Tuesday, April 30, 2013

Caffeine-Laced Gum Has Energized The FDA

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Friday, April 26, 2013

Obama Says New Abortion Laws Turn Back The Clock

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Thursday, April 25, 2013

Boston ER Doctor Finds Marathon Memories Hard To Shake

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Wednesday, April 24, 2013

Beyond Obamacare

How a Single-Payer System Can Save US Health Care

As Minnesota�s physicians, health care leaders and legislators grapple with the complex changes brought by the Affordable Care Act (ACA), many are concerned that even after the law is fully implemented, hundreds of thousands of people will remain uninsured while health care costs continue to spiral.

What if there were a simple, streamlined solution that would guarantee health coverage for every Minnesotan while saving the state billions of dollars? A growing number of Minnesota physicians are endorsing what they consider to be such a solution: single-payer health care. Weary of having to comply with hundreds of different insurance plans� administrative requirements while their patients are denied needed tests and treatments, these physicians are drawn to the simplicity, cost-effectiveness and truly universal coverage offered by a single-payer system.

Their views were supported by an independent analysis last year demonstrating that with a state-based single-payer system, every Minnesotan could have comprehensive coverage while the state would save billions annually.

A deeply flawed system

The desire for meaningful reform comes in the face of the U.S. health care system�s long-recognized dysfunction. Despite health care accounting for 18 percent of the nation�s economy�twice that of other wealthy democracies�48 million Americans lack health coverage. Another 29 million are underinsured, having poor coverage that exposes them to unaffordable out-of-pocket expenses. Health insurance premiums have doubled over the past decade, with the average annual cost for family coverage now exceeding $15,700; and health care costs now account for two-thirds of personal bankruptcy filings in the United States.

At the root of these problems is the fact that we have a fragmented, highly inefficient system. Employed Americans younger than 65 years of age have job- based insurance, if their employer chose to provide it; the elderly and disabled are covered through Medicare; the poor by Medicaid; military veterans through the Veterans Administration; and American Indians through the Indian Health Service. Persons who do not fall into any of those categories must try to purchase individual coverage in the private market, where it is often prohibitively expensive or unobtainable if they have a pre-existing health condition.

Owing largely to this fragmentation and inefficiency, a staggering 31 percent of U.S. health care spending goes toward administrative costs, rather than care itself. Inefficiency exists at both the provider and payer level. To care for their patients and get paid for their work, physicians and hospitals must contend with the intricacies of numerous insurance plans�which tests and procedures they cover, which drugs are on their formularies, which providers are in their network. Meanwhile, private health insurance companies divert a considerable share of the premiums they collect toward advertising and marketing, sales teams, underwriters, lobbyists, executive salaries and shareholder profits. The top five private insurers in the United States paid out $12.2 billion in profits to investors in 2009, a year when nearly 3 million Americans lost their health coverage.

The ACA of 2010, known widely as Obamacare, is expected to extend coverage to 32 million more Americans But it accomplishes this goal primarily by expanding the current fragmented, inefficient system and maintaining the central role of the private insurance industry in providing coverage. As a result, the ACA is expected to do little to rein in health care spending. Furthermore, it will fall far short of achieving universal coverage, as tens of millions of Americans (including 262,000 Minnesotans) will remain uninsured after its full implementation.

The solution

The central feature of a single-payer health care system would be one health plan that covers all citizens, regardless of their employment status, age, income or health status. Having a public fund that pays for care would slash administrative inefficiencies and eliminate profit-taking by the private insurance industry.

Under a single-payer system, the way society pays for health care would change, but the market-based health care delivery system would remain. Physicians and hospitals would continue to compete with one another based on service, quality of care and reputation. The chief difference is that they would bill a single entity for their services, rather than numerous insurers.

Individuals would benefit immensely by having continuous coverage that is decoupled from their employment. This would alleviate �job lock,� in which people remain in undesirable employment situations in order to maintain coverage. In a single-payer system, individuals could choose to see any provider, in contrast to the current system in which choice is restricted to those who are in-network. Deductibles and copays would be minimal or eliminated, removing cost as a barrier to obtaining needed care.

A single-payer system would be funded through savings on administrative costs, along with modest taxes that would replace the premiums and out-of-pocket expenses currently paid by individuals and businesses. The cost savings to individuals, businesses and government would be considerable. The nonpartisan U.S. General Accounting Office concluded that single- payer health care would save the United States nearly $400 billion per year, enough to cover all of the uninsured.

Physician support for a simplified, universal health care system is robust and growing. A 2008 survey published in Annals of Internal Medicine found that 59 percent of physicians supported a national health insurance system�up from 49 percent in 2002. Physicians for a National Health Program, a national organization advocating for single-payer reform, reports a membership of 18,000. In Minnesota, single payer has been formally endorsed by nearly 800 physicians, other providers and medical students.

The Minnesota model

Recognizing the implausibility of achieving single-payer reform at the national level in the current political climate, many single-payer advocates have turned their attention to state-level reform. The ACA provides for �state innovation waivers� to be granted beginning in 2017, allowing states to implement creative plans they believe would work best for them. With this in mind, organized single-payer movements have taken root in states as varied as Colorado, Hawaii, Illinois, New York, California, Oregon and Vermont. Vermont�s governor and Legislature passed a law in 2011 setting the path for the state to move toward single payer.

In Minnesota, two advocacy organizations�Health Care for All Minnesota and the Minnesota chapter of Physicians for a National Health Program�are garnering public support for a single-payer system. Gov. Mark Dayton has expressed support for single payer, and Sen. John Marty (DFL-Roseville) has authored legislation to establish such a system in Minnesota. Known as the Minnesota Health Plan, it would replace the current inefficient patchwork of private and public health plans with a single statewide fund that would cover the health needs of all Minnesotans�inpatient and outpatient services, preventive care, prescription drugs, medical equipment and mental health and dental care. A 2012 study by the Lewin Group confirmed the feasibility of single payer in Minnesota. It concluded that adoption of a single-payer system would provide coverage to every Minnesotan, including the 262,000 left uncovered by the ACA, while saving the state $4 billion in the first year alone. The average Minnesota family would save $1,362 annually in health costs, while the average Minnesota employer that currently provides insurance would realize savings of $1,214 per employee per year. The analysis showed these savings came primarily from administrative simplification; provider compensation remained unchanged.

Conclusion

With nearly 50 million uninsured people in the United States and skyrocketing health costs, the need for profound reform of our health system could not be more clear. The ACA is a start, but it will fall far short of achieving universal coverage, and it allows unsustainable spending growth to continue. Single-payer health care would eliminate administrative waste and inefficiency, thereby creating an opportunity to achieve truly universal, cost-effective health care.

This article originally appeared in the April 2013 issue of Minnesota Medicine.

Philadelphia Case Exposes Deep Rift In Abortion Debate

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Friday, April 12, 2013

Wait For Obamacare Price Tags Could Last Months

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Tuesday, April 9, 2013

Sweeping Anti-Abortion Bill Expected To Become Kan. Law

Kansas legislators gave final passage to a sweeping anti-abortion measure Friday night, sending Gov. Sam Brownback a bill that declares life begins "at fertilization" while blocking tax breaks for abortion providers and banning abortions performed solely because of the baby's sex.

The House voted 90-30 for a compromise version of the bill reconciling differences between the two chambers, only hours after the Senate approved it, 28-10. The Republican governor is a strong abortion opponent, and supporters of the measure expect him to sign it into law so that the new restrictions take effect July 1.

In addition to the bans on tax breaks and sex-selection abortions, the bill prohibits abortion providers from being involved in public school sex education classes and spells out in more detail what information doctors must provide to patients seeking abortions.

The measure's language that life begins "at fertilization" had some abortion-rights supporters worrying that it could be used to legally harass providers. Abortion opponents call it a statement of principle and not an outright ban on terminating pregnancies.

"The human is a magnificent piece of work at all stages of development, wondrous in every regard, from the microscopic until full development," said Sen. Steve Fitzgerald, a Leavenworth Republican who supported the bill.

Abortion opponents argue the full measure lessens the state's entanglement with terminating pregnancies, but abortion-rights advocates say it threatens access to abortion services.

The declaration that life begins at fertilization is embodied in "personhood" measures in other states. Such measures are aimed at revising their constitutions to ban all abortions, and none have been enacted, though North Dakota voters will have one on the ballot in 2014.

But Kansas lawmakers aren't trying to change the state constitution, and the measure notes that any rights suggested by the language are limited by decisions of the U.S. Supreme Court. It declared in its historic Roe v. Wade decision in 1973 that women have a right to obtain abortions in some circumstances, and has upheld that decision while allowing increasing restrictions by states.

Thirteen states, including Missouri, have such language in their laws, according to the National Right to Life Committee.

Sen. David Haley, a Kansas Democrat who opposed the bill, zeroed in on the statement, saying that supporters of the bill were pursuing a "Taliban-esque" course of letting religious views dictate policy limiting women's ability to make decisions about health care and whether they'll have children.

And in the House, Rep. John Wilson, a Lawrence Democrat, complained that the bill was "about politics, not medicine."

"It's the very definition of government intrusion in a woman's personal medical decisions," he said.

Brownback has signed multiple anti-abortion measures into law, and the number of pregnancies terminated in the state has declined 11 percent since he took office in January 2011.

The governor said he still has to review this year's bill thoroughly but added, "I am pro-life."

This year's legislation is less restrictive than a new North Dakota law that bans abortions as early as the sixth week of pregnancy and a new Arkansas law prohibiting most abortions after the 12th week. But many abortion opponents still see it as a significant step.

"There is a clear statement from Kansas with respect to the judgment on the inherent value of human life," said Senate Public Health and Welfare Committee Chairwoman Mary Pilcher-Cook, a Shawnee Republican and leading advocate for the measure.

The bill passed despite any solid data on how many sex-selection abortions are performed in Kansas. A 2008 study by two Columbia University economists suggested the practice of aborting female fetuses � widespread in some nations where parents traditionally prefer sons � is done in the U.S. on a limited basis.

But legislators on both sides of the issue said the practice should be banned, however frequent it is.

The bill also would require physicians to give women information that addresses breast cancer as a potential risk of abortion. Advocates on both sides acknowledge there's medical evidence that carrying a fetus to term can lower a woman's risk for breast cancer, but doctors convened by the National Cancer Institute a decade ago concluded that abortion does not raise the risk for developing the disease.

The provisions dealing with tax breaks are designed to prevent the state from subsidizing abortions, even indirectly. For example, health care providers don't have the pay the state sales tax on items they purchase, but the bill would deny that break to abortion providers. Also, a woman could not include abortion costs if she deducts medical expenses on her income taxes.

"Every taxpayer will be able to know with certainty that their money is not being used for abortion," Pilcher-Cook said.

But Jordan Goldberg, state advocacy counsel for the New York City-based Center for Reproductive Rights, called the tax provisions "appalling and discriminatory."

"It's probably, if not definitely unconstitutional, and it's incredibly mean-spirited," she said.

___

The anti-abortion legislation is HB 2253.

___

Associated Press Writer Maria Fisher in Kansas City, Mo., also contributed to this report. Follow John Hanna on Twitter at www.twitter.com/apjdhanna

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Wednesday, April 3, 2013

Insurers see way to dodge federal healthcare law next year

A little-known loophole in President Obama’s landmark legislation enables health insurers to extend existing policies for nearly all of 2014.

A new fight is brewing over health insurance companies letting millions of Americans renew their current coverage for another year � and thereby avoid changes under the federal healthcare law.

That may offer a short-term benefit for certain consumers and shield some of those individual policyholders from potentially steep rate increases. But critics say this maneuver could undermine government efforts to remake the insurance market next year and keep premiums affordable overall.

At issue is a little-known loophole in President Obama’s landmark legislation that enables health insurers to extend existing policies for nearly all of 2014. This runs contrary to the widespread belief that all health insurance must immediately comply with new federal rules starting Jan. 1, when most provisions of the law take effect.

“Insurers are onto this, and the big question is how many will try to game the system,” said Timothy Stoltzfus Jost, a law professor and health policy expert at Washington and Lee University.

Some of the nation’s biggest health insurers are looking to take advantage of this delay, and Arkansas officials are encouraging companies to do this by resetting customers’ renewal dates for the end of December. There’s also concern that some insurers and agents could rush to sell more individual policies before year-end so they could be extended in 2014.

Some policy experts are expressing concern about this practice for fear that insurers will focus on renewing younger and healthier policyholders and hold them out of the broader insurance pool next year. Their absence could leave a sicker and older population in new government insurance exchanges, driving up medical costs and premiums there.

“This could undermine the Affordable Care Act, and it opens the door for exacerbating potential rate shock in the exchanges,” said Christine Monahan, a senior analyst at Georgetown University’s Health Policy Institute. “The health insurers can cherry-pick some healthy people and it raises prices for everyone else.”

This issue could affect some of the 15 million people nationwide who purchase their own coverage and millions more of the uninsured who are expected to join government exchanges next year. It would not pertain to the 150 million Americans who get health benefits through their employers.

Many health insurers are still mulling over their options on how to handle these individual renewals.

“Some carriers will require everyone to switch plans Jan. 1, and other carriers will allow customers to stay on their existing plan as long as possible,” said Bob Hurley, senior vice president of carrier relations at online site eHealthInsurance. “We are trying to nail this down with the carriers. I think it would be better for consumers to have that choice to carry their policy forward.”

The nation’s largest health insurer, UnitedHealth Group Inc. of Minnetonka, Minn., said, “We are currently looking at the best way to serve our customers’ best interests while continuing to comply with the Affordable Care Act going into 2014.”

WellPoint Inc., the Indianapolis insurance giant that runs Blue Cross plans in California and 13 other states, said its renewal practices will vary by state. In California, the company said its Anthem Blue Cross unit may allow individual policyholders to renew through March 31.

Kaiser Permanente, a major nonprofit health plan based in Oakland, said it doesn’t plan to renew policies beyond Jan. 1 in California and most of the other states where it sells coverage.

Richard Kern and his wife, a retired couple in Los Angeles, say they would welcome the flexibility to keep their individual policy from Aetna Inc. for another year amid so much uncertainty over next year’s rates.

“We don’t even know what the prices and alternatives are under Obamacare,” Kern said. “We are waiting for the other shoe to drop.”

If an insurer offers this option, it would then be up to consumers to decide whether they want to renew an existing policy into 2014. The length of any renewal may depend on what month their annual plan year begins.

Many lower-income people will qualify for federal premium subsidies, which will be available only when purchasing new coverage available in state- or federal-run insurance exchanges. It would make financial sense to take advantage of that government aid. Individuals earning less than $46,000 or families below $94,000 annually would be eligible for subsidies.

However, many people who are middle income or above could face significantly higher premiums next year with no subsidies. Those premium increases are tied to federal requirements that insurers accept all applicants regardless of their medical condition and the inclusion of more comprehensive benefits.

Renewing an older policy could mean forgoing some of those richer benefits and new limits on out-of-pocket medical expenses.

Last week, California officials estimated that premiums may rise 30% on average for about 1.3 million existing policyholders primarily because of those changes in the federal law. Insurers have warned that some customers could see their premiums double depending on their age and other factors.

Citing that threat of higher rates, Arkansas officials issued a bulletin to insurers last month describing how they could extend individual policies until Dec. 30, 2013, and then renew them for another year.

These health plans “would not be required to comply with the [Affordable Care Act] market reforms until 12/31/2014,” according to the Arkansas bulletin.

“For those folks who don’t qualify for subsidies, this is a consumer-friendly thing because the premium rates for 2014 will be substantially higher,” said Dan Honey, deputy commissioner of compliance for the Arkansas Insurance Department. “You will be exposed to rate shock.”

Other states may oppose that approach, further underscoring the uneven implementation of the federal healthcare law across the country. Oregon Insurance Commissioner Louis Savage said these renewals could be problematic and his office issued a rule barring any extension beyond March 31, 2014.

“We want to get as many people as possible into the exchange,” Savage said. “I think having renewals go deep into 2014 is counterproductive to the goals of the federal healthcare law.”

In California, state lawmakers are working on legislation that could address this renewal issue and other details about how individual policies comply with the federal overhaul.

These questions over renewals are separate from “grandfathered” health policies that existed before the federal law passed in March 2010. Those plans don’t have to meet all the requirements of the healthcare law as long as insurers or employers don’t make significant changes to them.

In South Jersey, New Options For Primary Care Are Slow To Take Hold

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