IPAB repeal: good policy and good politics

What if I told you there was a country where medical decisions were made not by doctors in consultation with their patients, but by a panel of 15 unelected bureaucrats who determine the fate of millions of Americans? You would probably think that such a system would only exist thousands of miles off our shores, where access to even the most rudimentary healthcare is reserved for the privileged few. You would be incorrect.
When the Affordable Care Act (ACA) was passed, it created the Independent Payment Advisory Board (IPAB) with the intent of slowing future spending growth of Medicare, which already consumes $468 billion of our federal budget and is projected to rise ever higher. But Congress decided to give the Board unprecedented power to make cuts to Medicare where they see fit, and only a supermajority vote can overturn them. On Wednesday, the House Energy and Commerce Committee’s Subcommittee on Health will vote on HR 452, the Medicare Decisions Accountability Act, which would repeal IPAB and send a clear signal that the American people will only fully except the ACA when all of its fatal flaws, chief among them IPAB, are rectified.


Fundamental shift needed to tackle deficit, health care

American health care spending continues to rise, and by 2019, health care costs will approach $4.5 trillion – nearly 20 percent of our projected GDP. With this spending trajectory and our significant debt in mind, serious deficit reform must tackle rising health care costs, particularly in Medicare and Medicaid, and do so by sustainably removing costs from the system. 

Traditionally, cost-cutting efforts in health care have involved tweaking eligibility, increasing out-of-pocket costs, and squeezing reimbursement to providers of health care goods and services. Though these actions may achieve a small favorable score from the Congressional Budget Office, they fail to contain costs over the long term. They also often create other problems, primarily because they address symptoms of the problem in our system and shift them to someone else instead of addressing the source of the problems directly. 

It’s like rearranging the deck chairs on the Titanic to make it harder to reach the lifeboats while doing little to alleviate the need to abandon ship.


PDUFA critical for innovation and patients

Just a few decades ago, a company could submit a new drug application and commonly wait up to 30 months before the Food and Drug Administration (FDA) rendered a verdict. FDA Commissioner Margaret Hamburg says the Prescription Drug User Fee Act – better known as PDUFA – has become a “game-changer” in the agency’s efforts to more efficiently review and approve potential new treatments.


Care work in America: Expected but not respected

Last month the Bureau of Labor Statistics reported that home care is the fastest-growing occupation in the United States. More jobs will be created in home care than in any other occupation through 2020.

But this positive news is tempered by the negative realities facing many workers in the industry. Home care work is too often “expected but not respected,” in the words of worker Tracy Dudzinski, dismissed as neither skilled nor demanding enough to qualify as a real job. That may explain the surprising fact that home care workers are denied federal minimum wage, overtime, and other protections under the Fair Labor Standards Act (FLSA), a law that was passed over 70 years ago.

Reform is long overdue, but it may be finally taking root. On December 15, Tracy stood proudly behind President Obama as he announced a proposed rule that would provide most home care workers with FLSA coverage. Unfortunately, an opposition movement led by highly profitable national home care corporations is trying to keep the rule from being issued.


In setting health care reform’s path, we must protect equity in care

This year is shaping up to be another year of monumental changes for health care in this country. With the two -year anniversary of the Affordable Care Act (ACA) bill signing fast approaching, stakeholders across the country are working feverishly to build the infrastructure and get the necessary provisions in place so that the goals of the ACA can be attained. Even with the looming Supreme Court decision muddling the process, there are steps that the Centers for Medicare and Medicaid Services (CMS) can take now to solidify some of the key patient protections that have stood at the center of health reform over the last few years.

One of the most promising aspects of the ACA, from the kidney patient community’s perspective, is its creation of a baseline Essential Health Benefits (EHB) package that will create a floor of benefits and services offered by all insurance plans as of 2014. This key provision was created with the intent to ensure a consistent, minimum level of benefits across all plans, to allow easier comparisons of plans for consumers and to prevent insurers from manipulating health plans to “cherry pick” healthier enrollees.


Getting outdoors for healthier families, children and economies

The American West has loomed large in our Nation’s imagination ever since Lewis and Clark started sending stories back East about its geography, stunning landscapes, plants and wildlife. Today it is tourists, retirees, adventure lovers and entrepreneurs who are the explorers.

Outdoor recreation employed an estimated 6.5 million people and contributed $730 billion to the national economy, according to a 2006 report by the Outdoor Industry Foundation. In 12 of the Western states, outdoor industries employed 1.3 million people and contributed $143 billion to the region’s economy. The economics alone are a good reason to protect the West’s natural assets and enhance tourism, but there is another, perhaps less obvious reason, and that is our nation’s youth.


Jim Towey is wrong about President Obama

The summer before Senator Obama was elected president, he invited 30 Evangelical and Catholic leaders to meet with him in Chicago. The purpose of the meeting was transparency about his faith journey. All of us, including Franklin Graham, heard him share his testimony of how he had come to trust Christ as his Lord and Savior.
Months before that, in a personal conversation with Senator Obama, he asked me what I thought was a good direction for faith communities when it came to government activities. He knew that I am a pro-life evangelical that believes the less need for government the better. That’s why he was talking to me. I said, “The faith communities of this nation have way more resources and relationships than are being engaged right now to address our nation’s problems.”  He agreed.  He said, “But there are certain problems that are too great for the faith communities to solve.”  I agreed.
After what I assume were many more conversations with other faith leaders, the newly elected president decided to expand the Office of Faith-Based Initiatives started by President Bush and transform it from a fair-funding administrative program to an effort engaging religious communities via their counsel and their service to our citizens.


Faith-based farce

It seems George W. Bush’s “armies of compassion” have become Barack Obama’s armies of contraception. 

Many were surprised that when President Obama entered the White House he didn’t close the faith-based office his predecessor had created. As the man who led that office for over four years under Bush, I think I now know why.

Indeed, Obama telegraphed his intentions from the start. The new administration wasn’t in place a month before he re-launched the initiative and declared that a priority of his faith-based office would be to “look at how we support women and children, address teenage pregnancy, and reduce the need for abortion.”

From day one he set his administration on a course to make contraception another federal entitlement, and to utilize his faith-based office as a political outreach shop. He even appointed a Pentecostal preacher who was the president’s “director of religious affairs” on the campaign trail (talk about audacity of appointment!). Of late, the White House faith-based office has been scrambling to line up religious leaders, many themselves the recipients of millions of dollars in federal grants and TARP funds, willing to vouch for the president’s faith-friendliness. On the day of the “accommodation” announcement the faith-based office staff conducted the political equivalent of an “altar call” to secure such support.


Remembering Deamonte Driver

February 25th will mark the fifth anniversary of the death of Deamonte Driver, a 12-year old Prince George’s County child whose untreated tooth abscess led to a fatal brain infection. Deamonte’s passing -- from a condition as simple as a tooth infection -- was tragic, but even more so because it could have been prevented if he had received timely and proper dental care.

For Deamonte’s mother, Alyce Driver, and for many other parents across the nation, bureaucratic red tape and a shortage of willing Medicaid providers blocked access to desperately needed care. America’s health care system failed Deamonte, who lived in a community less than 10 miles from the U.S. Capitol, in one of the wealthiest states in America. 

As members of Maryland’s congressional delegation, the incident brought home to both of us the message that former U.S. Surgeon General C. Everett Koop issued to our nation years ago, when he said that “there is no health without oral health.”


Transparency should bring clarity, not confusion

Transparency is a word that often gets casually bandied about in Washington, especially when it comes to regulatory rulemakings. When done right, it can be a very good thing. But transparency without appropriate context runs the risk of actually muddying the waters and causing more confusion than clarity.

The ongoing implementation of the aptly named Physician Payment Sunshine provision of the Affordable Care Act offers a good example. This is a law that is intended to provide the public with transparency in interactions between biopharmaceutical companies and health care providers – and last Friday, PhRMA submitted comments to the Centers for Medicare and Medicaid Services on the related proposed rule.

Just as we supported the legislation that led to the law, PhRMA and its member companies continue to work as constructive partners to CMS during implementation. But we want to ensure that the ultimate outcome is not confusion or misrepresentation of information – rather, the goal should be a useful tool for patients to fully comprehend the role that their physicians play in clinical research and in the dissemination of scientific information among their peers.