In today’s Dose:
Health care reform
(Insurance industry practices; Maggie Mahar on insurance; Analysis of the public option’s status)
Health news
Mid-life migraines update)
The Medical profession
More on Dr. Arash Hejazi)
Health care reform
- Ezra Klein has a column in the Washington Post on Wendell Potter’s testimony before Rockefeller’s Commerce Committee (see my posts from Wednesday: Health insurance insider speaks out and A health insurance executive changes sides).
On the practice of rescission – cancelling insurance coverage if a policy holder has omitted a minor illness when applying for coverage – Klein comments:
And don’t be fooled: rescission is important to the business model. Last week, at a hearing before the House Subcommittee on Oversight and Investigation, Rep. Bart Stupak, the committee chairman, asked three insurance industry executives if they would commit to ending rescission except in cases of intentional fraud. “No,” they each said.
That story is covered in Mother Jones and is called “Healthcare CEOs Shoot Themselves in the Foot.” An example of rescission from the Mother Jones story:
A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.
Klein’s conclusion:
The reason we generally like markets is that the profit incentive spurs useful innovations. But in some markets, that’s not the case. We don’t allow a bustling market in heroin, for instance, because we don’t want a lot of innovation in heroin creation, packaging and advertising. Are we really sure we want a bustling market in how to cleverly revoke the insurance of people who prove to be sickly?
- Maggie Mahar makes an excellent case for keeping non-profit private sector insurance, in addition to a public option. She points out potential problems with a single-payer solution (which admittedly is not too likely at this point).
If you have only public sector insurance (as in the U.K.) and Sarah Palin is elected president, you have a problem. Don’t laugh. Were you laughing when GWB was re-elected? Okay, some people liked President Bush. Obviously quite a few people voted for him. But you never know who is going to wind up in the White House. When Margaret Thatcher took charge in the U.K., she took a hatchet to the National Health Service. It still hasn’t fully recovered.
She gives a few examples in her response to comments from readers of this post:
Until 1998, the Federal Employees Health Insurance (which is run by the Federal Government) didn’t cover contraception.
If we had single payer, a dozen years from now, it is quite possible that we would wind up with a president and a conservative Congress that would decide that our only insurance option — the government plan — shouldn’t cover contraception. “The Pill” has become quite expensive. A great many young women would be hard-pressed to pay for it out of pocket.
Or, a libertarian president and Congress might decide that everyone should be “responsible for himself” — and that the government insurance should not pay for many treatments for poor people who are obese, or are addicted to tobacco, or “just aren’t taking care of themselves.”
- The big question these days in health care reform surely is whether there will be a public option – government sponsored health insurance. The Associated Press has a good summary and analysis of where things currently stand.
Some liberal Democrats worry that President Barack Obama may be waiting too long to face down Republicans [on the issue of a government-run health insurance program]. … [H]e is standing by as a watered-down, bipartisan version appears likely to be included in a Senate package. …
Frustrated liberal activists, however, point to polls showing strong public support for a government-run option that is more robust than the one apparently favored by the Senate Finance Committee. They ask why Democrats, who control the House, Senate and White House, are pushing a version backed by many Republicans. …
Obama wants to avoid issuing nonnegotiable demands early in the legislative process. He feels President Bill Clinton made such a mistake in a failed 1993 bid to revamp the health care system. … Some Democrats, however, feel Obama has over-learned the lessons of 1993 and is bending over too far to attract GOP support in the Senate. … California Democratic Rep. Lynn Woolsey … said, if a bill “does not include a real and robust public option that lives up to our criteria, then we will fight it with everything that we have.” …
The House is moving a Democratic-crafted bill virtually certain to include a publicly run health insurance provider with the clout to compete with private insurers.
In the Senate, Finance Committee Chairman Max Baucus, D-Mont., wants some Republican support for a far-reaching health care bill, which eventually must be reconciled with the House version to become law. GOP members oppose a public option similar to the House’s plan, saying it would have unfair advantages that would drive private insurers out of business. …
Finance Committee Chairman Max Baucus … is leaning toward a compromise version involving nonprofit cooperatives. Critics say co-ops would not be genuine public options for health insurance. …
“Right now, this co-op idea doesn’t come close to satisfying anyone who wants a public plan,” [Sen. Chuck] Schumer said this week. …
“The public plan, I think, is an important tool to discipline insurance companies,” he [Obama] said in a news conference Tuesday. But he said he would draw no “lines in the sand,” leaving proponents to wonder whether he might eventually drop the public program in exchange for something else. …
Some proponents of revamping health care hope a modified public option will win support from doctors, hospitals and makers of medical devices and drugs, which would leave insurance companies as the main opponents. The insurers’ cause was hurt this week when congressional investigators said two-thirds of the industry used a faulty database that overcharged patients for seeing doctors outside their insurance network, costing Americans billions of dollars in inflated medical bills.
Health news
- There’s something I neglected to mention in a previous post on women who have migraines with aura during mid-life. In addition to the study published in The New England Journal of Medicine, which described a link to the blockage of blood supply in the brain (infarct-like lesions) later in life, there was also an editorial in the same issue with comments on the study. The upshot is that the editors were not convinced this study indicates something women (and their doctors) should be concerned about, at least not yet.
In the absence of the source and the nature of infarct-like lesions and the absence of clinical symptoms or consequences, it is premature to conclude that migraine has hazardous effects on the brain.
The full text of the editorial is available by subscription only.
The medical profession
- I’ve learned more about Dr. Arash Hejazi, the man who was present when Neda Soltan was murdered in Iran and who appears in the widely circulated video of her death. There’s a compelling BBC interview with him (19 minutes). The version on the BBC website caused my browser to crash, so I recommend the one on Paulo Coelho’s blog. If you’re short of time, there’s a YouTube extract that covers only the shooting and Dr. Hejazi’s response. It’s a little over two minutes.
Dr. Hejazi, 38, is an Iranian novelist, translator, and publisher. He is currently a post-graduate student in publishing at Oxford Brookes University in Oxford, England. He attended medical school in Iran, where wrote his thesis on “The influences of storytelling on children’s anxiety disorders”. Before leaving Iran to study abroad, he was a general practitioner in Iran.
Hejazi has translated the works of Brazilian novelist and lyricist Paulo Coelho (The Alchemist
Here are Hejazi’s comments on being a doctor in an emergency situation such as this, from the BBC interview:
I’ve seen people dying many times. It’s my profession. I’ve seen even people hit by a bullet. And while I was over her body, I didn’t think of anything other than to do the things that a doctor has to do, when he faces such a situation. But afterwards I just went to the bathroom and just tried to … I was washing my hands compulsively, for I don’t know how many minutes. And I was appalled. … I didn’t sleep for three nights.
Hejazi describes how he felt when he stood up from the body of Neda Soltan and realized he had been one meter away from her and could have been shot himself. He was overwhelmed with the fear of death and, at the same time, felt guilty for thinking of himself in the presence of the dying woman.
The interview includes details of the event, such as the lack of an exit wound in the back of the body – the Iranian government has suggested that Neda was shot in the back by the CIA – and the crowd’s capture and release of the Basiji militiaman who admittedly killed Neda. “I didn’t want to kill her,” he kept shouting. There are photos of this man, and the crowd took his identity card. There was nothing the crowd could do with him. If they had turned him over to the police, he would simply be released. To my knowledge, his identity has not been publicized.
Foodborne illness
- The Associated Press has a story about a Nestle USA cookie dough factory that refused several times to supply FDA inspectors with complaint logs, pest-control records and other information. The FDA was denied access to documents from 2004 through 2007.
An FDA spokeswoman said: “Companies have the right to make conditions on what they will or will not permit during an inspection.” Nestle made a statement rejecting the implication that it did not cooperate with the FDA.
In a 2006 inspection,
[T]he FDA found three live “ant-like” insects on a ledge along a wall by a powdered sugar station in the cookie dough manufacturing area, dirty stainless steel equipment in a bin that was identified as clean and water dripping from an overhead line. The company told the FDA inspector it had called its extermination company and said the other issues would be corrected immediately.
This is the type of scrutiny a food manufacturer has to expect when one of its products causes wide-spread food poisoning. Obviously something went wrong, but it’s probably too soon to draw conclusions. I’m sure the CDC will get to the bottom of this.
Nestle has had image problems before, such as their promotion of powdered milk formulas for babies rather than breast feeding in third world countries. That public relations fiasco led to a major boycott of Nestle products.
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