Happy New Year everyone! Since it's still a holiday for most people, and the med blogosphere is particularly slow, it's time for more Best of '05 in Health Care. This edition, courtesy of Leif Wellington Haase, includes the Worst of '05 (just to rile you up a bit) and some under the radar gems. We're positive folks here at HP so let's start with the worst and end on a good note.
The worst in '05? Well, it's partisanship as usual, with a splash of greed and corruption:
Docs on the take? Needless to say, most physicians are ethical and conscientious—but the commercialization of modern medicine has sent many down the wrong path and put other doctors on the defensive. There’s a rogue’s gallery of unseemly behavior—possible conflicts of interest, dubious clinical trials, and ghostwritten scientific articles—here, here, and here, and in a valuable book-length expose by Jerome Kassirer, the former editor of the New England Journal of Medicine.
Whose moral hazard? Cervical cancer is diagnosed in about 10,000 U.S. women each year and kills about 3700. Merck has developed a vaccine for cervical cancer that targets the virus that causes 7 in 10 cancers and has shown impressive results in clinical trials. The company intends to apply to the Food & Drug Administration by the end of 2005 for permission to market the vaccine. (GlaxoSmithKline is also developing a cervical cancer vaccine.) Amazingly, the Family Research Council and other conservative groups have raised doubts about administering the vaccine to children (where it would be the most effective) because they fear that it will encourage promiscuity and undermine their preferred message of sexual abstinence.
The Medicare Drug Benefit. There’s a lot of potential for good here for low-income Medicare beneficiaries, who get tremendous help under the benefit with prescription drug costs. And it’s hard to criticize the impressive efforts of government officials, state and local volunteers, and private insurers to make sense, on behalf of older Americans, of this needlessly complicated benefit. But the early sign-up numbers don’t seem to be impressive—including, sadly, among low-income seniors and the disabled—and there are lots of minefields both structural and political ahead. To paraphrase Yogi Berra, for the drug benefit, it’s getting late early.
But surely there's some good things, right? From the Best:
Take Care New York. An ambitious, simple, and no-nonsense Web site introduced by New York City Public Health Commissioner Thomas Frieden to improve public health citywide. Thanks to his education efforts and tough anti-smoking legislation, the number of smokers in the city has dropped by an estimated 200,000 over the past three years. Governing magazine rightly named Frieden one of its public officials of the year.
Minnesota hospital systems that have stopped gouging uninsured patients. One of the ongoing scandals of U.S. health care is that uninsured patients frequently have to pay more than patients covered by large insurers for the same procedures. Then they get dunned by bill collectors as they try to dig out of impossible financial holes. Under an agreement with Minnesota Attorney General Mike Hatch, this honor roll of hospitals—Allina, North Memorial, Park Nicollet, and HealthEast Care—agreed that uninsured patients with annual household incomes not greater than $125,000 would pay no more than the large insurer rate for their treatment.
Civil libertarians bitch and moan about smoking bans, but they work. And for those of us non-smokers, they make going out a much more pleasant experience. Public health is getting more attention, especially in relation to preventable illness and its effects on rising health care costs.
The Minnesota hospital story is particularly interesting. Many people are completely shocked when they hear that hospitals can charge more for the uninsured. As Leif points out, even at the normal prices the uninsured get in bottomless financial holes. It's great to hear some hospitals volunteering to end the punishment.
I've only excerpted a little, so go read the original for the entire list. All in all, 2005 in health care has been like the last 9 or so years. Nothing major has happened, partisanship continues to paralyze any real reform, pharmaceutical companies get in trouble, and costs continue to rise. Things will remain that way until at least 2008, and the more pessimistic analysts will predict for much longer.
In the meantime, I'll keep plugging away here at Healthy Policy, preparing for the year when my summation post will go something like, "There's no question what the top health care story was this year. The implementation of..." (Hey, there's always hope, right?)