Posted 10/13/15 on The Doctor Weighs In
A few weeks ago, the clinically positive results from the CLEOPATRA oncology trial were released, showing that pertuzumab, when added to docetaxel and trastuzumab as first line chemotherapy, produces an average survival benefit of 15.7 months in HER2 positive breast cancer patients.
That good news notwithstanding, the authors calculated that Genentech’s price for adding pertuzumab to gain one Quality Adjusted Life Year is a breathtaking $713,219. In dry academic language, the authors dropped a bombshell conclusion. “The addition of pertuzumab to a standard regimen … for treatment of metastatic HER2-overexpressing breast cancer is unlikely to provide reasonable value for money spent in the United States compared with other interventions generally deemed cost effective. This analysis highlights the economic challenges of extending life for patients with non-curable disease.”
Drugs only consume about a quarter of cancer costs. The other three-quarters are distributed between physicians, outpatient facilities and hospitals, delivering such lucrative returns that hospitals are rushing to get in on the action. As many as one in four US hospitals are building new cancer centers now. Hospitals’ acquisitions of oncology practices have accelerated, in part because they can charge almost twice as much as physician practices for chemotherapies and other cancer drugs. Continue reading “Is Oncology Ground Zero For Reform?” →
Posted 11/12/12 on Medscape Connect’s Care & Cost Blog
The most striking aspect of the election was that it decisively clarified the philosophical preferences of most Americans. And because the outcome was largely determined by minorities, women, and the young, it appeared to be a much broader and more independently-minded vision than most pundits have given the electorate credit for. That unexpectedly portends big changes.
Peggy Noonan’s analysis in the Wall Street Journal quotes a brutal summation by conservative activist Heather Higgins:
A majority of the American people believe that the one good point about Republicans is they won’t raise taxes. However they also believe Republicans caused the economic mess in the first place and might do it again, cannot be trusted to care about cutting spending in a way that is remotely concerned about who it hurts, and are retrograde to the point of caricature on everything else.
Continue reading “Arriving at the Beginning” →
Posted 3/22/12 on Common Sense Family Doctor
Can’t get a Supreme Court-side seat for next week’s six hours of oral arguments on the constitutionality of the Affordable Care Act? Want to understand how the United States reached the point where the fate of a mostly yet-to-be-implemented 2010 federal law that extends health insurance coverage to nearly all of its citizens may rest on the Justices’ interpretations of the Constitution’s Commerce and Taxing and Spending clauses? You would do better to spend those six hours reading two essential books that shed a great deal of light on the legislative history and contemporary health policy issues that have shaped the current debate: Paul Starr’s Remedy and Reaction and Douglas Kamerow’sDissecting American Health Care.
Continue reading “Essential Readings on Health Reform” →
Posted 3/12/12 on The Doctor Weighs In
Recently, The Doctors Company (TDC), the country’s largest insurer of physician and surgeon medical liability, decided to survey doctors to determine what they are thinking and feeling about health reform. The results are pretty gloomy.
To put this in context, it is important to understand a bit about how TDC conducted the survey. First of all, the universe of doctors they reached out to were doctors insured by The Doctors Company. That means large self-insured medical groups, such as those affiliated with Kaiser Permanente, were not included. Nor were doctors whose insurance was provided by their employers or doctors using other insurance carriers. This matters because if the TDC insured physicians are not representative of doctors as a whole, the results of this survey would not necessarily reflect the attitudes of all doctors.
Continue reading “Surveyed Physicians Are Gloomy About Health Care Reform” →
Posted 1/19/12 on Forbes
Great post by Rick Ungar over on The Policy Page. Still, I’m left wondering. It’s an election year and given the stakes, I think we’ll look back on 2012 as the year of the great Healthcare Reform debate – Part 2. What we have today is really just the beginning of a long and winding investment in Healthcare Reform – Part 1. I think the question remains – have we tamed the cost beast with real legislation – or is it just legislation around the edges? Here’s why I’m wondering.
National Healthcare Expenditure – or NHE. Total agreement with Rick that costs are “out-of-control” because our NHE is really $3 trillion – this year. Actually, NHE for 2012 is probably closer to $2.7 trillion but there’s this nagging bookkeeping accrual of about $300 billion where we (narrowly) avoided those darn pesky SGR cuts to Medicare. It’s come to be known affectionately as “doc fix” – and we’ve kicked that can down the road for 9 consecutive years. Maybe we’ll just write it off – and maybe we should – but it’s actually on the books so we can’t just ignore it – can we? That puts the real NHE at about $3 trillion for 2012 (+ about 4% for each year forward – as far as the eye can see). As one economist said – we don’t have a debt problem in this country – we have a healthcare problem.
Continue reading “US Health Care Hits $3 Trillion” →
Posted 1/14/12 on Not Running A Hospital
14 Jan 2012 05:30 AM PST
Massachusetts Attorney General Martha Coakley has submitted an amicus brief in the pending Supreme Court case about the national health reform legislation. The brief focused on the “individual mandate” portion of the law. I think it is really well done and I copy the argument summary here:
Having enacted six years ago a prototype of the comprehensive healthcare reform package that Congress would later adopt in 2010, Massachusetts is in a unique position to assess the rationality of the assumptions that underlay both enactments. Specifically, the Court has held that the Commerce Clause empowers Congress to regulate activities that substantially affect interstate commerce. Congress properly exercised that power in adopting a provision in the ACA that requires all non-exempt persons to purchase at least a minimum level of health insurance coverage. Through its legislative findings, Congress rationally concluded that those who fail to purchase health insurance despite their ability to pay for it (“free riders”) not only drain finite State and federal free-care resources, but also negatively impact the availability of privately-issued health insurance policies and the prices at which such policies are sold. Congress further concluded that curtailing the practice of “free riding” would make private health insurance coverage easier for individuals both to procure and to afford.
Continue reading “Making the Constitutional Argument” →
Posted 11/26/11 on Gooz News
Writing in next week’s New England Journal of Medicine, Harvard professor David Blumenthal, former head of Medicare’s health information technology division, forecasts the following scenario should the Republicans win the White House and both houses of Congress next year and repeal most of the Affordable Care Act:
By 2020, 20% of Americans may be uninsured, even as 20% of our gross domestic product is devoted to health care.
Continue reading “Scary Predictions” →
Posted 11/1/11 on Common Sense Family Doctor
Last month, my family was involved in a scary traffic accident en route to the Family Medicine Education Consortium‘s North East Region meeting. I was in the left-hand eastbound lane of the Massachusetts Turnpike when a westbound tractor trailer collided with a truck, causing the truck to cross over the grass median a few cars ahead of us. I hit the brakes and swerved to avoid the truck, but its momentum carried it forward into the left side of our car. Strapped into child safety seats in the back, both of my children were struck by shards of window glass. My five year-old son, who had been sitting behind me, eventually required twelve stitches to close a scalp laceration. Miraculously, none of the occupants of the other six damaged vehicles, including the truck driver, sustained any injuries.
Family physicians like me, and physicians in general, like to believe that the interventions we provide patients make a big difference in their eventual health outcomes. In a few cases, they do. But for most people, events largely outside of the scope of medical practice determine one’s quality and length of life, and public health legislation is more likely to save lives than the advice of well-meaning health professionals. My colleagues can counsel parents about car seat safety until they’re blue in the face, but state laws requiring that young children be belted into car safety seats are what made the difference for my son between a scalp laceration and a life-threatening injury.
Continue reading “In Praise of Individual Health Mandates” →
First published 7/17/11 on Kaiser Health News
Health reform raises central ideological questions about the size and scope of government, about progressive taxation, about the individual mandate and more. It’s easy to forget that cost control will be a huge challenge, no matter how these ideological matters are resolved, indeed under any health system. Finding the right combination of humanity and restraint will be particularly hard in addressing life-threatening or life-ending illness. Economic incentives, American culture, a changing doctor-patient relationship and fundamental uncertainties at the boundaries of clinical care conspire against our efforts to provide more humane, more financially prudent care.
First published 6/10/11 on Managed Care Matters
It’s pretty simple, really.
Once people gain actual real-life experience with a government program, they abandon their fear of the unknown, see its benefits more clearly, and become invested in its future.
We’ve seen that with Medicare, which consistently pleases its beneficiaries. Part D has similar traction, and now we’ve learned that the citizens of Massachusetts are increasingly happy with that state’s health reform.
Continue reading “Why Health Care Reform Is Here To Stay” →
First published 5/31/11 on Common Sense Family Doctor
PPIP is an acronym that officially stands for “Put Prevention Into Practice,” which serves as both the name of the Agency for Healthcare Research and Quality’s programs to disseminate the preventive care recommendations of the U.S. Preventive Services Task Force as well as the tagline for a series of case study questions about these recommendations that I wrote for the journal American Family Physician from 2008 to 2010. Given theunfortunate events that have occurred since the USPSTF became inextricably linked to the Obama health care reform bill, however, I now propose a new meaning for PPIP: Prevention Politics Injures Patients.
In a recent New York Times editorial, “Squandering Medicare’s Money,” Archives of Internal Medicine editor Rita Redberg, MD pointed out that the Medicare program paid physicians more than $40 million in 2009 for screening colonoscopies in patients over age 75, and $50 million in 2008 for PSA screening in men age 75 and older and Pap smears in women age 65 and older. That’s nearly $100 million alone for 3 tests that the USPSTF concluded have few or zero health benefits and have a high potential to cause harm, and it doesn’t count the additional millions (billions?) of dollars of additional testing and procedures that result from these unnecessary screenings. Dr. Redberg writes:
Our medical culture is such that if the choice is between doing a test and not doing one, it is considered better care to do the test. So while Medicare is obligated to follow the [U.S. Preventive Services] task force’s recommendations to cover new preventive services, it has no similar mandate to deny coverage for services for which the task force has found no benefit.
Continue reading “Prevention Politics Injures Patients” →
First published 4/28/11 on Health Care Reform Update
The Congressional Budget Office estimates that the government deficit will exceed one and a half trillion dollars this year, with federal health care annual expenditures expected to hit the trillion dollar mark by 2012. The largest federal health care program is, of course, Medicare, with costs projected to be close to $600 billion in 2012, and growing at around seven percent a year thereafter, although forecast to drop to a mere six percent annual increase if and when the Accountable Care Act is fully implemented.
Continue reading “Controlling the Medicare Budget – Time To Fast Forward to 1999” →
C. Eugene Steuerle
First published 4/21/11 on The American Square
President Barack Obama and House Budget Committee Chairman Paul Ryan (R) have laid out different approaches for curbing growth in health care costs. One would empower government-appointed officials to constrain health prices and services by, for instance, strengthening the power of the Independent Payment Advisory Board (IPAB) created in 2010’s health-reform legislation. The other would provide Americans with premium support up to some dollar limit to cover their health insurance purchases. Both count on efficiency improvements as well. The political debates have quickly centered over whether Obama is heading toward ever-more cumbersome government regulation and price-setting and whether Ryan is opening up unregulated markets that would deprive many of needed health care.
It’s not that simple, though. Three questions are actually at issue:
(1) How should budget constraints be applied?
(2) Should automatic budget growth for health care programs (particularly, Medicare) finally be reined in?
(3) Should government health program budgets be limited even if neither side gets its way?
Continue reading “Does Constraining Health Cost Growth Require Choosing between Obama and Ryan?” →
First published 3/21/11 on Kaiser Health News
When President Barack Obama met with the nation’s governors last month and offered to allow states to establish their own plans to reform health care in place of the Patient Protection and Affordable Care Act, he insisted that states meet or exceed the same goals established in the health overhaul to expand insurance coverage, improve the quality of care and contain rapidly escalating healthcare costs.
Continue reading “Health Reform’s Next Act: A Focus On Achieving Health Equity” →