Why Republicans Can't Repeal Obama's Health Reform: Tea Party Take Note

Rosemary Gibson: Why Republicans Can't Repeal Obama's Health Reform: Tea Party Take Note, Huffington Post, 10/21/2011

As the congressional super committee looks for $1.5 trillion in deficit reduction, Republicans on the Senate Finance Committee urged repeal of President Obama's health care reform, The Hill reporter Sam Baker wrote this week. The truth is that Republicans are playing a two-sided game over repeal. Here's how.

You'll remember that in February of this year, House Majority Leader John Boehner led Republicans in the House of Representatives to vote for the repeal of the health care reform law even though the Senate didn't have the votes to do the same. It made for a good show of solidarity with the Tea Party that had swept Republicans into office in the 2010 mid-term election.

But wait a minute. Why would Republicans want to repeal health care reform? Sure, they don't want to see Obama succeed on his signature domestic issue. But their natural allies, big health care businesses -- drug companies, device manufacturers, health insurance companies -- gained a whopping 32 million new customers beginning in 2014 with the stroke of Obama's pen on March 23, 2010.

What businesses would ever get that many new prospective customers - with government subsidies to boot? Even better, each customer will spend, on average about $8,000 a year on health care. The medical-industrial complex will divide the lucrative spoils. This means that another 32 million people are at risk of having unnecessary cancer-causing CT scans, open heart surgeries and stents and drugs which I wrote about in The Treatment Trap.

Los Angeles Times reporter, Norm Levy, reports that conservative experts think that if the GOP wants to dismantle the law, they need to replace it with something else. They'll need a replacement, too, if the US Supreme Court declares the individual mandate unconstitutional.

Are Republicans having a moment of compassion for people without health insurance? Hardly. 
The truth is that Republicans face great peril if they succeed in repealing the reform law and denying the medical-industrial complex the hundreds of billions of dollars they expect in revenue from Obama's health care reform. Expect a big push back from an apoplectic industry.

Levy from the LA Times quotes Mary Grealy, president of the Healthcare Leadership Council, a coalition of executives of big health care industry companies, 'Wholesale repeal leaves you with nothing." That's right. Repeal of health care reform leaves the health care industry with nothing.

That's not an option for Republicans who have conspired with the big-moneyed health care interests whose bottom lines depend on the blind generosity of the American taxpayer.

Health care is still so lucrative now that private equity firms are jumping on the bandwagon and pouring money into health care with the expectation of profits in the next couple of years. See my earlier blog post:They want to get in, grab the money, and go before health reform's Independent Payment Advisory Board (IPAB) kicks in beginning in 2015. Maybe.

Republicans and the industry are targeting the IPAB and anything that gets in the way of them taking a larger share of America's income. The board acts like a circuit-breaker if Medicare spending shoots up too much in a given year. It's the only part of the health care reform that has a meaningful chance of making Medicare sustainable as the boomers reach their 80s and 90s.

Of course, the medical-industrial complex doesn't care about that. It claims that the board will allow government bureaucrats to get in between you and your doctor. Here's the truth.

Drug and device companies want to get in between you and your doctor so they can market every drug and device known to humankind right on your IPad and IPhone. This gives new meaning to direct-to-consumer advertising. People will succumb to all kinds of gimmicks -- treatments, tests and surgeries that can cause more harm than good.

Whatever happens, Wall Street-driven health care will find its way into your wallet.

Rosemary Gibson is the author of The Treatment Trap: How the Overuse of Unnecessary Medical Care is Wrecking Your Health 


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Medicare Unveils New Online Patient Safety Ratings for Hospitals

Medicare Unveils New Online Patient Safety Ratings for Hospitals - California Healthline (10/18/2011)

"...Medicare officials last week began publishing patient safety ratings for hospitals across the U.S. on CMS' Hospital Compare website, Kaiser Health News/MSNBC reports.

The data evaluate hospitals based on rates of surgical complications, infections, medical errors and potentially avoidable deaths. The website compares hospitals' ratings with national averages for medical complications and hospital-acquired conditions.

The ratings are part of an initiative mandated by the federal health reform law in which hospitals with the lowest quality ratings will receive lower Medicare reimbursements.

Patient Safety Advocates Commend Ratings
Patient safety advocates have praised the ratings.

Rosemary Gibson -- the editor of a series of articles on overtreatment in the Archives of Internal Medicine -- said, "This is pulling the curtain back on preventable health care harm to older Americans." She added, "These are really good things to know."

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Attention Wall Street Protestors: Wall Street is Messing With Your Health by Rosemary Gibson Cross-Posted from Huffington Post, 10/7/11

Have cancer? Don't worry, Kohlberg and Company bought 16 outpatient cancer centers this year.

Live in Massachusetts and need to go to the hospital? No sweat, Cerberus Capital bought six Catholic hospitals that the Archdiocese of Boston had to sell in a fire sale.

Have a loved one who needs home health care? Check out the four largest publicly traded home health care companies that are in the crosshairs of the US Senate Finance Commitee for overtreating patients just to make a buck - Amedisys, LHC group, Gentiva, and Almost Family. If you think overtreatment doesn't matter, read The Treatment Trap for tips on how to avoid medical care that can cause you more harm than good.

Live in Detroit? Did you know that the Blackstone Group controls Vanguard Health Systems which bought the Detroit Medical Care System?

Have a loved one who is dying? No need to fear. They can get care from hospices owned by a private investment firm, Cressey and Company.

If Wall Street messed with your wealth, imagine how it is messing with your health.

Investor-owned, for-profit health care is determining the medical treatment you get.

It wants you and everyone else to be a patient every day and forever. In return, the investors run to the bank after billing you, your insurance, and Medicare.

In fact, you need to worry less about government bureaucrats getting in between you and your doctor, and more about Wall Street interests determining the treatment you get. Perish the thought.

The financial industry nearly brought the country to its knees. No worry there either. For-profit health care will replace them if they ache too much for too long.

Its tentacles reach into the homes all across America, on Maple Streets, Sycamore Avenues, and Grand Boulevards.

Their ideal patient is taking ten drugs that cost thousands of dollars a month; has repeat back surgeries that cost $80,000 each; and has cancer and goes to the doctor three times a week.

Wall Street needs you, me, and everyone to be sick so they can report ever-escalating stock prices and earnings per share. Don't have the money?

Charge it on your credit card. As for the federal government, no worry their either. It will just keep borrowing 40 cents for every dollar it spends. Thank you, China.

As for health reform, well, health insurance used to be about giving people access to providers. Now, it's about giving private equity firms access to people.

Rosemary Gibson is the author of The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do To Prevent It.

Many hospitals overuse double CT scans, data show

Many hospitals overuse double CT scans, data show - The Washington Post

By Julie Appleby and Jordan Rau
8/18/11  Washington Post

"...Experts say almost all chest problems can be properly diagnosed with a single scan. But some physicians who order the tests still value double scans for gathering the most information possible. Hospitals and radiologists are paid more for the double scans, so they have a disincentive to crack down on them.

“This is one of thousands of things we do every day in health care that cause more harm than good,” says Rosemary Gibson, co-author of “The Treatment Trap” and editor of a series of articles on overtreatment in the Archives of Internal Medicine.

Most hospitals used the double chest scans sparingly. The median rate was 2 percent of all Medicare patients who received chest scans, according to Hospital Compare data on 3,094 hospitals. But 618 hospitals performed the tests on at least 10 percent of Medicare patients getting a chest CT scan.

Ninety-four of those hospitals performed double scans on at least half their patients getting chest scans. The highest rates “really raise a red flag,” says Paul L. Molina, chief of chest imaging at the University of North Carolina School of Medicine."

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Sometimes, Less is More

CROSS-POSTED FROM AUSTRALIA'S INSIDE STORY

BY MELISSA SWEET 
A growing movement among US healthcare professionals is arguing that medical treatment can cause more harm than good, reports Melissa Sweet
http://inside.org.au/sometimes-less-is-more/

MOST of us have grown up listening to the constant refrain of modern healthcare: the chorus telling us that we should have more tests, more treatments and more interventions – for the sake of our health.

But another tune is increasing in volume, urging us to be alert to the potential for people to suffer harm as a result of over-diagnosis and unnecessary treatment. And it is probably no coincidence that the “less is more” riff is taking off in the home of what some call the “medical-industrial complex,” the United States.

Again, it is probably no coincidence that one of its powerful proponents, Rosemary Gibson, has long experience working in patient safety and palliative care policy. These are two areas where the harmful impacts of unnecessary interventions are particularly evident.

Gibson spoke recently at an Association of Health Care Journalists conference in Philadelphia about her experiences at the Robert Wood Johnson Foundation leading a national strategy to improve end-of-life care.

“When we started this work,” she says, “if you picked up a medical or nursing textbook you would never know that a human being ever died. If you never talked about the fact that people die in teaching, then people don’t know how to care.”


Gibson argues that one of the major obstacles to achieving a more humane and appropriate end-of-life care is treatment that causes more harm than good. Too often, she says, health care services and professionals don’t know when to stop. Clinicians are often “so busy doing”, she adds, that they don’t recognise the “burden of treatment… We have to respect nature – from that wonderful song, there is a time to be born and a time to die.”

It was when she was researching Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans, co-written with Janardan Prasad Singh and published in 2003, that Gibson began thinking about over-intervention. The book sought to put a human face on the landmark 1999 Institute of Medicine report, To Err is Human, which estimated that between 44,000 and 98,000 people die in US hospitals each year as a result of preventable medical errors.

Gibson says that the three critical dimensions to patient safety, as identified by the Institute of Medicine, are underuse, misuse and overuse. In 2010, she and Singh followed up with The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health and What You Can Do to Prevent It, which offers policymakers and consumers suggestions for avoiding excessive healthcare. Many of the ideas in that book would resonate in the Australian healthcare system.

Apart from the potential for overuse to cause patient harm and waste, Gibson highlights the question of equity. “We’re providing unnecessary back surgeries on the one hand, when there are people in the US who can’t get proper dental care… It’s a complete misallocation of resources.”

Concerns like these are gaining increasing attention in the medical mainstream. In recent months Gibson has been editing a series for Archives of Internal Medicine titled “Less Is More,” which aims to help identify areas of medical care in which harm outweighs benefit. “Our goal is to educate patients, as well as their physicians, so that such medical care can be avoided in the interest of patient health and safety,” the journal said. Articles in the series have examined the harm caused by overuse of diagnostic imaging, proton pump inhibitors, and medicines in the elderly.

In one accompanying editorial, a group of medical researchers who have been at the forefront of “less is more” research, Lisa Schwartz, Steven Woloshin and H. Gilbert Welch (authors of a recent book, Overdiagnosed: Making People Sick in the Pursuit of Health), blame the daily barrage of medical news, public service announcements and advertising for pushing more testing and treatments. “The truth is, most patients would do better with less, not more, testing,” they write.

Another editorial drew attention to the forces driving overtreatment, many of which will be familiar to Australian audiences:

These include payment systems that reward procedures disproportionately compared with talking to patients, expectations of patients who equate testing and interventions with better care, the glamour of technology, the fact that it may be quicker to order a test or write a prescription than explain to a patient why they are not being treated, and of course, defensive medicine.

Another reason is “technology creep.” After a device is approved for use with a high-risk population in which there is a proven benefit, its use often expands to lower-risk groups in which the benefit does not outweigh the risk.

Meanwhile, the “less is more” chorus is pushing for more than a share of the airwaves; they want action.

The National Priorities Partnership, which represents a variety of US health groups and is convened by the National Quality Forum, has nominated overuse as one of its core priorities. It has identified a long list of overused interventions that it suggests should be targeted by health care services and providers, as well as information sheets to help members of the public avoid unnecessary interventions.

The interventions it suggests targeting include inappropriate antibiotic use, unnecessary laboratory tests, unwarranted maternity care interventions including caesarean sections, unwarranted diagnostic imaging procedures, inappropriate end-of-life interventions and unwarranted use of procedures such as spine surgery, hysterectomy and prostatectomies.

Given the juggernaut of interests that promote the use of such interventions, it is clear that Rosemary Gibson and other members of the “less is more” chorus have an almighty task ahead.

“It took us a long time to become a system where overuse is pervasive, and it will take a long time to dig ourselves out,” she says. “If we want a financially sustainable system, we have to start digging.” •

Melissa Sweet is a health journalist and editor of the health policy blog Croakey. She has honorary appointments in the School of Public Health at the University of Sydney and the School of Medicine at Notre Dame University (Sydney campus).

Sometimes, less is more | Inside Story

Sometimes, less is more Inside Story

Medical Professionalism, Conserving Resources -- Just How Much is a Trillion Dollars?

Cross-Posted from the Medical Professionalism blog of the American Board of Internal Medicine

by Rosemary Gibson

In recent weeks, headline news has been reporting on the battle to curb the federal debt. What does this have to do with medical professionalism?

The federal government must borrow forty cents of every dollar it spends. In health care, it needs to borrow from China and other lenders to reimburse doctors, hospitals and other providers who bill federal programs.

The government’s debt totals $14.3 trillion. It is hard to fathom how much money a trillion dollars is. Here’s one way to grasp the magnitude:

If I paid you, reader of this blog, $1 million every day since the year 1, or $1 million a day for 2,011 years, this would not tally to a trillion dollars. Multiply this by 14, and that’s how much debt the federal government owes its lenders.

Congress must vote in the next three months to raise the debt ceiling so the Treasury Department can borrow even more money – because the debt keeps growing. If it is not permitted to borrow more, the federal government will default and join the ranks of Greece, Portugal and Ireland. The U.K. avoided default by unprecedented cuts in government spending.

I applaud the American College of Physicians (ACP) for its statement earlier this year, “How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?”. Physician leadership is needed to help fix the unsustainable growth in health care spending so that patients’ interests are paramount.

The ACP said: “Physicians have… a responsibility to use health care resources wisely and responsibly. Resource allocation decisions also must be made at the national or systems level on how to control costs fairly and effectively for the health care system.”

I think that an important place to start is overtreatment. The National Priorities Partnership, convened by the National Quality Forum, identified areas of medical care that are overused.

By eliminating care that does not add to the health of patients, and which can cause more harm than good, precious resources can be used to help people live healthier, longer lives.

The future of our country depends on us digging ourselves out of this financial hole. We have no time – or money – to waste.

Go to: http://blog.abimfoundation.org/medical-professionalism-and-conserving-resources-%e2%80%93-just-how-much-is-a-trillion-dollars/#more-355