This week USA Today reported that "High-deductible health insurance policies coupled with savings accounts — touted by proponents as an answer to rising medical costs — did not grow in popularity among employers this year, even as premiums for insurance continued to rise."
The Wall Street Journal reported that "Wal-Mart Stores Inc. next year will curtail options it offers newly hired workers for health-care coverage, promoting a low-premium, high-deductible plan. The retailer anticipates its "Value Plan" will let employees with few health-care needs save money through low premiums. Critics, however, argue the shift allows Wal-Mart to cut its costs for health-care benefits and discourage unhealthy people from seeking work at its stores."
And the Minneapolis Star Tribune questioned such plans in an editorial, "Bad medicine for health insurance." An excerpt: "Is it really a powerful new weapon for consumers to control health-care costs, or mostly a new tax shelter for affluent Americans and a marketing tool for insurance companies? Health care experts are still debating the question. But that hasn't stopped House Republicans, who launched the concept three years ago, from heaping a package of new tax advantages onto it this fall. That's a bad idea -- one the federal government can't afford at a time of big budget deficits -- and it should return to Congress' back burner as the fall session winds down this month."
David Leonhardt's "Economix" column in the New York Times yesterday argues that we don't need to restrain health care costs. He writes, "we often imagine that the costs and benefits are unrelated, that we can somehow have 2006 health care at 1950 (or even 1999) prices. We think of health care as if it were gasoline, a product whose price and quality have nothing to do with each other."
The column is, perhaps, an example of how you can't plunk an economist down in the health care industry and expect him to make sense of it. The column is blind to some of the hard data-driven realities of the U.S. marketplace.
2006 health care is not a hallmark of quality. As Dartmouth's Jack Wennberg has established over more than 30 years of research, there are wide, unexplained variations in the way medicine is practiced in this country, driving him to say, "In U.S. healthcare, geography is destiny."
Elliott Fisher of Dartmouth has shown that more is not always better in health care - that high-spending areas may have worse outcomes than low-spending areas.
Former U.S. Senator David Durenberger (R-Minn.) is eloquent on the point that we don't know what we're buying in health care.
So Leonhardt's argument that "an affluent society should devote an ever-growing share of its resources to the health of its citizens" is simplistic. Why encourage more spending in an arena of uncertain quality, where more is not better, where we don't know the value of what we're getting now for our unprecedented 15% of the GNP in health care???
How easy it is to forget the 46.6 million Americans without health insurance (according to the latest census figures). And how difficult it seems to be for many journalists to remember to cover this growing portion of the population.
Last week I got a note from Gary Rice, who calls himself "an old newspaperman and journalism professor" at Cal State-Fresno. He wrote, "You may not remember me, but we talked a year ago after your presentation at the SPJ (Society of Professional Journalists) convention in Las Vegas. I asked you for suggestions of health-related stories my community journalism students could do, and you suggested focusing on the uninsured and underinsured.
We did it.
My best student in the spring semester put together an incredible 8-story package with info boxes on the health care crisis in Reedley, Calif., population 21,000. The weekly newspaper there is running the whole shebang as a special section."
Congratulations, Professor Rice and to your student on a truly special effort.
I was talking with a major metro newspaper health reporter recently who said, "You can talk about news of the uninsured, but how do we make that new and interesting to our editors?" You showed how: by reminding editors that more of their readers - of many demographics - are now among the uninsured. You've reminded your students that one of the jobs of journalism is to give voice to the voiceless and to put faces on the statistics.
"Every time somebody in Washington says what a wonderful benefit this is, I think they have to look a little closer."
That's what a consumer says in a Washington Post story about the millions of older Americans who are now hitting the "doughnut hole" in Medicare drug coverage. That means they've spent through the first wave of coverage are now in a hole wherein they must pay the full cost of prescription drugs - or stop taking them.
The Post reports: "Some seniors knew nothing of the coverage gap until they were hit with a bigger drug bill, advocates say.
"Virtually everyone who calls to say they've been denied coverage, they're shocked," said Robert M. Hayes, president of the Medicare Rights Center, a nonprofit that helps seniors navigate Medicare. "Trying to explain that this is the way the program was created by Congress angers folks who think it makes no sense. Many people feel blindsided."
The coverage gap was one of the most contentious elements of the 2003 legislation that created the new benefit. It ends federal payments for a person's drug purchases once an annual spending limit is reached, resuming them only after the beneficiary has spent thousands of dollars out of pocket.
Proponents saw the unusual setup as a way to provide some help to all beneficiaries, and substantial help to those with catastrophic drug costs, and yet not break the bank in a federal program that is expected to cost hundreds of billions of dollars over the next decade.
Nine months into the program, as more and more seniors reach the threshold that puts them in the gap, many see it as a headache -- or worse."
The Wall Street Journal (subscription required) today profiles one employer's experience with high-deductible health insurance plans ("consumer-driven" as marketing folks like to call them) for his employees. The story reflects some of the good and some of the bad from this concept.
From WSJ: "The new strategy has motivated some workers to research what they are paying for medical care. One found an over-the-counter replacement for a more expensive brand-name heartburn drug. That is good news for Nick Bond, who runs the business and had suspected some employees were overusing medical care because they didn't have to pay for much of it themselves.
The bad news: The employees' research often consists of going to Mr. Bond and asking for his help, even after they have had 19 months to get familiar with the plan. At one point, he and his office manager had to hole themselves up in their offices for about two weeks developing a spreadsheet with price information on 32 drugs.
Mr. Bond's experience suggests that although information about the price and quality of health care remains sketchy, the president's push to make the health-care market more like the market for other services can change consumers' behavior. However, some managers have to turn themselves into instant experts both on health care and on the law. Mr. Bond knows about a transmission rebuilder's heartburn, a technician's blood-pressure medication and a visit to the emergency room by a mechanic's daughter. If he uses health information in firing or demoting an employee -- or is perceived to do so -- he might be in for a lawsuit."
From former U.S. Senator David Durenberger’s Sept. 21 newsletter from the National Institute of Health Policy:
“AARP just launched a $500,000 advertising campaign to persuade Congress to allow Americans to buy prescription drugs in Canada. This is the same AARP that helped Republicans in 2003 pass Medicare reform legislation to provide a prescription drug benefit, but to prohibit Medicare from negotiating drug prices for Americans. This suggests it is AARP’s policy to require 26 million Canadians to do for Americans what they won’t allow 42 million Americans to do for themselves.
We do know now that one thing that drives AARP insurance policy is the Insurance Trust – separate from its policy board – which decides which insurance carrier will offer official AARP Medicare Supplemental and related products. UnitedHealth Group (UHG) owned that franchise before and after passage of the MMA, which gave the company a huge advantage over its rivals in the first year’s competition for Pt. D and Medicare Advantage plans. The same will hold true in the future unless someone in leadership at AARP insists on giving AARP member beneficiaries a choice of AARP- endorsed products. ….
No matter which way you look at it, the costs of prescription drugs are rising. AARP reported this week that the cost of the 200 most commonly-prescribed drugs for seniors has risen by an average of 6%. That’s twice the cost of living adjustment in Social Security. Plus the Medicare Pt. B and Pt. D drug co-pays are rising too. Considering the annual income of the aged and disabled with ongoing medication needs, these cost increases are painful."
First, a followup to yesterday's Erbitux story. A student reminded me of a book, "The Cell Game: Sam Waksal's Fast Money and False Promises--and the Fate of ImClone's Cancer Drug." It's a story of insider trading, Martha Stewart, questionable clinical trial data - the whole shootin' match. Now add billionaire Carl Icahn into the mix as an ImClone Board member (the Wall Street Journal reports on Icahn's fiery first ImClone Board meeting), and you have a high-stakes, big pharma funfest to follow.
Today's newspaper brings other cheery news of the marketplace at play in this era of market-based solutions to health care reform.
The Associated Press reports that "HCA, Inc., the country's largest for-profit hospital operator, denied allegations Wednesday that it implemented anticompetitive practices against UnitedHealth Group Inc. in the wake of a contract dispute." This all sprung up when contract negotiations between the two health care giants broke down over new reimbursement rates affecting health care centers in the Denver area.
So this week so far, just one little slice of health care news includes:
* patent disputes;
* anticompetitive practice charges;
* billionaires at biotech board meetings;
* very little (if any) discussion of patients and consumers in these stories.
The Wall Street Journal (subscription required) reports that ImClone Systems was caught off guard by a judge's ruling this week about the patent for the cancer drug Erbitux. The Journal reports the judge "ruled Monday that three Israeli scientists were the true inventors of a patent covering a use of the monoclonal antibody Erbitux when given in combination with chemotherapy."
The paper further reports that the attorney for the three Israeli scientists "said his clients' win would be good for patients and good for competition. By seeking wider, nonexclusive licensing of the patent, (they) will encourage other manufacturers whose entry into the market will apply downward pressure on pricing for such cancer treatments."
I was at the National Press Club in Washington, D.C. yesterday to accept a Knight-Batten Award for Innovations in Journalism for the creation of the HealthNewsReview.org website. It was a terrific event, hosted by the J-Lab, The Institute for Interactive Journalism at the University of Maryland.
The news release about the event is available online.
About our efforts, the judges said: "Strong methodology, great content, and a great service for reporters and the public."
It was motivating and encouraging to see the inspiring work of so many creative journalists who, true to the mission of the awards, use "new information ideas and technologies to involve citizens in public issues."
The Therapeutics Letter out of British Columbia reports that "Canada now spends 25% more on pharmaceuticals than on doctors." And "me too" drugs are responsible for 80% of the increase in spending. "Me too" drugs are new drugs that are basically old ideas in new wrapping - new competitors that don't represent a major advantage over existing alternatives but which allow drug makers to compete for a slice of a lucrative pie.
They report similar findings in France and Sweden.
The piece concludes that, "Since most new “me-too” drugs are much more expensive than equally effective older drugs, they represent a waste of health care resources. Physicians collectively have the power to prevent this waste and thus free up money for other sectors of the health care system. ... If the increased use of “me-too” drugs in Canada could be stopped for just one year, we could save more than $1 billion off of total drug costs. After this one-year break, even if everyone went back to usual prescribing patterns, the savings generated and carried forward would pay for the salaries of 4000 new primary care physicians."
The New York Observer reports that Dr. Jonathan LaPook, recently named medical reporter for the CBS Evening News (with Katie Couric), also helped arrange Katie's on-air colonoscopy in 2000. The Observer also reports:
"Over his quarter-century in medicine, he has consulted with some of that network’s most important figures: former news division president Howard Stringer; Andrew Lack, the creator of the newsmagazine West 57th and a former senior executive producer of CBS Reports....His father-in-law is Norman Lear, the television legend and creator of CBS hits All in the Family and Maude.
In August, Dr. LaPook officially joined the payroll. Still a practicing physician and a member of the faculty at Columbia Presbyterian Hospital, he is now also the medical correspondent for Ms. Couric’s CBS Evening News. That evening-news job was previously held by Elizabeth Kaledin, a practicing journalist who has covered the medical beat for the network since 1996.
Ms. Kaledin was still under contract when Dr. LaPook replaced her, and the contract will not be renewed when it expires at the end of this year, according to three network sources. ...
Dr. LaPook declined an interview request because he was “seeing patients and crashing a story,” said a CBS News spokesperson. Ms. Kaledin declined to speak at length because of the sensitivity of her position at the network.
“The thing I’d feel most comfortable saying, which is the truth, is that I am heartbroken by the loss of my job and have spent 20 years working to get to this point, only to be replaced by someone with no journalistic experience only because he’s a doctor,” she said. “I have worked incredibly hard from the smallest markets in TV to get to this point. I have never pissed anybody off. My reporting career is unblemished. I’m well-liked. I work hard. I’ve been loyal to CBS.”
All maybe true, Elizabeth, but you didn't help arrange the famous colonoscopy and you're not a "popular Upper West Side gastroenterologist." You were only, apparently, a journalist.
An internal audit by the National Institutes of Health criticizes one of its senior cancer researchers for "serious misconduct," according to the Los Angeles Times.
The Times reports that Dr. Thomas J. Walsh entered "into dozens of unauthorized private arrangements with drug companies ... failing to report annually the outside income, totaling more than $100,000. ... The internal review, conducted by lawyers and other ethics specialists within the office of the NIH director, found that from 1999 to 2004, Walsh received fees totaling $100,970 from pharmaceutical and biotechnology companies. He accepted fees from 25 companies and has led government-sponsored research involving some of those companies' drugs."
The Times says a congressional hearing this week is expected to review NIH's handling of the Walsh case and that of another senior NIH researcher, Dr. P. Trey Sunderland III. The Times adds: "Sunderland, who has specialized in researching Alzheimer's disease, accepted hundreds of thousands of dollars in drug-company fees — including about $612,000 from Pfizer — without obtaining required advance approval. In June, Sunderland asserted his 5th Amendment right against self-incrimination while declining to answer questions before the congressional subcommittee. Neither Sunderland nor Walsh has been publicly disciplined, and each maintains his senior government position."
California governor Arnold Schwartzenegger last week vetoed a single-payer health insurance bill passed by the state's Democratically-controlled legislature last month.
Merrill Goozner writes: "The text of the veto message was instructive because it uses every Big Lie that will be thrown against progressives who unite around a national single-payer plan as the only real solution to the U.S. health care financing crisis." Goozner analyzes phrases in the governor's message, familiar phrases in the anti-single payer litany: "create a vast new bureaucracy...cost billions and lead to significant new taxes," etc.
Meantime, the latest U.S. Census Bureau survey shows there were 46.6 million uninsured Americans last year, up 1.3 million over the previous year. So almost one in six Americans lack health insurance. Nearly all the new uninsured were working adults ages 18 to 64 - a sign that employer-based health insurance is drying up fast.
Yet, as Goozner opines, Schwartzenegger's "rhetoric ... suggests honest discussions about health care reform is not on anyone's agenda."
And any reasonable, thinking adult must ask: How does consumer-driven health care make this picture any brighter?
A Dutch epidemiologist and colleagues warn in the BMJ this week that news coverage of a diabetes finding may raise unrealistic expectations. They write that a New York Times story earlier this year quoted a diabetes researcher saying the gene discovery (a variant of the TCF7L2 or transcription factor 7-like 2 gene) could lead to a diagnostic test to identify people who carry the variant gene.
They say that a Scottish scientist headed the research team, which led the Glasgow Herald to report, "Discovery of holy grail will help scientists treat diabetes."
The editorial acknowledges that the discovery is undeniably noteworthy. But the claim that this discovery will lead to a diagnostic test - and the chance to prevent type 2 diabetes - may not be true and may mislead the public.
“Raising unrealistic expectations – even inadvertently – could distract attention from what can be done by applying what we already know to prevent diabetes and its complications," they conclude.
In his September 6 newsletter from the National Institute of Health Policy, former U.S. Senator David Durenberger (R-Minn.) reflected, as he often does, on the current state of U.S. health care:
"In a speech given here in Minnetonka, Minnesota late last month, it appears President Bush is traveling down two parallel tracks towards health system reform. One might get us there, the other won’t.
The President promoted good messages about better information, broad use of IT and standards, the need for quality and price transparency, and a pledge to think differently about how to fix healthcare.
He undermines these good messages, however, with his impassioned focus on tort reform, his unwavering promotion of HSAs and consumer choice as the answer to everything, and his suggestion that association health plans were an American ideal. ...
Every other developed country in the world has national health insurance systems in which the government strongly influences costs and payments. The U.S. system has always been pluralistic - powerful medical professions have prevented pay-for-performance comparisons, assured multiple choice of doctors and insurance, and complained continually about efforts of Medicare and Medicaid’s single-payer systems to influence their behavior.
The good news/bad news in America is that the battle against single payer healthcare is over and government-run health care is in terminal demise. The bad news is that the privatization of our health care financing means the financial services industry decides who gets what for how much. That is after they, their investors, and all the transactionists in the health services commodity markets have been paid. How does this make health care more affordable for all? And less dependent on tax revenue support?
It’s hard to see the answers from where we are today. The medical markets seem to be dis-integrating into ever more McSurgery, McUrgi, McMinute, and McMRI. Behind all that consumerism on the same-day illness margin are the big ticket items, the medical miracles, and the high-cost chronic illnesses. And if you and I aren’t paying for big tickets, then who is?"
Katie Couric signed off her first anchor evening at CBS News by saying she had "racked my brain" over what clever signoff to use each night. The brain racking came up empty; she said she had no good ideas. Then she showed examples of signoffs from Edward R. Murrow, Huntley- Brinkley, Dan Rather, Walter Cronkite and even from TV and movie anchor-spoofs Ted Baxter and Ron Burgundy.
Since she got no inspiration from the serious or the comedic, she invited the audience to send her ideas for a signoff.
One can only hope that isn't the biggest issue on the minds of Couric, CBS, or their audience.
The National Research Center for Women & Families released a report that suggests a lot of FDA rubber-stamping of approval of new medical devices and drugs.
A news release on the group's website quotes Center president Dr. Diana Zuckerman:
"From our analyses of the FDA advisory committee voting patterns and committee discussions, our study shows advisory committee members usually recommending approval, even if they have strong concerns about the products' safety and effectiveness. And, on those rare occasions that the advisory committee opposes approval, the FDA frequently approves the product anyway. That is especially likely for medical devices." ... "Our study indicates that even one committee member with a financial conflict of interest could easily influence the votes of the entire committee, and thus the FDA decision to approve the product."
Last week's New England Journal of Medicine article postulating that the U.S. is getting quite a bargain from what's it's spending on health care garnered a lot of news coverage.
(This despite the fact that the authors said, "The rising cost of healthcare has been the source of a lot of saber-rattling in the media and the public square, without anyone seriously analyzing and discussing the benefits gained. But the dramatic increase in life expectancy that we've seen over the last decades shows that rising medical costs have been largely justified.")
Well, journalist Merrill Goozner did some analysis of his own, in a blog entry entitled, "Paying for an Aston-Martin, Getting A Ford." He concludes: "But studies like (this) can only serve to distract attention from the fact that our fractured and inefficient health care system, plagued by high administrative overhead, delivers worse outcomes than most other advanced industrial nations despite imposing far higher costs."
What a flashback! 21 years ago, National Cancer Institute researcher Steven Rosenberg became a media darling because of his work with Interleukin-2 against cancer. Magazine covers, newspaper headlines, Today show appearances. Much of it hype.
Yesterday a new media feeding frenzy was kicked off when the journal Science published a Rosenberg (et al) paper about remissions in two people with advanced melanoma using genetically altered white blood cells from the patients themselves. The 15 other people in the trial died.
The Knight Science Journalism Tracker website comments on the variation in the way journalists covered the story:
"Gene therapy has failed so many times to live up the hype of a generation ago (much of it abetted by journalists) that good reporters are usually cautious in writing about it. So it was that some who covered this put the experiment’s limitations ahead of its achievements. The Baltimore Sun’s Michael Stroh, for example, wrote a lede that started: “In a small study…” Lauran Neergaard of the AP went with a more upbeat lede: “Government scientists turned regular blood cells into tumor attackers that wiped out all signs of cancer in two men with advanced melanoma,” but followed with a second graf that started “But” and said the treatment failed in 15 others.
A sampling: The Washington Post’s David Brown was careful to note that none of the scientists would claim the two patients were cured, a verdict that would have to wait at least five years; however, Karen Kaplan, writing in the Los Angeles times, called the treatment a “cure.” Sabin Russell in the San Francisco Chronicle appropriately called the study “tiny”; Joe Palca had a good backgrounder-cum-news story on NPR Thursday afternoon; The Telegraph’s Roger Highfield in the UK was unusually upbeat, spinning a heartwarming anecdote of one patient in whom the treatment worked through nine paragraphs before telling his readers that the treatment failed in 15 others."