DCMedical News: January 4, 2018
DCMedical News
Washington, D.C.
Thursday, January 4, 2018
THE BIG STORY TODAY IN HEALTH CARE
Third world public debt levels (forcing budget caps for domestic programs!) are discussed in a January 2nd CBO letter (found here) to Senator Wyden: “CBO and the staff of the Joint Committee on Taxation determined that provisions in the Conference Agreement would increase deficits over the 2018-2027 period by $1.5 trillion (not including any macroeconomic effects). By CBO’s estimate, additional debt service would boost the 10-year increase in deficits to $1.8 trillion. As a result of those higher deficits, debt held by the public would increase from the 91.2 percent of gross domestic product in CBO’s June 2017 baseline to 97.5 percent.”
DOCTORS
“Patient Experience” further debunked: GWU researchers publishing in the Annals of Emergency Medicine found further reason to doubt the validity of “patient experience” scores for physicians. Reports Healthcare Finance News: “The authors looked at commercially-generated patient experience data from 2012-15 collected from a large sample of emergency departments . . . The research team found the data varied greatly month-to-month, with physician variability considerably higher than facility variability. In some cases, a physician was ranked in the 20th percentile one month, 80th in the next and 30th in the next after that -- even though the experience the physician provided for patients was similar.” The article itself (found here) reads: “The physician community has been critical of patient-experience data: a 2011 information article from the American College of Emergency Physicians raised concerns about data capture, reporting, and use,” and, not surprisingly, “To our knowledge, there have been no external evaluations of ED patient-experience data.”
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
If you like your current health insurance: A response from the Office of Personnel Management to Senator Ron Johnson’s subpoena for information concerning the health insurance coverage for Members of Congress and Congressional staff is due this Friday. Johnson’s letter of December 22 said “The American people have a right to know how and why OPM drafted a final regulation that allows Members of Congress and staff to continue to receive an employer contribution, paid by the taxpayer, without authorization in law. The limited information available to the Committee shows that OPM initially believed it could not provide an employer contribution to Members of Congress and staff.” Johnson’s letter can be found here.
EVENTS & PUBLICATIONS, MEETINGS AND READINGS
Victor Fuchs assesses proposals for single payer plans in the U.S. in the January 2 JAMA. One powerful argument: “[A] single-payer system would have the bargaining power needed to offset the monopoly power of drug and device manufacturers and hospitals and physicians. At present, prescription drug prices in the United States are double the prices in . . . (OECD) countries. The expensive artificial devices required for every hip and knee replacement carry a US price tag more than 3 times that of other countries. In addition, . . . the fees of US physician specialists are double or triple those of their peers in other countries . . . Recent mergers and acquisitions by hospitals and integration with physician groups . . . increase the monopoly power of the organizations that provide care. Single payer could offset this imbalance.”
But Fuchs warns that even Canada, with one tenth the population of the U.S., avoids centralized administration, using the provinces instead. He cautions that using the 50 states for this purpose risks the following: “[A]n annual health insurance budget in the tens of billions of dollars may offer a target for lobbying, favoritism, bribery, and corruption that would probably be too difficult to resist.” The strongest case for single payer, says Fuchs, is the chance for cost control.
Toronto’s David Naylor follows on in JAMA, noting that Canada and the system begun nearly seventy-five years ago is no model for the U.S., but that, in the “good news” category, “[T]he United States already spends so much so badly that it now has a chance to leapfrog every nation in the world as and when the United States devises and implements a home-grown solution to achieve equitable and universal health care coverage.” MAGA? MHCGA!
Baicker (now at Chicago) and Chandra discuss the nature of evidence-based health policy in the 12-21-2017 NEJM. In particular, a chart of Slogan, Policy, Goal and Evidence is helpful, the authors noting “What makes for ‘rigorous enough evidence’? Professional medical societies have developed gauges of the strength of evidence to support clinical guide-lines, and we should demand nothing less for health policy.” Article here.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com