More Best of '05

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.

  I'll be the first to admit my proverbial panties are in a knot.  Corruption is screwing patients left and right while the Medicare drug benefit does its best with tax payers. 

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?)

Comments

[Tom]

Re: "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."

Nice language Kate. Regarding public health, civil liberties, and healthcare costs, what do you make of New York's new public health initiative to track diabetes patients by compiling a data base detailing info about citizens with the condition? (1)

According to the AP, "the policy breaks new ground because it involves the collection of information about people who have a disease that is neither contagious nor caused by an environmental toxin."

The health commissioner sites the number of lives the program could save, and saving lives is great, but that doesn't justify it as a "public" issue. Clearly the rationale is driven by cost concerns-which, under current payment structures, are largely public-not infection concerns.

Remember that obesity, as the public health machine has made us poignantly aware, is a major cause of diabetes and that lifestyle choice plays an important role in maintaining weight.

Therefore, if it would help contain costs, should public health officials also compile data on the lifestyle choices that contribute to weight and thus obesity, by tracking resteraunt purchases in the city and perhaps cross checking them for calorie content? What about other costly but non-communicative health conditions? Cervical cancer comes to mind. Would you object to a government database detailing the personal information of women with cervical cancer? And if not what's the difference?

I believe public health officials should consider how some policies affect civil liberties, but I might just be %@*!$ing again.

(1)http://msnbc.msn.com/id/10470060/

[Kate]

Excuse me, but where did I give opinion about obesity or New York's program to track diabetes? All I mentioned is smoking bans. And smoking bans work.

Should civil liberties be considered in instituting policy? Absolutely. But as far as smoking bans are concerned, they make public environments a lot more comfortable for the majority of the population (who does not smoke) while reducing the number of smokers, and thereby reducing health costs.

I've never advocated for following people's eating habits or punishing obese people.

So yes, you can bitch all you want, but you're making a straw man.

[Tom]

If you think issues of civil liberty in public health are important then address them and their supporters as if you take both seriously.

Leaving out profanity would be a good step toward substantive discussion.

[Ezra]

Man, fuck that shit.

[Tom]

Hi Ezra.

[Kate]

I do take the issues (and their supporters) seriously, I just don't appreciate your spurious accusations which aren't relevant to what I said in my post.

[Ezra]

Hey Tom -- how's it hangin?

[Tom]

Re: "I just don't appreciate your spurious accusations which aren't relevant to what I said in my post."

Kate, I was responding to what you wrote here...

"Public health is getting more attention, especially in relation to preventable illness and its effects on rising health care costs."

The cost concern argument you make is the one used by supporters of the NY diabetes program: diabetes must be tracked because it is a costly, preventable disease. And according to the AP article I site, this has "raised privacy concerns in some quarters."

Since you use a civil liberties discussion ("...Civil libertarians b%*ch and moan about smoking bans") to segue into the the role of public health in cost contaiment, I thought it was relevant to discuss a new public health cost-containment program with civil liberty implications.

But I'm not accusing you. I know you don't believe in punishing obese people. The comment was a "slippery slope" argument, not a spurious straw man parade-though that would be a fun addition to Thanksgiving day parades :).

[Tom]

You know Kate, the more I think about it, the more I like the idea: let's write an NIH grant proposal together for funding of the inaugural, annual "Spurious-Health-Policy-Straw-Man Parade." I am positive that many, of all political pursuasions, from within the public health discipline will be able to contribute. Ezra can help us if he wants, but only if he behaves.

[Kate]

That's the best idea I've heard in a long time.

I think we should actually try and get the FDA to give us $$ because this seems more down their alley.