Numbers That Are Less Than They Seem

April 28, 2011
2:36 pm

As the Ryan and Obama 2012 budget proposals square off against each other, we’re seeing an increase in polling stories, the news media using public opinion surveys to ascertain whether the public favors revamping the Medicare system or leaving it largely as it is.

So, what do these surveys tell us?

In reality, not a whole lot.

One of the top journalists on the healthcare beat, Julie Rovner, discusses this on “Shots,” National Public Radio’s health blog.  As she points out, with just a little prompting in the form of creative wordsmithing on survey questions, public opinion can go through some drastic swings.

As she reports, the Kaiser Family Foundation survey team found that 50 percent of Americans want to keep Medicare as it is today, while 46 percent support changing to a system in which beneficiaries could choose their insurance from a list of private plans with government providing financial support.

Those numbers change considerably, though, when the question is re-phrased.  When respondents are told that reform will preserve the program for future generations and allow seniors to choose plans based on cost and quality, support for reform goes up to 54 percent.  When told, however, that changing the system will result in ending Medicare as we know it and seniors paying more out-of-pocket for fewer benefits, opposition jumps to 68 percent.

So what’s the takeaway from this experiment?  It’s hard to come to any other conclusion other than the various Medicare reforms being debated are still too new and unfamiliar to the public for hard opinions to be formed.

Or, as Ms. Rovner said, we shouldn’t “take much stock in the findings of any single poll on anything as complex as nuanced changes to Medicare.”

Perpetuating Misconceptions on Patient Confidentiality

April 27, 2011
1:17 pm

Yesterday, the Supreme Court heard the case of Sorrell v. IMS Health Care which concerns a Vermont law that bans the voluntary exchange of a physician’s prescribing history.  (The Healthcare Leadership Council signed an amicus brief in this case, advocating that the Vermont law be invalidated.  We joined a number of individuals and organizations, including the Associated Press, the U.S. Chamber of Commerce and two former HHS Secretaries in doing so.)  This could have been an opportunity to illuminate the often-confusing issue of patient privacy laws for the public but, unfortunately, some of what I’ve heard has done just the opposite.

Vermont Public Radio did an interview yesterday with the state’s attorney general regarding his defense of the law restricting information exchange. (You can hear the interview here.) He compared the release of a physician’s prescribing history to allowing someone to paw through your tax returns.  I’ll admit that if I heard that and didn’t know better, I’d be petitioning the Supreme Court to strengthen the Vermont law instead of striking it down.  But, nowhere in the interview did the attorney general mention the fact that the medical information at the heart of the Sorrell case is all de-identified.  There is no use of names, addresses or any other data that could be used to identify an individual.  So, instead of taking the opportunity to help the public better understand how de-identified health data can be used to improve healthcare quality and advance medical research, we see the use of scare tactics that are not grounded in fact. 

On a more positive front, the tenor of the questioning by the Supreme Court Justices yesterday seemed to indicate they are leaning toward striking down the Vermont law which, as we said in our amicus brief, “makes it harder, not easier for healthcare professionals to identify and reduce the substantial variations that exist in the delivery of healthcare services and the considerable health disparities that affect the lives of many Americans.”

Reviving Discredited Ideas

April 19, 2011
4:08 pm

Washington’s newly-intense interest in deficit reduction is, by and large, a good and necessary thing.  There is no question that our nation’s economic health and the security of future generations are endangered by rising oceans of red ink.  There’s an unfortunate side effect, however, to this budget cutting debate.  It’s opening the door to those who want to revive bad ideas that have already been defeated and discredited.

We’re seeing that right now with the renewed energy behind the idea of giving the federal government the power to “negotiate” (the quotation marks used because “negotiation,” in this case, is a euphemism for price controls) prescription drug prices for the Medicare Part D program. 

Of course, the only reasons for giving CPR to this idea are ideological ones.  It’s well known that the cost of the Medicare Part D program has been substantially below the original projections for the program.  It’s also known that the Congressional Budget Office has said more than once that giving the HHS Secretary “negotiating” powers would have a “negligible” (legitimate quote this time, from the CBO report) impact on federal spending.

But those facts apparently aren’t going to deter efforts to give this idea the Weekend At Bernie’s treatment.  We got an indication of the campaign to come from Paul Krugman’s blog post in the New York Times last week, in which we ridiculed Congressman Paul Ryan (R-WI) for suggesting that Medicare Part D is an example of cost savings that can be achieved through consumer choice.

Mr. Krugman cavalierly dismissed Part D’s lower-than-expected spending totals by ascribing them to the fact that relatively few new drugs have been introduced and a greater use of generics.  I’m not sure what Mr. Krugman sees as the reason for this increased generic drug usage.  In fact, it is the competition between competing private sector prescription drug plans that is guiding Medicare beneficiaries to lower-cost generic alternatives where appropriate.

Then, Mr. Krugman makes the point that Medicare Part D should shift to the Veterans’ Administration government-pricing model in which prices would be less “at the cost of somewhat restricted choices.”  Well, “somewhat” is a bit of an understatement.  Even in the study cited in the Krugman blog post, the authors write that the VA covers 59 percent of the top 200 most popular drugs while Medicare prescription drug plans average about 85 percent of those drugs in their formularies.  That’s a pretty significant difference. 

That study’s authors, by the way, say that beneficiaries still come out ahead in this tradeoff because, according to their estimates, the costs saved through government pricing would outweigh the value lost from having fewer drug choices.  I would argue that you can’t so easily attach a dollar value to lack of insurance coverage for a preferred medication.

We’re certainly getting indications that the campaign for government pricing power in Medicare Part D is back on again.  Based on the arguments in favor it, though, neither logic nor better healthcare for beneficiaries have anything to do with it.

IPAB Dissent Disregards Party Lines

April 15, 2011
11:55 am

It’s worth noting that, in the same week that President Obama cited the Independent Payment Advisory Board (IPAB) as a key tool in cutting future Medicare costs, a House Democrat known for her expertise on healthcare issues went public with her belief that IPAB is a bad idea that should be repealed.

In fact, Representative Allyson Schwartz (D-PA), co-chair of the New Dems Health Care Task Force, said she would support Representative Phil Roe’s legislation to do away with IPAB.  She’s not the first member of her Democratic caucus in the House to do so.  Fellow Democratic Representatives Shelley Berkley (D-NV), Michael Capuano (D-MA) and Larry Kissell (D-NC) have already cosponsored the bill.

IPAB was created by the Affordable Care Act.  The board would have the power to make Medicare spending reduction recommendations if program expenditures exceeded the per capita gross national product plus one percent.  If Congress didn’t vote down the IPAB recommendations, they would automatically take effect. In President Obama’s deficit reduction proposal, he would give IPAB even greater authority, lowering the spending threshold at which the board’s powers would kick in.

Schwartz’s reasons for opposing IPAB are good ones.  First, it transfers decisionmaking over healthcare policy from members of Congress to an unelected commission, placing an unwanted layer of bureaucracy between patients, healthcare providers and their elected representatives.  In Schwartz’s words, it would “undermine our (Congress’s) ability to represent the needs of seniors and disabled in our communities.”

She also said that she “cannot condone the implementation of a flawed policy that will risk beneficiary access to care.”

That, I believe, is the greatest knock against the IPAB concept, as it’s drawn up in the health reform law.  Rather than develop innovative ways to deliver high quality, cost effective care to Medicare beneficiaries, IPAB is simply about chopping spending levels downward.  At a time in which likely physician shortages are on the horizon, it makes little sense to “fix” Medicare by cutting payments.  As Alex Valadka, a neurosurgeon, said in National Journal, “Doctors cannot continue to ably treat Medicare patients if they are constantly wondering whether or not the money will be there to reimburse them.”

Yes, we do need to take steps to place Medicare on a sustainable course, but as Congresswoman Schwartz and others so ably point out, IPAB is the wrong tool to pursue that objective.

A Food Writer Brings Perspective to the Budget Battles

April 14, 2011
8:01 am

Sure, the topical thing to do in this space today would be to comment on the President’s deficit reduction speech and the contrast between the Obama budget plan and the one put forward by Congressman Paul Ryan (R-WI).

But there will be plenty of time to do that.  This debate over our nation’s priorities and how best to reduce the debt will be going on for months to come.

Instead, I wanted to share an item that caught my eye because I found it fascinating that it took someone other than a political or economics journalist to put the current budget wars into a proper perspective.  Mark Bittman, the food columnist for The New York Times Magazine, pointed out in an online commentary this week that, by the year 2030, the cost of treating heart disease in the United States will escalate to $800 billion.   And incidences of diabetes, according to the Centers for Disease Control and Prevention, are projected to reach a point at which every other American will have either Type 1 or Type 2 diabetes, which will cause cumulative treatment costs to rise to $500 billion.

So that’s over $1 trillion in future costs connected to just two chronic diseases.  By comparison, the recent congressional budget fight that almost resulted in the federal government shutting down was over a small fraction of that, $38 billion.

Bittman’s point is that many of our healthcare costs – and, subsequently, costs to taxpayers because of the number of Americans receiving care through Medicare or Medicaid – can be addressed through better diet.  He’s right, but the point is bigger and broader than that.

It is going to be impossible to get a grip on future healthcare costs unless our nation makes wellness and disease prevention an urgent priority.  Today, the treatment of chronic disease is responsible for 75 cents of every healthcare dollar we spend in this country.  And if projections are correct on the significant increases in heart disease, diabetes, pulmonary illness and various cancers, huge budgetary outlays in both the public and private sectors are going to be unavoidable simply to treat a less healthy populace.

Many employers and communities have made tremendous progress in developing incentive programs to encourage individuals to live healthier lifestyles and seek diagnostic tests and preventive care.  We need to take these success stories and expand them so they can benefit a nation. 

Now, I don’t expect the upcoming budget debates to focus on how we can get more Americans to quit smoking, eat healthier, get exercise and see their doctor for regular exams and blood tests, but if we don’t give wellness and prevention at least as much attention as, say, appropriations for public radio, then aren’t we missing the point?