rollover charts. Here's a sampling of what the authors wrote: "The uninsured present an immense fiscal and public health challenge: 18,000 Americans die each year because they aren't covered, according to the Institute of Medicine, a nonprofit research organization. This is because having insurance is closely tied to health outcomes: The uninsured won't see a doctor regularly, and if they seek care it is likely to be inadequate or too late. Moreover, the uninsured are a cost for society: One economist recently estimated the tab at $56 billion per year, 75 percent of which is paid by governments. In cash-strapped California, that cost is critical: 6.6 million residents went uninsured in 2007, more than in any other state, according to the California Healthcare Foundation." You can bet that, with massive layoffs and small businesses closing since that Census count, the number of those among us -- members of our communities -- who are going without health insurance is a great deal larger. Factor in the Governor and Legislature's cuts in health and insurance programs for lower-income Californians, their children and the elderly, and you get an unimaginable sum of fellow Californians without access to affordable, quality health care -- notably, preventative health care, with better outcomes. This is what the conversation about health care reform boils down to, not pumped-up talking points and hyper-emotive protests based on misinformation. This is not a partisan issue. It is a people issue. And the bottom line is that the majority of Americans have already voted -- for substantive change for a better future for our country.

California Offers Lessons on Insurance Exchanges

Aug. 6, 2009

As Congress debates creating insurance "exchanges" as part of a health-care overhaul, the failure of a similar effort in California may offer important insights, former participants in the program say. From 1993 to 2006, small businesses in California could buy health insurance through an exchange run initially by the government, and later by a nonprofit group. The plan was undermined when some businesses with relatively healthy workers bought policies more cheaply directly from insurers, bypassing the exchange. That left the exchange with a shrinking pool of less-healthy workers, forcing rates higher and prompting many insurers to withdraw. Managers chose to shut the program in 2006 when one of three remaining insurers withdrew. "There are definite lessons to be learned," said John Ramey, who as former head of the Managed Risk Medical Insurance Board helped implement California's exchange. "We learned them the hard way out here." Among those lessons, he and others said: Employers and individuals who qualify must be required to obtain health insurance through the exchange. Failing that, John Grgurina, who ran California's exchange from 2002 until it ended, said government must impose rules governing rates and eligibility to protect the exchange from attracting a disproportionate share of high-risk people. An exchange aims to get better prices for coverage by banding together businesses and individuals. Insurers would have an incentive to join an exchange because they would gain access to more potential customers. Individuals and employees of businesses that participate in an exchange would be able to chose from the available plans and pay the same rate. Exchanges, either on a regional basis or a single national one, are likely to be a part of any final health-care legislation. Late Friday, the House Energy and Commerce Committee approved its health-care bill, though a full House vote won't come until the fall. President Barack Obama on Saturday praised the House committee's action and urged lawmakers to "build upon the historic consensus." The compromise proposal agreed to in the House Friday exempted more businesses from the mandate to provide coverage to their employees and offered subsidies to fewer individuals to buy insurance through an exchange, which would shrink the number of potential participants. Each of the three major bills -- one in the House and two in the Senate -- would create one or more exchanges. The specifics vary, but most of the proposals would impose more regulations than the failed California program, which analysts say would help the exchanges compete. Despite California's struggles, insurance exchanges are still the most effective way to expand coverage, said Elliot Wicks, a health-care consultant who wrote a report on the California program. The report, released last month, was commissioned by the California HealthCare Foundation, a private independent nonprofit. Veterans of the California effort said the ultimate effectiveness of any exchange would rest on details that have yet to be worked out. They said the pool of people in an exchange should be as broad as possible, to spread both risk and administrative costs. Click here for your free California health insurance now!

Public Health Insurance Would Be Too Good and We'd Like It Too Much

Dec. 17, 2008

A common thread is emerging in the right wing response to healthcare reform. Its opponents aren't claiming that public healthcare will be bad. Rather, they are terrified that the new system will be so good that no citizen would buy expensive private insurance--or vote for politicians who wanted to take public insurance away. The Obama team is sending clear signals that healthcare reform is a core economic issue, and the health insurance industry is becoming increasingly anxious by the future administration's determination to bring healthcare costs under control. Some Americans are seeing their healthcare premiums rising at four times the rate of inflation, if they have insurance at all. Healthcare reform is a pocketbook issue for all of us, according to the Obama team. In tough economic times it might be tempting to postpone healthcare reforms, but Obama is adamant that delay would be a false economy. In the American Prospect, Joanne Kenen and Sarah Axeen support claims about the high cost of doing nothing: A recent report by the New America Foundation's health-policy program estimates that the cost of doing nothing about health care, including poor health and shorter lifespan of the uninsured, is well above $200 billion a year and rising. That's enough to cover the uninsured and still have some left over for other public-health needs. If healthcare costs continue to rise at their current rates, it will cost $24,000/yr to insure a family of four by 2016, an 84% increase from today. At these rates, half of American households would have to spend at least 45% percent of their income to be insured. In the Nation, Willa Thompson describes how a bicycle crash made her appreciate the connection between healthcare and politics. Thompson was 21 years old when she suffered major injuries after a collision with a truck. Luckily, she was covered by her parents' medical insurance until she turned 22. She later realized that if she had been just a few months older when the accident happened, she wouldn't have been able to pay for her medical care. We all agree that something needs to be done. Let's briefly review the options that have been proposed so far. Obama wants to provide healthcare for all by requiring private insurance companies to cover everyone and creating a public health insurance plan to compete with private insurers. The second part of his plan is the public option that Republican opponents are so scared of. Click here for your free California health care quote now!

Why is single-payer health reform not viable?

Dec. 2, 2008

When it comes to health care reform in America, there is a relatively simple solution that will cover everyone's basic health care, control costs and save businesses, most people and the country a lot of money. It's called a single-payer health plan, where the government collects taxes to finance national health insurance. The government, which is the "single payer," covers all citizens and pays the bills when they visit private (or public) doctors, hospitals and other facilities for medical care. All would have basic coverage, regardless of whether they have a job, or where they work. Nobody gets billed for basic care. No-body goes broke because of medical bills. Yet this option has been declared "off the table" by Sen. Max Baucus, D-Mont., who's among those leading the charge for health care reform in America. Top Democrats who will be deciding policy in America in 2009, including Baucus and President-elect Barack Obama, say single-payer is "not politically feasible," because the public won't strongly support it. What they really mean is that when it comes to health care reform, they don't want a political fight with some of the nation's most powerful financial interests, which have the resources and the motivation to turn public opinion against meaningful reforms. These interests include the health insurance industry, pharmaceutical drug companies, some hospitals, highly paid medical specialists, medical suppliers and others who now profit handsomely from our current system - and who could no longer command those profits under a single-payer system or an alternative form of a national health plan. Californians, click here for your free health insurance quote now!

CBO Gives Democrats Good News On Health Reform

March 18, 2010

Breaking news this morning provides some cheer for Democrats on health reform. The Congressional Budget Office reportedly will release this afternoon a preliminary analysis of the Senate-passed health reform bill as modified by a separate “reconciliation” measure, and the numbers look favorable for Democrats. According to reports, CBO estimates that the combined package will cost $940 billion over the first [...]

Individual Market Premium Increases: The Debate Continues

March 17, 2010

Editor’s Note: Anthem Blue Cross of California, the largest health insurance company in California, recently announced plans to increase insurance premiums by as much as 39 percent for people insured in their non-group health insurance plans. There are two competing narratives about this dramatic and unprecedented premium increase, wrote Jonathan Kolstad and Neeraj Sood in a [...]

Can Health Care Investments Stimulate the Economy?

March 16, 2010

Editor’s Note: In addition to Dr. Leighton Ku (photo and bio above), the authors of this post include Dr. Peter Shin, an Associate Research Professor and Director of the Geiger Gibson Program in Community Health Policy at the George Washington University School of Public Health and Health Services, and Brian Bruen, a Lead Research Scientist and Lecturer at [...]

A Consumer Advocacy Group Refutes The Anti-Health Reform Myths

March 16, 2010

At long last, health reform legislation appears headed for a series of final votes in the next few weeks. The ultimate outcome in treacherous political waters is uncertain. What should happen, from the perspective of a consumer advocacy organization, is abundantly clear: Congress should pass legislation this year to begin dramatically improving health care access, [...]

The Way Forward On Child Obesity

March 15, 2010

Editor’s Note: The March issue of Health Affairs is a thematic issue focusing on the child obesity epidemic and supported by the Robert Wood Johnson Foundation. Two days after the issue and an accompanying series of policy briefs was released at a March 2 Washington DC briefing, the Senate Health, Education, Labor, and Pensions Committee held the first [...]

HEALTH POLITICS: Beaming Up Kucinich

March 18, 2010

Tim Egan at the New York Times has a terrific piece on liberal UFO-seeing Dennis Kucinich's decision to vote for health reform, even though he'd rather have a single payer system. It's a great, enjoyable read, but here's the gist:On Wednesday, he ended months of self-righteous defiance, deciding not to stand with every single Republican in Congress trying to block health care reform....If Kucinich had gone ahead as promised with a “no” vote, it would not have an asterisk next to it. It would simply be another no, putting him in league with Michele Bachmann, John Boehner and other congressional defenders of the costliest, most inefficient and least accessible health care system in the Western world.It is hard to write about Kucinich without noting his belief in UFOs. Egan, thankfully, did not resist that temptation. But while Kucinich may still believe in UFOs, perhaps he can at least help put an end to UIOs -- Uninsured in Ohio.  Health Policy Program

HEALTH CARE: Reading List for the Ten Minutes This Week You Were Not Focused on the House..

March 18, 2010

There are a couple of interesting health articles and studies floating around that we just haven't had time to focus on given all that's happening in DC. We were tempted to deem them read, but instead we'll reconcile ourselves to directing you to some other blogs that have smart things to say. 1) Pallimed, a terrific blog mostly by and for clinicans but accessible to anyone interested in palliative care and hospice, has done a good job of summarizing and interpreting the latest research on palliative care for patients living with -- not just dying from -- cancer. They also discuss why patients with advanced cancers end up in the ER. We were perhaps the first to write a major article in 2008 on palliative care for cancer in the outpatient setting, so the JAMA update was of interest. And our recent post on a cancer patient's unfortunate ER experience has generated a lot of discussion. 2) The Lucian Leape Institute at the National Patient Safety Foundation issued a very critical report on safety and med schools: Medical schools today focus principally on providing students with the knowledge and skills they need for the technical practice of medicine, but often pay inadequate attention to the shaping of student skills, attitudes, and behaviors that will permit them to function safely and as architects of patient safety improvement in the future. Specifically, medical schools are not doing an adequate job of facilitating student understanding of basic knowledge and the development of skills required for the provision of safe patient care, to wit: systems thinking, problem analysis, application of human factors science, communication skills, patient-centered care, teaming concepts and skills, and dealing with feelings of doubt, fear, and uncertainty with respect to medical errors. Maggie Mahar at Healthbeat blog and David Harlow at Healthblawg have more on the med school topic. Maggie addresses the culture of "shame and blame" in medical education, and Harlow notes that it's not enough to give a med student a course on safety, it must become "part of the basic fabric of training a physician, rather than an add-on." Health Policy Program

IN THE NEWS: Health Wonk Review

March 18, 2010

Minna Jung hosts the latest edition of the Health Wonk Review over at the Robert Wood Johnson Foundation's blog, The Users' Guide to the Health Reform Galaxy. In the March Madness edition, Minna weaves together all the top-scoring posts from the health care blogosphere. What does an NCAA basketball tournament have in common with health reform? Lots of "make-or-break, game-changing" plays. March Madness is just getting started, but it looks like policymakers could be warming up for their final round, with a House vote expected as early as March 21st. This edition features Joanne Kenen's post on palliative care -- check it out!(Make sure to put the finishing touches on your bracket this morning. Here's the president's, if you want some last-minute executive advice!)  Health Policy Program

HEALTH REFORM: Former Presidents Watch Their Weight, Too

March 17, 2010

Everyone has a different motivation for staying in shape. For Bill Clinton, Chelsea’s upcoming wedding to Marc Mezvinksy may have done the trick. (Learning that there are nearly 500 calories and 18 grams of fat in his Starbuck’s pastry of choice probably helped, too, of course.) The 42nd president spoke at a Newsweek-sponsored briefing this week, tying in to a cover story on Michelle Obama’s campaign against childhood obesity. The former president labeled childhood obesity the number-one public health problem facing the United States today. He blamed much of his own heart condition on childhood eating habits, insisting he had “food shoved down [his] gullet from the time [he] was an infant.” Both the size of the problem (literally) and the understanding of its impact on public health have intensified since Clinton left office. It wasn't a priority for his administration, but it has been for his foundation. The American Heart Association and the William J. Clinton Foundation in 2005 established the Alliance for a Healthier Generation. One focus has been sugary beverages in schools. Since embarking on the Alliance School Beverage Guidelines project, the group boasts an 88 percent decrease in total beverage calories shipped to schools between the first half of the 2004-05 school year and the first half of the 2009-10 school year. Shipment volumes of full-calorie carbonated soft drinks to schools were 95 percent lower in the first half of the 2009-10 school year than in the first half of the 2004-05 school year -- before the beverage guidelines went into effect. Clinton explained that he didn't ask the beverage and food industry to lower their profits. Instead, to engage them in the solution, he asked that they change their business practices, and generate profit in ways that are more sustainable and healthy. That could mean smaller portions or offering lower calorie drinks. And, he added, disclosing nutrition facts shouldn’t hurt the industry. Consumers are seeking information to make smart and informed choices. That in turn will induce the appropriate market response. (We've written about this too). Just this week, for example, Pepsi Co. announced that it will remove full-calorie sweetened drinks from schools in more than 200 countries by 2012 . Responding to consumer trends, PepsiCo is ramping up its “good-for-you” portfolio, churning about $10 billion in annual profits from its Tropicana, Naked Juice, Lebedyansky, Sandora, Aquafina, Quaker Oats and Gatorade brands. “If you want people to make the right choices, they need to have the right choices to make,” Dr. William Dietz, director of the CDC’s Division of Nutrition, Physicall Activity, and Obesity, told Newsweek. People have grown accustomed to big portions. A “medium” drink at McDonalds was 7 fl. oz. in 1955. By 2002, it had tripled. Similar trends occurred in other fast food and chain restaurants, from sodas to fries to main dishes. “Even age-old zoning laws work against us,” Newsweek’s Claudia Kalb explains. “A century ago, residential neighborhoods were separated from workplace factories to spare people from breathing in soot. Fast-forward to 2010: we live in subdivisions and drive to shopping centers and office parks.” But there's hope. “We have changed the recipes for more than 10,000 of our products to reduce fat, calories, sugar, and sodium,” says Scott Faber of the Grocery Manufacturers Association. As Kalb reports, salads are now offered at fast-food chains, KFC added grilled chicken to its menu (one grilled wing has 80 calories and one extra-crispy fried wing has 190 calories), Coke is selling a mini 7.5 oz. can and the 100-calorie snack pack trend is helping with portion control of many foods. Clinton of course left us with food for thought. The problems the U.S. faces are problems of old and wealthy countries. Making the world a better place for our children, he maintains, is something we can all agree on. We are the longest lasting democracy in the world, Clinton concluded, and that means we have to be young in spirit and need to embrace relentless change. (Or a relentless diet!) So, we laud the First Lady for her ambition, and the former President Clinton has strong faith in her too. As Mrs. Obama explains, “Our kids didn’t do this to themselves. Our kids don’t decide what’s served in the school cafeteria or whether there’s time for gym class or recess. Our kids don’t choose to make food products with tons of sugar and sodium in supersize portions. And no matter how much they beg for fast food and candy, our kids shouldn’t be the ones calling the shorts at dinner time. We’re in charge. We make these decisions … we can decide to solve this problem." (And, if you have any ideas about apps that could help get the ball rolling, submit them to the White House here.) Health Policy Program

COVERAGE: Decrease In Employer-Sponsored Insurance Hurts Middle Class

March 17, 2010

How is the American middle class faring under the employer-sponsored private health insurance system? For a lot of people, the answer is "not so hot."The Robert Wood Johnson Foundation has just released a report analyzing the decline in employer-sponsored private health insurance coverage in the last decade. Barely Hanging On: Middle-Class and Uninsured features a state-by-state analysis of where Americans are getting their insurance -- and how that coverage has changed since 1999. Across the board (all income levels and ages under 65) employer-sponsored insurance coverage decreased by 6.3 percent, while enrollment in public or government sponsored insurance programs increased by 4.5 percent.  All but a handful of states saw sizable losses in employer-sponsored insurance (ESI) enrollment between 1999 and 2008. The states hardest hit were Mississippi (with a 12 percent decrease), Rhode Island and North Carolina (10.2 percent decrease) and Missouri and Maryland (10.1 percent decrease). Massachusetts, North Dakota, Montana, and DC saw slight increases in ESI, but none greater than two percent. Also during this period, the number of people purchasing insurance on the individual market remained relatively stagnant, with an increase of only one-tenth of a percent. The decrease in employer-sponsored insurance coverage was particularly harmful to the middle class, argues the report, as declining enrollment in ESI outpaced middle class enrollment in public health insurance programs. The price of premiums has increased as well. At the beginning of the decade, the average cost of coverage was $3,067 for an individual and $7,904 for a family. By 2008, the cost for an individual was $4,386, while the family cost reached $12,298 -- increases of 43 percent and 55.6 percent, respectively. (And, as we’ve mentioned before, these premium increases are also outpacing income increases -- often by a ratio of ten to one.) Employer-sponsored insurance is important to the foundation of our current health care coverage system. Current health insurance legislation would help to build on and strengthen the employer-based coverage system -- while giving a lot of help to people who cannot or who no longer get insurance through their jobs. It would also help small businesses who want to cover workers but need subsidies or tax breaks to do so. Health reform calls for shared responsibility between individuals and employers, by including an individual mandate to purchase insurance, the establishment of insurance exchanges to enable people to shop around for quality, affordable insurance coverage, and requiring employers to either cover their employees or help pay into the system.Check out where your state stands by reading the full report here.Health Policy Program

"Medicalizing" Life

March 17, 2010

How much medical care do we want in our lives? H. Gilbert Welch poses this question in his excellent op-ed piece for the LA Times entitled, “The Medicalization of Life” and tells us that the answer will be vitally important...

The Top Ten Immediate Benefits Americans Will Receive When Health Care Reform Passes

March 17, 2010

Today, the Democratic Caucus of the House listed the provisions of the health reform bill that will take effect “as soon as health care passes,” The legislation would: Prohibit pre-existing condition exclusions for children in all new plans; Provide immediate...

A Culture of Fear and Intimidation: Reforming Medical Education

March 16, 2010

Even as we set out to reform U.S. health care, we continue to train medical students as if they were going to work in the old, broken system. Today, everything about medical education needs to be re-thought, from how we...

Lots of Bark, Little Bite in State Efforts to Block Health Reform

March 16, 2010

Last week, Virginia became the first state in the nation to pass a law that aims to block the individual mandate for health coverage, a key element of President Obama’s health reform plan. Virginia has a history of defying federal...

Do Democrats Face “Unmitigated Disaster” at the Polls if They Pass Reform?

March 15, 2010

Republicans continue to warn Democrats that if they pass health care reform, they will lose their seats in November. For what it’s worth, I believe that a fair number of incumbents (Republicans as well as Democrats) will lose their jobs...

How Reliable are the Dartmouth Atlas Estimates of Hospital Efficiency?

March 18, 2010

This is Peter B. Bach, writing in The New England Journal of Medicine: The predicted risk of death at the time of admission varied widely among hospitals. At the average hospital, the average risk was 15%. But the severity of illness was far lower in hospitals at the 10th percentile (6% risk of death) and far [...]

Spend, Entitle, Borrow

March 18, 2010

Over the period 2010 to 2020, CBO expects the Obama budget would run a cumulative deficit of $11.3 trillion… By 2020, total federal debt would reach an astonishing $20.3 trillion — [an amount equal to $58,670.52 for every man, woman and child in the country]. See full article by Jim Capretta at National Review Online. Source: Congressional [...]

How the Market for Long-Term Care Could Be Destroyed

March 18, 2010

The long-term care insurance ownership rate among those at genetic risk for developing Huntington Disease (HD) (50 percent) is five times the rate of ownership in the general population (10 percent). Furthermore, among individuals whose genetic testing shows that they are 100 percent at risk to develop HD, 50 to 75 percent own insurance… In [...]

But Can It Tell You If Your Lover Has Been Faithful?

March 17, 2010

Brain scan can apparently read people’s thoughts: The researchers scanned the participants’ brains while the participants were asked to recall each of the films. The researchers then ran the imaging data through a computer algorithm designed to identify patterns in the brain activity associated with memories for each of the films. Finally, they showed that those patterns [...]

Subsidizing the Rich

March 17, 2010

Source: Mark Pauly and Thomas Grannerman, Medicaid Everyone Can Count On, American Enterprise Institute, February 2010.

GlaxoSmithKline’s Evolving Business Model: For Profit and For Greater Good?

March 16, 2010

What is the modern business model? GlaxoSmithKline (GSK) CEO Andrew Witty is leading the front on modernizing pharmaceutical multinational companies (MNCs) with his recent announcement for a customized drug pricing scheme for emerging market economies like India. He outlined the new approach clearly in several interviews such as this one: “Our strategy is to grow our business [...]

Community Programming, the Final Frontier: Going Where No World Bank Evaluation Has Gone Before

March 4, 2010

On February 8th, the World Bank released a two-page summary of an evaluation underway to identify the effectiveness of the Community Initiatives component of the World Bank MAP, and how, if at all, it adds value to the national response. The evaluation—conducted in collaboration with DFID and the UK NGO AIDS Consortium—hopes to garner enough [...]

Death Toll from Haiti’s Earthquake in Perspective

Feb. 19, 2010

This is a joint post with Owen McCarthy. The January 12th earthquake in Haiti is the most lethal natural disaster of the past 20 years. On February 12th, the Associated Press reported that official Haitian government estimates of the dead had been revised upwards, now reaching 230,000 dead. Furthermore, the number could be much higher, since the [...]

FDA Goes Global: A New Approach to Food and Drug Import Safety

Feb. 12, 2010

Last week, I participated in an event at the Center for Strategic and International Studies (CSIS) in which U.S. Food and Drug Administration (FDA) Commissioner Margaret Hamburg announced a remarkable shift in the FDA’s thinking on food and drug import safety. If adequately supported by Congress and translated into concrete action, this change in strategy [...]

Daddy Healthbucks: How Will the Gates Foundation Leverage the New $10 Billion for Vaccines and Immunization?

Feb. 9, 2010

In announcing a $10 billion, decade-long commitment for vaccine development and immunization in poor countries, Bill Gates made no claims that the vaccine financing challenges are solved. Quite the contrary. He and many others have highlighted the need for other donors, industry and developing country governments to up their own ante to immunization. [...]

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