Health policy: Medicare drug benefits=the end of drug co. charity programs?

Drug companies have touted their charity programs in an effort to improve their image. But as the feds roll out Medicare drug benefits, some patients are being told they must choose between the charity programs and the Medicare drug benefits, as the NYT reports:

Mr. Bach, 65, who is blind, received worrisome news last month from Bristol-Myers Squibb. The free Plavix he gets from the company's charitable foundation will stop if he enrolls in the new Medicare prescription program that begins in January.

Mr. Bach says that his free Plavix, a $125-a-month blood thinner that reduces the risk of heart attacks and strokes, is more valuable than the immediate benefits he would receive from signing up for the Medicare program, even taking into account the three inexpensive generic drugs he also takes.

The letter telling Mr. Bach that he must choose between Bristol-Myers's program and the new Medicare drug benefit speaks to an unintended effect that the new Medicare plan is having on the pharmaceutical industry's charity drug programs. Some companies are simply eliminating their charity programs for older people, taking the position that the recipients are now eligible for Medicare drug coverage.

Other drug companies, like Eli Lilly, are discontinuing their charity programs entirely.
Link (free reg req'd)

Health policy: outsourcing medical care

There's an interesting article at washingtonpost.com about southern California HMO's that require their patients to receive nonemergency care in Mexico. Maybe this only seems mindblowing to me because I live so far north of the border with Mexico:

Five years ago, California became the only state to regulate insurance programs that require border crossing for basic health care. Since then, more than 700 non-agricultural businesses have offered plans requiring treatment in Mexico. Hundreds of farms offer similar coverage for about 120,000 migrant laborers.

At the Santaluz golf resort in San Diego, where Gonzales supervises golf course maintenance, workers can sign up for a Blue Shield of California plan called Access Baja. Their doctor visits are covered in the United States or Mexico, while their families are covered only in Mexico. Dale Standfast, the resort's controller, said several workers whose dependents were not covered switched plans to cover their families.

Offering Access Baja saves the resort about $1,000 per month in premiums, he said. This year the club used the savings to offer vision coverage to all employees for the first time, Standfast said.Lower-priced labor, malpractice insurance and overhead in Mexico mean both basic and sophisticated medical procedures can be performed at a small fraction of the cost. A hysterectomy that averages $2,025 in the United States costs $810 in Mexico, said Mary Eadson, director of legal compliance for the Western Growers Association, an agricultural organization that provides health insurance for California workers in Mexico.

Passport to Health Care At Lower Cost to Patient

Health policy: Americans pay more, get less

Hey, another study says Americans spend more on health care and get less. Yawn. Throw it on the pile, I guess.

Clearly, it's going to take something more than studies to get some kind of traction on health care reform. Note that we still come out ahead in one important measure: getting access to specialists. Maybe that's enough to make us feel like we're getting better care than we are: even if we're not getting the best care for our money, at least we're getting attention. Maybe we value that more.

The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost and more than one-third endured mistakes and disorganized care when they did get treated.
Americans had the easiest access to specialists, but they experienced the most problems getting care after hours, and Americans and Canadians were the most likely to report problems seeing a doctor the same day they sought one.

Americans were also much more likely to report forgoing needed treatment because of cost, with about half saying they had decided not to fill a prescription, to see a doctor when they were sick or opted against getting recommended follow-up tests. About 38 percent of patients in New Zealand reported going without care; the numbers were 34 percent in Australia, 28 percent in Germany, 26 percent in Canada and 13 percent in Britain.

Link to article in Washington Post.

Government in action: DEA gets veto in painkiller approval

For the second year in a row, language tucked into an appropriations bill gives the Drug Enforcement Agency (DEA) the power to veto new narcotic medications. While I can understand the desire to prevent another crop of Oxycontin addicts, I don't understand why it's necessary to involve DEA at this stage in the process:

Before the provision was passed last year, the DEA's role with prescription drugs was primarily to decide how much of a controlled drug each company got to make, and then to monitor the use of those drugs on the market. Now, however, the DEA must sign off on any new FDA-approved medications containing controlled substances before they can be sold.

The FDA's deputy commissioner for medical and scientific affairs, Scott Gottlieb, said yesterday that the agency opposed the legislation, which for the second year in a row was added by the House to the yearly appropriations bill for several major departments. 'Specific language attached to the appropriations bill would ultimately delay access by physicians and their patients to important, safe and effective pain management and palliative care medicines,' Gottlieb said. He said giving DEA authority over traditional FDA territory could upset 'a delicate balance for managing both safety and access.' Although the dispute is ostensibly over a limited change in how controlled drugs are approved and labeled, it has become something of a stand-in for a larger battle over whether DEA's actions are intruding into the practice of medicine and denying pain sufferers relief they need.

Link to Washington Post article.

Research: have another helping of turkey?

I absolutely guarantee that at this year's Thanksgiving dinner, Aunt Janice will present you with a clipping of an article about this study:

A team of scientists in California and Germany have prevented paralysis in mice with multiple sclerosis by feeding them a synthetic version of a by-product of an important amino acid. The body uses the amino acid, tryptophan, for many things, including regulation of the neurochemical serotonin. The new findings, published today in Science, suggest that tryptophan also interacts with the immune system to reduce abnormal inflammation of the myelin sheath, the protective coating around nerve cells that is damaged in MS.

Link to item at Newsday.com
technorati tag: multiple sclerosis

Current events: motorcycle powered by 24 chainsaw engines

I quit riding a motorcycle about ten years ago, because it was just too scary, but every now and then, I think about maybe getting back on a two-wheeler. This machine might just do it:

The plans call for individual engines coupled together with a double-sided drive belt in sets of three in alternating V configurations. In other words, a set with one engine above and two below alternated with a set of two above and one below. An additional drive belt will be arranged between the rows of engines. The original centrifugal clutches on the chainsaws will be used. And a two-speed transmission is suggested to transmit the power to the rear wheel. (Later a 5-speed Harley-Davidson transmission is substituted.) The bike will be called the Dolmette.

The engines are the PS-7900 professional chainsaw engines. In standard trim, each of these high-performance, air-cooled, 79-cc engines generates about 6.3 horsepower at 9,500 r.p.m. For use in the Dolmette, the engines were tuned and tweaked to deliver about 7.1 h.p. at 10,000 r.p.m. Maximum torque delivery is 4.1 foot-pounds at 7,750 r.p.m.

Ultimately, the design for the powerplant was increased to 24 engines. When all are combined, the result is a 24-cylinder unit with a displacement of 1.9 liters and output of 170 h.p. and 95.9 foot-pounds of torque at the centrifugal clutches, both large for a motorcycle.

Link to article in Chicago Tribune (free reg req'd)

Health policy: Massachusetts bill aims for universal coverage

The Massachusetts legislature is considering legislation aiming to create universal coverage in that state by taxing employers who don't provide insurance and by requiring everyone to obtain insurance.

Official filing of the House bill yesterday sets the stage this week for the most sweeping healthcare debate in Massachusetts in a decade, when the state expanded the number of people covered under Medicaid. Governor Mitt Romney and Senate President Robert E. Travaglini also have plans to dramatically expand health insurance but have not included a payroll tax for universal coverage. They say their proposals can meet the same goals without raising new revenues.

DiMasi said the business levy, which would raise $650 million to $700 million annually, is needed to pay for such an ambitious expansion. Among other things, the bill would expand Medicaid coverage to 147,000 low-income families and create a subsidized insurance program for about 100,000 low-income people who don't qualify for Medicaid. Estimates vary, but the state has around 500,000 uninsured residents.

Combined with a proposed mandate that individuals obtain health insurance, the business levy in the House bill would place Massachusetts at the vanguard of states trying to establish universal healthcare coverage for its citizens. No other state has both, advocates and political leaders said.

Link to story at Boston Globe (free reg req'd).
Link to somewhat more skeptical story at Boston Herald.

I imagine Harry and Louise have been notified...

Health policy: more young adults uninsured

One-third of Georgians ages 18-24 are uninsured, and private health insurance coverage has declined 11 percent among this age group in the past five years, according to a new study from the J. Mack Robinson College of Business at Georgia State University.

Aside from the immediate cost of providing care for these uninsured young adults, there are long-term implications for the health-care industry, researchers say. The uninsured are less likely to get primary and preventive services, which means they may end up with more advanced and costly illnesses later in life. For those who do end up in a major accident, they could become "uninsurable" for life. "The worst-case scenario is they decide not to invest in insurance and they have a terrible accident and become uninsurable for life," said Minyard, alluding to the difficulty people with major health problems have in buying individual health insurance plans.

And if you're an uninsured 21-year-old who develops MS, what do you do? When it happened to me, I decided to get married and go to law school. So far, so good. If it happens to you, I'll be happy to lend you my LSAT study books.

Link to item at MSNBC.com
technorati tag: multiple sclerosis

MS bladder therapies: a good review of the basics

I stumbled across this review in Nature Clinical Practice Urology of how MS affects bladder function and what can be done to help. Includes a discussion of Botox injections into the bladder detrusor:

Voiding-diary data are showing exceptional clinical efficacy for BoNT/A, with significant improvements compared to baseline of urinary urgency, frequency and incontinence episodes at 4 and 16 weeks postinjection. Urodynamic parameters, namely maximum cystometric capacity and detrusor pressures during filling, have also shown significant and sustained improvement.64 Because there is an increased incidence in incomplete bladder emptying following treatment in patients with neurogenic bladder dysfunction, patients must be willing and able to perform [intermittent self-cath], if they are not already doing so.

The full article, not just an abstract, is available for free here, but you'll need to register.
technorati tag: multiple sclerosis

Health policy: NYT on "concierge care" for those who can afford it

NYT's health care reporting continues with a piece about "concierge care":

These doctors charge fees as high as $10,000 a year, depending on the services promised. The majority charge $1,500 to $2,000. Basic services consist of same-day or next-day appointments and 24-hour telephone access to the doctor. The most expensive may also promise the doctor will make home visits, deliver medications and accompany patients on visits to other doctors.

"Concierge care is like a new country club for the rich," Representative Pete Stark, Democrat of California, said at a joint economic committee hearing in Congress last year. "The danger is that if a large number of doctors choose to open up these types of practices, the health care system will become even more inequitable than it is today."

Link (free reg req'd)

Tag cloud: interesting

My new tag cloud is brought to you courtesy of tagcloud.com. I thought it might be an easy shortcut to generating tags, because Blogger doesn't seem to support an easy method for generating tags.

Tagcloud generates the cloud from my RSS feed, which is nifty, though somewhat problematic. The initial 100-item cloud included items like "obviously" and "apparently" and "reg req'd". So apparently, I use the word "apparently" too much, and, obviously, "reg req'd" isn't really a topic of interest.

So some editing is necessary. But once the editing is done, the tag cloud seems to emphasize the extent to which one repeats oneself. Anyway, now I've got some functional tags for finding stuff about certain stuff. ("Stuff" was another item I had to take out of the tag cloud.)

Current Events: Cat sails to France

I'm not really a cat person, probably because I didn't grow up around cats, but I tip my hat to Emily, who made her way from Wisconsin to France:

Lesley McElhiney now figures her cat went prowling around a paper warehouse near home and ended up in a cargo container that went by ship across the Atlantic Ocean and was trucked to Nancy, a city in northeastern France near the border with Germany. Employees at a French lamination company found her in the container, checked her tags and called Emily's veterinarian, John Palarski, in Kimberly, just east of Appleton. Palarski called the McElhineys Monday to tell them their pet was safe, if a little hungry.

"It probably had access to food and water," Palarski said. "I doubt if it went three weeks without it. There must have been a lot of mice on the boat. Even if it was in the cargo department, you would assume there was water down there. She had to have something."

Link to story at Chicago Tribune (free reg req'd)

Oh my gawd: awake during surgery, but paralyzed

Can you imagine?

The American Society of Anesthesiologists, meeting in Atlanta, approved the group's first-ever standards on preventing a rare but terrifying situation in which patients wake up during surgery and sometimes feel excruciating pain without being able to cry out. Such awakenings occur in one or two cases out of every 1,000, the group said. But the phenomenon received press coverage following some lawsuits by patients, and after the Joint Commission on Accreditation of Healthcare Organizations last year urged hospitals to better monitor patients for the problem and ask them about it after surgery.

Carol Weihrer, who won an out-of-court settlement after her anesthesia failed during a five-hour eye surgery in 1998, was disappointed. Now a patient advocate, she said that technology that might prevent a patient's suffering should be used and also called for the society to help establish a registry for case reports of surgical awareness. "It's nothing," Weihrer said of the society's action. The 54-year-old Virginia woman was awake but paralyzed while doctors cut and gouged to remove her right eye seven years ago.

Link to article in Seattle Post Intelligencer.

Politics: Harriet Miers, "Bar weenie"

Non-lawyers may not appreciate the relative insignificance of what have been touted as the jewels in the crown of Miers's resume: her election to lead the Dallas and American Bar Associations. I belong to my state's bar association, because a lawyer can't practice law in my state unless he or she is a member. Back when I was in private practice, I belonged to the bar association of the county in which I live, and to the American Bar Association. It wasn't required, but between the two, I got access to some decent seminars, a magazine, and discounts on Avis car rentals.

Each year, I receive and complete a ballot for state bar president. I read the candidate information and I look to see who endorses whom. I do this because I think it matters who's running the state bar. Each year, I have to send the bar a big check to cover membership dues, and the bar, in turn, takes the lead in many of the legal issues that arise in my state. I wish I didn't have to belong, but because I do, I'm interested in who's in charge. On the other hand, I had no idea who ran the county bar or the ABA when I was a member, because it just didn't ever seem worth my time to care.

A piece at Slate.com by Mark Obbie nails it:

Guess who seeks election to [lead the voluntary bar associations]. Not the busiest, in-demand lions of the bar. Instead, it's usually the second stringers, the runners-up in the lawyer game. Real lawyers, for the most part, snicker about "bar weenies"—much as they did about the goofs in high school who ran for class president. Does David Boies spend his $800-an-hour time going to committee meetings and wrangling over the ABA's next convention schedule? Hardly. He might deign to give a speech at a bar gathering if he can fit it into his busy trial schedule. But bar weenies—their slightly kinder name is bar junkies—are the ones holding the Town Car door open for Boies when he arrives at the hotel. And when they're not doing that, they're jabbering endlessly about legal-regulatory policy questions that even most lawyers find stupefying.

Link

"Divine protection," not health insurance

An article in the Washington Post reports on groups of evangelical Christians who have formed a kind of health insurance co-op, paying into a common pot of money to cover members' medical expenses. It's an interesting counterpoint to the recent NYT article about the growing financial risk borne by those who have health insurance:

Huff and his family are among the 60,000 members of Medi-Share, the largest of a little-known group of nonprofit organizations that market themselves as faith-based alternatives to health insurance. The half-dozen plans, which claim a total membership of more than 120,000 Americans, are especially popular in the South. The appeal of these 'church plans,' as they are known in the insurance industry, is both economic and religious. Because their monthly cost is roughly half that of conventional health insurance premiums, they appeal to those who find medical insurance difficult or impossible to afford. And because their membership is strictly limited to evangelical Christians certified as regular churchgoers by their pastors, they cater to people opposed to 'subsidizing high-risk, sinful lifestyles,' in the words of Medi-Share's Web site.

"These plans function just like health insurance, but they operate in a regulatory black hole," said Mila Kofman, an assistant research professor at Georgetown University's Health Policy Institute. "There is no accountability, no oversight, and the people who participate have no protection." Unlike insurance companies, which are required to have reserve funds to pay claims, church plans do not maintain reserves.

Link

Journal: I heart the Cool Moms

Each day, during my daily commute, I end up stopped at a red light next to this day care center that obviously caters to the Cool Moms. Each day, I watch the Cool Moms walk their tots from their Subarus to the door. These are tots, I'm sure, with cool old-timey names like Ella and Gus. The moms and tots are dressed in hip, sensible layers of woolly and fleecy things, and they look happy.

My wife and I have decided not to have kids. We've been married for 13 years (!) now, and it's been an ongoing conversation with us, but as our biological clocks start to run out (we're both 35), we agree: we don't have the time or energy, we don't feel a baby-shaped void in our lives, we're living happy lives without kids, etc.

And yet I think both my wife and I see each other as a potential perfect parent. And yet it's an indescribable frustration to me that my illness should play such a large part in this decision (and it does). And yet I'm envious of the Cool Moms and their Subarus and woolly and fleecy get-ups and whatever it is that seems to make them so happy.

Maybe I need to take a different route to work.

NYT: When health insurance is not a safeguard

The NYT's series on health care continues with a piece about the increasing gap in the protection afforded by health insurance:

After decades in which private and government insurance covered a progressively larger share of medical expenses, insurance companies are now shifting more costs to consumers, in the form of much higher deductibles, co-payments or premiums. At the same time, Americans are saving less and carrying higher levels of household debt, and even insured families are exposed to medical expenses that did not exist a decade ago. Many, like the Dorsetts, do not realize how vulnerable they are until the bills arrive. Lawyers and accountants say that for the more than 1.5 million American families who filed for bankruptcy protection last year, the most common causes were job loss and medical expenses.

Link (free reg req'd).

The political consequences of new techniques for obtaining embryonic stem cells

At Slate.com, William Saletan lays out the ethical and political implications of research suggesting that scientists might be able to harvest stem cells from an embryo without harming it ("biopsy"):

If you've opposed federal funding of [embryonic cell] research on the grounds that embryos shouldn't be killed, biopsy solves your problem. The only people bound to oppose biopsy are those who 1) oppose [in vitro fertilization] because it's artificial or 2) object to exposing embryos to the same risks involved in [pre-implantation genetic diagnosis]. The billion-dollar question is which way President Bush will go. His past statements indicate that his concern is embryo killing and that he's looking for a way forward. Both factors suggest that he'd allow funding of research on ES lines derived from biopsy.

Link.

"Consumer-directed" health plans: providing the consumer with just enough rope

The Washington Post reports about the emergence of high-deductible "consumer-directed" health insurance plans:

Today's consumer-driven health plans typically require deductibles of $1,000 to $2,000 for individual coverage and $2,000 to $4,000 for family coverage, after premiums, before the insurance policy kicks in. Many policies also require coinsurance payments after deductibles are met, and patients seeking care out of network face steep charges. Now, as millions of workers enter open-enrollment season to choose next year's health insurance benefits, many will consider high-deductible policies for the first time. According to the Kaiser Family Foundation, only 5 percent of large employers offered such policies in 2003; this year, 20 percent did, and more will do so next year.

For workers who've seen premiums jump sharply for HMOs, PPOs and point-of-service offerings, the lure of lower premiums and fewer restrictions on provider selection can be tantalizing. But those opting for such insurance "should expect to have less health coverage," says Karen Pollitz, project director at Georgetown University's Health Policy Institute.

Link.

Journal: Going out, and art

Last night, my wife and I went out to see The Decemberists play a show, the first show we've been to in maybe a year. Their Melvilleian pop was charming, and they played a great show, but I felt pretty out-of-place. The show was at an old movie theater in which the bathrooms are in the basement, which meant that not only did I have to do the excuse-me-pardon-me-excuse-me-pardon-me thing to get to the aisle four times during the show, I also had to haul my sorry ass up and down the stairs four times. Also, everyone in the theater was standing, so if I wanted to see anything (and there was a lot to see: a six-piece ensemble fronted by a man wearing a pink-and-white-striped suit coat), I had to stand. Or, if I didn't want to stand, I could truck up to the balcony where the view was unobstructed, but each trip to the men's room required twice as many stairs. And this, I suppose, is why I haven't been out to a show in a year.

It's an example of how I sometimes feel MS has cut me off from experiencing art: I used to be a voracious reader, but I find I lack the concentration to stick with anything longer than a New Yorker cartoon. I used to enjoy making (mediocre) music, but I lost a lot of sensation and manual dexterity in my fingers, making it frustrating to sit down at the piano or pick up a guitar. I used to do some printmaking from time to time, but I haven't felt like I had the stamina, time, or inspiration for it. I'm reluctant to go out to see art in museums or galleries because it means extended periods of standing around and walking. Unfortunately, art increasingly seems like a luxury I don't have the time, energy, or motivation for; tending to the necessities comes first.

Here's a bright spot, though: for whatever reason (MS, maturity, contaminated drinking water?), I think art elicits a much stronger emotional response from me than it used to. I've had an iPod for a year or so now, and the experience of listening to good music through a good set of headphones can be amazing; it can, and regularly does, make me cry.

technorati tag: multiple sclerosis