Healthcare Professionals for Healthcare Reform

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Update in Health Care Policy and Health Care Reform

With the elections over and the economy suffering one of its worse period since the Great Depression, it is easy to believe that efforts to change health care will fall by the wayside, as it has so often in the past. Indeed, with the withdrawal of former Senator Tom Daschle, arguably the personification of health care reform, from consideration for Secretary of Health and Human Services, it seemed that reform took a major hit even before it could start.

But it appears that the Obama administration and the 111th Congress were already quite committed to getting some meaningful reform through. This was evident with the passage and signing of the often vetoed SCHIP bill in late January followed by several important provisions in the $787 billion economic stimulus bill signed by the president on February 17th.  

The final bill provides $87 billion of federal money to the states for Medicaid allowing them to continue to fund the program, and prevent people from losing coverage at a time when the need will probably keep growing. For those workers who lose coverage when they lose their jobs, the bill offers financial help with interim coverage.

Under the 1986 Cobra law, workers can temporarily keep group health benefits, but the cost is often prohibitive because they must pay the entire premium, including the employer’s share. Under the stimulus bill, the federal government would offer premium subsidies, paying 65 percent of the cost for up to nine months.

The measure also provides more than $19 billion to digitize medical records and link up doctors and hospitals with information technology. It includes new safeguards to protect the privacy of medical records, generally forbidding health care providers to sell individually identifiable health information without permission from the patient.

Finally, there is $1.1 billion provided for the federal government to compare the effectiveness of different treatments for the same illness. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money. The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.

It is the reaction to this last provision that probably gives us a good idea of the rancor we should expect in the coming debate for further health care reform. The New York Times summarized the debate:

“Consumer groups, labor unions, large employers and pharmacy benefit managers supported the new initiative, saying it would fill gaps in the evidence available to doctors and patients.

“The new research will eventually save money and lives,” said Representative Pete Stark, Democrat of California.

The United States spends more than $2 trillion a year on health care, but “we have little information about which treatments work best for which patients,” said Mr. Stark, who is the chairman of the Ways and Means Subcommittee on Health.

In the absence of information on what works, Mr. Stark said, patients are put at risk, and billions of dollars are spent each year on ineffective or unnecessary treatments.

Steven D. Findlay, a health policy analyst at Consumers Union, said the action by Congress was “a terrific step on the road to improving the quality of care and making it more efficient.”

 

“As Congress translated the idea into legislation, it became a lightning rod for pharmaceutical and medical-device lobbyists, who fear the findings will be used by insurers or the government to deny coverage for more expensive treatments and, thus, to ration care.

In addition, Republican lawmakers and conservative commentators complained that the legislation would allow the federal government to intrude in a person’s health care by enforcing clinical guidelines and treatment protocols.

Critics say the legislation could put the government in the middle of the doctor-patient relationship.

Bureaucrats “will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost-effective,” Betsy McCaughey, a former lieutenant governor of New York, wrote on Bloomberg.com. Rush Limbaugh broadcast the charges to millions who listen to his radio talk show.”

 

It is clear from these debates that we are in for a major fight when the Administration’s full health care reform bill is introduced. It is likely though, now that Daschle is out, that there may be a delay in introducing legislation until all the Administration’s players are in place and ready to push it through. However, it seems that there is very strong interest in the Administration and the Congress for healthcare reform and it is very likely to be introduced within the year.

Gil

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February 20, 2009 - Posted by | Uncategorized

2 Comments »

  1. […] Negotiations are Beginning In follow-up to the prior post, there is an interesting (and troubling) article in the NY Times today entitled “Health Care […]

    Pingback by The Negotiations are Beginning « Healthcare Professionals for Healthcare Reform | February 20, 2009 | Reply

  2. The debate over how best to reform our health care delivery system will indeed be interesting. We may soon have bureacrats deciding what is evidence based/cost effective medicine and this could easily lead to rationing of health care. Such a scenario may significantly implant government in doctor-patient relationship. In all probability, the insurers will jump on the rationing band wagon and most companies will likely deny coverage claiming the care desired isn’t supported by evidenced based/cost effective medicine.

    If this comes to pass, then the use of “evidence based” medicine must become an affirmative defense in a court of law and all levels of government must be in step with one another. A few years ago, the CT attorney general’s office challenged the promulgation of evidenced based guidelines for the treatment of Lyme disease developed by a prominent national infectious disease society claiming their work product may be a violation of the anti-trustlaws. More recently, Connecticut’s medical licensing board then took a physician to task for exercising individual medical judgement in the treatment of Lyme disease and for not the following prescribed guidelines developed by the national scientific organization. A bill has been proposed this year in the state’s Public Health Committee that would protect a physician for exercising independent and sound medical judgement in the treatment of patients.

    Physicians should be allowed the latitude to go outside the treatment box when they believe it will be in the patient’s best interest. The insurers, however, are probably the worst arbitrators when a physician may practice outside the box as the financial tug on the insurer’s bottom line to deny coverage is just too powerful.

    With the practice of evidence based/cost effective medicine comes great responsibility. Conflicts abound.

    Comment by Mark Thompson | February 24, 2009 | Reply


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