There has been some drama going down on The Hill in case you haven’t been paying attention. This year was arguably the closest physicians have ever come to having the Sustained Growth Rate formula automatically reduce their reimbursement under Medicare.
Medicare is supposedly a fixed budget system when it comes to paying providers like physicians. Built into the system is something called the SGR. The SGR is a formula. Whenever Medicare goes over its fixed budget in a fiscal year (which is every year essentially) the SGR is used to determine how much physician payments from Medicare should be reduced so that (hopefully) Medicare will be back under budget the following fiscal year. Every year as July approaches and the SGR cuts are supposed to go into effect physicians freak out and organized medicine makes a major push for Congress to forestall the cuts. And every year that seems to happen, except that Congress can’t seem to come to a consensus on eliminating the SGR system altogether and instead only revoke the cuts on a year by year basis.
This year, per the formula, Medicare physician reimbursement was supposed to be cut by more than 10% across the board. So if a doc got $200 for hitting a patient with a reflex hammer on June 29th then he’d get less than $180 for doing the same thing on July 2nd. As has become standard Congressional leaders pushed forward a bill to prevent those cuts from taking effect. The bill is HR 6331 also known as the Medicare Improvements for Patients and Providers Act of 2008.
It sailed through the House of Representatives.
In the Senate however some Republican Senators were upset because the halt in the physician pay cuts was “paid for” by reducing some income streams for private Medicare insurers. While the Senate had enough votes to pass the measure they did not have enough to prevent the Republicans from stalling and preventing the bill from even being called for a vote. And they certainly did not have enough to override President Bush’s threatened veto.
The cuts for physicians were supposed to go into effect July 1st and that day came and went without the Senate being able to act on the bill because of the stalling tactics by Republican Senators. Luckily CMS decided to hold physician reimbursement claims to wait and see if the Senate might eventually act on rescinding the SGR cuts.
In a dramatic turn of events the Senate did just that. Senator Ted Kennedy, currently undergoing treatment for a GBM, returned to the Senate to break the deadlock. As soon as it became apparent the bill was going to be called for a vote some Republican Senators turned around and announced their support for the bill.
The patriarch of the Kennedy family entered the chamber, alongside Democratic presidential candidate Barack Obama (Ill.), to a rousing ovation from senators on both sides of the aisle, some of them tearing up. Greeted with hugs and handshakes, Kennedy, bearing a big smile, went to the well and declared loudly, “aye” in support of the legislation.
Democrats cheered loudly, and Sen. Charles Schumer (D-N.Y.) was seen blowing a kiss to the Republican side of the chamber.
[…]
Kennedy’s presence Wednesday, along with the reality that Democrats had the votes lined up to move ahead, was enough to flip nine of the 39 Republicans who previously voted against the bill. The bill was approved by a 69-30 margin, more than enough to override an anticipated presidential veto.
Among those who turned around their support were both Texas Senators - John Cornyn and Kay Bailey Hutchinson. The initial refusal to support the bill so enraged the Texas Medical Association that it withdrew it’s support from Cornyn in his upcoming race to retain his Senate seat. Although I’m sure it should surprise no one if they turn around and restore it considering Senator Cornyn is a likely shoe-in to keep his Senate seat.
The Hill newspaper had this to say about the role of the two Texas Senators in switching their allegiance to the Democratic point of view on the bill,
Soon after Hutchison’s vote, her Texas Republican counterpart, Sen. John Cornyn (Texas), flipped his vote, prompting more cheers and smiles from the Democratic side of the aisle. Cornyn had lost an endorsement from the Texas Medical Association and had been the subject of heavy criticism and attack ads from the American Medical Association for voting to block the bill last month. The group said that Cornyn and Republicans were putting insurance providers before doctors who would need to limit access to Medicare beneficiaries if they received a 10.6 percent cut to their reimbursement rate from the government.
Cornyn had been trying to push through a separate, longer-term fix, but Democrats objected. Finance Committee Chairman Max Baucus (D-Mont.) called Cornyn’s bill a “big warm kiss” to doctors without fixing the problem. In unusually sharp terms, a frustrated Cornyn called Baucus’ comments “insulting remarks.”
But with his Texas counterpart voting yes and the bill appearing likely to clear, Cornyn was boxed in a corner.
“I made a commitment all along that the cuts would not go through,” Cornyn said after his vote for the bill. “I still think the legislation is flawed and the idea of doing this every six months or 18 months is a terrible way to do business… I would hope the majority would consider legislation that would permanently resolve this. But it reversed the cut, and that’s the commitment I made to the physicians of my state.”
“I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it,” Bush said in a statement to the House.
But he can obviously suck on it considering the result.
Seriously, John McCain Has Never Even Heard of A Health Savings Account
Everyone likes feeling like they ‘know‘ their leaders. No matter how cynical they are about politics in general. I’m not different; I’m star struck of Barack. I’ll say with a smile (despite it’s true inconsequence) that I met the future President once. I attended the AMSA Legislative Affairs Leadership Institute in 2006 with about 40 other medical students and had the joy of having Senator Obama speak to us and indeed getting to chat one on one with him. Granted that makes me far from a political mover and shaker but that is one of the joys of Senator Obama, his ability to create rock star-esque moments as I now realize I had.
I remember thinking, at the time, how I could never find myself agreeing with the man’s health care policy but how intelligent he was. Senator Obama was direct and critical of physicians’ role in maintaining the current health care system and highly knowledgeable about the workings of health care policy. Granted, he had an RWJF fellow on his staff at the time but I remember appreciating his fund of knowledge and his willingness to criticize those medical students before him and challenge them to do more than physicians currently were to help fix the American health care system. That even if I didn’t agree with the charge.
Now, over the course of a brutal primary, he has proven his charisma and leadership as well as that intelligence and integrity I saw that day on Capitol Hill.
I went out and gave my winter break to campaign for Ron Paul in four degree weather in the Iowa Republican primary. I am a libertarian (with a small ‘l’). But one of the privileges of staking out that territory of political ideology is that no mainstream candidate will ever satisfy all of my positions on the issues. Largely I am socially liberal and fiscally conservative. Because of such I am, for all intents and purposes, an independent.
I will never agree with Obama’s effort for universal health care or likely with his tax policy or any number of his fiscal policies. That said, as much as I have trouble stomaching liberal health care proposals, Mr. Obama having David Cutler as his chief health economics adviser is about as good as could be hoped for from a Democrat. Dr. Cutler has long refuted the claim that America’s spending on health care is somehow dramatically misappropriated. And, where Dr. Cutler has spent the considerable bulk of his work I actually agree with his conclusions - pay for performance. Granted, such is a delicate matter which we may argue over the specifics of, but certainly tying provider pay to outcome measures is where I stray from organized medicine and more conservative commentators in general.
Even if I find much fault with his proposals on health care, on a whole host of issues I will agree with Barack Obama. Namely, something every American should cherish, his promise to protect our civil liberties.
My greatest fear remains that Senator Obama will get so caught up in securing the middle, in toeing the line that he will forgo his promises (I do feel shameful linking to the Huffington Post) to defend our civil liberties.
But until that plays out Obama remains everything we need right now. His charisma and intelligence are things desperately needed on the world stage. This coming from an author who generally, initially supported the war in Iraq - so far as America had the will and stomach for it - and who doesn’t give a whole lot of credence to multilateral action or for how the world thinks of us.
I don’t believe that America is in it’s darkest hour as some crazy ass liberals will shout but what more could America hope for after the blunders of the Bush administration than a charismatic intellectual as President? John McCain that certainly would not be.
Pending surprises on the campaign trail I imagine that down here in Texas my vote may not count for much but, even if Ron Paul throws in his hat as an independent and even with the Libertarian candidate on the ticket, I will be casting my ballot for Barack Obama.
Health care, something I was sure would be the primary domestic issue this election is slowly fading away as it usually does. Not into oblivion obviously but taking a decidedly back seat to the more pressing economic issues facing the country. But it is important and people should take the time to distinguish Obama’s and McCain’s plans for health care in this country.
Like many professional/specialty organizations the AMA polled the presidential candidates (before Hillary’s bail) about their health care plans. It is little more than a venue for the campaigns to harangue to those who like to pretend they’ll actually cast their vote based on the nuances of the issues. I wonder what intern got to drum up the answers, considering I doubt Senator McCain even knows what HIT is,
HIT is essential to the success of my proposal. It amazes me a health economy of over two trillion dollars that epitomizes advanced technology has an underdeveloped HIT infrastructure.
Back to the point at hand, the AMA’s little fluff publication does at least summarize some of the differences between McCain and Obama and you should go read it for that reason. I’ll spare you an analysis now, although I’d like to put individual ones for both candidates up once I am done with psych (and third year in general). Such analysis will be a little redundant as there are already great resources out on the web. If you’re pressing to read more, right now on the two candidates health care plans I encourage you to check out The Health Care Blog’s look at both Obama’s and McCain’s plans.
Come Down To My Basement…I’ve Got Candy Down There…
Organized medicine is certainly facing a little bit of a faith crisis. From those they’re supposed to represent come cries that the AMA, specialty and state societies do not do enough for [put individual specialty here]. From the interested public and other interest groups comes cries that the AMA, specialty and state societies move to benefit the physician over the patient.
Throw amongst those pragmatic concerns the intellectual and long held criticism that organized medicine suppresses the supply of physicians and the scope of non-physician practice and is thus inherently anti-free market.
I’ve ignored this topic for long enough considering my considerable involvement in leadership roles within organized medicine and my libertarian leanings.
The clamoring from far right wing free market speakers like the late Noble Laureate above (who I respect considerably, despite the little joke above) and crazy think tanks like the Ludwig von Mises Institute is that the AMA is essentially a guild whose will the government has succumbed to. In a publication titled “100 Years of Medical Robbery” the think tank has this to say about the history of the American Medical Association and its goals:
In the days of its founding AMA was much more open–at its conferences and in its publications–about its real goal: building a government-enforced monopoly for the purpose of dramatically increasing physician incomes. It eventually succeeded, becoming the most formidable labor union on the face of the earth.
To accomplish the twin goals of artificially elevated incomes and worship by patients, AMA formulated a two-pronged strategy for the labor market for physicians. First, use the coercive power of the state to limit the practices of physician competitors such as homeopaths, pharmacists, midwives, nurses, and later, chiropractors. Second, significantly restrict entrance to the profession by restricting the number of approved medical schools in operation and thus the number of students admitted to those approved schools yearly.
The emphasis is my own.
I’ll offer a candid response to this. Through it’s history the AMA appears to have focused largely on improving physician income. Perhaps not as single minded or nefariously as the Ludwig von Mises Institute would have you believe but it remains. And the AMA has had considerable success doing such. The allowance of self governance that medicine enjoys and the sway it holds over the scope of practice for other providers is incredible. I think there are some real issues of ‘patient safety’ buried in these efforts. Even so it is clear that the AMA has a vested interest in restricting what nurse practitioners or chiropractors or optometrists are allowed to do under the law thus maintaining the physician monopoly over some income streams.
Organized medicine was responsible for the Flexner Report and continues to hold the greatest sway over the number of physicians this country will (or will not) have by controlling the LCME and ACGME. To argue some conspiracy to suppress the number of medical students (and thus number of future physicians) through these entities is baseless. But the fact such control exists shows organized medicine’s influence. Combine such with the AMA’s success in limiting the practice of other health care providers and you can see why it draws the ire of some libertarians.
Government regulations on the chiropractic profession, lay midwifery, and on the freedom of nurse practitioners to offer services within their competence, all of which make perfect sense from the point of view of the medical guild that lobbied for them, make no sense at all from the point of view of consumer wishes (as repeatedly expressed in polling data) or from economic considerations. In many cases, such people can provide health services far more cheaply than can licensed physicians (or, in the case of chiropractors, can provide services that licensed physicians do not provide at all), but consumers are prevented from making their own decisions regarding their medical care. Given the logic of the guild structure, no one has the right to be surprised to find that the AMA has put so much effort into undermining its professional opposition.
There is nothing wholly unique about physicians’ efforts towards this. Other professions do the same and also limit their membership through limiting education spots (see: lawyers). It is just that medicine has been so successful at it.
I will accept the blows Milton Friedman lands against the American Medical Association but let me make an argument on why organized medicine’s actions are reasonable despite violating the libertarian ideal.
Let us call what the AMA and the rest of organized medicine does a necessary evil. It might not have been through all of its existence granted but today it is. It is because physicians are not playing on a level, free market playing field.
That is the question the thoughtful should be asking; not whether guaranteed access for all can work. Let us be honest, if you goal is improving utilitarian public health measures - life expectancy, infant mortality, time to treatment for diseases, access to care - then a single payer system could work in the United States, provided enough funding. Complaints and nay say against such a system by providers is nonsense and nothing but protection of self interest. There are tradeoffs with such a system, but there are trade offs with any health care system. Look at our current one. If you want to improve what the public would consider ‘health’ then a well funded single payer system would be far superior to our current system, no matter America’s ‘uniqueness’.
But should we do that? The real debate is should the government fund access for those who cannot afford it themselves. Who has such a right?
The Miller Center of Public Affairs tried to do that recently with a panel debate. On the transcript at times the talking heads fall short in defining the debate and staying on course, but it still something worthwhile to look at.
Ana Puente was an infant with a liver disorder when her aunt brought her illegally to the U.S. to seek medical care. She underwent two liver transplants at UCLA Medical Center as a child in 1989 and a third in 1998, each paid for by the state.
But when Puente turned 21 last June, she aged out of her state-funded health insurance and was unable to continue treatment at UCLA.
Now this young lady is getting a fourth transplant.
Here are the two arguments made, summed up in a sentence each. For restricting illegal immigrant access to organs,
“All transplants are about rationing,” said Roy Beck, executive director of NumbersUSA
For transplanting illegal immigrants,
“People are people, and when you make an incision in an organ donor, you don’t find little American flags planted on their organs,” [Dr. Michael] Shapiro said.
I’m torn by the issue. There really are two separate issues here and I think, despite some ethicists opinions to the contrary, that I can separate the two. From a bioethical standpoint, I think as long as we’re going to allocate organs through a central sharing process (and notice that I’m a long time supporter of targeted donation and actually a donor’s right to sell their organs) that such should be done on need and independent of citizenship or alien status. But I really don’t think, as in most instances, that tax dollars have any place supporting illegal immigrants.
Sovereignty is important. While their odds are no doubt much worse in their home countries that is where these illegal immigrants should be seeking their organ donations. Or they should be seeking legal immigration into this country.
It’s no surprise that I’m not a fan of Paul Krugman. His dismissal of the potential for market forces to help reform health care is chief amongst my disagreements with his positions. In his most recent column, “Voodoo Health Economics,” he’s up to it again. His starting point is this claim,
Elizabeth Edwards has cancer. John McCain has had cancer in the past. Last weekend, Mrs. Edwards bluntly pointed out that neither of them would be able to get insurance under Mr. McCain’s health care plan.
The absoluteness of that claim might be a little far fetched. Both of these individuals have essentially unlimited financial resources and, at least in Mr. McCain’s case, could probably, with enough searching, pass the underwriting process somewhere and get insurance. Even if that insurance excluded cancer as a pre-existing condition and had extremely high patient side costs it would represent something real. The cancer screening, for these individuals, is the important thing. The poor outcomes for the uninsured with cancer are almost entirely attributable to the advanced stage at which cancer is found in the uninsured not in a lack of funding for the actual cancer care.
Mr. Krugman also brings up this age old claim,
[T]he United States has the most privatized system, with the most market competition — and it also has by far the highest health care costs in the world.
It seems to imply a cause and effect in a vacuum without admitting other contributing factors to the high cost of health care in this country.
I’m not disputing that the United States “runs” one of the least effective health care “systems” in the world but there is obviously more contributing to our comparatively high health care costs. Namely that, independent of access to care, the United States has the least healthy population in the western world (i.e. United States patients cost more on average than patients in any other western country).
And, he also praises the Veterans Health Administration. Such was in vogue recently. But I doubt Mr. Krugman has ever spent much time in a VA hospital. As most medical students I will raise my hand that I have. I’ve also had the privilege of hearing and actually speaking with (apparently former) VA Secretary Nicholson. I think I can speak for many, many medical students who have served at many, many VA hospitals in saying this is an incredibly inefficient system.
And I do mean medical students actually do something at the VA. Public health care generally runs easily whether medical students are there or not. Sometimes we even get in the way. I’m not sure that such can be said about some services at VA hospitals. There are many an example where things would’ve taken days longer to get done if I or another medical student hadn’t been there to do grunt work or make phone calls. The complete disregard for expediency, the often times lack of focus on basic patient safety efforts seems like a system wide problem despite some of the praise the VA system has gotten. With the wars in Iraq and Afghanistan dragging on such is finally getting some focus in the media,
VA hospitals are also receiving a surge of new patients after more than five years of combat. At the sprawling James J. Peters VA Medical Center in the Bronx, N.Y., Spec. Roberto Reyes Jr. lies nearly immobile and unable to talk.
[…]
Maria Mendez, his aunt, complained about the hospital staff. “They fight over who’s going to have to give him a bath — in front of him!” she said. Reyes suffered third-degree burns on his leg when a nurse left him in a shower unattended. He was unable to move himself away from the scalding water. His aunt found out only later, when she saw the burns.
Anecdotes of course but there is good evidence that such problems actually affect patient outcomes.
Measuring comparative outcomes in VA patients is difficult. VA patients are more likely to be homeless, to make far less use of care, to make use of care at a later stage of disease versus Medicare patients and just generally are sicker than their counterparts out in Medicare. That said, when trying to control for these there is some evidence that in several key disease states they do worse versus their Medicare counterparts. For example, heart attacks.
Yet Mr. Krugman extends praise over the system,
As I’ve mentioned in past columns, the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. Since it was reformed during the Clinton years, the V.A. has used the fact that it’s an integrated system — a system that takes long-term responsibility for its clients’ health — to deliver an impressive combination of high-quality care and low costs. It has also taken the lead in the use of information technology, which has both saved money and reduced medical errors.
Sure enough, Mr. McCain wants to privatize and, in effect, dismantle the V.A. Naturally, this destructive agenda comes wrapped in the flag: “America’s veterans have fought for our freedom,” says the McCain Web site. “We should give them freedom to choose to carry their V.A. dollars to a provider that gives them the timely care at high quality and in the best location.”
That’s a recipe for having healthy veterans drop out of the system, undermining its integrated nature and draining away resources.
Draining away resources? What resources? These veterans aren’t (and rightly so) generally paying for their care. It isn’t like an insurance system where having healthy veterans in the pool subsidizes the sick.
Okay, the points above are, in some part, merely semantics but you have to wonder about the soundness of the rest of his arguments when Mr. Krugman makes examples like those above.
This survey of British physicians was published in a British magazine a while back and I only now picked it up. In it a majority of respondants say that some care, apparently especially some operations, should be limited by patients’ age and lifestyles.
Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.
[…]
About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt.
Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.
One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements.
Tony Calland, chairman of the BMA’s ethics committee, said it would be “outrageous” to limit care on age grounds. Age Concern called the doctors’ views “disgraceful”.
That’s taking voluntary, transparent rationing to a pretty incredible level. When resources are scarce, as in most of medicine, then lifestyle can play a role in who gets what. I have no problem, along with 94% of British doctors in the survey, in saying an alcoholic who is likely to return to drinking shouldn’t be at the top of the liver transplant list.
Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant…
Roger Williams, who carried out the 2002 transplant on the former footballer [George Best,] said doctors could never be sure if an alcoholic would return to drinking, although most would expect a detailed psychological assessment of patients, who would be required to abstain for six months before surgery.
But rationing based on age and some of the other suggestions put up in the survey just elicit a ‘yikes.’ Such transparent, open and flamboyant rationing efforts are inevitable in any limited global budget health care system (i.e. Britain’s socialized NHS).
[Larry] Niven said a good way to help hospitals stem financial losses is to spread rumors in Spanish within the Latino community that emergency rooms are killing patients in order to harvest their organs for transplants.
“The problem [of hospitals going broke] is hugely exaggerated by illegal aliens who aren’t going to pay for anything anyway,” Niven said.
“Do you know how politically incorrect you are?” Pournelle asked.
“I know it may not be possible to use this solution, but it does work,” Niven replied.
I don’t even know how you respond to the stupidity of a comment like this, except just to denounce it as such. Larry Niven simply doesn’t know what he’s talking about…or how to write a novel.
Tens of thousands of Oregonians queued up quickly for a chance at the state’s latest lottery, but this one is no game.
Officials began drawing names last week for a chance at some rare openings in the state’s healthcare plan.
Announced in February, the lottery drew 91,675 hopefuls in 30 days. The winners will receive a postcard notifying them that they can apply for the Oregon Health Plan.
Budget limitations capped the Oregon Health Plan standard benefit package in mid-2004. Now the plan has room for a few thousand people. The lottery winners will be the first new applicants since the cap was imposed.
Perhaps reflecting some of the obstacles and limitations in/of trying to implant social assistance health programs in the United States, the Oregon program is kind’ve drifting clumsily along. And far from achieving the original goals envisioned for it.
When it was fully funded, it was considered a trailblazing program. In 1996, the benefit package enrolled five times as many people as are enrolled today, and only 10.7% of Oregon’s population lacked insurance, compared with about 16% today.
Blue Cross of California had been sending out letters asking physicians to disclose any medical history that patients hadn’t disclose when applying for health insurance with Blue Cross. They were searching for expensive pre-existing conditions, so they could cancel (or modify) those patient’s policies.
The state’s largest for-profit health insurer is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose “material medical history,” the Los Angeles Times reported on its Web site.
“Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately.”
And although the program was far from new apparently, once it broke out into the media it naturally drew an outcry. Now BC has agreed to stop the practice but there is one thing to note,
After getting slammed yesterday by everybody from Arnold Schwarzenegger to Hillary Clinton, Blue Cross of California said it would stop sending letters to doctors asking them to help find patients who had failed to report pre-existing medical conditions to the insurance company.
The company said it had been sending out the letters — which include a copy of the patient’s insurance application — for years, and hadn’t received any complaints.
In handing Gov. Arnold Schwarzenegger his biggest legislative setback, members of a Senate panel expressed concerns Monday that his plan to cover most Californians without health insurance was inadequately funded and would worsen the state budget crisis.
Democrats who voted against the bill cited a report released last week by the Legislative Analyst’s Office that concluded the plan could be underfunded by billions of dollars. They also expressed concern it would add to the state’s projected $14.5 billion deficit.
“You can say you’re going to cover 800,000 more children, but if there’s no money, you’re not going to do that and it’s cruel to raise such expectations,” Sen. Sheila Kuehl, the panel’s chairwoman, told reporters.
I still contend we’re going to see the state’s take the lead in increasing health care access before we see a major, successful national effort at such.
Also, the people who are so adamantly against throwing a couple bucks of their tax money into the pot to help out their fellow countrymen are really sad excuses for human beings. Really. Subhuman at best.
Certainly, but it ignores the entire point - being an asshole with one’s ‘property’ is a right while no such ‘right’ to health care can be defended with any sincerity.
I don’t agree with the choice not to aid your fellow human being, and it isn’t the choice I have/will make with my life, but it should remains that. A choice.
This is one of the worst stories I’ve ever heard. A girl goes into liver failure, is sent by her insurer to get evaluated for a transplant. Then develops complications and the insurer denies the transplant despite the organ sharing network having found a match for her. Then just hours after her family has taken her off life support, they learn the insurer has changed their mind.
The case of a Northridge teenager taken off life support just as her insurance company reversed itself and agreed to pay for a liver transplant is highlighting tensions among physicians, patients and insurers over the definition of experimental procedures.
About 4:40 p.m., just as Sarkisyan said the family had decided to remove Nataline from life support, Cigna sent a letter to the family’s attorney approving the transplant.
The letter, faxed to attorney Mark Geragos, is stamped 4:44 p.m. Geragos said his staff tried unsuccessfully to reach the Sarkisyans at the hospital. The family said they didn’t see the letter until after they removed Nataline from life support at 5:20 p.m.
“They took my daughter away from me,” Krikor Sarkisyan, 51, an automotive technician, said at the news conference outside Geragos’ downtown L.A. office.
The trouble was two-fold. First, the procedure was considered ‘experimental’ and the family had not purchased a plan to cover such. Basically it failed to reach some mystery threshold of evidence in the literature, the guidelines for which probably only exist in some dark room at CIGNA HQ. Second, she had a gross 65% survival rate at six months.
Dr. Goran Klintmalm, chief of the Baylor Regional Transplant Institute in Dallas, said the operation that UCLA wanted to perform was a “very high-risk transplant” and “generally speaking, it is on the margins.”
But Klintmalm said he would consider performing the same operation on a 17-year-old and believes the UCLA doctors are among the best in the world.
“The UCLA team is not a cowboy team,” he said. “It’s a team where they have some of the soundest minds in the industry who deliver judgment on appropriateness virtually every day.”
I think the aftermath of this tragedy, by some of the groups who have latched on, is a really lovely demonstration of America’s expectations for health care versus their complaints about cost.
A representative for America’s Health Insurance Plans had the best quote to summarize the voices that should be favored in making health care decisions,
“The transplant was recommended by the medical professionals at the bedside,” [Karen] Idelson said. “They should have been listened to.”
Keeping the bueacrats out of health care decisions costs money. Demanding absolute deference to the physicians in a controversial case like this while also expecting low health care costs or pining for health care hand outs is incompatible. For instance, while certainly not even attempting to make a judgment in this case, the issue of coverage for experimental therapy.
In such a battle of costs versus expectations, the California Nurses Association made a particular ass of themselves,
The California Nurses Assn. publicized Nataline’s case, calling it an illustration of the need to abandon private insurance coverage in favor of a single-payer plan.
The reality is that Natalie would’ve almost certainly been less likely to get a liver transplant under a single payer system. An ‘exponential’ (I use that as hyperbole) increase in rationing is the trade off you make with health care systems with global budgets. Never forget that.
The Field Poll found 64 percent of California voters inclined to support the universal health insurance plan outlined in the bill, compared with 23 percent opposed.
The Field Poll also found 63 percent of voters in favor of the state raising its cigarette tax to support the medical insurance plan, compared with 33 percent against doing so.
The poll only surveyed support for one of the actual final proposed funding mechanisms. That is a cigarette tax as cited above. If you remember (here’s my previous post on California’s plan) the other funding mechanisms are a 4% tax on hospitals and a pay or play deal for employers.
But with media coverage like this, would anyone be surprised if voters just put those two other little new taxes out of their mind or weren’t even aware of them at all (I mean, the majority don’t even read the plain language explanations on the ballot in full) when they vote?
So despite whatever campaigns the California hospitals or the Chambers of Commerce roll out, I would expect the funding mechanisms to fall into place.
This Is A Stick Up! Give Us Your Money!
And despite claims that the bill faces a challenge in the Senate, the actual ballot initiatives are probably the most likely place for this plan to be defeated. That said, there’s a slight glimmer in the Senate as the bill will not even be taken up in that chamber until the new year.
Despite a last-gasp effort in the Assembly last week, the Legislature is about to finish the “year of health care reform” without passing a health care plan.
While that outcome had become expected, what was surprising to many observers was the person responsible for blocking action before the new year: Don Perata, the Senate leader and a liberal Democrat from Oakland who co-authored the bill.
Perata announced he would not allow the Senate to vote on the Assembly-approved bill - not until he knows more about how the $14 billion-plus measure would affect existing health programs and the state’s overall finances.
[…]
[B]y pushing Senate consideration of the bill into next year, some proponents privately fret that Perata may stall its momentum and kill the measure’s already slim chances of being enacted.
At one point last week, the blunt-spoken Perata said in a TV interview that the health plan was “DOA” - a remark his office quickly said that he didn’t mean literally.
[A] risk of waiting may be that by the time the Senate debates it, presumably sometime next month, the political climate will be much more treacherous. Gov. Arnold Schwarzenegger plans to call the Legislature into a special session to grapple with a projected $14 billion deficit, and Perata himself is stoking doubts about whether the sprawling health care proposal would widen that gap.
That said, because the new funding mechanisms for the plan are being put to a vote by the people, and thus the bill doesn’t need a 2/3rds majority in the rooms to either side of the capitol, the bill will likely squeak out of the Senate.
In the end, even Republicans expect Perata will scare up the votes to pass the bill sometime in January. But they have enjoyed hearing the senator talk their talk.
“I love it,” said Assembly Minority Leader Mike Villines, R-Fresno. “I’d love to see it happen throughout the year.”
The Fields Poll certainly seems to emphasis the political capital California politicians have to implement a plan like this. What’s funny is that, according to the poll, the enthusiasm for the plan is tempered under certain circumstances. It shows the absurdism in the growth of society’s greed expectations of hand outs. The circumstantial evidence for this: the plurality oppose the health care plan if it is funded by a 1% increase in sales tax.
Now true, sales taxes are regressive and place a larger burden on the very population this health care bill is trying to “help.” But if you think the average Californian is thinking that deeply when answering this poll question your faith in humanity is, uh, misplaced. We all know that the “more real” it fells like dollars are being taken out of our pockets the less likely we are to support helping our fellow man. Sure the reality is the costs for the program will be passed onto all in some shape or form, but it’s only when it is obvious enough for them to see it, to feel it’s a reality that they pull their support away.
That speaks wonders to society. It also speaks wonders to the growing expectations of the role of government as a teat to suckle at, as welfare provider. Have no doubt that as income disparity grows we will continue to see increasing clamor from the majority for various forms of wealth redistribution (not to sound like Marx and Engels or anything).
That’s a shame. Just because the majority hawk for such handouts doesn’t make it right.
p.s.
Now, I’ve said it numerous times on this blog, but I’ll repeat: I personally believe I have a moral obligation to help the less fortunate. My continuing efforts throughout my career do and will speak for themselves. I just don’t think the government has any place forcing such an “obligation” on others.
I did my undergrad work in USC's School of Cinema-Television Cinematic Arts. I have a Bachelors of Fine Arts in Writing for Screen & Television. I loved it, but a future of waiting tables and taking meetings with B-List producers was not for me.
This blog is ostensibly to discuss healthcare policy and maybe educate a few of my fellow medical students. But it will stray into current events, politics, and other science topics when they draw my interest
Other odd notes about me:
I've skied half the resorts on this list (Squaw Valley/Lake Tahoe, Snowbird/Park City, Whistler, Taos, Vail)
I "played" lacrosse in high school and through a club level team in college
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"Please be more precise in your practice of medicine than you are in your blogging!"
- Mark Lanier
