Posts Tagged ‘health policy’

December 17, 2009

Bernie Sanders and George Will Got It Right on Health Reform

Two people recognize the health reform bill is not reform and are signaling that we need to start anew. 

Sen. Bernie Sanders,  the Independent from Vermont, is telling the world that the proposed legislation is not good.  Yesterday, he said that he could not accept the health reform bill in its current form because it does not control costs or rein in health insurance companies.  More important,  Senator Sanders showed the courage of his convictions and brought a real answer to the Senate and the American people.  He proposed a single-payer amendment to the current bill.  In calling up his amendment, Sanders said, “For the first time in American history, the Senate will debate a proposal to create a single-payer, Medicare-for-all health care system.” Unfortunately, Senator Tom Coburn (R-Okla.) objected to Mr. Sanders’s request to dispense with the reading of the 767-page amendment (as called for earlier by  Coburn).  After nearly three hours of listening to a team of Senate clerks read the proposal,  Mr. Sanders gave up and withdrew his amendment (Why,  Bernie? There’s nothing to fear but fear itself.)

(Of course, Coburn knew that would be the outcome because the dealy would prevent a vote on a funding bill for the Department of Defense. The current funding provision expires at midnight tomorrow).

George Will reflects today in The Washington Post on the latest CNN poll showing that 61 percent of the public oppose what the Democratic Senate is trying to do to health care.  “It is clear what the public wants Congress to do: Talke a mulligan and start over.”

Bernie and George are both saying that what we have is not good enough.  President Obama should say the same and ask for the creation of a “super special” congressional committee to start anew in January.  Health reform before the holidays may not make the season jolly.

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November 19, 2009

Mammogram Payment Leads to Empty Seat at CMS

The brouhaha about breast cancer screening is raising major concerns about who should get mammograms.  It is also heightening anxiety about whether mammograms will be paid for by Medicare and private  insurers.  Which leads me to the  Centers for Medicare & Medicaid Services (CMS), the government agency charged with responsibilities for health care  payments.  CMS, the agency with control over Medicare and Medicai,  is still leaderless even though more than a year has passed since President Obama took office. 

Secretary Sebelius, as secretary of Health and Human Services (HHS), presides over this agency and knows something about payments to insurers, having been an insurance commissioner back in Kansas.  With that background, she should know how critical CMS is to the functioning of the health care system. It is troubling that Secretary Sebelius has not taken action to fill what is the perhaps the most significant and essential slot in HHS.  At this critical juncture, there is no leadership in place to assess the structure and resources of CMS that will have the massive task of implementing any health reform legislation. 

Of great importance to academic health centers,  the Administration has not taken action on some of the most pressing issues for Medicare beneficiaries, which fall under the purview of CMS, specifically  participation of Medicare beneficiaries in clinical trials.  The current clinical trials policy hampers such participation.  In fact, the clinical trial policy threatens the nation’s ability to conduct clinical research and compete globally?  Secretary Sebelius and Mr. Sunstein, our new regulatory czar in the White House, have been made aware of the future dangers but have taken no action.   Why is CMS not an issue?  

Waiting for health reform is no answer.  The problems with CMS organization, resources, and policies will only be heightened.  Action must be taken now.  Nominating and appointing someone to head this agency is critical.

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Posted in Health Reform, Policy, clinical trial policy, research | No Comments »

August 13, 2009

Bambi, Ford, and Health Reform

I hit a deer the other day.  Bambi is not supposed to gallop out of nowhere on a busy street and land on the hood of your car.  Bambi got up and ran away but my car needed major repair.  Which leads me to the Ford Focus, the only rental car available from the vendor used by my insurance company.  One only has to drive two minutes in this car to realize why Detroit went under.  What a piece of tin, I kept saying. From the design to the operation to the flimsy sunshade, the car is a disaster.  

We blinded ourselves for years to the fact that American cars were terrible by blaming industry troubles on unions, high wages, environmental controls and lots of other diversionary issues.  Many of us wanted to buy American but American design was no good.

Which brings me to health care.  The design of the system—employer based coverage—is not good.  It is not working because it is a model of a bygone era.  We have to admit it—and move on to something better.  All the hoopla at recent town meetings is diversionary from the real issue of health reform.  It’s not a question of who pays for abortions; it’s not a question of death bed counseling or pulling the plug on granny.  Wake up America.  Think about cars.  It’s a design issue.  

Many in Congress—like the CEOs of the automotive industry–continue to promote a bad product–a health system that cannot fulfill current or future needs.  What’s the answer? Stop the shouting.  Americans are confused.  They want to buy that American car but know that something is wrong with it.

 The answer is to go back to the drawing boards.  Mr. President– Take back control and call on Congress to create a special new committee for health care.  Why are we using the old committee system for something that crosses the boundaries of so many committees?  Start with a new structure and put out one plan from one committee—a plan that is understandable and creates a new delivery system.  It has to be a new design for health care for the future.

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July 23, 2009

Mr. President: Provide the vision, take command of health reform

Mr. President. The press conference usurped the time slot of So you think you can dance? but you did not command the dance floor. You did not command the attention of the American people by telling them why health care is important to the future security of this nation. You provided no vision last night. You talked about the costs of health care as if you were the director of the Congressional Budget Office. Yes, health care may an important part of  the economic recovery –which you are taking extraordinary steps to address. And the costs of health care are a worry for the government.  But you forgot to tell the people that there are costs that go beyond the numbers on some CBO balance sheet.  There are also the costs of greatness. Without health care, the greatness of the nation is at risk. Health care reform relates to life, liberty ,and the pursuit of happiness for the American people who still believe that the U.S. should be the shining example of what is good in the world.

You did not call  upon the nation last night to think about a new and better way to live, as you have done in the past. Where was the orator last night? You are capable of raising the nation’s heart and soul. It is about the economic future that comes from good health care for each individual. You should be telling us how health care is about individual and national security–about freedom from worry about your child’s health or your mom or dad’s Alzheimer’s disease. Tell us that the nation is only secure if the health of its people is secure–that American greatness is built upon caring for each other.

Mr. President, we want you to  provide the vision that is so lacking in this health care debate. You talked about insurance premiums, employer coverage, and insurance exchange programs. You talked about passing reform at the “lowest cost.” How can health and security be equated to the “lowest cost”? I am not sure the nation wants to hear that, Mr. President.

What can you do Mr. President? Here is my short list. #1. Give us new vision on health care–one that’s about health–not just money and costs. #2. Reframe the debate by getting some new voices in the mix–including the single payers. Don’t close them out. #3.Make sure the nation knows what health reform will mean for the health workforce–and for biomedical research in this nation. Those are real issues for the future. Open the door to new thinking on all fronts. #4. Take control of the debate. The Congress is pushing many agendas and may not be doing what is best for the nation. #5. Take a stand. Tell the nation that the government is a good guy and can solve this problem. #6. Tell the nation that the bureaucrats making decisions about health services do not work for the government but for the insurance industry. It’s time to get creative to find out how the insurers can contribute in new and different ways to the economy. There may be a new world out there for them in job retraining. #7. Be strong and be confident that the nation is behind you.

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July 16, 2009

SOS on Regulatory Reform in Health Reform

I read that countless numbers of people are worried about being regulated by government in any reformed health system.   But no one, especially policymakers, seems to be addressing the regulatory infrastructure and the costs of regulation, which might open up a pandora’s box and really shed light on the extent to which the public is benefiting from the regulations developed to protect the American people (which is an issue for a longer discussion).  No one is asking whether the agencies mandated to regulate, including the Centers for Medicare & Medicaid Services,  have the resources to address implementation and enforcement of current and new regulations.  Policymakers should be addressing those resources now.  Policymakers would also do well to look at the costs of compliance for the government and for health care providers.   A 2005 study by the Association of Academic Health Centers  found that the costs of compliance  increased up to 300% in the previous decade and often more than 70% a year at academic health centers throughout the nation. We are hearing of even greater increases at the present time.  No one is denying the need for accountability and protecting quality, safety, and privacy in the health care arena.  But it may be time for the government to ask about the costs and benefits of regulation along with addressing the need for rational and ”smart” regulations.  There is also an urgent need for harmonization within the regulatory environment.  Interagency task forces have done little to ensure there is no contradiction and confusion between regulations coming out of the many government agencies.  If we really want to ensure safety and quality for the public as well as savings in health care delivery, reform of the regulatory world must be addressed now. 

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July 10, 2009

Michael Jackson and Health Reform

Michael Jackson is being remembered for his extraordinary talent, vision, and  courage.  He changed music,  dance, and culture in the U.S.–and around the globe.  He understood new technology, had a new vision for the entertainment world, and had the courage to take on a music giant, MTV,   forcing the playing of the Billie Jean video and ultimately music by black artists.  He was not satisfied with tradition and the status quo.  His courage resulted in amazing transformations in the entertainment industry–and American society.  Which brings me to health care.  Who on Capitol Hill will be remembered for courage, vision, and talent when it comes to health reform?  Where is the vision?  Where is the courage?   Isn’t everyone  trying to preserve tradition–employer based coverage and the insurance industry?  What will be the achievement that will reshape the nation?Aren’t we seeing a complicated mix and match game built on the current dysfunction in the system.  Is there a Michael Jackson on health reform?  I don’t see one.  Do you?

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