Latest Drugwonks' Blog
Now that Uncle Sam is in the automotive business, some members of Congress are beginning to behave like used car salesmen (with apologies to used car salesmen). Specifically, some of our elected representatives are trying to sell the American public on healthcare reform via the old bait-and-switch.
The issue at hand is taxing employer-provided health benefits – another third rail in the battle for healthcare reform.
60% of the American public gets their health benefits through their jobs -- and they’re not “free.” According to the Kaiser Family Foundation, the average American worker with “employer-provided” healthcare pays about 41% of the cost.
Two of the “players” in Congress, Senators Baucus and Wyden, want to tax employer-provided health benefits (according to an article by Robert Pear) “above a certain value.”
Question: is that “certain value” before or after the 41% cost-share?
For those of you with selective memory issues, during the most recent presidential election, candidate Obama called candidate McCain’s proposal to tax employer-provided health benefits “the largest middle-class tax increase in history.”
Here’s what Josh Karden, Mr. Wyden’s chief-of-staff has to say on the matter – “Cadillac health plans should be treated as income, regardless of who is receiving them.” Mr. Karden specifically mentions “wealthy chief executives.”
Welcome “Cadillac health plans” to the rhetoric of healthcare reform. It’s not the last time you’ll be hearing it.
How do you define a “Cadillac” health plan? Didn’t candidate Obama say that he wants every American to have “the same healthcare as members of Congress?” (Hint – yes, he did). Are the “employer-provided” health benefits that federal employees have “Cadillac?” (Hint – yes, they are – if you define “Cadillac” as comprehensive in formulary and patient choice.)
Does this mean Uncle Sam will tax the healthcare benefits of members of Congress, federal government employees, teachers, fire fighters, police officers, as well as “wealthy chief executives?”
Consider a new website set up by American Federation of State, County and Municipal Employees and the AFL-CIO -- www.stopwydenshealthtax.com.
Is that a coalition I hear breaking apart?
Also, does this mean the touted “public plan” that’s getting so much attention won’t be of the “Cadillac” variety?
Perhaps it will be more like a Yugo or a Zhiguli.
This is healthcare reform?
The issue at hand is taxing employer-provided health benefits – another third rail in the battle for healthcare reform.
60% of the American public gets their health benefits through their jobs -- and they’re not “free.” According to the Kaiser Family Foundation, the average American worker with “employer-provided” healthcare pays about 41% of the cost.
Two of the “players” in Congress, Senators Baucus and Wyden, want to tax employer-provided health benefits (according to an article by Robert Pear) “above a certain value.”
Question: is that “certain value” before or after the 41% cost-share?
For those of you with selective memory issues, during the most recent presidential election, candidate Obama called candidate McCain’s proposal to tax employer-provided health benefits “the largest middle-class tax increase in history.”
Here’s what Josh Karden, Mr. Wyden’s chief-of-staff has to say on the matter – “Cadillac health plans should be treated as income, regardless of who is receiving them.” Mr. Karden specifically mentions “wealthy chief executives.”
Welcome “Cadillac health plans” to the rhetoric of healthcare reform. It’s not the last time you’ll be hearing it.
How do you define a “Cadillac” health plan? Didn’t candidate Obama say that he wants every American to have “the same healthcare as members of Congress?” (Hint – yes, he did). Are the “employer-provided” health benefits that federal employees have “Cadillac?” (Hint – yes, they are – if you define “Cadillac” as comprehensive in formulary and patient choice.)
Does this mean Uncle Sam will tax the healthcare benefits of members of Congress, federal government employees, teachers, fire fighters, police officers, as well as “wealthy chief executives?”
Consider a new website set up by American Federation of State, County and Municipal Employees and the AFL-CIO -- www.stopwydenshealthtax.com.
Is that a coalition I hear breaking apart?
Also, does this mean the touted “public plan” that’s getting so much attention won’t be of the “Cadillac” variety?
Perhaps it will be more like a Yugo or a Zhiguli.
This is healthcare reform?
Imagine -- an editorial in the San Francisco Chronicle of all places that actually takes President Obama to task on some elements of his health care agenda.
And the toughest question posed is also the most obvious:
Finally, neither Congress nor the president has spelled out an answer to the most nagging question about health care reform: how we're going to pay for it. This is no small question. Independent experts have put the cost for reform at about $1.5 trillion over 10 years, and much of that has to be paid up-front. How the country pays this bill is likely to be one of the toughest negotiation points of the discussion.
That is a discussion we all expect to occur next month – and we’re looking forward to it.
That is a discussion we all expect to occur next month – and we’re looking forward to it.
The increasing refusal of parents to vaccinate their children is a sad and frightening result of the ongoing propaganda campaign by the anti-vaccine lunatic fringe.
A new paper in the New England Journal of Medicine explains the growing health threats posed by vaccine refusal.
Here’s the abstract:
“Vaccines are among the most effective prevention tools available to clinicians. However, the success of an immunization program depends on high rates of acceptance and coverage. There is evidence of an increase in vaccine refusal in the United States and of geographic clustering of refusals that results in outbreaks.Children with exemptions from school immunization requirements (a measure of vaccine refusal) are at increased risk for measles and pertussis and can infect others who are too young to be vaccinated, cannot be vaccinated for medical reasons, or were vaccinated but did not have a sufficient immunologic response. Clinicians can play a crucial role in parental decision making. Health care providers are cited as the most frequent source of immunization information by parents, including parents of unvaccinated children. Although some clinicians have discontinued or have considered discontinuing their provider relationship with patients who refuse vaccines, the American Academy of Pediatrics Committee on Bioethics advises against this and recommends that clinicians address vaccine refusal by respectfully listening to parental concerns and discussing the risks of nonvaccination.”
The good news is that more and more physicians are vocally expressing their concerns.
Writing in the Los Angeles Times, Dr. Ryan Coller laments, “We are retreating into illnesses that had nearly vanished, and we are stalling research progress by deferring enormous sums of money to dismantle autism/vaccine theories and establish campaigns to educate families. Wouldn't that money be better spent understanding the true causes of autism and pursuing effective therapies?”
He concludes with a call to action: “We must vaccinate against this misinformation, and stop its spread.”
Let’s hope both physicians and parents are listening.
With the amount of misinformation and deliberate distortion that characterizes the American discussion of health care reform, it is no surprise that it has tended to devolve into little more than a shouting match. In the process, both extremes seem to have lost any grip they ever had on reality. This is especially true when many American commentators invoke the failings and successes of health care systems in other countries.
Perhaps the greatest and most prevalent fallacy about health care overseas is the enduring myth of the ‘European health care system’ where treatment is free. First, Europe is a continent with more than two dozen countries – and just as many health care systems. Second, single-payer, government-run systems are only one end of a continuum that runs all the way to systems that are highly market based systems, arguably more so than that of the US.
Countries with government single-payer health care include: the UK, Portugal, Spain, Italy, and the Scandinavian countries. The Republic of Ireland is single-payer but with a substantial private sector. The UK is actually somewhat unusual in that the government owns the public providers as well as paying for care, in many single payer systems doctors and hospitals are at least partially private.
France is often labeled a single-payer country but in fact it has a two-tier mixed system. The French are charged a payroll tax that funds basic coverage for everyone that is administered through quasi-private insurers, not through a government bureaucracy. Most people also buy separate supplementary coverage. Doctors and hospitals are private and patients have full choice. Belgium is similar.
Germany administers health care through private (but nonprofit) insurance companies and is paid for through premiums deducted from payroll. There is also a private insurance system in which about 10 percent of Germans participate. Recent reforms, however, are introducing more of a role for government. Austria has a similar system.
The Netherlands and Switzerland have market driven systems which use a philosophy called ‘managed competition.’ Coverage is purchased from primarily nonprofit insurance companies, via work in the Netherlands and by individuals in Switzerland.
The rampant confusion about what these systems look like seems to stem from a tendency to elide universal coverage and single-payer. It makes sense to look to other countries, especially when most any strategy Americans are considering has been tried somewhere, but if policy wonks and politicos, never mind the population, cannot do the most cursory of research, than they squander those lessons.
The ‘European healthcare system’ may be imaginary, but the consequences of believing in it aren’t.
How about a tax break for staying healthy?
Senators Max Baucus, D-MT, and Tom Harkin, D-IA, are drafting legislation to use tax incentives as an incentive for businesses to develop a healthier workforce through employer-sponsored wellness programs.
“Prevention and wellness should be a centerpiece of healthcare reform,” said Harkin, who regularly climbs the stairs to his seventh-floor office on Capitol Hill.
Certainly seems like a common sense approach, as employees with elevated cholesterol and blood pressure, poor blood glucose control and excess weight are more likely to get sick, develop chronic disease, experience absence and disability and over utilize their fair share of expensive healthcare resources, making U.S. firms less competitive and makes the tax incentive concept seem like a no-brainer.
Maybe. But there’s a more efficient and practical alternative without enacting yet another undue burden on business: Personal tax incentives to adults and their dependents for achieving and maintaining healthy body weight. See here to see how.
To facilitate public participation, a grass-roots social marketing campaign should be undertaken. One of President Obama’s eight principles for health legislation is that it must “invest in prevention and wellness. Yes we can.
Senators Max Baucus, D-MT, and Tom Harkin, D-IA, are drafting legislation to use tax incentives as an incentive for businesses to develop a healthier workforce through employer-sponsored wellness programs.
“Prevention and wellness should be a centerpiece of healthcare reform,” said Harkin, who regularly climbs the stairs to his seventh-floor office on Capitol Hill.
Certainly seems like a common sense approach, as employees with elevated cholesterol and blood pressure, poor blood glucose control and excess weight are more likely to get sick, develop chronic disease, experience absence and disability and over utilize their fair share of expensive healthcare resources, making U.S. firms less competitive and makes the tax incentive concept seem like a no-brainer.
Maybe. But there’s a more efficient and practical alternative without enacting yet another undue burden on business: Personal tax incentives to adults and their dependents for achieving and maintaining healthy body weight. See here to see how.
To facilitate public participation, a grass-roots social marketing campaign should be undertaken. One of President Obama’s eight principles for health legislation is that it must “invest in prevention and wellness. Yes we can.
Check Out CMPI's New Book:
Few relationships are more personal, private and important than the one between doctor and patient. Yet, today, one both sides of the Atlantic, physicians are increasingly having there decisions second-guessed by distant third parties. “Physician Disempowerment: A Transatlantic Malaise,” a new book from the Center for Medicine in the Public Interest (CMPI) chronicles the recent -- and pronounced -- intrusion by government and other disinterested third parties into the private medical relationships patients have with their doctors.
While this insidious “adverse event” has been an issue in Europe and Canada for many years, it is just now emerging as the hidden third rail of American healthcare reform. The book also includes essays by physicians and policy makers who work in the oft-vaunted socialized healthcare systems of our neighbor to the North and
Dr. François Sarkozy, a pediatrician (and also the brother of the French President) shared his impressions of the state of the French medical profession. "There’s a relative loss of status in being a physician. There’s a malaise with the French physicians," he says. "We’ve seen that independent private practice has become less attractive in France than it was before.
The book is based on a conference recently held by CMPI in Washington,
An electronic copy of Physician Disempowerment: A Transatlantic Malaise can be downloaded at by clicking here. Hard copies can be obtained by contacting CMPI at (212) 417-9169.
Dr. Margaret Hamburg will be sworn in as the 21st commissioner of the Food and Drug Administration. The Senate confirmed her nomination by voice vote.
All in favor, say "yea."
All in favor, say "yea."
Comparative effectiveness is alive and well....
Here is the entire decision from CMS on CTC for colorectal
Click Here to View the Decision
And note the key word that runs throughout... AVERAGE as in one size fits all. The key to disallowing advances is to insure that the benefit has to be shown to fit everyone in a large scale randomized trial... Or as CMS says (and you better get used to this phraseology... the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries. While it is a promising technology, many questions on the use of CT colonography need to be answered with well designed clinical studies that focus on health outcomes for the Medicare population.”
Why not try getting evidence of cold fusion?
May 19, 2008
CMS initiates this national coverage analysis for the use of screening CTC for colorectal cancer. The public has 30 days to submit comments on this topic. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information related to the technology under review. We are especially interested as to the types of studies needed if the evidence is determined to be premature for coverage or if the appropriate frequency interval is uncertain.
November 19, 2008
CMS convened the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) to review the available evidence on the use of CTC as a screening test for colorectal cancer for average risk individuals, including test characteristics, screening frequency, cost effectiveness, safety and training requirements.
February 11, 2009
CMS posts a proposed decision memorandum and the 30 day public comment period begins.
March 3, 2009
CMS met with representatives of the American Cancer Society, the American College of Radiology, and the American Gastroenterological Association and listened to their concerns regarding the proposed decision memorandum and asked them to reflect those concerns in the written comments they submit during the public comment period.
March 10, 2009
CMS met with representatives of the Medical Imaging and Technology Alliance and listened to their concerns regarding the proposed decision memorandum and asked them to reflect those concerns in the written comments they submit during the public comment period.
Here is the entire decision from CMS on CTC for colorectal
Click Here to View the Decision
And note the key word that runs throughout... AVERAGE as in one size fits all. The key to disallowing advances is to insure that the benefit has to be shown to fit everyone in a large scale randomized trial... Or as CMS says (and you better get used to this phraseology... the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries. While it is a promising technology, many questions on the use of CT colonography need to be answered with well designed clinical studies that focus on health outcomes for the Medicare population.”
Why not try getting evidence of cold fusion?
May 19, 2008
CMS initiates this national coverage analysis for the use of screening CTC for colorectal cancer. The public has 30 days to submit comments on this topic. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information related to the technology under review. We are especially interested as to the types of studies needed if the evidence is determined to be premature for coverage or if the appropriate frequency interval is uncertain.
November 19, 2008
CMS convened the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) to review the available evidence on the use of CTC as a screening test for colorectal cancer for average risk individuals, including test characteristics, screening frequency, cost effectiveness, safety and training requirements.
February 11, 2009
CMS posts a proposed decision memorandum and the 30 day public comment period begins.
March 3, 2009
CMS met with representatives of the American Cancer Society, the American College of Radiology, and the American Gastroenterological Association and listened to their concerns regarding the proposed decision memorandum and asked them to reflect those concerns in the written comments they submit during the public comment period.
March 10, 2009
CMS met with representatives of the Medical Imaging and Technology Alliance and listened to their concerns regarding the proposed decision memorandum and asked them to reflect those concerns in the written comments they submit during the public comment period.
The value-based design legislation proposed by Senator Hutchinson and Senator Stabenow could be a great platform for promoting personalized medicine...
Bill Would Test Value-Based Insurance in Medicare
Legislation filed yesterday would create a demonstration project to test whether value-based insurance design can work in the Medicare population.
Trumpeted by employers and health plans as a way to both improve patient outcomes and lower long-term health costs, VBID lowers or eliminates copays for high-value prescriptions and treatments, such as medication for diabetes, asthma, and heart disease. The concept follows the logic that removing cost barriers will help at-risk patients follow their prescription regimens and not postpone doctors' appointments because they can't afford the care.
The bipartisan legislation was filed by Sen. Kay Bailey Hutchinson (R-TX) and Sen. Debbie Stabenow (D-MI). Hutchinson says the federal government has lagged behind the private sector in adopting VBID strategies.
"Value-based insurance design has the power to truly bend the healthcare cost curve in the right direction. By taking practical steps to lower healthcare costs and improve health, we can make insurance more affordable for all Americans. Ultimately, that is the single most important goal of healthcare reform," says Hutchinson.
VBID pilot programs have been successful in the commercial population. Pioneers in the VBID movement, Marriott and Pitney Bowes, eliminated cost sharing associated with diabetes medications and achieved positive cost and quality outcomes.
While many health insurers and employers have increased copays and created high-deductible plans as a way to lower their healthcare costs, VBID supporters say the concept is a more forward-thinking way to tackle spiraling costs.
One of the creators of VBID, A. Mark Fendrick, MD, who is co-director at the University of Michigan's Center for Value Based Insurance Design, says, "Cost containment efforts should not lead to preventable decreases in quality of care. The inclusion of value based design into the Medicare program will show that an approach that encourages the increased use of high-value medical services will produce more health for every taxpayer dollar spent."
Could VBID work in Medicare?
A recent white paper by Avalere Health and the Center for Value-Based Insurance Design suggested that the government could implement VBID in Medicare. VBID addresses both the objectives of cost containment and quality improvement by promoting fiscally responsible, clinically sensitive cost sharing, according to the white paper.
VBID advocates and policymakers think the concept could be a winner in the Medicare population. Twenty-three percent of Medicare's 26 million beneficiaries have five or more chronic conditions and account for nearly 70% of the program's spending.
Medicare beneficiaries are more likely to have chronic illness than the commercial population and more apt to take multiple medications.
Costs can create a barrier to medication compliance for beneficiaries. In fact, the Medicare Part D population takes five prescription drugs per day on average and nearly 20% of them are not able to fill a prescription or delay filling a prescription because of cost, according to the white paper.
"You have the potential to have an even greater impact [in the Medicare population] because the sicker the beneficiary is and the more you can target a value-based insurance design, the better the outcomes are likely to be," says Lisa Murphy, manager at Avalere Health in Washington, DC, and coauthor of the paper.
The researchers reviewed five options for Medicare and found that three of them can be implemented immediately with minor operational changes:
Reduce cost sharing for specific drug or drug classes
Exempt specific drugs or drug classes from 100% cost sharing in the coverage gap
Reduce cost sharing for chronic special needs plan enrollees based on the plan's target condition
The other two options that were reviewed would require policy changes, such as CMS revising its non-discrimination clause to allow for reduced cost sharing for enrollees with chronic conditions or reducing cost sharing for enrollees in Medication Therapy Management Programs.
Tanisha Carino, PhD, vice president at Avalere Health in Washington, DC, and co-author of the paper, says her research shows VBID's potential in the Medicare population. She says VBID has the potential to help make Medicare a "more prudent purchaser of healthcare that meets patient needs. These tools need to be considered in the context of health reform as they map directly into the administration's goals of improving quality and preventing complications of illness."
Click Here to View the Full Article
Bill Would Test Value-Based Insurance in Medicare
Les Masterson, for HealthLeaders Media, May 15, 2009
Legislation filed yesterday would create a demonstration project to test whether value-based insurance design can work in the Medicare population.Trumpeted by employers and health plans as a way to both improve patient outcomes and lower long-term health costs, VBID lowers or eliminates copays for high-value prescriptions and treatments, such as medication for diabetes, asthma, and heart disease. The concept follows the logic that removing cost barriers will help at-risk patients follow their prescription regimens and not postpone doctors' appointments because they can't afford the care.
The bipartisan legislation was filed by Sen. Kay Bailey Hutchinson (R-TX) and Sen. Debbie Stabenow (D-MI). Hutchinson says the federal government has lagged behind the private sector in adopting VBID strategies.
"Value-based insurance design has the power to truly bend the healthcare cost curve in the right direction. By taking practical steps to lower healthcare costs and improve health, we can make insurance more affordable for all Americans. Ultimately, that is the single most important goal of healthcare reform," says Hutchinson.
VBID pilot programs have been successful in the commercial population. Pioneers in the VBID movement, Marriott and Pitney Bowes, eliminated cost sharing associated with diabetes medications and achieved positive cost and quality outcomes.
While many health insurers and employers have increased copays and created high-deductible plans as a way to lower their healthcare costs, VBID supporters say the concept is a more forward-thinking way to tackle spiraling costs.
One of the creators of VBID, A. Mark Fendrick, MD, who is co-director at the University of Michigan's Center for Value Based Insurance Design, says, "Cost containment efforts should not lead to preventable decreases in quality of care. The inclusion of value based design into the Medicare program will show that an approach that encourages the increased use of high-value medical services will produce more health for every taxpayer dollar spent."
Could VBID work in Medicare?
A recent white paper by Avalere Health and the Center for Value-Based Insurance Design suggested that the government could implement VBID in Medicare. VBID addresses both the objectives of cost containment and quality improvement by promoting fiscally responsible, clinically sensitive cost sharing, according to the white paper.
VBID advocates and policymakers think the concept could be a winner in the Medicare population. Twenty-three percent of Medicare's 26 million beneficiaries have five or more chronic conditions and account for nearly 70% of the program's spending.
Medicare beneficiaries are more likely to have chronic illness than the commercial population and more apt to take multiple medications.
Costs can create a barrier to medication compliance for beneficiaries. In fact, the Medicare Part D population takes five prescription drugs per day on average and nearly 20% of them are not able to fill a prescription or delay filling a prescription because of cost, according to the white paper.
"You have the potential to have an even greater impact [in the Medicare population] because the sicker the beneficiary is and the more you can target a value-based insurance design, the better the outcomes are likely to be," says Lisa Murphy, manager at Avalere Health in Washington, DC, and coauthor of the paper.
The researchers reviewed five options for Medicare and found that three of them can be implemented immediately with minor operational changes:
Reduce cost sharing for specific drug or drug classes
Exempt specific drugs or drug classes from 100% cost sharing in the coverage gap
Reduce cost sharing for chronic special needs plan enrollees based on the plan's target condition
The other two options that were reviewed would require policy changes, such as CMS revising its non-discrimination clause to allow for reduced cost sharing for enrollees with chronic conditions or reducing cost sharing for enrollees in Medication Therapy Management Programs.
Tanisha Carino, PhD, vice president at Avalere Health in Washington, DC, and co-author of the paper, says her research shows VBID's potential in the Medicare population. She says VBID has the potential to help make Medicare a "more prudent purchaser of healthcare that meets patient needs. These tools need to be considered in the context of health reform as they map directly into the administration's goals of improving quality and preventing complications of illness."
Click Here to View the Full Article
Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.
