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07/07/2017

Upcoming Podcasts: Discussions With the Authors of Two Recent Health Policy Books

Later this month I'll be discussing two recent health policy works with the authors:

  1. Dr. Halee Fischer-Wright, "Back to Balance, The Art, Science and Business of Medicine."
  2. Dr. Elisabeth Rosenthal, "An American Sickness, How Healthcare Became Big Business and How You Can Take It Back."  

(My interview with Ms. Peg Stessman, CEO of StrategicHealthSolutions, scheduled for July 13 concerning the extent of Medicare fraud and solutions to reduce improper payments, was canceled by her office.  Though I was solicited by the firm to interview Ms. Stessman, she I'm told is unwilling to discuss, however generically, the extent of the problem and corrective measures.)   

06/25/2017

Will Senate Republicans Get 50 Votes to Repeal the ACA? (June 24th)

This coming week the Senate will take up their amended version of the House repeal bill, the American Health Care Act. Here is my assessment of the legislation's prospects posted yesterday on The Health Care Blog.  I conclude the essay by citing a 2014 study by Gilens and Page.  If the legislation passes it demonstrates, as Gilens and Page wrote, the "American public actually have little influence over the politics of our government adopts."  Phrased another way, "when a majority of citizens disagrees with economic elites or with organized interests," they said, "they generally lose."

My essay is at: http://thehealthcareblog.com/blog/2017/06/24/will-senate-republicans-get-50-votes-to-repeal-the-aca/

Gilens and Page's article is at: https://scholar.princeton.edu/sites/default/files/mgilens/files/gilens_and_page_2014_-testing_theories_of_american_politics.doc

06/22/2017

Improving the Use of Evidence-Based Medicine: A Conversation with Dr. Todd Feinman (June 21st)

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 A 2012 National Academy of Sciences (Institute of Medicine) study titled, "Best Care and Lower Cost," found about one quarter of all medical spending is wasted, much of this excessive spending going to pay for treatments that are of unknown effectiveness.   With medical spending now accounting  for one-sixth of the nation's GDP, or over $3 trillion annually, how do we limit spending to treatments that are proven effective or are of high value.  How do we increase the use of evidence-based medicine.  While this issue or problem has been, or is being, addressed by several federal health care agencies including the Agency for Healthcare Research and Quality (AHRQ) and the the ACA-created Patient Centered Outcomes and Research Institute (PCORI), progress has been frustratingly slow.   (For example, a day prior to this interview a Health Affairs blog post discussed the persistent use, despite clinical evidence to the contrary, of pre-cataract surgery blood analysis and EKG testing.)      

During this 23-minute conversation Dr. Feinman discusses how his background as a hospitalist led to his co-founding Doctor Evidence, what explains the variation in the use of evidence based medicine, how Doctor Evidence is working to improve the timely collection, dissemination and use of evidence-based medicine, how his work is related to the Cochrane Collaborative, and how work by Doctor Evidence can influence quality measurement and drive or improve health care value, or patient outcomes achieved relative to spending. 

Dr. Todd Feinman is the Chief Medical Officer and co-founder of Doctor Evidence where he works to create evidence Feinmantechnologies that will lead to improved care, better health care outcomes, greater patient satisfaction and reduced spending growth.  Among other partnerships, Doctor Evidence works with the USC Center of Body Computing and with several medical associations and pharmaceutical companies.  Dr. Feinman began his career as a hospitalist, developing the first such programs in Southern California.   He is a board certified internist.   Dr. Feinman earned his medical degree at UCLA's David Geffen School of Medicine and did his residency work at Cedars-Sinai Medical Center in Los Angeles and at Huntington Memorial Hospital in Pasadena. 

For information on the firm Doctor Evidence go to: http://drevidence.com.

 

 

06/15/2017

Medicare As a Neutral Payer (June 15th)

If your're interested in Medicare payment reform generally, you may be interested in my essay, "Medicare Programs Should Compete," posted today on the Health Affairs blog.  It is at:  http://healthaffairs.org/blog/2017/06/15/medicares-programs-should-compete/.

06/14/2017

The Medical Communities (Non) Response to Trump's Withdrawal From the Paris Climate Accord (June 13th)

If you're interested in learning what was the response by the trade and professional medical association communities to President Trump's June 1 announcement regarding the Paris accord please feel free to read my essay, "Medical Association's Non-Pulsed by Trump's Withdrawal From Paris Accord," posted yesterday on The Health Care Blog: http://thehealthcareblog.com/blog/2017/06/13/medical-associations-non-pulsed-by-trumps-withdrawal-from-the-paris-accord/.

06/03/2017

Extraordinary Altruism in Voluntarily Donating a Kidney to a Stranger: A Conversation with Professor Abigail Marsh (June 2nd)

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Approximately 8,700 Americans die annually awaiting a kidney donation or become too ill to receive one.  This is half the number of those who annually receive a kidney, or 17,000.   Over 100,000 at any time are awaiting a kidney.  The median wait time is over three and a half years.  One-third of kidney donations are live donations typically from a child, parent, sibling, spouse or other relative.  However, an increasing number of live donations are made by strangers voluntarily choosing to donate. The number of these donations while small, at less than 400 annually, has doubled in recent years.  The benefits of receiving a donated kidney are pronounced, the expected benefits to the recipient are estimated at 100xs the expected costs to the donor. 

During this 26 minute conversation Professor Marsh explains why she became interested in altruism particularly extraordinary altruism, what her and her colleagues' research has found that explains donor reasoning in providing a kidney, how "social discounting" and other factors play into their decision making, how brain development, or the size of a donor's amygdala (the part of the brain responsible for decision making and emotional reactions including compassion), plays a factor and to what extent normalizing voluntary kidney donations may over time reduce or eliminate the shortage of kidney donations.

Professor Abigail Marsh is an Associate Professor in the Department of Psychology and the Interdisciplinary Program in MarshNeuroscience at Georgetown.  Prior to Georgetown, Dr. Marsh conducted post-doctoral work at the National Institute of Mental Health at the National Institutes of Health from 2004 to 2008.   Her areas of expertise include social and affective neuroscience, particularly understanding emotional processes like empathy and how they related to altruism, aggression and psychopathy.   Her work has appeared in the Proceedings of the National Academy of Sciences, Psychological Science, the American Journal of Psychiatry, JAMA Psychiatry and Nature Human Behavior.  Dr. Marsh was graduated with a BA in Psychology from Dartmouth and a Ph.D. in Social Psychology from Harvard.   

Professor Marsh's June 2016 TED talk, "Why Some People Are More Altruistic Than Others," is at: https://www.ted.com/talks/abigail_marsh_why_some_people_are_more_altruistic_than_others.

A 10-page, footnoted discussion weighing the pros and cons of voluntary donating a kidney can be found on the Effective Altruism Forum website, at: http://effective-altruism.com/ea/ay/kidney_donation_is_a_reasonable_choice_for/

06/02/2017

AHCA In Context of Social Justice: A Conversation with Jason Silverstein (June 1st)

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This past May 4, US House or Representative Republicans passed the American Health Care Act (AHCA).  The bill, defined by Republicans as a repeal of the Affordable Care Act (ACA), is now under debate among Senate Republicans. (Neither any House Democrat voted for the AHCA nor are there any Senate Democrats expected to vote for related Senate bill should it make the Senate floor.)  Per the Congressional Budget Office's (CBO) estimate of the AHCA's spending and revenue effects, published May 24, the AHCA would cause 14 million Americans to lose their health insurance in 2018 and 23 million by 2026, 14  million of this latter total would be Medicaid recipients.  This is because the AHCA would cut $834 billion from the Medicaid program over the ten year budget window, or by 2026.  The cuts in Medicaid spending, along with substantial reductions in tax credits, would allow for ACA taxes, approximately $600 billion, to be rescinded.  For example, the ACA's 3.8% tax applied to capital gains for family incomes over $250,000 and a 0.9% Medicare surtax on wage income in excess of $250,000 per year, i.e., tax cuts that would benefit the comparatively wealthy.           

During this 25 minute conversation Dr. Silverstein provides, among other things, his assessment of the AHCA, i.e., legislation moreover as tax relief for the wealthy, the likely effect it would have one women's health and on disparities in care and alternatively how the ACA could be improved. 

Dr. Jason Silverstein is a Lecturer and Writer-in-Residence at Harvard Medical School in the Department of Global Health Silversteinand Social Medicine. He is also currently an Instructor at the Harvard T. H. Chan School of Public Health.  He is also a faculty affiliate of the Science, Religion and Culture Program at the Harvard Divinity School.  He is a regular contributor to VICE's health channel, Tonic.   He has written for The New York Times, the Atlantic, The Guardian, Slate, The Nation and others and has provided commentary for, among others, MSNBC, NPR, HuffPost Live and BET.   His previous experience includes conducting research at Children's Hospital Boston, the Dana-Farber Cancer Institute, Harvard Law School's Program on Disability, and Stony Brook's HIV Treatment Development Center. Dr. Silverstein holds a Ph.D. and Master's in Anthropology from Harvard, a Master's in Religion, Ethics and Politics from Harvard Divinity and an undergraduate degree in philosophy from Penn. State. 

Dr. Silverstein's Tonic writings are at: https://tonic.vice.com/en_us/contributor/jason-silverstein

05/04/2017

"Would Repealing the ACA Violate International Law?" (May 3rd )

 

The Health Care Blog (http://thehealthcareblog.com/) posted an essay under this title on April 28th by myself and Jason Chung. The blog post summarizes Washington Post opinion writer, Dana Milbank's, April 25th essay noting the UN forwarded to the Trump administration on February 2nd a letter arguing repeal of the ACA would likely violate several US-agreed to international treaties and other international agreements concerning the rights of everyone to enjoy the highest attainable standards of physical and mental health. As Milbank noted, and as repeated in the blog post, the Trump administration, despite the UN's request to make known the letter to Congressional leaders, buried the correspondence.  The letter was leaked by a DHHS employee who had obtained a copy from the State Department.   

Milbank's article and the UN letter are at: https://www.washingtonpost.com/opinions/apparently-repealing-obamacare-could-violate-international-law/2017/04/25/2794a77c-29f4-11e7-b605-33413c691853_story.html?utm_term=.3d3cbd497026 and  https://www.washingtonpost.com/r/2010-2019/WashingtonPost/2017/04/25/Editorial-Opinion/Graphics/103_17_ACA_Repeal_Request_for_Information.pdf?tid=a_inl

04/28/2017

The Current Status of Employer-Based Insurance: A Conversation with James Gelfand (May 3rd)

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Considering the debate over the past five months about repealing the ACA (and more generally reforming the Medicare program via premium support),  it is worth remembering that approximately 55% of non-elderly Americans, or 155 million, still receive their health care coverage via their employer.   In addition, as of 2016 the ACA requires employers with over 50 employees to either offer health benefits or face a financial penalty.   The question remains what is the future of employer based insurance coverage, both for employees and retirees) if, for example, the ACA's "employer shared responsibility" provision and/or the employer tax exclusion (addressed in the ACA by the so called "cadillac tax") is repealed. 

During this 25 minute discussion Mr. Gelband briefly describes ERIC's mission/work, identifies what methods large employers are using to continue to offer employee coverage, how retiree coverage is being addressed, how employers are incenting providers to deliver quality care, ERIC's view of much debated HRAs (Health Risk Assessments) and wellness programs and his organization's position on the employer tax exclusion.  (Listeners may recall I interviewed Dr. Joe Antos last August 5th on the tax exclusion.)

Mr. James Gelfand is Senior Vice President of Health Policy at ERIC where he works to develop and advance public policies to James Gelfand's Headshot support the ability of employers to design and administer health plans.   Previously, Mr. Gelfand was the Director of Federal Affairs at the March of Dimes Foundation.   Prior to, he served as Associate Director for Luntz Global Partners.  He served on Capital Hill as Counsel to Senator Olympia Snowe, on the Senate Small Business Committee and to Senator Tom Coburn.   Mr. Gelfland also was for four years a lobbyist for the US Chamber of Commerce.   Mr. Gelfand received his JD from the George Washington University Law School and his undergraduate degree from Northwestern. 

For more information on ERIC go to: http://www.eric.org/.

04/18/2017

CMS' "Market Stabilization" Rule Goes Final: My Comments (April 17th)

For those carefully following the ACA state marketplaces, i.e., the viability thereof, here's an update to my March 22 THCB essay (four posts down).  This one is titled, "The Strange Making of the 'Marketplace Stabilization' Rule," at: http://thehealthcareblog.com/blog/2017/04/17/the-strange-making-of-the-marketplace-stabilization-rule/.   The CMS rule is at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-04-13-2.html.