Health Culture Daily Dose #2

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In today’s Dose:

Health care reform
(Robert Reich; Blaming doctors; Lobbying Congress; Individual mandate)

Foodborne illness
(FDA and food safety)

Health care reform

  • Lobbyists who oppose the “public option” component of health care reform are spending big bucks. Robert Reich’s latest blog post on health care documents the dollar amounts: $9.8 million from the AMA since 2000, $6.4 million from Big Insurance in the first quarter of this year, $6.1 million in the first quarter from Pfizer, the world’s largest drug firm. Optimist that he is, he encourages everyone to contact Congress and the White House.

The President can’t do this alone. You must weigh in and get everyone you know to weigh in, too. Bombard your senators and representatives. Organize and mobilize others. And let the White House know how strongly you feel. This is one of those battles that define a presidency. But more importantly, it’s one of those battles that define the state of American democracy.

Here’s a website, Health Care for America Now, that will help you contact members of Congress and connect you to local groups. There’s a rally in Washington, DC on June 25th.

The basic view from behind the stethoscope is that health care would be a whole lot better if only the docs were given free rein to treat their patients, organize their practices, run the hospitals and set their own fees. …
Most often, studies show that physicians are simply unaware of the latest medical evidence or choose to discount it because it runs contrary to their training, local custom or economic self-interest. …
… the “House” factor, named after the popular TV show. It’s the belief, widely held by doctors and their patients, that a really clever and creative practitioner can outsmart the standard protocols and achieve heroic outcomes. This makes for great TV drama but … we could all have better health at a lower cost if docs were less inclined toward the medical equivalent of the diving catch and simply were more disciplined about kneeling down for routine ground balls. …
To its credit, the American Medical Association … has embraced payment reform and the push toward evidence-based medicine. And insurance companies report that docs have begun to respond positively when they are contacted by another health professional and shown scientific studies finding that there is a better way to treat a particular disease. By and large, however, practicing physicians still think that nothing should interfere with the sacred right of doctors and patients to make all medical decisions, even when they are wrong.
Docs seem to take it as a given that physicians in the United States should earn twice as much as doctors in the rest of the world — and five times more than their patients, on average. Mention these facts and you are guaranteed to get a lecture about the crushing debt burden that young docs face upon completion of their medical training. Offer to trade free medical education for a 20 percent reduction in physician fees, and you won’t find many takers.

House, MD, BTW, is currently the world’s most watched TV show, with 81.8 million viewers in 66 countries.

Many have expressed amazement that the interest groups historically opposed to fixing the health system seem ready to work with the reformers. Their public-spiritedness reflects enlightened self-interest: The health system is so unstable that even the drug industry and the insurance companies are worried that it will crash on top of them.
Health-care reform could bail out these interests by adding the currently uninsured — fast approaching 50 million people — to their customer base and by preventing more individuals and employers from dropping insurance altogether. …
[A]ll participants in the health-care system see a vicious cycle at work unless government intervenes. It involves “more and more uninsured, which means more and more premium increases, which means more uninsured, which means more premium increases.” From the point of view of the interest groups … that means less market share for the insurance companies, more uncompensated care by the providers, and less ability for people to afford high-cost prescription drugs.”

[T]he GOP will undoubtedly attack them [the Democrats] for adding untold billions to the mounting federal deficit and leading down a road to socialism. Recognizing this inevitable onslaught, Obama took full advantage of a pledge made by major organizations representing U.S. physicians, hospitals, health plans, and medical suppliers to do their part to reduce the growth of health care spending by 1.5 percentage points annually — saving an estimated $2 trillion over the next decade. Though the importance of the pledge was interpreted in various ways, Peter Orszag, the director of the president’s Office of Management and Budget, took it to mean that “even doctors and hospitals agree that substantial efficiency improvements are possible in how medicine is practiced.” And there is no question that the administration will take every opportunity to hold these key stakeholders accountable for their pledge.

  • In a second NEJM article on health care reform, John Holahan and Linda Blumberg make a case for the individual mandate – an enforceable requirement that everyone have health insurance.

Health insurers engage in many practices that make it difficult for people with health problems to obtain and maintain their coverage; they do so for the express purpose of protecting themselves from the potentially enormous financial consequences of adverse selection. Adverse selection entails the disproportionate enrollment in insurance plans of people with higher-than-average health risk. There is a natural tendency for such selection to occur, because people prefer to pay for coverage only when they think they will need health care services. Insurance pools cannot be stable over time, nor can insurers remain financially viable, if people enroll only when their costs are expected to be high. Consequently, insurers create, and regulators permit, structured barriers against such behavior, including such policies as exclusion periods for coverage of preexisting conditions, benefit riders that permanently exclude particular types of care, higher premium rates or cost-sharing requirements for people with health problems, and outright denials of coverage.
If we required that every person obtain at least a minimum package of health insurance benefits — that is, issued a so-called individual mandate — we would eliminate adverse selection, and these barriers would become unnecessary and, in fact, indefensible. Remove them, and being in bad health would no longer prevent people from obtaining adequate coverage. But allow some opportunity for people to remain uninsured, and the straightforward argument for removing the barriers quickly evaporates. At that point, the only mechanism for creating equity in the health insurance system regardless of health status would be government subsidization of the cost of adequate, guaranteed coverage using a revenue source unrelated to the decision to buy coverage (e.g., income surtax, sales tax, or other general revenue base). Because any guaranteed source of coverage in a nonuniversal system would attract a high-average-cost population, the amount of new government revenue required for subsidizing the “excess” risk in this way would be very large.

Foodborne illness

The legislation would give the FDA authority to order food recalls, impose new civil penalties and require companies to follow food-safety standards. It also would require the agency to inspect so-called high-risk food facilities at least once a year and make companies keep detailed records to help the FDA more quickly trace the distribution of tainted foods and track the course of the contamination.

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