The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need. - Atul Gawande’s commencement address at Harvard Medical School.
On the same morning that Dane County Circuit Judge Maryann Sumi struck down Wisconsin's infamous union-busting bill on the grounds that it violated the state's Open Meetings Law (PDF of decision, previously), Vermont Governor Peter Shumlin signed America's first state-level single-payer legislation into law. [more inside]
Obstetricians and gynecologists are meeting the increased demand for cosmetic vaginal surgery (NSFW)
With the constitutionality of the Affordable Care Act being argued in lower courts, it's probably also worth looking at Vermont's adoption of single-payer health care: "On May 26, Gov. Peter Shumlin of Vermont is expected to sign legislation that will create universal coverage in the state—eventually. Vermont will use subsidies from the Affordable Care Act to help create a Canada-style system. And its system, or so the theory goes, will become so popular and cheap that the rest of America will want to copy it." [more inside]
"With regard to the idea of whether or not you have a right to health care, you have to realize what that implies... It means you believe in slavery." Senator Rand Paul weighs in on the notion of human rights at a Senate subcommittee hearing yesterday, equating the right to health care, as well as the right to water and food, as tantamount to a belief in slavery.
"For the progress of humanity, work alone is not adequate, but the work should be associated with love, compassion, right conduct, truthfulness and sympathy. Without the above qualities, selfless service cannot be performed."On Sunday morning, Indian guru Sri Sathya Sai Baba passed away. He leaves behind a massive empire, several million mourning devotees worldwide, an extensive religious philosophy, a great deal of controversy and a legacy of large-scale philanthropic projects in India, including free hospitals and mobile medical facilities, a free university and schools, and other efforts which included supplying clean water to hundreds of rural villages. [more inside]
Coalition health reforms will spell the end for the NHS and lead to U.S. style system, claim researchers. 'Prof Allyson Pollock, from the Barts and The London School of Medicine, and David Price, senior research fellow at its Centre for Health Sciences, write in a paper published on BMJ.com that the legislation “amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery”. They say the Government “has repealed the health secretary’s duty to provide or secure the provision of comprehensive care” in order to create a commercial market in care. Instead, under the new system the state "finances but does not provide healthcare", in “equivalent to Medicare and Medicaid schemes in the US”'. Meanwhile, Dr Kim Price, claims 'the UK coalition government's planned NHS and welfare reforms, and their use of 'nudge' theory, hark back to ideas on welfare and recession from the end of the nineteenth century, according to studies by a University of Leicester historian whose research paper has recently been published in the Lancet'. [more inside]
Progesterone caproate injections have been used to reduce the likelihood of premature births in at-risk pregnant women for years. Up until now, the drug was custom-compounded by wholesale and specialist pharmacies, legally, but without federal approval. These injections cost between $5 and $15 a dose and were regularly reimbursed by insurance companies and Medicaid. Last month, the FDA announced their approval of a commercially produced version of the compound, to be marketed under the brand name Makena by a company called KV Pharmaceuticals. No stranger to controversy and trouble, KV barely survived a rash round of layoffs and wrongful termination lawsuits. Their former chief executive now faces criminal charges surrounding the company's failure to notify the FDA that they were producing oversized morphine tablets. (He could also do for a shave, it appears.) Now, KV has announced that the new drug will be available at a cost of $1,500 per dose, bringing the total pregnancy term cost of treatment to $25,000-$30,000, from its former cost of $250-$300, a 100-fold increase—but it gets worse... [more inside]
Hello! I am a person who is training to become an abortion provider. As you can imagine, it is really fucking weird to be one of me, especially lately!
South Dakota Rep. Hal Wick (R-Sioux Falls), is sponsoring a bill [text] which would require all citizens to buy a firearm “sufficient to provide for their ordinary self-defense” within six months of turning age 21. Rep. Wick said he is introducing the bill to prove a point that the federal health care reform mandate passed last year is unconstitutional. [previously] [more inside]
It's Only Rape if They Say So House Republicans decide to fight abortion access by redefining rape.
The Hot Spotters examines the possibilities of a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them. — by Atul Gawande [more inside]
HR 2, officially the "Repealing the Job-Killing Health Care Law Act", has passed in the U.S. House of Representatives with a vote of 245 to 189. 3 Democrats (Reps. Boren (OK), McIntyre (NC), and Ross (AR)) joined all 242 Republicans voting Aye. The bill will not be brought for a vote in the Senate, nor would it escape veto by President Obama. [more inside]
As a result of legal settlements, 7 of the major drug companies, representing a little over 1/3 of the prescription drug market in the US, are publishing their direct payments to physicians and other medical professionals. All payments are supposed to be published by 2013. Would it bother you to know that your doctor was making a decent part-time income from promoting specific prescription drugs on the side?
The tax cut created in the new health care reform law providing small businesses with an incentive to give health benefits to employees is working.
Major health insurance companies around the country are reporting a significant increase in small businesses offering health care benefits to their employees. (via Forbes)
Wikileaks may have been the big news, but there were numerous other data breaches in 2010. [more inside]
Per capita US spending on health care in 2008 exceeded $7500-- more than any other OECD nation, half again the spending of the runner-up [PDF], and double its spending in 1990. Why? Aaron Carroll of the Incidental Economist explains in 12 parts. [more inside]
Shadofax at MovingMeat has an interesting writeup about two WSJ articles on the AMA's RUC and warring specialities. [more inside]
What should medicine do when it can't save your life? Atul Gawande looks at the system of final-stage treatment for terminal patients, which, despite more than 40 years of a hospice movement for better end of life care, often ensures that patients die exactly how they least want to: in a hospital, hooked up to machines. Gawande tries to envision how, "when the chemotherapy stops working, when we start needing oxygen at home, when we face high-risk surgery, when the liver failure keeps progressing, when we become unable to dress ourselves" medical care can focus on quality of life, rather than prolonging it. [more inside]
Although the Stupak amendment was defeated, women in the new high risk pools will be denied coverage for abortion. The "clarification" from the administration comes in the wake of a scuffle over Pennsylvania's plan to provide abortion coverage. Hopefully, building criticism will have an effect.
Kabuki Democracy: Why a Progressive Presidency Is Impossible, for Now. And what we should do about it. (one-page link)
Dirty Medicine — How medical supply behemoths stick it to the little guy, making America’s health care system more dangerous and expensive. [more inside]
On July 1st, the US Department of Health and Human Services launched the website Healthcare.gov to explain changes that will occur by 2014 because of healthcare reform. It describes the reforms, and also suggests options for those who need insurance. Meanwhile, there are 80 signatures on a congressional petition by Rep. Steve King (R-IA) to repeal the bill via the House. The petition was started with the support of the Heritage Foundation.
What US Health Care Needs Medical doctor and writer Atul Gawande gave the commencement address recently at Stanford's School of Medicine. In it he lays out very precisely and in a nonpartisan way what is wrong with the institution of medical care in the US — why it is both so expensive and so ineffective at delivering quality care uniformly across the board. (via)
It is not our role to take power. It is our role to make the powerful frightened of us. And that's what we've forgotten. Give up that dream! Chris Hedges talks neoliberalism and neofeudalism, the civil rights movement, Camden, Obama, Clinton, Tea Parties, moral nihilism, inverted totalitarianism and corpocracy, NAFTA, welfare reform, health care, labor, poverty, Yugoslavia, post-industrial capitalism, economic crisis, imperial collapse, socialism, and democracy, among other things. [more inside]
The votes are in, the people have spoken. An official commemorative health reform t-shirt design has been chosen and is now on sale at Organizing for America. The Vice President must be so proud.
The Obama Coalition "These general findings suggest the possibility that the political strength of voters whose convictions are perhaps best described as Social Democratic in the European sense is reaching a significant level in the United States. With effective organization and mobilization, such voters are positioned to set the agenda in the Democratic Party in the near future."
The New York Times has published an informative graphic realization of projected costs and likely funding sources for the recently enacted Patient Protection and Affordable Care Act (PPACA). [more inside]
Following the vote on Sunday, Mike Troxel of the Lynchburg Tea Party posted the address of what he thought was Dem Rep Tom Perriello, with the comment that activists should add a "personal touch" to their anger at Periello -- who voted yes on the health care bill -- by going to his house. It turns out the address was actually Perriello's brother's house, and the FBI are currently investigating the cut gas line that was discovered the next day. [more inside]
In honor of the Health Care Reform bill that passed on Sunday, here is a 1992 episode of Star Trek: "I, Borg" (2, 3, 4, 5). It is one of the unsung heroes of healthcare reform. [more inside]
House passes Healthcare reform. All that's left is voting on a reconciliation package for the senate to sign. But the house has passed the senate bill, which means this is basically a done deal. [more inside]
"In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance. Shortly after his diagnosis, however, his insurance company, Fortis [now Assurant Health], revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that." [more inside]
Atul Gawande offers a way for health care to be improved through experimentation and pilot programs, much as agriculture was in 20th century
The Legacy of Billy Tauzin: Paul Blumenthal of the Sunlight Foundation details the complicated set of meetings that allowed the now retiring head of prescription drug lobby group PhRMA (derided in a popular Obama campaign spot) to secure influence on the health care bill in exchange for their endorsement. The White House officially announced its health care plan today. [more inside]
Will marry for health insurance. "They're not going to pass health-care reform, so what are my options? Friends and I were joking, and one friend said,'Well, you could always marry some guy who has a good policy.' And I thought, You know what. That's crazy. That's unbelievable, but it's my only option." [more inside]
Is There Life in Health Care Reform? Elizabeth Drew analyzes the current prospects for US health care reform, in the New York Review of Books. Logically, there should still be a way to get a bill passed. But logic went out the window on January 19. The situation was as much psychodrama as legislative stalemate. The perfectly reasonable argument was made to Democrats in Congress, mainly by the administration, that, having voted for the bill already, it would be worse for them to fail to pass it than to pass it, but this seemed not to be heard.
Health Care: Who Knows 'Best'? "...comparative research on effectiveness is only part of the strategy to improve care. A second science has captured the imagination of policymakers in the White House: behavioral economics. This field attempts to explain pitfalls in reasoning and judgment that cause people to make apparently wrong decisions; its adherents believe in policies that protect against unsound clinical choices. But there is a schism between presidential advisers in their thinking over whether legislation should be coercive, aggressively pushing doctors and patients to do what the government defines as best, or whether it should be respectful of their own autonomy in making decisions. The President and Congress appear to be of two minds. How this difference is resolved will profoundly shape the culture of health care in America." Interesting NY Review of Books article by Jerome Groopman.
Newfoundland Premier Danny Williams (no stranger to Metafilter) has travelled to an unspecified location in the United States to have heart surgery.
Newfoundland Premier Danny Williams (no stranger to Metafilter) has travelled to an unspecified location in the United States to have heart surgery. [more inside]
Republican Scott Brown has defeated Democrat Martha Coakley in the special election to fill Ted Kennedy's former senate seat. [more inside]
"Melissa" (name changed for privacy) is a transwoman who was badly injured in a car accident and is in hospital in critical condition. While in treatment, some of the medical staff and her family decided that since she still had a "male" body, to make things "less confusing", they will erase 4 years of her female identity by referring to her as a man and taking her off her hormone therapy. (Warning: possible triggers) As little light puts it:
And if she woke up as from a deep sleep, she’d wake up into a world where her best friend was dead, where her body had been forcibly edited back to its pre-transition state and given a few more years of the influence of testosterone to boot, where her memory and self were hazy and confusing and nobody was calling her by the right name and pronouns, they were in fact pretending four years of her life, the four years she finally got to be honest and true to herself, those had never happened, and shh, she’s just confused, shhhh, calm down, let’s work on fixing your memory some more.[more inside]
Landmark health care reform legislation passes senate on a Christmas-eve party line vote. So after a turbulent and contentious legislative process with many sudden reversals and last minute surprises, what's actually in the bill? NPR offers a "Consumer's Guide" to the form the final, reconciled legislation now seems likeliest to take. [more inside]
You’re going to hire people to guard your sh*t, but you’re not going to give them health care. Vice has a long spoiler- and profanity-laden interview with The Wire creator David Simon, running the gamut from backstage Wire details to the media's obsession with "the Dickensian aspect" to his next series (set in New Orleans) to Joe Lieberman to this fight he almost got in at a concert one time. Via /Film.
The New Republic's Jonathan Cohn declares the public option dead. "The Senate isn't going to include any version of the idea in its bill. And while the House can still demand a public option in conference, nobody I know expects the House to prevail." [more inside]
The Senate votes to bring health care bill (text in an amendment) to floor, 60-39. Major concessions extracted by holdout senators. Other analysis here and here. Differences between this and the House bill.