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Answer Me This...

October 25, 2012

With the last of the three debates completed and the presidential election just around the corner, the New America Foundation has pulled together this video with people from our various policy teams to ask the candidates a few final questions about how they plan to govern. Check us out, tell us what you think, and if you seeeither candidate answering any of the questions, let us know--tweet to us at @NewHealthDialog and @NewAmerica!

Tara Parker-Pope Highlights Overtreatment Harms

August 27, 2012
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Tara Parker-Pope, Well columnist for the New York Times website, highlighted overtreatment as a serious problem in a blog post yesterday. The post describes several people's direct experiences with unnecessary testing and treatment, and does a good job conveying the physical, emotional, and financial harm that comes from a disorganized system prone to overtreatment.

Overtreatment is a human issue, and reducing the personal harm it causes is at least as important as controlling healthcare spending growth. But healthcare spending is a crucial political issue, so it was smart to put the post on the Times's current campaign issues channel, The Agenda. Tackling overtreatment will be a defining issue of the next few years--either because we make crucial progress toward eliminating overse and reducing total medical spending, or because the next President ignores the problem while we continue on the ruinous path of letting healthcare strangle the rest of our economy.

Given the importance of the issue, though, I wish the post had looked a little bit closer at the policy issues involved. Most importantly, the post doesn't address the causes of overtreatment, including the financial incentives faced by clinicians and hospitals, lack of research on what treatments are effective, and physicians' failure to communicate to patients about their treatment options. The thing is, there are huge differences in policy between the two tickets on those issues. Since the post appeared on The Agenda, it could have done a lot more to point out those differences--like the fact that the ACA moves Medicare away from paying for the volume of services and toward rewarding higher-quality, more cost-effective care, or that it funds patient-centered outcomes research to determine which treatments actually work. On the other hand, Romney's running mate, Paul Ryan, recently parroted the absurd idea that IPAB is a "death panel," even though it is specifically prohibited from rationing care. That kind of rhetoric is hard to square with the notion that a Romney/Ryan administration would be willing to take any political risk to push back against unnecessary care.

Finally, on a related note, Dr. Aaron Carroll of The Incidental Economist has pulled together an incredibly useful set of politically difficult truths about reducing healthcare spending, in a set of posts titled "Why is this so hard to understand?" All of them are important and worth reading:

Part 1: When Medicare spending goes up, seniors’ premium costs go up.

Part 2: You can be for reducing Medicare spending, or you can be for increasing Medicare spending, but you can’t be for both.

Part 3: If you spend more on Medicare, someone has to pay for it.

Part 4: Don’t argue that reducing government involvement is the way to reduce spending.

Guest post on Delve Into '12!

August 17, 2012
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We don't often weigh in on electoral politcs here on New Health Dialogue, but the introduction of Paul Ryan into the race as Mitt Romney's running mate has distinctly shifted the focus of the debate onto Medicare, at least for the moment, and the editor of Delve Into '12, the New America campaign blog, asked for our thoughts.

You should definitely check out the full post (here) and the rest of their campaign commentary, but if you're short on time, here's an excerpt from the end of our post:

[...T]he Ryan budget slashes government healthcare spending, but it does relatively little to reduce total health spending. (In fact, if Ryan’s plan was implemented, it could reduce Medicare’s bargaining power and actually increase total spending.) While the ACA includes specific programs aimed at reducing waste (for instance by giving doctors incentives to reduce spending on ineffective treatments, funding research on which treatments actually benefit patients, and making it easier for cheaper generic drugs to get approved), the Ryan plan’s main savings mechanism is competition among private insurers. In theory, giving people a choice of insurer should reduce healthcare spending –people will choose plans that offer  better value, forcing inefficient plans out of the market. But competition among private insurers has failed to control spending in the private insurance market for decades, so some skepticism of its ability to rein in spending on the elderly is warranted. If that doesn’t actually work and total medical spending doesn’t go down, the Ryan budget saves money by shifting spending from the federal government to individuals.

Ultimately, the Ryan budget's laser-like focus on reducing the federal deficit has led to a glaring oversight in the proposal’s healthcare component. Policy should be focused on reducing total healthcare spending, including private insurance premiums and out-of-pocket payments, not just on reducing what the federal government spends. Healthcare spending has become a drag on the economy, accounting for up to two percentage points of unemployment—and that drag isn’t dependent on whether it’s funded by the government or the private sector. That’s the much more important challenge, and the Ryan budget ignores it completely.

Enjoy the weekend!

For Your Thursday Enjoyment: Health Wonk Review!

August 16, 2012
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Hosted this week by Dr. Jaan Sidorov at the Disease Management Care Blog, it's "A Brainy Health Wonk Review on Health Reform, the Affordable Care Act and Lots More!" Go check it out.

Health Wonk Review will be back on September 13th, hosted by Louise Norris of the Colorado Health Insurance Insider Blog.

Film Screening: Money & Medicine

Monday, September 10, 2012 - 6:00pm

Please join us for the Washington, D.C. premiere of a new PBS documentary by Roger Weisberg, hosted by the New America Foundation, Families USA, and the Lown Cardiovascular Resaerch Foundation. The film is an investigation of the dangers the nation faces from runaway health care spending, and the dangers patients face from over-diagnosis and over-treatment.

Light refreshments will be served.

NEJM Headed in the Right Direction on Overuse

July 26, 2012

The New England Journal of Medicine just published a great article about physician stewardship as it relates to medical spending. The piece, called "Cents and Sensitivity—Teaching Physicians to Think about Costs," discusses whether or not we should be training physicians to consider the bills patients will face when making decisions about what treatment to choose. (Aaron Carroll’s treatment of this piece is here.) The authors propose that teaching physicians to be more cost-conscious will increase their capacity to care for the whole patient, not just their symptoms:

"Whether it’s lack of time, fear of “missing something,” or simple ignorance, the incentives to do more often overwhelm our impulse to use resources wisely. Now some educational reformers are offering us an added ethical incentive. Put simply, helping a patient become well enough to climb the stairs to his apartment is meaningless if our care leaves him unable to afford that apartment. Protecting our patients from financial ruin is fundamental to doing no harm."

We agree that overtreatment is a problem, and we applaud the NEJM for addressing it. It says a lot about how far we have come from even five years ago when everyone was thumping their chests and talking about how we have “the best healthcare in the world.” But we believe that there’s an even greater reason to address the topic of overtreatment: because it is dangerous. Starting with the Institute of Medicine’s 1999 report, “To Err is Human,” the research has continued to demonstrate that more does not always mean better

So yes, physicians should consider what patients can afford, but even before that, physicians need to realize that doing nothing is often safer than putting patients at risk with treatments that don’t work. Fiscal responsibility—making sure we aren’t sending Grandpa Frank from the ICU to the poor house—will be the natural consequence.

Health Wonk Review: Summertime Edition

July 19, 2012
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Health Wonk Review is back with a summer edition packed with links to a myriad of topics. Check it out!

The Bad Old Days

July 17, 2012
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Austin Frakt tweeted a news release from AcademyHealth this afternoon that brought painful flashbacks to the health policy world.

The House Appropriations Committee has released its proposed 2013 budget for the Departments of Labor, Health and Human Services and Education, in which it "terminates" the Agency for Healthcare Research and Quality (AHRQ). The budget proposal also cuts $150 million from PCORI's funding source, and prohibits any federal agency covered by the committee's jurisdiction from performing patient-centered outcomes research with other funds.

The proposal is, quite simply, insane. It's a direct attack on the only federal agency that produces research on the health care sector and the delivery system--research that is crucial to any effort to reduce unnecessary care, improve patient safety, and curb the increase in healthcare spending.

This budget marks a return to the bad old days, when Congress stood up against science and killed the Agency for Health Care Policy and Research. It's not clear whether this is just dangerous political posturing that will die on the House floor or in the Senate, or if it's dangerous political posturing that might actually pass, but either way we'll be watching the story and keeping you posted. In the meantime, The Incidental Economist is collecting stories about AHRQ funding of valuable (or not-so-valuable) projects.

This program has received funding from AHRQ in the past, including funding for the Avoiding Avoidable Care meeting. That funding has not colored our perspective on this--we would be ardent supporters of the Agency and of evidence-based medicine regardless.

Drug Regulation, Symbolic Votes, and Hospital Safety

July 16, 2012

Here's our wrap-up of last week's articles by our own Shannnon Brownlee and Joe Colucci:

Letting Big Pharma Review Its Own Drugs — What Could Go Wrong? (The Atlantic Health Channel):

Earlier this month GlaxoSmithKline agreed to pay a record breaking $3 billion fine for a slew of criminal and civil violations. But is a fine really enough? In a piece in The Atlantic, Shannon Brownlee and Joe Colucci argue that we need to stop letting drug companies track the post-market safety of their drugs and establish an external automatic review system. 

 

12 Ways Health Care Could Be Improved If the House Wanted to Hold More Than Symbolic Votes (The Atlantic Politics Channel):

In the wake of the House's 33rd vote to repeal/defund Obamacare, Joe and Shannon propose a list of 12 things the House could have done to make a better use of tax payers' dollars and actually improve health care. In the article in The Atlantic the proposals range from enacting a less intrusive mandate to funding after school programs to teach kids how to cook. Any of them would have worked better than another "symbolic vote."

 

Why The ‘Best’ Hospitals Might Also Be The Most Dangerous (TIME Ideas):

We've all seen them—the U.S. News Rankings of everything from colleges to cars. How do their hospital rankings look? In her latest article for TIME, Shannon argues that, based on new rankings by Consumer Reports, many top-name hospitals fail to measure up in terms of safety. Hospital rankings would be a lot more useful if they considered how medical care affects most patients, not whether a hospital performs some cutting-edge procedure on three patients per year.

31 Things the House Could Have Done...

July 16, 2012

Last week the house voted to repeal Obamacare... again.  This marks the 31st time that they have voted to repeal, defund, or otherwise try to hamper the PPACA, even though they have known that such efforts would go nowhere with Democrats controlling the Senate and the Presidency.  In response to this less-than-momentous occasion, my supervisors here at the New America Foundation wrote a piece for the Atlantic detailing real, meaningful reforms that could have been enacted instead of the 31 "symbolic" votes.  Those are great, but I've compiled a more comprehensive list of things that I think would really improve the health of both Congress and the American people:

  1. Sell the audio from all 31 repeal attempts as an over-the-counter insomnia cure.
  2. Create "Fast Food Health Savings Accounts": Every time you buy fast food, your credit card transfers $2 into an HSA to pay for your future diabetes treatment.
  3. Build a new exhibit in the Newseum: "Florets v. Freedom: Broccoli as Propaganda in American Life."
  4. Collect all the taxpayer money that would've been spent on these “symbolic votes” and associated debates, and buy insurance for 4500 families.
  5. Create a new weekly C-SPAN show called "Mandate: Delicious." Each show will consist of the reading of USDA-approved healthful recipies.
  6. Replace all the desks in the House with standing desks.
  7. Replace all the chairs in the Senate with yoga balls.
  8. Take the House on a field trip to a primary care doctor's office.
  9. Hold a Congressional Scavenger Hunt. The first Congressperson to bring back the following wins:
    1. An underpaid primary care doctor,
    2. A grossly overpaid specialist,
    3. A person who is uninsured by choice,
    4. A legible prescription,
    5. Credible evidence of "death panels."
    6. Bonus points to anyone who manages to get a primary care appointment without mentioning that they're insured.
  10. Get corporate sponsorship for major surgeries: “Well, Jim, you’ve got an artery that’s almost completely blocked. I recommend an immediate McDouble Bypass!”
  11. Compile a cookbook of heart-healthy broccoli recipes and start a CSPAN cooking show where Justice Scalia and George H.W. Bush demonstrate them.
  12. Have the two parties compete against each other in a special election-year season of "The Biggest Loser."
  13. Require all sodas in the Congressional cafeteria to be served in Dixie cups.
  14. Change the national salad from Jell-O salad to “anything containing actual vegetables, and comprised of no more than 50% by weight of ranch dressing.”
  15. Candy salad is not salad.
  16. Meat salad is definitely not salad.
  17. See if members of Congress are fitter than a fifth grader: Require all Members of Congress to perform the Presidential Fitness Challenge. Anyone who doesn't pass will be held in contempt.
  18. Get exercise by changing the House rules: Allow bills to be passed by calling for a dodgeball vote, where the last member standing gets to decide whether a bill goes on to the Senate.
  19. Commission a CDC report on whether broccoli consumption has gone down among conservatives since Obamacare passed.
  20. Establish a National Speed Limit for hot dog consumption of no more than fifty-five hot dogs per hour.
  21. Buy "Twinkie sniffing dogs" for the TSA.
  22. Form a committee to study the long-term effects of spray tan, chaired by Speaker Boehner.
  23. “Vaccinate” against obesity and related problems by making gastric bypass surgery part of the childhood vaccine schedule.
  24. Forget “a chicken in every pot.” Pass the "Wii the People" bill, putting a Wii Fit in every American home by 2014.
  25. Block grant Congressional health insurance. Stop giving Representatives federal health insurance; instead, increase their salaries by $8000 and let them choose their own plan in the individual market!
  26. Exclude any gathering involving a "You Bring It, We Fry It" truck from the Assembly Clause of the First Amendment.
  27. Enact a broccoli mandate (er, I mean, tax...?), just to see if it would work.
  28. Clarify to school lunch programs that pizza and ketchup are not, in fact, vegetables.
  29. Put WMATA in charge of the nation’s moving walkways and escalators. We'll all be taking the stairs within a week.
  30. Blame China.
  31. Just give up: Paula Deen 2012!
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