Healthcare

Gradual phase-in of Medicare regulation is logical

With the nation’s skilled nursing facility (SNF) sector already surviving on the lowest operating margins of all provider groups, facing $127 billion in Medicare funding cuts in the FY 2012-21 budget window, and reeling from a deep 11.1-percent Medicare funding reduction that went into effect late last year, facility job losses now occurring places the well being of seniors in clear and present danger.

The sheer weight of the federal Medicare funding pressures put on a sector where three of every four patients’ care is government-funded -- combined with state Medicaid cuts -- has destabilized America’s second largest health facility employer to an extent not experienced in more than a decade. Today’s economic stress on SNFs, more commonly known as nursing homes, is increasingly reminiscent of the 1997 Balanced Budget Amendment (BBA) aftermath, where facilities across the nation were forced to close. Some providers were even driven into bankruptcy, creating access issues for seniors seeking intensive post-acute rehabilitative SNF care.

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Working together on global health

Amidst the cacophony of screaming partisanship in Washington, did you notice that strange sound emanating from the FY12 consolidated appropriations bill that President Obama signed on December 23? It was the quiet hum of bipartisan agreement, between the Congress and the administration, to sustain America’s commitment to saving and improving lives around the world. 

Despite real budget pressures, US investments in global health remain strong. This is good for American interests and smart for American jobs because healthy societies and consumers abroad represent the growth frontier for our economy.   

As the World Economic Forum kicks off this week in Davos, Switzerland, the importance of global health – and the health of the globe – is getting special attention.  The world’s still massive bottom of the economic pyramid – some 2-3 billion people – represents a potential $5 trillion in purchasing power. But many of them lack access to quality health care and services, even the most basic ability to plan their family sizes safely, and their global economic impact suffers.

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Why ObamaCare is bad medicine for seniors

As a physician, access to quality care for our nation’s citizens, especially our seniors, has been and will continue to be a top priority of mine in Congress. During my 15 years as a practicing cardiothoracic surgeon, I treated hundreds of Medicare patients. My experience as a Medicare provider provides me firsthand knowledge of the negative impact the so-called Affordable Care Act (ObamaCare) will have on America’s seniors.
 
Medicare is a solemn promise that we have made to our seniors. ObamaCare threatens this vital program and the health care of millions of Americans. ObamaCare will exacerbate existing access problems and places unelected bureaucrats between patients and their doctors.

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Congress must tackle obesity and costs to economy

Politicians are struggling with ballooning Medicare and Medicaid budgets, and a looming national health care plan that we cannot afford. This challenge will only get more difficult unless we address the big elephant in the room that no politician wants to publicly address: the cost of obesity. Addressing obesity with tough love talk about individual accountability is the kiss of reelection death (who wants to call their constituents fat?). And addressing the government programs and policies that stand in the way of a slimmer society are met with heated debate and powerful lobbying.

There are roughly 150 million adults in the U.S who are overweight or obese, a number that is projected to increase dramatically over the next decade. Statistics around childhood obesity are equally unsettling. The cost of obesity is staggering and is arguably a greater threat on America’s collective well-being than any terrorist or flu epidemic. In 2008, medical costs related to obesity were estimated at $147 billion – double what it was just ten years ago. If we continue to munch away carelessly, that figure will rise to $344 billion by 2018. What is even more disturbing is that these figures are significantly understated, as they do not include the millions of people who are overweight or mildly obese with preventable chronic diseases who would benefit from a healthier diet and greater activity. In the U.S. an estimated $1.8 trillion is spent per year in medical costs associated with chronic diseases.

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Congress can put a stop to use of chimpanzees in biomedical research

Invasive biomedical research on chimpanzees may soon draw to a close — this is the implication of a report released in December by the National Academies’ Institute of Medicine. This report, which focused on the use of chimpanzees for research from a scientific perspective, is an extremely welcome contribution to the national discussion. It declares that there are now very few scientific rationales for subjecting chimpanzees, our closest relatives, to the pain and suffering of invasive research.
 
As physicians, we are strong advocates for effective scientific research to improve human health. We applaud the far-reaching deliberations of the IOM committee, which advanced three important principles for evaluating whether or not further biomedical and behavioral research on chimpanzees should be performed: that the research is necessary for public health; that no other method can be used; and that any research on chimpanzees must sustain the animals in an enriched environment that meets the animals’ mental and physical needs.

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FTC should block proposed Express Scripts-Medco merger

The perfect example of the law of unintended consequences can be found in the 7 million acres from Texas to Washington DC that is covered by Kudzu vines. During the dustbowl days of the Great Depression, one of the biggest challenges facing the country was soil erosion. In an attempt to address this problem, the Soil Conservation Service advocated the widespread planting of kudzu, an imported vine that would cover the ground quickly, preventing further soil loss.

However, while the kudzu did help stop the soil erosion, it also created another problem altogether. Kudzu vines, which can grow up to one foot per day during the warm season, spread throughout much of the Deep South and currently inflict up to $500 million in damages annually to forests alone.

Today, another unintended consequence is happening in the healthcare industry. Although most people have never heard of pharmacy benefit managers (PBMs), they are making health care decisions that affect the lives of well over 100 million Americans. PBMs were initially hired by companies to manage prescription drug plans and control costs. The entities that were originally hired to help manage prescription plans are now extracting so much profit and distorting the markets so thoroughly that they have become the kudzu of the healthcare industry.

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Regulatory bid-rigging will cost medical patients

The CMS has not done what Congress legislated it to do, and without correction, the result will be reduced patient access to prescribed medical supplies for home use, worsened patient outcomes and increased medical costs.

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PBMs NOT the friend of consumers

In a Nov. 28 opinion piece on The Hill’s Congress Blog (“PBMs Save us Billions of Dollars”), Jonathan Orszag portrays pharmacy benefit managers (PBMs) as the best friend of consumers. In defending the upcoming merger of two PBMs, Express Scripts and Medco, Orszag claims the transaction will save the health system money. But Orszag seems to lose sight of the interests of the ultimate consumer here — the patient.

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Regulators and doctors must work together to ensure safety of biologic medicines

The U.S. Food and Drug Administration (FDA) is holding an important public meeting today on its proposed biosimilar user fee program recommendations.  This meeting is a major step in making biosimilars available for the first time in the United States.  Biosimilars will benefit the patient community-at-large – but only if important safety measures are adopted.

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Plan B and politics vs. common sense

The recent decision by Secretary Sebelius to override the FDA recommendation that young children under 17 should be allowed to purchase Plan B over the counter has received much criticism from women’s groups.  Clamoring that politics influenced the decision-making process, abortion rights supporters are actually correct.  However, they were pointing the finger at the wrong person.  It was not Secretary Sebelius who was playing politics. Rather, it was the Federal Drug Administration (FDA) who approved initially Plan B for underage girls in the first place.

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