Health Reform

With all the talk of financing and mandates and public options, it's important to make sure the essentials -- that patients are helped, not harmed, by health care -- don't get overlooked. Consumers Union's Safe Patient Project held a daylong event here in DC today to help us keep that in mind.

Roughly 100,000 patients die a year from medical errors and about another 100,000 die of infections acquired in health care settings. "The status quo is not acceptable," Art Levin, director of the Center for Medical Consumers, told the forum.

Consumers Union last May marked the 10th anniversary of the Institute of Medicine's landmark "To Err is Human Report" with a report of its own called "To Err is Human - To Delay is Deadly" (Here's what we wrote about it at the time). The bottom line: not a lot of progress.

The event today highlighted some achievements; the health reform legislation does take some important steps to improve safety and quality. It also sheds a rather depressing light on how much remains to be done.

A new study from America's Health Rankings predicts 103 million American adults (43 percent) will be obese by 2018, if obesity levels continue to grow at their current rate. At that point, the U.S. will spend approximately $344 billion dollars annually on health care costs attributable to obesity, according to the new study.

The study, conducted by Emory University professor Kenneth Thorpe, utilizes weight data, Census statistics and medical expenditure information, according to USA Today. Thorpe's study, The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses, is the first to provide projections for the future medical costs of obesity, and also provides state by state calculations for obesity levels and cost, according to a press release from the United Health Foundation. (Mississippi tops the list for the most obese population, while Colorado is all the way at the bottom.) USA Today has some highlights from the report:

The New York Times had two interesting reports this week on the pharmaceutical industry.

Monday Duff Wilson reported that drug makers have raised the prices of wholesale brand-name prescription drugs by more than 9 percent during the  the last year (more than twice the general inflation rate of 3.8 percent).

The paper reported that this dramatic price increase will boost the U.S. prescription drug tab by more than $10 billion this year. Total pharmaceutical spending is expected to trump $300 billion (up from $230 billion in 2003), and at least one analysis indicates that this will mark the highest annual rate of inflation for drug prices since 1992.

Remember, this is despite the pharmaceutical industry's pledge to reduce the nation's drug costs by $80 billion over 10 years after health care reform kicks in.

Huh?

"Price adjustments for our products have no connection to health care reform," said Ron Rogers, a spokesman for Merck. The drug makers say that several patent expiration dates are right around the corner and that they need to maintain high profit margins to invest in research and development. 

The government paid $47 billion (that's billion with a B) in false or questionable Medicare claims last year, according to a new federal report obtained by the Associated Press.

The report shows a dramatic increase in Medicare fraud from previous years. In 2008, the government paid an estimated $17 billion in improper claims. So what caused this number to nearly triple in the past year? The most likely culprit is not more fraud attempts, writes the AP, but the increased scrutiny on Medicare claims. The Department of Health and Human Services's new  stricter methodology is part of the Obama Administration's effort to crack down on Medicare fraud.

The Center on Budget and Policy Priorities concludes that the idea of raising the Medicare payroll tax "on high-wage earners would represent a sound and well-targeted way of paying for health reform."

Senate Majority Leader Harry Reid is reportedly considering raising the Medicare payroll tax  to 1.75 percent (up from 1.45 percent) for individuals earning more than $200,000 a year and couples earning more than $250,000 a year. Reid needs to fill a health reform financing gap if he raises the threshold for taxing the so-called "Cadillac" plans to $8,500 for individual plans and $23,000 for couples (up from $8,000 to $21,000, respectively). Scaling back the reach of that excise tax would please labor unions, among other groups, who have expressed opposition. The Medicare alternative has quickly gained popularity.

The CBPP report has several interesting conclusions:

It's Monday, the day after Sunday, which in America means a surprisingly large number of Americans are talking trash about their fantasy football teams. (Good hustle Ben, but the Cleveland Steamers are on a roll.) So forgive us for the gridiron gab, as we reset the play clock on health reform.

As you know, the passage of H.R. 3962 in the House two Saturdays ago pushed health reform into the red zone and brought us closer to the goal line than we've ever been before. The problem, as the Senate prepares to take the field, is that the goal posts keep getting pushed back. A slow handoff between Senate Majority Leader Harry Reid (D-NV) and the CBO has delayed the bill's release, but Reid seems determined to keep the ball moving. Roll Call's Emily Pierce lays out the potential Democratic gameplan going forward:

Be careful  what you wish for! Maggie Mahar,  who writes the Century Foundation's Healthbeat blog,  had a piece in the Washington Post's Sunday Outlook section calling for a public plan option -- but telling progressives who had yearned for a fully single payer system to visualize the downside.  Just imagine, she wrote, if a movement conservative like Sarah Palin ends up making the rules.  That could make the current controversy about abortion in the health insurance exchange seem tame. What about coverage of contraceptives? Or the ability to decline life support? Think the government wouldn't intrude on such sensitive private decisions? Ever heard of Terri Schiavo?

Of course, we do usually have checks and balances in our system. The party that controls the White House doesn't always control Congress, and it's even rarer for one party to control the White House, the House and a filibuster-proof Senate. And as anyone who has watched the long and winding road of President Obama's health reform agenda, even a filibuster-proof Senate has a mind (and politics) of its own.  Still, Maggie makes a point:

It's no secret that people who lack health insurance have poorer health outcomes. In his column for the New York Times yesterday, Nicholas Kristof (who has been writing a lot about the need for health reform recently) tells the story of Sue, a 31 year old woman from Oregon:

Sue was a single mom who worked hard -- sometimes two jobs at once -- to ensure that her beloved daughter would enjoy a better life.

Sue's jobs never provided health insurance, and Sue felt she couldn't afford to splurge on herself to get gynecological checkups. For more than a dozen years, she never had a Pap smear, although one is recommended annually. Even when Sue began bleeding and suffering abdominal pain, she was reluctant to see a doctor because she didn't know how she would pay the bills.

Finally, Sue sought help from a hospital emergency room, and then from the low-cost public clinic where Dr. Harris works. Dr. Harris found that Sue had advanced cervical cancer. Three months later, she died. Her daughter was 13.

If all goes well, and we have a new and improved health care system -- which will have to absorb millions of newly insured people, many of whom have been putting off needed care -- one thing we're going to need is more nurses. And once we have them, we need to use them well.

As the AARP's John Rother and RWJF's Risa Lavizzo-Mourey reminded us earlier this year in Health Affairs:

It is nurses -- of every stripe -- who will deliver, coordinate, and direct care in hospitals, clinics, and physicians' offices, and it is these same most necessary nurses who are in short supply...

Nursing has developed and implemented innovative models of care that promote the goals of policymakers for health reform: expanding access, improving quality and safety, and reducing costs, (but) extending these models of care to the general public will be difficult without action to bolster the future nurse workforce.

Talking about health care reform all over the country, I have the opportunity to see many states' health systems up close.  In particular, we spend a lot of time in Colorado -- as evidenced by our study on Grand Junction. In the context of current reform discussions, I began focusing on the state in earnest in 2006 when the Colorado Blue Ribbon Commission for Health Care Reform began trying to identify a sustainable future for the state's health care system. It was a privilege to be consulted by the Commission -- a true bipartisan and multi-stakeholder effort -- about choices they could make to cover more Coloradans, improve the quality of care while reducing health care cost growth, and make the health system economically viable in the long run. At the end of a long and impressive (but surely exhausting) process, the Commission's recommendations look prescient, in that they are structurally and conceptually consistent with the federal health reform proposals under consideration today.